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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)

  • 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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