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1559: The unique challenges faced by small practices

Dr Krishna Chaturvedi describes the difficulties, and the rewards, of working in a small practice in Southend in Essex.

My day started with clearing all my faxes, reading information from the hospital including ICE pathology results around 7.45am, and looking at my emails.

My staff arrived at 8.30am and there were patients waiting to be seen, as they were told by out-of-hours and NHS Direct to see their GP on Monday morning. This has become a typical feature of morning surgeries because out-of-hours and paramedics, after seeing patients, request them to follow up with a visit to their own GP. In some cases, I feel this is reasonable but in the majority of cases, I find this is a duplication and waste of resources.

After seeing those emergencies, I had routine follow-up patients and some other emergencies, which I quite enjoyed clinically, seeing them and dealing with them.

As usual we had one DNA.

After dealing with my clinical paperwork, hospital mail, repeat prescriptions and queries for home visits my clinical work was over - until I see an email requesting various targets be done by the end of March. This is the bit of NHS practice which makes me want to retire soon. There are endless targets and fragmentation of the services which makes it very difficult for the practice as well as patients.

My proudest moment in clinical work is forming the Small Practices Academy of Clinical Excellence (SPACE), a group of 15 small practice doctors and nurses working together and sharing information once a month since the group's inception in 2002.

This was against the backdrop of the statement made by ex-prime minister Tony Blair, whom we invited to Southend to demonstrate that the general impression of small practices being isolated GPs is misinformed. We have a very cohesive group, of course with some differences of opinion from time to time - the group seems to be working despite no support from PCT.

As we know policy still hasn't changed despite patient satisfaction ranging from 80% - 96% for seeing the same doctor, for their continuity of care. Small practices are disadvantaged and seen as one of the targets for PCOs to deal with in a discriminatory way. I know the PCT is instructed from the top down and the DH and SHA are continuously making existence difficult for small practices.

Finally I would like to say that, in our small practice, we have extremely nice reception and management staff, clinical as well as non-clinical, which makes the job very enjoyable and challenging.

Dr Krishna Chaturvedi