Over the next week, we will be focusing on those practices that closed for good. We will look at the geographical hotspots where no practice stands, their staffing and funding levels, their levels of deprivation, size and the triggers for them closing.
This was a mammoth investigation, and we used a number of different data sources, as well as freedom of information requests we have collected since 2014.
There were times when we didn’t have the perfect data, and had to use the best available – for example, basing average list sizes on English practices, rather than UK wide. But we are confident in our results and we hope these results will have an impact on policy-makers.
Determining the ‘lost practices’
Our aim in researching practice closures every year has been to look at the physical premises that had closed. This is not the same as comparing the number of practices in 2013 with the number of practices in 2022 – in many cases, a reduction in the total number is meaningless. They might be mergers where nothing materially changes.
To find out premises closures, since 2014 we had been submitting freedom of information requests to CCGs and health boards in the devolved nations, as well as NHS England. We asked about full practice closures (where they hand back their contract and close their only surgery), branch practices and surgeries that had closed as a result of a merger.
This year, we reviewed all the information we have collected over the past eight years. We realised there were examples of CCGs and NHS England sending us the same practice with different names and in different years, so we removed these.
To get the list of ‘lost practices’ we collected the data on active practices and branch surgeries from all four UK nations. We compared this list to our list of closed practices and removed instances of duplicate postcodes. This left us with 474 practices or branch surgeries that had closed, and there is no current surgery in the same postcode.
We only had data for England on this. We also only focused on actual practice closures either through partners handing their contracts back, or where a practice had closed due to merging with other practices.
We used the NHS Digital document NHS Payments to General Practice 2020-21. We used the practice codes we collected through our FOIs and matched them to the NHS Digital document.
To calculate total payments, we removed premises payments, dispensing fees, locum reimbursement and prescriptions reimbursement, as these either distorted the figures or were straight ‘in and out’ payments that represented no profit or loss to practices.
For the closed practices, we used the final full financial year before they closed to calculate their average funding per patient. We then measured them against the average funding for all practices in the same financial year.
We used NHS Payments to General Practice 2014-15 to calculate the average number of each contract type – ie, GMS, PMS and APMS. The reason we used this dataset was because we suspected there had been a relatively large proportion of APMS practice closures since them, so this would be best as a baseline.
We used NHS Payments to General Practice 2014-15 to determine whether a practice was an ‘MPIG’ practice, defining this as a practice that received minimum practice income guarantee funding in 2014-15, before the funding was reduced.
In our FOI, we did ask for list size before closure. Where this wasn’t provided – mainly for branch surgeries – we looked at other official data sources.
To calculate the number of patients displaced, we used the data whichever surgeries – including full practices and branch surgeries – that had been permanently closed. However, when calculating the median list of the practices that had closed, we excluded branch surgeries.
We used the NHS Payments to General Practice 2020-21 data set to calculate the median list size of all practices, but this applied to England only as adequate data wasn’t available for a UK wide figure.
We used NHS Digital’s annual reports on practice level staffing. We looked at the closed practices’ – but not branch surgeries’ – staffing levels from the year before they closed. We calculated the aggregate of patient numbers and the aggregate of full-time equivalent GPs and divided the total number of patients by the total number of FTE GPs for closed practices and practices in England overall. This data wasn’t readily available for the other UK countries.
We checked each closed premises postcode against the 2019 deprivation indexes in England, Scotland, Wales and Northern Ireland. Using their rankings in the index of multideprivation to give them a decile score to two decimal points in their respective countries. We then worked out the median score of the closed practices across the UK. We used the same method to work out the median score of all practices in the UK, except for Northern Ireland due to logistical problems, but we don’t believe this had any effect.
For the funding element of deprived practices in England, we used the deciles assigned in the English indices of deprivation 2019 and worked out average fundings using the NHS Digital Payments to General Practice removing premises payments, dispensing fees, locum reimbursement and prescriptions reimbursement (see funding section).
We input the postcodes of current active practices and permanently close practices into Google Maps using different colours. We reviewed the areas where there was no active practice close to a closed practice, researching the reasons behind this.
We used official papers and contemporary local newspaper reports to determine the trigger for the closure. We only used reasons that had been given directly by the practice’s partners or commissioners. For those we could find reasons, we sorted them into the following categories: