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Practices should not be punished for being ‘atypical’

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It was a heartbreaking letter. ‘The partners of Charlotte Keel Medical Practice regret to inform you that we have given notice to NHS England that we are terminating our contract. This has been a very difficult decision for the partners whom have spent their whole careers working in inner-city Bristol.’

The letter goes on to explain that their decision to leave their practice is due to PMS funding cuts, rising tenancy costs and because appeals for ‘adequate compensatory funding in acknowledgement of the needs of our atypical patient population’ were ignored. It is a sadly familiar story.

I know one of the GPs in the practice very well – our columnist Dr Shaba Nabi – and I have heard from her over the years how the practice has struggled, despite being filled with bright and dedicated people who care a great deal for the 17,000 patients they serve in a deprived area.

It is hard enough to stay afloat at the moment if you are a typical practice (whatever that means) but it is doubly hard if your patient population does not fit the mould.

Reform of the GP funding formula to recognise these differences has been kicked into the long grass more times than I can remember, and even though CCGs were told to identify practices  which are ‘unavoidably small and isolated’ or have high numbers of patients who do not speak English for additional funding, we learn today this is failing to materialise in some areas.

Patients have been failed by a system that does not sufficiently recognise difference 

The harsh reality is that the patients at Charlotte Keel Medical Practice and countless others have been failed by a system that does not sufficiently recognise difference or fund it appropriately. All the nice words about tackling widening health inequalities mean absolutely nothing if hard-working, locally-rooted practices such as this are not supported.

Scotland is attempting to recognise this problem in its new contract with the introduction of a new ‘GP Workload Formula’  to re-estimate the number of consultations per patient, dependent on their age, sex and the deprivation status of the neighbourhood in which they live in. Credit must go to the Deep End Project for its diligent, methodical research (and tireless lobbying), which have underpinned this move.

But we have yet to see any similar move in the rest of the UK. Of course, there is short-term vulnerable practice funding available in some areas, but a long-term solution is needed to ensure that no practice is disadvantaged purely by its location or patient mix. And it is a kick in the teeth that in the same week Charlotte Keel went to the wall, there are large amounts of money being spent on extending seven-day access to millions more patients.

Somewhere the health service’s priorities have got very screwed up.

Nigel Praities is editor of Pulse. You can follow him on Twitter @nigelpraities