Dr Heather Ryan on setting up a private GP practice in a bid to provide an ‘ethical’ service to patients and free up NHS appointments
Until a couple of years ago, I had never seriously considered working in the private sector. I had gone straight from GP training into partnership when I qualified in 2017. But the Covid pandemic, along with a relocation back to my home city of Liverpool, prompted a change of pace. Both my husband John – who has been a GP since 2004 – and myself left our partnerships and found ourselves looking for a way of practising medicine sustainably and providing good quality care.
The expansion in private GP services is a consequence of the decline of NHS general practice, not the cause. Many GPs are leaving the NHS, or reducing their working hours, because NHS general practice is now an incredibly difficult environment in which to work. There is a ludicrous mismatch between what politicians expect of general practice and what funding they give it.
We identified a gap in the market for an ethical, high-quality private primary care. Many existing private practices seem to target healthy young people by offering non-evidence-based screening, aesthetic interventions, and other questionable treatments such as IV vitamin drips. Instead, we decided to operate much more like a traditional family doctor, offering patients unhurried face-to-face care, and only arranging tests and treatments if clinically indicated.
Unfortunately, we encountered a backlash when we opened Formby GP in January. We paid for advertising on Facebook, including on a local community page, and that elicited angry comments: some accused us of being part of NHS privatisation, while others suggested that we were greedy and should increase our NHS commitments. One commenter even joked about running us over with his car.
I understand why people are worried about the growth in private GP services, especially if they can’t afford to pay for private care. But our intention is not to undermine the NHS; patients who see us are not attending their NHS GP surgery, so, if anything, we are taking a bit of pressure off practices.
As former NHS GP partners, we felt strongly that our service should not create additional work for NHS GPs, so we worked with our LMC to ensure that we were set up to do our own referrals and paperwork as much as possible. Private GPs are entitled to refer into NHS secondary care – the entitlement to NHS care rests with the patient, not the referrer – so we do our own referrals rather than bouncing patients back to their NHS GP.
Opening our own private practice has not been a straightforward process. It took us several months to find suitable premises, and then several more months and tens of thousands of pounds to refit those premises to meet the necessary healthcare buildings specifications.
In terms of finances, we have funded the project entirely ourselves, without external investment. This felt important to us so that we could maintain our independence and set high clinical standards. I still work part-time in the NHS, as a GP in secure services, and that income pays our personal mortgage and living expenses. Meanwhile, John does some locum work through our limited company to help with company cash flow.
We have loaned the company a significant amount of our own money. As a result, we share one old second-hand car between us, and we don’t have as many holidays or gadgets as most of our doctor friends. There is a common misconception that medics go into private practice for the money, but, in the short-term at least, we would have been better paid if we had stayed wholly in the NHS.
We’ve been open just under five months now, and it has been wonderful. Having time to get to know patients and their families properly is an absolute joy. Before we opened, I worried that we might spend our working days saying no to patients inappropriately requesting antibiotics or scans, but it’s been quite the opposite: I feel like I’m picking up serious pathology at a higher rate than I did in my NHS GP partnership, and, at the risk of sounding trite, I really feel like I’m making a difference to my patients. Our patients seem to agree. So far, feedback has been overwhelmingly positive. We have already picked up cancers, co-ordinated end-of-life care, averted admissions, and formed strong working relationships with the local district general hospital and hospice.
Given that neither of the major political parties has a credible GP rescue plan, I suspect that we will not be the last doctors who look for a means of escaping a broken system – and I hope, for the sake of patients, that the powers that be find a way of ensuring that patients who cannot afford to pay for their care do not get left behind.
Dr Heather Ryan is managing director of Formby GP, a private GP clinic in Formby, Merseyside