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At the heart of general practice since 1960

Shifting sands of seaside practices

The dramatic collapse of general practice in resort towns should be a wake-up call for the rest of the UK, warns Dr Eamonn Jessup

A strange pattern has emerged over the past few years, of practices at seaside towns collapsing – in Folkestone, Frinton-on-Sea, Bridlington, Brighton, Plymouth, Prestatyn and Colwyn Bay, to name a few.

These areas used to attract doctors with ease, but many now struggle to recruit at all. They seem to have acted as weather vanes foretelling the stormy conditions ahead for the rest of the UK.

My own Prestatyn practice handed back its contract in April 2016, after younger partners left prematurely and multiple attempts to recruit failed.

Facing 18,000 patients with four partners, our contract became unsustainable, especially as only one partner was under the age of 50.

I believe this scenario was largely reflective of other similar resort town practices around the UK.

So, what is unappealing about resort practices?

It’s not the money; many resort practices have significantly higher incomes than average. Nor is it the quality of the service – our practice had high QoF points and offered an excellent quality and range of care.

It’s not the towns themselves. A seaside town is generally a good place for a young family to settle and housing prices are often reasonable.

The reason is clear: it is workload. For many coastal practices, it is quite simply overwhelming.

I had not realised the scale of this until I became a locum. Since then I have worked across all types of practice across North Wales – urban, rural, deprived, GMS and managed – and none of these has workloads coming close to that of my previous seaside practice.

GP trainees have strong word-of-mouth networks. I suspect that practices who handed back contracts are the ones where the word is out that the workload is crippling, resulting in no recruits coming forward.

Seaside practices often have an aged population, indeed the term ‘Costa Geriatrica’ was coined for the Llandudno area. This elderly population have often, in retirement, moved away from family and friends, relying heavily on local social and health services for support when illness, bereavement or frailty intervene. A doctor’s visit can be the high point of the social calendar.

With such demography comes pathology, seemingly rising exponentially in the over-70s. Many moving to seaside towns suffer from the heritage of industrial disease, adding to this high burden of morbidity.

Elderly patients with multiple pathology create a ‘double whammy’ for practices, needing longer consultations and more frequent reviews, often making a 15-minute appointment, beloved of RCGP academics, an unrealistic goal.

On top of this, the collapse of resort practices has created ripples that flow deep into the surrounding locality, putting increased pressure on nearby practices.

In North Wales, few localities are unaffected by practice closure. Fifteen practices have resigned to date, and many more have serious sustainability issues. Seven seaside practices in Prestatyn, Colwyn Bay, Conwy and Criccieth have resigned their contracts, resulting in enormous stress in the surrounding localities.

Many resort towns are not located near large cities, so medical schools are often considerable distances away. The resulting lack of long term placement of medical students further hinders recruitment.

This is especially acute in North Wales, where the natural alma maters of Liverpool and Manchester have been relegated by the forces of devolution, directing most undergraduate training 200 miles away to Cardiff.

North Wales also has the quirk of being seen as an enclave, where the myth exists that you have to speak Welsh to work there.

The rest of the country must take lessons from the experience in resort towns, as their problems are not unique – the causes of practice collapse are likely to be reflected across the UK as the population ages.

The future has to be better than it is now in North Wales: managed practices are taking up the challenge of providing health care in areas where GMS provision has failed, giving a greater variety of working patterns, but the quality of such care delivery has yet to be evaluated satisfactorily.

We have many industrious and evangelical GPs striving to sell the amazing experience of working in North Wales where the people, scenery and environment make it a wonderful place to live and work. The close proximity to Chester, Liverpool and Manchester is an added bonus.

I hope we get others to understand what we have to offer before it is too late.

Dr Eamonn Jessup is a locum GP in North Wales Chair of North Wales LMC

 

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Readers' comments (10)

  • Great summary of the unfolding wave of GP implosion.

    As the average GP workload is unsustainable in the medium term, higher workload areas such as social deprived and elderly predominant populations are untenable even in the short-term.

    Hence, GP word of mouth to avoid these jobs which are not manageable or fulfilling.

    It will now take a lot of sustained investment to turn this situation around.

    No sign of this yet!

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  • Well I worked in Clacton on sea until the collapse
    And live in frinton on sea so am registered as a patient there.

    There's a story to tell

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  • also in Littlehampton where Arun Medical Group closed in september 2016 and 7000 patients needed to re register with the remaining 6 practices -- we also all closed our lists to ensure the CCG gave us some help

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  • Same experience on the south coast- small practices in crisis after partners leave, unable to recruit partners, commercial providers move in- poor working conditions for salaried- reliance on locums such as myself- who are not keen to work there as workload and organisation of practices unsafe- worsening of crisis - higher locum fees-practices fail. Personally I prefer to work in non coastal practices for £200+/day less and feel safe and supported. The inverse care law still applies.

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  • Same reason why I left an urban practice . Too many bungalows and blue badges - unreasonable demand from retired white and blue collar workers. The practice has a reputation for being a sweatshop and is now eschewed by all doctors in the area.It's on the verge of collapse

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  • I would challenge the view that seaside jobs are not fulfilling. Worked here all my working life. Lifestyle, housing, bringing up children here wonderful. Just the last 5 years of worsening remuneration for falling income made recruitment impossible and workload unmanageable. Retiring soon. Can't wait.

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  • PS ex senior partner now salaried

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  • I still can't believe how people with no idea about patient care smashed my practice and put me under such stress.....and now the situation is much much worse for the patients
    For me however as a salaried I can coast until retirement
    There's a strory of arrogance and negligence here from the ccg

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  • Hi everyone. Thanks for your views. My job was fulfilling but once the downward cycle of retirements and lack of recruitment set itself up in a vicious circle resulting in an absolutely awful work situation. I'm no slouch having worked in Africa for a while but the demands an lack of enjoyable time in patient consultation was hell. Yes all down to demography and pathology and frankly bright ideas on social prescribing or other initiatives will save it.

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  • Meant won't save it!!

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