NHS reform: Small practices should be valued and supported

In the rush towards bigger surgeries, the NHS is in danger of smothering small practices that offer the best in healthcare to the most vulnerable in our society, argues Dr Zahid Chauhan.

Local commissioners are currently encouraging practices to cluster closer together, with some CCGs even using veiled threats of withdrawal of funding for those who do not join in.

On the face of it, patients may find the idea of big merged practices rather than perceived antiquated independent small ones, to be a good thing. After all, they claim to offer complex procedures and increased expertise under one roof within the same borough.

That is, if patient doesn’t live on one edge of their local authority area where travelling to the next-door borough would have been much nearer. Or, as with the vast majority of our patients,  they are too frail to walk to the super-surgery (which incidentally is bound to be understaffed and overstretched), or maybe cannot afford to get there now public transport has been cut.

Yet again this is money men viewing health as a product; the patient as a consumer; the survival of the financially fittest as the priority.

And frankly, it stinks.

The small surgery is a vital part of British life. Not least because it houses the trusted family doctor. Successive studies have shown that in the pursuit of saving pounds, the small practice has been squeezed out of existence. That, we should remember, has cost jobs and led to stresses and strains that have resulted in qualified and valued professionals leaving healthcare.

It has also had a profound impact on the vulnerable. Merging practices to bring care closer to home cuts no ice with the older person with angina, living on a state pension, who has to meet the cost of a taxi to a larger surgery miles away.

Doctor-patient relationship

But it also fundamentally alters the doctor-patient relationship which is, thanks to austerity policies and a change in society that has seen those in public service continually undermined, in danger of complete collapse.

There is a clue in the name of our profession. A family doctor was called that because he or she was directly known to their patient. They were trusted and respected within their community. Their knowledge and experience wasn’t questioned by what had been seen on Google, because they had been there close after birth and around the times when their patients were in greatest need. Surgeries were at the heart of their communities.

That all changed when health became a commodity. It was all about supply and demand. And demand mismatched by a lack in funds meant that GPs left the profession in their droves and medical students were lured to other branches of healthcare and other countries where stress levels were lower, time more available and the joy of practicing medicine persists.

While no one is naïve enough to suggest that money should be simply thrown at the health service, the parts that work should be treasured and supported.

Smaller practices not only offer the best in healthcare to the most vulnerable in our society, they epitomise all that is good about a NHS that could, and should, focus on the health and not the wealth of the nation.

  • Dr Zahid Chauhan is GP at the Medlock Medical Practice in Failsworth, Manchester and supports small surgeries (including out-of-hours provision) across the Greater Manchester region.   

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