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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)

  • It is a mystery why his loquacious partner and another of our illustrious LEADERS, Lady Wessely aka Clare Gerada, has not made a comment

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  • The essence of general practice is continuity - it's the only reason the gatekeeper system works. Without it care will suffer and secondary care pressures will rocket. The man is a dangerous fool

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  • Agree with almost everyone's comment earlier,but has anyone given a thought on what are the alternatives? Does everbody thinks that current model is viable? I accept that our current model gives continuity, personalized care and patients love it which no super practice will ever give.
    But we are dealing with question of our existence. Has anybody given thought on from where increased funding is going to come which we need desperately? Current situation we are in is because of years of under funding and no government is going to give increase in funding in real terms.
    So either we keep on accepting squeeze on our take home pay and continue delivering care as per our current model & be happy that our patients love us or we embrace the changes which are needed for our survival.
    Patients will be very happy for us to keep on giving personalised care as long as they don't have to fork it out of their pocket . They don't care one bit about our stress / reduction in pay/ whether we loose our job or die.

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  • Commented earlier and to be honest my only concern for alternatives is I and my elderly parent likely to be using the service once retired! (hopefully a way off though)

    My partner retired at short notice and my small practice recruited (poached) from big practice actually as she fancied a more civilised work load and environment.

    Would stay longer if felt valued but powers that be don't so I don't either.

    Didn't sign up for all this crap as a medical student.

    Unfortunately patients wont like the change but I'll be long long gone!

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  • From NHS Choices:
    Rude staff and always rude

    I started stop smoking program with this surgery and in middle of my course they stopped my prescription twice. Staff was sending me back and forth over and over which wasted my time and energy. Still were not able to resolve problem.

    Staff is always in extreme anxiety and rude. I saw them shouting on other patients specially kids.

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  • Great idea. So please explain why small practices consistently perform better in almost every way but particularly in patient surveys.
    And please explain how it is that other European countries with more successful health care systems still mainly have very small practices and mostly single handers.
    And explain how now we know that continuity matters how exactly is it acheived in a big practice.
    Answers awaited with no expectation of a result.
    This is the 'tyrannisation' of our profession

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  • Practice does not read correspondence

    Sent an email for a modified amount of medicine because the GP has a habit of hitting print instead of reading what I actually need. I clearly laid out how many pills I needed and today discovered i've been given too much of one and not enough of the other.

    I went at 5.30pm to speak to reception and was told there was no one to help despite the practice shutting at 8pm. I was told to send another email despite the content of my emails being ignored. I have been telling the practice for months that I am leaving the country for an extended period and have been assured at every point that when i asked I would get the amount of medicine I needed. Today I was told that this was not possible, that the GP only issues in 1 month batches. For some reason the receptionist assumed I was after contraceptives and not my usual medication.

    The receptionist walked off while I was writing down my prescription and went to do his dishes. He ignored me when I called and asked for the name of the person he said I'd need to phone tomorrow. Another staff member had to give me her name.

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  • Terrible service

    No one answers the phone. Can't get help. No appointments. The most disorganised practice I have ever come across. Just awful.

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  • Very poor patient care and experience

    I have been a patient with this surgery since it opened some years ago. Whilst they ware also running the walk in centre things were quite good.

    Since then getting through on the phone is almost impossible. Getting a convenient time for an appointment requires a three week wait.

    using the online appointment system is just not fit for purpose. I tried to use it and was given a random date and time. No choice etc: An appointment in the middle of the day doesn't work for me.

    The only way to be assured of getting an appointment is to visit the practice to book an appointment.

    Issues about the reception staff being unhelpful and uncaring are true. Whilst I was there a visibly ill and frail person came up and asked for an appointment and was told a date some 2 weeks later. When challenged she then said I will put it on a card for you.

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  • Enjoy your 30 pieces of silver Madan.

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