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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)

  • 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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