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Practice list closure requests increase by 160% in three years

Exclusive More GP practices than ever are reaching capacity and applying for permission to refuse new patients, with the number of requests soaring by 160% in three years, Pulse has learnt.

GPs say that to protect ‘patient safety’ and their staff they have been forced to apply for a temporary list freeze, with some 104 struggling practices asking their local area team for permission in England to close their lists to new patients last year.

This was a big leap from the 78 requests made by practices in 2012 and the 40 made in 2011.

The high level of temporary list closure requests has continued this year, with 34 requests from practices to NHS England just four months into the current financial year, according to figures obtained by Pulse under the Freedom of Information Act.

In a further distress sign from practices, NHS England also told Pulse that 45 practices have asked to shrink their practice boundaries since April last year in another attempt to ease capacity problems.

Pulse previously reported on the Watton Medical Practice in Norfolk had to remove 1,500 patients off its list due to severe recruitment problems, and that practices in large student populations are considering closing their lists due to funding problems.

The figures come as more than 100 practices across the UK are being forced to close or actively considering closure, as a result of funding cuts and a recruitment crisis. This has led to Pulse launching its Stop Practice Closures campaign.

But the requests for list closures are not necessarily guaranteed to help ease the crisis as Pulse revealed earlier this year that area team managers are rejecting one-in-three requests to close patient lists.

NHS England said the circumstances for a practice wishing to close its list is judged individually, although the local area teams will base their decision on a national policy, introduced in July last year.

Pulse received responses from all of England’s 27 local areas teams and found the situation was particularly striking in Hertfordshire and the South Midlands, where the area team had recorded 14 applications to close lists between April and July this year.

GP leaders said falling funding, recruitment problems and the Government’s reluctance to invest in upgrading GP premises meant more practices than ever were considering closing their list to new patients.

Bedfordshire and Hertfordshire LMC chief executive Dr Peter Graves said practices could barely cope with their existing workload and were looking for drastic options to survive.

He said: ‘Like many areas I suppose we have vast numbers of new properties going up and new people coming into the area as well as those moving within the area. [Practices] are concerned that taking on new patients jeopardises the service for their existing patients and the only way they can cope with that is to have a period of list closure.’

‘There are real concerns about workload, recruitment problems and premises. We are certainly getting more requests for advice from practices on how to go about closing lists and indeed I am getting calls from practices with straining from capacity problems and problems with their premises, asking how can I possibly solve that, and one of my suggestions would be: “Why don’t you close your list for a short period of time?”’

Dr Brian Balmer, chief executive of the LMC in Essex where the area team has seen 7% of all the patient closure requests since April last year, said: ‘The practices are struggling to provide for the patients they have got because of issues with workload and recruitment.’

Milton Keynes Village Practice told Pulse it had just applied for a temporary list closure for the fifth time in recent years in order to protect their staff and patients.

Practice manager Kim Foy-Oluwo said the practice, which has six GPs and almost 14,000 patients, was struggling: ‘[It is] in the interests of patient safety and staff welfare alone.

‘For us it is about space and there seems to be no immediate intentions from the area team to be able to work with us in creating more space and capacity so that we can take on any more patients.’

‘We understand that there is a strategic review of primary care nationally and locally, and we are willing and prepared and want to work with them to establish this review. We are happy to fall into line with that, but something has to happen with the immediate pressures and problems that we are experiencing.’

Dr Maureen Baker, chair of the RCGP, said that it was ‘distressing’ for practices to close their lists.

She said: ‘This is an extremely distressing situation for patients and for GPs and their practice teams. Every patient should be able to register with their local family doctor, and GPs want to provide the best possible access and high quality care for all their patients.

‘No GP practice wants to close their list and turn away patients, even as a temporary measure. Unfortunately, what we are seeing now is a sad consequence of the desperate shortage of GPs in many parts of the country, with many practices finding it difficult to find replacements for those doctors that have retired. This is leaving general practice teetering on the brink of collapse and having a severe impact on the care we can provide for patients.’

GPC deputy chair Dr Richard Vautrey said any number of list closures was a big problem. He said: ‘I think even one practice is one practice too many because it doesn’t only affect the practice that closes their list, it has a knock on, a domino effect for other practices around that area, who then have to take on the patients because one practice is not able to do so.

‘It has a wider ripple effect, not just for the relatively small number of practices that have closed their lists but there are much larger number of practices that are subsequently affected by that.’

A Department of Health spokesperson said: ‘We know GPs are working under pressure which is why we have cut GPs’ targets to free up time with patients and are increasing trainees so that GP numbers continue to grow at a faster rate than the population.’

Have practices in your area requested to close their patient lists? See our map.

Readers' comments (8)

  • Will the bears ever stop filling them woods.

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  • Practices do not request closures just for fun. One has to rememebr that GPs always care for patients and their interests and safety is the main priority in all circumstances

    It is therefore, immoral of NHSE to decline Practice closure requests on the grounds of strategy or financial concerns.

    This puts both patients and the GPs at risk.
    GMC and BMA should work together to help GPs with this issue and MPS/MDU advice should be sought as a matter of urgency if NHSE declines approval.

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  • If practice requests closure due to staff shortages and NHSE declines
    1) NHSE can`t says more patients are being sent to A&E unecessarily as to try accomodate everyone will result in higher risk to GP`s and existing patients.
    2) CCG budgets will blow up due to overactivity in A&E
    3) If someone came to harm due to increased pressure, NHSE should be made culpable under corporate manslaughter clause
    4) If GP partners or staff go of sick due to stress, LMC should support the practice sue NHSE for compensation. As its a imposed contract and not a mutually agreed contract, Europena human rights courts are likely to consider same as constructive dismissal.

    When we make mistakes or even when we don`t -the press, GMC, patients and public seem like giving us a bollocking,time NHSE is given same.
    GPC needs to grow a pair soon.

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  • I love the standard NHS England reply - its a complete lie and not in keeping with the rest of the story. GP targets have NOT been cut. There are NOT MORE trainees coming through. The ones who are coming through are emigrating or working as locums with portfolio careers. But obviously, why worry about facts NHS England.

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  • NHS England are incompetent and deluded yes, but the real culprits are Jeremy Hunt and The Daily Mail for "terrorising" GPs and creating all this mess. In particular, the "moral crimes" of The Daily Mail should finally be tackled.

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  • Sadly what they don't tell you about training is that majority of these are women and these only want to work part time when fully trained because of family committments. Some males also want to protect work life balance to enable time with family

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  • I agree with 11.25am...... We should clearly be "terrorising" any GP who wants to live some semblence of a normal life, making them work 120 hours a week, drive an old Morris Minor like "the good ole days" and taxing them at 90%-that is in full agreement with The Daily Mail

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  • We do not have to worry about he daily wail if we had any leadership at all. The best they can come up with is ' your GP cares' or some kind of a pseudo strike. Bah humbug. You would think the GPC is hand in glove with the DOH, otherwise we would not have half this rubbish. Any self respecting Union would have resigned long long ago. But oh no, we are the whipping boys for everyone.

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