If GP ran a Time magazine-style person of the year feature for 2014, the smart money would be on the Jubilee Street Practice duo at the heart of the east London Save Our Surgeries (SOS) campaign.
Since revealing in April that their large, popular, successful East End practice would close before the end of the year because of MPIG cuts, Dr Naomi Beer and managing partner Virginia Patania have helped propel the crisis in general practice funding to the top of the political and news agenda.
Jubilee Street Practice sits on the bustling Commercial Road, which runs through the heart of the East End - from the Docklands skyscrapers, through Limehouse, Shadwell and Stepney, and on towards the City. On its railings and outside GP practices across Tower Hamlets, the SOS banner declares: 'A threat to one is a threat to all.'
Despite Jubilee Street securing an 18-month reprieve on MPIG cuts after the campaign forced concessions from NHS England, Dr Beer and Ms Patania are not in the mood to wind down. Survival allows the practice to 'continue the fight', says Dr Beer, sitting in the practice manager's office. Ms Patania, held up at another meeting, is yet to arrive.
This part of London has a rich tradition of radicalism and medical politics is no exception. The ethos of collaboration between GPs has been vital to the SOS campaign, says Dr Beer.
One of the most deprived, ethnically diverse areas in the country, Tower Hamlets has achieved remarkable results through GPs' commitment to quality, collaboration and clinical leadership.
Dr Beer joined Jubilee Street as a registrar in 1989, attracted by the 'diverse population'. Improving and protecting care for deprived populations has provided a real sense of achievement, she says. Going public with the SOS campaign not only focused attention on the byzantine GP funding system, but also raised the profile of deprivation.
For many inner-city practices, MPIG was a correction for the additional workload created by deprivation, not reflected in the Carr-Hill global sum formula.
Funding reform
SOS has put reform of Carr-Hill back on the agenda, as recognised in the 2015/16 GP contract agreement.
Current policy, Dr Beer believes, is undermining good work in deprived areas like Tower Hamlets. 'It shouldn't be that boroughs like ours are first and most heavily penalised - the most vulnerable should be protected first.'
The practice partnership has given Dr Beer and Ms Patania reserved time to run the campaign. But seven months of late nights, weekend work, media interviews, top-level meetings and leading street protests have left their mark.
While Ms Patania says the campaign has more energy now than ever, Dr Beer admits she needs a break and worries about the effect the pressure could have on patient care. 'The partnership has said to me, step back a bit. That's what I have to do for my own sanity,' she says.
The past seven months have been 'a rollercoaster' of 'tremendous highs'. 'To be out on the streets with the patients - I've never had that feeling in my life before. That sense of unity across the community was fantastic,' she says. 'But everything has its cost. I think of my kids at home and the fact I'm not there.'
Joining us, Ms Patania describes how she chose to miss a family birthday trip to New York to meet health minister Lord Howe. 'On the night of my birthday, I was sat at this desk until 1am. And my boyfriend (now my ex-boyfriend) was at home waiting. It's come at massive personal cost.' But she is 'proud beyond words' of what they achieved.
The Italian-American practice manager describes how she moved to the UK, attracted by the ideals of the NHS, after working in counselling in the for-profit Italian health service.
She admits she was scared by Tower Hamlets when she first arrived for an interview. 'It was so different from everything I'd ever known.' Now she is a resident in the area.
Both partners, while full of praise for the support they have received from GPC chairman Dr Chaand Nagpaul and RCGP chairwoman Dr Maureen Baker, say the professional bodies meant to represent them were slow to react.
On the day their story went public, the phone was ringing off the hook. Between calls from politicians and the media, they tried to contact the BMA and the RCGP, but found it difficult to elicit a response.
Ms Patania adds: 'It was an act of bravery, with our necks on the line. The professional bodies weren't right behind us. It took time.'
Dr Beer contrasts the marked difference between the public response and the 'apparent inaction' of organisations representing GPs. Ms Patania is in no doubt the SOS campaign pushed the professional bodies into action.
Jubilee Street's practice manager is angered by the implementation in primary care of plans that suit most practices while disadvantaging those with deprived or atypical populations. 'Whether it's the CQC, MPIG, capitation, deprived areas pay. It's always "good enough" for the rest of the country, and deprived areas will take the slack,' she says.
At the meeting to launch SOS in May, some warned of fears that noisy practices could be silenced with a payoff while less organised ones would be left to rot.
Just 17 practices across England, including Jubilee Street, won short-term MPIG support, and the partners here debated whether to take the money. 'They wondered if it would be seen as some sort of betrayal,' says Dr Beer.
They decided nobody would benefit if they were forced to close. Local colleagues were pleased they'd won, she says, and agreed Jubilee Street should take the money.
From the beginning, Ms Patania called on affected practices to follow Jubilee Street and open their books to the public. But none did.
In some cases, she fears practices have been unable to protect themselves against cuts because of GPs' reluctance to reveal their income.
Ms Patania says 'several' practices have been denied support under a rule preventing bail-outs where GP partners earn more than £160,000.
Transparency
'In my opinion, it is not OK for someone to go home with £160k and not see a patient for two weeks,' she says. 'Transparency is vital.'
With general practice in the national spotlight and Jubilee Street's short-term future secure, where does SOS go now?
Pleas about imminent practice closures have given way to calls for reform of the global sum funding formula to reflect levels of deprivation. That may prove a more difficult rallying cry.
Then again, who could have predicted in April the success of this campaign, with hundreds on the streets in defence of general practice and politicians lining up to visit this east London surgery?
Ms Patania says: 'Having aired everything we could about the way general practice is run, I think there is much less potential for anyone to take refuge behind ignorance. So we are in a great building position.'
