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CAMHS won't see you now

Why is guilt assumed in complaints?

By Rob Finch

Small practices could have as

little as two years to face up to patient choice or face being closed by PCTs, a new report warns.

The report from the Small Practices Association and NHS Alliance said small practices may have to form networks sharing management functions or cut costs by sharing premises in order to survive.

The major problem facing practices, it argued, was that patients were getting more information than ever about them and could desert a surgery in droves if it reported any negative data on access or quality.

Small practices would be particularly vulnerable, the report added, because they lacked the management capacity of larger surgeries and found it harder to respond quickly.

'A full turn of this virtuous cycle of knowledge could take as little as two years,' the report said.

Author Dr Michael Taylor, chair of the Small Practices Association and a GP in Heywood, Lancashire, said 'touchy feely' indicators such as continuity of care ­ on which smaller practices often fared well ­ would have less impact on patients' decisions than hard data such as QOF scores.

He said: 'There's going to be a period of two years and then it's really going to take off. If there's no tension in the system then change won't happen. But not all change is improvement.'

Dr Baljit Bhullar, a singlehanded GP in Feltham, Middlesex, agreed with the report's conclusions, arguing that small practices were struggling to keep pace with change. 'The fun of being independent is being lost,' she said.

Dr Michael Smyth, a singlehanded GP in Maguiresbridge, County Fermanagh, said he had no fears for his own practice, but Government policy was causing other small practices to 'wither on the vine'. He said: 'We will be OK as long as there is a level playing field.'

Dr Mark Hunt, a partner at a 26-GP practice spread across four sites in Somerset and former Government adviser, said small practices would remain popular with patients as 'a friendly local face'.

But he warned duplication of fixed costs would add to the 'attrition rate' of small practices.

How small practices will survive in a primary care market

· 'Nested' practices will share premises together with social services, specialist nurses and jointly purchased diagnostic facilities

· 'Virtual supersurgeries' of large partnerships with numerous small outlets will offer personal doctoring with shared management functions and budgets for equipment and services

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