Name: Dr Cornel Fleming
Location: Tufnell Park
Health Authority: Camden and Islington
Number of years as solo GP: 15
Number of years as GP: 21
Premises: Converted butcher's shop
List Size: 3,000 approximately
Practice staff: Receptionist, nurse shared with other practice, access to district nurse and health visitor.
'I worked as locum for a while in large practices and didn't like a lot of what I saw. Some are awful. You often get senior partners not pulling their weight.
Now I'm in charge and responsible directly to my patients. The downside is I work incredibly hard and get paid less than I might. But I take a positive view and get on with it.
I run two 90-minute surgeries a day, do house calls and fit in other meetings - for the Local Medical Committee, commissioning group and now the primary care group - as and when I can. I also do emergency surgery on Saturday mornings.
My patients love the fact they can come down and see me whenever they want to, rather than being told to make an appointment. It cuts down on the out-of-hours calls; if I get more than one a week I know something is wrong.
I vet my out-of-hours calls until midnight, although sometimes I'll get the deputising service to do a visit if necessary. I don't run clinics because I don't need to. Patients with chronic conditions see me whenever they need to anyway.
London patients can be difficult and many GPs are choosy about who they'll have on their list. I register anyone who comes through the door. I've had one patient whose address was a bus stop. I recently took on the residents of a refugee hostel, and I'm very happy to accept drug addicts - although I make it clear I won't prescribe the drugs they want. Just because you are on uppers doesn't stop you needing treatment for flu.
People say premises are a big problem for London doctors but it's important to remember you can practice good medicine in awful surroundings.
Most of the time it's possible to improve buildings. A big complaint among single-handed GPs is that health authority managers get a bee in their bonnet and spend all their cash on one grandiose new building, instead of thinking about imaginative upgrades.
Working single-handed allows me to set my own timetable. It's hard work and I don't suppose I ever really switch off. But if everything was routine I'd soon get bored.'
Name: Dr Ramesh Bhatt
Health Authority: Ealing, Hammersmith and Hounslow
Number of years as solo GP: 5
Number of years as GP: 16
Premises: Detached house in suburban estate
Practice staff: 0.75 wte practice nurse, 0.25 wte business manager, trainee practice manager, three part-time receptionists. 0.25 wte secretary, access to health visitor, district nurse, midwife, psychiatric nurse, continuing care nurse, incontinence advisor.
'I didn't choose to be single-handed, my preference was to be in partnership. But the practice split and I found myself mid-career, facing the choice of starting at the bottom in a new practice or setting up on my own. With a lot of support from a range of colleagues, I chose to go solo. I got help with meeting the cost of converting my surgery through the LIZ scheme.
The best thing about being single-handed is managing the practice itself. Trying new ideas is much easier if I make the decisions. Having to reach a consensus takes a long time and often dilutes the decision. The implementation of evidence-based medicine in larger practices can suffer because particular doctors have certain quirks. It is often difficult to establish the precise practice of each GP.
The down side is that finding protected time for holidays and academic work is difficult, and good quality locums are hard to find.
I believe patient care has improved greatly since I went solo. I have built up a robust patient database and set up efficient recall systems for chronic disease management.
I have difficulty with the current system of paid clinics in general practice, and as a single-handed doctor I think I am better able to treat patients as a whole, by taking an opportunist's approach to health promotion.
I made the decision to go solo because I didn't want to uproot my family, but also so as not to sever myself from the investments I had made in my patients here. General practice is about more than the biomedical - it's about getting to know your patients and understanding their culture. I'm from Uganda, but I studied in London and have lived all my adult life here. I feel I understand the London psyche and I think that's good for my patients.'
Name: Dr Hasmukh Makanji
Health authority: Barnet
Number of years as a solo GP: 5
Number of years as a GP: 15
Premises: purpose built centre for three solo GPs
List size: 2,500
Practice Staff: Part time practice nurse, practice manager, receptionist and counsellor plus dietician, physiotherapist and shared community nursing team.
'Before I became single-handed I worked for ten years in a group practice. But things went wrong because of the distribution of work and profits. These issues cause many partnership difficulties.
After that I found going solo the best thing since sliced bread. Working on my own means I can make decisions without being tied down. If your partners aren't thinking as progressively as you, life can get frustrating.
But I also have the advantage of working in a new surgery with two other GPs, which means I have the best of both worlds. Having other GPs around stops me being lonely, and we can also share staff and facilities in a way you couldn't if you were in different places.
I really hope that this model of general practice develops further, maybe with different GPs having different specialisms that each brings to a centralised location. It's better to get together in one place and share skills than to work in isolation.
Since I went solo my callouts have dropped dramatically. I think this is because in group practices there's a tendency for GPs to pass the buck - for me there's no advantage in putting people off. In large practices it's common for patients to have to wait up to two weeks to get an appointment. I'm around all day through the week, so patients get to see me at the first available opportunity.
I am considering taking on a female partner at the moment, because one of the problems with being solo is that you can't offer patients the choice of which gender of GP they want to see. Despite the problems I had first time round, partnership holds no fear for me now. It's fine if everything is done on equitable terms.'
Name: Dr Bharati Shah
Health authority: Greenwich and Bexley
Number of years as a solo GP: 8
Number of years as a GP: 11
Premises: Converted Victorian townhouses
List size: 2,700
Practice staff: Nurse, part-time receptionists and access to community nursing team.
'A couple of years after I qualified as a GP I joined a four partner practice and it was a living nightmare. The two senior partners were at retirement age, one never came to the surgery and the other was always off sick. So myself and another GP did all the work . I was treated like a salaried doctor, and even though I was the only one with young children I couldn't get any time off in school holidays.
I asked the health authority for help and they pulled out all the stops. I kept my list and became single-handed in 1990. I was also lucky enough to get an improvement grant to do up my building.
I really enjoy single-handed practice. It's hard work but I can fit work in around school hours and I manage about three weeks holiday a year. I've got a great team here.
I know some people find it hard in London, but we reach most of our higher targets and take good care of our patients, many of whom are young and chronically ill. A quarter of my list is made up of children below the age of 12 and the surgery is very child friendly, with wall to wall Teletubbies.
A lot of our female patients are in damaging relationships. Many get pregnant and enter a spiral of decline as their partners, most of whom are jobless, start abusing alcohol or drugs. They can come and tell us their problems and know we won't take a superior attitude with them. Single- handed practice is all about knowing your clientele and developing a mutual respect. '
'I register anyone who comes through the door. Just because you're on uppers doesn't stop you needing treatment for flu'
'Having to reach a consensus takes a long time and often dilutes the decision'
'My callouts have dropped dramatically ... in group practices there is a tendency for GPs to pass the buck'
'I joined a four partner practice and it was a living nightmare'