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15% of GPs considering closing their lists within six months

Exclusive More than one in seven GP practices say they may have to turn new patients away over the next six months because they are facing unsustainable workload demands, according to a Pulse survey of grassroots GPs.

The survey of 493 also revealed that around 21% of practices are having to consider mergers - an increase on the 16% who said they were considering such a measure in November 2014.

GPs cited massive increases in patient numbers on a backdrop of a declining workforce for wanting to close their lists, with the rise in more complex care leading to concerns they can no longer deliver safe, quality care.

Pulse can also reveal that commissioners are also raising concerns about the numbers of practices looking to informally close their lists.

However, the numbers of practices thinking of taking other measures - including cutting clinical and administrative staff, and cutting down on routine appointments - decreased slightly.

The survey found 15% of respondents said they were considering applying for a temporary list closure in the next six months, with GPs in some cases fearing closure of nearby practices would force them to close their doors to avoid collapse of their own services.

The figure marks a distinct jump in planned list freezes since November last year, when one in 10 GPs said they were thinking about closing their practice list to cope with demand, and comes after a Pulse investigation revealed requests for temporary list freezes was growing year on year, with a 160% rise in requests over the past three years.

And while some pressures have stabilised slightly, notably concerns about staff cuts, one fifth of GPs still said they were considering cutting routine appointments and around 30% that they were looking at discontinuing clinical services.

GP leaders said the moves showed practices were under ‘extreme pressure’ and struggling to sustain workloads – and called for an ‘injection’ of resources to put practices back on a sustainable footing.

It comes as one health board in Scotland is launching a £1m rescue package for GP practices in an area where one in six practices has a closed patient list.    

One GP from Scotland, who did not want to be named, told Pulse his practice may soon have to close its list because of impending practice closures nearby.

The GP said: ‘Two neighbouring practices are possibly on the verge of collapse and if either did we would need to close our list to prevent becoming overwhelmed.’

Dr Krishna Kasaraneni, chair of the GPC education, training and workforce subcommittee and a GP in Sheffield, said his practice was looking at closing its list as the ‘last option’ available to deal with an ever increasing workload and the loss of several GPs over the past few years.

Dr Kasaraneni said: ‘The only way for use to sustain staying open is to say we can’t take any more patients. That is our last option now, we’ve tried everything else, we’ve tried our best to control our workload and this is the only option we’ve got left.’

Pulse has also learned several practices in the Birmingham area have applied to formally close their lists, while Birmingham Cross City CCG has reported that nursing residents were ‘routinely’ being turned away by practices.

Recent board papers from the CCG said there ‘have been widespread anecdotal reports of practices refusing new patient registrations on the basis that their list is full’ and that ‘this is routinely reported as an issue during nursing home assurance visits’.

NHS managers have already been clamping down on list freezes in some areas, with reports they have been increasingly blocking requests for temporary closure, and even threatening GPs with breach notices for informally closing their lists despite following correct protocol.

In a statement, Birmingham Cross City CCG said: ‘There are currently no practices in the NHS Birmingham CrossCity CCG area with closed practice lists. Three of our member practices have indicated their intention to ask to close their list, however we have not received any formal applications.

‘At our Primary Care Committee meeting on 12 August, it was agreed that the CCG would start a dialogue with practices to openly discuss issues around patient registration requests to enable a more detailed assessment of the extent of any issues. This would allow us to engage with our members to explore possible solutions.

‘We take the ability of our patients to register with primary care services very seriously and residents who are not registered with a GP practice are able to access a patient registration helpline.’

Survey results

Which of the following measures are you considering over the next six months?

Temporary list closure

Yes – 14.6%

No – 75.9%

Don’t know – 9.5%

Shrinking your practice list

Yes – 11.2%

No – 79.9%

Don’t know – 8.9%

Cutting staff hours

Yes – 17.0%

No – 71.2%

Don’t know –11.8%

Cutting routine appointments

Yes – 21.1%

No –  66.3%

Don’t know – 12.6%

Discontinuing clinical services

Yes – 28.2%

No –  59.2%

Don’t know – 12.6%

Redundancies of clinical staff

Yes – 7.5%

No –  83.2%  

Don’t know – 9.3%

Redundancies of administrative staff

Yes – 11.2%

No –  76.9%    

Don’t know –12.0%

A merger with another practice

Yes – 20.7%

No –   67.1%

Don’t know – 12.2%

Federating with another practice

Yes – 45.6%

No – 41.2% 

Don’t know –13.2%

Closure

Yes – 3.7%

No – 90.1%

Don’t know – 6.3%

The survey was launched on 9 June 2015, collating responses using the SurveyMonkey tool. The 34 questions asked covered a wide range of GP topics, to avoid selection bias on one issue. The survey was advertised to readers via our website and email newsletter, with a prize drawer for a Samsung HD TV as an incentive to complete the survey. A total of 493 GPs answered this question.

 

Readers' comments (16)

  • The collapse continues

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  • Hard to assess the evidence on this, as to what the threshold for reporting was for these practices, and whether it represents a change from previous years (other than Nov 14) to show a long term increase.

    However - The key issue here is surely that there is no plan anywhere in the system for dealing with this.

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  • good thing that i have private medical insurance

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  • Resistance rather than collapse? Public and politicians only going to take notice when forced to do so, ie when patients unable to find GP with open list. We are about at our limit and struggling to maintain the service that our patients expect and that we want to give. Further expansion without more doctors would just leave us facing more complaints about waiting times, at risk of making errors or cutting corners due to over-work and coping with the backlash just to protect the NHS, in the short term, from current policies that have resulted in an increase in work and a shortage of GPs. Nursing home and other housebound patients in particular often require much more time than is reflected in the capitation fee yet there is no premium paid that might allow us to fund more medical time. From the patients' perspective the practice tends to be the focus of blame/complaint when things are not as they were and we can no longer do as we did. As GPs, we need to protect the quality of care given and strive for better rather than diluting it. Perhaps we could establish ideal and maximum safe weighted list sizes per full-time GP as a starting point.

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  • There has never been a time since the start of the NHS when it has ever become this bad.

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  • Bring back the payment per doctor that was previously received by practices as a guarantee of income for growing, and you will solve this. At present, there is no incentive to grow a list or to expand your team.

    The alternative is a minimum 'salary' allowance per acceptable list size (perhaps 1500-2000) to ensure that the staffing is safe and there is a sustainable model. surely this would be a better step.

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  • We are doomed.

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  • Oi - you 15% - stop considering and do it. NHS England would have a long deserved freak out if they opened their mail on Monday to find an avalanche of "stick it up your trumpet" notices. Surely the first step to dealing with a flood is to turn off the stopcock?

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  • It would be better to have a maximum number of patients per clinician say 1800. If new patients come into the area either the practice take these on with a increase in funding/GP or you open another medical centre to cope with the demand. I do not understand why current practices need to take on more patients without adding to their workforce. More practices should be closing their lists and sending the patients to their MP to sort the mess out. Unfortunately there is no new money anyway hence the predicament we are in at the moment!

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  • It is because GPC do not truly speak on our behalf. As Independent Contractors, we should have the unalienable right, without any clause to close list size for safety. When I wish to close my list for safety I should be able to do freely. I cannot at the moment.
    As long as GPs continue to have open lists, we will all face misery. It is time to pull this rabbit out of the hat, GPC.

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