One GP shares their story about the personal and financial cost of a broken primary care model, highlighting the unique position of general practice in the NHS
In 2015, after 12 years as partner of a small GP practice I had helped build into a thriving hub of care, teaching, and research, I found myself signed off from work with burnout. I was able to access the local occupational health service and had intensive psychotherapy. However, I was told by all health advisors that I would need many months to recover – not just a couple of weeks as I had initially thought. It was the first crack in what would become a financial and systemic avalanche, completely taking over my life.
During this period I reflected on the situation and realised that things needed to change. I started conversations with a neighbouring practice about a potential merger. Our practice only had 3,500 patients in a town with four separate GP practices, so pooling resources seemed sensible. At that time, mergers were not that common, but our CCG was working with an NHS England consultant who was trying to create practice federations. I was encouraged to approach local practices to start working together. For the following year, I was arranging meetings with an aim to develop commonality between the practices.
I returned from sick leave a year later. Unfortunately, the financial stability of the practice had taken a hit. Some locum funding had been provided but it was not enough. Our involvement in primary care research had been significantly reduced due to my absence and we lost our F2 doctor because she had asked to be relocated as I was not available for teaching. I quickly realised that federating would not save us. We were struggling every month to pay the bills. I started to talk to the other practices about merging, and by early 2017 I had reached an agreement with one of them. The merger was due to happen that April but it was delayed as we had to appoint two separate solicitors (one for each party).
Another blow quickly followed. During a planned holiday I took, a booked locum did not turn up for work. Our nurse practitioner was concerned, and the practice manager contacted the CCG. The CCG arranged for the practice we were due to merge with to cover the NP on that day. We were told we were to have an additional CQC inspection as a direct result of this occurrence. I was then informed by the local medical school that because of the CQC visit, they were removing all student placements from us.
The CQC’s verdict was that our practice ‘required improvement’ citing a ‘lack of leadership.’ Bear in mind that the inspection happened a month before the merger, meaning we had our hands full with preparing for the inspection as well as trying to finalise logistics and finances for the new practice. For me, it was just another sign of an institution that has lost sight of the human effects of their judgements.
The merger finally happened in August 2017. I took a 24-hour retirement and worked as a locum for the merged practice – who leased the building that I still owned. However, the two-year process of trying to form a federation and seeking a merger had led to debts building up. When I had spoken to the bank, they verbally agreed to roll together debts (business overdraft which had increased to keep paying staff wages and bills) and mortgage into one loan. Yet, when the merger happened, they changed their minds; as the existing practice business had ceased, they forced me to find alternative funding.
Because GPs are independent contractors to the NHS, I was now personally responsible for all the accrued business debts. Over the next two years, my pension lump sum was spent trying to keep on top of the interest payments on the overdraft and mortgage. I was bullied by one of the bank’s managers and became suicidal as I could see no way out. I self-referred to the Practitioner Health service and was lucky enough to have free therapy for 18 months. I don’t know how I would have gotten through this time without it.
In 2019 the merged practice started to have financial problems so was going to merge with a third practice. It gave notice on renting the building. I had to sell the building leaving me with significant negative equity.
As I approach my 65th birthday, I am forced to keep working as a locum as I am still paying all the business debts. The ongoing funding crisis in primary care means I must travel further and further in order to find work. It is the classic locum story: I can only book shifts at short notice; will drive over an hour to get there; work a ten-hour day; go home again and repeat. There is no prospect of me actually being able to retire, despite having worked hard as an NHS GP since I was 27 years old; something that our secondary care colleagues do not have to consider as they carry no personal liability for NHS funding.
What happened to me should not have happened, and cannot continue to happen to other GPs. I was caught in a Catch 22; taking on extra workload to make up for the lack of funding to my practice. This led to burnout and time off sick which then quickly spiralled into rising debts and loss of income from the additional income streams. It was compounded by the CCG who did not step in to support us (instead requiring me to work even harder on developing a federation) and the CQC visit.
I look back on this time and feel angry about the situation that GPs are in. There needs to be funded support available for GPs who need to shut their practices down, merge or get taken over by companies. The legal obligations should be provided by the NHS – not solicitors with no understanding of primary care, which in my case led to delay and substantial additional costs.
I believe it is the past 10 years of chronic underfunding that has led to the situation we are in now. The Government needs to properly fund primary care. It needs to acknowledge that practices will close if there is no support. The model of primary care that we currently have is broken. No individual who has worked for the NHS their whole life should be at risk of having to personally fund debts incurred due to lack of funding.
The GP locum has asked to remain anonymous
How remarkably gritty and heroic of you to continue battling and providing care to your patients against the stupidity of successive Govts and despite the cost to your mental health! I hope you are able to see the positives in the care you gave. Though you may not feel it at the moment, there will be countless numbers of your former patients who will always remember you with fondness and love..the best of wishes going forwards.
So sorry to hear of this situation which I suspect is not uncommon and more reason for everyone to do constructive action . The nhs does not protect its workforce and there is little benefit working for it unless you manage to escape and retire with your pension intact . This brave drs story should be front page news not just for all of us who already know this recurrent story
Interesting. Many Pulse commentators are polarised in their view of “greedy partners” vs “lazy locums “, but this writer has bitter experience of both sides. He stared into the void of unlimited liability bankruptcy as a Partner, then the wild uncertainty of Locum life with work drying up.
So whether you are in the Partner or Locum bunker, remember the grass isn’t always greener on the other side. Ultimately we’re all in the same boat, tossed around by the tempest that is NHSE, CQC, hyena solicitors et al.
Sad story. Hats off to your courage.
Sad story indeed.Hats off to you for. Your courage.
Thank you for being so candid . There can be no doubt that the workload of general practice has increased dramatically in the last 10 -15yrs . With the independent contractor model to a sole provider there has been a tacit assumption that GPs shall just absorb increasing workload whilst not having the financial remuneration to adapt . The implications of chronic underfunding being that GPs have in effect been taking increasing pay cuts . The choice at present seems to be one of working increasingly hard just to stay afloat , with the genuine risk of burn out or reduce one’s hours and take an actual pay cut – but as we all know , work in effect just as hard as one had done previously. Whilst extremely sympathetic to our secondary care contracted colleagues, they clearly have a very clearly defined contract which does not involve trying to maintain a business
I’ve never been convinced that practice mergers result in any efficiency gains or provide stability. If a single handed GP is unable to cope, try to exit in whatever way is possible. Don’t try any heroics – no one will thank you.
I am so sorry to hear your story. This certainly gives the other side to the image of fat cat partners – the personal financial risk is real and present in partnership. The independent contractor model isn’t suitable going forward, I believe, as shown by your story. I wish you all the best in the future. I know how hard burnout and mental health can be to manage in a job like ours.
Wish there was option to like comments, joining those who understand your anguish and wish you well going forward. Shocking there’s no mechanism how a commissioner could step in to support properly, you are on your own. The practice that I joined long ago was also receiving “special support” NHSE and what was then PCT, later CCG.
I remember at the last meeting discussing “support” no longer needed, the CCG/NHSE people asked if there’s anything more that they could do “to help”- the look on their faces when they got a unanimous chorus of “just go away and stay away please and let us do our work” from our side.
What an absolute nightmare. We can expect a lot more stories of GP partners facing financial ruin. Those that avoid partnership face employment uncertainty. What a mess.
I am so sorry you have been treated so poorly by the NHS. It’s scandalous that an individual GP is having to financially support the NHS due to repeated government failures , and even more scandalous that no help or support is provided by the BMA/GPC/RCGP etc . While ministers claim taxpayers money for massive electricity bills for their 2nd homes/ subsidised lunches every day/ absurdly expensive folders/ redecorating their offices etc etc , GPs are subsiding the NHS from their own personal accounts and suffering with significant mental health problems as a result . Why is this not on the front of the Daily Mail ?
Many CCG’s and ICB members who hold the budget caused the demise of the corner shop model GP practice with an explosion of managerial tiers and their private health care companies.Conflict of interest gone mad.