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We are gathered here today to mourn the death of small business



Once upon a time there was a village. Its residents consisted of a small, consistent group who lived harmoniously as a community. Life circulated around the village centre. The greengrocer, butcher and fishmonger were well known figures to all who lived there. The butcher knew exactly how Mrs Jones from Number 22 liked her meat prepared. The greengrocer had her carrots ready for her to collect them every Thursday at 5 o’clock as she walked home from her weekly trip to the library.

Another well respected member of the community was Dr Past, the village GP. Known to all its residents he had seen families through births and deaths. Villagers knew who to call if they had an overnight emergency but were keen not to bother Dr Past unless they really needed to. A strong sense of community support and family care carried the residents through.

Sounds great doesn’t it? But sadly, a great departure from modern life. Gone are the greengrocers and butchers, replaced by sprawling superstores with high turnover employees and low priced, mass produced goods. The modern community is also vastly different. Communication and infrastructure mean residents move year on year, often with long distance family connections.

So whilst the concept of the local village GP is a great one it cannot, alas, continue in the same small business fashion. Doctors and receptionists come and go in an era where information and products can be bought and sold in an instant. Many newly qualified GPs favour the flexibility of locum or salaried posts, shunning longer-term partnerships.

I’m not saying this a good thing. As a young’un I bought into this world, observing the contribution a family doctor can give to a community. I feel saddened that the environment I now work in will be vastly different. But reminiscing will not change the reality.

As more and more businesses have to work at scale, so must we. Yes, it’s not the way it used to be, but if we do not embrace it we will be left behind. We need to find ways to make general practice work in a larger business model whilst still providing personalised care. I don’t claim to know how this will work but collaborative working would be a good start. Single handed practices are dropping off left, right and centre. Let’s at least try and work at scale the way that we want to. If we don’t I have no doubt that Virgin and Tesco will do it for us.

Modern times aren’t all bad. We have more treatments and technology now than ever before and the population are living longer and longer.

But no matter how much technology advances and businesses mass produce there is one thing that will never change. People will always need clinicians to care for them. An avoidance of change is letting ourselves and our patients down.

Dr Sarah Merrifield is a GP leadership fellow in Yorkshire