GP Lives: Shaking up the system

Dr Victoria Holt describes herself as a City and Hackney GP through and through. It is where she did her GP training after winning one of four places for which there were 80 applicants. And it is where she took up her first job in 1989 as a GP in the Hoxton Health Collective, pioneering a completely different model of general practice.

Initially based in a two-bedroom council flat, the East London practice was, at the time, doing something very different. But much of what set them apart then is now a routine part of general practice, she muses.

“Lots of things we did were very much ahead of their time. Patients got to hold their medical records while sat in the waiting room, for example. There was much more of an extended role given to nurses. We had a counsellor in-house as an integral part of the practice team.”

The financial and management model was based on everyone in the team receiving the same hourly rate of pay and shared decision-making on everything from how the appointment system ran to what clinics the team would offer.

“As a socialist and feminist, the conventional general practice partnership model did not appeal, and I liked the idea of a collective. We had this vision that lots of practices would start doing it; there was a feeling we were at the beginning of something.”

The move to the new premises in the early 1990s may have altered the surroundings for the collective, who were now housed with other practices in a large medical centre, but it did not change their approach for patients, she stresses.

“All of a sudden we had oceans of space it was totally luxurious, each having our own consulting room, but it didn’t change what we were doing with patients.”

Yet by the early 2000s it became clear that the practice was no longer sustainable, with staffing a major problem. “No doctors wanted to work there and we were limping along with locums and we realised it wasn’t a sustainable model. After the decision was made to fold, it was a real mixture of sadness but also relief because it had become so incredibly difficult. But it was an amazing bunch of people and we’re still friends now.”