My next email to Jeremy Hunt on the #gpboundaryscam


Dear Jeremy Hunt,

I have received a reply from the Department of Health following my email to you on 14/6/15.

To remind you, my email raised the concern that there was no cover in place in London (and other parts of England) for patients taking up the offer to register with GP practices at a distance from where they live. Should they fall sick at home, there is no local primary care cover for them. They have to go to a local walk in centre or to their nearest accident and emergency department. This is for the in hours part of the week. Out of hours, they are covered by whatever service is available where they live.

This policy as a whole is fraught with problems, and I have written to you and others about these. The particular problem of lack of local GP cover for these patients is one I had not anticipated.

The reply from the Department of Health contains an untruth, an error of fact: “All NHS England regional teams have arrangements in place to ensure that those patients are able to access services should they require primary medical care whilst at home.

Those arrangements vary across the country.  Many regions commission the national enhanced service model, while some use the local out-of-hours services, and others commission a range of services.  However, all have ensured that, should the patients registered in their area require care, they are able to provide it.”

This is, to put it into plain English, crap, 100% crap. In London (and other parts of the country) there are NO arrangements in place to “ensure that those patients are able to access services should they require primary care whilst at home.” There are services in place to cover patients registered locally, but not those not registered locally, which is the case of those registered at a practice at a distance from their home.

The Department of Health official points out that 14,000 people in England have registered with out of area practices and that there have been no complaints. This represents 0.026% of the population which is very small numbers. The problems will arise for patients when they are unwell.

I have tried to complain to the Parliamentary Health Ombudsman; I have been told that it is not legal for them to look into this sort of problem and they have advised I contact NHS England. This I have done several months ago, and they have still not replied. The Ombudsman advised I contact the CQC; various people I have spoken to at the CQC have felt out of their depth and do not want to handle it.

So we have a strange situation: there is a Government policy riddled with problems and in some circumstances unsafe but the system is structured in such a way that someone like myself from the frontline who raises quite basic, objective concerns is fobbed off in a Kafkaesque way. And then you wonder why GPs are emigrating.


Best wishes,


The Tredegar Practice
35 St Stephens Road
E3 5JD

“For a successful technology, reality must take precedence over public relations, for nature cannot be fooled.”  Richard Feynman, Physicist

There is no cover in London for out of area patients; how many other areas affected?





Warning to GPs & public about ‘Choose Your GP Practice’ scheme


The ‘Choose Your GP Practice’ scheme started on 5 January 2015. Under this scheme GP practices can register patients who do not live in their practice area. This is voluntary. The practice does not have to visit or care for these patients if they are sick at home and unable to get to the practice. According to the scheme, NHS England area teams will have put in place cover for these patients local to where they live for in hours urgent care.

In London, this does not seem to have happened. I spoke to 3 separate area NHS 111 teams and none of them were aware of the new scheme and none of them had a list of local GPs that would offer patients not registered locally. Their advice to patients in this situation is to go to a walk in centre or A+E. One of the supervisors said that if someone required an urgent home visit that they would call SOS doctors (a provider I have not heard of) and send them; they would have to pay for this service and they would charge the registered GP practice for this call. This did not seem likely, but it gives you the idea of the shambles we are in.

So if you are thinking of registering out of area patients, make sure they check if there is robust cover where they live, otherwise they will be left without primary care cover if they are ill and unable to access their registered practice.

See my opinion piece in Pulse.

See my video on this issue.

My introductory video on GP practice boundaries



80% of GP practices have one or more GPs suffering from Burnout


Andrew McHugh - Cherwell

Are you in despair for your future in General Practice – Final Report

In 2013, my practice advertised in the British Medical Journal, on two occasions, for a salaried GP with a view to partnership. This recruitment process resulted in only one credible candidate. At the time my surgery constructed an unconvincing narrative to explain our failure to recruit. During the year and early in 2014 we spoke with other surgeries in Oxfordshire and realised that we were not alone in being unable to recruit.

In April 2014 we ran a Survey Monkey questionnaire across GP practices in Oxfordshire. We received 167 replies in the space of a few days. This convinced us that there was a serious situation developing that could affect the future of General Practice. At the end of June 2014, at the request of a group of concerned GPs from North and North-East Oxfordshire the survey was…

View original post 838 more words

Tweet to Dr Sarah Wollaston, new Chair of Health Select Committee


Save Our GP Surgeries March Route July 5th 2014


March Route July 5


March Route July 5 a







Are GPs too lazy?


Two evenings ago, when I arrived home at 9pm for supper, my daughter, with a smile on her face, pointed me to the front cover of the current edition of The Week which asks Are GPs too lazy?’ She and her brother were always clear that they were not going to study medicine because they thought their parents, both GPs, worked too hard.

I wish journalists were more precise in their use of language. Why not ask, ‘Are some GPs too lazy?’ Why not find out what it is like for a significant number of GPs?

It is 9am on Sunday morning and I am at work, trying to catch up on my mountain of work. I arrive at work at 7am weekdays, and leave on an early night at 8, other nights at 9. And I will not have finished. I work at least one day of every weekend. It is unsustainable. I will be 60 years old in 3 weeks. In our practice we try to provide good quality, evidence-based medicine in a respectful and compassionate way. But it is a real struggle. I would like to work on until I am 65. I have a sense of commitment to our population, I am aware that the role that I play is an important one.

Ultimately, there is a real problem with capacity. The demand outstrips the resources.

We have 10 minute consultations. Many of our patients require 15 minutes, some longer. The job I do now is far more complex than it was 15 years ago, it requires more time.

Yes, it is a bit of a slog for some to get appointments at times that suit their schedules. I am not happy about that.

The politicians and Department of Health set us Herculean tasks which undermine quality.

Politicians, journalists, citizens: be careful, if you blame us and ‘shame’ us in a mindless way, a significant number of us will just give up, and leave you to get on with it on your own. Let Jeremy Hunt do it; let the Department of Health spokesperson do it; let Janet Street-Porter do it.

If you want a better system, let people who understand the complexity of primary care design it and cost it. Then resource it.

NHS Choices Website: my attempt to leave a comment regarding ‘Patient Choice Scheme’


A few weeks ago, I found the NHS Choices page promoting the ‘Patient Choice Scheme’. I registered and left this comment:

I am a GP in Tower Hamlets, one of the sites chosen for this pilot. What the Department of Health is not telling you is that two of the 6 sites above (Tower Hamlets and City and Hackney) have refused to take part in this pilot in order to protect the local health economy and services to our local population.

The proposed policy to abolish GP practice boundaries is deeply flawed, but the Department will not tell you that.

For more information, see


I checked this afternoon, and noticed that my comment (which I thought had been accepted on 31/3/13) was missing. There are in fact no comments to this page. So I have tried again. My Comment on Choices website but somehow feel that it won’t be visible, ever, to anyone else.

My email to


Dear Sir/Madam,

I am a GP. I am not a member of a political party. I work hard trying to provide a good service to our patients in Tower Hamlets.

I am grateful when policy makers come up with policies which support us in doing a good, sustainable job.

Unfortunately, in recent years this has not been the case. All too often, the politicians and DH have introduced policies and directives which make our job harder.

The Health and Social Care Bill is a prime example. It is difficult not to feel contempt for the political class and for Parliament. Politicians do not seem to understand how the various parts of the NHS work. They have misled each other to pass this Bill.

The NHS Competition regulations (SI 257) made under the Health & Social Care Act 2012 are a case in point. Assurances were made to CCGs (of which I am a member) that we would not be compelled to put out all services to competitive tendering, and now we see that these regulations contradict these assurances. This is an act of deception.

Please ensure that this is debated fully, preferably in both Houses.

Best wishes,


The Tredegar Practice
35 St Stephens Road
E3 5JD