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GPs go forth

Managers in crisis talks as GP practices across whole town close their lists

Exclusive GP practices across an entire town have stopped registering new patients because of recruitment problems, leaving the CCG to call an urgent meeting with the last practice to close its list.

GP lists at two of the three surgeries in Hessle, Humberside, are formally closed with NHS England’s approval until January and March 2017.

Pulse understands that the third and final practice, Park View Surgery, is also now not registering new patients.

NHS East Riding of Yorkshire CCG said it had called an urgent meeting with the practice team this week to discuss their situation.

The Park View Surgery confirmed to Pulse it was no longer registering new patients but its management team was not available for comment on the planned CCG meeting.

Dr Margaret Lovett, a GP partner at one of the other two practices in Hessle, the Peeler House Surgery, said it closed its patient list in March.

According to Dr Lovett, the town has had an influx of people moving into the area due to new housing developments but that GP practices cannot recruit GPs and staff to meet the new demand.

She said: 'We were getting 30 or 40 new patients a week, [but] you can’t keep accepting people – you can manage a certain list size. NHS England points out you get more money for those patients, but it’s no good having the money if you can’t recruit anybody.'

The practice recently moved to larger premises because its former surgery had just one consulting room, and immediately saw its list size jump more than 20% – with patients leaving other practices due to access issues.

Dr Lovett said: 'Because of difficulties at the other practices, we were also getting quite a few patients from the other practices who were saying they wanted to leave because of the difficulties getting appointments.'

NHS East Riding of Yorkshire CCG, which co-commissions general practice with NHS England, said Hessle was not the only town in the area where practices are struggling to meet patient demand.

Chief officer Jane Hawkward said that out of the 36 GP practices in the CCG area, there are 'a number who are currently not accepting new patients'.

She said: 'In partnership with NHS England we are working intensively with these practices to review and accelerate implementation of their action plans to get them out of their closed status.

'There are areas in East Riding of Yorkshire where we are struggling to recruit GPs and this reflects the national difficulty with recruitment and retention.’

She added that helping practices to become training practices was one of the measures the CCG has taken 'to assist with attracting GPs into the area and improve workforce capacity and capability'. To date she said this 'has been successful in one practice which has attracted both GPs, nursing and management staff too'.

Local GP leaders told Pulse that the situation in Hessle was causing NHS England managers ‘headaches’ as it means they are forced to try to allocate patients further away.

GPC representative for the area Dr Andrew Green said the situation was testament to the growing pressures on general practice, as it was ‘not traditionally part of the area which is hard to recruit to',

He told Pulse: 'GPs in East Riding, like everywhere, are struggling with workload. Many are looking at the workload they’ve got and deciding that for patient safety reasons they have to close their list.

'I actually think the ability to close your list is an essential part of the contract, it enables people to concentrate on giving care to the patients they’ve got.’

'If the more pleasant parts of our area are having difficulties then it’s a very bad sign for other areas.’

List closure fallouts

With NHS England’s pledged £56 million resilience fund seemingly a long way off, practices have few options for controlling their workload in the short term.

Pulse reported back in 2014 that list closure requests had surged by 160% amid pressures.

Pulse blogger Dr Hadrian Moss revealed last year that his practice had ‘informally’ closed their lists after it was highlighted in GPC guidance on managing workload pressures.

Though the process is contractually allowed, Pulse revealed that NHS England had threatened the practice with breach of contract when it first found out.

The dispute even reached Parliament with health ministers drawn into investigate before NHS England finally conceded that lists could be closed ‘unilaterally’ in urgent circumstances.

 

Readers' comments (50)

  • Extra money in the system wont help if you keep trying to deliver care in the same way it was 50 years ago? This would be a good example of where 3 practices could look at merging to become stronger and share resources. I bet they have three lots of admin teams, three practice managers, three sets of receptionist taking calls. Have they tried using pharmacists? Advanced Nurse Practitioners? Physicians Associates? Other roles to take some of the non clinical work away from the GPs? Have they looked at paramedic led urgent clinics, or triage? have they tried educating their patients about appropriate use of services? What are they offering potential new recruits that makes them different or more attractive than every other GP practice?

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  • Stop whingeing folks.Just find a job in the constituency of Beverley and Holderness.Apparently it's the best place to be a GP.Far more convenient than heading off to Australia:

    http://www.pulsetoday.co.uk/home/finance-and-practice-life-news/revealed-the-only-region-in-britain-where-gp-workload-is-manageable/20032070.article

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  • The implication of this is that GP partners do not need to take the huge risks involved in handing in their collective resignations.

    Just resisting any pressures to increase your list size to a dangerous level will achieve far more and 'make it all the governments problem rather than ours'. Let them stew - rather than leap into the pot with them.

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  • 1:28 NHS Manager - Those measures (though laudable textbook MBA stuff) do not provide a definitive cure. Sticking plasters on a fracture. At best, they might give you a blip on the exponential curve of rising demand and cost. Just enough to win an election but not enough to sustain a system of healthcare. Crucially, you will have lost the personal touch that patients rightly value so much. Can't afford that? Then let's go public with that debate!
    Or we could just vacilate between "Centralise & release efficiencies of scale!" and "Decentralise with local responsiveness!" - ad infinitum.

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  • Perhaps the doctors on the CCG would be better seeing patients?

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  • 2:11 Consultant - Don't be ridiculous!
    Don't you know that CCG / CQC / Appraisal / GMC / LMC et al are ideal vehicles to get out of the trenches and criticise / command the troops who are still neck-deep in muck and bullets? ;-)

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  • 2.17. Exactly. Must be quite a few extra battalions and quid there.

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  • From NHS Choices, the other two practices - with lists already closed - had list sizes of 2208 & 12981 compared to Park View's 4112.
    According to the article, the problem appears to have been caused as much by an influx of new patients due to housing developments - and it sounds as though the failure to recruit GPs & staff is not following retirements.
    General question: when massive new housing developments are planned, what provision is made for the necessary coresponding increase in GP facilities?
    PCTs used to support new peactices until they became viable: what happens now?

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  • T Roscoe

    Large areas of Sheffield are struggling, many practices are a man down and unexpected sickness can destabilize. I would not be suprised if this happened here soon. Locum rates are nudging £100/hr if you include pension payments

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  • But there was this headline......Revealed: The only region in Britain where GP workload is 'manageable'

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