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Guerilla patient in our midst

I attended a meeting at a singlehanded practice recently.

The GP had worked in a group practice until he left two years ago to take over the small village practice. As is often the case in small practices, patient feedback was very positive and satisfaction levels and support were both high, particularly because the surgery was the only one serving its village, and covered an extensive rural area. But its excellent reputation meant patient numbers were increasing by an average of 50 per month and its practice manager was concerned this was not sustainable.

The GP was inevitably working very long hours – a 13-hour day at the surgery was routine, plus working from home and coming in most weekends to do paperwork. So the practice was keen to close the list temporarily and reduce the size of its catchment area. This would allow it to increase the clinical space available in the surgery and add more nursing and GP time.

The GP had set up a meeting with two representatives of the local area team, to present concerns that the practice was struggling with increasing patient numbers. I had been asked to attend the meeting, and I had suggested that the GP invited a member of the Patient Participation Group (PPG) along as well.

The GP agreed, and when I arrived at the meeting I was introduced to
a thoughtful-looking man with an imposing grey moustache. He shook my hand with a firm grip and introduced himself as a retired RAF officer from
the PPG.

The sharp-suited area team representatives started off by saying they wanted to give ‘robust support’ and to ‘explore different options’ to help, but then said there was no money for any premises development other than a small sum of Section 106 cash from a recent housing development.

They explained that no temporary list closures had been approved by the area team, as patient choice was the most important factor.

Close to tears

The next option was to reduce the practice boundary, which currently stretched some distance to include a number of larger towns where most new patients were coming from.

Once again, the area team representatives explained that no requests for boundary changes had been approved since NHS England was established in April 2013. The GP nodded wearily, having anticipated their refusal to help, but the practice manager looked close to tears.

He had been quiet until this point, but the retired RAF officer from the PPG cleared his throat and spoke up: ‘So, what “robust support” can you offer?’

 ‘Well,’ stuttered the officials, ‘for starters we can help the practice ensure they are making the most efficient use of clinical and non-clinical space…’

The ex-serviceman cut in: ‘At our last PPG meeting, the practice manager showed us the detailed arrangements and rostering for room usage and I am fairly sure you will struggle to improve that.’

The area team representatives looked uncomfortable as he continued. ‘I feel like I should have followed a white rabbit to this meeting – I really do feel like Alice visiting Wonderland. This is currently a very well-regarded, popular and successful practice, but you are telling me there is no money for premises improvements?

‘You seem to be suggesting the practice should go through the charade of applying for some breathing space in order to increase capacity, but that this is almost certain to fail. Are you just going to watch them drown?’

We were all speechless.

I couldn’t have put it better myself.

The LMC Insider is chief executive of an LMC in England. He is also a practising GP