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Gold, incentives and meh

34,000 patients left without a fixed GP as practices 'sucked into black hole'

One-fifth of practices in Plymouth have either closed or handed back their contract in the past three years, leaving 34,000 patients without a fixed GP.

Local GP leaders said the city faces a ‘black hole’ with surrounding practices ‘getting sucked in’ as a report seen by Pulse from a meeting of local primary care leaders adds that 10 out of 52 practices in Plymouth and the surrounding area have 'closed or handed back their contract' in the past three years.

This comes after CCG leaders in Dudley told the Health Select Committee last week that practices in that area are closing at a rate of one every six months.

Dr Matt Best, vice-chair of the western sub-committee of Devon LMC, told GPs at the UK-wide LMCs conference last week that the contract-handbacks and closures in Plymouth mean 15% of patients ‘don’t have a fixed GP’.

However, NHS England has said that 'only three small practices have closed since 2015' with a total patient lists size of 6,650.

Access Health is managing care for the population on an interim basis - but at a cost 26% higher than the surrounding practices.

The social enterprise receives core funding of £190 per patient, compared with £151.37 for the average practice, according to figures supplied to Pulse by Access Health.

The report from a primary care meeting said the extra funding ‘is required to manage the fall out generated by a failed primary care service and we understand Access Health are not making a profit despite the extra funding’. 

But Dr Best said surrounding practices ‘are struggling to help look after those patients and typically the patients that are the well patients don’t end up reregistering’. 

He said: ‘It’s the complex difficult patients that re-register and add on to the lists of neighbouring practices and make it so difficult.’

Dr Best was speaking in favour of a motion at last week's LMCs Conference expressing concern 'about the number of recent practice closures'.

Dr Best added that the closures are ‘appalling and horrifying for the patients’, telling Pulse later that many are adding to the pressure on A&E ‘just because patients aren’t getting to see a GP’.

Pulse has previously reported that the 22,000-patient Ocean Health partnership in Plymouth was forced to close its patient list, after its partners handed back their contract because of rising patient demand and a shortage of GPs.

This comes after Paul Maubach, chief executive of NHS Dudley CCG, told the Health Select Committee that the number of practices in his area has fallen from 52 to 45 in five years.

However, he said including branch practice closures, this equates to one closure every six months.

He told the committee that general practice in the area ‘is not resilient’, adding that ‘there aren’t enough GPs coming through, but also the demand pressures on primary care are huge’.

Mr Maubach was speaking to the committee about the development of Dudley’s multispecialty community provider (MCP), which he said would shore up general practice in the area. 

The CCG launched the procurement process for the £5.4bn voluntary contract in June last year to create an MCP, with all GP practices and four NHS Trusts expected to sign the contract.

Mr Maubach later told Pulse that if hospitals were closing at the same rate as GP practices ‘everyone would be aghast and it’s surprising to me that there isn’t quite so much visible concern about primary care’.

He added that the GP Forward View ‘doesn’t go far enough’ and the MCP would allow general practice ‘not to stand in isolation but to be supported by the other community services which are out there’. 

The motion proposed at the LMCs Conference was passed unanimously.

Readers' comments (17)

  • ‘Downbeat coastal resort’

    Plymouth has a population of over 250,000, hosts the largest naval base in Western Europe, has an independent medical school and a 25,000 student university and hosts the UKs largest independent Tv production company.

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  • ‘Plymouth has a population of over 250,000, hosts the largest naval base in Western Europe, has an independent medical school and a 25,000 student university and hosts the UKs largest independent Tv production company.‘

    But does it have the high paid jobs for the spouse of potential GP? Tax and pension issues mean that gp is more attractive as a second breadwinner part time job nowadays.

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  • Council of Despair

    no worries, the patients will be allocated to neighbouring practices or alternative providers sought. The government also has a robust 5 year plan fully endorsed by the RCGP and as part of that plan 5000 GPs will be available by 2020 ... by 5000 GPs I mean by 2020 there will only be 5000 GPs left in England!

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  • The data provided by Access Health to Pulse is dis-ingenuous and entirely incorrect. Access Health have compared their PMS contract value (£191.67 per weighted patient) to the TOTAL payments coming to general practice for every other practice giving the total of £151.37. This data also includes practices outside of the city that are dispensing and far from average.

    Let’s review publically available data from here: https://digital.nhs.uk/catalogue/PUB30089

    Let’s remove the dispensing practices from the calculations and focus on city practices - the total cost of these practices is £126.70 per patient (to include GMS, QOF, LES, DES, rental costs etc). If we want to tally up the same data for Access Health we get a whopping cost of £315.65 per weighted patient – a whole 249% more than the average practice. But the Access Health practices in the data used for this analysis do make heavy use of PFI property so let’s be fair and compare just core contract value GMS versus PMS - £191.67 versus £78.71 – and we still get Access Health receiving funding per patient at 244% of the average city practice.

    This differential is not only massively costly for the tax payer (over double the cost) it is also incredibly destabilising for local practices – My practice has been severely affected by this when a locum, due to work for us, cancelled and went to work for Access Health who were paying considerably more.

    It is time for the politicians to wake up to the current primary care crisis and realise that ongoing financial constraint is causing practice failure that not only threatens patient safety but also massively increases the cost of the NHS. Primary care needs help now before it’s too late.

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  • Dear All,
    Hats of to James Boorer for uncovering the truth.
    Regards
    Paul C

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  • Dr.msc, pls share the advert...mmmmh

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  • "But does it have the high paid jobs for the spouse of potential GP? Tax and pension issues mean that gp is more attractive as a second breadwinner part time job nowadays."

    The point is a proper city, not some 'coastal resort', is about to lose a functioning GP service. It has 'average' levels of employment opportunity and is near the South Hams, Dartmoor and Cornwall so was traditionally a fairly popular place to come work.

    Like all the experiments of the last few years it seems this will be allowed to continue just to 'see what happens'!

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