The GP Surgery

A Message from Lord Pickles and Lord Blunkett, followed by The GP Surgery's best practice article

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.

Blunkett signature Rt Hon The Lord David Blunkett
Pickles signature Rt Hon The Lord Eric Pickles

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. The publication in which this article originally appeared contained the following foreword from Rt Hon Elizabeth Truss.

Rt Hon Elizabeth Truss's Foreword For The Parliamentary Review

By Rt Hon Elizabeth Truss

Even by the standards of the day –this has been one of the most exciting and unpredictable years in British politics.

The leadership election we’ve just seen marks a huge moment in our country’s history. This government is taking a decisive new direction, embracing the opportunities of Brexit and preparing our country to flourish outside the EU.

As international trade secretary, I’ll be driving forward work on the free trade agreements that are going to be a priority for the government. Free trade isn’t just an abstract concept bandied around by technocrats. It is crucial for a strong economy and for the ability of families to make ends meet. Free trade benefits people in every part of our country, as British firms export to new markets and people doing the weekly shop have access to a wider choice of goods at lower prices.

The essence of free trade is in the title: freedom. It’s about giving people the power to exchange their goods without heavy government taxation or interference. Commerce and free exchange are the engine room of prosperity and social mobility. I’m determined to tackle the forces who want to hold that back.

One of my priorities is agreeing an exciting new free trade deal with the US, building on the great relationship between our two countries and the Prime Minister and US President. But I’ll also be talking to other partners including New Zealand, Australia and fast-growing Asian markets.

And with the EU too, we want a friendly and constructive relationship, as constitutional equals, and as friends and partners in facing the challenges that lie ahead – a relationship based on a deep free trade agreement. Our country produces some of the world’s most successful exports, and the opportunity to bring these to the rest of the world should make us all excited about the future. It is this excitement, optimism and ambition which I believe will come to define this government.

For too long now, we have been told Britain isn’t big or important enough to survive outside the EU – that we have to accept a deal that reflects our reduced circumstances. I say that’s rubbish. With the right policies in place, we can be the most competitive, free-thinking, prosperous nation on Earth exporting to the world and leading in new developments like AI. To do that, we’ll give the brilliant next generation of entrepreneurs the tools they need to succeed. Since 2015, there has been a staggering 85 per cent rise in the number of businesses set up by 18 to 24 year olds – twice the level set up by the same age group in France and Germany. We’ll help them flourish by championing enterprise, cutting taxes and making regulation flexible and responsive to their needs.

As we do that, we’ll level up and unite all parts of the UK with great transport links, fibre broadband in every home and proper school funding, so everyone shares in our country’s success.

2019 has been the year of brewing economic and political revolution. 2020 will be the year when a revitalised Conservative government turbo charges the economy, boosts prospects for people across the country, and catapults Britain back to the forefront of the world stage.



Rt Hon Elizabeth Truss
Secretary of State for International Development