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Independents' Day

NHS England primary care director 'sorry' for comments about small practices

NHS England’s director of primary care Dr Arvind Madan has apologised for suggesting GPs should be 'pleased' when small practices close.

In a bulletin to GP practices, sent out by NHS England, Dr Madan said he wants to help small practices 'thrive' by helping them transform by joining larger primary care networks.

As Pulse revealed on Wednesday, Dr Madan has suggested that GPs should be ‘pleased’ when small practices close, as there are ‘too many’ of them struggling to meet patient demand.

In response, the BMA called for 'immediate clarification' of the comments, while pressure group GP Survival is calling for Dr Madan's resignation.

Dr Madan said: 'To be clear, it is not NHS England’s view that GPs should be pleased when small practices close, nor is it mine. On the contrary, we are doing what we can to support all practices and help them thrive and I am sorry if you felt my comments reported by Pulse magazine were not supportive of you and smaller GP practices.'

But according to Dr Madan 'many small practices find it hard to provide the wide range of services we would want for ourselves and our families'.

'This is why we are helping join up practices into primary care networks to share resources and build resilience. GPs are able to work with a more diversified team, develop specialist areas of interest and work across groups of practices,' he said.

He said the 'involvement' of NHS England 'creates an opportunity to systematise support for this strengthened version of primary care that enriches the offer to our patients, drawing in support from a wider range from other professionals to work alongside GPs'.

'Not only will this help us manage the workload, but it also means patients can get their care closer to home and, where appropriate, out of hospital,' he continued.

RCGP chair Professor Helen Stokes-Lampard said that the college knows that 'many smaller practices provide care that is highly rated by patients, and research has shown that they can be particularly good at delivering continuity of care, which patients and GP teams value greatly'.

But she added that it also regognises 'the benefits of large-scale working in general practice, such as the ability to pool resources in the best interest of patient care'.

She added: 'Far from celebrating the closure of small practices, decision-makers should focus on how to best support GPs practising in surgeries of any type and size, and how we can retain the qualities that we know our patients value greatly in smaller practices and replicate them across general practice as a whole.

'Many of our members will have deemed Dr Madan’s reported comments out of touch and unhelpful given the intense resource and workforce pressures, under which they are currently working. We are pleased that he has since issued a clarification recognising that smaller practices are often the cornerstone of many communities and assuring GPs of NHS England’s desire to support all practices.'

However, GP leaders have pointed out that Mr Madan's stance ignores the reality that some practices are simply unable to transform or upscale. 

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.

And in 2016 Pulse revealed 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 (32)

  • be a man and stand by what you have said whether we like it or not. Would respect you more for that.

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  • I don't see my single handed dentist rushing to join a bigger group. That is because he gets paid for every piece of work that he does. And patients go to him because he provides a good service.

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  • AlanAlmond

    This vain and self interested man is part of a wider group who hold absolute responsibility for the utter mess we are in. I have no faith in him or any of the other so called ‘leaders’ of our ill profession.

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  • Vinci Ho

    Three things:
    (1) Apology is like making a cup of tea these days . Easy .
    (2) Bully the innocent, easy-going ones ; fear the sophisticated, confrontational others.
    (3)Drop a tear only when the coffin is brought right in front.

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  • Vinci Ho

    And teach me English :
    In a conflict , what do you call those who step on the dead bodies of his loyal colleagues , so as to raise himself up the hierarchy?

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  • Wow, Vinci Ho. So much from someone who knows so little.

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  • He told the truth and, as is the way of things these days, he has “apologised.” Doesn’t change a thing. It’s all part of the plan.

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  • If an elected Govt. wants to shut small practices, well, thee you are. If a nation wants Brexit, ditto.
    As long as there are GPs to do whatever at ever decreasing prices, why would the DOH pay more ?
    And if they can't get doctors, they can always get noctors.
    So we may gnash our teeth, only market forces will eventually prevail, whatever that may be.

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  • David Banner

    At least us cynics have (sadly) been proved right (again).
    For years we have heard mealy mouthed politicos bleat empty words about “supporting partnerships” (to avoid confrontation with GPs and patients) whilst their actions have screamed loud and clear that they seek the destruction of the traditional small partnership model.
    This odious man merely let slip what we already know. Smaller practices will be left to wither and die, the partners face personal bankruptcy, and the patients will lose continuity of care.
    But when we’ve all been pensioned off they will realise to their horror how expensive the mess they have made will be to clean up.
    The new breed of salaried docs who (quite rightly) refuse to do all the donkey work partners feel obliged to do (and demand their working hours fit with their personal life, not the other way round) will make the old system look like the bargain it was for 70 years.

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  • Agree with David Banner on almost everything including 'this 'odious man' and his ilk. These 'TOP DOCTORS' (as Pulse likes to call them), are all already, each and everyone, considerably wealthy. Yet it isn't enough for them, they look across the pond and compare their achievements to the likes of Henry Kaiser. We are truly f..

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