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A faulty production line

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)

  • I feel sorry for the small practices - the days are now over where wife / uncle / aunty can no longer be Practice Managers of their cottage industry.

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  • "Larger scale has the potential to sustain general practice through operational efficiency and standardised processes, maximising income, strengthening the workforce and deploying technology."
    NHS Manager - Amazing that you can trot this out. Would you like to be treated with operational efficiency and standardised processes? Really?
    In addition, if you'd worked for long enough in a commercial environment, you'd know that these merger efficiencies often do not materialise. Not least because larger entities require more managers and overhead cost.
    I shudder to think how you will react when you or your loved one is treated with a standardised process.

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  • How is going into schools going to help recruitment into the NHS? We can't recruit as conditions are horrendous and will only worsen. The junior doctors dispute is evidence of this.

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  • My MBA thesis covered the culture of GP practices . This has continued to interest me. Gold award to any CCG that can change this key item in any federation.
    If self interest and higher profits drive big practices, this is also the case in small practices..I would love to see sharing caring when 2 partnerships have always competed and by some slagging .

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  • Joe Mcgilligan | GP Partner20 Sep 2016 1:39pm

    That is certainly what NHSE see as the future.

    But it is unlikely to happen - even very good NP's and PA's struggle with simple medical cases.

    The medical legal cost goes up exponentially - at the moment solicitors have not targeted mistakes by nurses as there is always a supervising doctor on paper. If that changes which it will then any mistake will get legal minds asking - why wasn't more expert opinion sought immediately.

    Get the first PA or nurse being sued aand the whole construct will disappear.

    One of the pioneer practices for Nurses practitioner has now stopped using them after working out they were more expensive per patient seen!

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  • So our Governments which have always gone on about choice is now limiting our choice to large group practices and gone is the choice of registering with single or dual GP practices. I, in Worthing, registered with the nearest surgery which had two GPs and the local Clinical Commissioning Group (CCG) has since closed it down and told me to register elsewhere so I registered with the next nearest practice which has about 8 doctors although I have been given a particular named doctor whom I have not yet met. I asked the CCG why they closed down my nearest 2 GP practice but they have not replied so their much vaunted public engagement strategy is in tatters. They said in their invitation to register elsewhere that they had no choice but that is not an explanation. I want to know whether the list of patients was too small to attract applicants to take on the practice or whether there was no hope of finding any replacement GPs or whether they were so incompetent they did not know how to advertise for replacement GPs. If the UK is failing to recruit and train GPs (thus ruining a profession which was largely self replacing) then the CGG must advertise in the EU Medical Journals to attract a wider pool of applicants. But they must hurry because we, due to nonsense, fibs and ignorance, are going to leave the EU so that avenue for recruiting and training GPs is going to be closed off. I would abolish the commissioning function of the NHS for its incompetence in practical, clinical, and commercial matters: they could hardly run a piss-up in a Brewery and have not, despite garnering an increasing share of the NHS budget, benefitted the patient or the NHS or the taxpayer.

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  • 12.20
    Our 6000 patients rated us higher than most practices. We are most cost effective and perform better than most in other measures
    We had no issue recruiting.
    In fact locums say it is awful in the large practices

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  • History of general practice shows poor quality care in large health centres ..some small practices are bad but that is inner city issues and poor training

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  • It's the number of patients per GP that is important, not the size of the practice. The "ideal" list size used to be 1500 and should now be lower given the amount and complexity of illness being managed in primary care. We are currently 1900 and rising.

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  • Practice manager; 3:16
    Well said
    I think we are missing the point here
    Not only do we need more GPs, which is not achieved by merging practices, we also need the same if not more management
    As a population gets older and more complex the administration to manage their care gets more onerous and complex... Reducing management is a false economy in primary care. Not only that the only solution to reducing management costs is to reduce the demand on management in reports, and submissions and claims and.... The rest

    Let's not forget the statement " that we are preparing for a reduction in GPs by a third"
    And also let's not forget the other pulse article where a surgery of 18000 shut down as they were unable to recruit GPs... Not management as I understood

    So the bottom line is that the only solution, prior to how you strategically place practices ( regardless of size), is the training, recruitment, retention and recognition of GPs. Value, support, recognition, positive personalised supervision, personal health support (physical and mental), lifelong accessible/personalised training, career progression, the list goes on and on....

    Primary care is bleeding and the wounds are wide.... I know what a surgeon would say. You are going to die unless is stop the bleeding and close the wounds......

    My heart goes out to all battling in primary care and the wider NHS....
    Good luck wherever you are. The public needs us more and increasingly every day....


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