Pulse’s Lost Practices investigation looked at the practice closures where there is no longer an active surgery in the same postcode.
Of the 474 closures with no replacement surgery, 264 were practices that had closed completely and 119 that had closed following a merger, while 91 were branch surgeries closed by a parent practice.
Using official papers and local news reports, Pulse was able to identify the reasons or ‘trigger’ behind the closure of 162 practices.
Unsurprisingly, staffing was the most common by some distance – 42% of the 162. In a fifth of cases, this was retirement, in 8% resignation of a partner and in just over one in 10 an inability to recruit. We also identified 30 closures triggered by an ‘inadequate’ rating or enforcement action from the CQC, while 37 were due to non-renewal of an APMS contract.
While Pulse’s investigation found evidence that structural problems linked practice closures, the more unique circumstances of an individual practice can be the final straw. In the recent case of the Central Lakes Medical Group, for example, partners were forced to hand back their contract last month following the decision by commissioners to remove atypical funding worth £70,000.
‘This funding helped keep us afloat,’ says Dr Kaye Ward, a partner at the Central Lakes Medical Group in Cumbria. ‘Its removal also made us more vulnerable if a GP left.’
She adds that Central Lakes is also not the only vulnerable practice in the area: ‘Around us, GPs tend to be over 50. Locally, age, retirements, illness have all been triggers for closures.’
Northumberland LMC medical secretary Dr Jane Lothian says that GPs are ‘clever businessmen’ on the whole and so they learn to cope with what they’ve got, but she has seen practices tip over ‘for completely different reasons’ over the years.
‘Personal issues, political things that go back many, many years – and one situation built up over around twenty years where the patient population became almost impossible to manage. That is all historical stuff, and it is far more transactionally complex than just pounds and pence.’
Retirement
Two of the most common reasons for closure in our snapshot of 162 were retirement and an APMS contract coming to an end.
It’s no surprise that retirement can cause a closure – and there are already concerns that this is only going to get worse over the coming years, as more GPs opt to exit the profession early. A recent Pulse survey found almost half (47%) of more than 800 GPs surveyed intended to retire at or before 60, including one in 8 who said they intended to retire before reaching 55.
The issue with retirement is that if there are no succession plans in place for a partnership – and the commissioners can’t or won’t find anyone to take over – then a practice will have to close. Pulse’s investigation found many examples where this was the case. These included:
- Dr Benedict Glover, who retired from the Antrim Coast Medical Practice in Glenarm, Northern Ireland on March 31 2017 after 51 years, told the local newspaper at the time: ‘No one applied and no other practice wanted to take it over. It is a big loss for the area, now the nearest doctor will be 10-12 miles away.’
- When Porth Farm Surgery in Rhondda closed in 2019 after the retirement of two GPs, a spokesperson for Cwm Taf Morgannwg University Health Board said it had considered ‘every option’ to keep the surgery open but ‘due to the ongoing challenges of recruiting GPs’ had concluded that the only sustainable solution was for patients to register elsewhere.
- A local news article on the closure of the Lawns Surgery in Rustington, Sussex said that as there was no team to take over from the retiring GP Dr Charles Shlosberg, the CCG was ‘looking at alternative options with the other GP practices in the town’.
- A Healthwatch statement on the closure of Peppard Rd Surgery in Caversham in 2019 said no surgery could be found to take on the 2,600 patients in ‘one single transfer’ after the husband-and-wife GP team retired and was therefore dispersed between several practices. A CCG statement in the local press said Peppard Road was ‘considered too small these days to offer the full range of primary care health services and be viable in the long term’.
APMS contracts
Pulse found 37 examples of closures that were triggered by the ending of an APMS contract. In some cases, commissioners had tried unsuccessfully to find someone else to takeover.
- The contract for Whitehall Medical Practice in Shrewsbury was put out to tender in 2019, but received no bids, according to a CCG representative. Local news reports on the closure said the practice’s list of around 3,700 was dispersed to alternative local practices.
- It was a similar picture in the case of two practices in Bristol – Northville and Bishopston – which closed in 2019. A health scrutiny committee report says a review of the APMS contracts ‘identified that procurement would not be a viable option, as providers had not indicated an interest’. Over 15,000 patients were re-registered with surrounding practices.
There was also evidence that wider commissioning factors played a part in a practice’s fate when the time was up on its APMS contract: The Ali Practice in Trafford was closed in 2015 after the CCG recommended list dispersal. Official papers on the closure said ‘the procurement of a single-handed general practice with a registered population of 2,657 [was] not consistent’ with the CCG’s primary care strategy, which focused on a ‘greater collaborative, federated, more robust model’ delivered by larger practices.
CQC
Our analysis also found 30 cases where an ‘inadequate’ CQC rating or further enforcement action taken by the regulator had resulted in a practice closing its doors. These included:
- Devon Live reported that Barton Surgery, in Plymstock, closed temporarily in October 2019 after a CQC inspection found it to be inadequate. Five weeks later the CQC announced that the surgery would not be reopening. Our data shows the practice had a list size of 2,700.
- An article in the Liverpool Echo said Baycliff Health Centre was forced to shut in 2014 after NHS England terminated its contract with the practice following a ‘damning’ CQC inspection. An NHSE spokesperson commenting on the closure said: ‘Due to circumstances within the practice and following many months of support from NHS England, Merseyside, it is with regret that we have now taken the decision to end the contract with Baycliff Family Health Centre.’
- West End Surgery in Nottinghamshire closed in 2018 following an ‘inadequate’ CQC rating, according to local reports. The surgery had been rated as either ‘inadequate’ or ‘requires improvement’ since March 2015. An official FAQ document on the closure said the practice had faced ‘increasing challenges over the past few years’ and services had ‘become unsustainable’ as a result.
- The BBC reported that Goodwood Court Medical Centre in Brighton was ordered to close by the regulator in 2015 over concerns that patients were at risk. The immediate closure left commissioners having to arrange alternative practices for around 9,500 patients. An NHSE statement included in the article said the decision to shut such a large practice overnight was ‘unprecedented’ but justified in the circumstances.
