We set about trying to persuade the powers that be to let us see patients ‘on the NHS again.
Meanwhile I carried on as normal. As I’d previously explained to the PCT, I continued to see my patients free of charge at the surgery. The reception was manned by volunteers and my wife, Sue, our longest serving practice nurse, worked long hours to provide a service. I also did some GP locum sessions in Burnham and Wickford to keep a roof over our heads. The system benefitted some patients – for example, if you paid for prescriptions and needed an antibiotic like amoxicillin, I could give you a non-NHS prescription and you’d get it for a fraction of the cost of an NHS prescription. But, in most respects, the majority of our patients, would have benefitted from being under the NHS umbrella.
The biggest disadvantage was that the PCT, which had been allowed to use the surgery on the basis that they’d leave it as they found it (as a fully working surgery) removed all the old ‘Lloyd George’ (written) records and desecrated our computer system (which I had been working on for decades). For example, since the early days, we’d been asking new patients to fill in questionnaires which formed the basis of a summary of their records. And because there was no centralised computerised recall for cervical smears (and some women had theirs elsewhere – for example if there was a scheme at their place of work) our records were sometimes incomplete. So we set up a ‘smear campaign’. This consisted of a dedicated phone line with an ‘ansaphone’ (there were no emails in those days) so that anyone and everyone could update us on their most recent smear. This meant that we could set up a computerised recall system so that nobody who wanted regular smears fell through the net. We also had nurses busily summarising records when new patients registered at the practice so that there was a reliable computerised record of all the dog-eared old cards, results and letters in their old buff-coloured ‘Lloyd George’ records. All this disappeared in a trice. We were left without any clinical records whatsoever. This is the medical equivalent of trying to drive a car without headlights on a foggy night whilst wearing sunglasses. It is highly dangerous. I can see that. You can see that. The PCT (which had doctors on hand to advise) could see that. But putting patients at risk was all part of the game. They are just seen as cannon fodder.
Harrison was also allowed to remove the filing cabinets on the strict understanding that they would be replaced. Needless to say he reneged on this promise. (My fault for not getting him to sign an agreement before they were removed.)
On 31st March 2004, Dr McGeachy sent a letter to the PCT asking it to refuse permission for me to carry on running Greenwood Surgery as an NHS practice. The letter reflected the PCT’s pretence that Greenwood Surgery would be a new surgery and I would be GP who was new to the area. (Rather confusingly, their view was that their surgery (which they called ‘The New Surgery’) was in fact the old surgery – and mine was, in their eyes, the new surgery. He said: “It particularly has to be recognised that Dr Cormack plans to retire in three years time, and to set up a new practice with all the resources that requires for a period of only three years, when the patient list would probably have to be absorbed by a neighbouring practice after that, would seem just a gross waste of time, energy and resources.”
He went on to say: “ The mere fact that a local MP gets involved and indulges in threatening behaviour towards the Chief Executive of the Primary Care Trust is no reason to give into such threats and the professional executive committee needs to act as the independent body that it is and turn down this application forthwith.
In summary a new practice being established in South Woodham Ferrers would have no benefit to the community. It would have a serious detriment to the local GP practices in that the resources committed to South Woodham Ferrers would be seriously diluted.
I hope you find these thoughts helpful.
Kind regards.”
Let’s look at how his prediction stood the test of time. I continued running Greenwood Surgery until a few days short of my 72nd birthday. I worked full time – including most evenings – and I regularly spent long periods of time at the practice during weekends. On the other hand, according to patients who reregistered with me, once the ‘New Surgery’ had been established, Dr McGeachy was usually only seen there for around one day a week, spending the rest of his time doing what he most enjoyed … working for the PCT. After spending a small fortune on Portakabins unnecessarily (you’ll recall I had offered to split Greenwood Surgery vertically or horizontally to accommodate the two practices – whichever they preferred -) they then moved into ‘no cost spared’ fully kitted our premises in Tylers Ride. We were originally told that the cost of the ‘new Surgery’ premises was £70,000 per annum. We were later told that the real cost was £105,000+ per annum and they’d signed a 20 year lease. This was greater than the cost of ALL the other practice premises in the town centre (which between them looked after several times as many patients). The plan to put a permanent 4th surgery in the town centre was approved on the basis of a ‘business plan’ (so called) supported by 53 people in a town with a population at that time of around 18,500.
When the ‘New Surgery’ was taken over by The Practice circa 2010 (without any form of public consultation and despite local GPs asking if they could run it) patients reported that he was no longer seen there. Finally, after £millions of taxpayers’ money had been lavished on it over the years, it was eventually euthanized in early 2017 (the patients being ‘absorbed by the neighbouring practices’) … although the 20 year lease for the premises continued to absorb £105,000+ per annum. Think what we could have achieved in terms of patient care with all that money. What an extraordinary waste of scarce resources!
Dr McGeachy, referring to a new practice, predicted that: ” It would have a serious detriment to the local GP practices in that the resources committed to South Woodham Ferrers would be seriously diluted.” He said it would be “a gross waste of time, energy and resources.” He was referring to my practice – Greenwood Surgery – which was already set up and running and continued to provide a good service to its patients on a shoestring. In fact it was his practice – the ‘New Surgery’ – that was gobbling up resources. I was told that, even before the lease was signed, it was reckoned that, at that time, the ‘New Surgery’ was responsible for around half of the PCT’s debt. I had no way of verifying that but, on the basis of the figures that were in the public domain, it sounded about right.
Harrison admitted to spending well over £300,000 on the New Surgery in the first 6 months of its operation – although a widely held opinion was that his estimates were, in fact, considerable underestimates. He threw money at it in the hope that it would flourish and eclipse Greenwood Surgery. As well as the expense of the portakabins we were told that the PCT was indulging in extravagances like flying locums in from Europe and putting them up in the Oakland Hotel.
Meanwhile we waited … and waited … and waited to see if our practice and our patients would be reinstated by the NHS. We decorated our windows with ‘Save our Surgery’ posters. When nothing happened we asked our patients to sign a petition asking if the surgery could reopen to NHS patients ASAP. Despite a 4 figure list of signatures Harrison pretended that they didn’t actually say they wanted to be patients at the surgery … so we asked them to sign photocopies of the normal application forms to join a NHS practice. Pretty well all of them did – so that shut him up temporarily – but we still had to wait for the wheels to turn. NHS bureaucracy is based on Kafka’s vision of a labyrinthine, illogical, and inescapable system of arbitrary power that traps individuals in a hopeless cycle of confusion and despair. That said, Mervyn Peake’s Barquentine is also a significant influence. Would the waiting ever end? Tune in for next week’s exciting episode.
Dr. John Cormack