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The waiting game

NHS England accused of allowing small and single-handed practices to fail

Exclusive Local area teams are routinely failing to preserve distressed practices if they have fewer than 4,000 patients, local leaders have claimed.

Londonwide LMCs has said that a lack of capacity and expertise since NHS England took over from PCTs has meant contracts for small practices are only renewed in ‘exceptional’ circumstances, and typically the practice list is dispersed.

Figures obtained by Pulse reveal that eight practices with list sizes of fewer that 4,500 patients have closed since February 2014 - comprising at least 75% of all closures in the capital, but likely more.

The LMC told Pulse that because of ambitions to have general practices working at scale, small practices were under the microscope.

NHS England London area team denied that they had a policy on preferentially dispersing the lists of small practices, saying that each case was reviewed on its ‘own merits’ and that there was no ‘formula’ for practices to have their lists dispersed.

Pulse has been campaiging for NHS England to pledge support to practices under threat of closure as part of its Stop Practice Closures campaign, after finding scores of practices on the brink of shutting.

Pulse has also demonstrated the knock-on impact of closures, with one in five practices being burdened by a local closure.

But Dr Tony Grewal, medical director at Londonwide LMCs told Pulse: ‘We have heard in conversations with them, in open meetings, that they would not normally go to procurement for a list of less than 4,000 unless there were very special circumstances.

‘I have not seen, and am not aware that there is a formal, written policy on this. But certainly in terms of actions, that has been the case with every closure I’ve come across in a small practice.’

The LMC said there had been eight closures of small practices in the past 12 months, including:

  • Two Westminster practices - 3,500 and 2,500 patient list size
  • South London - 2,000 patient list size
  • City & Hackney - 2,250 patient list size
  • Harrow - 3,300 patient list size
  • Camden - 3,600 patient list size
  • Islington - 4,000 patient list size
  • Waltham Forest - 4,500 patient list size

Although there are no figures about how many practices closed overall in this time period, information obtained by Pulse from NHS England under the Freedom of Information Act revealed that six practices overall closed between April 2014 and December 2014, plus six between April 2013 and March 2014.

Londonwide LMC added that these dispersals were occurring without any management from NHS England, heaping pressure on stretched neighbouring practices and disadvantaging both patients who had to reregister and the existing practice population.

Dr Grewal added: ‘[Since PCT days] in terms of efficiency and the capacity to deliver a wider range of services, and lots of other reasons, small and single-handed practices are under the cosh, or at least under the microscope and then under the cosh.’

‘The dispersals are not even managed, it’s quite simply, patients are informed their practice is closing and they’re given a list of other practices within this area near where they live falls, and told to go along and register.

Dr Grewal told Pulse the LMC was in discussions with NHS England about formalising processes in future, he said: ‘One of the things we are trying to do with NHS England, is to actually set up a proper policy for what happens when a practice may be at risk of closure, and also what happens when a practice closes as a matter urgency – as also happens.

‘If you go back to the days of PCTs, the individuals there actually had the expertise and the experience to understand all of the ramifications of a practice closure. Unfortunately, that is not necessarily the case in NHS England as it is at the moment.’

A spokesperson for NHS England London told Pulse: ‘When NHS England is made aware by a contractor that a contract is to be terminated our priority is to ensure patients continue to receive a consistent, high quality service, whether it is at their current surgery under a different provider or at a nearby practice. 

‘A robust process is in place, which includes engagement with patients, the representative body for GPs, the local CCG and colleagues in the local authority to help inform our decision on next steps.  There is no formula which NHS England applies as each case is determined on its individual merit.’

They added: ‘List size is one of the considerations.  We’re also mindful of availability and suitability of premises, practice capacity and capability in the area of the vacancy generally, the geographic spread of the patients of the vacant practice, the health needs of the area and of course the views of patients, LMC, CCG and local authority colleagues.’

Readers' comments (10)

  • We Had at our Peak 6600 patients , 2 full time partners with locums 4 times a week . The List Fell to 5500 and we lost a lot of income . We had to drop the locums and do 10 sessions a week each . We dropped our drawings but still could not keep it going without a certain risk of Ill health .we informed the local team that we would close but that that the building we own was available for them to buy . No real interest was shown , a deal with another Practice to take it over fell at the last minute due ti Financial problems and our list is now being dispersed between the 12 local practices .They will find it hard to cope , which in turn will put them at risk of closure/burn out .I finish as a Full time GP on Friday age 54 , Retire in April and will look for Locum work .It is desperate times .i tried to get a patient admitted for a Pulmonary Embolism yesterday and was Told by the RMO that they were too busy and to put them on Heparin and we'll see them next week ! I said , they need to be in a safe place . The RMO said "This is not a safe place "! Jesus !!! I sent her in anyway .Glad I'm getting out but I feel for my patients I have known for 26 years !

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  • The whole NHS is falling apart...

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  • Vinci Ho

    If small practices are analogous to minor ethnic groups , this is 'ethnic cleansing'!
    Haruki Murakami's quote:
    If there is a hard, high wall and an egg that breaks against it, no matter how right the wall or how wrong the egg, I will stand on the side of the egg. Why? Because each of us is an egg, a unique soul enclosed in a fragile egg. Each of us is confronting a high wall. The high wall is the system which forces us to do the things we would not ordinarily see fit to do as individuals . . . We are all human beings, individuals, fragile eggs. We have no hope against the wall: it's too high, too dark, too cold. To fight the wall, we must join our souls together for warmth, strength. We must not let the system control us -- create who we are. It is we who created the system. (Jerusalem Prize acceptance speech, JERUSALEM POST, Feb. 15, 2009)

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  • NHS England is no different than PCT.
    When it suited PCT in fact asked me to open the practice giving all the initial help including finding the premises for me.
    But as the political climate changed same PCT put an enormous pressure on me.

    I was PMS GP with 1880 list size; there was another PMS practice in our pilot with 2200 list size. This other practice was allowed to take a partner. When I applied to get part time partner, both working part time I was refused citing PCT policy to create 10000+ list practices.
    My practice was and is run very efficiently still PCT put a pressure on me to join the neighbouring practice. I refused, went GMS taking income drop and taken partner.
    PCT then and now NHS England will do anything to put a pressure on GPs.
    It is going to get worse when regional boards will take control.
    Watch this place Manchester will soon get its own budget......!!

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  • The NHS England does not give a toss for smaller practices. It believes that big is beautiful and small is crap. Even though small print practices provide good personalized service. Even the CQC reports show this. Screw the NHS England. Unfortunately the NHS England rules the roost. The only alternative is to federate.

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  • This comment has been moderated.

  • The real problem is the endemic unfairness of funding itself. Some practices earn £ 500+ per patient and others just £ 100.
    The GPC needs to sort out funding. The fact may be that its officers may all be very high earners so there is no desire on their part to do anything. I think GP land is so intrinsically unjust and unfair that it needs to fold and disappear. We just cannot have a system where neighbouring practices have half the income per patient of the other. This is plain discrimination, but I am not sure which body oversees fairness.
    Could we put this to the fair business regulator?

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  • NHSE is monster from the Conservative toy shop and it's aim was to destroy general practice from within by privatization, liquidation of single handed practices and forcing Practices to overwork and burn out. Whether ethnic cleansing was part of it? In some areas of the southeast- Medway and Swale- it seems highly probable that this was the case.

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  • SINGLE handed practice are admired by all patients.every one knows it. it is not economical hence question or dispersing the list. i have 3600 patient and could have increased to as many as i liked but fear of loosing personal touch. i advise all of them to take partner and then retire. ccg has no power to close practice once you take partner. you do not need permission of ccg to take partner any more.

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  • We work in an area of high trust ,care and sensitivity and high risk .That is expected.
    The climate appears hostile and unsupportive and can easily lead to stress and as such is very sad for the good guys who care to post their feelings.
    How do you know they are good is what I will be challenged and that is what is going on,more and more.

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  • Everything that grows and gets larger must eventually collapse and fall. Tesco, Greece, Egypt. Greed is now rife in the NHS.

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