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There’s a reason small practices are so popular



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I still haven’t downloaded Mapp Hancock’s Matt Appcock app, so I don’t know what he’s had to say about the resignation of, ahem, ‘top GP’ Arvind Madan. I’m hoping he’s realised it’s time to begin a proper debate about the value of small practices, but I suspect he’ll actually say ‘hey, small practices are great, because the smallest of all is the one you can fit in the palm of your hand’.

But that’s not the sort of debate we need. Instead, we should probably start by confessing that we have all, by default or design, become complicit with the ‘bigger is better’ mantra. So loudly and persistently has this been chanted by the movers and shakers – some in suits but some with stethoscopes – that we have all been deluded, in a form of collective Madaness, into believing it.

Call them federations, networks or super-practices, the message is the same, usually couched in vacuous catchphrases: going forward, it’ll be survival of the fittest requiring strength in numbers to provide a general practice for the future, etc. And, by and large, we’ve chewed some grass, baa’ed and flocked in that general direction.

Yet I’ve always struggled with both the logic and the motive. The well-aired arguments about making us efficient and powerful rather than vulnerable and downtrodden are flimsy in theory and even flimsier in practice. As for political motives, you can take your paranoid pick from reducing costs, increasing control, nudging us towards a salaried service and so on.

What was once primary care will become the perfect place to dump all the work hospitals can no longer cope with

To a confused, knackered worker at the coalface, like me, the obvious rationale is that the Government wants to turn primary care into something that – with large organisations providing multiple services to huge populations – looks suspiciously like secondary care. Because that, in turn, makes what was once primary care the perfect place to dump all the work hospitals can no longer cope with but which creates politically embarrassing headlines every winter and beyond.

There’s one teensy problem, though: who’ll do all the general practice when GPs default to community care consultants? Yes, of course, nurse practitioners, pharmacists and other noctors, working in and around the megapractices. Which is where politicians show how wilfully clueless they are, and where the small practice argument really kicks in. There’s a reason small practices are so popular and, when allowed to, provide high-quality care: they’re run by people who know what they’re doing (GPs) offering, among myriad other worthwhile services, the most valuable commodity of all to patients who need good care the most (continuity).

Sacrifice that at your peril. The last time ministers tried to hive off a major chunk of GP work – out of hours – it didn’t go too well. This next step is, in effect, to deconstruct the day job. This brings me out in waves of nausea. The strongest arguments against it are staring the Government in the face, yet it refuses to see them. Most likely because ministers are looking in the wrong direction.

Dr Tony Copperfield is a GP in Essex