The Parish Magazine April 2022

HEALTH — 1
Dr Simon Ruffle writes . . . Big Yellow Taxi
I’m breaking from my monthly
themed article, I apologise. The song
mentioned in the title written in the
60’s is very pertinent to today’s world.
Taking areas of nature, sustainability
and loved institutions and turning
them derelict — ‘they paved paradise
and put up a parking lot.’
I write as a GP who has had the
privilege of working for the people of
Twyford and the surrounding areas,
including Charvil and Sonning, for
the last 25 years — from a trainee
at the practice to a contract holding
partner.
I am not a Berkshire native and,
honestly, had never expected to live
and work here until fate intervened.
I now cannot imagine working
anywhere else, having come to know
many of you and your families. It
may not always be obvious, and we
may not always get everything right,
but the concern I and my fellow GPs
share for your lives and health is deep
seated. The effort we put in to ensure
high quality care at the practice is
relentless.
GREAT CONCERN
I'll add at this point that in the
UK, full time working constitutes
37.5 hours, legally. I regularly work
at the practice for more than 50
hours a week, in addition to time
spent working out of hours doing
administrative work at home and my
role representing local GPs at the Local
Medical Committee and the BMA.
My 'part-time' colleagues often do
more than 30 hours. We also advocate
tirelessly for better services in hospital
and elsewhere for you.
Why? because we want things to
work — if they don't, you suffer.
It is therefore with great concern
that I read of the proposal by a
Conservative linked think tank, The
Policy Exchange, with a foreword
by Sajid Javid, secretary of state for
health, to end the ability of GPs to
work as independent contractors and
to make them employees of larger
organisations, including tax avoiding
overseas firms. 1,3
I think many local MPs of every
‘colour’ will see that the existential
threat to family practices with these
proposals is wrong as a wholesale
policy 2 and will lead to higher costs and
a poorer service.
I fear this not for my own income,
or, even that I am a patient of the NHS,
but because this threatens to destroy
the long term link between GPs and
their patients.
The proposal refers to GPs in
Birmingham managing patients in
Essex, digitally, and GPs working
in other countries consulting with
English patients. For example, the
future envisaged is you, speaking to a
GP in Australia, who you have never
met and never will.
Please think about this. Decide if
this is what you want for you? For your
elderly parent? For your child?
CIRCUMSTANCES
The value of knowing your area and
patients is immeasurable but I know
what it is like to consult a patient when
you have no idea what their area is like
or their family circumstances. I risk
25 years of gained knowledge being
thrown away.
Imagine our church being run by a
minister in New Zealand and having
different clergy taking services each
week in person or by video link.
Hospital and secondary care
services are expensive, so moving
these costs into a primary care sector
could be seen as value for money.
However, the Covid pandemic has
seen many issues that the Hospital
would normally deal with sent out
The Parish Magazine - April 2022 33
Derelict, Simon Ruffle
into primary care. We have not been
able to effectively soak up this work as
there has been no additional funding
for us to do this. I suspect you have
seen the results of this in the fact
that it is even more difficult to get an
appointment with us than it was before
the pandemic.
SECONDARY CARE
The changes proposed will see
hospital trusts essentially being our
contract providers and primary care
being at the beck and call of secondary
care for following up work that they
have started, investigating things that
they wish to be done that is outside the
expertise of a general practitioner.
We are expert in community care
and a jack of all trades which is highly
cost effective for the health service. We
will be unable to do the vital work we
do should secondary care bodies, that
have no idea how to run primary care
services, suddenly take over.
They seem to ignore the fact that
90% of all NHS contacts are made in
primary care already. We cannot do
more without extensive resources being
shifted into our service.
I know some people don’t like
me or my style of medicine, but we
are a diverse group at Twyford, who
support each other in learning about
our patients, their circumstances, and
medical conditions. How I do that with
a colleague in Birmingham, let alone in
Australia effectively is beyond me.
turn to page 35