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A faulty production line

Practices forced to re-open lists in crisis area leading to patient safety concerns

Exclusive All three practices in a Norfolk town have been told to reopen their patient lists by commissioners, despite concerns over patient safety due to GPs having to care for more than 3,000 patients each, Pulse has learned.

All lists at GP practices in the East Dereham area in Norfolk have been closed for the past two and a half years.

But last month, NHS South Norfolk CCG advised the Theatre Royal Surgery, Toftwood Medical Centre and Orchard Surgery practices that their practice lists would reopen in October.

One practice posted a message to patients on its website warning that there are 9,000 patients on their lists, but only 2.75 full-time GPs.

GP leaders said there was 'trepidation’ at the move from the practices involved.

This move comes after Pulse revealed the areas of the UK where practices are having to close their lists due to extreme pressures on general practice, while the BMA is considering whether to ballot GPs on mass list closure to highlight the problems in general practice.

A note on the website of the Theatre Royal Surgery explained the problems faced by practices in the town.

It said: ’Theatre Royal Surgery applied to NHS England for the practice list to remain closed for a further 12 months from 31 August 2017. The reason for this was to enable us to preserve the excellent service that we are able to offer to our existing patients.

’Our application was declined and we are unable to appeal this decision for three months. Now all practices in the Dereham area will be accepting new patient registrations.

’The practice currently has over 9,000 registered patients being cared for by 2.75 full time equivalents GP’s and whilst we will strive to offer a professional and clinically safe service to all our patients old and new, your understanding of the pressures currently faced in general practice is appreciated.’

Dr Ian Hume, medical chair of the Norfolk and Waveney LMC said that the closed lists were originally precipitated by a practice having ’difficulty recruiting, resulting in high list sizes consequently the practices applied to close their lists on the grounds of patient safety’, which was fully supported by the LMC.

He added: 'Unfortunately this resulted in a domino effect and all practices in the town also had to follow suit and applied to close their lists. A system of allocation has been in place since. Various initiatives have been tried to relieve some the workload pressure including locality nurses supporting care homes and NHS targeted recruitment but unfortunately the fundamental problems are based on nationally recognised problems of excessive workload, inadequate investment in primary care, poor recruitment and retention.

’Practices in the town and surrounding villages have worked very closely together supported by the CCG. All the lists of have opened from 1 October 2017 and we are monitoring the situation very carefully. Understandably there is some trepidation in relation to this move.’

A spokesperson for the NHS South Norfolk CCG said: ‘Prior to April 2017 the responsibility for primary care contracting and approving practice closed list applications sat with NHS England. During this period patients were allocated fairly to practices. Under co-commissioning and now full delegated commissioning the CCG has worked with the practices and NHS England to develop and implement plans to transition the practices from a closed list to open list status.’

Practices closing lists en masse

Mass list closures have become increasingly common as practices struggle to cope with increasingly workloads.

Last month, the Department of Health urged the BMA to consider how patients would fare if it were to put its threat of collective practice list closures into action.

Seven practices in Folkestone – which cover around 64,000 patients - have applied to NHS South Kent Coast CCG for formal list closure, saying there is a shortage of 16 full-time equivalent GPs.

This is the latest in a growing number of towns that have had to close their lists en masse, including Bridlington in East Riding of Yorkshire and the Three Towns area in Ayrshire, Scotland.

This move also comes after a survey of GP practices by the BMA revealed half of practices were willing to close their lists in response to the pressures facing general practice.


Readers' comments (21)

  • the CCG needs to commission more General Practice not keep piling on the agony to established Practices.

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  • CCG board should resign stat

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  • David Banner

    And one by one the remaining GPs will pack it all in as the pressure becomes unbearable. A few may face "last man standing" bankruptcy. Then from the wreckage money will be thrown at APMS contracts with salaried GPs, and Hunt's plan will be seen to have worked seamlessly.

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  • Probably daft query but if following the instructions to re-open list results in illness of the medical staff to the extent of being signed off with the same do we as GP's have any comeback to legally challenge the right to a safe working environment???

    I guess its a rhetorical question; suck it up, work to you drop/die and don't expect flowers from Mr H?

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  • It's important to remember that the practices need to prioritise follow up appointments over urgent care.

    If you fail to follow up someone's renal failure, abnormal chest xrays, medication monitoring and annual reviews the courts will come for you personally.

    If you have filled your appointments with the above and advise people with urgent problems to attend A/E as you are on Purple Alert, full to capacity and have had your list closures overridden by NHS England, you are in a defensible position, as your suggestion to attend A/E was quite reasonable.

    Whether A/E has capacity is not your problem, it is a commissioning one, and should not lead you to end up in court defending your livelihood and freedom.

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  • Appalling situation which will encourage early retirement of older GPS and severe strain on remaining principals! Steady reduction of morale in Primary Care doctors and staff. Hunt should be very concerned for the future of NHS! A sad legacy for all to see.

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  • A legal warning was given by a QC that adverse working conditions would not be considered a legal defence against prosecution. (I'm afraid I can't find the link). The implication is that if you are aware that your practice is unsafe, you have to hand back your contract or be prepared to stand in the dock. The more interesting legal question in my view is does using such tactics against practices constitute fraud, misfeasance or illegal contract?

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  • Again where is HSL in all of this?

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  • Why can't the three surgeries agree to resign en-masse and hand back their contracts in response? They could take a one month leave then return and off to locum instead

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  • Cobblers

    Just say NO.

    What is the CCG going to do?

    What they should do is commission new provision but, as usual, they take the easy way out and pile it on the remainder.

    At the end of the NHS Primary Care they will look all innocent and say it didn't have anything to do with them as it was the lazy GPs at fault.

    Look to number one here. Too many patients not enough GPs. Take control. Resign and go freelance.

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