STEPHEN LEWIS reports on the background to the row which has split a York medical practice and left patients unable to see the GP of their choice.

THE idea that a doctor's patients should be regarded, from a legal point of view, as little more than business assets, is one that many will find shocking. Yet a High Court judge's ruling that patients of two York doctors, Martin Ashley and Gillian Towler, could not follow them once they had decided to leave the York Medical Group, appears to regard patients as just that.

According to a statement from Lockharts, the London solicitors who acted on behalf of the York Medical Group against Drs Ashley and Towler, His Honour Judge Robert Reed ruled that the "patients of a practice were one of the elements of goodwill of that practice rather than the goodwill of the doctor on whose list they might be".

Goodwill, meaning the reputation and established client base of a company, is a term more normally associated with business than the health service.

But it appears to have been a crucial factor in the judge deciding a restrictive covenant signed by GPs at the York Medical Group, which prevented doctors who were leaving the group from treating the group's existing patients for a year, was "reasonable and enforceable".

The judge's decision means Dr Ashley and Dr Towler, who now work as 'locum' GPs at Minster Health, right next door to the surgery in Monkgate where Dr Ashley practised for 14 years, are not legally permitted, for the next 12 months, to treat any of their former patients - unless it is a medical emergency.

Many of their former patients are outraged at what they see as the denial of their right to choose which GP they go to. York MP Hugh Bayley shares many of their concerns.

"Providing health care is not like selling goods and services," he says. "There is a personal and human relationship between the doctor and the patient which the court's peculiar judgement ignored.

"The York Medical Group has the law on its side, but I hope they will give equal weight to the views of their patients. It would be perverse if they do not."

Mr Bayley has already called on the York Medical Group to allow those patients who want to follow Dr Ashley and Dr Towler to do so. He does not want to get drawn into the dispute between the two sides, he says. "But it is in everyone's interests to enable patients to go to see the doctor of their choice, and I hope that all the doctors will bury their differences to achieve that goal."

It is a hope that many in York will share. So how did a rift within a successful York medical practice develop to the point where the only way to settle it was to go through the courts in the first place?

The York Medical Group was formed in May last year, following amalgamation of two established medical practices.

One, to which Dr Ashley and Dr Towler belonged, had surgeries in Monkgate and in York Road, Acomb. Dr Ashley and Dr Towler provided the bulk of the care for the Monkgate patients, Dr Olga Kaliszer and Dr Jonathan Evans mostly looked after the Acomb patients.

That practice merged with another in Severus Road, Acomb, to form the York Medical Group. Dr Ashley and Dr Towler continued to provide most of the care for Monkgate patients, with the other doctors providing care mainly for patients in Acomb and Woodthorpe.

Ironically, the direct cause of the rift appears to have been a Government drive to encourage family doctors to adopt a new approach towards funding and delivery of patient care.

Known as Personal Medical Services, this initiative aims to cut bureaucracy and allow individual GP practices, in consultation with their local health authority or primary care trusts, to be more flexible in the way they provide care and so more responsive to their patients' needs.

This makes it easier for GP practices to offer more specialised services to meet local need, and enrol more nurses, or even the help of other professionals such as physiotherapists, to reduce the burden of work on GPs.

Minster Health, which has a surgery in Monkgate next door to the surgery where Dr Towler and Dr Ashley were based, was keen to set up a PMS pilot scheme in the Monkgate and Clifton area together with a neighbouring practice in Water Lane, Clifton.

The hope was it would allow them to provide a better, more flexible service to patients, including a 'nurse triage' system, where an experienced nurse would be able to prioritise patients who asked for an appointment so those most in need could be seen by a doctor more quickly and others could be dealt with by a nurse.

Dr Ashley and Dr Towler, who were looking after patients in the same area, were invited to join the Minster Group in its bid with the Clifton surgery to become a PMS practice covering Monkgate and Clifton.

But when they said they wanted to leave the York Medical Group, the other six doctors sought a court injunction to stop them taking their patients with them.

The problem faced by the remaining six members of the group, according to their solicitor Andrew Lockhart-Mirams, was that when Dr Ashley and Dr Towler left, they could have taken up to 25 per cent of the patient list with them, if the patients had been allowed to follow them. That would have seen the group's funding cut by 25 per cent.

Many of the patients being looked after by Dr Ashley and Dr Towler were less needy than those being looked after by other doctors in the group, Mr Lockhart-Mirams says - leaving the remaining doctors and their staff struggling to provide health care for a needy population on reduced funding. That would inevitably have affected the quality of health care they could provide, he says.

The question now is whether anything can be done to resolve the dispute. There is clearly a lot of bitterness on both sides.

"My life has been turned upside down by this," Dr Ashley says, "and I'm very saddened at the fact I've lost several of what I thought were friends at York Medical Group."

He is also very saddened that patients have been inconvenienced. "I hope that things can be resolved so that they can receive the medical care that they would like from the persons they would like it to be given by," he says.

That is a hope shared by Dr John Moroney, a partner in Minster Health. He is still keen to talk to the York Medical Group to see if the situation can be resolved amicably and whether they can come to a "mutually advantageous solution".

That doesn't look very likely.

The York Medical Group said it was unable to give a full statement, though a spokesman confirmed he was in discussion with the health authority and with Hugh Bayley, and would let patients know the outcome as soon as possible.

But asked about patients' concerns about not being able to see the doctor of their choice, he said that question should be addressed to Dr Ashley and Dr Towler.

"Why did they choose to leave?" he said. "We asked them not to."

Updated: 11:15 Tuesday, July 03, 2001