'Why controversial changes to rural GP services are bad news for my patients'

The Northern Echo: Dr Julian Fester Dr Julian Fester

THE British Medical Association is urging the Government to think twice about changing the funding formula for small and rural GP practices. North Yorkshire GP Dr Julian Fester explains why the changes will seriously undermine the services he will be able to provide to his patients.

EVERY day at my practice in Egton, a small two doctor practice on the North Yorkshire Moors, I see vulnerable patients reliant on the care we provide, but now I’m facing the stark reality that funding changes could threaten the service we offer and lead to poorer access for local patients.

From April this year, the government will phase out what’s called the minimum practice income guarantee (MPIG). This provides an important financial lifeline to many smaller GP practices, including mine, by guaranteeing a minimum level of funding that is not dependent on the number of patients the GP surgery has on its list.

For my practice, this means we’ll lose £50,000 a year in funding over the next seven years, which could have a huge impact on our ability to provide services such as minor surgery, minor injury care or home visits and could result in higher referral rates to hospitals.

Worryingly, I envisage a time where we will be unable to pay overtime, staff will be even more overworked, the clinical team will be overstretched, and regrettably patient access will be sacrificed. Our ability to replace retiring staff will be compromised and our ability to recruit GPs in the future might be more difficult.

My neighbouring practice is facing a similar fate, and the British Medical Association are now warning that a few hundred practices will lose significant levels of funding, with 98 practices identified by NHS England as being at risk of closure. While the government has not confirmed where these practices are or the extent of their financial difficulty, we do know that some are likely to be smaller GP practices, like mine, in rural communities.

The effect on these communities will be widely felt. Thousands of patients, many of whom who are vulnerable or suffering from long-term conditions, will really feel the loss of services.

General practice is facing real challenges as GPs cope with an ageing population and increased demand. This year GPs will carry out 340 million consultations. That number will continue to rise yet our funding it being cut. The Kings Fund, which works to improve healthcare in the UK, has suggested that general practice needs to merge into groups to manage the demand in healthcare in the future, but losing this funding will only make this less likely.

Similarly, NHS England believes that general practices should merge to create new federations, which will cover much larger areas, but by cutting this funding they have made neighbouring practices reluctant to merge as they struggle to survive. If NHS England wanted to foster a situation where our practices remain isolated and struggling, they couldn’t have engineered a better scenario.

I’m all too aware that these funding reductions are just weeks away from being applied and I am urging ministers to please get a grip on this problem.

My surgery and neighbouring surgery finished in the top ten in England for patient satisfaction in an NHS patient poll last year and how are we being rewarded? By being financially penalised while our patients are left uncertain as to what will happen.

I’m determined to keep working for my patients but now this funding announcement has been made and the reality of the cuts is apparent it is becoming increasingly difficult to continue providing the care they deserve.

We need to make sure that practices like mine aren’t forced to close and are still able to supply a robust and reliable service for patients.

Comments (1)

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7:46am Fri 21 Feb 14

detachedbystander says...

I do have a bit of sympathy for these smaller surgeries. But only a bit. As the BMA have been phenomenally successful in getting more money for other GPs and helping them get out of their 'out of hours' I guess the downsides will be that savings have to be made elsewhere to cover the finite costs of healthcare!

Julian needs to turn to his colleagues and to the BMA - as they have ultimately got General Practice to where it is now.
I do have a bit of sympathy for these smaller surgeries. But only a bit. As the BMA have been phenomenally successful in getting more money for other GPs and helping them get out of their 'out of hours' I guess the downsides will be that savings have to be made elsewhere to cover the finite costs of healthcare! Julian needs to turn to his colleagues and to the BMA - as they have ultimately got General Practice to where it is now. detachedbystander

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