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GPs go forth

GP practices in struggling town forced to re-open patient lists

Exclusive GP practices across a town in crisis have all been forced to re-open their lists to new patients despite voicing patient safety concerns, Pulse has learned.

NHS England told practices across Bridlington that they had to re-open lists by 1 May, after they were closed for nearly 18 months because GPs could not cope with demand.

The LMC said all practices unsuccessfully appealed the decision to the NHS Litigation Authority, but the litigation authority sided with NHS England's argument that 'patient choice' took priority.

Bridlington, a coastal town in East Riding of Yorkshire, has been struggling with especially severe GP recruitment problems.

Dr Alan Francis, vice chair of the Hull and East Yorkshire LMC, said: 'All practices are struggling with large list sizes and they were closed for over a year but NHS England has now forced them to re-open their lists against their wishes.

'All the practices appealed but were unsuccessful and from 1 May they have had to reopen them. Discussions around that are ongoing.’

While lists were closed practices had still taken on new patients but they were allocated by NHS England.

Dr Francis said: 'They say it is about patient choice. Our argument was that it is about patient safety and there was no way we were able to provide a safe level of care.

'We can’t just keep absorbing patients with limited premises and limited workforce. But NHS England’s view was that patient choice is a key NHS issue.'

As revealed by Pulse, all the practices in the town closed their lists due to unmanageable workloads at the end of 2016.

And a plan to boost viability of general practice in the town was scuppered when NHS England pulled the plug on promised funding for a new health centre, which would have housed five surgeries, earlier this year.

In the meantime, workload pressures persist. Last year, struggling a practice that was taken over by a local trust advertised a salaried GP role at £130,000 per year.

A spokesperson for NHS England in Yorkshire and the Humber said: 'Following 18 months of closed lists, the practices applied to extend this period further which was not supported by NHS England. The practices chose to appeal that decision via the independent NHS Litigation Authority who, having considered the case made by both sides, upheld NHS England’s decision. Contractually, the practices were then required to re-open their patient lists.'

Alex Seale, director of commissioning and transformation at NHS East Riding of Yorkshire CCG, said: 'We are aware that NHS England has requested GP practices in Bridlington to reopen their practice lists, and new patients are now able to register with a practice in Bridlington.

'We will continue to work with the practices and NHS England to look at solutions which will increase access and capacity for GP services in Bridlington.'

BMA GP Committee workforce lead Dr Farah Jameel said: 'It's important to remember that these practices closed their lists because GPs were concerned that unmanageable workloads were putting patient safety at risk. Therefore commissioners must work with practices and the LMC to ensure patient safety is not compromised and that the workload pressures are really being taken seriously.

'As seen earlier this week, GPs across the country are struggling to meet the demand for appointments, and this is a local example of what happens when this situation reaches crisis point. GPC has been warning about this for years now, and it is important NHS England heeds our call for sustainable and recurrent funding as outlined in Saving General Practice.'

It is not the first time NHS England has imposed a blanket decision on GP practices to re-open lists in an area. Last year all three practics in East Dereham, Norfolk, were forced to reopen their patient lists despite patient safety concerns. At the time, each GP was caring for 3,000 patients.

Readers' comments (22)

  • Cobblers

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  • Just don't register the patients. Bring on NHS england trying to play the "contractual obligation" card. The patient safety card will win everytime. Make sure you have a signed letter from the NHS England chief exec saying they take fully responsibility for harm to patients coming from this decision.

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  • Just remember what happened to Dr BG

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  • The one thing bureaucrats hate is publicity.If your trump card is Safety, get together with your LMC, write a short,punchy presentations, and get it out to all and sundry.Your MP,for instance, is entitled to ask a Question in the House. NHSE then has to spend time preparing an answer, knowing that it will have to stand up to national scrutiny.Unless you make a stand now (see prev comments) the bureaucrats will never let up.

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  • 100% agree, make a stand NHS E would be first to send you to Performance Advisory Group if there was an issue.

    Wait a minute that's the issue they caused!

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  • Monopoly employer exerting monopoly privilege. What you have is an unrelenting juggernaut whose entire existence is dependent on the subservience of GPs. Weapons of choice to perpetuate this include deliberate planting of negative media, patient satisfaction surveys etc as well the multiple disconnected regulatory bodies. GPs must respect themselves and stop accepting things just because thats the way it is.

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  • If the BMA or RCGP isn't going to fight for patient safety,who is ,Oh it the GMC the patient safety advocate, but rather than being a patient safety advocate, when the s**t hits the fan and an unsafe working environment causes harm what does it do.Aah we already know lookout the Dr BG case it strings up the nearest health care worker from the yard-arm to show it is looking after patient safety.Failing unsafe systems are not the GMCs problem, finding a minion to make an example of is.Its all about patient safety isn't it.

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  • Whistleblow to the GMC - you are being forced to practice unsafe medicine due to chronic underfunding and lack of staff. The problem here is managerial and sits firmly with NHSE.

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  • 1)discuss with GMC and MDU and ask in writing from both what their advice is in this situation- if you are being forced to practice unsafe medicine /lower your standard of care because of lack of appropriate resources -In my view what you are being asked to do also goes against the Hippocratic Oath -in the first instance "do no harm" and in this situation the significant danger for any patient is that they feel they are going to receive an appropriate standard of care. they wont -and it isn't their fault/or the professionals if you don't have the resources-.Iam in the twilight of my professional career having been qualified for nearly 42yrs .I can remember back when the doctors in our PCG advised the PCT, at times,what we would and wouldn't do -because sometimes we were asked /told to do things that we thought were wrong -and given very little time in which to do them -I think there were about 40 gp's in our PCG -and when we all agreed not to do them the PCT backed down - for me it was and I suspect is the same in this situation -DO the right things for the right reason - discuss amongst yourselves ,agree a decision with LMC support and stick to that decision unless new information/resources become available .I have always felt that the profession via the colleges/BMA/LMC's /and local practices,at times should be advising the government what they can and cannot do professionally including safely and not always be accepting of what we are told to do. I genuinely feel for everyone in this situation -the state of the nhs is currently the worst I have experienced in my career and until there is COMPLETE honesty from all those involved in the nhs and the department of health - we will continue in a downward spiral

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  • NHSE is a bully. If you miss any hospital letter or medication change or you are unable to see a patient that subsequently dies. Gross Negligence Manslaughter charges to you just like Dr Barwa Gaba. Just jail and strike more doctors off in the name of patient safety and choice. Inflict this on a low morale, overworked, NHS staff. Just to rub the salt in GP partners incomes are falling and potential tax rises are coming. I would get out of the country if I can.

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  • GPs are their own worst enemy sometimes and will ultimately just bow to the demands. Hand in your resignations, locum and set your own terms and conditions ... sounds like there will be plenty of work around!

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  • Hand back your contracts, return to the same surgery as locums with fixed rates and workload. Don't sacrifice your health and GMC registration on the alter of NHSEs and the government's failed policies.

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  • Surrendering the NHS contracts would be fan option except for high redundancy costs etc

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  • Bullying and Intimidation

    This is one of the fundamental problems with the 'Contract', which of course it is not, as one side can change whatever it wishes.
    The other fundamental problem is list based payments, where Consultation rates have doubled in 18 years, but payments remain the same, so, we work for less and less per item.
    We now get paid 50% less per item compared to 13 years ago, due to cumulative changes in pricing.
    The partnership is dying and rightly so because this is just WRONG in principle and execution, because we are FORCED to work beyond our capacity, and then strung up and convicted of manslaughter.
    We do not have an Union, that's our problem.
    The leaders whine everyday, just listen to them here in Pulse, but they never do anything.
    THE best solution is a complete collapse of GP land as we have it, because it is plainly unjust, unfair and IMPOSED, so not a Contract at all.[ DIKTAT ]

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  • Took Early Retirement

    Actually, there IS an easy solution: All GPs in the town send undated resignations to their LMC. If they get, let's say, 80-90% then LMC go to the media.

    However, if they DON'T get to that figure, then the GPs there have only themselves to blame and must continue to suck it up- as GPs usually do.

    I think in a relatively small locality, this might just work. Nationally, it won't as GPs are too timid.

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  • This is a disgrace, how many of us are up for temporarily closing our lists in solidarity? Could Pulse do a survey? The BMA ballot last year showed that over 50% of those who responded would consider it. Things have only got worse since then. NHSE couldn't force all of us to re-open, then they might actually have to do something constructive to get us out of this mess.

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  • Just Your Average Joe

    All practices should meet and send a letter to NHS England and ask whichever moron decided patient choice trumps patient safety should resign immediately.

    If they are not willing to do this, sign a letter saying they take complete managerial and criminal liability for any harm that comes to any patients due to this decision to force GP practices to work in a clinically unsafe environment.

    If they won't do this resign and reverse the decision.

    LMC if you don't enforce this - please also resign.

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  • Just Your Average Joe

    Do not bend to Managerial incompetence. No manager has the right to force practices to take on patients when it is unsafe. If they try then report them to the CQC and GMC as incompetent, and unfit to hold a post in the NHS.

    Enough letters on their HR files will eventually force poor manager to stp working in the NHS or stop making such danger decisions.

    It is for NHS England to make a solution for the patients without care, either find money to support practices to take on staff to make the situation safe, or create a new solution to give care to those without.

    Once this can't be done it will create media interest and it will be forced onto DOH and JH radar and help make primary care safe for all practices as they will have to act - as those 5000 GPs are not materialising on the front line to replace those leaving/retiring.

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  • Someone needs remind them of the Berwick report and the letter he sent after mid staffs..." make safety your number 1 priority..." It was Darzi that said you need do safety efficiency and patient choice in that order.....tbh if they all continue to decline registrations aa per contract nhse will have a bigger headache.

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  • NHSE and the DoH their pay master will need to be faced down.They talk about the safest health system in the world but their action are totally the opposite.The LMC and BMA and if the GMC is about patient safety(doubt it) should back you.There should be coordinated action.Close list due to safety, imposition list being open continue to refuse new patient until it is safe.Threatened with contract breech.This would need to go to court/judicial rv.The patient safety advocates will need to define safe practice and safe manning.JH we want airline levels of safety.Its time for the establishment to put their money where their mouth are and define this.Even if it mean a new contract, a new way or working.If this elephant is not in the room there will be no partner no drs and primary care will collapse in the next 2-5 years nationally.When it does the NHS will be finished an patient safety will be an afterthought.

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  • Time to leave the NHS, Plan B, The Guernsey Option.

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  • Hear,Hear John Oldring.
    It is time to show some REAL Clinical Governance - that is Governance and decision-making by the Clinicians, based on clinical grounds, not on political agendas by the unqualified managers!

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