It can’t be easy being a rural GP. It may look all Doc Martin, but as ever reality is much less glamorous than fiction.
I was asked recently to be a talking head on camera for a BBC report into a village practice which is being bought out of its premises by the local community. It was looking to close and transfer its patients to another surgery two miles away after a fruitless two-year search for a GP to take it over.
The parish council in Sussex is planning to spend £500,000 buying the surgery building to keep a GP practice there. It is a wonderful story about a community coming together and deciding that they are simply not willing to let their GP practice go to the wall. And there are similar heartening stories across the country.
In Cumbria, the Hawkshead practice was near closure, but was saved by their patients. Now they are opening a new purpose-built surgery in a donated building, with £40k raised by the local community to kit it out. And last year Thurrock council announced plans to buy the premises of East Tilbury Medical Centre to keep a 3,000-list practice in the community.
NHS reforms driven by mandarins in Westminster or Edinburgh are simply not interested in smaller practices
I think practices in rural areas perhaps do the purest form of generalist practice, providing a much greater range of care as they are further from hospitals and/or social services. As one GP in on Twitter put it to me: ‘The true meaning of family general practice is when the doctor knows all generations and can connect the social to the medical.’ I am sure that also is possible in practices in many other areas of the country, but it does seem to be a dominant theme for more rural ones.
But the BBC journalist was interested in talking to me about why – if they are so popular with their patients – so many are struggling. He set up a bright silver umbrella, shone a bright light in my face and switched on his camera.
Of course, I told him that there is a poisonous cocktail of factors that are common to many practices across most areas of the country. You will be painfully familiar with them: recruitment issues, rising patient demand and frozen funding.
But there are particular complications in a more rural setting. They are often smaller, and are just one or two retirements away from closure. Their catchment areas can be massive, with home visits a chore, and isolation driving more healthcare use. Recruitment is harder in rural areas – most doctors are trained in a city and they are unlikely to leave, despite the often glorious locations offered by rural practices. Scarce locum GPs are often unwilling (understandably) to travel across many hills and dales to get to work.
And they are out of step with the zeitgeist. I explained to the reporter that the NHS reforms, being driven by mandarins in Westminster or those in Edinburgh, are simply not interested in smaller practices, no matter how popular.
They want scale; practices banding together and employing many more non-medical staff to carry out more work out of hospital. This is hard for many practices, but nigh impossible if you are a very small concern, situated miles from the next village.
Rural practices have advantages too; their special relationship with patients, the ability to be nimble when responding to patient needs. But they have to work hard to keep their heads above water. It can be a lonely game. And be under no illusions, those not willing to ‘transform’ in this image, are left to ‘fail and wither’.
And it is a real shame, as the evidence above shows, they are the beating heart of many small communities and if they close they will be gone forever.
The BBC reporter nodded gravely and switched off his camera.
Nigel Praities is editor of Pulse. You can follow him on Twitter @nigelpraities