Jayne Dowle: GPs should be our rock, not a financial commodity

THE news that a GP surgery in South Yorkshire is to close at the end of the month because it is “financially unviable” worries me. Ministers may be pausing for thought as they set about the wholesale reformation of the NHS, but this closure of a surgery in Brampton forces us to ask ourselves the inevitable question: should our GPs be doctors or accountants?

It is not a typical situation, admittedly. A brand-new surgery opened two years ago with the intention of looking after 3,000 to 6,000 patients. But thanks to the economic downturn, a proposed housing development nearby never materialised, and the surgery only managed to attract 1,000 to its books. It became clear that this was never going to be financially viable – the sums simply couldn’t stack up. So the surgery is shutting, and patients are being helped to find new GPs elsewhere.

Job done? Well, yes. Situation managed effectively by the local primary care trust, at least. But what this case illustrates is the potential for unavoidable error. And what I worry about is that if this kind of miscalculation can happen once, it can happen many times, and with increasing frequency, across the country, if the plans to reform GP surgeries go ahead.

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And should the reforms, which will put all GPs in charge of their own budgets, be agreed, then the primary care trusts and the strategic health authorities will be abolished. So who will pick up the pieces when a GP surgery, perhaps through no fault of its own, like the one in Brampton, suddenly finds itself unviable? With no primary care trusts to rescue the patients when a surgery goes under, some of us could find ourselves facing the possibility of a real fight to find another doctor.

I know just how hard it can be to track down a dentist willing to treat patients on the NHS. So imagine what it would be like looking for a doctor. You and I might have sharp enough elbows to fight our way to the front of the queue, but what about the vulnerable and the elderly? And just because you are in sound health now doesn’t mean you will always be like that. One day, you might find yourself incapable of fighting your own battles. It is at times like this that you want your GP to be a rock, not a market commodity.

And while there is no suggestion whatsoever of any financial impropriety within the Brampton surgery, it is clear that wider economic factors were responsible for its downfall. Do you want your doctor to be constantly worrying about the bottom line instead of worrying about getting your blood-test results back?

Now, I’m not looking at this issue through rose-tinted glasses. To some extent, yes, a modern GP, in a well-run practice needs to have some business acumen, especially as they are operating in a health service which needs to make £20bn in “efficiency savings” over the next few years.

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Talking to GPs and surgery managers these past months, it is clear that many of them want to take a more active part in the financial management of what they regard as their “businesses”. We are naïve if we imagine that they are all sitting around waiting for top-down instructions. In the biggest group practices, the practice manager works with the GPs to run things, and it would be totally wrong of me to conclude that these professionals somehow aren’t up to the job. And obviously, if the GPs and practice managers are in charge, they will have the power to decide what happens in their surgeries, and arguably, make highly-responsive financial decisions which benefit their particular patients.

There is a strong argument in favour of keeping the overall structure pretty much as it is, with the local primary care trusts still in place as a strong safety net, but giving GPs and practice managers a much more forceful role in the financial decision-making bodies. This would also allow those GPs who enjoy the brokering to step up to the plate on behalf of colleagues who prefer to concentrate on, well, looking after their patients.

But this kind of compromise seems to be beyond the Government’s reasoning. What of those GPs in small practices without the business infrastructure?

Will they – and their patients – end up at the bottom of the pecking order? Pause for thought or not, these reforms are in danger of being rushed through without anything like enough consultation, probably because there are so many flaws in them that ministers know that if they stopped to listen to and answer questions properly, the whole roller-coaster would be derailed.

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So, doctors or accountants? If only the choice was that simple. Our GPs will have to become all things – medic, counsellor, entrepreneur, negotiator, salesperson, ambassador – to all men, women and children. I am not sure that this is fair on them, and I know for sure that it is not fair on us, their patients. In this business arrangement, it seems everyone will get a raw deal.