View from the ground, by Dr Satpal Shekhawat
General practice is facing a massive challenge from an ever-increasing workload and a reduction in workforce. More GPs are retiring at an earlier age, and fewer junior doctors are choosing to work in general practice. I work at a training practice in North Lincolnshire and we have observed a big change in junior doctors’ choice of specialisation; in the last few years none of our foundation year 2 doctors have wanted to become a GP.
A few years ago, a long-standing partner at the practice decided to retire. We were well aware of the challenges we would face replacing an experienced GP. At the same time, a partner at a neighbouring practice was retiring too, meaning the practice would face a recruitment challenge similar to our own. The two practices elected to work together and face this crisis jointly; as Churchill once said: ‘never let a good crisis go to waste’.
Once we had performed due diligence on the benefits and risks it became clear that merging the two rural practices would help achieve financial stability and provide a better work–life balance for all members of staff. However, despite being only 3 miles apart the practices were affiliated with different CCGs and under two different NHS England regions, making the process even more complex. Complexities led to delays, and delays to under-utilisation of the benefits of merger we identified at the outset.
We were very fortunate to recruit two GPs, one of whom was a previous trainee at our practice, confirming our theory that being involved in training GPs helps with recruitment. The new doctors joined the team knowing that merger was on the horizon, which would mean sharing of on-call shifts, support with home visits, and a shared mix of skills across both practices. Had the merger not been achieved in a timely fashion, we could have lost our newly appointed doctors; in the current climate GPs don’t have to look hard for lucrative job opportunities.
Our local medical committees (Humberside and Lincolnshire), and our local CCG (North Lincolnshire CCG) played a significant role in helping us during the merger process and maintained constant pressure on the organisations involved. Dr Arvind Madan and the Primary Care Unit at NHS England were also very supportive.
Following the merger, the benefits and successes became apparent.
The merger helped with both recruitment and retention of staff. Improved work–life balance for all staff members led to greater job satisfaction. Prior to the merger there were a total of five partners working at the two separate practices, whereas now we are a single organisation with two sites and seven GPs serving a population of over 10,000 patients.
We are now able to provide more teaching and training places for medical students, GP registrars, and foundation year 2 doctors. We strongly believe that being involved in teaching and training contributes towards the generation of new ideas, recruitment, and maintenance of good medical practice.
We are now providing more services, including musculoskeletal assessment and triage, and an intermediate care service alongside the basic general medical services. Our workforce is now able to deliver enhanced minor surgery services such as vasectomy and low-risk skin cancer surgery, as well as enhanced dermatology services (the two new recruits are GPwSIs in dermatology).
Patients have benefited from a wider choice of clinicians, more extended hours appointments, in-house availability of additional services such as minor surgery and physiotherapy, better continuity of care during staff holidays, and improved access due to an increase in the number of appointments offered.
The reduction in workload on individual GPs freed up time to take on new challenges such as bidding for new contracts, with the hope of providing financial stability and generating additional income for future development. Forward thinking is crucial to achieve a sustainable service, but that is only possible when we have time to plan ahead on top of the everyday workload.
It is too early to tell what the financial impact has been but we expect to see gains through a reduction in duplicate costs, a reduction in locum costs, and increased income from delivery of new services.
I wanted to share this story to spread hope, and show that good things are happening despite the negative stories in the press. Primary care and the NHS need positive stories in these difficult times and I hope that our success story will empower many others to develop better services, and provide better care for patients.
Merging is not the only answer to the challenges we face but it is certainly one possible solution to preparing ourselves for the future and making general practice even more resilient in these difficult times.
Dr Satpal Shekhawat
GP, North Lincolnshire