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GPs go forth

Nuclear option: Rise in practices seeking to close or merge

New figures reveal a massive increase in practices approaching managers about merging or closing. Alex Matthews-King investigates

500% - Stop Practice Closures - online

Practices are no longer just thinking about taking the nuclear option – they are actively pursuing it.

Figures obtained by Pulse reveal the stark truth: in a single year, there has been a 500% rise in practices telling NHS managers they wish to merge or close.

A Freedom of Information (FOI)  request by Pulse – made as part of our Stop Practice Closures campaign – reveals a staggering 169 practices in England approached their area team for advice about closing or merging between April and December last year.

Stop Practice Closures-logo-online-330

Extrapolated across the 2014/15 financial year, this represents an increase of 508% compared with the 37 requests over the whole of April 2013-March 2014.

The FOI request also revealed that 78 practices have either closed completely or closed a branch surgery as a result of merger since April 2013 – a trend that has accelerated since April 2014.

LMCs say their time is increasingly devoted to the growing numbers of practices who are considering closure. And in many cases, area teams are unable – and sometimes unwilling – to provide the support practices need to survive.

The GPs involved say they’re in an impossible situation, caught between continuing in an unviable practice and their reluctance to let patients down.

And there is a significant knock-on effect on neighbouring practices, who can be overwhelmed by an the influx of patients whose practice has just closed.

A cocktail of problems has led practices to take this difficult decision: NHS England is refusing one in three requests to close practice lists; the withdrawal of MPIG is seeing hundreds of practices lose funding worth £3 per patient each year; PMS reviews are removing vast chunks of funding of up to £400k from practices; and many simply cannot recruit enough new GPs to cope with crippling workload or replace partners who are retiring in greater numbers

Dr Robert Mockett, a GP partner in Brighton, was forced to close his Eaton Place Surgery on 28 February as he and his partner are retiring and could not find anyone to take over the surgery. They had to sell the practice to pay the mortgage, redundancy packages and other costs.

Dr Mockett told Pulse two days before the practice closed: ‘The outpouring of emotion from patients has had me in tears all morning.

‘I thought I’d stay until 65 but I would not survive. I feel for my patients.’

Dr Peter Maksimczyk, a GP in Weston-super-Mare, Somerset, is in the ‘very sad’ situation of potentially having to sell his surgery because he can’t find anyone willing to take it on in the current financial climate.

He says: ‘We have a nice, traditional practice with high patient population. I am 64 and still working full time; my partner is slightly younger. In the next few months, I will be seeking to retire, or at least drastically reduce my commitment, but am concerned that no one will want to take on the practice.

‘If that is the case, I will have to sell up and convert the surgery into flats, which would be very sad. I’m certainly not going to carry on doing what I am now.’ 

There is a feeling among GP leaders that we have reached a tipping point in terms of sustainability of general practice in many areas.

GP Closures Graph - March 2015 issue - online

Dr Robert Morley, chair of the GPC contracts and regulations subcommittee, says: ‘This writing has been on the wall for the best part of a couple of decades and is now painted in enormous bold capital letters in a fluorescent font with powerful searchlights pointed at them.’

In London, the area team received 33 requests from practices in need of support between April and December 2014, compared with 12 in 2013/14.

Londonwide LMCs medical director Dr Tony Grewal says this pressure is being felt on the ground. He says: ‘We spend a huge amount of time trying to rescue practices under threat, with variable success I would say.’

Dr Grewal claims the area team is not helping, and that it is happy to let smaller practices go to the wall.

He says: ‘We are facing the difficulty that for practices below a certain list size – certainly less than 4,000 and sometimes more than that – NHS England’s London area team has a default position that they simply disperse, rather than renewing the contract.’

Elsewhere, there is equally scant support from NHS England. In Cumbria, the Hawkshead surgery tells Pulse a perfect storm of problems means it is on the brink of closure, including removal of seniority payments, a fall in permanent patients and spiralling locum costs.

This has led to a funding gap of £30,000 – some 25% of its income – but there is no additional financial support, despite high-level discussions with NHS England’s head of primary care commissioning Dr David Geddes and health minister Earl Howe. Andy Pow, a campaigner for the practice, says: ‘The problem is when the current GPs retire, no one will come in. Why would they?’

But in the South-West, the North Somerset, Somerset and South Gloucestershire area team has been having ‘sensible’ discussions with struggling practices, the LMC says. There were 16 requests for support from practices considering merger or closure last year but none the previous year. 

Wider effect

The wider impact of closures is also being felt. A Pulse survey in January showed one in five GP practices had felt the ‘ripple effect’ on workload of taking on additional patients after nearby closures. In Brighton, the local area team acknowledged the problem by offering practices an unprecedented one-off admin fee of £25 per patient, after 3,000 patients were left without a GP following the closure of Dr Mockett’s surgery.

NHS England admits primary care is under severe strain, but says: ‘We are supporting general practice by progressing co-commissioning to help CCGs lead new, integrated pathways of care, and are investing £1bn in a primary care infrastructure fund.

‘We will see a change in the primary care landscape so the profile of practices will change, but we are taking action to ensure all patients have access to high- quality primary care where they live.’

What GPs are saying

Dr Peter Maksimczk - online

Dr Peter Maksimczyk, GP in Weston-super-Mare

[If we are unable to find people to take over the practice] then I will have to sell up, which would be very sad.




Dr Sanjeev Juneja - online

Dr Sanjeev Juneja, GP in Rochester

I have to decide whether to work myself to death or walk away and potentially close the practice.




Dr Naomi Beer

Dr Naomi Beer, GP in Tower Hamlets

I think NHS England is prepared to accept a certain percentage of practice closures.




Dr Harry Yoxhall

Dr Harry Yoxall, Somerset LMC chair

There are a number of practices looking at their future, especially in view of the workforce problems.




Dr Tony Grewal

Dr Tony Grewal, medical secretary, Londonwide LMCs

NHS England does its best. But it simply lacks the financial and administrative flexibility… to support a struggling practice.


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Readers' comments (12)

  • I think this is part of the DOHs long plotted plan. They are making General Practice so unpleasant that no new GPs will want to take on a partnership.

    That will be the death of traditional practice, leaving the DOH to pursue whatever master plan they have. It involves having all new GPs salaried. The only thing to be revealed is who they will be salaried to.

    I think they have miscalculated the shortage of GPs their policies will create.

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  • One of the major problems is that LMCs keep cosy and sucking up to NHSE because their members seem to have it going better than the ordinary GP lot. Dr Grewal's sympathy with NHSE for lack of 'flexibility' is touching and I think I'll shed a tear or two.

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  • Alan Shortt

    agree with both of you

    as Richard Butler once wrote "the first in the line is the last to remember her name"

    I might shed a genuine tear or two.

    UK GP and UK NHS was for all its faults inefficiencies and variances somewhat cost effective

    In the new world order of austerity Primary Care Physicians and all other health care providers will ultimately be employed by Serco, G4S or (in the medium term) CCG conglomerates run by colleagues looking after their own self-interests whilst selling the "Profession" and patients down the river.

    Nevermind their own children might wish to pursue a career in Healthcare/Medicine.... er to be an underpaid and undervalued worker bee drone vs said "Professsional".
    Nevermind we all become patients in the end

    I'm still genuinely puzzled how/why various RCGP & BMA campaigns tried / still try to posit "putting patients first" versus "Healthcare workers are highly skilled and committed and should be remunerated as such"

    The BMA does not hesitate to comment on a wide range of difficult political international problems - world poverty, global warming WMDs domestic violence etc

    Why are they not shouting loud and clear the need for ""Austerity" in the public sector is a lie designed to send all but the very rich (and clinging to the wreckage opportunists) back to the workhouse

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  • Abdul QADRI

    Frankly it is a scandal & unfair for the patients in the long term. Let us do some calculations: if A practice with 3000 patients is forced to close down due to present chaos. Neighbouring practices are given incentive of £25.00 per patient , in this case £ 75000.00 as a one off payment. This is to create a kind of greed culture among the group practices & they would be tempted to accept these patients. After few months , these group practices will feel the heat of extra work & the poor salary Gps will have to put up with it & in the long term will affect the patient care.
    Single or two doctor practice were backbone of General practice & used to serve the community within the populations for so many decades. Their staff were patient friendly & wouldn't be restrained by the rediculous 10 minute appointment slots & so on.
    Having worked in General Practice for over 30 years , I am deeply saddened to see the destruction of this noble profession. Both Gps & Patients are so so unhappy & the clinicians are at low time low in their morale. Otherwise why on earth Gps as young as 55 years are deciding to quite General Practuce & are openly saying that they don't want to work to their death. I retired at the age of 62 in March 2013 due to severe stress & was lucky to detect stress related cardiac problem. Reading the comments of my Colleagues , My heart goes for them as there don't seem to be any feasible solution in the near future. Our political parties are playing politics as usual with nations precious treasure GENEAL PRACTICE & I hope that the British electorate take them to account on May the 7th 2015.

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  • The tax payers alliance should sue the govt for taking their money and not providing GP services in their community.
    The govt will soon be forced to increase payments to make practices viable

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  • The reason GPs are on CCG boards is to push out and 'authentisise' the DoH interests with a GP scapegoat. I for not fall for that trick or the dangling of incentive schemes. As Tesco falls Lidl and Aldi impress. Smaller, refined care and something different. We could learn from that.

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  • Part of the plan. GPs to be replaced by nurses and 'cheaper alternatives' to 'downsize salaries'. The senior civil servants and the advisors who run the NHS and have never worked in healthcare push the message that technology will make this possible.

    Looks like we picked the wrong speciality, in this country at least. Until things turn full circle, perhaps.

    To say we feel let down by our 'leaders' is an understatement. Given the size of the national debt and the NHS Ponzi pension scheme (which would be illegal if it were a private fund) the 'old guard' who sold us out to fill their own boots shouldn't count on getting what they bargained for. 'Watch and wait'.

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  • The ultimate step towards to the privatization de facto of Primary Care is looming. But, do not bee fooled. There in no chance of a drop of the Healthcare costs going ahead this way. In fact, it will be just the opposite. Give the GPs the chance of "retraining" to a Specialty Consultant level, and you will then really see how many would be "on the run". RCGP as it is does not work.

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  • well, since your 508% was published... you can add us to the statistics too. Handed in Notice on Tuesday.

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  • We Sold the Practice premises today , completed this afternoon
    A feeling of emptiness , of sadness and wondering what else we could have done
    There was no other way out for us .
    I have a month off work , as part of the condition of starting to draw my pension at 55 .
    I am off to Bolivia Motorcycling which should lift my Soul a bit , but there is a terrible feeling of loss that keeps hitting me in the face. I have worked every day for 31 years as a Doctor , probably 4 days off ill in that time .For any of you thinking of Closing your Practice have a good Chat with your local LMC Rep , ours was great .Talk to the area Teams talk to your accountant .However if your job is making you feel very stressed and you have made as many changes as you can you may have no choice .I guess that is what is haunting me at the moment .Time to adjust and " reflect " I guess . Good luck to you all

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