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Independents' Day

Hundreds of ‘desperate’ practices apply to close lists, but one in three is declined

Exclusive  Around 100 practices a year are taking the ‘last resort’ of applying to close their lists, but almost one in three is turned down.

Figures, obtained through a Pulse request to NHS England under the Freedom of Information Act, reveal there were 100 applications in 2014/15 and 99 the year before, more than double the 48 in 2012.

In the 20 areas that were able to provide full figures, 56 of the 188 applications – 30% – were turned down.

GP leaders said NHS managers should ‘respond positively’ to requests to close lists as they signalled practices were in distress, but NHS England told Pulse it turns down requests because of the impact on neighbouring practices.

Family Doctor Association chair Dr Peter Swinyard said asking to close a list is not something practices do lightly, but as a ‘last resort’ when they can no longer safely take new patients.

He said: ‘If you’re desperate enough to say “we have to close our list just to survive” and NHS England says “no”, I can imagine some partners will feel they are not getting any support and will feel compelled to hand in their resignations.’

GPC deputy chair Dr Richard Vautrey said such an application was a ‘red flag’.

He said: ‘It’s essential NHS England and CCGs respond positively to requests to close lists as these can be red-flag warnings of serious pressures in the practice that have become unsustainable.’

NHS England said: ‘When we receive a request to close a list, we consider the impact on patients as well as on neighbouring practices and services. We know GP practices are under pressure and we don’t wish to see a problem displaced elsewhere.’

Earlier this year, Pulse blogger Dr Hadrian Moss was threatened with a breach-of-contract notice after taking steps to close his practice’s list informally in line with GPC advice.

However, after Dr Moss persevered, NHS England told LMCs practices with short-term staffing problems could ‘temporarily’ stop taking new patients on an informal basis.

But it is not clear from the NHS England figures how many practices may have chosen to take this option.

GP Closures Map


Readers' comments (28)

  • Whats happened to general practice in the UK folks???? its used to be the envy of the world; Now its the laughing stock

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  • Jesus wept

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  • Nothing in the NHS is the envy of the world. the NHS if often commended but NEVER copied the world over. says it all really.

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  • Clearly GPs are not independent practitioners but slaves to the masters

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  • One way would be to accept patient but put up notice in reception area to say that because of NHS England pressurizing us to accept new patients all patients will have to wait longer for appointments. If patients feels they cannot wait that long for appointment they can attend walk in Centers/ A&E. I wonder how will CCG feel about it.

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  • if I was a partner and I wanted to close the list and NHSE said NO...well I'd very (impolitely) tell them to shove it and resign immediately.

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  • The answer is reception and nurse triage people. GPs should only see those who really need our skills, not those that need their hands held just because their lives are not easy. GPs today deal with more complex pathology than ever before and it is not fair for those patients that our time and energy is eroded by unnecessary demand. We need to learn how to say no. The public does not expect a pilot to serve them coffee but they expect the GP to confirm they have a cold ( while coughing in our faces ). Enough is enough.

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  • Secure environments GP

    @9.51 good plan.

    Also, doesn't GMC guidance put an obligation on us to

    Contribute to and comply with systems to protect patients
    Respond to risks to safety
    Protect patients and colleagues from any risk posed by your ?burnout ?distress ?exhaustion etc
    Work collaboratively with colleagues to maintain or improve patient care

    There surely come a point where this must be used in mitigation for mistakes or complaints to CQC, Ombudsman, Area Team etc

    Confirms the need for Crown Indemnity (Shared Risk)

    Is an understandable reason for performance to be adversely affected by individual clinicians.

    Should we not inform the GMC no one is listening? Pre-empt later problems?

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  • As long as NHS England takes responsibility for any incident that results from a practice's declared inability to cope safely with its list size after the practice has been prevented from addressing the problem.

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  • If you work in the LMC, you can close your Practice list without consulting with neighbouring Practices. But heaven forbid, if you are an ordinary GP, you have to go through the rigmarole and be sure that only the LMC GP will protest your closing the list while other Practices understand your predicament.

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