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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)

  • 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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