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No practice to have fewer than 10,000 patients under radical local plans

Local commissioners are planning to ensure that no practice in North East London services fewer than 10,000-15,000 patients, and will be meeting with small practices who wish to remain independent.

NHS England and North and East London CCGs have said they expect GP numbers to reduce by a third over the next few years, and have set out radical plans to ensure general practice remains sustainable. 

As part of the plans, they will offer GPs ‘golden handshakes’ in a bid to alleviate the recruitment crisis, and offer funding to support the high cost of London living.

But they will also aim to ensure that all practices consolidate to cater for minimum list sizes of 10,000-15,000.

The proposals are part of its ‘Transforming Services Together’, which sets out how it will configure primary care over the next few years and will feed in to the wider region’s ‘sustainability and transformation plans’ - the secretive blueprints being drawn up by every region in England. 

The plan said:

  • GP practices should cater for 10,000-15,000 patients or be on the same site as other practices or work as part of a network of practices.
  • Primary care hubs for over 30,000 patients should have on-site minor surgery units, sexual health clinics, a greater range of test facilities, and learning areas with access to nutritionists.

The plan also addressed issues with GP workforce shortages, saying commissioners would:

  • Work with universities and other education providers to offer courses to qualify in new roles, e.g. physician associates and advanced nurse practitioners.
  • Encourage young people to work in the NHS by connecting with local schools and other education providers, as well as develop apprenticeships and internships.
  • Introduce flexible working options and financial incentives, which could include ‘golden hellos’ or ‘golden handcuffs’.
  • Support with the high cost of London living and transport; key-worker housing; bursaries or student loans to help fill hard-to-fill vacancies.

A spokesperson for the CCGs told Pulse: ’We hope that all GP practices will see the benefit of working in partnership with other practices. By joining forces GPs can offer better out of hours support, share knowledge and reduce back office costs.

’Their patients will be able to access services more quickly and at different places without going to hospital. Most practices are already working in this way. If small practices do not wish to work in this way we will seek to meet them in the first instance to understand their concerns.’

The plan said that by 2020 there would be 58 more pharmacists, 25 more physician associates, 49 more nurses and 46 more community health service staff working in surgeries in the area.

Dr Jackie Applebee, chair of Tower Hamlets LMC warned that failure to boost GP numbers in the area would badly impact on patient care

She said: ‘It is of great concern that the number of GPs across the TST area is projected to drop by up to a third while the population continues to rise rapidly. GPs are already struggling, due to lack of workforce, to provide the services that their patients need, such opposing changes in demographics.

’Decreased GP numbers on the one hand with an increasing population on the other is not sustainable. Simply relying on changing the skill mix will not address the problem and will adversely affect patient safety. There must be a concerted recruitment and retention initiative to avert crisis.’

Readers' comments (44)

  • and the reasoning is......??

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  • more flailing about in the lifeboat- come on - its time to eat the cabin boy

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  • The reasoning is that NHS London proposed that federation was the answer.

    This was some years ago and the question has been forgotten.

    But versions of federation are now the national answer to everything in general Practice. No matter what issue - mergers and federation and you see NHSE managers use terms such as 'working at scale'. Obviously trying in a rather pathetic way to draw a parallel towards 'economies of scale' found in manufacturing plants etc

    But the scary thing is that this is the aim of NHSE.

    The important thing to remember is that there is NO evidence that this improves care or reduces cost - probably does the opposite.

    This is an ideological mantra for NHSE

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  • accountants i have spoken to are reporting that these at scale federations are actually proving less profitable because of all the managers running around

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  • Change career. Only answer or retire. Worse is coming as the public get more disgruntled and complain.
    GMC visits for GPs will be yearly adventure.
    Good luck. I am leaving had enough

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  • I find it fascinating that we are all told to offer 'Choice'... but when the patients tell us, repeatedly, that they like small practices, suddenly the concept of 'choice' is nowhere to be seen.

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  • Choice is like "The free market","The weekend effect"etc, terms that are only used selectively when it suits politicians aims.

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  • "If small practices do not wish to work in this way we will seek to meet them in the first instance to understand their concerns"

    I find this sort of thing ominous and controlling. I am trying not to say Orwellian of course.

    How about "if small practices do not wish to work in this way then we will leave them the heck alone and let them get on with it and work to their own strengths and professional values"?

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  • Perhaps the other answer Anonymous GP Partner 11:44am is to leave them alone and just let them die out. The model of small independent practices ended with the last century. Its not sustainable and GP trainees have said they don't want it.

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  • NHS Manager 11:56 "Its not sustainable and GP trainees have said they don't want it".
    That's the sort of baseless bullshit that is managing us. My 5500 patient practice is one of the most cost effective practices in our CCG locality and we have had no problem replacing retiring partners or nurses in the last few years. So it is sustainable and GP trainees do want it.

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  • @Manager 1156:

    I wasn't necessarily saying I felt small practices were a good idea or a bad idea. My point is that it is for individual practices to decide what works for them and their patients, and to be allowed to keep their own house in order (as beautifully illustrated by GP Partner 1220). Interference is stressful and harmful. Support is good as long as it is a) optional and b) non-prejudicial. You should never set out to "support" someone to change their mind. That's not support, that's brainwashing.

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  • I have already left my partnership. I am salaried but ready to locum if even that gets too onerous.

    I have enough savings to fund a few years of gardening leave till I can take early retirement. Push me and I will go, along with quite a few others.

    When I left my partnership I wondered if I was doing the right thing, it seemed such a drastic leap. I now realise I was prescient in my action.

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  • The interesting thing will be how his will be funded.

    If it is a block contract - I would run a mile away. The costs will increase exponentially as he population get older and more demanding.

    This is where we are stuck at the moment - essentially a block contact for general practice - with ever increasing demand

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  • Shut down small practices so patients have to travel out of their community but if patients can't come out of area, then the friendly GP with a 'duty of care' will simply do a home visit across town....

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  • The crisis cannot be averted because there are not enough trainers.

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  • My view is that the drive is towards a fully salaried system. Even though the five year forward view is to move care into the community most of the work will be done by nurses paramedics and physician assistants with much more involvement of community pharmacists. The Family Doctor role will disappear into one of care co-ordinating and fire fighting demand.

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  • Vinci Ho

    We all know one plus one are two ; two plus two are not four , sometimes three , sometimes four , remember that ?
    Two practices merge together with more presumed 'efficiency' and hence total budget can be reduced even more . No new money, full stop. The old recurring question:where will the money saved go?

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  • We seem to have lost sight of the fact that the 4-5 GP/c.10k patient practice model is (was) actually very effective at managing usage. Not demand of course, that's almost impossible to manage. But when you know your patients and especially your high usage ones, you can help in ways that are just not open to the anonymous mega-practice style of medicine.
    Are the fabled economies of scale at best transitory and at worst a total mirage?

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  • 12:39 - Likewise, it felt courageous at the time, when I left. That was 2001. Never looked back.

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