The GP Surgery

Highlighting best practice as a representative in The Parliamentary Review

The ability to listen and learn from one another has always been vital in parliament, in business and in most aspects of daily life. But at this particular moment in time, as national and global events continue to reiterate, it is uncommonly crucial that we forge new channels of communication and reinforce existing ones. The following article from The GP Surgery is an attempt to do just that. We would welcome your thoughts on this or any other Parliamentary Review article.

www.thegpsurgery.co.uk

BEST PRACTICE SPONSOR 2020

THE PARLIAMENTARY REVIEW

Highlighting best practice

32 | HUNTINGDON ROAD SURGERY

practices now use telephone triage to

allocate patients to the next available

healthcare professional. GPs are

now encouraged to work “at scale”,

covering bigger population groups.

Federations of practices now share

resources and provide a wider range of

services. Each of these developments

has positive features but has also

resulted in negative consequences.

The changes make it more difficult for

us to provide the relational continuity

wevalue.

Rising to these challenges

We can trace the history of the

Huntingdon Road Surgery to Dr

Fordyse in 1910. Since that time, most

GPs have worked at our surgery for

20 or 30 years, often caring for four

generations of a family. We can no

longer take continuity for granted and

must adapt to the changes in the NHS,

embedding relational continuity at

every stage.

Our receptionists and clerical and

pharmacy teams play a key role

in every patient’s contact with

the surgery, often supported by

knowledge of their context and

preferences. Our practice nurses each

have a specialist clinical area, allowing

them to provide continuity of care for

patients with chronic diseases such

as diabetes and asthma. By getting to

know their patients’ circumstances,

the nurses are able to provide an

individualised approach and achieve

optimal care.

Continuity could suffer when doctors

and nurses choose to work on a part-

time basis and so creative approaches

have been taken to provide flexible

working and a team approach while

maintaining continuity. Providing care

to a list of patients traditionally meant

that a GP was required to be available

every day. We have now adopted

a micro-team approach where two

doctors each work part-time to offer

care to a list of patients throughout

the week.

We have also created a new role to

support those doctors who hold a list.

We now employ two acute care GPs

who provide same-day appointments

when a patient’s own doctor is not

available. Not all doctors are ready to

take on the responsibilities involved in

caring for an individual list of patients

and others wish to follow a portfolio

career path with specialist roles beyond

the practice. The acute care GP role

offers an alternative career path within

a practice that values continuity.

We have been a GP training practice

since 1995 and doctors in GP

specialist training join us for six or 12

months. They have little experience

of continuity of care throughout

their hospital training and so during

their time with us, each trainee

shares the care of a group of patients

with complex chronic and palliative

conditions in order to gain experience

of holding sustained responsibility.

Many of our previous trainees now

work in nearby practices and we

aim to inspire the next generation of

GPs to understand the benefits and

rewards which result from providing

continuity of care.

Continuity of

care matters

for patients,

the GP team

and the wider

NHS

“

A team with a common

purpose

33THE GP SURGERY |

HEALTH & SOCIAL WORK

Founders Dr Sudip Dutta,

Claudine Cash and Dr Carel

Benedict

A convenient, pay-as-you-go

alternative to NHS provision

Founded by NHS GPs to offer private healthcare services in

Wimbledon and southwest London, The GP Surgery provides

an affordable alternative for patients where the NHS cannot

meet a patient’s requirements. Co-founder Claudine Cash tells

TheParliamentary Review

that the services The GP Surgery

provides are broad and varied – everything from standard GP

services through to blood tests, vaccinations and more.

The founding members of The GP Surgery have worked within the NHS for many

years and continue to do so today. We believe the NHS offers a fantastic service;

however, we were frustrated by the increasing pressures on primary care and the

effect this was having on our own NHS patients, including longer waiting times to

see a GP and restrictions to certain services.

The majority of patients had little say in their own care – non-NHS primary

care services were too expensive and not always available at convenient times.

We wanted to offer more choice for patients who wished to take control of

theirhealth.

Looking for an affordable alternative

We set out to create a service that could provide an alternative to the patient’s

own NHS GP service. When the NHS is not able to meet the patient’s requirements,

either in terms of speed and convenience of an appointment, or restrictions on the

types of tests and treatments available, they can choose to take control and pay a

reasonable fee for private treatment.

FACTS ABOUT

THE GP SURGERY

»Founders: Claudine Cash,

Dr Sudip Dutta and Dr Carel

Benedict

»Founded in 2014

»Located in Wimbledon

»Services: General practitioner

and other services

»No. of employees: 11

»www.thegpsurgery.co.uk

The GP Surgery

THE PARLIAMENTARY REVIEW

Highlighting best practice

THE PARLIAMENTARY REVIEW

Highlighting best practice

34 | THE GP SURGERY

We believe that for each person who

decides to pay for alternative care,

space is freed up within the NHS for

another patient who may not be

able to afford alternative provision.

This relieves worry and frustration for

patients and reduces the pressure on

local NHS services.

Bridging the gap

The first challenge we faced was

how to bridge the gap between

NHS provision and existing private

provision, only attractive to people

with considerable disposable income.

The average cost of a private GP

consultation in London was around

£100 and often required an additional

registration fee.

We wanted to make private care

less of a luxury and more affordable

for more people but did not want

to compromise on quality for the

sake of cost. We ruled out the online

consultation as we believe in order to

provide comprehensive, personalised,

compassionate and safe care, face-to-

face interaction is required.

Co-location

Commercial rents in London are high

and it is not easy to acquire premises

with required planning consents. We

decided that the ideal solution would

be to co-locate with a pharmacy. This

would provide convenience to patients,

who could see a GP and pick up

prescriptions in the same location. The

decision would also reduce potential

property overheads, allowing us to

spend any savings on enhancing the

service itself.

We found a space within an existing

pharmacy store, which we could

sublet. Although this offered a small

number of consulting rooms, through

opening for extended hours we were

able to rotate services, making sure

that each room is utilised to the full,

with no space wasted.

We worked through the CQC

registration process and obtained the

relevant planning permission from the

local council. On December 1, 2014

The GP Surgery opened its doors,

offering services in Wimbledon, seven

days a week, including evenings

andweekends.

Allowing patients to inform

provision

Over the course of our first year we

gathered patient feedback and revised

our business model to meet their

preferences, altering opening times

and adding services that they were

struggling to access elsewhere.

As well as seven GPs and four nurses

providing services such as general

consultations, blood tests, vaccinations

and sexual health, we also host many

other clinicians. These include a plastic

surgeon who provides skin surgery,

a consultant radiologist who offers

cortisone joint injections and an

ultrasonography team offering a range

of ultrasound scans. We continue

Providing services in

response to patient

feedback

We believe

that for each

person who

decides to pay

for alternative

care, space is

freed up

within the NHS

for another

patient who

may not be

able to afford

alternative

provision

“

BEST PRACTICE SPONSOR 2020

THE PARLIAMENTARY REVIEW

Highlighting best practice

34 | THE GP SURGERY

We believe that for each person who

decides to pay for alternative care,

space is freed up within the NHS for

another patient who may not be

able to afford alternative provision.

This relieves worry and frustration for

patients and reduces the pressure on

local NHS services.

Bridging the gap

The first challenge we faced was

how to bridge the gap between

NHS provision and existing private

provision, only attractive to people

with considerable disposable income.

The average cost of a private GP

consultation in London was around

£100 and often required an additional

registration fee.

We wanted to make private care

less of a luxury and more affordable

for more people but did not want

to compromise on quality for the

sake of cost. We ruled out the online

consultation as we believe in order to

provide comprehensive, personalised,

compassionate and safe care, face-to-

face interaction is required.

Co-location

Commercial rents in London are high

and it is not easy to acquire premises

with required planning consents. We

decided that the ideal solution would

be to co-locate with a pharmacy. This

would provide convenience to patients,

who could see a GP and pick up

prescriptions in the same location. The

decision would also reduce potential

property overheads, allowing us to

spend any savings on enhancing the

service itself.

We found a space within an existing

pharmacy store, which we could

sublet. Although this offered a small

number of consulting rooms, through

opening for extended hours we were

able to rotate services, making sure

that each room is utilised to the full,

with no space wasted.

We worked through the CQC

registration process and obtained the

relevant planning permission from the

local council. On December 1, 2014

The GP Surgery opened its doors,

offering services in Wimbledon, seven

days a week, including evenings

andweekends.

Allowing patients to inform

provision

Over the course of our first year we

gathered patient feedback and revised

our business model to meet their

preferences, altering opening times

and adding services that they were

struggling to access elsewhere.

As well as seven GPs and four nurses

providing services such as general

consultations, blood tests, vaccinations

and sexual health, we also host many

other clinicians. These include a plastic

surgeon who provides skin surgery,

a consultant radiologist who offers

cortisone joint injections and an

ultrasonography team offering a range

of ultrasound scans. We continue

Providing services in

response to patient

feedback

We believe

that for each

person who

decides to pay

for alternative

care, space is

freed up

within the NHS

for another

patient who

may not be

able to afford

alternative

provision

“

35THE GP SURGERY |

HEALTH & SOCIAL WORK

to listen to patient feedback and try

to fill the gap in available provision

wherever we can, while keeping prices

as affordable as possible.

Overcoming obstacles

We have faced frustration along the

way, including the need to apply our

own interpretation to some often

unclear regulatory guidelines. This can

create uncertainty as to the best course

of action to take when planningservices.

A further challenge occurred in late

2018 when Google changed their

algorithms, resulting in a worrying

lack of visibility of our website, crucial

to attracting patients to the service.

After a major website redesign and

considerable web-based advertising

at additional costs, we managed to

ensure that people could once again

see our services when searching online.

It has also been a turbulent time

for staffing with the uncertainty

over Brexit impacting on some of

our non-UK national reception and

administration staff whose future in

the UK seems uncertain.

Recent high increases in GP indemnity

costs have also had to be absorbed

while trying to maintain affordability

for patients.

In spite of these challenges, however,

The GP Surgery in Wimbledon is now

operating at full capacity, with over

23,000 patients having used our

services in the past five years and this

figure rising daily.

The future

We are now in an expansion

phase, having been cautious not

to overextend ourselves until we

were certain that we had our model

absolutely right. Our second site

has been secured and we hope to

open in early 2020, with further sites

anticipated later in the year.

Our ambition is to offer top-quality

and affordable services to more

patients who are happy and able to

seek an alternative to the NHS in order

to have control over what, where

and when they receive the care that

theyrequire.

The GP Surgery

in Wimbledon is

now operating

at full capacity,

with over

23,000 patients

having used our

services in the

past five years

and this figure

rising daily

“

Healthcare available

at times convenient to

patients

www.thegpsurgery.co.uk

This article was sponsored by The GP Surgery. The Parliamentary Review is wholly funded by the representatives who write for it.