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‘We are over-crowded and over-subscribed’

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For the next seven years our minimum practice income guarantee (MPIG) funding is being withdrawn at a rate of £21,000 a year.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