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The waiting game

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)

  • I have had the pleasure to work with Dr Twomey and a more dedicated and caring GP would be hard to find. The comments above do not do GPs justice and maybe they too should start to focus on how best to deliver service quality rather than just maintain the status quo. We all know there is a range of practice out there and surely it is right to work to improve it, for the benefit of all.

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  • The assumption is that a vulnerable practice is a bad practice and nothing could be further from the truth.

    Reasons for vulnerability range from overnight funding reductions ( PMS review, service charges)to unscheduled recruitment issues (sickness or early retirement)

    But let's be clear - it is all of NHSE's doing. They created the funding crisis and they are also responsible for no-one going into general practice.

    How dare people suggest that it's time to move on to working a scale when we receive HALF of the NHS budget compared to some years ago.

    Working a scale is not the answer. But you will all find out the hard way when the NHS collapses.

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  • 8 years they have been killing good doctors pay and conditions now the poor doctors and their patients
    Always the weakest lose
    Civilisation is about ...

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  • Peter swinyard
    Why is he ignored as the small practice voice

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  • Daughters wedding
    Registrar fee £500 1 hour boournemouth
    We should wake up
    5 min with dentist £80

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  • I have to say better to get £300 per patient in Dorset
    Live the good life do some CCG work appraisal as well
    Small is a waste of time
    Remember Clare Gerada forget swinyard

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  • What do they assume is a vulnerable practice?
    If GP's do not want to be into NHS owned buildings and pay high rents, but deliver an excellent service in their old converted properties, with no complaints from patients, why should they be forced to merge ... other than to make the NHS properties service money?
    I belonged to oen of the new health centres where one of the GP's is chair of the CCG, and the service was appalling and appointments harder to find than gold dust.r
    I changed to a practice with just two Gp's working from a converted bungalow, the environment is invisible, what patients need is the best quality of care and that is what I get.
    Modern is not best, my GP is so good I would care if he ran his surgery from a tent!

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  • @Simon Ruffle | GP Partner12 Oct 2016 6:39pm

    Quo usque tandem abutere, NHS England, patientia nostra?
    patience or patients ?

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  • They're all SMEs
    It's the MARKET, stupid.

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  • Eventually when we have super practices the GPs in them will realize they have no autonomy.
    I am saddened by the current lack of support for GPs
    We have worked too hard for too long with ever increasing workloads
    We should all become salaried with the BMA contract terms or be self employed locums. GP partnership is just a slow form of self harm
    Let's wake up, somehow do less work so we can enjoy some social life and family life

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