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Camden New Journal - By DR STEPHEN GRAHAM
Published: 27 March 2008

Dr Stephen Graham
‘We can provide real care at a realistic price’

‘The core values that underpin general practice in this country are under threat’

I’VE been a GP in Camden for nearly 20 years. I primarily work at Parliament Hill Surgery near Kentish Town, which I run with my partner Dr Claire Chalmers-Watson.
It is a small practice with some 4,500 patients. We are one of the highest performing practices in Camden as judged by PCT markers.
We believe passionately in the personal relationship which we, especially as a small local practice, are able to enjoy with our patients. I have had the privilege of seeing many of my patients grow from childhood to adulthood and, at the other end of the spectrum, from their working life through to retirement.
Unfortunately, this relationship and the core values that underpin general practice in this country are under threat.
At present, general practice attracts many of the best doctors. These are doctors who are motivated by getting to know their patients and being able to influence how care is provided.
These doctors do not want to work for large impersonal organisation such as polyclinics, or for private multinational providers whose primary aim is to make a profit for their shareholders.
In addition, small practices are under threat. They are deemed to be inefficient and unable to offer a wide range of services. That is why, in order to try and secure our future, we formed a federation of three small practices between ourselves at Parliament Hill Surgery, Dr Halvorsen and Dr Moghissi at the Holborn Medical Centre and Dr Chuah, who was running the Brunswick Medical Centre temporarily after the retirement of Dr Skolar whose father originally started the practice.
We put forward a proposal for the practices to work together in a way that retains the unique individuality, friendliness and personal touch that patients value from a small practice but with the benefits of a wide range of services delivered by the sharing of resources across the federation.
This federation won the bid for the temporary contract which has been running since June 2007 and is due to end next Monday. Unfortunately Dr Chuah was unable to continue at the practice and he has been replaced by three excellent doctors that we have mentored and supported during that time.
In October 2007 we submitted our proposal to continue running the Brunswick Medical Centre on a permanent basis. This proposal was informed by our direct knowledge of running the practice since June and also by the partners’ combined experience of over 50 years of delivering medical care to the patients of Camden.
We entered that process in the belief that the bids would be judged fairly and that the PCT would follow its published selection process. Whilst I don’t believe that the PCT deliberately conspired to pervert the process, it was the PCT’s first attempt at this kind of tendering process and mistakes were made.
Unfortunately this has meant that, despite our proposal being scored highest at an average of 80 per cent, UnitedHealth – whose bid was significantly poorer at 68 per cent – was chosen on grounds of value for money, with a bid of £74 per patient compared to our bid of £100 per patient.
The costs of running the infrastructure of a practice are essentially fixed. The key variable cost is the workforce.
The workforce necessary to deliver the demanding contract specification set by the PCT cannot be provided at £74 per patient.
Why should the patients of the Brunswick Medical Centre be singled out to receive some of the lowest funding levels per patient in Camden? The answer is they probably are not because UnitedHealth will be happy to run this practice as a loss leader in order to get its foot in the door of running NHS General Practice.
Unfortunately, we as GPs do not have access to the billions of dollars available to UnitedHealth and therefore had to put in a realistic price.
– This is an extract from the speech Dr Graham delivered to campaigners during Tuesday’s meeting at the Town Hall.

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