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'We are over-crowded and over-subscribed'

Dr Darren Moore explains why his practice in Milton Keynes has had to request a temporary list closure for the fifth time.

Milton Keynes is a city that continues to grow rapidly. Located in a fast-growing area on the eastern side of the city, we currently have between 14,000 patients on our books with six full-time GPs.

Our patients are predominantly young families, and we have very high consultation rates for mental health problems, minor illness and minor injuries. In the coming years the pressures on our practice are likely to increase and we may have to look towards increasing, not only our list size to 16,000 plus, but also expanding the practice.

In our core area there are lots of new housing developments and the local council’s planning projections suggest a further 8,900 residents will have moved in over the next seven years. Despite this, we want to grow but are faced with two huge challenges.

For the next seven years our minimum practice income guarantee (MPIG) funding is being withdrawn at a rate of £21,000 a year. In addition, due to our patient demographics, we only receive funding for 75% of patients on our registered list. This combined with the loss of a proportion of the QOF funding, means that it will be very difficult to recover from the loss of the MPIG.

To offset this we will have to greatly increase the number of patients per GP to main sufficient practice funding to remain viable and provide the same level of patient care. One downside to this is that, by increasing our individual list sizes, we will have even less time than we have now to adequately deal with the paperwork, hospital correspondence and checking of results which comes with it.

Even more serious is the adverse effect it will have on patient access and safety, and the wellbeing of our GPs and staff faced with a significant increase in workload.

Then there are the practice premises. Ours are new by most standards, built in 2003, but it was designed for four GPs and a registrar. To meet demand we now have six GPs and two registrars in the same space.

To accommodate this we have moved all administration upstairs and based a GP in a room originally designed as a base for district nurses, while at the same time we have had to convert two store rooms, a dirty utility room and a toilet into consulting rooms.

Since 2004 we have been trying to work with the PCG, which then became the PCT, and now we have a local area team. With all we have pushed for help to increase our capacity and each time nothing has happened, resulting in us having to close our practice list four times for safety reasons due to over capacity. The short of it is that we’re operating in a building well above its designed capacity, in an area of significant local population growth, and so far we have not had any help from the NHS to support us.

Dr Darren Moore is a GP partner at the Milton Keynes Village Practice

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Readers' comments (10)

  • Surely there is a case for taking out a loan and building the extension yourselves and retrospectively getting monies back via rent?

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  • Anonymous | Work for a pharmaceutical company | 10 September 2014 10:30am

    you make the assumption that there is enough free land or capital to build such an extension.

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  • I sympathise completely and have a similar situation, although our building is from the 1960s. We stagger surgeries and share rooms. The NHS board recognises this but there simply is not the necessary £1.3million available for a new building. However - your simple solution is to stop taking registrars and replace one or both with new full-time partners.

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  • 'Anonymous | Work for a pharmaceutical company | 10 September 2014 10:30am

    Surely there is a case for taking out a loan and building the extension yourselves and retrospectively getting monies back via rent?'

    No actually as the NHS England Coffers are so tightly zipped closed they claim to have no money for even increases in rent if you take the risk and build, let alone provide funding for new capacity.

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  • With the best will in the world, how can you expect partners to take personal responsibility for a mortgage over 20-25 years with no guarantee of rent increase ( there have been threats of reductions) and a statement from NHSE saying that partnerships will not exist in 10 years?

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  • with the way the current GPs are treated by NHS enforced to prescribe medications against EBM else struck off,no wonder the remaining GPs are oversubscribed and overloaded.The GMC should look into this to to rectify the intolerable position of GPs

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  • I have extended because I am apparently legally required to take all patients, but I receive no rental for the extra areas as there is no budget for this.
    In effect, we have to provide surgeries for no rental income. I personally feel that the GPC is completely out of its depth. They should all resign because they do not do anything, except make noises [ not all rude] and apparently talk to the papers and get interviewed a lot and say how dreadful, dear me, tch,tch!! etc. But no action except to say your GP cares and that is worth a fat lot of good.

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  • I was the Senior partner of that practice until I retired in 2008 having set up the practice from scratch in 1998. With the help of Darren Moore and other partners we built up a high quality highly popular practice. I had the foresight to obtain a piece of land with plenty of room for expansion: the current surgery was merely the first phase. The PCT refused to support further expansion & wouldn't commit to increased rent if we did it ourselves. Instead they built a Darzi centre a few hundred yards away. That centre run by a private company is unpopular with patients & gets poor ratings on the NHS choices website whereas despite the overcrowding Darren Moore's practice remains highly rated. The first time we closed the list the PCT advised patients to go to 2 neighbouring practices which were deemed to be failing.Despite being retired for nearly 6 years I still feel very angry about the stupidity of NHS managers.

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  • The policy of paying rents separately from the patient list is crazy. If the rent (with appropriate weighting for location) was tied into patient numbers than a popular practice would thrive and be incentivised to expand and use their building more efficiently.
    As it is we are living and working in a centrally planned cliche of economic malincentives.

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  • (to follow from above)
    The policy advocated above would also allow practices to merge more organically, in order to maximise use of buildings, and invest in buildings, where this was advantageous or possible.

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