Following Pulse’s ‘Lost Practices’ investigation, Jaimie Kaffash talks to former Liberal Democrats leader Tim Farron, who has campaigned to save local practices. This includes the Central Lakes Medical Group, whose partners had to hand their contract back after commissioners withdrew £70k in atypical funding to set up a tourist triage service
What are the challenges facing general practice in rural locations like Cumbria?
Delivering healthcare in the countryside is difficult because you’re serving a small number of people in a large area, so the units of delivery are smaller and less efficient than in cities. That’s always been an issue but issues with general practice have become more challenging in recent years. The end of the minimum practice income guarantee (MPIG) seven years ago threatened the Coniston and Hawkshead practices with closure. Coniston remained a single practice; Hawkshead merged with Central Lakes and it was agreed that the new expanded surgery would get atypical practice funding. The problem is the arrangements for that funding ran out this year, which coincided with a change in commissioner from the CCG to the ICB. So, we’re dealing with the delayed consequences of a government funding cut combined with intransigence from a new outfit that doesn’t understand the finances of rural surgeries.
The ICB decided to fund a tourist triage service at the expense of the atypical funding that had been going to local practices. Why did that happen?
We understand that an out-of-hours company near Blackpool has been given a contract worth £170,000 a year to provide a triage service for tourists – which is bonkers. If you fall ill in the Lake District, will you know about this service? No, you’ll dial 111 or 999. This money will be wasted and could have been used to support surgeries like Central Lakes.
Does a move to a larger commissioning body run the risk of losing local knowledge?
Yes, definitely. Especially if you end up with a commissioning group three times bigger than your old one and therefore much more urban. Lancaster, the Lakes and Barrow all have a relationship and while their attention is within that geography, we’re adding into the ICB Blackpool, Preston, Blackburn, Burnley – places that are further away and much more urban. The percentage of the population in rural areas in the new ICB is much smaller than in the old CCG, so decisions could potentially be made from ignorance. We’ve got to hope the new ICB bosses understand that serving people in the Lake District and the Yorkshire Dales is a different kettle of fish to serving people in Preston and Blackburn.
Are there structural problems with GP funding in rural areas?
The loss of the MPIG is the source of a lot of our problems in Cumbria. In a rural community, it’s blindingly obvious why you have singlehanded practices. Coniston has 900 patients and to get to the surgery, they must cross two lakes and a mountain range. We need to recognise that some surgeries are justifiably small and need to be protected, in which case we need some core funding.
Have any GP practices closed and not been replaced in Cumbria?
There has been a lot of turbulence. We’ve had a lot of mergers and we’ve seen outpost surgeries close. The Goodly Dale practice is no longer a regular practice – after the partners retired, it was let to a private company that handled it badly. They ended the contract, and we were in hiatus until our out-of-hours service Cumbria Health On Call (CHoC) won the contract. They’re doing a fine job, but I wouldn’t like the answer to every threatened closure to be giving the contract to CHoC because it can centralise some of the costs. You just get salaried doctors; you don’t get that long-term commitment in the same way.
What’s the plan for Central Lakes?
Ideally, I’d like to ensure we can advance the tried-and-tested GP partnership model as much as possible. Most Central Lakes GPs would have stayed on had the contract been reasonable. So, what are the options? We could get a bright set of GPs just out of medical school who want to make a life in the Lakes. Someone like CHoC could take over. Worst of all, the contract could go to an out-of-area business that can afford to do things on the cheap and we’d end up in a situation that’s only one or two degrees better than losing the surgeries altogether. The perfect situation is that the current GPs unresign and take on a practice with a contract that works. But as things stand, I find it hard to see how the ICB’s approach to this won’t make the service worse.
Tim Farron is the Liberal Democrat MP for Westmorland and Lonsdale
READERS' COMMENTS [1]
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the problem they have created has led to a lot of gp resignations. obviously, this is a situation that the gp’s have thought about very carefully before acting. unlike politicians, they rarely have a “bump on the head” and go off and do something with long term consequences without weighing up all the pros and cons. if there are a lot of them (which there are), they have obviously all sat down together and agreed on a decision.
if you are an employer, surely that tells you something about the factory you are trying to run ?
the employers – icb, lhb, ccg or whatever their latest sexy title is – seem to have lost all the trust of their workers. it seems to me very unlikely they are all going to “unresign” after taking a step as drastic as this.
you can’t put the toothpaste back in the tube !!
perhaps, next summer, when the tourists start turning up again, the icb, lhb, ccg etc will realise they are NOT calling the shots, and there will be sufficient “egg on face” to hammer home to those in charge that most gp’s have had a gutsful, and that we do, actually have a choice.
i think if i were running the service, i would start losing sleep.
some years ago all the gp’s in a small welsh town resigned en bloc – google “prestatyn surgery” if you don’t believe me. the welsh government’s response – “we’ll get some locums in”. they then discovered that a lot of locums (myself included) didn’t want to work for an employer with an attitude like that, and within a very short space of time they began to say “please” and “thankyou”.
things are better now. not perfect by any means, but those at the top in the welsh NHS seem to listen a bit more than they did !