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NHS Guidance pdf Commissioning Web Site
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Dr Bulger and Archway Surgery
Keeping a choice and a small surgery in Bovigdon
Dear Archway Patients,
I expected 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.
The NHS 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 the portfolio.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 http://www.smallpractices.org.uk/
There is lots of evidence that small practices provide better patient care, for example http://news.bbc.co.uk/1/hi/health/2753571.stm But despite all the evidence to the contrary the Government believes small is BAD.
Lord DARZI Review of NHS is here
POST YOUR VIEWS and GENERAL PRACTICE HERE
Yours sincerely,
Dr Gerard Bulger FRCGP
Contact Gerard Bulger