Can single-handed GP practices survive the new models of care?

There remains a nostalgic view in the UK of the rural GP who knows everybody’s name and ailments. These pillars of the community do more than treat patients, they act as high priests of the national religion that is the NHS. But does this reflect modern general practice and more importantly can it survive the latest transformation of the new models of care?

The number of single-handed GPs in England has nearly halved since 2002, according to 2013 figures by the BMJ, which is reflective of wider demographic shifts in population towards more urban areas and a wave of retiring baby boomer generation GPs. A wider recruitment crisis in general practice has forced the NHS and GP bodies to launch a concerted drive to attract new recruits to the profession. The consequence of this shortfall in GP numbers has meant that an estimated 500 practices are at risk of closure, on top of the hundreds that have recently closed despite rising demand. These have in large part been single-handed surgeries who have been unable to find a new generation of doctors wishing to pursue a career of solo practice.

There are obvious financial disadvantages to single-handed practice, including increased administrative costs, however traditionally patients and GPs balanced this with what was perceived as more personal levels of care. This is all changing. Through NHS England’s new models of care more services will be delivered in the community and away from acute settings. The Multi-specialty Community Provider model will effectively hand primary care a central role in delivering a wide range of services, meaning GPs will move from being gatekeepers to holistic providers of a multitude of treatments. Added to this are the increased capacity pressures from the Government’s plans for seven-day services, which makes the long-term suitability of single-handed practice seem even more uncertain.

Although the new care models are in their infancy, it’s clear to see this will increasingly be the future of primary care. Concentrating services and offering higher levels of clinical expertise has had great success, such as the network of major trauma centres that is the inspiration behind the new emergency and urgent care vanguards.

Admittedly this is a different beast compared to treating patients with a mild dose of the flu but would an elderly patient really prefer to be referred by their GP to a hospital for a physiotherapy and x-ray appointment, followed by a stop in the pharmacy on the way home and a follow up visit from a social care worker? Or would they rather be treated by a multi-disciplinary team all within the same centre as their GP, where they can pick up their medicines and have initial contact with a social care worker?

Of course our geography and population spread means there will always be a place for single-handed practices, with transformation coming quickest in urban areas. However when these options are weighed up it seems that the friendly service of the single-hander won’t be enough to survive in the era of integrated community care.