GP practice closure case study: ‘We were swamped’

Dr Nigel Dickson, a single-handed GP from Southampton, says he was forced to retire because his practice could not cope with the influx of patients after nearby practice closures.

“Two small practices swamped my single-handed practice of 2,600, boosting it to 3,000. I was allowed to close my list at 3,000 on condition I merged with another small practice.

I’ve since resigned from my new partnership and will retire early at the end of the financial year and draw my NHS pension in April 2015 to begin the rest of my life.

We face a GP manpower tsunami next year as more and more GPs like me hand in the towel and what’s left will be unable to cope.

I’ve had just about enough as I can stomach – working harder year on year for less – forget it – early retirement it is.

People like me have put in huge amounts of our lives to keep the NHS going over last 30-40 years – my own stint has been 34 years. The spin doctors for current government have turned the ‘give the GPs a good kicking to shut up’ mentality into a real own goal. ‘NHS safe with us?’ It’s a joke, surely.”

Dr Nigel Dickson is a GP in Southampton.

Originally published by Pulse.

This is a case study accompanying this story: One in five practices burdened by local closures


One in five practices burdened by local closures

Exclusive: One in five practices has suffered from the ‘ripple effect’ caused by the closure of a nearby practice in the past 12 months, a Pulse survey has revealed.

The Pulse survey of 602 GPs revealed that 20% have been struggling with sudden influxes of patients from nearby practice closures, often without forewarning, leading to more stress, list closures, and patient access crises.

GP leaders warned that the ‘ripple effect’ caused by practices closing have left neighouring practices ‘unsustainable’, and there could be ‘dire consequences’ for patients if there is not adequate support for practices to stop them closing.

This comes after a Pulse investigation uncovered over 100 GP practices that had closed or were at risk of closure, caused by a range of issues from MPIG withdrawal, PMS reviews and the GP recruitment crisis, which resulted in Pulse starting the ‘Stop Practice Closures’ campaign.

More recently, a Pulse survey revealed that one in 20 practices were considering closing by spring 2015.

Dr Asim Malik, a GP in Milton Keynes said: ‘Four or five surgeries have closed within an 8-10 mile radius in Milton Keynes.

‘There is a patient access crisis in this town because no one applies for the posts advertised and patient lists have been redistributed by surname not geography. Some families living in the same home have been sent to different practices.’

Dr Chris Kenyon, a GP in Oxford, said that after a neighbouring practice closed, his practice received 1,000 new patients.

He said: ‘We have not had any increase in doctor sessions or funding for our ancillary services such as physiotherapy, so our funding per patient is down and workload up.’

GPC chair Dr Chaand Nagpaul said: ‘As practices close, the pressures on neighbouring practices has the potential for a ripple effect where further practices, who are already having difficulty coping, become unsustainable.

‘This is a phenomenon affecting practices up and down the country, because ultimately general practice has an inadequate work force, inadequate premises, and a demand that exceeds their capacity. The priority must be to enable practices to remain open.’

Related story: ‘We were swamped’

Originally published by Pulse.

Ugo Rondinone: Yellow white green clock – Brooklyn Rail

Yellow white green clock (2012) is an abstract stained glass clock face with Roman numerals. It hangs from a wire so that the “X” is where “XII” should be, meaning 12 is actually at 2 o’clock. Placed against a window with a view of Sunset Park, Brooklyn, the clock face transforms the gallery space into a time capsule where time is askew, becoming a Narnia-like parallel time zone, set as an atemporal freeze frame. A transformative boundary is established between the space of the gallery interior, where time is at a contemplative standstill, and outside, which becomes a world away, where time rushes on at its usual pace.

Ugo Rondinone, “Yellow white green clock,” 2012. Stained glass window and wire, 19 3/4 x 19 3/4″. Courtesy of the artist and Gladstone Gallery. Photo by Brian Buckley.
Ugo Rondinone, “Yellow white green clock,” 2012. Stained glass window and wire, 19 3/4 x 19 3/4″. Courtesy of the artist and Gladstone Gallery. Photo by Brian Buckley.

In Rondinone’s piece, the window provides a plane on which to project the inner mind and so the backdrop of the outside landscape seen through it becomes subjective. It brings to mind the windows in Samuel Beckett’s play Endgame, through which there is an apocalyptic “zero zero zero” for some and bountiful “rising corn” for others. For Beckett’s audience a great gulf opens between the onstage world that they are allowed to perceive, and the offstage world that one of the characters, Clov, alleges exists. In Rondinone’s piece, as in Beckett’s play, the alienation of the mind from others and from reality is a sad, claustrophobic truth.

Rondinone’s clock face engages the isolation of each audience member, who must view it in the wake of the catastrophe of Hurricane Sandy. The conjectured isolation of the viewer from empirical truths allows for the objective reality of the outside world to waver: it is seen through the window as two-dimensional, existing on a different scale and a different temporality than the gallery space inside the Surviving Sandy show.

Originially published by The Brooklyn Rail and the Dedalus Foundation here.

Shirin Neshat: Women of Allah – Brooklyn Rail

Shirin Neshat is split within by the barrier without: as an exile from Iran living in the U.S. she is caught between two worlds, simultaneously of both, and also of neither. To be exiled is to be divided not only from a homeland, but also from oneself. Although it is rarely directly addressed in her work, her state of exile unavoidably informs all of it, philosophically and emotionally. Charged with the impossible task of reconciling inviolable differences, one can see her work as a perpetual balancing act between these two worlds. In order to move forward, to exist, she must carve a passage for herself through the realities that invade her identity and that cast Iranian women as political territory.

Shirin Neshat, “Speechless” 1996. RC print and ink, 53 x 39 1/4 x 1 7/8″. Courtesy of the artist and Gladstone Gallery, New York. Photo by Rachel Styer.
Shirin Neshat, “Speechless” 1996. RC print and ink, 53 x 39 1/4 x 1 7/8″. Courtesy of the artist and Gladstone Gallery, New York. Photo by Rachel Styer.

Neshat’s Women of Allah (1993 – 97) series embodies these tensions, eliciting visceral responses to explore her identity and the conflicting lyricism and violence of the Muslim world: she arouses intense feelings which rage against each other until we too feel some of the perpetual turbulence of her world. In Speechless (1996), a woman stares out at us, the barrel of a gun peeking through the space between her cheek and her chador, Farsi script is printed so as to cover the skin of her face.

Speechless is an image that is strong, frightening, alienating, but there are also elements that counter this. We simultaneously feel threatened by the gun pointing straight at us, wonder whose unseen hand holds the gun so close to her skin, empathize with her because her eye glistens with sadness, and feel an echo on our own flesh of the calligraphy digitally etched onto hers. In this and other photos from Women of Allah, the script pulses with allusive possibility because of its placing on the body, though we cannot decipher it—on the palms of a woman’s hands (“Guardians of Revolution”), on the soles of a pair of feet (“Allegiance with Wakefulness”), or in the white of an eyeball (“Offered Eyes”).

The calligraphy contains the words of the Iranian poet Forugh Farrokhzad, famed for her daringly straightforward poetry about her experiences of love, sex, and the struggle for autonomy. The overlaying of this poetry onto skin makes each picture into the story of a woman and a body, which includes vulnerability, strength, pain, pleasure, banality, and spirituality.

“Hijab,” from which the Persian tradition of the chador (full-body cloak) originates, translates variously, including as “screen,” “curtain,” “barrier,” or “partition.” In its original incarnation in the Qur’an, such a partition is mentioned with the intention that it act between men and women (albeit as an instruction to be carried out by men): “when ye ask of them (the wives of the prophet) anything, ask it of them from behind a curtain.”[1]

A partition defines, or even creates, one object or group as separated from any other. The partition between the sexes creates further divisions, not only between people but within individuals, in other words, between public and private selves, homosocial and heterosocial selves, and one’s identity as perceived within Iran and as perceived by the West. This last division is felt acutely, since the hajib can act as a barrier to understanding: the culture of the West tends to understand through visual means, whereas Islam espouses aniconism, which shows itself by a tendency away from figurative representation in Muslim art. The face we are confronted with in Speechless elicits recognition of and empathy for the pictured woman’s inner self. This goes some way to redress the West’s lack of understanding of the Iranian people.

The creation of Women of Allah is in some sense an attempt to regain a closeness to and explore her own relationship with her fellow Iranian women. Paradoxically, this act of creating a body of work did in one sense sever her ties: these stirring images can and have been construed as critical of the Iranian government. It means that she feels she can never go home, and has forever set herself apart in the role of exile.

  1. 33:53, according to translation by Muhammad Marmaduke Pickthall, as quoted on the website of the University of Southern California.

Originally published by Come Together: Surviving Sandy