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Should we let GP practices fail?

Dr Una Coales


The Government has decided to scapegoat NHS GPs – and we should let them. Why work ourselves to an early grave to prove the Government wrong? Why bother putting up a fuss and bothering our trade union to ballot on industrial action? Haven’t you heard ‘British GPs are the most lavishly rewarded in the world’ as quoted in the Times newspaper only the other day? We must ‘drop the moral blackmail and open all hours’, it read.

What would happen if we all resigned and allowed our practices to fail? After all, we can’t starve our children or live in our cars if we continue to accept negative monthly drawings for the sake of keeping our surgeries open.

How much worse does it have to get, before we are forced out? Admissions avoidance schemes, referral management schemes, delays, gate-keeping blockades, begging for remuneration, begging for practice lease renewals. Why not do their job for them and just put up a frontage sign that reads, ‘This NHS GP surgery is closed by the CQC due to safety reasons’?

We tried reasoning with the Government, but it didn’t work. Compromise!, we said. Allow GPs to work like dentists. But please, stop giving us money only to take double away.

But it all fell on deaf ears. It seems there is no recruitment crisis, and no funding crisis.

If we continue to work overtime for less pay, the slave master will expect this as the norm and work us harder. But if we work to rule and allowed all surgeries to fail, we would regain our lives and our self-respect. When the public sees every surgery in the country close in the run-up to the next election, it will wipe out our enemy’s chances of victory. Sweet revenge!

We would finally be in the driving seat. We could bring our old colleagues home from Australia. We could reshape the delivery of primary care on our terms – prioritising patient health needs instead of consumerism; responsibility for outcomes shared between the doctor and patients, instead of the paternalistic approach of the nanny state.

For too long we have relied on the odd brave GP sticking his or her head above the parapet on behalf of the whole profession – only to have their heads blown off in spectacular fashion.

It’s time for all of us to make a stand, side by side (not 20 feet behind the leadership). Make some Plan B income provisions and let your surgery fail.

The 2014/5 NHS GP contract is financially unfeasible, and you are all about to prove it to the public.

Dr Una Coales is a GP in south London and former BMA Council member


Dr Kailash Chand head SQUARE


A crisis that is threatening to overwhelm GP services and force the closure of some GP practices. Pulse’s initiative is a timely reminder of these threats, which I believe politicians and the public are slowly beginning to wake up too.

The biggest issue facing vulnerable practices is that there is no one cause for this crisis. Rather there are many interconnected pressures that are coming to fruition at the same time. Patient demand is continuing to rocket and while GPs are working harder than ever before – performing 40 million more consultations than in 2008 – the sheer number of patients arriving for treatment is far outstripping GP’s capacity. Funding has been flat lining or declining for many practices for years, leaving them in the untenable position of doing more, with less.

A number of practices have faced an extra blow due to the phasing out of MPIG which from April has some practices in challenging circumstances begin to see a vital funding lifeline phased out. NHS England have acknowledged the phase-out will leave 98 practices in serious difficulty, while hundreds more will be affected to a high degree, but so far little has been done to help those GP services affected. The BMA has done a lot of work highlighting these cases to the public and the chair of the GPC marched with GPs from Tower Hamlets (an deprived area that could see a whole sway of practices close) to protest the issue. Practices in rural England, the commuter belt and at universities, are facing the same desperate fate.

As recent BMA surveys have shown, GP services are also being undermined by decaying practice buildings and a workforce crisis. Four out of 10 GPs say they are struggling to provide basic GP services because their buildings are too cramped and inadequate.  Around seven out of 10 are considering early retirement. Some 451 GP trainee places went unfilled in the most recent recruitment round – no-one wants to do this job anymore.

Overall, it is clear we cannot allow practices to continue to be undermined to the extent where some – even if a small number – are tipped towards closure. Any practice shutting would leave a damaging hole in local patient care and rip out a key part of the local community. We need to prevent this from happening.

There is a clear solution. We need to have long-term, sustained investment across a range of GP services. Practices need to be backed with proper resources, better premises and an expanded workforce. Most importantly we have to protect those practices on the edge. If we don’t, patients will suffer.

As well as the Pulse campaign, the BMA have also started Your GP Cares because of the crisis. If general practice starts to crumble then the rest of the health service will collapse, with disastrous consequences for patient care. General practice is in crisis – the Government must listen to Pulse and BMA’s campaign.

Dr Kailash Chand is deputy chair of the BMA and a retired GP