In the early years of the 21st century most of the general practices in SWF were functioning normally. All the GPs who had a grain of common sense kept their heads down and got on with the job … with the occasional exception for extremely serious problems (such as the aforementioned disastrous changes that were made to antenatal care.)

I was the odd one out. Every time management made an avoidable cock-up, every time they wasted large sums of money on ridiculous projects (whilst stinting on patient care) I made sure it didn’t go unnoticed. You won’t be surprised to hear that this didn’t go down well with our lords and masters.

As previously mentioned, the primary care services in SWF grew up in a haphazard manner in the wake of the development because there had been no ‘master plan’ for the town. The NHS was content to let it muddle along. Rather late in the day, Essex County Council came up with the ‘concept’ of a central ‘health hub’ (so long as someone else paid for it) … and the residences for the elderly were, by and large, grouped round this. ECC forced all the town centre practices (dentistry and medical) to enter into a leasehold deal on the understanding that the leaseholders would be given first pickings when the leases were sold off. (It later ‘forgot’ about this.)

Strangely, the haphazard distribution of practices worked out rather well. Because the surgeries were conveniently located, most of the population could get to their GP surgery on foot if need be. The surgeries were ‘on the small side’ by today’s standards and were therefore able to offer a personal service.

With regard to Greenwood Surgery … as you know, we had been through a period when we had no traditional (paper) notes and no computer records and it took a VERY long time to resolve this problem. To add to our problems there was clearly a directive sent out (presumably by the Maldon & South Chelmsford PCT ) instructing hospital doctors and their secretaries not to reply to my referral letters. So I’d refer a patient who would later be seen by a hospital doctor – and the reply was then sent to the PCT-run practice. This meant that I was having to advise patients and provide them with, for example, their pre and post-operative care without knowing what was going on. Some of these cases were tricky – e.g. surgery for what was thought to be a large abdominal tumour. As we said in our ‘Quality Award’ poster we didn’t kill anyone whilst we were working with our metaphorical hands tied behind our back – but at times it was more by luck than judgment.

These basic problems slowly resolved over time but we were left with the problem of having a tiny budget with which to try to provide a service to our patients whilst the PCT continued to throw taxpayers money at the surgery it was running. By and large, the public has the weird idea that the NHS treats everybody equally. In SWF, however, we took a hypothetical situation to illustrate the dispariaties: let’s say identical twins shared a house, had identical jobs, an identical dietary regime, an identical exercise schedule – and had no significant health differences. The one that registered at the PCT run (‘New’) Surgery would have got a MUCH larger slice of the NHS pie than the identical twin who registered at Greenwood Surgery. In most other organisations this would be regarded as overt discrimination … but the NHS simply looks the other way. Our job was to do our best to minimize this disparity which meant taking a leaf out of the Book of Exodus and making bricks without straw.

To draw attention to this situation we decided to email all the other NHS Primary Care Trusts to see if they had any practices worse off than ours. In the NHS you can’t always ask a simple question and get a simple answer – but, even so, some PCTs were very helpful. The results we received underlined the fact that we were on the lowest rung when it came to funding

Meanwhile, another practice in the area was also in the PCT’s line of fire. Dr Ashley Pain had been running The Hoppit surgery in Danbury successfully for many years but a prolonged bout of ill health forced him to retire early. It was financially secure as, although it was a ‘single handed practice’, it was also a dispensing practice (i.e. providing medication for patients) … and such these had traditionally been described as ‘a license to print money’ (although that was changing.)

Harrison saw this as an opportunity to close it down. The patients were furious. They loved the fact that it was small and friendly, that they were on first name terms with the staff and that they could dispense with long explanations as everybody at the practice had known them for years. To top all that ,small practices seemed to get better results because of the continuity of care offered and scored as well if not better in the government’s ‘Quality and Outcomes’ framework.

The patients mounted a very successful campaign … and seemingly made the PCT climb down. The PCT advertised for a replacement GP to run the practice and found somebody who, on paper at least, looked good. Within just a few months the new GP closed ‘The Hoppit’ without the patients prior knowledge and consent and moved them all across to the bigger Danbury Surgery where they were seen in Portakabins. The patients were even more incensed than they had been in the first place – they felt betrayed by the new GP – but it was a done deal so there was nothing further they could do at that late stage to save their practice. It did not escape their notice that this was exactly what Harrison planned to do in the first place. All this was covered in the local press with additional mentions in Private Eye. I kept a ‘video diary’ of these events – and, despite it’s somewhat scrappy appearance, it serves as a record of the sort of shenanigans that went on ‘behind the scenes’ at that time.

Dr John Cormack