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All practices in crisis town restrict patient lists over patient safety concerns

All practices in an under-doctored seaside town in Kent have restricted new patient registrations due to concerns over patient safety. 

Five practices in Ramsgate are refusing new patients and redirecting them to the local CCG - which then assigns them to a practice that has capacity - after struggling to attract staff for a number of years.

It follows a similar situation for practices in Folkestone, Kent, last year, where several practices were allowed to refuse to register any new patients, due to recruitment and funding problems. 

Three of the practices said the decision to refuse patients was as a result of concerns for patient safety - with one pointing out its patient list of 8,000 is served by just two GPs, far above the national average of 1,800 per GP.

They have adopted a system known as 'managing' patient lists, meaning GPs are not in breach of their contract and can avoid applying to NHS England to close their list entirely.

Local commissioners said recruitment of GPs 'remains a significant challenge for Thanet’s GP practices' and that the CCG is supporting practices to develop new models of care.

In letters sent to patients, and seen by The Isle of Thanet News, Newington Road Surgery, Dashwood Medical Centre and The Grange Practice said they had taken the decision to refuse new registrations due to safety concerns caused by unmanageable patient demand.

GPs at Newington Road Surgery said: 'We came to this decision based on clinical safety reasons. We currently have nearly 8,000 patients and just two GPs, almost 4,000 patients per GP. The national average is 1,800 per GP.

'We have been advertising for a new GP to join our team since August 2015 without success. This is a situation echoed in practices locally and nationally.

'Junior doctors do not see general practice as an appealing prospect and many experienced GPs are burnt out through pressure of work and are leaving the profession. Some local surgeries have closed down recently, adding additional pressures on the remaining few.'

Similarly, a letter from Dashwood Medical Centre said the surgery has 10,400 patients for just three full-time equivalent GPs.

Meanwhile, The Grange Practice, with 12,000 patients, said in a letter: 'We have been advised by NHS England's Kent and Medway area team, that we may register new patients but we are not obligated.'

The practice added it will only accept new patients every month that coincided with the number of patients deregistering over the same period.

Kent LMC medical secretary Dr John Allingham told Pulse that Thanet is among the regions in England that have suffered the most from GP shortages. 

He said: 'Kent as a county has struggled to recruit GPs for many years. The Thanet area, which includes Ramsgate, is one of the most under-doctored areas in the country and also has areas of significant deprivation similar to many other coastal communities.'

He said the LMC had been advising practices for many years on how to 'list manage', and that a similar situation had occurred in Folkestone a few years ago.

He added: 'Kent LMC are engaging with the practices and the CCG and a meeting has been arranged to consider what support can be given to the practices to try and manage this situation.'

Kent CCGs' managing director Caroline Selkirk said: 'The recruitment of GPs remains a significant challenge nationally, and for Thanet’s GP practices. Although GP practices are responsible for recruiting their own staff, NHS Thanet CCG continues to support all our practices to develop new models of care to support GPs and help improve patient access to healthcare.

'The five GP practices in Ramsgate have all been "list managing" since 2017, although not all of these practices have seen an increase in their list sizes over the last year.

She added: 'Practices can refuse to accept new patient registrations but this must be all new requests to register to avoid any discrimination.'

Ms Selkirk said the opening of the Kent Medical School in 2020 'will support our efforts to recruit more GPs locally in the future'.

A Pulse investigation earlier this year revealed GP surgery closures have risen almost eight-fold in six years, hitting record levels in 2018, with GPs pointing to recruitment issues and escalating workloads as the reasons for the rise.

Readers' comments (4)

  • Cobblers

    Looks like Thanet CCG has a forward thinking leader. Very forward thinking in that GPs (if they choose to go into GP AND stay in the area - a big ask) will not be available until 2030+ and then be as green as grass.

    Several of those big practices in Ramsgate are lead by doctors close to or even well past retirement age. They'll be gone soon. Implosion of GP beckons.

    COI ex Ramsgate GP of 34 years.

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  • Perhaps the government has already projected forwards to the worst point in this continuing shortfall of GPs
    Perhaps there needs to be a fundamental approach in making a GP s job more sustainable with appropriate remuneration and a work life balance that is sustainable.
    Make current GPs an offer they can’t refuse and thus encourage more retention of part time retirees.
    In capitalism supply and demand are corrected by paying more for highly skilled people and working hard to retain them.
    Oops looks like the government is doing the opposite ?

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  • The system needs to change. There is no unlimited funding for staff/appointments and there should not be unlimited appointments. The GMC, CCG, NHSE does not take into account you have done your best to help.
    The system is collapsing as they are punishing clinicians who try to help in a strained system and people are moving to jobs that does not involve seeing patients or abroad. A real sad state of affairs. More MEWS scoring or any scoring card is not going to help except to cause more delays and risk to clinicians registration.

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  • up the pay direct to practices with no strings massively and reduce workload by removing any obligation to provide any service that is unpaid or grossly underfunded. its simple. will it happen - yes, if a brave CCG invests and supports the service and ignores government and cqc directives. time to take a stand and defend general practice. Once its gone you won't get it back .

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