Neil Bacon’s misunderstanding about how general practice works

The name Neil Bacon came up in Twitter yesterday. Roy Lilley thought at one point that he had written Jeremy Hunt’s speech at the Nuffield Trust summit. I looked him up and, lo and behold, he had just written an article about general practice and the need to abolish GP practice boundaries. So I had to stay up late and post a reply on his blog, his Telegraph article, and the Telegraph journalist’s article.

Neil Bacon is an entrepreneur (says so on his blog; the Biography page is so far empty so I don’t know what experience he has with primary care). He is selling a product, so obviously he will promote himself and his product.

This is what I posted on his blog piece:

I am sceptical about much of what you write. It’s all a bit too black and white.
I know quite a lot about the issue of GP practice boundaries and here you are on very shaky ground. I work in a practice which in one report was cited as the one with the highest satisfaction rating in Tower Hamlets. Yes, this was gratifying but we are in no position to accommodate patients wanting to join us: we are unable to register all the patients within our practice area who want to register with us so we are certainly not able to register those who live outside that area. In addition to this limitation, we also have over 20 years experience that tells us that looking after patients at a distance from the practice is full of problems and at times unsafe.The drive to de-regulate general practice by removing geographical boundaries will benefit some mobile relatively healthy patients (and Virgin Care) but it will actually create a systemic mess and harm many.If you are willing to have your views challenged, see the record, I think serious efforts should be made to improve the standard of general practice across the board so that everyone, wherever they live, has access to a ‘good enough’ GP practice, but that would require other strategies which nobody seems to be talking about.)

For the record, my comment to his Telegraph article was this:
I am a GP in Tower Hamlets. My practice gets high patient satisfaction ratings, and we score relatively highly on the various outcomes ratings. We would like to do better, but are struggling in difficult times.
I think the public needs to be warned about the illusion of choice, which Neil Bacon seems to subscribe to. There was an article in the local press saying that our practice had the highest satisfaction rating in Tower Hamlets
In Neil Bacon’s universe this would mean that patients from the lower rated practices could move to our’s. But there is a simple, very basic problem with this: we are currently working at full capacity, in fact exceeding our capacity. We are unable to register all those within our geographical area who wish to register with us. In fact, we recently had to shrink our practice area. So eliminating GP geographical areas will not suddenly allow you to register with the GP of your dreams.
There is another reason you need to be aware of: general practice in the UK is a community-based technology, it looks after communities which are local. The ecology of general practice is such that looking after patients who live at a distance introduces a large number of problems, and is at times unsafe.
New Labour launched the idea of abolishing GP practice areas, Andrew Lansley has always backed this idea. As a GP who is committed to providing good quality primary care to our patients it is a mad idea. It sounds like a good idea, a no-brainer, but when you look into it it just does not add up. I think the politicians are either remarkably stupid, or they are actively deceiving you. And journalists have been duped.
For anyone wanting to look into this further, see my blog
(Yes, I think every effort should be made so that all have access to a local ‘good enough’ GP practice, but this market driven model is, I think, not the answer. In fact, it will make things worse.)

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