Derry hybrid GP practice controversial

The opening of Derry’s first hybrid GP practice, accepting NHS and private patients, has proved controversial.

Dr Tom Black, a GP partner at Abbey Medical in the Bogside, opened the new practice on January 2.

Speaking to Derry News about the decision, Dr Black said: “We are doing what we did not want to do and we are doing it because we had no choice. The only alternative is to close.”

Ruth McIlwaine, who described herself as a concerned citizen and user of the NHS, said she had contacted Derry Now as she was “angered and annoyed” at the way in which the Derry GP had spoken about the patients in his practice.

She added: “What particularly annoyed me was his claim this hybrid model was needed but it was not going to impact the ‘free’ services for the NHS patients. He said that none of his NHS patients would pay for anything. He made a distinction between his new fee-paying patients and his ‘free’ patients.

“NHS patients are not ‘free’ patients. We are all paying for the health service through our National Insurance contributions and our taxes. How dare he say that, as though doctors are giving a special service to the ‘poor’ people.

“I cannot see how this hybrid model is going to work. How is it going to be a fair system? How is it even going to be policed properly?

“After all, the doctor is serving his NHS patients under a contract with the NHS, for which he is getting paid per capita of the patients he is seeing. If half of his patients are going to be private and half his business is going to be private, who is going to lose out here? 

“You don’t have to be a rocket scientist to know that it is going to be the NHS patients. We are going to be pushed to the side because if you are a private patient and you are paying top dollar, you will want to be seen there and then. You will want to get your prognosis and everything straight away.”

Ms McIlwaine pointed out the whole idea of the formulation of the NHS in 1948 was to be “fair and just” to everybody.

“Are we going to go back to the pre-1948 days when, if you wanted to see a doctor, you had to pay for it?” she asked.

“Also, what he is doing is trying to have his cake and eat it. If he wants to go private, then let him go private. I would also ask how the nurses in the practice are being paid. How is their time being split? They are being paid by the NHS. How do you police that? I don’t think you can.

“And then, when every other GP practice becomes a hybrid practice, it will become a feeding frenzy, with everybody going after everybody else's patients, because it will have become an open house.

“The doctor said in his piece that he could attract patients from any other practice. This is all nonsense. He is talking as though people are stupid and don’t understand this situation. He talks about his ‘business’ and how he is in difficulties. Well, that is something very separate.

“That is why I am angry. We are paying for the service. The NHS will not survive if we don’t pay. It is as simple as that. We all know these things - all of us who access the NHS but it is standing up and saying it. This Derry practice is going to impact everybody else. It is being put forward as an option for all other practices. We do not want that.”

Speaking to Derry News, Dr Black, who chairs the British Medical Association (BMA) NI Council, said the situation in general practice was “worse than it has ever been and it is not going to get better”.

Dr Tom Black.

He said: “Abbey Medical has 6,800 patients throughout the Bogside and Brandywell area. The Black’s are from the Bogside. This is my family practice and this practice will close in the next six months, due to underfunding, unless I do something.

“General practice is being underfunded by the Department of Health - in Britain and Northern Ireland. It is a double whammy. The Tories cut funding in England. On top of that, the Tories have set aside 6% for increasing GP funding but the Department of Health in Northern Ireland can’t access that funding because there is no Stormont. We are, therefore, 6% short.

“We lost a receptionist during the summer and we couldn’t get anybody to fill the vacancy because we were paying less than the supermarkets. As a result, all my staff - receptionists, managers and nurses - got an 8% uplift.

“We have been losing money every month for 15 months. I already had a big overdraft, so the bank paid the 8% uplift. This meant I had a second overdraft.

“If I continue on the way I am going, I will have a six figure overdraft within six months and the place will be closed and probably as a business it will be bankrupt.”

Dr Black said the wages of the doctors had been cut every year for five years.

He also said it was impossible to reduce the services offered by Abbey Medical Practice.

“I could sack the nurses but I then wouldn’t have a treatment room. I lost one doctor last year and I am losing another one this year and the GP locums won’t work here because the work is ‘too hard’. I haven’t got the money to pay them anyway,” said Dr Black.

“I agree I shouldn’t be doing this [hybrid model]. In fact, I have worked for 40 years in the NHS and I have never, ever done any private work and here I am with the choice, to close the practice and see my 35 years invested in this practice go down the drain or do something radical.

“The practice has been here for 100 years, between Dr McLaughlin and his son-in-law Dr Kinsella. I am probably the next generation. I am not letting my people down. I am not closing this practice without making every effort and even doing something that would to be blunt is quite embarrassing for me, private practice, after not doing it for 40 years.

“There is a relationship of trust between a person and their doctor. Patients trust their doctor to do their best for them. That is what we are doing and that is why we are not getting any grief from our own patients.

“We will see our 6,800 patients non-stop and that will happen exactly the same. It will be completely separate from the private practice (Cathedral Private GP Service). The only people employed in the private practice will be the GPs. Everything will have to be separate.”

Dr Black said Abbey medical was undergoing a medical inspection today (Thursday).

“There will be three inspectors coming to the practice and I am really looking forward to explaining to them how it is done. I think, when they leave, they will be happy because everything is being done right.

“We are continuing to look after our NHS patients and the only reason we still have a practice for our NHS patients is because it is being subsidised by the private patients.

“We are seeing in excess of 100 patients daily at the minute and that will continue. No-one should lose out. Hopefully it will be a win-win situation. The service for my own patients will continue. I will not see NHS patients privately that would be against the rules. It is unethical.”