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GPs buried under trusts' workload dump

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)

  • Ivan "3 single handed GPs in Manchester should have retired long time ago" Benett (your words, not mine)

    Good of you to jump up on agenda which you have been pushing for months. As previous posters pointed out, where is your evidence?

    My local area showed a clear trend of better patient satisfaction, lower referral and AED attendance rate, inversely propotional to list size (i.e. smaller the better outcome).

    Many wannabie economist/politicians talk about economies of scale. But you might want to look for words like diseconomy of scale, horizontal vs vertical integration. Many will then realize the perceived benefit of the integration may not always materialize. And it is this assumption that by having a larger unit you'd achieve efficient service (and hence savings) leads to many failed mergers. In fact many large companies now separate parts of it's branches for this reason. It will also make the economy vulnarable and whilst it may be good for those in the exec chair, it may not be the case for the workers and customers - look at South Korea for example.

    It's all very well wanting change, I'm all for it - but don't try and sell us your vision with your agenda without factual evidence as "good change"

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  • Why so quiet about federations and pensions . Do they have something to hide?

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  • yes evidence would be welcome to this debate. as one poster has mentioned already. it is not patient related factors that are leading to pressure on small single handed/2 partner practices but the top down re organisation and endless hoops to jump through with 0 support.
    Unfortunately IMAO those who are pushing their agenda are usually owners of very large practices.

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  • I totally agree with Ivan , and the best way forward is to have a crystal clear understanding about the roles ,i.e whether one wants an entrepreneurial role or just a clinicians role. Once this basic requirement is completed ,why not go for the biggest merger and I am sure sure,all the indications are this will happen any way!!

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  • Re federations - it depends whether you are limited by shares or guarantee as to pension eligibility. Full guidance is here
    http://tinyurl.com/prw5mlm

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  • I loved working with my patients until the list grew past 1700 .nights and weekends were exciting and I could get to a suspected heart attack quicker than an ambulance as no speed cameras were around. I worked my patch like a ward and asked we all care for the area as our patients, without arguing about why should we do this for your patient . Sometimes it was tiring but with my wife's supoort the patient came first .
    Now even knowing when a patient is admitted trickles and I can't visit them in hospital.
    Once I rang about my patient and was told by 2 locum nurses she had an amputation but was on the eye ward.
    Wrong. She was fine but had anaemia and was an outlier.

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  • I should add the continuity helps.
    Yesterday a friend was in casualty with severe pain which occurred on standing after a 2 hr meeting
    He was 14 hrs In hospital saw 4 consultants with Xray 3 ultrasounds 2 prs several bloods and too late for pharmacy after his oramorph . I saw him fine and laughing. He has several recent scans pr etc as a private businessman

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