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Closures are a grim reminder of the state of general practice

Editor’s blog

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Pulse has been monitoring the number of practice closures in the UK since 2014. That year, we launched our ‘Stop Practice Closures’ campaign with the worrying message that LMC leaders were predicting a potential 100 closures in the following year.

This was a quite astounding prospect. Although these were still only predicted closures, at the time we felt such a big number justified the launch of a campaign.

A year from its launch, Pulse’s campaign yielded what we thought was a win: a £10m fund from then health secretary Jeremy Hunt for vulnerable practices as part of his doomed ‘new deal’. It wasn’t a huge amount, but it was an acknowledgement that closures were a problem.

In 2016, NHS England released its GP Forward View. This provided even more financial support as part of its ‘resilience fund’. All the devolved nations launched their own versions of this fund.

Yet by now the figure of 100 was no longer notional. Indeed, 130 practices were closing a year. Singlehanded GPs continued to retire, with no one to hand the reins to; partners in larger practices could not handle the workload and, unable to recruit, they had no choice but to close; and the CQC went about its business removing registrations from practices – leaving their neighbours with little choice but to absorb their patients.

The following year, 2017, brought a similar story. For the second successive year, more than 130 practices closed. By this time, GPs were feeling saturation point must have been reached; surely there were only so many more closures the system could handle.

Surgeries aren’t closing because GPs want to join bigger, shinier ones

Sadly, our investigation this month reveals that closures show no signs of slowing. There were more than ever last year – from a smaller pool of practices, of course.

These surgeries aren’t closing because GPs want to join bigger, shinier practices, as some would have you believe. Partners at these practices are taking the heartbreaking decisions as a last resort.

Our case study, Dr Hazel Drury, says she didn’t close her singlehanded practice so that she could move to her current one, as much as she is now happy there. Nor did her colleagues who were forced to shut their practices. They were left with no other option.

As Dr Drury puts it: ‘Because of other closures of all the practices around us, it’s like all the rats jumped onto the one ship that’s actually still floating and not sinking.’

We have featured health secretary Matt Hancock on the cover. He may have had little to do with these closures personally. But I fear that his plan – which revolves around primary care networks – won’t stem the flow of practices shutting their doors. It won’t magic up GPs. And I don’t believe the more robust practices will be able to help much when their vulnerable network-mates succumb to what are systemic problems.

This might be a particularly grim editorial. But practice closures are grim. And while they continue to take place at the current rate, we can only look back on the halcyon days of 2014 where a potential 100 closures was seen as big news.

Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at editor@pulsetoday.co.uk

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Readers' comments (6)

  • Great Work! Keep it up... I see Pulse has been mentioned several times on the front covers....

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  • I second that!

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  • Thank you Pulse. Someone on our side.

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  • This is true. NHSE spouting that practices are closing due to practices merging... Nonsense. It’s desperation, not choice. no-one has done (or will) do a study on GP satisfaction at super practices versus traditional smaller practices. Give doctors decent working conditions and don’t force a top down reorganisation with the hope of economies of scale. You need a bloody great economy to cope with the mass exodus. And younger doctors and trainees - don’t believe the soundbites about super practices being the way forward. A big pile of BS you will be left to clean up.

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  • "1. CQC inspections too demanding in the context of funding cuts.

    2. Annual appraisals sold as a chat over tea and now extremely onerous and time-consuming endless unpaid paperwork with unpredictable appraisers from overly OCD to supportive if you are lucky.

    3. 5 yearly career ending revalidation, multiple the bureaucracy of appraisals by 5. As in 5 times complete audit cycles, 5 times multiple source feedbacks, 5 times patient surveys, clinical cases, CPD etc. When do GPs have time to see patients?

    4. Lack of GP workforce means no holidays, working overtime, no locums, burnout.

    5. CCGs now delegating what used to be outpatient clinical care onto GP’s laps so many feel out of their clinical expertise and fearful of the GMC if they make a mistake with treating a patient who should be under hospital consultant care but this is now called community care.

    6. 10 minute appointments when in Europe and abroad GPS get 20+ minutes to safely treat a patient. Interruptions and phone consults added in between 10 minute slots or added at the end of an exhaustive list,

    7. Seeing colleagues enjoy the best of both worlds emigrating to Canada or Australia to work safely as a GP.

    8. Pressure from CCGs to reduce hospital referrals, to cut expenditure on prescriptions, to deliver safe care without a minimum practice income guarantee, having to fire staff to make ends meet and watching single mums in tears as they lose their jobs working for practices.

    9. Fear of a GMC referral as investigations may take up to a year during which time the GP may be treated as guilty until proven innocent and God forbid the DM gets ahold of any investigation and publicly shamed a GP before he has had his right to a fair trial.

    10. Students are reconsidering whether medicine is a viable profession when other professions pay double, with free weekends and evenings to enjoy a life and are able to repay student loans. Training is so many years to be a GP. They ask is it worth it?

    11. When you know a GP colleague who has ended his or her life, you start to question whether it is time to retire early, emigrate or change paths.

    12. When you are fearful and anxious, as you may be referred to the gmc for a domestic squabble, raising a voice to a train conductor, drink driving, depression, a jealous colleague, an angry patient who does not get what he or she demands, and think if I were in any other job, I would not be treated like a criminal.

    13. When you decide you need to put yourself and your family’s well being first above the needs of overworking as a GP to an early grave."

    A company founded on the principle of goodwill/charity from its workforce refuses to compensate hard work....

    Unfortunately until people stop seeing medicine as some sort of calling from the heavens above (the sort Noah had) the NHS will continue to take advantage of hard working employees expecting them to bend down further and take it deeper instead of questioning why their hard work isn't being compensated.

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  • prashant, please credit Una Coales as the author of most of your post

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