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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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  • It has already happened here in Worthing, and in Brighton. My local two-doctor surgery has been closed and we patients were invited to register at another practice so I have registered at a large multi GP Group Practice further down the road. I asked the clinical commissioning group why they were closing my local surgery down but they never replied, when I thought they had a public engagement strategy. In Brighton I have observed several small GP practices being closed after the commissioner attempted to keep them open by using a private contractor when there is no reason why a private firm should succeed any better than an NHS GP would with a small list practice income and these GP practices had lists of around 1,000 patients which I always understood was insufficient for a GP to make a good living. Such practices may be best as branch surgeries
    of main practices but one needs to offer the main practice inducements such as more finance for an additional partner and some attractive premises surely and the commissioner had found no main practice interested in taking on these small list practices in isolated pockets of outlying populations in Brighton. The commissioner shall have to try harder with attractive inducements or a more useful re-organisation of practices and locations. One declared problem in one part of Brighton was a population of less well-off and elderly folk without cars and therefore not able to travel further distances if the local GP practice was closed. It was closed and I don't yet know how this local population is coping.

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  • Response to 31 Aug 2016 4:53pm.
    Large=good? Our local virgin group functions on locums and some doctors don't see patients as is the local huge super surgery run by corporation docs who do not see patients but are experts and they know best. Part of having small practices is being closer to patients and more continuity unlike being in a hospital which sounds like what you are aiming for.

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  • Staff numbers vs patient numbers and work load is what counts plus the funding, not all the fancy innovations to blind and confuse people.

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  • The comments made by locum on 31/8 @ 7.33 are well made and unanswered by comments to date we're trying to preserve general practice in aspic and responding with the mantra give me more money and leave me alone, too often seen on this site, are insufficient to deal maturily with the problem

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  • In Dorset most branches serve many patients ,enough to say meet needs of 3000 patients.
    Why did they not close a list of 1800 in a mess ?
    Patient consultation.
    If the CCG and NHS plan to wreck years of work at the branches ,they will only push patients to large practices with high income and not really loved by those around..proceeds not heal as tesco tills

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  • Can you explain the story for Dorset in detail.
    You mention this...my first inkling and I work there
    McKinsey at over £2m gave some worrying ideas, but it will cost much more in the long term. Dorset CCG have to explain to the practices and people how they will save secondary care spending.
    So many complaints and so many cancelled appts all dumped on gps to defend colleagues under strain in hospitals, never mind staff morale

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  • 4.43
    You could be right report them to CCG cqc gmc and NHS
    You are not very bright using this forum for such a serious finding.
    Can you show evidence please
    Is it possible to review your generalisations

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  • It may that commissioners wish to reduce the number of GP Practices in order to pay for additional care and nursing home beds under this Sustainability and Transformation Plan. My local GP practice has been closed down (the commissioner offered no explanation when I asked why, so much for their public engagement strategy) and so I have had to register at a large group practice further down the road.

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  • Ah...so that is how they will spin the loss of local services and popular-with-patients small practices driven out of existence - it's all the sustainability plan for "better provision of services".

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  • I find the the 4.53 pm comment very offensive. I have worked in both a large practice and small practice and small practices offer continuity of care. The practices in our ccgs with the highest satisfaction rating from patients are small practices. As for practice managers, regardless of whether they are related to the GP or not, they work incredibly hard to keep things together, sacrificing their weekends. Sadly, their work goes unrecognised.
    Reducing the number of practices is a step backwards rather than forwards, leading to loss of continuity of care and fragmentation. Has the plans been discussed with patients??

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  • So sustainability means cuts?
    DOH outdoes the ministry of truth in their mendacious mangling of the English language
    We need radical slashing of the NHSE bureaucracy and their blue sky BS plus destruction of the internal market pfi and multiple failed privatisations and outsourcings wasting 20 or more billion a year
    Their grotesque waste and incompetence has and continues to cause immense patient suffering
    The nation cannot afford this insanity a nanosecond longer

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  • If this goes through I feel the only ethical action is mass GP resignation from CCGs to bring the whole failed sick English NHSE and its secretive acolytes down which has scant public support
    Further simple Simon should resign rather than admister such a deeply unethical programme due to deliberate NHS underfunding and knowing waste on ideological claptrap like internal market pfi and outsourcings the latter of which have frequently collapsed in expensive wasteful disaster
    Yet these blind delusional ideological people continue down the same imbecilic cul de sac for which as well as being sacked for the real patient harm they are causing should be in court
    Certainly this will not happen in my name

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  • So no useful replies .....come on
    First what cheek to say all small practices are not up to the job
    Secondly ..what are the Dorset plans in more detail
    Beware they spent a lot on Darzi centres £600 per patient in Weymouth

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  • Mass resignation and you are handing the primary care on plate to beurocrates. Do they really care about the patients?
    Impersonal care, apathy and how they going to really manage care with Pointing a finger and
    'it's not me gov' attitude. I have seen in my area, emphasis given on cutting antibiotics and pt goes to A/E or OOH and comes with you guessed it antibiotics
    Still co codamol handed to pts like smarties. Some practices struggle to convince new pts that they are being handed sweetes they don't need.
    You know who know who doesn't get punished. I am not saying smaller practices do better but they at least try to give personal care NHS claiming to aim to achieve.
    NHS does not need "real" doctors, Dr Google will do the job. In case you missed it, it's a sarcastic comment. Please God, save the NHS by doing brain transplant to these beurocrates. God Save the Queen and God save patients from these morons in NHS. My heart bleeds!!!!!!

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  • Ours is a small practice Partners came and went sighting overwork. Locums earning £600/day moaned the same song. And they were the worst prescribers and we were picking the pieces
    But there are Drs who looked for the job satisfaction
    Now we recruited a doctor who will eventually take over and the doctor came from locum sector taking the income drop for job satisfaction. She wants to do 'medicine' and not handing our prescription so sending the referrals just to have easy time.
    So stop using small practices to criticise. Many big practices are the worse offenders. And those are the GPs have time to go on committees, they don't have time for being a real GP. I am not saying it's universal and do practice bashing as some are doing to small practices. For God's sake, get heads together, stop bickering and do something constructive to the service which still envy of other countries. As they say Once it's gone, it's gone.....

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  • 4.43
    Great comment and should have included large practices have partners on £500,000 exploit nurses and women gps
    And there is no continuity .Remnds me of tesco self service
    Small practices at least know their patients .i don't know if they are all family ,but the Hippocratic oath does demand you try.

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  • 4.53
    You are right
    Shame your family were not up to the job
    Most businesses use family in the world
    A good choice would be to go to Cambridge
    Maybe an MBA
    Then employ them

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  • Shame on Dorset CCG
    They have not communicated this plan
    Shame on other CCG s that plan a cut of a third of gps
    They should look at secondary care performance wasting resourses

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  • Even these ignorant managers can see tesco and Sainsburys going local
    Big is for rich managers exploiting young females small is for individual efficient care

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  • I have worked singlehanded ,in large practices and now in a 3 dr plus excellent nurse practitioner over 32 years since I qualified and feel my current practice offers both personalised healthcare and best balance for gps - we are forward thinking and constantly try to streamline services for our patients and for staff , including gp's. we realise that the model of patients booking to see gps is outdated and unsustainable , paramedical staff have the skills to deal with a lot of what come our way both effectively, safely and cheaper. Gps should recocognise this and be prepared to be consultants in primary care for the complex cases and those referred up from their colleagues who they cannot deal with. We shouldn't see urti, simple chest infections,warts etc - these cases should rarely require the specialised and expensive expertise of a gp - forget what has gone before - it's a bygone and wasteful era - with proper integration and better systems management we can provide a good service with fewer gps dealing with complex cases with 15-20 minute appointments as long as the 'lesser' cases are dealt with by staff more appropriate to their illnesses be it nurses, hca's with appropriate training and watertight protocols, physician assistants, Psychological counsellors, pharmacy assistants etc - -The ability for smaller practices to share such skills would be paramount to make it work so not every practice needs everyone full time but the practitioners could be full time over 2-4 likeminded practices. It's the only way to survive and give gps control back with the inexorable demand and make this honourable profession attractive to our junior colleagues.

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