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Why our high-performing practice in a deprived area had to close

Why our high-performing practice in a deprived area had to close

Last week, the East Barnwell Health Centre in Cambridge announced it was handing back its GMS contract after years of financial struggles. Here, the partners share their story with Pulse.

Last week we – the partners at East Barnwell Health Centre – announced we were handing back our GMS contract. It was a devastating decision made after ten years of increasing financial difficulties. It was by no means an easy choice and was the very last resort. 

These financial difficulties had come from three main areas. The first was an exponential rise in the charges to work out of our NHS Property Services owned building. The second was the inadequate local health funds in meeting the needs of our patients; the Carr-Hill formula does not recognise the needs of our younger, deprived population. And then of course, there is the national funding increases well below inflation, affecting all general practices. 

In 2021, we were facing a significant six figure bill from NHSPS which was substantially reduced after negotiation. But then from 2021 again the yearly charges resumed. We had to go to the ICB each year saying we could not afford to be working out of this building.

We have had many intensive meetings over the past two years with local NHS leaders, and had always believed that we would reach a solution; that the system would want us to find a solution so we could continue to meet the needs of our deprived population. We were motivated to adapt, expand and plan for the future. There was continued talk of support and help. Unfortunately, in spite of all these discussions, there was no solution proposed that could give us enough financial certainty going forward.

The past 12 months have been especially hard; the process was so drawn out and we could not get reliable reassurance about our ongoing situation. The questions looming over our funding restricted us in terms of what we could pay our staff, and consequently many of them moved on to other, more secure, practices which could pay more. We felt we could not invest with the risks of debt hanging over us. We are a close-knit team with a great ethos, but people need financial stability. In the last year, a third of our staff left, completely destabilising us. 

Cambridge is one of the country’s most unequal cities in terms of wealth; home to the very poor and the very rich. We are an interesting and unusual practice as we serve a deprived area within this wealthy city. We are the only ‘Deep End’ practice in Cambridge in the ICB; the other 17 ‘Deep End’ practices being in the Peterborough area. Like all GPs, we are expert generalists. We know our patient cohort and have decades of experience in managing our resources to provide high quality care despite the added pressures of caring for a deprived community. We are advocates for our patients whom we know as individuals, not as a statistic.

This is partly why we believed that the system would support us, and help us to keep going, because addressing health inequalities is one of the ICB’s priorities. We feel we exemplify that, in terms of what caring for a deprived community looks like in an unequal city.

Because of our particular model of general practice, which works on a patient list system, we have a deep understanding of our patient cohort, prioritising continuity of care. On any given day, we know the names of those sitting in our waiting room, and their families too – proper ‘cradle to grave’ care. It is this sort of holistic healthcare that allows us to manage acute and long-term conditions, along with the wider social issues that impact on those conditions. It also keeps patients out of hospital unless that is where they need to be. That is good general practice, and we are proud of our whole team who make this happen day in and day out.

We had discussions with the ICB who were keen for us to change our approach and embrace other models of practice. We were happy to engage with new models, but not just for the sake of it; what we do needs to be driven by evidence that this works for our patient cohort, and by the certainty that patient care will be maintained or improved. Our patients were already satisfied with our services and consistently gave us high ratings (we had the highest patient survey results in the whole of Cambridge in 2021, and in 2023 had patient satisfaction scores significantly higher than national and local scores). We are actively involved in innovative health improvement projects in our community, with the integrated neighbourhood team, PCN, local charities, faith groups and the schools, reaching out to those who might not otherwise prioritise their own health.

One size does not fit all. We continue to prioritise an inclusive service with a range of ways that our patients can contact us: telephone; walk-in; online; email; SMS; or post. We believe that forcing through a digitally-led service would disadvantage the very groups we are trying to reach, such as those with language challenges, poor digital literacy, the elderly, and the housebound – leading to an increase in health inequality.

Since making this announcement, we have had an overwhelming reaction from our patients and community who value their practice, and the care they and their families have received over the years. We have had some patients concerned about the future of their healthcare. We have been keen to reassure them that there will be an ongoing service here, even though we don’t know what that will look like at this point. We have been working with local groups, such as the community charity Abbey People, to ensure we give a consistent message to our community.

One of the most important things about this story is that we are not a failing practice in any sense of the word. Our health centre is a thriving and successful training and teaching practice, with high patient satisfaction embedded in our local community. We are immensely proud of the service we provide to a deprived population within a very wealthy city. And yet these compounding financial challenges have rendered us unable to continue, which for us is utterly tragic. 

Dr Rachel Harmer, Dr Amine Boualem, Dr Alisdair Macnair and Dr Katherine Mellanby are the partners at East Barnwell Health Centre



Please note, only GPs are permitted to add comments to articles

Allister Woodstrover 21 June, 2024 4:01 pm

For years government has wanted to break the partnership model as they have little direct control over how that model and can’t see what GPs earn etc.A salaried model is what they want and they have realised they can starve partnerships out
Which is what they are doing.

Centreground Centreground 21 June, 2024 6:20 pm

As stated previously, the issue across the country with destructive ICBs across the nation , destructive PCNs and destructive PCN CDs and there are many examples across the UK in my personal opinion.
This is supported in my personal view as I believe (please correct if wrong ) that this practice is now been offered out as an APMS contract with HIGHER FUNDING and this could in my view have been given to the previous partners.
Please all realise that in my personal opinion and across the country ICBs, ICB Managers, ICB GPs and PCNs and PCN CDs are acting in their own interest and the damage caused to practices , patients and the careers of GPs/doctors continue to face serious harm in the face of this onslaught.
NHS management groups continue to operate in my opinion this subterfuge.
They continue to be paid very highly in these roles and Primary care continues to be destroyed.
The ploy used by ICBs in our area in my opinion once more, is to hold meetings, appear superficially sympathetic, tick the box that they have followed a process, they themselves will be paid highly for this meeting and for them a leisurely chat and they will leave on time whereas the GPs will have to make up this meeting time and catch up their work in their own time.
The ICB in our area will make suggestions, organise aimless meetings to give themselves something to gossip about and add to their claims of being helpful, BUT DO NOTHING OF ANY PRACTICAL USE,OFFER NO FUNDING AND NO MEANINGFUL PRACTICAL SUPPORT ONLY USELESS WORDS DISGUISED AS ASSISTANCE again my personal opinion.
Hence, we end up with another practice lost to APMS and a further decline in our once acclaimed Primary Care System which is now lost due in my personal view to these disingenuous NHS groups and individuals.

David Church 21 June, 2024 6:50 pm

This is not sad. This practice has worked hard and achieved a lot clinically and sociologically for their patients. This is a great success story.
It is , however, dowright Appalling that the ICB has let property arrangements with unjust biases and prioritising private shareholder gains, destabilise and demoralise, and demean the future of this Practice and quality of care it gives to local patients.
But that is what people voted for at last election – to destroy the NHS !
We can only hope the people think more clearly this time on July 4th, and realise what a great asset the NHS is, and could be once again, if they chuck out the corrupt, self-serving, American-influenced, Privateers.

So the bird flew away 21 June, 2024 8:01 pm

The fundamentalism that is Friedman economic theory is not a native species. Get it out of our public sector as it leads to absurd and tragic situation like the one that this excellent GP practice and its patients are in. The unthinking local NHSE and ICB clearly just follow orders (and the filthy lucre).
Bring back the spirit of Clem Attlee after the next election and fund the NHS properly…

Mark Alban 21 June, 2024 8:16 pm

NHSE through its puppet ICBs has conducted a vendetta against General Practice. Tragic tales like this will only become more common. What they cannot see and accept is that the nimbleness of the partnership model and the generosity of GPs has kept things going for years. Just read the Health Select Committee on General Practice from 2022. But if you cut off funding, you kill it. This is being done.

Turn out The Lights 24 June, 2024 3:41 pm

Red or Blue this is what is coming.

Dave Haddock 25 June, 2024 6:48 am

You are a failing Practice.
You have failed to live within your means.

Dave Haddock 27 June, 2024 4:49 pm

Failed to control spending.
Ran out of other people’s money.
Blame everyone but those responsible.

ps. Overwhelming local support for the Practice?
Ask patients to pay £3/week each and see how many remain.

Dave Haddock 27 June, 2024 4:50 pm

You are a failed Practice.
You failed to live within your means.