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Beware the super-practice soggy bottom



As you read, the memory may be fading. But as I write, it’s still raw with me. First, tears over Nadiya’s emotional Bake-Off victory. Then sobbing as we realised the series was over. Finally, wailing in fear of what was to come.

Because where there was sweetness, there is now Alan Sugar. But that’s where the similarity ends. Bake-Off embodies goodwill, community spirit and simple pleasures, all against the backdrop of the British summer. Whereas The Apprentice is a harbinger of winter gloom, with inflated egos jostling for Sir Alan’s attention, not in the hope of making a nice Battenburg, but shedloads of cash.

This leap from people-eat-cake to dog-eat-dog is a real culture shock. It’s also a metaphor for the state of general practice. It is though, isn’t it? At least for the purposes of this column.

To explain. Pulse has highlighted the rise – in number and architectural scale – of ‘super-practices’, comprising scores of partners and massive patient lists. Across the country, the movers and shakers are trying to outdo each other, with the latest declaring an incredible list size of 275,000 patients. And partners? Two hundred. Blimey. We’ve only got six and we still can’t agree on the biscuits.

Do we want to be part of the community or part of the skyline?

These uber-practices will inevitably have a hierarchical structure with executive teams, partnership boards, subcommittees, ‘dynamic’ leaders and so on. They will chime with current political thinking and be in a position to exploit the prevailing funding streams. They will have ambitious plans to expand, embrace the Five Year Forward View and feature sharply dressed individuals who know what ‘MCP’ stands for. And, despite soothing words about tradition and local needs, they will be seen as huge, faceless, soulless, corporate structures employing staff just doing a job on behalf of a disenfranchised population. There’ll be some hiring, but probably quite a lot of firing.

All very Apprentice.

Now, we’ve all been aware that the days of the singlehander are numbered. But suddenly, it’s our traditional small group practice that’s under threat. You know, the one that’s been there for years, has an identity, serves the community, employs staff that patients and doctors can name, gives a sense of vocation and provides continuity. And only occasionally shuts up shop so the senior partner has time to ice his buns.

So are we really at the Bake-Off/Apprentice crossroads? Do we want to be part of the community or part of the skyline? Or is there a middle ground?

Maybe. Remember federations? They were originally the solution to a problem no one could quite identify. Now their time has come. We can capture the zeitgeist by banding together, benefiting from extra clout and economies of scale, but still maintain our identity and our local functionality.

In reality TV terms, then, that would be some sort of hybrid – ‘The Great Apprentice Bake-Off’ – in which the most obnoxious apprentices are bundled into an oven for a couple of hours, then fed to the needy at a local fête. I’d watch that.

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield