Inside Kirkcaldy’s ‘super surgery’ after 6000 patients move to new location

The GPs at the helm of Kirkcaldy’s new ‘super surgery’ have spoken of the first weeks in operation since it added 6000 patients from the now closed Nicol Street surgery in the town.

Dr Clare Murphy and Dr Alan Stewart, Path House Medical Practice partners, reflected on the first eight weeks at the helm after three of the Nicol Street GPs retired with a combined 93 years of service.

There were no other GPs willing or able to step in and save the clinic, so the call was made to merge the surgeries. It was a move that has so far paid off.

Dr Stewart said the transition has had some teething problems, but overall it was working well.

“There have been lots and lots of challenges,” he said. “There were 6000 patients who weren’t going to have a home and there was no real solution to the problem. We had to come up with this idea of what may hold for the future because we see this as an ongoing problem - it’s not going to be an isolated event.”

Dr Murphy agreed: “It’s been a long process - it’s been about a year in the planning between ourselves, the health board and Nicol Street. It’s taken a lot of work from everyone to make it happen, but it has come together quite nicely”

She continued: “When we took on this merger, it was all about sustainability. We could see it coming like a freight train - the same thing happening to Path House. Despite how young Dr Stewart looks he’s going to have to retire at some point!”

“This was an opportunity to rescue Nicol Street and also to try to rescue ourselves and keep this building going. If the building falls down and we have no staff to run it then the Kirkcaldy cluster has 17,000 patients that no one is able to look after. It was a collective rescue mission.”

Dr Stewart used the phrase “new model” over and over when talking about the merger. Bigger GP teams and “super surgeries” are not exactly what patients want, but he said they are a way of “future proofing” local health care.

“Young GPs who are now coming through the system are not keen on the whole model of being property owning partners and having to manage a building,” he said.

“They don’t want to work in isolation in a small team. They’re used to a multi disciplinary team like in a hospital. If you go to a hospital bed as a junior doctor and see there’s a problem, within five minutes you have an experienced consultant and surgeon all standing next to you helping you on your way. As a GP, you're in a room on your own. It’s a really isolating position to be in.”

Both Dr Murphy and Dr Stewart believe the “super surgery” model is the way of the future - for better or worse.

“This is what’s happening in other places around the country - more so in England but it’s a pattern that’s been evolving over the last 20 to 30 years,” Dr Murphy said.

Dr Stewart added: “Super surgeries are how it’s going to go - not because people want them, but because it’s the only model that’s going to be sustainable in the long term.”

He continued: “It’s not a perfect solution, because people will like what they like. Yes, patients used to be able to go to Nicol Street down the road and now they have to come here, but they’re still getting a proper GP service.”

Recruitment

Since the merger was announced, Path House has welcomed three new GPs to the team.

“Recruitment in the past has been a massive problem. We’ve been really struggling to recruit over the last 10 years. Nicol Street struggled for years to replace its retiring GPs and couldn’t,” Dr Murphy said.

“This model of a bigger practice seemed to be more appealing to younger GPs so the recruitment process has worked and we’ve managed to recruit where we haven’t been able to before.”

She continued: “We’ve actually more than matched the number of GP positions that were there on a weekly basis befor, so the clinician cover is as good as - if not slightly better than - it was across the two sites in the past.”

Community consensus

It’s too soon to tell how patients are feeling about all the changes. Dr Stewart said it will take a long time before all of the new patients even come through the door. He pointed out that most healthy, working age people only come to the GP once or twice a year. It also takes time for people to adjust to change.

Dr Murphy said: “It’s difficult for us to know how people are feeling only eight weeks in. There were loads of concerns about lots of different things at the start. Some things have transitioned well, and there are still glitches that we’re still trying to iron out.”

The new patients who have already been through the door have come with anxieties, but Dr Murphy said that was only to be expected.

“A lot of patients have been at Nicol Street for literally decades. Of course it’s going to be unsettling to meet somebody new. It almost feels like you’re starting over again - especially if you have a chronic health condition,” Dr Murphy said. “I would like to think we’ve managed to get on really well with most of them and I’m hopeful that we’ll continue to foster new relationships with all our new patients. Overall I think it’s been going pretty well so far, but time will tell.”

The Big Picture

The Path House-Nicol Street merger might be a big change for Kirkcaldy patients, but it lines up with challenges facing GP surgeries across the country.

“For patients, the change is a very difficult, tangible thing for them to get a hold of,” Dr Stewart said. “Your average person doesn’t understand why they can’t get seen. They say ‘you’ve got all these doctors at Path House, why can’t they work at Nicol Street like they used to?’ That’s where the difficulty is in understanding this. It’s not just us, or Kirkcaldy, it’s the whole of the country and England as well. It’s a massive ongoing issue. The more people that understand how these ‘super surgery’ models will keep the service local, the more they’ll accept it.”

Dr Murphy added: “Access to primary care in general is a national issue. None of this is particular to Fife or Path House."

“We’re trying to do the best we can with the resources we have. No service is perfect and no service is ever going to meet demand but we’re doing our best. And if this merger hadn’t happened the demand really wasn't going to be met at all. "