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Independents' Day

Scores of practices teetering on the brink of closure

Practices across the country face imminent closure, but the NHS seems happy for them to go to the wall. The time is right to fight back, argues Jaimie Kaffash

General practice is heading towards a precipice. Scores of GPs across the country are facing such hardship that they may be forced to shut their practice doors altogether.

LMC leaders have told Pulse they are aware of more than 100 practices that have either closed or face imminent closure – and this is likely to be the tip of the iceberg.

Local GP leaders say they have ‘not seen anything like it’ and warn of a ‘domino effect’ on surrounding practices if closures cannot be avoided.

‘I think mergers are the only way to keep practices in the hands of the profession’
Dr Robert Morley, West Midlands

Some practices say they have ‘exhausted all other options’ and have no choice but to close, while others are preparing to merge with others in order to continue providing services.

Either way, the grim reality is that, before the year is out, the profession could face an unprecedented mass closure of practices across the UK, unless the NHS steps in with emergency help.

The warning signs were there several months ago. Former GPC negotiator Dr Peter Holden warned in April that there was ‘a year to save general practice’ predicting the profession would see practices going bust within months.

Since January at least 13 have closed, many of which were single-handed practices that had been unable to find anyone to take over their lists. And there are many more that are very close to dropping over the edge.

Pulse asked 47 LMC leaders from across the UK whether they had been contacted by practices that were considering closing. More than half (24) said practices in their area were considering closing, identifying a total of 96 practices.

Dr Mark Sanford-Wood, chair of Devon LMC, says the situation in his area is unprecedented: ‘We have on our radar at least half a dozen practices that we are very concerned about. It is highly likely a good number will end up closing by the end of the year.

‘I’ve been involved with the LMC for 20 years and I’ve never seen this before. For this to start happening now is significant.’

It could get even worse as trainees shun partnerships, Dr Sanford-Wood suggests: ‘I see a lot of bright, young, highly talented GPs. They see
a workforce that is chained to the wheel, and they don’t want in.’

Join the fight to protect your patients

Stop Practice Closures-logo-online-330

Scores of practices across the country face closure and many more are likely to follow unless better support is given to GPs. If these closures go ahead it will be a disaster for patients struggling to find a new GP - and for all the remaining neighbouring practices who will be left to mop up the mess.
Pulse is launching a campaign to raise awareness of the growing crisis in general practice and to help practices fight for the support they need.

As part of the campaign, Pulse will:

  • Lobby ministers to ensure practices facing closure are given emergency support to help them restructure and protect their patients;
  • Begin an e-petition calling for a parliamentary debate on the threat of practice closures across the UK;
  • Bring GP leaders together to discuss ideas on how the morale of general practice can be improved and GPs can be funded more sustainably to prevent more practices going to the wall;
  • And create resources for practices to share ideas and campaign locally for better support so that practices and patient services are protected.

We are calling on GPs to:

Click here for more information on the campaign

Out of options

London has the highest number of practices in danger – with up to 30 practices contacting their LMC regarding closure. In Wales at least 14 practices are preparing to close, while Wessex, Northamptonshire and Devon each have six practices on the brink.

One GP partner, who wished to remain anonymous, says her high-achieving practice has run out of options following struggles with recruitment.

She says:  ‘Despite all efforts to recruit or merge over a two-year period, there is currently one faint hope left. If this goes the way of all past hopes then closure beckons in the next few months.’

She adds that this is not because the practice has failed in any way: ‘This is because of the starvation and withdrawal of primary care funding and resources in the face of the relentless increase in unfunded and underfunded workload.’

Dr Charlotte Jones, chair of the Welsh GPC, says four practices in her area have given notice that they will give up their contract to health boards, while there are ‘more than 10… examples of surgeries that are struggling and for whom the next steps may be that they have to close’.

She adds: ‘Sometimes practices are reluctant to voice concerns; some keep on working over and above what is safe.’

‘I’ve spoken to about six practices who are considering resigning their contract. It’s a mix of practices and areas - it’s
a universal problem’
Dr Nigel Watson, Wessex

Dr Beth McCarron-Nash, a GPC negotiator and a GP in Cornwall, says there are a clutch of familiar problems that lie behind the closures. She says:
‘I am hearing about more and more practices considering their options.

‘It’s a perfect storm of problems: the contract imposition from 2013, funding swings as a result of MPIG redistribution and difficulty recruiting. That, alongside spiralling workload and increasing demand… is having a catastrophic effect and practices are struggling to cope.’

If significant numbers of practices hit the wall, the level of destruction to the NHS would be unprecedented, with the likelihood of a ‘domino effect’ on nearby practices, GPs say.

Dr Chris Hewitt, chief executive Leicester, Leicestershire and Rutland LMC, says two practices in his region ‘have decided that if their financial situation gets any worse they will formally ask NHS England to take over their contracts’.

But the region is already under strain from branch surgeries closing. He adds: ‘In the past six months, 10 surgeries (out of 152 practices) have been tasked with dealing with a sizeable influx of patients as lists are disbursed as a result of surgeries or branch surgeries closing.

‘The very real threat of practice closures due to retirements or loss of financial viability will start a chain reaction, which impacts on surrounding practices that are only just coping with the demand from their current patient list.’

NHS England unconcerned

But managers seem to be taking a relaxed response. A spokesperson from NHS England tells Pulse that it did not have any intelligence centrally regarding practice closures, as this was a matter for area teams working with CCGs and LMCs.

She says: ‘Practices close – and open – all the time and it should not be assumed that this is a problem or a reduction of service; it needs to be seen in the context of local provision.’

In Wales, on the other hand, the Government is working with the RCGP, the GPC, health boards and deaneries to try to ease recruitment problems.

In Scotland, the Government is directly tackling the problems for dispensing practices with new regulations brought in from last month. 

But in England, on the various issues of recruitment, MPIG withdrawal and PMS reviews, local leaders are receiving patchy help from area teams.

‘There are only three health boards where practices are not closing. It is due to an inability to recruit partners - and remaining partners can’t cope’
Dr Charlotte Jones, Wales

Dr Robert Morley, chair of the GPC contracts and regulations subcommittee and executive secretary of Birmingham LMCs, whose area has already seen two practices close this year, says the only way for many practices to survive will be to merge with others.

He says: ‘The only way to safeguard the profession and safeguard these practices is for partners to merge. [It’s] the only way forward to keep these practices in the hands of the profession, but also, from a business perspective, to try and work within a business model that allows general practice to continue.’

Other practices have used their relationship with patients to campaign for better support. The Jubilee Practice in Tower Hamlets, east London, has been at the centre of a major campaign in the borough to prevent practices going under.

The ‘Save Our Surgeries’ campaign has already seen marches organised with neighbouring practices, articles in The Guardian, a meeting with health minister Earl Howe and co-ordinated actions with MPs – all with little help from BMA or RCGP. They have managed to win some guarantee of emergency payments from NHS England to protect them from the withdrawal of MPIG, but are continuing their campaign for more sustainable funding in the future.

‘There are several practices that are in trouble and threatened with closure, because of dispensing being withdrawn’
Dr Alan McDevitt, Scotland

Dr Naomi Beer, a partner at the practice, says: ‘We are having to do the co-ordinating for ourselves – working to get the message across to practices, developing tools for practices to do up to a seven-year forecast on income, pushing for co-ordinated action by local MPs and councillors to press for meetings, raising questions in Parliament and delivering a petition to Downing Street.

‘These ideas all come from us and we have little communication from the BMA or GPC except during an event such as the marches we organised in Tower Hamlets.’

It may be that galvanising local patients in this way can help practices fight back against the threat of closure, and that is why Pulse is launching a campaign to help practices do just this.

For many practices, this could be the last resort.

Additional reporting by Christina Kenny

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Readers' comments (20)

  • Lots of little general practices is not the DoH model of primary care. They have no interest in saving general practice and every interest in its downfall as they need to release the money to give contracts to United Health and Boots. General practice is now beyond saving as the entire machinery of government, politicians of all parties and the DoH, want rid of general practice. Quit now and go private, or wait until you go bust and have to sell out to United Health. But for gawd's sake stop pretending to yourselves that you can make the govt realise what is happening - this is what it wants to happen.

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  • Check the backgrounds of people in NHS England, Primary Care Agencies, CCGs and PropCo -especially those who previously worked for NHS Trusts and you will find a lot of them have connections with private providers. If the going gets tough, the man from county A becomes the Head in County B and the Head from County B slides in his/her place and the merry go round goes on. We need to weed out corruption in the NHS first to make any headway. Sometimes I feel that politicians are scapegoats as they really don't know who's reponsible for the mayhem on the frontline as sometimes they do come up with brainwaves but nothing works.

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  • It's just not true that this is the end of General Practice but it will be if you don't fight back right now. Why have we allowed ourselves to feel so immasculated? Let me remind you that almost every registered voter in the country is on a GP list. Voters have consistently voted for the NHS. These changes have gone in via stealth and deception and need to be exposed. Things are starting to happen. The media is starting to prick up their ears at the whiff of protest and stirring. As we have shown, when the information is brought to the people they rise and take their grievances to their MPs, their local councils, the Health Scrutiny Committees, the press. Give them the ammunition they need. Show them how your services are affected and put the blame squarely where it belongs! A good army takes stock of its position, analyses it's strengths and resources and develops a strategy. Battle mode colleagues- collective battle mode! The battle is not lost it's just that the stakes are now as high as they can be. Show yourselves for the leaders you are and fight! Remember in the battle of David vs Goliath, who won? Goliath underestimated his enemy. Show them they have underestimated us or the enemy will turn out to be our own fears and disillusionment. It is a choice my esteemed colleagues- still a choice we have the power to make. Naomi Beer

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  • Naomi, wake up. Both Tory and Labour want to deal with just two or three big contractors, not thousands of independent GP partnerships. Same policy at DoH. Since they control the purse strings, that is what will happen. Public doesn't give two hoots as long as there is a med centre with a doctor, they don't care if it is United Health and salaried GPs, or a partnership.

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  • PM above is spot on.
    It's finished.
    I'm always surprised by some GPs' spelling too.
    Naomi - it's emasculated not immasculated.
    Clearly an A in English is no longer a requirement for our young doctors!
    As for the David and Goliath metaphor, for all it's worth you might as well use George and Mildred.

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  • Noddy, 'Tis internet age - spellings don't matter on the web unless u r writin' an essay. Savvy colleague?

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  • Anonymous above
    U R so rite!

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  • why dose no one remember its not about keeping practices open but about good patient care? I hope those words are eaten by the traitor who said it? no practice = no patient care!

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  • First regulate the individuals so tight up(RCGP,appraisals,revalidation) that they cannot think properly.Then introduce CQC,medicines management,infection control, impossible targets so that small practices without enough infrastructure/resources fail.Squeeze funding and say efficiency savings.Unsustainable transfer of work without remuneration from secondary care on the form of localised services.This is due to misguided information given to secondary care colleagues that primary care holds the budget so they are pocketing the profits.Creating division between professionals.

    You can see where it is going.

    Well the younger GPs have smelt the coffee and are not playing ball.Some are falling into the trap of partnership though.Sad.

    Any way the current model is terminal.Face it.A five star buffet for 100 pounds a year as many times as you like including unlimited homevisits and if you judge the home visit inappropriate-good luck with the complaints (area team,CCG,ombudsman,GMC,courts,trial by media,trip advisor type websites-well you even dont need to send a letter just punch some buttons and the regulator will be at your door for months on end.

    Only way is change in funding model.Link pay to activity in real terms-face to face consult with a qualified dr(not paper pushing).Link the pay to a GMC number only in GP and in hospital and see the value of GMC number soar.(why do you need a performer number any way).Value face to face consultation with a professional.Instead of medicines management charge the cost of medications the state will not provide to the patients.(Must have a agreed list.If the patient wants nexium/crestor-can buy it rather than endless complaints).

    TIC the future is big corporate surgeries milking the government and patients with 20-30 gps as shift workers.If the pay is linked to the doctors GMC number there will be some bargaining power if not good luck.The corporates will get anybody to do the work with 1-2 weeks "training" (eg-111)

    Just my observations and may or may not reflect true facts for any GMC lurkers.

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  • great work,National Health Sabotage Executive.
    i hope you all never sleep at night

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