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What is happening to GP practices?
Published: 3rd May 2023
I have been involved in running GP practices in Surrey for 28 years and we are at a point of greatest challenge for primary care. But from challenge comes change and opportunity.

When I started in Dorking, there were a small number of GP partners looking after about 2000 patients each, mainly on a personal basis. These doctors were responsible for caring for their patients every hour of every day. Records were paper based and there was a physical appointment book. Over the intervening 28 years, GP practices have adapted to meet many challenges such as the now culture, changes to patients’ expectations; fragmentation of the supportive family, greater regulation and advances in technology and medication.

Are we losing the battle to keep changing and adapting? How far is burnout affecting our GP workforce?
It might help us to answer this question if we look at things through the eyes of the patients as well as the clinical staff.

The latest national GP Survey showed that patient satisfaction with GPs is on the decline, with 72% of patients in England reporting a good experience of their GP practice early in 2022, down from 83% the previous year. I was disheartened after reading a recent survey published on a GP news platform, Pulse Today, which revealed that a quarter of GP practices are at risk of closing due to workload pressures and a shortage of GPs.

My personal experience is very different. In 2022, patient satisfaction with the four Dorking practices I have worked with was 86%, 87%, 89% and 99% compared to the national average of 72% and a Surrey average of 75%. That includes Leith Hill Practice who received the highest patient satisfaction in Surrey.

Looking across DHC GP Federation, over 28 years, none of the GP partners have left their practice apart from those retiring, with the exception of one partner who relocated abroad. This surely demonstrates the strong connection between settled leadership, continuity of care and satisfied patients. A stable practice has a greater chance of coping with the unprecedented demands of the last couple of years and in managing the burden placed on individual clinicians.

But when foundations are not strong, the pressures can cause practices to struggle and some to break. Recent experience has made this very real for me.

Tough times for a GP practice

There are some circumstances where a GP practice is on the brink of failure because of a lack of permanent GPs and, in 2021, Pond Tail Surgery in Godstone was in that unfortunate situation. Their patient satisfaction had dropped from 72% to 50%. It fell to Surrey Heartlands Health & Care Partnership to choose someone to take over running Pond Tail and they appointed DHC.

It quickly became apparent that recruiting new GPs for Pond Tail would be an enormous challenge. We were in the middle of a national GP recruitment crisis; why would anyone choose to work in a dysfunctional practice without a supportive team of GP colleagues when there were better job offers around? Drawing upon expertise from across our Federation, we put together a team we referred to as the ‘Pond Tail Transformation Board’ to come up with a rescue plan.

Bringing about change in a practice that is not functioning is tougher than I expected. But the problems were not impossible. We took it step by step and worked hard, with other practices in our GP Federation providing generous support. We discovered that it was better to be open about the difficulties as it attracted people who wanted to make a real difference.

Looking ahead for GP practices

General practice is the cornerstone of the NHS and unless it functions well, the rest of the NHS will be overwhelmed. The Fuller Stocktake was a timely and helpful assessment of where we are and how we can solve some of the challenges. GP Federations need to support all practices, both the high performing and those that need help. Above all, we need to keep innovating and finding new ways to provide access to good quality care for our patients and create roles that clinicians want to commit to long term.

A new start for Pond Tail Surgery

Fast forward one year and I’m proud to say that Pond Tail Surgery really has transformed. With a flexible and innovative approach to recruiting GPs at different stages of their career and a focus on work-life balance for the new clinical staff, we now have a complete and motivated team. Most importantly the practice is robust enough to provide what the local community needs and has some exciting plans ahead. We know we have further improvements to make, but the foundations are in place.

“I am really pleased since your take over. I have always had lovely treatment and care, always able to get an appointment”
A Pond Tail Surgery Patient

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About me...

My name is Michael Arnaud and I am the CEO of DHC GP Federation. I have over 28 years of experience working alongside GPs and in this blog I discuss my thoughts on how we can bring healthcare services closer to patients’ homes.

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