GP crisis: Becoming a partner was a shock to the system

When Huddersfield GP Dr Shanny Rasakumaran became a partner in late 2015, he thought he knew just how tough it would be. But, writing for GPonline, he describes the shock he experienced as he began tackling PMS reviews, service cuts and bureaucracy.

When I took on a partnership role at the Huddersfield University Health Centre in October 2015, a retiring partner's parting words were: 'General practice is in a bit of a crisis, but I'm sure you will see improvements in five years' time.'

Having worked as a salaried doctor for four years at the practice I thought I was well aware of the challenges ahead, but I was in for a shock.

My first test in the partnership role was to deal with decommissioning of successful practice-based musculoskeletal and physiotherapy service - the very service I led when I started out as a salaried doctor.

GP services cut

We had refined the service to self manage most musculoskeletal and sports and exercise medicine cases, with year-on-year reduction in referrals. We delivered a service within the university campus, enabling students to 'walk in' following sporting injury and are promptly managed by an experienced specialist team.

The commissioners felt that the service was inequitable because other local practices did not have anything similar. What they failed to understand was the importance of tailor-made care for an atypical practice.

The next major challenge was our CQC visit. As the clinical governance lead I took on a lead role, and despite being supported by an experienced clinical and admin team, preparation was a mammoth effort.

We felt that this was a good opportunity to showcase specialist services we provide, which are specifically designed to support our atypical practice population. The visit itself was positive and fair and we received an overall rating of 'good', with 'outstanding' for working age people and students - a category that makes up 90% of our practice population.

GP funding

However, the reporting criteria is weighted heavily towards care of older people and QOF, which makes it difficult to score highly when you predominantly look after young people. We had anticipated that the report would also better reflect the financial pressures this practice is currently facing.

As a new partner I was abruptly brought up to speed with the problems posed by an impending funding cut, and found myself trying to make sense of our PMS review and the Carr-Hill formula - problems that I only fully understood after becoming a partner.

Changes to the way medical records are transferred between practices are another concern. The new system will be extremely labour intensive - practices are now expected to send records to their new GP practice by individually bagging and tagging each set of notes.

That may be manageable for an average practice, but for a practice like ours with a turnover of 6,000 notes per year it is likely to require significant admin time. We expressed concern and enquired about a contingency plan...and were threatened with breach of contract.

GPs under pressure

It is disappointing to discover that general practice can be managed in this manner, and far more surprising that our leaders seem powerless to stand up and say enough is enough. We have got to see a real change before we accept any more work being pushed into general practice.

As a new partner I have read political promises of investment in general practice, but the reality for our practice is an impending funding cut. I have experienced services being moved into the community and into general practice, while our practice is facing decommissioning of well-run services that were specifically built up over the years to look after a specialist population.

I have seen my senior colleagues being micromanaged, and the recent PMS review has taken its toll - resulting in increased health issues and sick leave. 

Whatever happens, I realise that the challenges ahead for this practice are immense. We will continue to provide the best possible services and to look after the health and wellbeing of patients and staff. However, we need support from decision-makers, who need to realise that general practice is in a desperate state.

Atypical practices like ours cannot be managed with a sticking plaster approach - major surgery is required. We need to act now - we can no longer afford to wait and hope that as my retiring colleague suggested, things will eventually swing back in our favour over a five-year cycle.

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