In a few months, the NatWest bank in our village will close. Elderly people will no longer pop into their local branch and will have to rely on relatives or friends to transport them five miles away. My son will no longer cycle excitedly to the bank to deposit his Christmas money. And I’ll no longer see the friendly faces I’ve been visiting for years (I don’t get on with apps and online banking).
Although it is inconvenient to lose your local bank or post office, it won’t have a direct impact on your health. Yet, somehow, the same consumerist ethos is now applied to the provision of general practice, without any thought for what will be lost in the process.
On April 1, my practice partnership will terminate its contract with NHS England. Although I resigned from this partnership two years ago, I continue to work there as a salaried GP and still feel immense loyalty to my patients and colleagues.
Between us, the partners and I have given more than 150 years of service to our local community. It’s a very special community of patients who are normally at the fringes of society – asylum seekers, immigrants, substance misusers, sex workers, the homeless and the mentally unwell. It’s by no means an easy gig, but we are driven by a sense of camaraderie and equality of care. We’re not here for the material rewards as there are huge additional costs associated with deprivation and language access. But we strive to be advocates for our population, which is easier as three of us are bilingual.
GPs who are rooted in their community are losing sleep over what the future holds
But society no longer values this. We’re squeezed into the general PMS review bucket, with no consideration for our atypical population. So, as well as seeing global sums plummet, we’ve taken the extra blow of losing our additional PMS cash – originally conceived to keep practices like ours afloat. We’ve also been hit by a three-fold increase in service charges demanded by NHS Property Services, an increase likely to destabilise up to 10% of practices in England.
We have discovered the inequalities agenda NHS England constantly bleats on about is all lip service. When push comes to shove, there are no pots of money earmarked for inner-city practices such as ours, serving deprived, multicultural populations.
So, what is the human cost of the rush to rationalise, upsize and streamline? Patients at the margins, who have benefited from an enduring relationship with their GP, may find themselves abandoned in an increasing maze of complexity. Health inequalities will widen even further than the existing 10-year mortality gap between rich and poor here in Bristol.
GPs who have spent their entire careers rooted in their community are losing sleep over what the future holds, although we are grateful that a GP-led organisation is set to procure our contract and we hope the values of the practice remain intact.
One thing is certain: many more practices are on the brink, left to expire because there is no knight in shining armour. And the sad fact is that such partnership dissolutions will become so commonplace that they won’t even be newsworthy any more.
Dr Shaba Nabi is a GP trainer in Bristol