I spent my last decade as a GP as a single handed practitioner – but very well supported by a bunch of excellent clinicians.

The evidence shows that small, consistent primary care practices improve patient outcomes – including lowering mortality rates, reducing hospitalizations, and raising patient satisfaction. Relational continuity builds trust, and knowledge of families over decades strengthen the bonds between patients and clinicians, especially for those with long-term or complex conditions. At every new consultation you start off from where you left off last time rather than beginning again from scratch.

There is also evidence that a better relationship results in fewer complaints – see: https://qualitysafety.bmj.com/content/early/2025/10/07/bmjqs-2025-018989 – and that was certainly our experience.

From the GP’s perspective, being single-handed makes administrative decisions quick and easy. You don’t have to have a practice meeting every time somebody wants to change the colour of the loo paper.

This raises the question: “If they are so good, why have such practices been gradually phased out by the NHS?” One reason is that they are vulnerable … they are always just a heartbeat away from closure. If the single handed GP drops off the perch, the NHS has to step in and keep the surgery ticking over. Another is that young doctors want a reasonable work/life balance – and you do find yourself burning the candle at both ends if the buck always stops with you.

But it was the Shipman Inquiry (2001–2005) that markedly accelerated the decline of single-handed general practices in the UK by highlighting the risks of clinical isolation, inadequate monitoring, and lack of peer review, leading to active policies by NHS managers to phase them out. While Harold Shipman committed his crimes while in both group and single-handed practices, his ability to operate undetected was, in part, facilitated by the lack of scrutiny allowed by working alone. Moreover, a multitude of obvious clues were missed … and the net result was that Shipman did great damage to general practice over and above the appalling harm he did to his patients.

So, whilst Greenwood Surgery was already in the cross hairs of the ‘NHS assassins’, there was a situation grumbling along in the background which was making life more difficult for all single handed GPs.

With respect to life after retirement, I did a little part time GP work – mainly helping out Dr Sai Sankar from Bicknacre who sadly developed pancreatic cancer. I charged him £1 a day on the basis that I was getting quite slow by this time (so it was a case of: “Johnny has got a new master, He shall have but a penny a day because he can’t work any faster”)… and also because I knew full well that having to pay a locum when you’re off sick (because in general practice you can’t just put up a notice saying: “The Doctor is unwell so please come back in a week or two’s time”) can be enough bankrupt you.

John and Sue on vacation

I also took an interest in local infrastructure. We desperately need more houses but Chelmsford City Council’s theory that you can keep plonking houses here there and everywhere without commensurately improving the roads, schools, medical facilities etc is clearly unworkable. I was collared by the late, great Alan Brunning at the public meeting held to discuss the Crouch Vale Medical Centre (CVMC) and, together with Mike Benning, we did our bit to spread the word.

As for CVMC itself, once it had got over the not inconsiderable teething difficulties, it appears to be reasonably popular with those who have their own transport. The new premises coped very well with the Covid vaccination campaign and this was well received locally. As predicted, though, the majority of the elderly and those with mobility issues are disadvantaged by having to travel much further than they used to for primary health care services. It’s a shame that all the services that were available within the town weren’t transferred to the new building as promised – and we had been hoping over the years for lots of additional services in any new facility that might transpire – most of which didn’t materialise – but, that said, it’s probably the best outcome a bunch of doctors with no expertise in such matters could have hoped to get from our dysfunctional local NHS management.

Time will tell if the building has been adequately ‘future proofed’ – but don’t hold you breathe.

Dr John Cormack