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GPs buried under trusts' workload dump

Revealed: more surgeries than ever closed last year

EXCLUSIVE Surgery closures have risen almost eight-fold in six years, hitting record levels in 2018, a major Pulse investigation has revealed. 

Nearly two million patients have been affected by surgery closures across the UK - including full practice closures, branch closures and surgeries that closed following a merger - since 2013.

Figures obtained by Pulse showed that almost 140 surgeries closed last year, estimated to affect a record half a million patients – more closures than in any previous year and almost eight times the number seen in 2013.

In addition, provisional data revealed 12 more closures in the first month of 2019, compared with eight at the same time the previous year.

According to GP leaders, the recruitment crisis is to blame for the closures. NHS Digital figures released yesterday showed that the number of full-time-equivalent qualified GPs fell by 441 between March 2018 and March 2019. 

The pace of closures has not slowed despite national attempts to address the problem. In 2015, NHS England set up funding for vulnerable practices, which later became the 'resilience fund'. Similarly, the other devolved nations brought in their own versions of emergency funding but failed to address the closures.

Pulse's figures, which were obtained through freedom of information (FOI) requests sent to all CCGs, health boards and trusts in the UK, alongside NHS England, showed 138 practices shut their doors in 2018, affecting some 519,500 patients.

Previous FOI requests revealed 445 surgery closures between 2013 and 2017, having an impact on 1.4 million patients.

However, the data could be an underestimate as some of the health bodies failed to respond to the FOI request.

NHS England said that in the financial year of 2017/18 there were fewer closures than the year before, according to NHS Digital figures – although these do include mergers where no surgery has been shut.

A spokesperson said: 'We continue to support all general practices to help them thrive. Thousands of practices continue to be helped through the GP resilience programme, where investment has been increased from a planned £8m in 2019/20 to £13m.'

As part of the new five-year GP contract, NHS England is hoping that the move to larger groupings of practices through the primary care networks - serving between 30,000 and 50,000 patients - will promote 'resilience'.

The BMA argued the networks will halt the number of closures by 'reducing the need for formal mergers, and addressing some of the pressures'.

BMA GP Committee chair Dr Richard Vautrey said: 'As with all those that have had a challenging time in recent years, we hope smaller practices will receive greater mutual support from others with the development of the new networks.

'These networks, built on top of existing contracts, mean practices can support one another with workforce and resources, which may reduce the need for formal mergers, and address some of the pressures behind closures.'

But GP leaders expressed concerns that the proposals will not suffice to reduce the number of closures, with some being worried that the extra money available in the contract – which includes £1.50 per patient from CCGs – will not fully materialise.

Tower Hamlets LMC chair Dr Jackie Applebee said: 'Primary care networks certainly won’t save general practice. We’ve been told there’s all this extra money coming in but the CCGs have to find the £1.50 per patient from their budgets.They haven’t budgeted for that and didn’t know this was happening until January of this year.'

Liverpool LMC medical secretary Dr Rob Barnett said the requirement in the new Network DES for surgeries to offer extended hours in exchange for funding is also a problem.

He said: 'If the workforce is already stretched in relation to the in-hours contract, we’re going to stretch it even more and I’m worried that will pose additional strain on the system. It’s almost as if one good initiative is counterbalanced with something that hasn’t been properly thought through.'

'Adding one pharmacist or a paramedic to a population of 50,000 patients is a drop in the ocean and that’s not going to prevent practices closing.'

In an interview last year, Pulse revealed NHS England’s then director of primary care Dr Arvind Madan had suggested GPs should be 'pleased' when small practices close as there are 'too many small practices struggling to do everything patients want for their families in a modern era of general practice'.

 

Readers' comments (14)

  • The BMA have sat on their hands and done zip whilst one nonsense after another has been dumped on GP: the CQC, Appraisal and Revalidation, and now they collude with the worse than useless networks nonsense. Why do they have any members?

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  • Vinci Ho

    Thanks , Rob . Exactly the words I want to say .
    As you have always taught me : you have to know the answer(s) before asking the question in politics.
    I guess the question here is ,’ Are PCNs going to save general practice?’ or probably better ,’ How is a government going to make PCNs save general practice?’

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  • Like the steady reduction in GP numbers this will continue and the inaction of the medical establishment is deafening.Networks phah a crock of underfunded legally complex sh++te which if anything will speed up the stinking of the ship.The jewel in the crown of the NHS,the Tories have taken that down the pawn shop, doubt they will buy it back.Good Luck everyone we are gonna need it.

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  • End game

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  • They didn't understand the NHS Pension. The idea was to offer a very generous pension that reduced significantly if you retired a few years early. That way you kept older GPs working hard at the end of their careers with the result that 50% died within 12 months of retirement.

    Now everyone gets out earlier. On a smaller pension--but lives into their 80s on an index linked pension.

    Government can solve the GP retention problem overnight by putting the GP pension back to where it was.

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  • Una Coales. Retired NHS GP.

    1. CQC inspections too demanding in the context of funding cuts.
    2. Annual appraisals sold as a chat over tea and now extremely onerous and time-consuming endless unpaid paperwork with unpredictable appraisers from overly OCD to supportive if you are lucky.
    3. 5 yearly career ending revalidation, multiple the bureaucracy of appraisals by 5. As in 5 times complete audit cycles, 5 times multiple source feedbacks, 5 times patient surveys, clinical cases, CPD etc. When do GPs have time to see patients?
    4. Lack of GP workforce means no holidays, working overtime, no locums, burnout.
    5. CCGs now delegating what used to be outpatient clinical care onto GP’s laps so many feel out of their clinical expertise and fearful of the GMC if they make a mistake with treating a patient who should be under hospital consultant care but this is now called community care.
    6. 10 minute appointments when in Europe and abroad GPS get 20+ minutes to safely treat a patient. Interruptions and phone consults added in between 10 minute slots or added at the end of an exhaustive list,
    7. Seeing colleagues enjoy the best of both worlds emigrating to Canada or Australia to work safely as a GP.
    8. Pressure from CCGs to reduce hospital referrals, to cut expenditure on prescriptions, to deliver safe care without a minimum practice income guarantee, having to fire staff to make ends meet and watching single mums in tears as they lose their jobs working for practices.
    9. Fear of a GMC referral as investigations may take up to a year during which time the GP may be treated as guilty until proven innocent and God forbid the DM gets ahold of any investigation and publicly shamed a GP before he has had his right to a fair trial.
    10. Students are reconsidering whether medicine is a viable profession when other professions pay double, with free weekends and evenings to enjoy a life and are able to repay student loans. Training is so many years to be a GP. They ask is it worth it?
    11. When you know a GP colleague who has ended his or her life, you start to question whether it is time to retire early, emigrate or change paths.
    12. When you are fearful and anxious, as you may be referred to the gmc for a domestic squabble, raising a voice to a train conductor, drink driving, depression, a jealous colleague, an angry patient who does not get what he or she demands, and think if I were in any other job, I would not be treated like a criminal.
    13. When you decide you need to put yourself and your family’s wellbeing first above the needs of overworking as a GP to an early grave.

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  • I suspect the government want GPs to fail. Action speaks louder than words. It would explain all the cheating, time limited targets on QoF so you do the work and hopefully not get paid, gross negligence manslaughter charges, CQC, GMC double jeopardy, taxing you so it is not worth your while and now pension tax. Sorry, not going to help or do anymore as it is both too risky and you are not really improving your earnings working harder. Much better to sit in the garden and have a drink or go abroad where work actually really pays without the misleading figure and you get nothing after tax.

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  • Time for GPs to be NHS employees with all the rights, leave, protection that employees have and partners don't have. The current model is just not working

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  • With support frpom Arvind Madame and the RCGP cabal, GPs don't have a chance. I honetly think Julia Hartley Brewer would do a better job

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  • Just Your Average Joe

    Poor Work force planning means there are more male full time GPs who were working 8+ sessions now being replaced by new GPs who assuming they actually stay to work for the NHS (Many are not), are only willing to work part time.

    If you surveyed the GPs leaving VTS schemes you would be lucky to find half a Full time equivalent per GP leaving.

    You don't need to be a genius to realise 1 out, half in and the tank will be empty soon.

    Most want to work as part time locums, or in some sort of portfolio career.

    Most do not want to be salaried as doesn't pay enough for them, and almost all don't want the limitless pit of work that partnership is, as they think they can earn as a locum, without the headaches and workload.

    The GP 5yr deal is a waste of time and paper. Forcing GPs into PCNs is simply stretching GPs even thinner, with CCGs and federations already sucking them into meetings and non clinical roles.

    Then forcing GPs into extended hours at threat of ex-communication from PCN, and any hope of extra finances, when there are not enough to cover day time hours is ludicrous.

    We need new medical schools immediately set up, with the whole cohort destined to be GPs from day 1, with that as the end goal of training for that new intake.

    Recruit for resilience and make the NHS and saving it core to the beliefs being taught and embed it.

    We need to return primary care to a vocation not a job, and at the same time the DOH and government need to back partnerships with real money and support via contractual changes to make it the best way to work as a GP.

    Then maybe the NHS and primary care has a future.

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