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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)

  • Ar5ehole

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  • If the BMA aren't onto this like wolves cancel your subscription.

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  • How sad and totally incorrect.
    Not in touch with real life caring general practice which you are systematically destroying. No evidence for your statement. It time for proper caring hard working Gp to stand up and say NO. Enough is enough. Our Gp leaders have failed us and many have kept their lead positions on CCG and LMC’s , resigning from their practices and working as Locums. No credibility !

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  • Ah top gp eh. Good luck with that.
    As partnerships go maybe the lackeys will realise the emperor has no clothes and charge market rate?

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  • Generally we are still a 'green ans pleasant land' .
    If we allow the PC driven metropolitan elite 's to Take over--'God help us all'.

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  • Beyond belief.

    What is the point of being a GP without developing the knowledge of people and families that comes from working for long periods at a reasonably small scale?

    Like many other commentators here - I simply despair.

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  • Dear Pulse,
    Please cease to refer to this utter waste of space as a 'top GP'.
    I suggest something like 'top bum licker' because it's clear who is yanking his chain beyond the ivories of NHSE.
    An utter disgrace and a traitor to his profession and any notion of good holistic patient care.

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  • Resign

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  • Yet another open goal that our "Leaders" should be hammering home. What is depressing is that we on the front line are feeling so helpless in the face of this abuse ( add GMC, CQC, NICE and that's just for starters) Joe Public has no idea what is going on with this agenda and where it inevitably will lead and whilst some may say they will get what they deserve, the matter needs to be brought out into the public domain. If any up and coming journalist working for Panorama was wanting to make a name for him/herself "The Wilful Destruction of the Main Pillar of the NHS" would be an eyeopener! Get all these punters who preach Cherry picking Apps, casting aside hardworking popular small GP units, the use of every man and his dog apart from the one person that patients want to see etc. Subject them and the consequencies of their proposals to proper scrutiny and at least get a debate on the subject. This unhealthy abuse really has to be addressed. Can you imagine the Firefighters Union putting up with this! If the whole shooting match goes to pot at least hold the feet of the guilty parties to the fire!

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  • He has made the terrible mistake of assuming small means poor. That makes him a moron. Not only are there some excellent small practices, but small practices are more likely to be excellent when considering important clinical data. The worst practices in my areas are mostly large. (I don’t work in a small practice)

    Finally he has assumed that the other businesses (practices) want to add customers because that makes them more viable. It might apply to Tesco or Amazon where prices can be set to make sure customers are profitable, but for most GP surgeries with limited space, little infrastructure investment and difficulty recruiting quality GPs; expansion is certainly not profitable or stabalisibg. For that system to work the price per gms patient must be pushed up to the point where practices compete for them. That is unlikely to happen soon.

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