Why our high-performing practice in a deprived area had to close

Last week, the East Barnwell Health Centre in Cambridge announced it was handing back its GMS contract after years of financial struggles. Here, the partners share their story with Pulse.

Last week we – the partners at East Barnwell Health Centre – announced we were handing back our GMS contract. It was a devastating decision made after ten years of increasing financial difficulties. It was by no means an easy choice and was the very last resort. 

These financial difficulties had come from three main areas. The first was an exponential rise in the charges to work out of our NHS Property Services owned building. The second was the inadequate local health funds in meeting the needs of our patients; the Carr-Hill formula does not recognise the needs of our younger, deprived population. And then of course, there is the national funding increases well below inflation, affecting all general practices. 

In 2021, we were facing a significant six figure bill from NHSPS which was substantially reduced after negotiation. But then from 2021 again the yearly charges resumed. We had to go to the ICB each year saying we could not afford to be working out of this building.

We have had many intensive meetings over the past two years with local NHS leaders, and had always believed that we would reach a solution; that the system would want us to find a solution so we could continue to meet the needs of our deprived population. We were motivated to adapt, expand and plan for the future. There was continued talk of support and help. Unfortunately, in spite of all these discussions, there was no solution proposed that could give us enough financial certainty going forward.

The past 12 months have been especially hard; the process was so drawn out and we could not get reliable reassurance about our ongoing situation. The questions looming over our funding restricted us in terms of what we could pay our staff, and consequently many of them moved on to other, more secure, practices which could pay more. We felt we could not invest with the risks of debt hanging over us. We are a close-knit team with a great ethos, but people need financial stability. In the last year, a third of our staff left, completely destabilising us. 

Cambridge is one of the country’s most unequal cities in terms of wealth; home to the very poor and the very rich. We are an interesting and unusual practice as we serve a deprived area within this wealthy city. We are the only ‘Deep End’ practice in Cambridge in the ICB; the other 17 ‘Deep End’ practices being in the Peterborough area. Like all GPs, we are expert generalists. We know our patient cohort and have decades of experience in managing our resources to provide high quality care despite the added pressures of caring for a deprived community. We are advocates for our patients whom we know as individuals, not as a statistic.

This is partly why we believed that the system would support us, and help us to keep going, because addressing health inequalities is one of the ICB’s priorities. We feel we exemplify that, in terms of what caring for a deprived community looks like in an unequal city.

Because of our particular model of general practice, which works on a patient list system, we have a deep understanding of our patient cohort, prioritising continuity of care. On any given day, we know the names of those sitting in our waiting room, and their families too – proper ‘cradle to grave’ care. It is this sort of holistic healthcare that allows us to manage acute and long-term conditions, along with the wider social issues that impact on those conditions. It also keeps patients out of hospital unless that is where they need to be. That is good general practice, and we are proud of our whole team who make this happen day in and day out.

We had discussions with the ICB who were keen for us to change our approach and embrace other models of practice. We were happy to engage with new models, but not just for the sake of it; what we do needs to be driven by evidence that this works for our patient cohort, and by the certainty that patient care will be maintained or improved. Our patients were already satisfied with our services and consistently gave us high ratings (we had the highest patient survey results in the whole of Cambridge in 2021, and in 2023 had patient satisfaction scores significantly higher than national and local scores). We are actively involved in innovative health improvement projects in our community, with the integrated neighbourhood team, PCN, local charities, faith groups and the schools, reaching out to those who might not otherwise prioritise their own health.

One size does not fit all. We continue to prioritise an inclusive service with a range of ways that our patients can contact us: telephone; walk-in; online; email; SMS; or post. We believe that forcing through a digitally-led service would disadvantage the very groups we are trying to reach, such as those with language challenges, poor digital literacy, the elderly, and the housebound – leading to an increase in health inequality.

Since making this announcement, we have had an overwhelming reaction from our patients and community who value their practice, and the care they and their families have received over the years. We have had some patients concerned about the future of their healthcare. We have been keen to reassure them that there will be an ongoing service here, even though we don’t know what that will look like at this point. We have been working with local groups, such as the community charity Abbey People, to ensure we give a consistent message to our community.

One of the most important things about this story is that we are not a failing practice in any sense of the word. Our health centre is a thriving and successful training and teaching practice, with high patient satisfaction embedded in our local community. We are immensely proud of the service we provide to a deprived population within a very wealthy city. And yet these compounding financial challenges have rendered us unable to continue, which for us is utterly tragic. 

Dr Rachel Harmer, Dr Amine Boualem, Dr Alisdair Macnair and Dr Katherine Mellanby are the partners at East Barnwell Health Centre