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University practices consider closing lists to students in order to survive

Exclusive Practices in large student populations have warned they are considering closing their lists, because recent cuts to MPIG and changes to QOF mean it is ‘not affordable’ to treat young adult populations.

The Student Health Association (SHA) – which represents university practices and GPs with large student populations – has said ‘there is a real risk of practices going under’ unless changes are made to the practice funding formula, in a letter to health secretary Jeremy Hunt and shadow health secretary Andy Burnham.

GPs practising on university campuses have warned that students might be forced to use A&E, as neighbouring practices will be unwilling to take them on if they were to close lists.

The GPC has said it is campaigning for ‘groups of practices that have a unique population’, while the SHA’s campaign, which calls on GPs to lobby MPs, has already received support from MPs including Dr Sarah Wollaston and Charlotte Leslie from the House of Commons Health Committee.

The SHA’s letter warns that action is needed to prevent the health service ‘failing an entire generation’, particularly in funding for mental health problems which affect one in four young people.

It highlights that university-based practices have been particularly badly hit by the removal of diseases of low prevalence from the QOF, while the withdrawal of MPIG will not be compensated by an overall increase in the global sum because a young adult is calculated as one-sixth as ‘valuable’ as an over-85 by the equation used to calculate practice income.

The letter argues that large student populations should be included in the updated Carr Hill formula’s measure of deprivation, as they are a ‘vulnerable/low income population’.

The letter states:‘Students and young people in general are frequently dismissed and ignored by those who decide how and where NHS funding should be spent, and over the last few years several changes to the GP contract have undermined our small amount of funding further.’

It adds: ‘Unless significant steps are taken very rapidly there is a real risk of practices going under and no longer being able to provide their expert care to their young adult patients.’

‘We urge concrete action now to ensure ongoing excellent care and prevent our society from failing an entire generation.’

NHS England had promised to support MPIG-reliant practices, at a local level via area teams, but this has failed to materialise prompting a call for action from the GPC in a letter to Simon Stevens, NHS England’s new CEO.

Dr Robin Hollands, who is senior partner of the University of Gloucestershire Medical Centre, told Pulse that they were facing the reality that their university branch wouldn’t be financially viable, but was concerned what would happen to the practice’s 3,500 students.

‘We’re a PMS practice, and we’re protected by PMS funding. But that is being eroded, so we’ve got to look at this global sum issue.’ 

‘And the problem is, the way I calculate it, we get about half the global sum payment – which we don’t think is affordable to run a branch surgery.’

‘Obviously another practice might take up the health centre, but I’d be surprised because it’s not a profitable thing, and if no surgery takes it up the concern is that students will start using unscheduled services because they won’t be registered.’

Dr Dominique Thompson, a member of the SHA’s executive committee and director of the University of Bristol’s Students’ Health Service, said: ‘One in four [students] have a mental health problem, plus all the other problems that afflict young people.’

She added: ‘These are vulnerable people, same as in an inner city; if we’re looking at services we can’t ignore huge chunks of the population. If there are, in this country, 2.34 million students, and about 20% of them from overseas, we can’t ignore that. That’s a huge number.’

Dr Beth McCarron-Nash, a member of the GPC negotiating team and a GP in Cornwall said the GPC had been lobbying NHS England to take action and support practices affected by the MPIG withdrawal.

She told Pulse: ‘There have been some changes in terms of QOF incomes which have hit certain practices extremely hard.’

‘We have been lobbying NHS England extensively around practices which have either a unique population, or characteristics which are not within the  mainstream formula - who may well be providing a range of services which are above and beyond mass of GMS.’

‘And we’re doing everything we can to support those practices, because these students do have very specific needs and that should be commissioned via another route, via a LES or via PMS for example. But it’s one of many groups of practices which are really up against it.’

In April Pulse revealed that CCGs had been making cuts to child and adolescent mental health services, despite GP leaders’ warnings that the NHS would ‘pay in the long term’ for failing to fund services for young people.

GP leaders also warned that MPIG withdrawal would impact on practices who receive a low fee per patient, such as student practices, as well as those in rural areas who care for geographically dispersed populations.



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Readers' comments (18)

  • A war of attrition with last man standing being the winner.The consequences of meddling in a system which is difficult to understand.As far as HMG+ NHSE the old saying In the land of the blind the one eyed man is king definately applies.HMG + NHSE dont have a one eyed man between them.Or they choose not to see which is much more likely?

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  • Very sad.
    Yes these practices major on health promotion to a young inteligent group and are the foreseeable front line casualty of a shift to elderly chronic disease management admission avoidance policy.
    However the lesson for us all is fail to support our colleagues existance and the rules will change to wipe us out at some point.
    Neglecting the health of this group of mainly young " instant consumerism" patients will drive up unscheduled attendances Walk in Centres and AED- all of which will cost the taxpayer more than adequately resourcing the full variety of general practice primary care.

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  • The idea that it has been historically ok to downward negotiate services to young adults that are often at some of their most vulnerable stages in their lives has been a repeated disgrace.
    It is also difficult, as there is only a 'minority' of surgeries in the UK that have this problem, and therefore, it is common for them to be ignored if favour of more vulnerable, or politically popular groups.

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  • Starving General Practice is booming buisness for A&E and Hospital Trusts.

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  • Una Coales

    Place blame where blame is due. US subprime mortgages led to the collapse of some very major investment banks and led to some countries being on the verge of bankruptcy. We have seen what happens when people invest unwisely and have to be bailed out. Alas it means the UK's £1.4 trillion debt is very very real and this means ALL PUBLIC SECTOR funding is being slashed and if possible privatised to relieve the government financial burden to keep this country from financially imploding.

    I wouldn't want the Treasurer's job of trying to balance the books in a socialist country supporting the EU and a nanny state! And I wouldn't want to continue to be a worker paying 40% income tax on income over £32k to support a welfare state or contributing extra into a NHS pension to refill the empty pot.

    Just my opinion.

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  • SCRAPE CARR-HILL FORMULA. this was main reason mpig was negotiated. i sympathise wit uni practices.payment, prescribing budget , referral rate and everything else is calculated on weighted list . LMC Levy
    in some area on actual list. this has been injustice but mpig was compensation. if mpig goes so should the carr-hill. bring back incentive to appoint partner lik basic practice allowance and some incentive to appoint other staff.

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  • students from the UK and overseas are often seeking healthcare on their own for the first time in their lives. University practices offer same day surgeries and this means they do not use A&E inappropriately in hours. we can back this up be the number who use it out of hours inappropriately. These are often vulnerable young adults who do not understand the NHS and do not look after themselves properly once they start university. these are not all well healthy young adults and mental health problems affect 25% of them. The changes to funding that is planned is very worrying and will probably ultimatley cost more than it saves.

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  • "warning" and "considering" is very different from actually doing it.Sadly it seems that our profession is very good at shroud waving but totally spineless in action.

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  • Russell Thorpe

    good luck being allowed to close your list

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  • Vinci Ho

    I do not disagree that the job of the Treasurer is difficult . Question is what is he aiming to do? Driving the GDP up and up in short space of time is very eye pleasing but was that done in the expense of people's lives. I have read and seen too much about my country of origin running an autocratic system to keep annual GDP rise by 8% every year. Yes, it has created wealth , enormous wealth in a group of 'elites' but had sacrificed all common values ,moral standards and social justice.
    As I said in the past , in the time of global financial downturn , some right wing(even extreme right) ideologies always try to creep back to the mainstream . History rewrites itself over and over again . It is the sole responsibility of the government to check the balance . Look at the result of the European election (not just UK). It is self explanatory that each government has to do more to strike a happy medium .
    What has this government done? PM and Treasury wasted no time to visit China simultaneously in separate trips to ensure Britain has got 'first hand benefit' from the expansion of new Chinese financial empire (as long as one leaves human rights alone).
    So what is the real aim? It is always about redistribution of wealth and narrowing the polarity between the rich and the poor (call me socialist by all means). One can argue William Beveridge 's Five Giant Evils were out of date , not applicable . But I would say history keeps repeating itself . Of course, it is still one's personal choice whether to fly the flag of NHS or not but at least that was what I signed up for over 20 years ago.

    4th June this year marks the 25th anniversary of the Tienanman Square Massacre in 1989 in China. I will be mourning for death of social justice.

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