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Dr Peter Swinyard: ‘A perfect storm threatens general practice’



The FDA fully supports any action which can support practices in providing excellence in care to their patients, with good continuity of care being the hallmark of modern traditional family practice, proven to increase patient satisfaction and reduce health care costs.

The perfect storm of reduced resources, expensive locum cover (my practice had recently to pay £1,000 for a day’s cover) and impossibility of recruitment even to desirable practices is threatening the whole future of general practice in the UK.

The domino effect is becoming a reality. If a neighbouring practice closes due to impossibility of recruitment, how will neighbouring practices recruit to service the patients allocated to them?

Market forces only work where the provider (ie a GP) is a truly independent contractor. We have so many confounding factors here that market forces cannot work. We cannot choose who we take on as ‘customers’. We have a monopoly ‘employer’. We have books of regulations governing how we run our businesses. We are inspected to death. We cannot set our own prices, nor decide what work we do. We cannot even recruit a partner without ‘permission’ from the CQC. We are dependent on the ‘employer’ for premises and for our pensions (which look much more like those of an employee than an independent contractor – also the discretionary sick and maternity pay). We cannot set our prices at a level which allows us to develop premises independently. We cannot choose our hours of opening.

So – market forces? I think not.

If the government believes so much in market forces, it must allow us to have the independence to compete in a true market, with pricing of services set by practices not by central government.

I don’t see that happening. What could happen is that an entire area loses its NHS GPs and the remaining doctors set up as private GPs. As long as the government allows patients to receive NHS prescriptions (as is their right) from non-NHS doctors, the economics would work out fine even in deprived areas as no government would leave a population without health care and some subsidy arrangement would be quick to emerge. A medical fund? Panel doctors?

There is a dearth of good young doctors wanting to be GPs and we must wise up to this and work smarter with an increased use of a clinical team. But where are the training schemes for practice nurses and health care assistant to support this? Where is the demand management, which must come from Government, to allow the remaining GPs to cope?

I wonder who will be there to look after me as I head off towards senility.

Dr Peter Swinyard is the chair of the Family Doctor Association and a GP in Swindon.