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Gold, incentives and meh

Sharp rise in GP mergers as smaller practices struggle to stay above water

Exclusive The decline of the smaller GP practice is accelerating, with double the rate of practice mergers in the first half of this year, compared with last year.

Figures obtained by Pulse show 93 practices have been involved in mergers in the first five months of this financial year in England, with a further 76 pending.

This compares with 80 overall in 2013/14.

The figures, supplied by NHS England’s area teams under a Freedom of Information Act request, have confirmed reports from accountants that the number of practices looking to merge is sharply rising.

Accountants and LMC leaders have said a merger is often the ‘last option’ for a practice to avoid having to close amid challenges such as a squeeze on funding or partners retiring,

The news comes at a time when various bodies are developing plans for GPs to work in larger organisations, with the chief executive of NHS England, Simon Stevens, claiming that the ‘corner shop’ model of general practice was finished, and that GPs will form ‘expanded group practices’ that employ – or take on as partners – hospital consultants, pharmacists and social care workers.

The Labour Party has also announced plans for every hospital to become an ‘integrated care organisation’ with ‘GPs at the centre’, which the GPC has warned could lead to the ‘destruction of practices’.

GP leaders have said there is ‘no time to waste’ for practices to merge, saying it is the only way ‘GP-partner led general practice can… survive’, but others have warned of the unintended consequences that this may have for average list sizes, an important determining factor for the value of QOF payments.

In the year to date, 12 practices have merged in Birmingham, Solihull and the Black Country – the second most of any area, after Derbyshire and Nottinghamshire – to create six practices, while a further 14 practices are involved in pending mergers expected to result in five practices, the area team said.

Birmingham LMC executive secretary and chair of the GPC’s contracts and regulation subcommittee, Dr Robert Morley, said practices had not made the decision on the basis of funding pressures.

He said: ‘I am not aware of any local mergers specifically because of funding pressures, they have been more for strategic and operational reasons.’

Dr Morley added that the GP partnership model can survive ‘only if GP partnerships merge into significantly larger partnerships and as soon as possible. There is no time to waste. GP-partner led general practice can only survive within a radically different business model.’

Dr Nigel Watson, chief executive of Wessex LMC, which has seen 10 practices merge into five to date this year and has a further six mergers pending, said locally practices were taking the step proactively in anticipation of future consolidation of GP providers.

He said: ‘We have quite a few [practices merging] but most have made an active choice to protect their future rather than be forced into an unhappy alliance.’

Dr Guy Watkins, chief executive of Cambridgeshire LMC said he suspected more practices than cited by NHS England were looking at merging.

But he warned there could be unintended consequences, saying: ‘We have got more mergers pending than the area team has confirmed to you. I think the practices believe it will make them more stable and ready for the future, and it might do. But it also has some consequences to the average list size, which affects QOF payments, so the math of mergers becomes very complicated.’

Former RCGP chair Professor Clare Gerada said: ‘Small, single-handed practices have had problems with viability for years. The model is, for all sorts of reasons, impossible to maintain.

‘Where I worry, though, is if practices are merging just because they can’t keep their doors open because of financial constraints – if the decision to merge is based solely on financial grounds, rather than because it is in the best interest of patients.’

It also comes as the Government admitted that there are now 518 fewer GP practices since five years ago, with some of the decline resulting from mergers and practice takeovers.

Readers' comments (27)

  • Economies of scale suit a financial model of supply in cities. They do not suit rural areas where a 40 minute round trip to a distant farmhouse is a massively inefficient but inevitably necessary daily occurrence (lessened by good continuity). Think about any of the large economy of scale businesses that you have tried to contact for "customer service" - if this becomes how we administer general practice to the frail and vulnerable we have lost the plot. Can we please stop pretending that one size fits all. Which super-practice will the remote rural or island GP's join? Or could someone perhaps admit that some areas are just more expensive to administer primary care.

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  • It is not Practices that need to merge but there should be a system of sharing good practice manager s. It is not cost effective having a few highly paid professionals doing the same job in a small geographical area.
    This also goes for Prescribing Leads and Clinical Governance Leads

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  • STOP PRESS - pensions newsletter suggests that income derived from federation activity eg enhanced services will not be pensionable . A good way for the government to cut down their pension liability as increasing amounts of our income is likely to come from enhanced services .

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  • And it was never ever about keeping practices open, it is all about good patient care. not clinical need, but clinical want. no matter how unrealistic the want is. free at the point of abuse. Go NHS. RIP.

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  • News to me . Surely any NHS work is eligible for a pension . A federation is an NHS body ?? If not then collaborative working may be better than federating because pay for our core services is so crap it would massively reduce our pensions . We really need to include enhanced service income.

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  • Could someone please clarify the situation viz federated income and pensions? It seems pretty fundamental to joining or not.

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  • Re is federated activity pensionable or not - perhaps the RCGP should seek a definitive opinion from
    Ross Matthieson at NHS Pensions

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  • Merging two struggling practices, in the expectation that things will improve, is absolutely stupid.
    When the number of partners dwindles (which it is bound to do, because of the recruitment crisis), the remaining partners will have a even greater number of patients and workload, and even greater staff redundancy liabilities, when things collapse.
    If a practice is struggling, it should simply close, and leave the problem for the department of health to sort out. Perhaps then, they might start helping, instead of punishing us.

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  • big practices for big cities maybe, but wont work in less densely populated areas.
    I don't see why the small practice cannot be maintained. The only benefit of larger practices is savings and perhaps more flexibility for extended hours. Unlikely to be better for the patient as continuity is more important in my view.

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  • Ivan Benett

    Yes, continuity needs to be preserved as much as possible but the days of 24/7 responsibility were given up by the profession a long time ago. So we need to find a balance. As I said Dr Findlay has long gone, however nostalgic some may be for those days (not me)
    Yes, there needs to be a more complex solution in sparsely populated areas. The principle of bigger practices using more salaried staff still applies. Perhaps more use of internet consultations and other local solutions.
    Look, we need to change! The current way of providing General Practice is not sustainable and young GPs don't want it.
    Better solutions on a postcard, and say who you are!

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