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GPs go forth

Can GP practices be brought back from the brink?

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Cassandra came in the unlikely form of Dr Peter Holden earlier this year when the veteran GPC negotiator predicted in April that we had ‘a year to save general practice’ and prevent widespread closures.

This is proving prescient. LMC leaders have told Pulse that they are already seeing hundreds of practices across the country teetering on the brink of closure. As Dr Mark Sanford-Wood, chair of Devon LMC, says: ‘I’ve been involved with the LMC for 20 years and I’ve never seen this before.’

The scale of the potential closures is shocking and they probably represent the tip of a very large iceberg. A chronic lack of investment, worsening recruitment problems and exhausting levels of workload mean many good GPs are close to hanging up their stethoscopes.

It would, of course, be carelessly negligent of the NHS to allow this to happen; the ‘domino effect’ would damage patient care, put a huge additional strain on other local practices and potentially destabilise the whole of the local NHS. So far there have only been weak promises that managers will ‘work with’ struggling practices and little sign of the cold hard investment needed to enable them to restructure, merge or federate.

As one LMC leader said recently, they are employing a ‘deliberate ground zero’ strategy.

The funding pot may be empty and – in the current climate – funding increases for GPs are probably politically unpalatable, but there are other options. As one CCG leader put it in a recent blog: ‘CCGs and NHS England should be looking at ways of putting resources into general practice in other ways: management support, better IT and the staff to get the most from it, staff training and mentorship.

‘The list is as long as your imagination and none of it needs to go through the practice books where it can be misconstrued as a pay rise.’

All this is great in principle, but it will have to be fought for. The BMA and the RCGP have launched their respective campaigns, but it will take more than a ‘Your GP Cares’ poster to get area teams to pull their fingers out.

Others have led the way on this – take the fearless campaigning of practices in Tower Hamlets. They have created such a rumpus through talking to the national media and involving their patients that the area team has had to sit up and listen.

And this is the only way that some practices will survive, by galvanising support locally and ensuring that those who really care about them – their patients – know what is going on.

Pulse is going to try and help with this (look out for more resources on PulseToday over the next few weeks), but please do let us know if you are struggling. We are trying to raise the national profile of the current state of general practice and we can only do this with your stories. Email me in confidence at

And take heart. There is time to still prove Cassandra Holden wrong.

Nigel Praities is editor of Pulse 

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Readers' comments (13)

  • Vinci Ho

    This is an anti-bullying war which was started on the day when Agent Hunt said he was not picking a fight with GPs. He personally did not need to do that but all his guard dogs have been doing so well.

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  • Bob Hodges

    This could easily be tested - allow GP partners to buy and sell goodwill in their practices........

    My guess is that NOTHING would happen. The vast majority of practices are not 'worth' more than the liabilities and costs of winding up, proving that GP businesses are not operating in a commercially viable environment.

    I think that a large proportion of partners would 'sell up' and go salaried or locum if the they could sign over their financial liabilities, but the clamour of offers from the private sector is deafeningly quiet.

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  • It always struck me as legally dubious that partners are not allowed to sell good will when they are forced to take on all the risks and liabilities of a regular business. Is this compatible with normal European business practice? Perhaps this is something that could be tested in the law courts?

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  • simple solution, establish zones of viability.

    Gp partners should work and join practices around areas where a service can be maintained.

    There will be large areas without any service but will may get NHS England to wake up.

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  • Bob Hodges

    'The Zones of viability' theory has cropped up in my mental modelling of the 'domino collapse' scenario.

    'Islands in the stream'

    NHSE unfortunately lacks a Barbara Streisand.

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  • Are we beggars or are we a profession? What is happening beggars belief. These doctors are still working to the bone seeing 40+ patients in 12 + hour days and still going under. Down under they would be earning 200000 pounds. Even in Eire these doctors would be on 150000+. Here , in the UK, this arcane mathematical Carr- Hill formula has devised a fiendish system where lots of practices need bailed out by MPIG. It is time for the GPC to act for their profession instead of all this GP cares stuff. It seems ridiculous that funding goes down and down and our pay per consultation has halved in 10 years from a take home of £ 6 to £ 3 and we go around with Your GP cares. I think patients know we care deeply about them and the NHS. Such statements as Your GP cares make people believe we protest too much. It is time to change the Contract which can be imposed, so one- sided that it is no Contract at all. Or simply resign. Seeing extremely hard working colleagues go down makes my blood boil and it should the GPC's. How does the rest of the world manage without a NHS ?

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  • Cut clinics to match funding. Carry out other activities to maintain income, eg urgent care.

    This will secure the future of GP surgeries in the interim, whilst negotiations with nhse continue.

    I have partnered with a recruitment consultancy to deliver this.

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  • Isn't the Government's long game to privatise General Practice, piece by piece? To have GPs working for Virgin and co on a VERY different contract?

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  • If the government were serious about improving the NHS, where is the necessary activity to save our surgeries?

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