“If our profession is to survive, we need to work differently.”

The following words have been taken from a recent speech written by Dr Carla Ingram, GP Partner at Marden Medical Practice, to explain the reasons why the practice has decided to be involved in the Shrewsbury Health and Wellbeing Hub programme, and why the proposal could be the solution to many of the problems faced by General Practice both locally and nationally.

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“I joined the practice almost 10 years ago, initially as a salaried GP and then as a partner a few years later. When I joined, our practice population was around 6,500. Since then, it has steadily increased to our current population of approximately 10,000. An increase of 1,000 since the time of writing of the Project Initiation Document (PID).

“My first job in General Practice was at a teaching practice in Huddersfield, 21 years ago when I was a junior doctor. I very quickly realised that General Practice was the career I wanted to pursue. It was a role that would enable me to work and live within a community of patients and their families, providing support and healthcare throughout their lives.

“I quickly submitted my application for the GP vocational training scheme and at interview I remember being asked to give a presentation on what I believed the most important qualities were required to be a good GP in the new millennium.

“The main focus of my presentation was on the need to be adaptable and willing to change with the ever-evolving needs of General Practice.

21 years later, I can honestly tell you that I had absolutely no idea what the scale of that change would look like.

“Meanwhile in Sutton Farm, Drs Bottomley and Mosehli had bought an old, detached house, converted it into a GP practice, and successfully established a very well-respected medical practice within the heart of the community. This is the premises from which Marden Medical Practice runs today.

“I completely understand reservations about the idea of changing the fundamental model of how General Practice has always been delivered. I signed up for the very role of ‘family doctor’ that many are concerned will become extinct if the proposed health and wellbeing hub goes ahead and we move out of this premises.

“But the job description of being a GP has changed beyond recognition since this practice was established, and never more so than over the last 5 years.

“Every day I encounter patients who are unhappy at the long waiting time for a routine GP appointment. But every day I also encounter at least one patient who is surprised that they are being offered a face-to-face appointment because they thought that GPs stopped seeing patients at the beginning of the pandemic and haven’t returned to offering these appointments since.

“At Marden, over the last 5 years there has been a 33% increase in the average number of face-to-face appointments we are providing each day. But there has also been a 65% increase in the demand for telephone and remote electronic consultations. Many patients have embraced the convenience that this style of consulting gives them, and so this is additional work we are doing over and above our face-to-face appointments.

“There has also been a substantial increase in the amount of work which has moved from secondary to primary care. We are now required to monitor increasing numbers of conditions and treatments that were previously monitored in the hospital.

“As a nation we are living longer and so there is an increase in the complexity of managing an older population with multiple conditions, many of whom are continuing to live in socially precarious circumstances in their own homes and requiring frequent input from other agencies.

“We are trying to provide this greater breadth and volume of care with dwindling numbers of GPs, because both recruitment and retention of doctors in General Practice is decreasing year on year.

“Sadly, this has been reflected at Marden only this year with the loss of an exceptional GP Partner, who has decided to take a complete, and possibly permanent, career break from General Practice altogether.

“This situation isn’t unique to Marden; these issues are being replicated across Shropshire and across the country as a whole.

“Which is why I, and a great many other GPs locally and nationally, believe we need to look at different models of how Primary Care and General Practice are provided.

“And this is why when the former Shropshire, Telford and Wrekin Clinical Commissioning Group (CCG) (now known as NHS Shropshire, Telford and Wrekin) advised us that they had been successful in a bid for funding for a pilot Health and Wellbeing Hub for Shrewsbury, Marden and five other local practices CHOSE to express an interest in the project.

“Not because this is being forced upon us, and certainly not because we have any intention of merging practices, but because we know that if our profession is to survive, we need to work differently.

“We need to be able to take on more additional clinicians such as Advanced Practitioners, First Contact Physios, Pharmacists and Social Prescribers to enable us to focus on delivering the healthcare that can only be provided by a GP.

“And we need to be able to employ more administrative, reception and secretarial staff to support all of this increase in clinical workload.

“But we can’t provide these services from our existing premises. We have no more clinical rooms for additional staff to work from. Clinicians providing telephone or e-consult clinics often have to work out of non-clinical rooms upstairs because of issues with capacity. This limits our ability to bring patients down to the surgery to be seen if we feel that a face-to-face consultation is needed.

“Our admin team are already working from cramped first and second floor rooms accessed via a narrow staircase. Recently, a member of our reception team wasn’t able to return to work following an operation because she couldn’t climb the stairs on her crutches, which resulted in one fewer person answering the phones at 8am to book appointments. Several members of the team were working in temperatures of up to 40 degrees in the heatwave this summer.

“Marden isn’t currently able to be an ‘equal opportunities employer’ because we have no capacity to provide disabled access for our staff and this building can’t be modified to provide this without losing another consulting room.

“A purpose-built health care facility would enable us to recruit and accommodate all the clinicians and support staff needed to meet the future health needs of our patients.

“It would enable us to co-habit and collaborate more easily with other GP practices and allied services, working together to improve not only the medical, but also the lifestyle and social factors which impact on a person’s wellbeing.

“And most importantly, it may help to entice newly-qualified doctors into applying and training for a career in General Practice and to prevent any more excellent GPs from leaving the profession in the middle of their career, because their workload no longer feels safe, manageable or sustainable,

“I want to remain a ‘family doctor’. I want to be able to continue to do the job I fell in love with and trained to do 21 years ago. But if the role of the ‘family doctor’ is to survive then we need to find a new way of working. And that’s what I believe the proposed Shrewsbury Health and Wellbeing Hub would offer.”

Dr Carla Ingram
GP Partner, Marden Medical Practice
October 2022