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At the heart of general practice since 1960

Will mass GP list closures force a Government rethink?

dr applebee online

YES

It is beyond doubt that general practice is in meltdown. Last year, a GPC survey found 84% of us believe the current level of workload undermines our ability to provide safe patient care, while 31% of practices said they had been unable to fill a vacancy.

Young doctors are not choosing general practice; 27% of GP training posts are unfilled and one in three GPs plans to retire in the next five years. Yet the Government insists patients should be able to see a GP routinely 8am to 8pm, seven days a week.

Ministers want the NHS to become more ‘efficient’ by shifting care from hospitals into the community. But there is no evidence this would save money and there is certainly no capacity, given the shortage of community nurses and the huge cuts in social care.

The NHS is grossly underfunded. In 2015 the UK spent 7.3% of GDP on the NHS; this is set to fall to 6.6% by 2020. We have fewer doctors and nurses per head than comparable developed nations.

It is not safe for GPs to continue to work under such pressure. If ministers won’t listen we must make them listen.

Collectively closing lists - as voted for by LMCs - will increase safety for our registered patients without a breach of contract. Yes, it will affect access for some, but if general practice collapses there’ll be no access for anyone.

GMS and PMS contracts allow list closure ‘particularly when there is unusual and sustained demand from patients or in situations of workforce or recruitment difficulties that affect a practice’s ability to provide to an acceptable and safe standard’. Surely the current situation fulfils these criteria?

We must explain to patients we want to provide safe general practice to the whole population, but that in the current climate this is not possible. Many already know this; some 250,000 marched in defence of the NHS earlier this year.

Collective action, involving patients and backed by a high-profile media campaign will soon make the Government acknowledge our worth, especially given the result of the general election. I predict we won’t have to close our lists for long.

We cannot continue to jeopardise patients and ourselves by working crazy hours and absorbing more unresourced work. Enough is enough. The Government is not listening so we must take decisive action. If not now, when?

Dr Jackie Applebee is a GP in east London and chair of Tower Hamlets LMC

dr ivan camphor online

NO

Closing practice lists en masse is not the answer to the current crisis. It is true general practice is on its knees and I understand why colleagues voted to try this course of action.

But our health service is on the verge of collapse and I believe mass list closures will only exacerbate the strain, undermining the foundations of general practice, hastening its dismantling and leading to a backlash of public opinion.

GMS and PMS contracts allow practices to apply formally to close their lists if workload is jeopardising patient care. But practices that do not wish to have patients assigned to their lists by the area team must go through the formal list closure procedures set out in paragraphs 29–31 of Part 2, Schedule 6. Closure can be for a maximum of 12 months and has to be approved by the area team.

Patient safety is the priority. Practices are required to consult with key local stakeholders, which entails a formal process of engagement. If a practice opts to restrict patient registration without prior discussion with NHS England, it could face contractual action.

We are all-too aware of our responsibilities under the Hippocratic Oath, which states: ‘I will use treatments for the benefit of the ill in accordance with my ability and my judgement, but from what is to their harm and injustice I will keep them.’ Collective list closures could lead to the most vulnerable not getting the care they need.

This does not mean we should sleepwalk to the edge of the precipice. The present state of affairs is critical and there needs to be a clear, workable solution that addresses the concerns around seven-day access, which, amid financial constraint and the workforce crisis, is a national tragedy in the making.

List closure is akin to rearranging the deck chairs on the Titanic while fundamental questions relating to workforce, workload and infrastructure remain unanswered. It is these that must be addressed in a considered manner.

Our last industrial action, in 2012 – when some practices withdrew routine care for a day in protest at pension cuts – was, to put it mildly, toothless. Rather than taking high-risk action, we need to strengthen our GPC negotiating team to encourage dialogue with the Government and NHS England to resolve the issues in a sustainable and practical manner.

Dr Ivan Camphor is a GP in Cheshire and medical secretary of Mid Mersey LMC

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Readers' comments (10)

  • Cobblers

    A car crash is a car crash. It is happening as we speak. You can be passive (aka Ivan) or active (Jac. You can take your hands off the wheel and hope or guide it to the best spot, if any, for the accident.

    Closing lists unilaterally is a breach of contract. However not closing jeopardises patient care. Too many punters and too little medical time. Rock and a hard place.

    Control the crash. Serve those who are on your list and close to the rest.

    NHSE may take your contract away. Good luck with that. Doing that does not magic up new GPs. If you all do it they are buggered.

    The message should get home. It is difficult to have dialogue with the Government when they are not prepared to listen.

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  • I vote Appleby..........Dr Camphors response offers nothing other than saying we have to bend over and take it...... when will he realise it is pointless trying to negotiate with these bodies????? The government only responds to crises, until we break they will keep pushing, the longer you try to prop it up the more damage general practice will incur..... if you really care about the patients you have to let it collapse to bring some political will to it.....

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  • I know some friends who have decided to change and reduce practice boundary size

    Still needs to go through a ccg/nhse process but doesn't breech contracts as far as I'm aware and allows you to reduce list size

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  • The contract cannot enforce unsafe working. If list sizes are too high then things will inevitably go wrong and NHSE along with the rest of the regulation industry will soon have their knives out for you. Knowingly allowing your patients to be seen in unsafe conditions is unethical and recent events show us what happens when people choose to turn a blind eye to safety - you will not be granted clemency. List closure is not industrial action, it's simply ensuring your practice is fit to fly. Saying that contract law trumps health and safety is like saying it's OK to force truckers and pilots to work outside of their regulated hours.

    This situation has been engineered by powerful and corrupt people in government with financial interests in forced privatisation. £1Bn was found to buy control of parliament so of course we can fund GPs. We cannot allow them to get away with it. When the prosecutions start (which they will eventually) we need to ensure the right people are in the dock and held accountable.

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  • It won't make the govt rethink but it will give them an opportunity to channel funds to favoured groups and Providers at local levels under the pretext of saving NHS. The intent is clear - Hunt will have top position in an American HC giant and our local small fry heading the NHSE and DoH will get their shares in Bitcoins:)

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  • Very sensible idea , millions of taxpayers without gp services will soon force the govt to stop cutting nhs spending(set to fall from 7.7% of GDP to 6.6%).

    Once GP leaders suggest maybe a million unregistered will rush to do so and GP revenues will rise.

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  • of course if you are too busy you should close your list. Is about safety for your patients and your mental health. Its not GPs responsibility to ensure everyone has a GP its their responsibility to look after their own patients and not take on more work than they can manage.
    Ultimately its the public who are responsible for making sure they have access to healthcare or not. The government can be their proxy and they have to ensure the government provides what they want through voting for those who offer what they want or campaigning or obtaining care privately if that is preferred.

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  • I'm sure Ivan means well but does he really think negotiating works with these people? Where has it got us so far Ivan?

    GPs should shake off the shackle of the nhs and go full private, removing all the ridiculous access requirements, insane demands can be rejected easily, and removal from the nhs complaints system would do wonders for GP morale.

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  • Till the time colleagues like Dr Ivan whose line of thinking does not change & i am sure there are many more like him, NOTHING WILL HAPPEN. This government will take action ONLY when general public forces them & general public will not come on street till it really affects them. so YES mass closure will be one of the way.

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  • Vinci Ho

    It is a fine line between negotiation and extortion. If the government likes to politicise general practice (and NHS) , the political wisdom is to play the game , no doubt dangerous, with similar tactics . An eye for an eye (yes , a danger of making the whole world blind) . But the government leaves us no choice and should bear most of the blame.
    There is a limit of how many times our faces could be slapped repeatedly with no action.
    We all remember the story of Neville Chamberlain, Earl of Halifax on one hand , Dunkirk and Churchill on the other......

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