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Practices bid to close patient lists as LAT seeks to relocate patients from 'unviable' APMS practice

Exclusive Three GP practices have applied to close their patient lists and others are considering following suit after the imminent closure of a ‘financially unviable’ APMS practice forced a local area team to relocate almost 1,500 patients.

Brambles Surgery in Brentwood, Essex – which is run by Malling Health - is set to close at the end of next month, after declaring its APMS contract was no longer financially viable. Essex local area team is in the process of finding new practices for the surgery’s 1,495 registered patients.

But GPs in Brentwood fear that they will also struggle to provide care for the extra patients on current funding levels, and are fighting the move. Three practices have already submitted an application to close their lists, and Pulse understands the remaining five practices are also set to apply. Essex LMC told Pulse it has advised practices not to take on the Brambles patients unless the LAT agrees to provide additional resources over and above the standard per patient funding.

Dr Brian Balmer, chair of Essex LMC and a member of GPC, said the LMC was ‘not very impressed’ with the behaviour of the LAT.

He said: ‘The company that was running it said that on this pricing it is unviable so they have correctly decided to pull out. They are behaving like a company should do, but the LAT is not expecting other practices to act like this.

He added that the LMC was advising practices to consider whether they can take on any more patients. He said: ‘Three practices in the area have applied to close their list. We are asking them all to consider how they will provide patient care.’

Another GP in Brentwood, who asked not to be named, confirmed the other practices were set to join the three who have already applied for their patient lists to be closed.

Dr Tom Reichhelm, medical director for Malling Health, told Pulse: ‘It is tragic. We have tried to make it work but the funding is just not sufficient. That is a widespread problem - general practice is being squeezed and we had not other choice than to give notice.’

Dr Chaand Nagpaul, GPC chair, said the situation in Essex showed the risks involved with commissioning issuing APMS contracts.

He said: ‘This represents the real risks of tendering out GP contracts to commercial contracts for fixed term arrangements and many of these contracts have been won on the basis they are commercially viable prospect for providers.

‘Given the current workload pressures, it is not appropriate for GP practices to absorb a huge sudden increase in their patient list size and we really do need to find a more manageable approach to such events.’

In a response to an FOI request from Pulse, Essex LAT said one practice had requested to close ‘due to the contract being financially unviable’.

A spokesperson for NHS England said: ‘NHS England can confirm that Malling Health, who currently hold the contract to provide medical services at the Brambles surgery in Brentwood, have given notice to terminate their contract on 30 September 2013.

‘The Brambles has a list size of 1,495. There are a total of nine practices in Brentwood covering a registered population of 76,306 (as at 1 July 2013). There are currently no practices in Brentwood with a closed list.’

He added: ‘NHS England has considered a number of options in relation to the future continuity of care for the patients registered at the Brambles surgery and is in discussion with local Brentwood practices about these options. We will confirm future arrangements as soon as discussions have been concluded.’

Readers' comments (8)

  • But are GPs not overpaid, golf playing layabouts ? So how can a private company not find it a gold mine? And we are worried about private care taking over. It is time to leave the NHS and charge a reasonable fee.

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  • There is more to this than seems to be reported. What terms are the other practices on - PMS or GMS and the value of pounds/patient. MH have either over committed themselves to their hours/services in their contract or have not been able to attract the patients for them to be able to make a profit that they anticipated. However they are still expanding in other areas of the country.....those left are the doctors who have to continue working harder in other practices to fill the everincreasing void whilst MH seek profits elsewhere. Never mind the patients..... Just business!!!

    Prof Field - new CQC Czar - put that in your pipe....Just business like mid Staffs.

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  • This shows how efficient the NHS GP model contract is. Private companies cannot compete. The take home message is resign from the NHS, stop working yourselves into an early grave and go private.

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  • Figure re GP salaries do not take into account what the GP has to pay out. a GP's salary is what is left after all the expenses have been paid, that includes all the staff / 'locums', receptionists, secretaries, managers etc. etc.

    Then there is tax, insurance, vehicle costs to be mobile ... sounds great when you bandy figures about, but start making deductions and there i not much left in he pot to live!

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  • "...sounds great when you bandy figures about, but start making deductions and there i not much left in he pot to live!"


    The average GP partner in the UK earned £104,100 before tax in 2010/11.

    Another out of touch comment. Try telling your patients as they make their way to the foodbanks that £104,100 pre-tax is not much to live on. They'd think you're in cloud cuckoo land.

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  • Bob Hodges

    £104,100 pre-tax is about 25% more than I get from full time General Practice, and the rest of my colleagues in the area get.

    Not being old enough to have been gifted capital by a property bubble and being liable for the full costs of a high LTV mortgage on a home with an inflated 'purchase value' and with the majority of my earnings in the >40% tax bracket, it doesn't go anyway near as far as it would have 10 years ago. I'm not ashamed to earn more than average, because I work harder than average and I spent over 20 years in full time education amassing debt that still has an effect 12 years after qualifying.

    I have other income from private sector work done in the evenings and weekends - but that's MY business and none of yours. The lowest per hour income from any of my 4 jobs is NHS General Practice - it's also the one having detrimental effects to my own health.

    If I have to cut back - I'll cut back General Practice.

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  • Perhaps if GP's had 1 full time job being a GP rather than various other jobs then the burn out claimed in other article on this site would be considerably lower.

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  • Our accounts show that we keep 39% of our GP income after pension NI and tax. My hours are longer than 10 years ago and the drawings have halved.
    Bring on some market forces, please. Perhaps the NHS should be reported to the Competition Authority?

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