Dr Bulger and Archway
Keeping a choice and a
small surgery in Bovigdon
Dear Archway Patients,
that there would have been be a mailing to all the patients letting you
that I was handing over Archway Surgery. The PCT no longer
does mailings on retirements, so you have this instead.
Once I left, I could not send letters myself as that would have
infringed the data protection laws.
I was 14 years at Archway Surgery. In 2006 I recognised that
I would soon be running out of steam, and needed to hand over the practice to new blood.
closes small practices if it can and policy may be given extra impetus by Lord Darzi
as he outlines a new vision for the NHS. If I announced
my retirement well in advance it was likely that the PCT would have
dispersed the practice. Dacorum PCT managed to
do just that with two surgeries in Dacorum in recent years. The Health
Authority tried to close Archway Surgery in 1993, before I was
appointed, but Bovingdon village protested. Such protests may not work these
days as the local health service debts are so much larger.
Protests and a judicial review could not save Hemel Hospital's casualty.
My wife and I brought in Dr Omar
Rahim in October 2006. He is also a qualified surgeon, and
specialises in medical education. He is also that rare beast, for
a modern young GP, in wanting to run small practices. His model
is to run a group of practices as a confederation. This is
also in line with Lord Dazi's thinking. Recently together we have won
as preferreded bidder Pathfinder Practice and HMP The Mount to add to
Archway’s loyal staff
had some hints of what we were planning for 6 months; we were able to
tell the staff formally once we had all the legal agreements in place,
which was just over two months before we sold the building to Dr Rahim in
April 2006. I still held the contract for the surgery until I retired
from the NHS (for just 24 hours) in July this year. The contract for
Archway Surgery then moved over to Omar Rahim as smoothly as we
intended. Archway Surgery continues.
Letting the news out
early, before the sale, or of my one day retirement, may have allowed the
health authorites to insist on dispersing the list and closing the
surgery, or putting forward a commercial tender process. All has
worked out very well, but did come as a shock to the patients…. But at
least Archway Surgery is still in place. Also I did not want to let the
services run down.
Meanwhile Dr Omar Rahim
and I are involved in other projects. I remain on the PCT list as a GP
performer and reamin in full time work. I am involved in practice based commissioning which of
course has the future of Hemel Hospital high on the agenda.
Letting go of Archway’s
lovely patients and loyal staff has been very difficult.
I have not got more
recent figures, but in 2004 alone, the number of single-handed practices
collapsed by more than it fell in the previous decade, from 2,578 to
1,918. The overall number of practices fell by 291, the largest fall
since 1994. By single-handed we mean small practices with one contract
holder. Except in islands such as Sark, no practice is a
one-doctor practice. The closure trend is continuing as PCTs
disperse the patient lists, force mergers, and sometimes offer the
surgeries out to tender.
I first took
out planning permission, some years ago, to turn the surgery into flats
or into a general office, hoping we could build a new polyclinic
locally with other practices. At the time we had put in an offer
on a site to develop the clinic, very much along the lines now
suggested by Lord Darzi, but the PCT opposed us. Now that the PCT
would want us to develop such ideas, the site has gone (http://www.bulger.co.uk/planning.htm).
I could have made use of those permissions, closed the surgery, paid
redundancy costs and developed the current building! It would have
been more profitable than selling the building as a surgery - but would have hurt
too many people and dispersed an excellent healthcare team.
To defend small paractice in 2000 I had
formed the Dacorum Alliance of Small Practices, DASH, which still runs
to this day and help protects small practices in the locality by being
in a group. The defence
of small practice continues at
There is lots
of evidence that small practices provide better patient care, for
despite all the evidence to the contrary the Government believes small
Lord DARZI Review of NHS is here
POST YOUR VIEWS and GENERAL PRACTICE HERE
Dr Gerard Bulger FRCGP