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