Dr Chris Mimnagh: NHS bosses are making a big mistake by letting small practices disappear

GP practices have always come in all shapes and sizes. The NHS would be making a colossal error if it lets small practices - and the continuity of care and personality they bring - wither away, says Dr Chris Mimnagh.

I hadn’t planned on writing again so soon, but four  recent events sparked my interest.

The first was the NHS England 'withergate' an admission that sometimes you can’t beat evolution and sometimes small practices will not survive alone. NHS England may or may not be happy to let that happen.

The second event is the announcement that a major trust in Lancashire now has partnership positions with two local practices. The third was the CQC announcement that smaller practices do less well in their inspections at the hands of the CQC.

The fourth we’ll come to later.

Now I need to be clear, I’m a big practice guy. I’ve worked in small practices, even ran one as a locum for holiday cover, but most of my career is big practice stuff.

Even so, I recognise that the small 'mom and pop corner shop' has distinct strengths, satisfaction, continuity and personality are the big draws. The downside is that they lack economies of scale and resilience.

Unfortunately we are on the edge of making a big mistake.

Allowing smaller practices to fail or helping them to be 'partnered' by trusts or private sector or even, dare I say, operated as branches of bigger groups, will be the equivalent of Tesco shutting down the corner shops and then putting in place the Tesco local.

General practice is not Tesco. We need a varied approach, but more than that, our patients need a relationship with their GP. The operatives in your Tesco Local are just that, operatives - they change, but the shop stays open. They come and go, but the product lines are still there.

General practice is not a product line, and while access can trump continuity in the eyes of patients at a big practice, relationship and continuity are the attracting factors for patients who attend small practices. We all need to work together, federate even, to ensure that diversity of supply remains.

The demise of the smallest practices puts us at risk of becoming a series of clones, standardised product lines and access methods. Thats all well and good for supermarkets, but general practices come in all shapes and sizes, some you like, some you don’t.

In that respect it’s a bit like Marmite, you either love it or hate it.

That brings up my fourth point - monopoly of provision means that thanks to Brexit  your local Tesco won’t have Marmite soon. Don’t let this happen to general practice - now is the time to fight for your right to Marmite.

  • Dr Chris Mimnagh is a GP in Liverpool and co-director of clinical strategy at the NHS partnership organisation Liverpool Health Partners

Read more from Chris Mimnagh

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins


Already registered?

Sign in

Just published

BMA Scotland GP committee chair Dr Andrew Buist

'Disappointing' uplift falls short of 6% pay rise promised to GPs in Scotland

A 'disappointing' uplift to contract funding worth £60.4m in 2023/24 will not deliver...

Person selecting medicine in a dispensary

Dispensing GPs demand funding overhaul to ensure services remain viable

Dispensing doctors have demanded improved representation in GP contract negotiations,...

GP consultation room

GPs seeing cases of malnutrition and rickets as cost-of-living crisis hits patient health

Three quarters of GPs are seeing a rise in patients with problems linked to the cost-of-living...

Female GP listening to a patient

What GPs need to know about changes to Good Medical Practice

Dr Udvitha Nandasoma, the MDU’s head of advisory services, explains what GPs need...

Dr Caroline Fryar

Viewpoint: Doctors should be given protected time to digest Good Medical Practice

There's a lot for doctors to digest in the GMC's Good Medical Practice update before...

MIMS Learning Clinical Update podcast

MIMS Learning Clinical Update podcast explores the ‘defining issue of our age’

The latest episode of the MIMS Learning Clinical Update podcast features an interview...