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Independents' Day

GPs should be ‘pleased’ when small practices close, suggests NHS's top GP

Exclusive The leading GP in NHS England has suggested that GPs should be ‘pleased’ when small practices close, as there are ‘too many’ of them struggling to meet patient demand.

Dr Arvind Madan, NHS England director of primary care, stood by comments attributed to him where he said ‘most businesses are pleased to see rationalisation of providers’, which he linked to small practices closing.

He also stood by comments where he suggested that GP practices should take some blame for a failure to recruit.

Dr Madan said that practices should be moving towards working at scale, and that there was a ‘degree of responsibility’ for them to not ‘passively wait for the system around them to change’.

Leading GPs expressed fury at the comments, pointing out that many small practices don’t have the time or headspace to transform, or their location may prevent them from doing so.

Pulse found earlier this year that 1.3 million patients had to move surgery after their own had closed, following 450 closures over the past five years. In 2013, only 18 practices closed.

However, in the comments attributed to Dr Madan, he suggested GPs should be ‘pleased’ about this. He said: ‘Most businesses are pleased to see a rationalisation of providers, as it makes the remainder more viable. In the general practice market, there are too many small practices struggling to do everything patients now want for their families in a modern era of general practice.’

In an exclusive interview with Pulse, Dr Madan stood by these comments and explained: ‘General practice here is built on a foundation of 7,400 small and medium-sized businesses. In all markets, there is some degree of difficulty for a proportion. The environment is a big factor within that. But actually, I think we would all like modern, thriving general practice available to us and our families.’

He said grassroots GPs should embrace the rollout of between ‘1,000 and 1,500 “primary care networks”, covering 30,000-50,000 patients’, which will have ‘multidisciplinary teams’, formed of nurses, mental health workers, and clinical pharmacy teams and expanded diagnostic facilities.

He added: ‘I think it is our job to help every practice on this journey. There is a degree to which the central national team can create the environment in which all practices can thrive.

‘But there is also a degree of responsibility within practices, which I am sure they will accept, to take up the opportunity because I am not clear that passively waiting for the system to change around them is sufficient.’

GP leaders were furious over the comments. Dr Zoe Norris, chair of the BMA’s GP sessionals subcommittee, says: ‘I’m surprised and disappointed. I would have more respect for NHS England if they were upfront about their agenda.

‘Many GPs have felt for a long time that there is only one direction of travel being pushed by NHS England: away from small practices and into groupings of a defined size as primary care networks.’

Dr Rachel McMahon, England Conference of LMCs chair, said practices are not always able to transform. She added: ‘To suggest practices in these areas have the headspace available to drive forward major transformation when all their efforts are going into just keeping the doors open seems naive to the issues these GPs are facing.’

Dr Mark Sanford-Wood, BMA GP committee deputy chair, said: ‘Small practices are often delivering the best standards of care to patients, who are seeing the same doctor who is embedded within the community and has a detailed knowledge of individuals’ medical history.

‘While the BMA believes there is a benefit in practices working together across an area, this needs to be done in a positive, mutually beneficial way, in which full support is provided to practices. For such systems to thrive, all parties, not least patients, must benefit.’

Pulse revealed in 2016 that Paul Twomey, medical director of the Yorkshire and Humber NHS England area, sent an email to practices saying vulnerable practices must ‘transform…or be allowed to fail and wither’. NHS England immediately denied this was national policy. 

Readers' comments (69)

  • Lost for words. What about CONTINUITY you MORON. General Practice has thrived in small groups in the past. But in the last five years (as we can now clearly see ) it has been deliberately pressured and attacked and targeted.

    If group so 30,000 patients were ideal they would have naturally evolved in the past- the fact that they haven't speaks volumes. Bigger means worse - worse for doctors and worse for patients.

    Pass the sick bag.

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  • Not a helpful comment, overall. What about those areas where expansion or combination is impossible - i.e. rural and semi-rural ones? Where the GPs delight in knowing all the patients; where the patients delight in always being seen by someone who know them (or perhaps, always by the same doctor).
    Remember also - our notes are only the tip of the iceberg of our knowledge about the patient: all the rest of the un-noted (but personally remembered) knowledge is there and being utilised in the small practices, providing the best possible quantity and quality of continuity of care.

    Or doesn't that matter, suddenly?

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  • The good news is my small practice has capacity, available appointments, personal lists and triage by the Dr himself. Last time I looked less OOH and A/E attendance, and a better than national 2WW conversion rate.

    Also didn't some clever study recently come up with broadly similar data for small practices.

    Feel free to visit Grimsby where I work, but guess he has no idea where it is on the map far less the ability to find it!

    Better be quick though as comments like these do nothing to encourage me to stay 1 minute longer than I have to as I'm such a valued member of the medical profession as a GP in a small practice.

    As Rowan Atkinson said "I spurn you like I would a rabid dog!"

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  • Professional prostitution and irrational ass licking allows you to get to the top but you tend to slip on your own scum or grease as you would like to call it.
    The 'Family' was lost out from 'Family Medicine' because of leaders like this one.
    I propose him as the 50th most influential so when he slips he has 49 still more stinky ones on top.

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  • We were quite happy as we were until the last few years of punishment funding cuts and stoking up of demand. The job hasn't changed in essentials - just the (lack of) support, funding and stability with the new political agenda. Do any of these "leading GPs" consider that they might not actually be right and that this forced direction of travel might be as damaging as some of us fear and certainly not applicable in all areas and types of practice? Any new funding is now only for those playing the current "locality working" or "open all hours regardless of need" game and then we are blamed for failure to recruit!!! Regarding the presumption that he knows what sort of general practice we all want - Dr Madan does not speak for me.
    Here's a thought - ask patients what sort of general practice they want and are prepared to fund then work towards that.

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  • By the pricking of my thumbs something evil this way comes.Here comets the end of days for the NHS,and the beginning of Yankee based HMOs.Meanwhile we are all a decade of all comparable professions in terms of renumeration and t&cs.The country is unattractive to Health care workers throughout the world.

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  • Completely flies in the face of recent evidence that suggest continuity is very important. Especially as patients get older with more comorbidities. It’s short sighted.

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  • THE HURLEY GROUP HAVE 100,000 patients/13 practices.

    Is he still a director of this group? if so then some might suggest a potential conflict of interest??

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  • Clear evidence of the political desperation to close small practices despite the mounting evidence that continuity of care provides benefits far beyond those that may exist by forming bigger practices. Business consultant/MBA drivel lapped up by thick politicians and their medical lackeys.

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  • Vinci Ho

    Where you sit your arse will govern which way your brain goes . Whether you believe something or not , it is not important anymore.
    As long as you live on the reward granted by your emperor, you take on his worries and concerns.
    Sigh , the conscience and honour of some are out for sale......

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  • Moron!

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  • The clarity that NHSE actively want our businesses to fold and that continuity of care is no longer important (despite evidence to the contrary) in order to fit in with this years policy vision is helpful. Transparency is good though I suspect he was forced to be transparent.
    To assume anyone should be pleased is utterly ludicrous and delusional. He must listen only to the sound of his own ambition.

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  • I think this is a resigning issue and needs a wider audience.

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  • To think he may benefit from policy direction.....

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  • General practices of any size are not "most businesses" and GPs might be 'pleased' if this fact was acknowledged by our leaders. The closure or impending closure of small practices in our already underdoctored area causes my partners and me to feel terror and despair at the extra workload we're going to be obliged to take on; with no prospect of recruiting, no amount of money can buy us the time we need to provide care to large numbers of extra patients whose care may need to be overhauled as they've come from struggling practices.

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  • This is so serious. It needs the strongest possible reaction from the RCGP and the BMA.

    This has to be a line in the sand. All is lost otherwise.

    Who does this man think he is?

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  • Rogue1

    He cant be a GP? Was he ever a GP?
    I cant believe anyone who has ever worked and committed themselves to the job could actually come out with such drivel !
    It shows complete ignorance. Absolutely flabbergasted

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  • Hawkeye

    Will it be a Knighthood or Lord

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  • Who made him director. foreign doctors have worked in small practices with big list and working in deprived area. how dare he insult them. he says "gps will be pleased" so small practices are run by ghost or gps.why would they be happy of their demise? all comments above show how happy they are. they will be happy with his derogatory comments. get dr madan out of office today please. I presume is to look after primary care.

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