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GP surgery numbers to be cut as part of major plans around sustainability

Local areas are proposing to reduce GP surgery numbers as part of significant long-term plans to make savings, it has emerged.

A  campaign group has uncovered a number of Sustainability and Transformation Plans (STPs) - the blueprints for how services are going to be provided in 44 areas across England -  which detail plans for the future of general practice.

One area is proposing to reduce the numbers of GP practices, claiming that the current set-up will ''will over-stretch... workforce and finances', while another is planning to cut GP workload by a third and significantly reducing patients' face-to-face contact with primary care.

This month, Pulse reported that GPs were being 'excluded' from discussions over the plans, and in some instances have not even had sight of them before publication next month.

An investigation by campaign group 38 Degrees into the 44 Sustainability and Transformation Plans (STPs) uncovered plans across the country.

They reveal a number of proposals specifically targeting general practice, including:

  • In Dorset, a plan for the sustainability of the local NHS suggests that a current 98 GP practices, operating at 135 sites, 'will over-stretch' local 'workforce and finances'. It suggests that a 'reduction in the number of sites' would lead to a better provision of services 'for more hours of the day and days of the week';
  • In Hampshire and Isle of Wight, commissioners are planning to to make general practice more sustainable by cutting GP workload by almost a third, while also significantly reducing patients' face-to-face contact with primary care.

NHS England, which has asked all areas what is their 'plan for sustainable general practice and wider primary care', said plans were not going to be put into action without 'local engagement'.

It comes as Pulse revealed earlier this month that grassroots GPs have been left largely in the dark throughout the first six months of the planning process but NHS England said it would not approve any plan that does not support general practice. NHS England has said the plans will be finalised then published in full by October.

The STP for Dorset, seen by Pulse, said: 'Our analysis work to date suggests that the current 98 GP practices delivering care in 135 sites will over-stretch our workforce and finances, and that a reduction in the number of sites would allow more services to be consistently delivered across the county for more hours of the day and days of the week…

'Our planned expanded integrated teams could deliver more and better services from a fewer number of sites than the 13 community hospitals with beds and 135 primary care sites that currently operate across Dorset.'

It added that an 'integrated care hub' - which covers nine GP practices and 74,000 patients, and operates 8am to 6pm - has the 'potential to act as a blueprint for the rest of Dorset'.

Wessex LMC chief executive Dr Nigel Watson said: 'It is a natural evolution as practices are merging and working together. We would be opposed to it if it were a requirement but where it is supporting practices working at scale then it is fine, and that is what is happening.'

The Hampshire and Isle of Wight STP, also seen by Pulse, said: 'Collective primary care working will ensure that citizens will have access to on-the-day support and advice, and 40% of primary care issues will be resolved remotely.'

It also plans to 'reduce 30% of the activity that is currently done in general practice to free up GPs to focus on the highest impact interventions, such as upskilling GPs with new specialist skills to better manage care in the community'.

This will include 'learning from the commercial sector' to 'identify and stop processes and activities that do not add value to the citizen instead providing alternative digital solutions (largely self-service) to enable people to self-manage and self-care'.

NHS England said in a statement: 'No changes to the services people currently receive will be made without local engagement and, where required, consultation. There are longstanding assurance processes in place to make sure this happens.'

What are STPs?

At the end of last year, NHS England tasked regional teams, CCGs, trusts and local authorities with forming regional footprints, and then write plans for how the NHS Five Year Forward View would be delivered within them.

By January, 44 footprints were formed, and by 30 June each had submitted its first draft Sustainability and Transformation Plan (STP) to NHS England.

As previously reported by Pulse, each plan has to adress ‘sustainability and quality’ of general practice, including both ’workforce and workload issues’.

At the time, NHS England chief executive Simon Stevens said: ’This guidance sets out the next steps to make the vision set out in the Five Year Forward View a reality.

'A new approach to how local NHS leaders plan to meet health needs across whole areas will sit alongside the new Sustainability and Transformation Fund established as part of our £560bn funding plan for the NHS.'

 

Readers' comments (40)

  • '40% of primary care issues will be resolved remotely.' 'learning from the commercial sector' to 'identify and stop processes and activities that do not add value to the citizen instead providing alternative digital solutions (largely self-service) to enable people to self-manage and self-care'.

    Were these ideas put forward by a GP or by a no-win-no-fee lawyer?

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  • Yeah, because we all love those self-service tills where if you have more than half a dozen items you have to balance them on that tiny counter and then have to wait for someone because you have stupidly scanned something alcoholic ( or so a friend tells me) - where will it all end?

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  • NHS England said in a statement: 'No changes to the services people currently receive will be made without local engagement and, where required, consultation. There are longstanding assurance processes in place to make sure this happens.' We all know what engagement and consultation means don't we - basically they will meet stakeholders and tell they get what they are given - we need to all alert our patient groups to act on this if they are to keep their Practices running

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  • No secret there that the plan is privatization and total annihilation of small practices as a bigger chunk will attract big Corpos who wish capitalize on the demise of NHS.
    It is flawed thinking that we should learn from the commercial sector as health services are always non-profit and require government subsidy. Corporations will tear the system apart to squeeze out any profits that can be made and that will spell doom and gloom for the ordinary sick populace.
    No country runs a profit-making Healthcare system.
    This talk of sustainability is a guise to sell out to the fat cats who would not venture into a doomed jungle if there was no lure of smoking venison.

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  • DH are doing this to pharmacy as well. Plan is to close up to a quarter of English pharmacies as there are too many, too close together. Despite pharmacy being the only healthcare profession that contradicts the inverse care law - areas with lots of pharmacies are the most deprived ones.

    I suspect this has nothing to do with DH but that they've been told by the Treasury that they must save 'x' amount and they've always seen pharmacy as an easy target.

    What they didn't expect was over 2m people signing the PSNC/NPA petition backing the services their local pharmacies deliver. Usual short term (i.e. no longer than five years) thinking by government. Something like "Let's save money now and worry about any fallout later. When we're hopefully not in power..."

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  • "NHS England said it would not approve any plan that does not support general practice."

    "When I use a word it means what I choose it to mean" - we truly are in Looking Glass land now

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  • Vinci Ho

    Right winged mentality to handle a public service. Except, the difference in a commercial sector , it is about sustaining profit . Here it is about sustaining 'survival' merely because the government would not invest new money into health and care because they do not generate incomes for the government in a system of social medicine accordingly .
    Remember the original Robocop film( not the rubbblish remake two years ago) played by Peter Weller(1987) and its setting of the story:
    ''In the near future, Detroit, Michigan is a dystopia and on the verge of total collapse due to financial ruin and a high crime rate. The mayor signs a deal with the mega-corporation Omni Consumer Products (OCP), giving it complete control of the underfunded Detroit Police Department. In exchange, OCP will be allowed to turn the run-down sections of Detroit into a high-end utopia called "Delta City", which will function as an independent city-state free of the United States.''

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  • ALL THAT THESE SO CALLED HUBS DO IS CREATE ANOTHER ACCESS POINT ! IT WOULD BE FAR BETTER TO INVEST THE ENORMNOUS AMOUNTS OF MONEY FOR THESE PROJECTS INTO EXISITING PRIMARY CARE AND LET THE SURGERIES AND DOCTORS MANAGE DEMAND THE BEST WAY FOR THERE OWN POPULATIONS. wE HAVE A SHORTAGE OF SKILLED MEDICS THAT IS NURSES AND DOCTORS ALREADY, WHERE ARE THEY GOING TO FIND TIME TO STAFF YET ANOTHER ACCESS POINT !

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  • I've just been told what NHS really stands for: NO HEALTH SERVICE!!! Gulp!!

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  • The sooner the small practices get closed the better. The small practices have become places where maximum abuse of General Practice takes place - most of which have become family run businesses where relatives of GP are Practice Managers and where most clinic just run by locums and thereby compromising care to patients.

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  • So - increased demand met with reduced access to a GP, reduced practices and less spending.

    This isn't a plan, it is a situation report from the front line of general practice in 2016.

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  • 4:53 Anon: If you know of such a Practice please speak up as you are putting patients at risk by not naming. You become a partner in crime by hiding behind an anon and disclosing something that should be out in public interest.

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  • Small practices ,offer far better continuity of care ,are better liked by patients and consistently score higher on any criteria you wish to measure.This i'm sure is not to do with better doctors ,just that patients know who their doctors are and visa versa.
    In fact they rate so much higher than these large practices(supposedly the future)it is a compelling argument to suggest all general practice should be in partnerships of no bigger than 4 doctors!!

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  • I visit Practices in a large part of the country, and the footprint of most is little changed from 1949.City centres often contain several small Practices in close proximity,indeed I saw one the other day that was separated from the next door Practice by a brick wall following a dispute between Partners years ago. I also see large modern purpose-built premises where several small Practices retain their identity but benefit from management costs at scale.If we can move on from the infantile drivel about privatisation(not least because most of us are private contractors to the NHS)we should have the humility to acknowledge that the clock has not stopped at 1949 and perhaps there may be alternative ways of working.

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  • Sanjeev 12.19pm
    "No country runs a profit-making Healthcare system."
    I think you are wrong: isn't this the USA model so beloved by Conservative governments?

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  • Anonymous | Sessional/Locum GP31 Aug 2016 7:33pm

    GP's are not really private contractors. its a single monopoly relationship - private contractors have some degrees of freedom - unlike GP's

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  • Agree
    Absurd to say GPS are private contractors
    This is pure management speak BS lying to pretend real cuts have a plan
    They don't
    When do they propose this unelected quango NHSE to ask the voters ?

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  • STP stands for Slash,( the budget),Trash, (the services) and Privatise.

    Our only hope lies in the NHS Reinstatement Bill, due it's second reading in Parliament on 4th November. Please look up the details, online, and also join 'Keep our NHS Public' and 'Health Campaigns Together'. Health professionals, allied health workers and the public, MUST all join forces and stop this undemocratic and blatant dismantling of the NHS.
    It's not too late but we have to do it together.

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  • @Mary Hawkings: I wouldn't compare this with the profit making American system which is driven by insurances. We are talking of a state run NHS here and people with insurance in UK actually do not use the NHS unless their insurer gives them a bonus to do so.

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  • Conservatives love the American system because they are pushing for an insurance fed system. We do know however, that not everybody can afford insurance and Americans do have a problem with great numbers who can't access health services. This was the case prior to Obama care but I believe there are still some who cannot get the care they need. Do we need to emulate everything the Americans do?

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