Written evidence submitted by Chawton Park Surgery (FGP0076)

 

There are limits to the extent that “patients’ preferred method of access” can or should be accommodated.  Contrary to the sanctimony of the Health Secretary, we were seeing TOO MANY people face-to-face before the pandemic.  Mrs Miggins could book herself in without the infrastructure of triage, and push the waiting list out to many weeks. The pandemic, like wartime, brings on technology,  and access via phone and econsult in the first instance  -  just as a portal of entry  -  now means I can see you much faster;  and we are all taxpayers. We are working hard at small scale to get a very devoted bunch of patients just to relax about these technologies. Then I’ll phone them back anyway, plus-minus get them down same day.

 

The main challenges to primary care have been and remain the increasing obsession over the years with working at scale, with networks and larger groupings,  to the detriment of the practice partnership model, of stakeholding, continuity,  and the rewards thereof. In a recent building expansion bid, the Powers That Be took about forty minutes of my gentle reiteration that I wasn’t after a magic pot of money / capital,  and that the building expansion might be funded how the rest of this 3-million pound building is  -  how GPs’ front rooms have been reimbursed since 1947  -  by notional rent.  They simply couldn’t think in terms of the single practice, but only of the latest gizmo funding stream at supra-practice level.  I think I convinced them in the end.

 

We are tired, but thrive  -  and have fun -  with an emphasis on the partnership model,  all the while seeing practices around us go under or be privatised because they have merged, or tried to buy salaried non-partners on the cheap (who then leave and the few remaining partners’ workload becomes unsustainable), or have gone for the next financial wheeze and the next,  or the ‘low-hanging fruit’ and forgot why they were there in the first place.

 

As to working with other groups, a network-funded proactive care nurse (sounding awfully lot like an old district nurse) has been a boon but likes working HERE and we may employ her in the practice.  She has even asked about becoming a partner (as our wonderful practice manager now is).  The rest of the district nurses, housed by a separate Trust, faced a summary move to offices in a field twenty minutes up the road and leapt at the chance to move into this building;  the cohesiveness of our working will be immeasurably improved.  And even their fun, and sense of belonging.

 

A great little, very acute physio team here at the Community Hospital were privatised from under our noses early in the pandemic by a CCG (‘your organisation’  -  remember Lansley?) to Circle Integrated Care in Reading,  who as the lowest bidder patently don’t have the capacity and the service is a disaster. The two network physios (who used to be part of that team) really like their sessions here,  and I nip next door and inject a knee or two and they press on,  sharing the same coffee room. Maybe one or two might be taken into the partnership  -  good working relationships.

 

The ancient Greeks had no word for blue and so had a wine-coloured sky;  if it can’t be named or conceived of,  it won’t exist. The traditional partnership model would indeed be sustainable if people looked to the rump of happy,  longterm and (so far) thriving partnerships. Jackie (fellow partner here from about my time) and I recently calculated that the latest CCG mergers were the thirteenth reiteration of management structures in our time,  the latest merger looking really quite a lot like a Health Authority from the 1970s. Our lovely ex senior partner Terry used to look at the next political football and the next and sigh ‘but we’re doing it already’ and we Latinised it into our practice motto on the wall:  hoc iam facimus

 

We still are.

 

Dec 2021