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Vulnerable practices 'to be allowed to fail and wither', says NHS England director

Exclusive A senior NHS England official has said vulnerable practices must ‘transform…or be allowed to fail and wither’, a leaked document obtained by Pulse and the BBC has revealed.

Paul Twomey, medical director of the Yorkshire and Humber area team, made the claim in a briefing sent to NHS managers and GP leaders in the region.

He said that NHS England is ‘no longer in a position’ to continue supporting vulnerable practices ‘irrespective of their willingness or ability’ to transform.

GP leaders said that NHS England were taking on ‘Orwellian tones’ with this latest statement.

NHS England has been urging practices to federate and merge, but this is the most explicit a medical director has been about allowing practices to fail.

It comes as Pulse has revealed that a £10 million fund to support vulnerable practices announced 14 months ago has had very little impact, with many area teams having failed to even identify the practices that will receive funding.

Pulse has revealed through its Stop Practice Closures campaign that practices are closing across the UK, and reported today that partners of a practice in Warwickshire are having to take out personal loans to pay for redundancies after the local CCG blocked its attempts to merge. 

Other notable recent practices in danger include an 18,000-patient practice in Oxfordshire, and another closing while it was waiting for vulnerable practice funding, while the local trust is taking temporary charge over four GP practices in Lincolnshire, and four practices in Brighton and Hove servicing over 10,000 patients had to close after funding was pulled through the review of PMS contract.

NHS England has previously said that practice closures are ‘not always a problem’ and ‘happen all the time’, and occur through mergers, new premises and death of a single-handed practitioner.

But the comments by Mr Twomey go further than this, indicating that NHS England would actually allow practices to fail.

In the briefing note, he wrote: ‘The message we need to communicate to general practice is the GP Practice Forward View must be about transformation and in that sense is not like a pilot.

‘This is what we do need to explore I think in particular with the LMCs, who on the whole across Yorkshire do have a commitment and focus of quality, and appreciate that vulnerable practices must either transform and deliver a quality service or be allowed to fail and wither by the system.

‘We are no longer in a position to continue supporting practices irrespective of their willingness or ability as a provider to transform appropriately.’

But GP leaders reacted angrily.

Dr Richard Vautrey, deputy chair of the GPC, said: ‘The term transformation seems to be taking on Orwellian tones when used in this way. There are many practices who were previously performing well and valued by their patients but are now vulnerable because of spiralling workload and recruitment problems beyond their control.

‘Such practices should not be written off. The whole basis of the practice resilience scheme is to provide appropriate support to practices and NHS England and CCGs should be trying to do all they can to utilise this resource.’

Dr Peter Swinyard, chair of the Family Doctor Association, said: ‘Starve the practices of resources. Micromanage them into the ground. Over inspect and over criticise. Then stamp on them.

‘It is hard to be transformative when you cannot recruit doctors or nurses and are under the cosh of all the stresses we know, then have your income and resources reduced making it even more likely that you cannot manage change and adapt.’

He added: ‘This is the most desperate and negative policy I have heard.’

Mr Twomey declined to comment, but an NHS England spokesperson said his comments ’do not reflect national policy whatsoever’.

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Readers' comments (47)

  • Is anyone surprised ?. The phrase "wither on the vine " keeps cropping up from our "leaders" . Feels like we're on a runaway (virgin) train

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  •'s the ordinary people who will be falling like flies.

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  • Thing is he's right. The GP Forward View says exactly the same thing.

    There is NO proper help for individual small (or large) practices. We must work together or die. There are significant resources for collaboration.

    There is no doubt of this.

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  • It doesn't reflect national policy, IT IS NATIONAL POLICY.

    Do as we say or die.

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  • Anonymous | GP Partner12 Oct 2016 12:00pm

    We need to be planning for the health service after the collapse of primary care . The demise of general practice is inevitable now . This is because those leaving ( in droves ) cannot be replaced . There is no one left to train anyone willing to take on the job. This government wants rid of a state funded service and the best way to pull it down is to undermine the foundations . There is an orchestrated assault on primary care . Even our receptionists are getting a kicking now . No help can be expected from the establishment because the quicker things fail the better for them . Any direct action from us will allow them to blame us . Time to take to life boats and save what you can . This ship is going down .

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  • Nhsfatcat

    Quo usque tandem abutere, NHS England, patientia nostra?

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  • This is correct. NHS England has to save money. How better than letting 1:4 Gp practices close by refusing to allow them to merge and not helping them access the transformation funds in time- with the partners personally taking all the liabilities for redundancies and leases etc at no extra cost to the NHS?
    Once the money is saved some can be redirected, they hope, to the remaining drowning Gp practices who can only cope with the increased demand by operating 8-10pm 7 days a week just as they had all planned. Saved rental and running costs by NHS England and public gets its extended hours. See it as increased efficiency. Job done. Except no continuity of care any more. No local GP practices and still the public never got to vote or debate this plan.
    Well done Hunt! Well done NHS England! At least if they can be honest about this now the public and media may start to support those left struggling and be a bit more sympathetic to the individuals caught up in this mess rather than vilifying us all the time. Hard to be painted as greedy GPs anymore now many of us face personal bankruptcy as a result of NHS policy.

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  • There has never been any real understanding from anyone other than primary care exactly how primary care works. The drivers are not financial but money is important to pay the bills. I have had many instances where senior NHS people and politicians believe GP's are on huge salaries as they believe the media rhetoric. There is little reward for good practice nor for long service. With the introduction of the £10 per patient per contact as described by the Kings Fund discussion paper there may be some respite from the relentless demand. There certainly won't be any help from NHSE before the cards come tumbling down.

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  • If you are over 50 don't worry. There is still just enough game left to play. If you are 30-40 then you should prepare for a portfolio career. You need to gain further skills either in or out of medicine.
    If you are 40-50 I grieve for you. This is not what you bought into.

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