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Analysis: What is the future for small and single-handed practices?



The economic squeeze that all GPs feel is even worse for single-handers. As a single-hander you can’t exercise the economies of scale as well as a medium or large practice. Either you must pay to employ more people, or more skilled people, or do more yourself.

I work as a single-handed GP as part of a corporate group. We share a lot, and if we didn’t I don’t think we could run our practices. But even so, we’re only three GPs, and an even bigger grouping would be better. True single-handers must be working really hard at the moment.

Single-handed GPs often struggle to engage with the LMC or CCG because they find it hard to find the time to do their work and go to meetings. But I would advise GPs – whether single-handed or not – to start saying yes to invitations from these groups. At the moment, nobody’s got the time for the work that’s being piled on general practice. Everyone’s working in the evenings too but that does not mean you should stay away from involvement.

If you’re not part of local decision-making, you risk feeling isolated, which makes you more vulnerable to being bullied or picked off by the local health authorities. There is safety in numbers. Showing your interest and involvement with local commissioning despite your size gives you more protection, and might also provide them or you with new perspectives on your business.

After all, small practices have their advantages. We are more resilient because we’re more independent. We can exercise greater individualism. We can react faster – if something needs changing we can do it without having to have a long practice meeting. Our openness to trying new things also means that when CCGs ask if someone will run a pilot, you can say yes.

Combining my role on the GPC with single-handed practice is hard work, but I still really enjoy it. At a small practice it feels like I and my patients have a kind of mutual ‘ownership’. The relationship is priceless – we’ve invested in each other, respect each other, and enjoy a high level of continuity of care, which brings its own benefits.

I’d recommend it to anyone looking for a challenging second role – for instance, someone with partnership experience or a spell as a locum, looking for the next step. It’s the kind of work that gets you out of bed in the morning!

Dr Laurence Buckman is a  single-handed GP in north London and chair of the GPC