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Does size matter?

Dr Shaba Nabi

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There’s been a growing trend in recent years for our GP Leaders to make proclamations which come back to bite them. I’m sure you remember the infamous quote from Professor Steve Field within the Daily Mail, stating he was ashamed of some GPs in relation to CQC inspections. Many, including the GPC, called for his resignation, which I supported.

A few years later and it is the turn of the Director of Primary Care for NHS England, Arvin Madan, who states GPs should be pleased when small practices close.

This disingenuous comparison with the business sector is quite astounding. I quote from his article:

‘Most businesses are pleased to see a rationalisation of providers, as it makes the remainder more viable. In the general practice market, there are too many small practices struggling to do everything patients now want for their families in a modern era of general practice.’

These insensitive remarks do nothing to allay the anxieties of struggling practices and those already forced to hand back contracts

What this statement so obviously fails to appreciate is that general practice is not a small business in the competitive sense of the word, there is a monopoly provider within the NHS, and it is not a level playing field.

And business issues aside, what of quality of care? It’s no good spouting some anecdote about the single hander who sends everyone into hospital; what does the evidence tell us?

This report from 2014 states that although smaller practices perform slightly less well in QOF and have higher emergency admission, they have fewer elective referrals and significantly higher patient satisfaction scores. A more recent review shows that continuity almost halves mortality, which trumps earlier research conducted by Sir Denis Pereira Gray, linking continuity with reduced admissions and referrals.

But enough of evidence, what of the human cost here? These insensitive remarks about smaller practices do nothing to allay the anxieties of those struggling, or even those practices like mine, who have been forced to hand back contracts.

So, let me be blunt Arvind, I am not pleased. I am furious. Furious that so many practices have been allowed to fail by NHS England, furious that I am contemplating alternative career options, and furious that my vulnerable patients will lose the continuity of care they so badly need.

I am certain these vulnerable patients are not ‘pleased to see a rationalisation of providers’.  As per the inverse care law, they have no voice. 

Dr Shaba Nabi is a GP trainer in Bristol

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Readers' comments (10)

  • Perfectly stated. Thank you Shaba.

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  • I have been struggling to articulate my fury with this political, self serving lapdog and I think you have covered it beautifully Shaba-thank you

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  • Well said

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  • Vinci Ho

    You see
    The term ‘GP battering’ seems to have disappeared for a while and now re-emerged again . The reality is Dr Madan is not a lone wolf . There are many technocrats , politicians and even ‘some of us’(comments on this platform) holding the same attitude about small practices. Their agenda is no longer hidden.
    For those who ‘really’ represents us , there is no place for peace talk in here . This is WAR.
    Sarah Wollaston, what are you going to say , eh?

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  • Top GP.
    They say the scum rises to the top.

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  • I am 46 and would quit tomorrow and am actively looking for a way out of this misery. Who will this help or benefit Arvind? (Other than my family)
    Oh yeh, by the way there are many people living and working outside London too and your plans to destroy small practices will ruin many parts of these countries.

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  • These people are after their OBE or such similar goodies. They are NOT interested in patients care or gross root GPs who deal with patients daily. Such people get away with it and that's why the NHS is in this situation.

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  • Yes quite right. I my experience usually people who exibit such hubris eventually meet their nemesis

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  • Very well written article.
    Sadly the views of Dr Madan are shared by individual leaders. within BMA and LMC where we turn for help but the opposite happens. Cqc have also shown bias.
    It is of no wander that many practices are closing.

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  • Shaba is spot on. I see the Daily mail readers are crying over his loss and feel Arvind tells the truth. They didnt mention his £600k yr from tax payers money not to see patients.... I wonder if he's the kind of GP they'd like to see more of? Perhaps he should become salaried like he proposes everyone else should be? That would give him a massive paycut...... ironically he is the Daily Mails stereotypical view of a GP..... greedy.

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