Much Birch Surgery is a busy rural dispensing practice with a list size of around 5,000 patients. Located between Hereford and Ross-on-Wye, patients are drawn from the edges of Hereford to Ross and into the villages of the Golden Valley.

Over the past two years, there have been a number of changes to the practice partnership due to retirement and resignation. As a result, instead of five GP Partners, the surgery was expecting to reduce to just one by February 2024. Clearly this situation was unsustainable.

Despite the surgery’s best efforts, a two year campaign to recruit new partners was unsuccessful. Although disappointing, this mirrored the national picture where GP recruitment particularly into partnerships is challenging.

This ‘last man standing’ issue is not uncommon in many practices throughout the country and often results in surgeries having to close.

However, the surgery team including the remaining partners, salaried GPs, other clinical and administrative/support staff were keen to keep the surgery open and to continue to provide the services their patients need.

If this couldn’t be achieved, the surgery was faced with a choice of either trying to merge with another practice or to disperse its list of patients to nearby surgeries. Neither of these options seemed to offer the best outcome for patients, staff or already hard-pressed alternative Herefordshire surgeries.

The surgery was clear about what it wanted - but how could this be achieved, given its circumstances?

Much Birch Surgery is part of South and West Herefordshire Primary Care Network within Herefordshire General Practice Federation.

The GP Federation was made aware of the situation facing Much Birch Surgery in 2022 when partners approached us for support. Since then we have worked closely with the remaining partners to offer practical help and support to keep the surgery running. 

This has happened in a number of areas, including help with HR and Recruitment, Finance, Estates, Business Intelligence and Performance. We've also sourced additional GPs, Advanced Nurse Practitioners (ANPs), Practice Nurses and reception staff through our workforce pools, as required, and helped to deliver new clinical models. 

At the same time we have worked hard with the surgery team to explore long term options.

After extensive discussion 'novation' was chosen as the best model. Novation means: 

• Responsibility for the clinical workforce, plus operational and financial responsibility for delivery of the General Medical Services, pass to the GP Federation.
• All of the practice team, including the remaining partner, continuing to work at Much Birch but as salaried members of the GP Federation’s staff

Through taking this approach, we have enabled the GMS contract to be maintained and ensured that the practice can continue to operate from its existing location with minimal disruption to patients and staff. 

Novation was approved in September 2023 (with conditions) and finally granted on 6 February 2024. One of the conditions of the novation was purchase of the surgery premises by the GP Federation. This was completed on 2 February 2024. The dispensing application was approved on 1 February 2024.

What is different?

• A Senior Management Team at the practice makes the decisions day-to-day. This team includes a lead GP, an operational manager, dispensing manager, lead nurse and finance manager, alongside a Federation chair.
• The surgery is currently without a practice manager (since Feb ‘24), who has moved to another role within Primary Care Analytics. This presented an opportunity to re-evaluate the practice needs and recognised that the role was becoming increasingly pressured. A new model of support has evolved where the Federation is providing a wider range of support for quality, clinical governance, finance and payroll, IG and strategic leadership, managing incidents and complaints and all HR functions - plus providing resilience at the same time. This allows the Operations Manager greater focus on the day-to-day functions of the practice and the time to develop this role further.
• New GPs work at the practice, as part of portfolio roles working across Herefordshire General Practice.

The vision is to maintain the excellent quality care that Much Birch has always delivered, but to ensure that everyone gets a realistic workload and aims to get home on time.

Dr Avril Seftel (pictured above), previous GP Partner at the surgery and now salaried GP, says:

“Thank you for the support you have given Much Birch Surgery over the last two years. I am not sure how we would have managed without your help…. I know there is a lot of work to do still and changes to be put in place but we’re far better placed to do that as part of a more robust organisation.”