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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)

  • Leading does not mean top!
    The best primary care system in the world being ruined
    Some things are not improved with economies of scale

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  • Come on Pulse. Lazy headline. We all know a 'top GP' is one whose patients say "thanks, you're a top GP" on leaving the consulting room. I see that comment in the 360 feedback of appraisees working in the sort of practices he seems to despise. It's rare to see it relating to a Bum on Seat Conglomerate GP. Twit GP (other vowels are available) may be more apt.

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  • I feel sorry for the patients in his practice who obviously receive no continuity of care.

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  • Nhsfatcat

    Wow! Partner in Hurley Groups presumes he knows what's best for all practices. As ignorant as the SoS and DH on this issue. Massive conflict of interest. How about TOP GP in NHSE considers what is best for all patients and asks for funding and scraping of useless regulation. No gongs for being sensible! Traitor

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  • please look at dr madan's practice nhs choices web site. see how patients review his practice.

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  • What’s this nonsense about ‘Top GP’ etc - who gives these designations?? R the rest ‘fool’ GP’s ??

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  • Anyone can blabber !! Small practices are the ones who work the hardest, provide personal care to patients and serve the community. Who is this chap ??

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  • David Banner

    Delighted to face unlimited liability when forced to close.
    Chuffed to pay off the entire lease from my own pocket.
    Tickled pink to pay all my staff redundancies
    Thrilled to enter personal bankruptcy.
    Yep, small practices clearly will welcome closure with open arms.
    What a callous, stupid, insensitive man.

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  • National Hopeless Service

    What an utterly disgraceful comment. If my small rural practice were to close it would be an unmitigated disaster for the patients and longterm who have a major financial impact on secondary care costs when continuation of care was lost. This man has turned into a pointless manager.

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  • No Need for me to comment- see all above comments which say it all
    see Hurley group reviews 2 stars out of 5
    " No one answers the phone, it just rings out. I’m changing gp at this point."

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