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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)

  • The whole proposal for scaling up is unscientific and poorly constructed. People who come up with these proposals should be sent back to training courses in health economics and business management. Scaling up in Primary Care and merging sites will not reduce the need for GPs. This will remain at a minimum of one GP per 1900 patients. To manage additional workload being imposed on GPs, we will not only need more GPs but also alternative workforce (such as Physicians Associates and Clinical Pharmacists). There is nothing in the current UK workforce development strategy that will build the required capacity of GPs and allied professionals in the next 7-10 years. Even staying in EU will not solve this problem. Meanwhile, our so called experts on transformation and change management will keep on bullying GPs and Practices to accept their new messy models and bringing chaos to the health care needs of the population. There is significant evidence that large practices have poor clinical outcomes as compared to small practices. Many in the health care system believe that the current policy of the government is to bring in disruption to the system and force privatisation on the back of failed GP led system.

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  • Is there any evidence that practices of this size are most efficient?
    How do you measure efficiency?

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  • Anonymous | GP Partner20 Sep 2016 12:20pm
    "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."

    Not baseless - Suggest you read the BMAs 'Future of General Practice Survey' from 2015 which states only 27% of salaried GPs and 29% of GP trainees want to become partners or contractors. Who's going to take on small GP practices if 70% of GPs aren't interested in that model of working??
    https://www.bma.org.uk/collective-voice/committees/general-practitioners-committee/gpc-surveys/future-of-general-practice

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  • Anonymous | GP Partner20 Sep 2016 4:16pm
    Is there any evidence that practices of this size are most efficient? How do you measure efficiency?

    Larger scale has the potential to sustain general practice through operational efficiency and standardised processes, maximising income, strengthening the workforce and deploying technology.

    http://www.nuffieldtrust.org.uk/publications/bigger-better-lessons-large-scale-general-practice

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  • @Anonymous | NHS Manager20 Sep 2016 5:17pm

    Yes, but it doesn't suit everyone does it? That's the point - if you're a thrusty business orientated city GP then go for it - fill yer boots - bigger is better, baby.

    If you're in a quiet rural practice you may prioritise other factors such as continuity, stress, patient satisfaction, logistics etc.

    It is not appropriate for group A to tell group B they are doing it all wrong and must change.

    Horses for courses, as they say.

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  • NHS Manager, I have just read the Nuffield link and the conclusion was;

    "In light of these findings, the authors argue that policy-makers and practitioners should be realistic in their expectations of the pace at which large-scale organisations can contribute to service transformation".

    I do think Jeremy has been brainwashing you.

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  • Re NHS manager's comments - perhaps the policy makers should ask themselves why this is the case and fix it instead of selecting stats to force through their own agenda. It's the management and other external elements that have changed, not the essential work.

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  • "learning areas with access to nutritionists"

    hahahahahahaha!

    All we need is a bunch of nutritionists to resolve the GP recruitment crisis.

    It just gets better

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  • absolute insanity purely imbecilic dogma to make short tern financial savings creating long term much higher costs in the system.
    no evidence base
    plenty of evidence moderate sized partnerships provide the highest quality most cost effective care
    much evidence that patients are EXTREMELY unhappy with poor continuity and personal care in large gp factories..and certainty patients will be FURIOUS if this proceeds without consent.

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  • logically why stop at 10,000 ?

    if u want scale - why not go to 65 million and base it in Manchester - i know who'd i'd volunteer to staff it.

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