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A faulty production line

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)

  • 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 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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  • 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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