NHS efficiency cuts lead to raft of practice closures

By Ian Quinn

Exclusive: NHS managers in many areas of the country are planning major programmes of practice closures as they resurrect plans by Lord Darzi to move GPs into polyclinics, Pulse can reveal.

Some trusts plan to cut their number of GP providers by half, with managers preparing for a cull of single-handed practices and pressuring GPs to merge with neighbours.

In at least one area, managers are already putting in place plans to shuttle patients across the PCT after acknowledging the new arrangements will leave some facing long journeys to new facilities.

GP leaders welcomed plans for shared resources and premises upgrades, but accused trusts of drawing up ‘hit-lists'.

NHS South East Essex revealed plans to cut a quarter of practices within four years, with incentives to merge and a phase-out of single-handers, after claiming many practices are ill-equipped to handle the shift of work from hospitals. It wants to replace practices with polyclinics.

‘The new centres will benefit from shared enhanced services and improved access at weekends and evenings,' says its operating plan: ‘We will also explore the potential for the centres to be supported by a patient transport service for those patients who need it.'

Dr Brian Balmer, medical secretary of Essex LMCs, said the GP practice he was registered with was among those threatened with closure: ‘We've questioned whether they're drawing up a hit-list. But they can't force GPs to close and if they try to they'll face huge protests.'

NHS London has introduced a blanket ban on replacement of singlehanded practices once contracts expire and PCTs have begun releasing plans to drive out underperforming GPs.

NHS Harrow plans to halve its number of practices and will serve increasing numbers of performance aimed at ‘demanding higher standards of compliance and cooperation'.

‘We've had conversations with all practices and half are keen to merge,' says its 2010/11 plan.

Nearby NHS Hounslow revealed similar plans to merge practices by ‘ceasing to subsidise substandard facilities', while NHS Croydon said talks were underway between a number of practices about mergers because they were not seen as being of sufficient scale to match its polyclinic plans.

NHS Coventry is consulting its 67 practices on plans including a big cut in singlehanders and an umbrella APMS contract for GPs prepared to merge and work in a new polysystem, based around the city's hospital.

Juliet Hancox, director of primary care, said the PCT's plans had been positively received by ‘entreprenurial GPs', but with resistance from those who did not want change.

‘We need practices to work co-operatively', she said, ‘You can go in with a big stick or do it in partnership as we're seeking.'

Dr Jamie Macpherson, medical secretary of Coventry LMC, said he welcomed plans for GPs to share resources but feared the proposals would cull popular practices.

‘What I'm opposed to is a one-size fits all approach. The PCT's policy is supposed to be having services closer to the community, but having fewer, bigger practices flies in the face of that. Many that will close are in deprived areas.'

Some PCTs have claimed special local circumstances for the raft of closures and mergers but the trend appears to be going on accross the country, sped up by the efficiency savings demanded by the DH and moves towards polysystems and GP federations.

NHS Medway said four practices had merged this month alone, with others likely in the coming year, while NHS Bolton said it planned to turn seven trust-run practices into one.

Other trusts to reveal plans to cut the number of practices include Heart of Birmingham Teaching Primary Care Trust and NHS Rotherham.