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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)

  • Predeep. If the powers that be funnelled the money into primary care rather than the twaddle that NHSE children (on £80,000 a year) come up with then there would t be a crisis in general practice.
    There is enough money it is just being misdirected and misspent.
    They want you to think that general practice in its current form is unsustainable because it fits their plans of privatisation

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  • Well, what a surprise. Lets have a look at the reviews for your surgeries sir: Sternhall Lane Surgery 5 x 1* in a row, Liberty Bridge 2.5*. You are fully staffed by locums in London. Great vision of primary care you have. "Dr".

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  • A little more than 30 pieces of silver.
    Dr Arvind Madan is paid £205,000 pa as director of primary care. This is on top of his income from Hurley Group and other sources of income (Google). To maintain his current level of income requires Dr Madan to reduce the more modest income of his colleagues.
    It's just business.

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  • ‘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.’

    Oh dear, oh dear, oh dear. How dangerous a little knowledge can be. Does he believe he's a business guru too? This completely mis-understands how business dynamics apply to GP. Practices are not threatened by not having ENOUGH patients, like many businesses. They are inundated with patients and paid too poorly on a subscription payment model.

    But it's helpful to confirm the trajectory, I suppose. Larger practices, more virtual consultations from a series of doctors connected only by a shoddy care record and maybe augmented by some kind of AI. My family are patients in this sort of practice and its pretty poor. But it is probably (in the short term, at least) CHEAPER.
    And THAT is the point...

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  • as one commentator said: its just business guys, not sure why everyone is getting upset. Why would he care about small practices? we knew this already a la NHSE failure to support small practices. CQC's subliminal messages and all the roll out of network groups which prize out small practices etc.
    I don't think anyone goes into politics let alone medical politics for righteous reasons. Its quite refreshing to actually hear this from people in power so some of us (sadly) in smaller practices can accelerate our exit.
    Hopefully he can use his silver winnings on a fast car and family holiday.

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  • OK, this link is to the GP patient survey, comparing Dr Madan to our 1,800 patient practice.

    https://gp-patient.co.uk/compare?practices=G85715,G82175&s=0&w=1&g=0&a=0&e=0&h=0

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  • Why does Pulse insist on referring to 'top GP. This is the language of the tabloids. Is the new editor of Pulse up to the job?

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  • Agree with 2:21pm.
    It's refreshing that NHSE 'top doctor' comes out and states NHSE's exact goals. Dr Madan possibly see's himself as a latter day Henry Kaiser, who is going to bring quality, instantaneous and cheap medical care to the masses (while making a billion or two on the side for his efforts - he will also expect to be lauded for his achievements).
    'I have seen all things under the sun and found them all to be futile, a pursuit of the wind'. Ecc 1:14

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  • % of patients who usually get to see or speak to their preferred GP

    26%

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  • % of patients who describe their experience of making an appointment as good

    59%

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