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Letting practices 'wither' is a complete dereliction of duty

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After months and months of Pulse highlighting the plight of hundreds of vulnerable GP practices across the country, now this.

Pulse and the BBC have obtained a leaked briefing note from an NHS England director in Yorkshire and Humber that reveals a secret strategy to allow practices to ‘fail or wither’.

‘We are no long in a position to continue to support practices irrespective of their willingness to transform,’ it says.

What a scandal. A complete dereliction of duty. Each practice that closes is a tragedy, for the partners and the patients, and is a further kick to the knackers of a health service that is already struggling to cope.

You cannot tell them to ‘transform’ when they are struggling to survive. Transforming takes head-room, time to think and plan.

Look at this one in Warwickshire: the partners are being forced to choose between taking out significant personal loans or declaring bankruptcy to cover the liabilities they have been left with after handing back an unsustainable contract.

Do you really think they were saying towards the end: 'Hm, how about a bit more social prescribing?'

NHS England says the leaked document does not reflect national policy, and to his credit, Dr Arvind Madan, director of primary care at NHS England, did admit errors, telling the RCGP's annual conference that they had not been good at 'getting the money out the door to practices that are in trouble’.

But practice closures have hit a three-year high, with 200,000 patients displaced last year and, as Pulse recently revealed, a £10m national fund for vulnerable practices has been tied up in so much red tape it has yet to reach the front line.

As Dr Zoe Norris points out in her blog today, NHS bosses have a choice here. They have the funds from the GP Forward View so there is no excuse for holding onto them and not passing it onto practices in trouble.

Because if they don’t, then the implication will be clear. They wanted it that way.

Nigel Praities is editor of Pulse

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Readers' comments (22)

  • Superb as always Nigel. But...

    The issue is even more stark. Because Hunt, Stevens et al have all declared that the NHS hinges on primary care. And if they are prepared to let general practice wither, they are happy for the NHS to be flushed down the pan.

    Time to get a visa sorted.

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  • This sadly just confirms what many knew already I think

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  • Very little political capital keeping practices open. What will happen is mounting pressure on other practices then overflow into the A+E sector. Patients only know two places to get help GP or A+E if one is not there the other will always be. Targets get missed before the winter and the NHS as an organisation starts the finger pointing blame game. Junior Doctors going on strike will have upset waiting lists and subsequent funding flows so will be blamed for the failing finances. Long waits will allow the politicians to offer tax breaks to go private then the £10 charge for GP's will be introduced. That will have to be extended to OOH and A+E to prevent gaming and then we have private providers offering services to compete with NHS. Training out the window. Patients voting with their feet and the NHS as a whole allowed to wither on the vine and not just primary care. Denationalisation complete!

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  • Good analysis from Joe. Objectively, the Gov is playing a blinder! Ie the rational means to achieve a tough goal

    I have made A LOT of bad decisions in my life but c.2004 i knocked back a lot of pressure from bien-pensant partners to join up and "be like them" ....thank f***

    Generally you can blame the uk labour party for most things bad in the uk in the ladt 40years...the 2004 contract which untied GP committnent to their patients for 24hours (although it had partners skipping with joy in the corridors) did fatal damage to the role of GP

    And here we are today

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  • The 2004 contract was an attempt to improve pay and morale by the Labour party . Now we'll be left to wither . Thank goodness for the tories. Evil hunts .

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  • |Anonymous | GP Partner|13 Oct 2016 8:29am


    Ha ha ha -love your blind devotion to Labour. Good old Labour! Never did the NHS any harm! They wanted us to be happy and rich!

    Look outside the bubble, friend.

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  • Is pretending that practices under 3,000 list sizes are still financially viable really helping Nigel?

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  • Manager - why wouldn't a list size under 3000 be financially viable? Why pick that figure? Just staff in proportion to patient numbers. If small practices that are safe, efficient and popular with patients are not financially viable, the financing arrangements are wrong.

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  • That 3,000 figure is being given to us by multiple GP practices, who are really feeling financially squeezed at the moment.

    The problem is that no-one at NHS England, CCGs or practice levels expects that to change - the rate and complexity of workload is continuing to increase in excess of funding levels.

    If that's the case then practices with smaller list sizes need to prepare to work at these funding levels, not expect them to magically change in the future.

    If that's then the case, then Pulse's campaign would seem more populist than helpful - may help as clickbait for banner adds, but is creating false expectations really helping practices?

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  • "That 3,000 figure is being given to us by multiple GP practices, who are really feeling financially squeezed at the moment"

    My point is that they shouldn't be and if they are, something is wrong either with the funding structure or with the work being demanded for that payment given that such practices have always been viable before. Ideal list size per doctor some years ago was 1500. It should be lower than that now given the increasing complexity of work undertaken in primary care.

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