Author Archives: idaswears

About idaswears

I left the U.S. for Cornwall 4 years ago. Since then I have spent my time writing, walking and studying the English. It's not always easy being a Yank in Cornwall, but it's always fun and rewarding.

Managing Consultation

How the NHS and Government are “managing” Public Consultation

by protectournhs

The following is the summary of a paper written by Ursula Pearce in October 2014 on the way in which public consultation is currently being ‘managed’ by the NHS. A link to the full article can be found at the bottom of the piece.

CONCLUSION

The type of public engagement preferred by NHS organisations and the Cabinet Office is the involvement of individual patients or individual members of the public – in marginal decision making and on management terms. A more democratic approach seemed possible in 2013 when NHS England published guidance stating people should be directly involved in decisions about who should provide services. However, that guidance was soon altered. It now refers to patient representation on panels and their need for support and training, not consultation with the general public. Individual participants, as discussed, have no means of redress when their views are ignored. So engagement with them allows managers to operate unhindered while, paying lip service to public accountability and consultation. The NHS Constitution, meanwhile, gives individual patients or members of the public the right to claim judicial review if they are personally affected by an illegal or discriminatory decision. But recent moves by the government to limit the number of judicial reviews make it increasingly difficult for them to do so.

Opposing policies such as the above, where statutory rights are given by one hand and removed or weakened by the other, are now widespread. Local authorities or OSCs, the last remnants of democracy in the NHS, have the right to require NHS Foundation trusts, private sector providers and CCGs to provide them with information but they have no enforcement powers, outside the formal consultation process, or visiting rights to enable them to seek information for themselves. They have the right to be consulted on proposals for substantial changes but it is becoming more onerous for them to refer objections to the Secretary of State. Moreover, the duty on NHS organisations to consult with OSCs is shrinking. There is no formal requirement for commissioners to involve LAs/OSCs in deciding whether to classify services as commissioner requested services or not. Changes to or closures of services deemed ‘non-commissioner requested’ or ‘non–essential’, by definition, would not trigger a requirement for consultation even though such services may be valued or needed by patients. OSCs do not have a right to be consulted on Foundation Trust plans to increase private patient income or make significant transactions or mergers, acquisitions and separations or to form joint businesses with the private sector, all of which could pose a significant risk to local services. Foundation Trust governors, alone have the power to approve them. Yet OSCs are far better placed than FT governors to assess the implications of such decisions for the wider health economy. The duty to consult LAs or OSCs does not apply when Trusts go bankrupt and are taken into special administration. The amendment to clause 118 of the Care Bill was rightly viewed as a triumph by campaigners. It requires administrators to consult with every CCG likely to be affected by their recommendations, not just the CCGs attached to the failing trust, and provides some scope for public consultation. However, the amendment leaves a basic loophole intact, namely, when administrators and CCGs cannot agree, NHS England, not the CCGs or public opinion, has the final say.

Local Healthwatch organisations – the official ‘consumer champions’ – are constrained similarly. Healthwatch members have the sole right to visit and inspect health service premises on behalf of local residents. They can report their findings to Healthwatch England and NHS organisations but are forbidden by law to use the information to oppose government policies or engage in policy work. They may campaign if they have enough evidence but only if it is kept as a minor activity. Equally odd, is the Secretary of State’s refusal to provide Healthwatch members with the right to information or the right to attend CCG board meetings as observers. Healthwatch members have a duty to provide the public with information and help patients exercise choice. Yet they may have to use the Freedom of Information Act to obtain official information for themselves. Another key role for Healthwatch organisations is to gather the views and experiences of patients and feed these back to Healthwatch England, the Local Authority, OSCs and NHS organisations. Yet Healthwatch members cannot make use of their own knowledge in public consultations as they do not have a statutory right to be consulted. Instead, Healthwatch committees have been subsumed into the planning process by virtue of their single seat on Health and Wellbeing Boards. In practice, far from being ‘consumer champions’, Healthwatch organisations are the equivalent of a government smoke screen, engaging the public in a minor way, while fundamental changes to the NHS, including privatisation and its consequences, remain hidden from view.

A prerequisite for accountability to operate is a free flow of information to ensure citizens have the knowledge to scrutinise and challenge the decisions and acts of those in power (Ref 4). However, under the Freedom of Information Act, information can be withheld on the grounds of commercial confidentiality. Contracts between NHS bodies and commercial firms are shrouded in secrecy. As a result, consultation documents are bereft of essential information, so that consultees cannot make an informed response even if they wish to.

Moreover, contracts with private firms leave patients with less information to choose where to be treated. This irony and the fact many patients may be too ill to choose fosters not only spurious competition but health inequalities, as shown in the recent Labour Party Parliamentary health committee review. An absurdity at the heart of government policy is the ideological belief that privatisation and competition promote choice, improve services and reduce health inequalities.

Ominously, profit hungry commissioning support firms are coming together in groups to bid for lucrative NHS contracts. One shadowy commissioning support group, chaired by United Health, the giant US health insurer, is currently lobbying NHS England strongly for a contract worth £1 billion, even to the extent of taking NHS officials on a fact finding trip to the US. When so much tax payers money is at stake, it is, perhaps, not surprising that CCGs are taking major decisions in closed sessions and disengaging from local accountability mechanisms, as reported by Healthwatch organisations. The decision of the Secretary of State to refuse Healthwatch representatives an observer seat on CCG committees reinforces the view that deals with private firms are being struck in secret. The prescient words of historian Charles Webster spring to mind “local communities and their representatives are likely to count for little when it comes to appeasing corporate interests” (Guardian May 8th 2002).

There may still be time to save the NHS and restore democractic accountability. People of all political persuasions, in England, as well as Scotland, support the health service and do not want it handed over to profit driven private firms. And irrespective of how hard the government works behind the scenes to curtail statutory rights, it cannot remove the power of the public to vote politicians out of office at the ballot box. That power, above all, explains the politicians fear of exposure, their drive to hide information and to privatise by stealth. Thanks to the persistence and direct action of campaigners, however, news of NHS privatisation is getting out, hopefully in time to influence public opinion and galvanise grassroots support before the general election in 2015. Effective grassroots campaigners have shown they have the power to jolt and influence politicians out of their complacency. The survival of the NHS rests in their hands.

Ursula Pearce
October 2014

Full Article:
UPConsultPaperOct14

Save Our NHS

est Briton Newspaper – Truro

From “Keep our NHS Public Cornwall”

C/O, Press Secretary, Chris Dayus, 7 Lychgate Drive, Truro, TR1 3UE.

Title – End NHS Privatisation.

Since the coalition government passed the Health & Social Care Bill, there has been an explosion of privatisation across the NHS.

In Cornwall we have direct experience of the Private sector.  Running car parking at RCHT, making profit from those who have no choice but to pay extortionate prices to park at the hospitals. Serco, running the G.P. “Out of hours” service. During the life of the contract they have generated a catalogue of problems and incidents, clearly evidencing poor quality of services to patients.  The Patient Treatment Centre in Bodmin, badged as an NHS treatment centre is actually run by Ramsay Healthcare. Community Health Services across Cornwall are provided by Peninsula Community Health, a social Enterprise.

Most recently we have seen the transfer of ambulance patient transport services to NSL and Hotel Services to Mitie a private equity company. Both NSL and Mitie have recently featured in the news as providing poor service to patients and even worse, reportedly compromising patient safety.

This is evidence that the private sector do not improve services for patients, their objective is to provide profits for shareholders.

On the 21 November MP’s are being given the chance to support a private members bill. If passed it would end many of the damaging aspects of the “top down” reorganisation of the NHS. It would remove the requirement to put services out to competition and promote integration to provide improved patient care.

We urge readers to support this move to save the NHS, and end private profits. Please lobby your MP to support the Bill and the NHS they claim to value.

Also sign the online petition being run by the TUC at www.unionstogether.org which also has further information and details of events being organised on the 15 November in support of the Bill.

Your Friendly Boots

From Our NHS    Guddi Singh   26 August 2914various_pills[1]

Britain’s trusted high street chemist hasn’t been feeling well of late – and it’s getting sicker.

The brainchild of agricultural worker John Boot in 1849, the Nottingham herbalist store rapidly grew from humble beginnings into the country’s largest chemists’ chain. By revolutionizing access to affordable medicines in the pre-NHS era, Boots became a household name.

Since 1948 it has retained its central place in the functioning of the NHS. It is the largest single employer of NHS-trained pharmacists (6700) and pharmacy technicians (2500) outside of the NHS.

Pharmacy has long-been held up by the pro-privatisation lobby as an example of how the private sector has in fact been providing NHS services for years, ‘playing nicely’.

Boots made its name on providing patient care to millions. For 165 years it had what other companies would do almost anything for: the trust of its customers. Repeatedly named as one of the UK’s most trusted brands, Boots symbolised reliability and quality, securing a prominent and enduring position amongst our national retail heritage.

But times have changed. In 2006, Boots UK merged with European pharmacy wholesaler Alliance Unichem Plc to become Alliance Boots. And just one year later, the company went private in a £12 billion buyout led by US private equity firm Kohlberg Kravis Roberts (KKR).

That’s when the fairytale took a dark twist. KKR is one of the largest private equity firms in the world, ranking with the likes of Goldman Sachs and Bain Capital. KKR and its fellow private equity beasts don’t want to be passive investors, but to take the reins of the business and use their controlling position to restructure the company before ‘flipping’ their assets and selling off at a profit.

Now, KKR is selling its remaining stake in Boots to what will now become the biggest pharmacy chain in the world, US-based Walgreens. The complex deal is not likely to undo the damage inflicted by eight years of being one of the largest private equity buyouts in Europe. Walgreens have already said they will make $1billion of efficiency savings – or cuts – as a result of the deal, with no guarantees on protecting pharmacist and other staff numbers.

And for the last eight years, Boots has taken advantage of the private equity model that allows it to operate with far more secrecy and less regulation in its business dealings, than do publicly listed companies.

The impact on Boots values during this time has been stark. A recent example was its decision by Boots to sell e-cigarettes despite warnings from the Royal Pharmacological Society (RPS) about their risks. The World Health Organization (WHO), British Medical Association (BMA) and the US Food and Drugs Administration (FDA) are all unable to vouch for their safety. But Boots has persisted in the multimillion dollar deal – joining up with Fontem Ventures, a subsidiary of Imperial Tobacco.

More generally, Boots pharmacists increasingly feel that the logic of big business is compromising their professional autonomy, integrity, and statutory duties towards patients.

“I gave up my job because I could not keep working in such conditions,” a former Boots pharmacist told us. “I was offered a 40-hour contract, training, competent staff… But none of my colleagues had the requisite training to dispense medicines and I worked 12 hours every day without a break. It was all a lie. I became very anxious; it was just too much.”

Boots pharmacists have far less say over their working conditions than their NHS counterparts. Boots refuses to recognize the independent trade union, the Pharmacists Defence Association Union (PDAU). Without this protection and professional support, they are under pressure from management targets and a private equity culture that sees professionalism as a hindrance to profits. Their pay and conditions are cut, and their bureaucracy is increased. Anxiety and depression amongst staff is soaring, their mental health falling victim to the neoliberal message that if your lifestyle is on the down, it’s your own fault.

And Boots is becoming increasingly adept at using financial gimmicks to line its pockets – deriving enormous wealth not from management or investing skills, but from exploiting the tax system. Alliance Boots avoided paying at least £1.12 billion in tax in the 6 years after it became private, reducing its UK corporate tax bill by 95 percent, according to a report published in October 2013 by Unite, War on Want and US labour federation Change to Win. This money has disappeared offshore, personally enriching a handful of senior executives and investors, and shrinking the UK tax base.

It’s a classic private equity trick. By borrowing huge sums to ‘invest’ in a ‘leveraged’ buyout, then saddling the company with the debt repayments, they can deduct massive interest expenses from pre-tax profits. Boots 2007 buyout was funded with £9 billion in debt.

Such tax avoidance is significantly to blame for the growing strength behind the dangerous message that we cannot afford a free health service for much longer. It’s bad enough when it’s Google, Amazon and Apple. But it’s particularly galling when it’s a company that gets more than 40% of its UK revenue from the taxpayer, through NHS prescription dispensing and wholesale services.

Not only does debt allow private equity companies to avoid tax. They often borrow even more post ‘buyout’, and use that money to pay themselves huge “special dividends”. They recoup their initial investment while keeping the same ownership stake. These dividends create no economic value; they just redistribute money from the company to the private equity investors.

So private-equity firms are increasingly able to profit even if the companies they run crumble under the weight of debt and poor performance. In this way, private equity firms can actually fail to improve a company’s performance, fail to meet creditors’ obligations, screw workers – but still make a profit. It’s the trick pulled in social care – most notably doomed care home provider Southern Cross, bought out and driven into the ground by private equity company Blackstone – and now it’s taking root in healthcare as well. A back and forth between private equity and publicly listed companies is not uncommon – but with each throw, the race to the bottom worsens.

Boots is only the beginning.

Pharmacy – already more than 70% owned by corporate entities – is a soft route in for private investors interested in taking control of health infrastructure. Under the rhetoric of ‘care in the community’ and ‘self-care’, high street pharmacy chains including Boots are widening their influence by offering a range of healthcare services through the Any Qualified Provider (AQP) contract model. They are moving in on anti-coagulation and hearing test services already – services that many clinicians feel are better offered in the multi-disciplinary, fully equipped expert setting of NHS hospitals and clinics. Boots are also taking over hospital pharmacists, using favourable tax loopholes that put the NHS at a disadvantage.

Beyond pharmacy, private equity company Cinven bought the BUPA hospital chain a few years back, re-branding it as ‘Spire’ and again indulging in a level of debt-driven tax avoidance that commentators branded a ‘scam’. Fellow private provider (and owner of many of the disastrous ex-NHS 111 services) Care UK is ultimately owned by Bridgepoint private equity. Both groups are advised by former health ministers – and both have benefitted hugely from the increasing outsourcing of NHS clinical services from hip operations to mental health beds. This outsourcing – or privatisation – is often invisible to patients, disguised under the NHS logo.

In November 2013, the Department of Health sold an 80% stake in Plasma Resources UK, the state-owned NHS plasma supplier, to a US private equity firm Bain Capital, the company co-founded by Republican presidential candidate Mitt Romney, in a £230m deal. Lord David Owen commented “It’s hard to conceive of a worse outcome for a sale of this particularly sensitive national health asset than a private equity company with none of the safeguards in terms of governance of a publicly quoted company and being answerable to shareholders.”

The Boots story tells that ownership affects institutional values. Unethical tax practices, unfair labour arrangements and unsafe patient services are the only way private equity can work.

A number of organisations concerned with tax justice, NHS privatisation and the rights of healthcare workers are highlighting these concerns. In June protests took place outside Boots stores in London and across the country, organised by Medact, Unite, War on Want and most recently, UK Uncut, calling on the company to pay its fair share of tax and on the government to investigate the company’s finances. Meanwhile, pharmacist employees at Boots continue in their struggle to win independent representation to protect their rights and working conditions. Medact are urging healthcare professionals to add their name to their petition asking the government to investigate these issues.

The growing disquiet about private equity in the NHS is not mere brand-bashing. Given the already apparent effects of private equity trickling down through Boots, we can only expect the same for the NHS – and that’s the kind of ending to the story that we must try to avoid at all costs.

Additional reporting by Caroline Molloy

The NHS will last as long as there are folk left with the faith to fight for it

Aneurin Bevan, the Labour Health Minister who created the NHS, famously said: “The NHS will last as long as there are folk left with the faith to fight for it”.

On 16 August 2014 a group of mothers from County Durham will set off from Jarrow to march to the Houses of Parliament, following in the footsteps of those who marched the route in 1936 to protest against mass unemployment. They did this as a bold but peaceful protest against the current NHS policy.

Whilst the Government can clearly influence the State media, it might also be true that the NHS will last as long as there are folk left in the social media and also those willing to show their democratic stand against the undemocratic demolition of a publically-owned NHS.

That people care about NHS issues, for example, is shown by the enormous affection held by many for groups such as the “NHS Action Party” and “Keep our NHS Public”, as well as the trades unions.

There have been some Labour MPs, especially, who have served in an outstanding way to represent the views of their constituents and beyond over health and social care policy.

The lack of credibility from the Department of Health is demonstrated in their statements below:

The first statement read, “We’re committed to an NHS which continues to be free at the point of use for everyone who needs it.”

Evidence of a postcode lottery in surgical provision has especially become clear in the lifetime of the current term of office.

The critical thing for the next Government not to do, of whatever political variety, is to introduce compulsory unified personal budgets and a system of co-payments, as that will torpedo in an onslaught against the free-at-the-point-of-need principle.

It clearly is a problem if one part of the system which is means-tested is soldered onto another part which is not means-tested, like a dodgy banger.

The second statement read, “By taking tough financial decisions elsewhere, this government has been able to increase the NHS budget by £12.7 billion during this parliament.”

Last year, the UK Statistics Authority upheld a complaint by Labour about government claims the NHS budget had increased in real-terms in the past two years.

And members of the current Government keep on lying about this.

The current Government took the public for granted in inflicting on them a £1.5bn top down reorganisation, turbo-boosting the awarding of contracts to the private sector.

It is conceded that the extent and speed of NHS contracting under the current Coalition have been a disaster.

Lynton Crosby, PR guru of the Conservative Party, does not want to talk about the NHS, it appears.

But now it is clear that people should make clear what type of NHS they wish to have.

Furthermore, the next Labour government will be seeking to fuse the NHS and social care, and to pool their budgets. This will be a huge step, and could have massive implications for the national roll-out of a shift from hospital to community care to promote wellbeing and health rather than acute crisis management.

People who have had their local hospital services shut down will also have a chance to make their opinions known. It is well know that many people do not want a ‘platinum service’ miles away, if they do not have ready access to an emergency service on their doorstep.

These are indeed testing times for the NHS and social care, but Jeremy Hunt fails to command a leadership necessary to lead the NHS beyond 2015, many feel.

 

via The NHS will last as long as there are folk left with the faith to fight for it.

Why do private hospitals want to hide their patient safety records? | openDemocracy

Why do private hospitals want to hide their patient safety records?

Colin Leys 21 August 2014

In opposition George Osborne criticised the ‘endemic culture of secrecy in some private hospitals’. But after 4 years in government, the secrecy persists, even as the NHS itself is opened up to ever more scrutiny.

In February 1999 Mrs Laura Touche, the wife of an American lawyer in London, died of a brain haemorrhage after giving birth to twins by caesarean section at the private Portland Hospital in London, the favoured choice for maternity care of the Royal Family and many celebrities. It emerged that unlike NHS hospitals, the Portland had no protocol requiring patients’ vital signs to be checked at frequent specified intervals following a delivery. Although complaining of a headache Mrs Touche was not checked for two and a half hours, by which time it was too late.

In the UK maternal deaths directly due to pregnancy are extremely rare – around five in 100,000 live births. A coroner’s jury found that neglect had contributed to Laura Touche’s death. Her husband Peter Touche said the facts disclosed at the inquesthad convinced him that his wife’s death was ‘completely avoidable’. He added: ‘This all took place in a private hospital at the end of the 20th century. I understand that the Government is now contracting out NHS operations to the private sector. The NHS is opening up and publishing statistics. So should the private sector. The irony is that often, as in Laura’s case, a patient is transferred to an NHS bed and so the death is registered at the NHS hospital.’

And it is not just deaths that are a cause of concern. Serious incidents short of death can be devastating too. For example over the past year no fewer than three patients at one private hospital in Southend had the wrong joints replaced – ‘never events’, in NHS parlance.

The key lesson from all such cases was actually drawn in 2002 by George Osborne, then a backbench MP. Referring to the Touche tragedy he moved a private members’ Bill ‘to require private hospitals to publish independently audited information on clinical performance and on complaints from patients on the same basis as that required of NHS hospitals.’ He pointed out that:

Unless the hospital volunteers the information, it is impossible to know how many deaths occur within 30 days of surgery or how many emergency readmissions take place, yet information of that kind is now freely available in the NHS. Although private hospitals now need to have a proper complaints procedure, there seems to be no requirement for them to publish complaints in the same detail. Other prospective patients therefore cannot judge the hospital’s record for themselves.

But as a new report by the Centre for Health and the Public Interest points out, this information is still not available. Sir Robert Francis reporting on Mid Staffs, Sir Bruce Keogh reporting on 14 NHS trusts, the American Don Berwick reporting on the safety of NHS patients in general, and more recently Jeremy Hunt, all stress the importance of openness. But what George Osborne called ‘an endemic culture of secrecy in many private hospitals’ persists. There were 1.6 million admissions to private hospitals for surgery last year, including some 420,000 funded by the NHS; yet none of the patients involved had any means of knowing whether the hospital they were going to had a better or worse than average patient safety record, or how it compared with their local NHS hospital.

Suppose you need a hip replacement. The NHS Choices website shows all the hospitals in your area, including private hospitals, which as an NHS patient you now have the right to choose. Since Jeremy Hunt’s recent patient safety drive, for every NHS hospital you can now see, besides a users’ rating, the number of hip replacement operations it does, the average length of stay in hospital, whether the mortality rate and the rate of unplanned readmissions are above or below average, plus the hospital’s rating for infection control, whether its staffing level is safe, how far its own staff recommend it, whether patients are assessed for blood clots, and whether it reports safety incidents honestly. But for private hospitals only a users’ rating, the number of operations they do, and (for some) the average length of stay, are given. The rest remains secret.

This makes informed choice impossible, even for private patients. There is a separate Private Hospital Information Network website. But it compares private hospitals only with each other, and for most indicators does not provide the data on which the comparisons are based.

And having informed choice is only one reason for transparency. Even more crucial is that only full information allows risks to patients to be identified, trends to be analysed and lessons to be learned so that mistakes are not repeated. Yet the Care Quality Commission acknowledges that it has comparatively little information on private hospitals.

Given that the taxpayer is now the second largest source of funding for the private hospital sector and that this has, according to the Competition and Markets Authority, sheltered private hospitals from the economic downturn, there is no good reason why they should not be subject to the same reporting requirements on patient safety as NHS hospitals.

via Why do private hospitals want to hide their patient safety records? | openDemocracy.

Doctors at St Austell’s biggest GP surgery terminate NHS contract due to “financial difficulties” | Cornish Guardian

Doctors at St Austell’s biggest GP surgery terminate NHS contract due to “financial difficulties”

By Cornish Guardian | Posted: August 13, 2014

 

THOUSANDS of patients have been left shocked after doctors at St Austell’s largest GP practice terminated their contract with the NHS due to “financial difficulties.”

Partners at Polkyth Surgery, on Carlyon Road, informed NHS England of their decision last week.

Doctors Angus Senior and Manisha Cooper said in a statement on the surgery’s website that the practice would remain open while a new contractor was found.

“We would like to reassure our patients that we are fully open as normal for all services,” they said. “We can confirm we will be ending our contract for GP services. We will remain open while NHS England put in alternative arrangements.”

The statement continued: “We apologise if this is unsettling. It is with great regret that we have decided to relinquish our contract, having made many friends and supported the community for so many years.”

NHS England said it was working with the practice “to make sure patients are not affected”.

A spokesperson told the Cornish Guardian: “The practice has told us it has financial difficulties and therefore cannot continue with its contract.

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“Discussions are already under way with another provider with the aim of securing continuity of care and making the transition as smooth as possible.

“Patients can continue to make and take up appointments as usual during this time.”

St Austell and Newquay MP Stephen Gilbert said he was gravely concerned by news of the surgery’s plight.

“As the local MP, I have visited Polkyth Surgery on a number of occasions and I know what a valuable contribution the doctors and nurses have made to the local community,” he said.

“The news that the GPs will hand back their contract will be deeply worrying for patients. It is vital that our National Health Service providers are able to operate viably and I will be raising the specifics of this case with ministers after the summer recess.”

He added: “Ultimately, I am pleased that managers are working to put alternative arrangements in place to provide continuity of service for patients; and I have offered my support and assistance for this process if needed.”

Jenny Curtis, vice-chairman of the Polkyth Patient Participation Group (PPG), said she had no idea the situation at the surgery had become so dire.

“It’s been as much of a shock to us as anyone else,” she said. “We heard about it in the news.

“I would hate to see Dr Senior or Dr Cooper leave for any reason. They’re both caring GPs. I don’t know what their situations are, but it would be a terrible shame if they did.”

Polkyth Surgery serves almost 11,000 patients, but has struggled to cope with long-term staff absences and the pressures of recent government healthcare reforms.

In 2012, the abolition of Primary Care Trusts (PCTs) forced GPs to take control of their own finances and made them responsible for planning, and buying local services for their patients – effectively turning doctor’s surgeries into businesses.

NHS England refused to speculate about who would take over the practice, but under the Health and Social Care Act 2012 the contract will be put out to tender to the private sector. “It could well be a private company that takes over, it wouldn’t surprise me” said Mrs Curtis. “These days doctors’ surgeries are forced to chase profit.

“GPs never used to be involved in the business side of things, so it’s no surprise some practices are struggling.

“The amount of pressure on GPs at the moment is incredible,” she said. “It’s appalling, but it won’t end at Polkyth. I think this is going to

via Doctors at St Austell’s biggest GP surgery terminate NHS contract due to “financial difficulties” | Cornish Guardian.