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A faulty production line

We’ve become just another practice closure statistic

Dr Shaba Nabi

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In a few months, the NatWest bank in our village will close. Elderly people will no longer pop into their local branch and will have to rely on relatives or friends to transport them five miles away. My son will no longer cycle excitedly to the bank to deposit his Christmas money. And I’ll no longer see the friendly faces I’ve been visiting for years (I don’t get on with apps and online banking).

Although it is inconvenient to lose your local bank or post office, it won’t have a direct impact on your health. Yet, somehow, the same consumerist ethos is now applied to the provision of general practice, without any thought for what will be lost in the process.

On April 1, my practice partnership will terminate its contract with NHS England. Although I resigned from this partnership two years ago, I continue to work there as a salaried GP and still feel immense loyalty to my patients and colleagues.

Between us, the partners and I have given more than 150 years of service to our local community. It’s a very special community of patients who are normally at the fringes of society – asylum seekers, immigrants, substance misusers, sex workers, the homeless and the mentally unwell. It’s by no means an easy gig, but we are driven by a sense of camaraderie and equality of care. We’re not here for the material rewards as there are huge additional costs associated with deprivation and language access. But we strive to be advocates for our population, which is easier as three of us are bilingual.

GPs who are rooted in their community are losing sleep over what the future holds

But society no longer values this. We’re squeezed into the general PMS review bucket, with no consideration for our atypical population. So, as well as seeing global sums plummet, we’ve taken the extra blow of losing our additional PMS cash – originally conceived to keep practices like ours afloat. We’ve also been hit by a three-fold increase in service charges demanded by NHS Property Services, an increase likely to destabilise up to 10% of practices in England.

We have discovered the inequalities agenda NHS England constantly bleats on about is all lip service. When push comes to shove, there are no pots of money earmarked for inner-city practices such as ours, serving deprived, multicultural populations.

So, what is the human cost of the rush to rationalise, upsize and streamline? Patients at the margins, who have benefited from an enduring relationship with their GP, may find themselves abandoned in an increasing maze of complexity. Health inequalities will widen even further than the existing 10-year mortality gap between rich and poor here in Bristol.

GPs who have spent their entire careers rooted in their community are losing sleep over what the future holds, although we are grateful that a GP-led organisation is set to procure our contract and we hope the values of the practice remain intact.

One thing is certain: many more practices are on the brink, left to expire because there is no knight in shining armour. And the sad fact is that such partnership dissolutions will become so commonplace that they won’t even be newsworthy any more.

Dr Shaba Nabi is a GP trainer in Bristol



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Readers' comments (8)

  • Just Your Average Joe

    The question to ask here: For this new GP organisation taking on this new almost Cast iron certainty an APMS contract - how much are they being paid pound for patient, and what Special arrangements are being agreed in regards to the Prop Co problems in regards to contracts etc, if they will remain in the same building?

    If the contract was not viable as a partnership, then it will certainly not be making profits for a private/social enterprise, and costs will usually be higher, and the contract not viable without sweeteners.

    If they pot of money is increased to allow APMS profits - why was this extra funding not given to the original practice.

    Well worth investigating ?????????

    Almost all APMS contacts seem to get a 'Premium', or sweetener resulting in funding not available to standard practices - which is discriminatory and surging the shift towards privatisation.

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  • Cobblers

    From 1 April 2018, the current Partners will no longer run Charlotte Keel Medical Practice.

    NHS England and Bristol Clinical Commissioning Group (CCG) have announced that BrisDoc has been named as the “preferred bidder” in a formal procurement process to award a contract to run the Practice for two years from 1 April 2018. BrisDoc runs a range of services in Bristol including other GP surgeries.

    APMS it looks like.

    Anyone going to ask what they have been offered per capita? It is or should be public knowledge.

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  • while you are entitled to privacy,I would be interested to know in future if the contract holders offer shaba or any replacements the same or a much higher salary for the same work to attract applicants.

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  • Azeem Majeed

    Very sorry o hear about the closure of your practice Shaba.

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  • "We’re not here for the material rewards"

    But the practice closed when costs became too high????

    Make your mind up? This type of muddled thinking is what makes the Govt think they have us bent over the barrel. Lets all start thinking of the material rewards and running practices like a business and maybe less will close.

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  • AlanAlmond

    A practice run by an OOH provider (Brisdoc) isn’t general practice as we knew it. It’s the walk in service model. No continuity of care, maximum access, staffed by locums. Sadly I think its right to say ‘society no longer values’ general practice. Of cause some people do, but as a whole, society doesn’t care enough to stop it disapearing. If they did, it wouldn’t be happening.

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  • Best wishes

    It’s not nice at all. All the best

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  • So sorry to hear this, I guess this is the final blow after years of stress and struggle.
    I am curious- do you work under new management or do you leave and they recruit from fresh. I guess the former as there simply aren't the dedicated GPs like yourselves out there. It would be very interesting to hear how it goes as there are many of us in a similare position......

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