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At the heart of general practice since 1960

Gerada: Single-handed GPs will not survive

The RCGP chair has sounded the death knell for small practices, saying the landscape of general practice was ‘too complicated’ for single-handed GPs to survive on their own.

Professor Clare Gerada told Pulse that single-handed practices were ‘really good organisations’, but that they were likely to become ‘financially unsustainable’ if they continue to work alone.

The RCGP chair was speaking at a workshop on federations organised by Newham CCG and the RCGP, where she said that new ‘integrated care co-operatives’ should be set up to meet the Government’s aim for GP-led 24/7 community care.

The idea follows the publication of controversial College recommendations that GPs should work together as federations to commission 24/7 services for patients with complex comorbidities.

She said the organisations will be ‘geographically bound, population based integrated care co-operatives’, which would ‘sit between federations and CCGs’ she said. They would be the ‘optimal size’ for risk pooling and local and national accountability’, she added.

The ICCs would ‘bring together all relevant health care providers- within a contiguous and geographically bound authority area – as not-for-profit organisations with resources allocated and distributed according to the best needs of the population’.

The aims of the new organisations would be to ensure access and equity and reduce fragmentation of care, she said.

She told delegates: ‘The ICC allows for the provision of 24/7 community care, chronic disease management, urgent care outside hospitals, care for the frail elderly, end-of-life care and the like, as well as creating better joint working between all parts of the local health economy.’

Professor Gerada also warned that single-handed practitioners will be unable to remain financially viable unless they join federations.

She said: ‘There is the CQC, QOF, CCGs – keeping up with it is a nightmare.’

When asked whether single-handed practitioners can remain financially sustainable, she said: ‘Yes and no. Yes, but only if they are part of a network or federation. No, if they are on their own – they will be financially unsustainable.’

Readers' comments (25)

  • Is general practice going to survive?Doesnt feel like it at the moment

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  • Hazel Drury

    I am a single hander. Not through choice, I kinda ended up here locuming 12 years ago and stayed. The geography of my locality is that we have small towns strung out along the coast of North Wales. These towns are populated by many elderly retired who are unable to drive. We generally have poor public transport and taxis are expensive due to large distances involved. Most are unable to get to super surgeries in the big towns so we have many single handers in the county. Alas we are treated the same financially as big practices. 2 of us have no MPIG as we were set up after 2004.
    What will happen with these elderly communities if we are driven out of business?

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  • Hazel Drury

    There again, in Wales there is no CQC or CCG. Having said that though, there are precious few GPs the way things are going.

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  • The harsh reality is that deprived areas of all types are being neglected be it rural poverty or inner city. the obsession with competition means people will suffer.

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  • I think the future of general practice is that anyone with any sense will quit. I am amazed that so many GPs still plug away at a job that becomes more untenable each year. I left years ago when all this stuff was starting.

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  • I think you're right.Most single handed practices are run by first generation immigrant doctors from the Indian subcontinent who are now close to retirement age.These practices are usually based in deprived inner city areas.The likelihood is that they will end up becoming branch surgeries of larger federated practices

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  • Amazing comments to make, large organisation eg nhs England apparently can't sort out payments even though its bigger, so no idea why small practices have to fail or be made to fail.
    Most community services , social service budgets do not come under general practice at all so economy of scale is meaningless.
    The real success came under fund holding back when there loads of small practices and when gps had 24 hour responsibilities as well and could commission community service directly,
    The only reason to federate is more a work force issues ie to have enough holidays, sick leave etc for cover and that's about it.

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  • @7.43 the problem is that a lot of costs/ work is based at practice level. CQC registration is per practice. A single hander will have to do all the work (or pay for it) whereas a 10 partner practice will be able to share out the work between a group. The cost of inspection will be less, but the work involved in preparing those pointless policies is the same.

    I have no real idea why anyone would go single handed, it would drive me crazy. But in some parts of the country it is needed and they have my sympathy that things are being made harder for them.

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  • Keith Taylor

    Increases in bureaucracy will inevitably reduce the number of single handed GPs. When that is coupled with the constant squeeze on practice income, enhanced services being placed out for tender by AQP and rising costs, economies of scale available at larger practices and a sharing of the workload must lead to consolidation.

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  • Peter Swinyard

    I think that the reports of the death of single handed practice are a little premature. My time as a single hander was the most rewarding professionally in my career (vocationally, not financially!). Yes, there is scope for and need for sharing some admin functions between practices but the essence of the continuity of personal doctoring provided in a single handed practice shows genuine (and in the modern dreary way, financially provable) health benefits and, with good organisation, the full range of services can still be provided to the patients. Being given a death sentence by a very eminent and respected doctor who actually works in a mega-practice with few profit sharing partners and many employed GPs may show a certain lack of insight of the essence of the small practice.

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