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Doc Martin could soon be a thing of the past

Editor’s blog

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It can’t be easy being a rural GP. It may look all Doc Martin, but as ever reality is much less glamorous than fiction.

I was asked recently to be a talking head on camera for a BBC report into a village practice which is being bought out of its premises by the local community. It was looking to close and transfer its patients to another surgery two miles away after a fruitless two-year search for a GP to take it over.

The parish council in Sussex is planning to spend £500,000 buying the surgery building to keep a GP practice there. It is a wonderful story about a community coming together and deciding that they are simply not willing to let their GP practice go to the wall. And there are similar heartening stories across the country.

In Cumbria, the Hawkshead practice was near closure, but was saved by their patients. Now they are opening a new purpose-built surgery in a donated building, with £40k raised by the local community to kit it out. And last year Thurrock council announced plans to buy the premises of East Tilbury Medical Centre to keep a 3,000-list practice in the community.

NHS reforms driven by mandarins in Westminster or Edinburgh are simply not interested in smaller practices

I think practices in rural areas perhaps do the purest form of generalist practice, providing a much greater range of care as they are further from hospitals and/or social services. As one GP in on Twitter put it to me: ‘The true meaning of family general practice is when the doctor knows all generations and can connect the social to the medical.’ I am sure that also is possible in practices in many other areas of the country, but it does seem to be a dominant theme for more rural ones.

But the BBC journalist was interested in talking to me about why – if they are so popular with their patients – so many are struggling. He set up a bright silver umbrella, shone a bright light in my face and switched on his camera.

Of course, I told him that there is a poisonous cocktail of factors that are common to many practices across most areas of the country. You will be painfully familiar with them: recruitment issues, rising patient demand and frozen funding.

But there are particular complications in a more rural setting. They are often smaller, and are just one or two retirements away from closure. Their catchment areas can be massive, with home visits a chore, and isolation driving more healthcare use. Recruitment is harder in rural areas – most doctors are trained in a city and they are unlikely to leave, despite the often glorious locations offered by rural practices. Scarce locum GPs are often unwilling (understandably) to travel across many hills and dales to get to work.

And they are out of step with the zeitgeist. I explained to the reporter that the NHS reforms, being driven by mandarins in Westminster or those in Edinburgh, are simply not interested in smaller practices, no matter how popular.

They want scale; practices banding together and employing many more non-medical staff to carry out more work out of hospital. This is hard for many practices, but nigh impossible if you are a very small concern, situated miles from the next village.

Rural practices have advantages too; their special relationship with patients, the ability to be nimble when responding to patient needs. But they have to work hard to keep their heads above water. It can be a lonely game. And be under no illusions, those not willing to ‘transform’ in this image, are left to ‘fail and wither’.

And it is a real shame, as the evidence above shows, they are the beating heart of many small communities and if they close they will be gone forever.

The BBC reporter nodded gravely and switched off his camera.

Nigel Praities is editor of Pulse. You can follow him on Twitter @nigelpraities

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Readers' comments (7)

  • A few years ago I left my single handed isolated rural practice. I knew the patients, they knew me. The medicine was good, the patients were great. We had extremely low acute admission rates and excellent QOF scores. In the end I couldn't defeat the NHS who didn't want my kind of practice to exist. Now it is branch of a Practice in a nearby town. The patients are less happy and I cannot comment on the medicine. "Supermarket General Practice" can never provide the tailored care that we delivered. Certainly the end of an era.

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  • Vinci Ho

    It is sad that we have to rely on ‘big society’(remember who brought this term along in 2010?) to salvage these practices and nobody needs to be held accountable for this mess?
    Lord Vader , you cannot repay your historic sin even if you died ten thousand times .

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  • The founding fathers of the NHS did not nationalise the GP's because they didn't think they would be needed once everyone was healthy and doing the decent thing and die at 66 before they used the services! The Collings report published March 1950 was the catalyst for the formation of RCGP yet GP's still don't have specialist recognition. The Dr Findlay model is remembered by those from their childhoods who are now entering the autumns of their lives and expect that sort of service. Sadly the system has not supported care in the community even after Keith Joseph tried in 1973 and every iteration of NHS planning is to shift care into the community. The resources never follow because the savings are assumptions and aspirations that get signed off at Board level yet never materialise. The move to any form of ACO ACS or whatever TLA(three letter abbreviation) can be thought up to 'save' the NHS will require GP's to be salaried and standardised and interchangeable so the patients get McDonalds medicine rather than the Michelin star they desire. There is no real career progression for the Dr Martin GP, no long service medal and no recognition of seniority. The job is very much the same on the last day as the first. The doctors that do portfolio jobs or enter medical politics either the GPC route, RCGP or NHSE seem to weather the storm that is modern primary care but not without effecting coalface provision. There needs to be another Collings report for the public and the purse string politicians to open their eyes to what is really happening and react before it is too late.

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  • I remember when I was a med student, they brought out the Oxford handbook Of clinical Specialties (blue and red)And the first line in the GP section went soemthing like "The GP is an expert in Mrs Jones the person" I thought at the time, what a flimsy basis for choosing a career. Frankly, it made GP a joke..

    "The job is very much the same on the last day as the first" nothing is more depressing than letting this thought circulate around your brain for a couple of minutes.

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  • As a semi retired GP I totally disagree that the job is the same at the end of your career as at the start
    Over the last 35 years GP land has seen many changes and the day job has changed markedly
    The best part is still the face to face consultations and the increased confidence that comes from disease pattern recognition and having seen most problems before
    The downside are all the telephone triage calls to try and ration the appointments and make sure that it is clinically safe
    The explosion in data that now needs to be read before filing into a patient record has become overwhelming and I still do not understand why we can’t have a repeat prescribing system like Australia where you issue the drug for up to three or six repeats and the patient gets it from the pharmacist with no more GP input
    The best part of being a GP is seeing a patient through an illness episode and I certainly hope that this continues as I still find it very rewarding as am sure we all do - I hope that never changes

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  • Dear colleague,
    I am writing for your advice on following issue
    I am a GP trainee, I completed my training, achieved all competencies but I was one of the unlucky ones and failed CSA a few times. Now I have been released from training and I am going to be jobless next week.

    Now, I am totally last, I don't know what opportunities are available, and what is next?

    I understand that you have some information about other GP trainees who have been in similar situation.

    Therefore, I would be grateful if you could advice or put me in contact with other x-trainees.
    I also would like to know if you have any sub-group or committee for this group of trainee.
    It is so sad and frustrating seeing GP shortage all over the country and some of the trained, competent GPs forced out of training.

    Kind regard
    Fatemeh

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  • Fatemrh i hope you get the help. We need good doctors and your trainer should have rehearsed csa .it is a taught skillset.

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