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GPs go forth

More than one in ten GPs have closed their lists over the past year

Exclusive Relentless pressure on GP practices has led to more than one in ten GPs closing their list to new patients at some point over the past year, Pulse can reveal.

Some 12% of 508 GP partners responding to a recent Pulse survey said they had either formally or informally closed their patient list in the past year.

Further, several GPs who had not closed their lists said this was because NHS England or the CCG had declined their requests to do so.

GP leaders said the situation was 'depressing' but 'not surprising', given the pressure GPs are currently under.

Under the GP contract, practices can apply to NHS England to close their list temporarily but it is up to the area team, or co-commissioning CCG, to decide whether this can go ahead.

But as of last year practices can also legitimately take steps to 'temporarily halt' taking on new patients on an informal basis, if they face short-term problems providing adequate cover.

A Pulse investigation also revealed that area team managers refused almost a third of all requests from practices wishing to close their lists. 

Dr Rebecca Hardy, a GP in Calderdale whose list has been informally closed, said that in her 30 years in the job she has never faced this level of demand.

She said: 'We have been told we must continue to register patients even though we do not have enough staff in our team and are constantly relying on locum GPs and nurses. This has never happened at my practice before, but it is now the norm in the last 12 months.

'It is a distressing situation and prevents the continuity of care that is so important for our most vulnerable patients.'

Dr Zishan Syed, a GP in Maidstone, Kent, whose practice has also informally closed its list, said 'There are a huge number of houses [and] new accommodation being built in my area. It will be unsustainable to manage the increasing demands and numbers of patients unless something is done. 

’I can see no logical plan to help. Non-doctors to replace GPs as suggested by the Government are not a solution to this problem and might even worsen the problem and put patient safety at risk.'

A GP partner who wanted to remain anonymous said her practice has tried to close its list twice now, but was barred from doing so by the CCG.

She said: 'They didn't allow it - they said it would put too much pressure on neighbours. They offered no help, and told us we would be fine.

'Our list remains open although we have reapplied to close as three out of six partners are resigning over the next few months.

She added that the practice has now been classed as a 'vulnerable practice' by the CCG but suggested that 'a more supportive stance' at an earlier stage 'might have prevented this'.

Family Doctor Association chair Dr Peter Swinyard said: 'We are all under great pressure and we have the facility under our contracts to close lists if we cannot provide a service which is safe to those patients who are already on our list. That is the situation that many practices now find themselves in and that is very sad.'

He added: 'You don't rush off to NHS England saying "can I close my list" because you want to do less work, you do it if you're desperate.'

Dr Swinyard added that NHS England needed to offer support to practices if it was going to refuse a list closure request, or it was risking them having to close altogether.

The survey question in full

Has your list been closed at any point over the past 12 months?

Yes, formally: 25 (5%)

Yes, informally: 34 (7%)

No: 449 (88%)

Total respondents: 508

The survey was launched on 28 April 2016, collating responses using the SurveyMonkey tool. The 24 questions asked covered a wide range of GP topics, to avoid selection bias on one issue. The survey was advertised to readers via our website and email newsletter, with a prize draw for a Samsung HD TV as an incentive to complete the survey. A total of 508 GP partners answered this question.


Readers' comments (9)

  • the soln for this very simple, GPC need to co-ordinate removal of GP services from certain areas in a co-ordinated fashion. Allowing Drs to plan new lives and allowing those areas left to be handled by NHSE.
    Unfortunately the current drip drip does not cause even the slightest concern to NHSE.

    Because the New models of care is the absolute answer - even if they no idea what the question is!

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  • We have lost 2.8 wte partners from a total of 5.3 over the last 9 months. We informally 'capped' our list after 4 months and then applied for a formal list closure which was granted by our CCG for 6 months. (Their only other option was to accept our handing back the NHS contract - perhaps this is what other practices need to do!).
    We have been heavily reliant on 'expensive' locums but hopefully have now recruited replacement GPs after advertising continuously for 15 Months.
    My point is that by allowing us to close our list at a very 'troubled' time the CCG has saved itself from having to put our contract out to tender.

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  • Until all lists are closed - no investment will be forthcoming.

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  • Peter Swinyard

    NHS E seem to be able to go out to tender for new practices on an APMS contract which will cost them a fortune and do not invest in saving existing GMS practices which could cover the demand for far less investment. There is a curious disconnect here.

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  • What is the legal basis for practices "informally" closing their list?

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  • @ NHS Manager -12:16- What is the legality preventing GPs from 'informally' losing their lists if they cannot provide safe care to increasing number of patients?

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  • 'closing'

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  • Shouldn't the contract detail the maximum Patients per partner ??? If not then why not ?

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  • Mr hunt

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