Patients fight for small practices

A PCT with an explicit policy not to replace single-handed practices is subject to a High Court challenge by patients.

Islington PCT closed Dr Mrigendra Nandi's Finsbury Park practice in north London shortly after he died on 23 January.

Two of the GP's 3,824 patients applied to the High Court for a judicial review citing a lack of public consultation. A decision about how the case proceeds could be made next month.

The case is likely to have far-reaching implications because NHS London is believed to be on the brink of announcing a plan for the capital that would see primary care dispensed from super- surgeries serving populations of 50,000 patients.

Dr Michael Taylor, chairman of the Small Practices Association (SPA), said many PCTs operate 'cryptic' list dispersal policies. However, Islington PCT's is explicit.

'The PCT does have a general policy of not replacing single-handed practices,' chief executive Rachel Tyndall told shadow health minister Dr Andrew Murrison in a letter last month.

She said that many small practices find it hard to provide services.

'Smaller practices often do not meet the required national standards and targets in key areas,' Ms Tyndall said.

She added that 80 per cent of single-handed GPs in Islington practise from premises that can not be made Disability Discrimination Act-compliant.

'When a single-handed GP retires, resigns, dies or has his contract withdrawn by the PCT the practice list immediately reverts back to the PCT,' its practice closure plan states.

'A list should always be dispersed if it can. This helps promote the PCT's wish of having few larger practices.'

LMC representatives at this month's conference condemned the policy of abolishing small and single-handed practices.

Dr Peter Swinyard, SPA secretary, told the conference that PCTs should 'cherish' their small practices.

'The future is for single-handed GPs to work together but not necessarily from the same building and not necessarily as a group practice,' he said.

An Islington PCT spokeswoman said that the majority of Dr Nandi's patients were happy with the new arrangements. The PCT received fewer than 20 letters from patients complaining about the practice closing.

Stuart Williamson, a partner at accountants Williamson West, advised that solo GPs who wanted their practice to continue after their retirement should appoint a successor before they left (GP, 11 May, 2007).

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