In a Question Time-style debate at the RCGP annual conference on Friday, NHS England director of primary care and London GP Dr Arvind Madan said that the health service wanted to preserve the flavour of smaller practices, but as part of larger organisations or networks to give them greater resilience.
A panel including Dr Madan and RCGP chair Professor Helen Stokes-Lampard debated the future of small practices in response to a question from the audience, and reflected on how networks could offer support.
Bristol GP Dr Holly Hardy - a member of the panel - told the conference that she had been forced into giving up her patient list because her small practice had found itself unable to recruit.
Giving up her contract had been 'one of the hardest decisions of my life', she told the conference. But she added: 'If I’d been in that situation now things might have been different.
'I’m starting to see in the area working between practices - it was just too soon then for my neighbouring practices to see that they were able to help me. They were under strain too. It’s possible to exist in a small unit but work together in part of a big organisation.'
Dr Madan told the conference that although there was a drive towards working at scale in the NHS, the model the health service wants to create 'involves smaller practices, and the resilience a larger model can provide'. He told the conference: 'Back in 2007 in Tower Hamlets, the ability for collegiate working to support the smaller practices was tangible in their survival in that period.
'I think we can have [collaborative models] and all the access platforms and multidisciplinary teams and also support the small practice down the road. Our patients tell us that they prefer that - we want to maintain the flavour of each individual practice.'
Smaller practices
But he added: 'We are losing two practices a week. The average list size of those is is under 2,000. If that is a choice on the part of a retiring doctor so be it, because they are finding it difficult and getting squeezed out of the system because they don’t have that wrap-around resilience, that’s something we hope to achieve in the roll-out of primary care networks and primary care home... so this is a movement, but hopefully one that doesn’t leave anyone behind.'
RCGP chair Professor Helen Stokes-Lampard told the conference: 'I don’t think one size will ever fit all. The college debated models of care recently, and reaffirmed full support for partnership model as very successful - the only model that works in some parts of the country. But in other parts of the country it is too late. And other models work beautifully. We have to work to the needs of local populations and it has to be from the ground up'.
She told the conference that her own 8,300-patient practice was merging, and added: 'There is a generational shift. People of a certain generation are very happy to collaborate in a way that people haven’t had to be in the past.
'The tide of change has forced us to have these conversations. Mergers are not easy but we are all learning from it. Change is coming. Many smaller practice say they are scared, that they are being forced into something. You are not being forced - if it works for you, great. My advice is to get linked up in a federation-type way, so you can share best practice and learn to trust one another and if you hit the sort of crisis Holly hit you have got resilience in your system.
'That is the vulnerability of a small practice. If there are only one or two of you running a small practice and one of you get hit by a bus then actually you are suddenly very vulnerable. In years gone by there was no problem covering that, but with the amount of work in the system now we can't.'
