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GP recruitment crisis forces removal of thousands of patients from practice list

Exclusive A practice is having to deregister 1,500 patients from its list because recruitment problems have meant partners’ workload is above ‘clinically safe’ levels, Pulse has learnt.

Watton Medical Practice in Norfolk has had to write to patients asking them to find a new practice after efforts to replace two GPs failed, leaving it with a ratio of 2,700 patients per GP – which its practice manager said is compromising the standard of patient care.

Local leaders warned that this could cause a ‘domino effect’, which could put neighbouring practices under greater pressure.

GP leaders said practices are requiring ‘desperate solutions’ to the recruitment crisis.

The move by Watton Medical Practice, which has a list size of 13,500 patients, follows a series of drastic actions taken by practices to mitigate the effects of the recruitment crisis, including offering £20,000 ‘golden hellos’ to prospective partners, and building practices around teams of nurse practitioners.

Mary Osborne, practice manager at Watton Medical Practice, said it was ‘an immensely difficult decision’ to make but that because recruitment efforts have failed, the list review is ‘the only option’ left to ensure services are safe for patients.

She said: ‘Due to circumstances beyond our control and the continued growth in population within the Watton area we have had to review our patient list. Patient safety is paramount in the services we provide and the ratio of patients to doctors has increased above that which is seen as clinically safe within the NHS, and, we feel, is compromising the standard of care that our patients need and expect from us.’

Norfolk and Waveney LMC medical secretary Dr Ian Hume said the practice had been unsuccessful in using innovative working, such as doctors providing a triage service and building around nurse practitioners, and said they were left with few options.

However, he warned neighbouring practices could face greater pressure. He said: ‘Asking significant numbers of patients to re-register obviously puts greater pressure on neighbouring practices who are also struggling and also having problems. So it is a destabilizing domino effect.’

NHS England’s local area team said it had been working with the practice together with the LMC, South Norfolk CCG and NHS England for help to solve the recruitment problem.

A spokesperson said: ‘Watton Medical Practice knows that patients affected will be upset at having to register with an alternative GP practice and is very sorry for any disruption this may cause.’

‘Difficulties in the recruitment of GPs is a national issue as well as being particularly evident both in Watton and in Norfolk more widely. The practice has been unable to recruit enough GPs to ensure it can continue to provide the standard of care which patients need and expect.’

It added that the list closure remained a temporary measure.

GPC deputy chair Dr Richard Vautrey said the Government has to do more to sort out the crisis in the long term, while area teams should do more in the short term, such as fundingpractices to offer ‘golden hello’ payments.

He said: ‘Practices are in a desperate situation and are looking to desperate solutions to try and solve that.’

‘The long-term solution is actually getting doctors into the practice, and into other practices in similar situations, who are there for the long term… You might at using “golden hello” type of scenarios for providing support practice [or] putting in place innovative ideas about refunding student debts for some young doctors to work long term in certain areas.’

‘There are various solutions that could be put forward [but NHS England] area teams have not yet shown the willingness or commitment to try and do that.’

It comes as Pulse reported of a Doncaster practice where GPs were forced to dig into their own pockets to fund a £20,000 ‘golden hello’ payment.

Meanwhile, Health Education England has stepped in to help fund recruitment efforts in Essex, where practices have been severely suffering from problems with recruitment.

Pulse reported earlier this year that a GPC paper said ‘the time has come to declare that the workforce gaps in general practice have reached crisis point,’ the consequences of which could be ‘catastrophic’.


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Readers' comments (31)

  • I would love to see more practices doing this. Only then will things change.

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  • Una Coales

    @10:49 thanks. I hadn't taken into account compounding interest. I hear that Inland Revenue will chase repayments even if a GP emigrates but I guess if he or she never sets foot in the UK again how can they reclaim?

    @2:32 pm the figures were cited at the annual LMC conference by a member of the BMA sessional GP subcommittee from NHS England stats. No, the hurdles for returning are so high, we are talking about 100s and not 1000s of GPs trying to return. It is almost a catch 22 for GP returners as they have to pay, sit and pass an MCQ test, then pay, sit and pass a simulated surgery exam and try to find a training practice who will take them on to retrain. But they cannot get a place on a returner training scheme until they have sat the SS exam. Yet they cannot revise as they are not allowed to see patients as they are not on a training scheme.

    The NHS England graph for NHS GPs leaving the NHS shows 2 peaks, one at 34 and one at 56, for women and men respectively.

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  • Just wait for the domino effect...

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  • If the dominoe effect doesnt happen quickly it will build up steam over the next year or two.Wait til practice have to close for being non viable or due to retirement,it really will hit the fan when demographics help build the momentum.I only hope it blows up before the election so the blame can be apportioned to this shower in government at the moment.

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  • There are still far too many young doctors entering general practice.Perhaps it's their youth and naivety;perhaps it's limited hospital training posts.Whatever the reason they are ensuring that the crisis in general practice will never reach the tipping point or "dominoe effect" as some posters suggest.

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  • I'm happy to work as a partner in your practice .. But I will like that golden hello and a wage that is the equivalent of that in Canada or Aussie, or as a locum... Ie.. You can forget it if it's under 180k

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  • We get £ 60 per patient profit year. That is £ 30 take home. 60% consultations[6 a year] and 40 % paperwork [ prescriptions, letters, blood tests, telephone consults etc] That equates to £ 30 /6 = £ 5 X 60% = £ 3.00 per consult. You are doing well to get £ 7 per consult . Have you factored in Paper work ?

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  • GP registrar,

    Not sure if you are taking a Mick or naive. You won't find a practice who can give you a drawing of 180k/year, perhaps you should research average partner drawings?

    If you work very hard s a locum you might make 180k but you'd have to be doing 45 hours every week without any holiday @ 80/hour. Yes, it's very difficult to achieve this.

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  • I am newly qualified GP. I work in an area of chronic shortage. Yet I see my fellows going for interviews and offered very humiliating contracts, what to say of partnership. One of my friend worked in a practice as "salaried with a view to partnership" yet even after one and half year of hardwork, no sign of "partnership" on the horizon. As you imagine he left. Still that practice has shortage of doctor. It really make me laugh. Another practice keep on interviewing doctor not recruiting and I know inside story that they are waiting for a suitable GP. I my self am a multifaceted GP with Fellowships in surgery from three countries, MRCGP and offered only salaried post. I will leave practice if not offered partnership in next six months. So before complaining you are not getting GP please make good offer if salaried and make them partner if you like them.

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  • Who decides what level is safe? What is the number? Einstein said the Universe is mathematical but the NHS is never ever thus, eg 4 hour target in A+E - for how many ? no one knows. Take Mid- Staffs . A 5* hospital in 1997, 300 frontline staff were cut - ergo patients suffered and died, something forecast by Christine Hancock, the nurses union would happen. Enter Francis and 3000 recommendations!! What about duty of CARE to staff. Oh no, cut staff and now the hospital is closed and there is NEW culture of care !! when it was 5* previous to the staff cuts.
    The NHS is absurd and gets more so everyday. There is going to be more cuts - 20 billion in savings it is called. Here is a predication and candour - more patients will suffer and die.
    So, for everyone's safety and health, for patients and doctors, please let us define what is safe- how many appointments , how many patients in all the different specialities to be dealt with everyday. If we do not, the BLAME, as Francis so clearly demonstrates, no matter how hard you work or how burn tout you are, will fall squarely on you.

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