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Gold, incentives and meh

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)

  • The current model for General practice is not sustainable. The primary care needs assessment has shown this and the only option is to change. The adaptation of these primary care networks is the rationalisation of providers and NHS England have been clear that there is no necessity for practice closures or even mergers. Pulse has a history of twisting words and has portrayed Dr Madan unfairly.

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  • Don’t ask me to sign you off Dr AW

    Sometimes when something works it’s best left alone instead of allowing people to justify themselves by f******g it about.

    Especially when inconvenient evidence confirms the dinosaurs were right after all.

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  • Dear Dr Madan, Doctors in the NHS (tax payer funded ) should be paid for providing a good service to patients. They should not get paid for just pushing paper.

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  • Sorry, really really sorry. But here have some “top doc” actually explicitly saying that the personal style of GP that we and the patients love is being actively killed off and we are having a good cathartic rant about it on a teeny weeny (no offence Pulse) corner of the web. Not even a mention on national news, no support whatever from the Daily Wail and nothing whatever will happen to stop it. And that just about sums up GP for ever since I’ve been a (latterly semi detached) part of it.
    Nobody cares, everybody loves their GP (if they’ve still got ONE) but the cavalry isn’t coming!
    GET OUT!

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  • Before I call it quits and head off to a career abroad, i am hoping to legally challenge the bar on charging our own patients for private additional services, just as hospital consultants, nhs dentists and nhs pharmacies can. Our contract is only 08-00 to 18-30 so why cant we see our own patients out of core hours. The bar is also potentially a restraint of trade and unenforceable and also potentially contrary to the Competition Act.

    My practice is about to launch a crowd-funding website to fund the legal challenge to private practice bar. Website coming soon.

    If we don't help ourselves, do not expect anyone else to.

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  • Gp’s should be pleased ??!! I thought we were here for the benefit of patients ... Having been single handed for 25 years I suggest you ask the patients what they think !

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  • NHS England "Direction of Travel" is to "Encourage" 7500 GP.Practices to "Evolve!"into 1500 Super Hub Facilities offering Pharmacy/Paramedical/SocialCare and Primary Care Services "At Scale!" Evidence Values Continuity of Care in Smaller/Varied GP.Group Practice Settings!AWKWARD!!

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  • Conflict of interest? Make that conflictS. What about econsult and Dr Maden's interest in it? Dr Madden published an article in pulse extolling the virtues of the econsult product.

    http://www.pulsetoday.co.uk/your-practice/how-allowing-one-million-patients-to-consult-their-gp-online-solved-our-appointments-shortage/20030114.article

    He was a director of the company at the time. The article was written like a good news story and the sharing of knowledge with colleagues. It gave no clear indication that he stood to gain from the product financially. The timing was great too. Clearly he knew he was appointed to the role of Director of Primary Care, so managed to have his article published just before he officially took up his post only days later. Do his omissions meet the Nolan principles for standards in public office? Certainly not on transparency methinks. And once in post, why is it that it took so long for him to reveal the NHS is definition of online consultations? And why was that definition so much like a description of econsult? By keeping his cards so close to his chest, the rest of the software market could not respond in the time allowed for the funds to be spent. He may now have resigned his directorship of eConsult but does he still hold shares? Even if he does not, he is so closely linked with those that do, that he is indirectly conflicted.

    Whilst conflict of interest may be unavoidable sometimes, it must be managed appropriately. Who is managing this man's conflicts?

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  • It is NOT a market! It is a publically funded health system - don't you understand this?

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