General practice in Bridlington, an East Yorkshire coastal town with a fairly elderly population that grows in the summer months due to an influx of tourists, has been in crisis for some time.
But the first few months of this year have dealt a particularly heavy blow when plans to develop a single building to house five GP practices were scrapped after NHS England funding was pulled.
First promised in 2016, the proposed health and wellbeing centre was part of plans to inject new life into general practice in the small town and enable GPs to develop more services for the 42-000 patient population.
By December 2016 all six practices in the town had closed their lists to patients wishing to move after a shortage of GPs – one local GP had predicted 10 more were needed – was putting practices under strain.
Some GPs, dealing with complex older patients with multiple comorbidities in an area of deprivation, were taking the decision to retire early with no new doctors coming into the town.
‘Recruitment is a big issue and it is not just GPs, it’s other staff such as advanced nurse practitioners’
Dr Alan Francis
One of the practices – Field House Surgery, run by Humber NHS Foundation Trust since the end of 2016 after it handed its contract back – had been forced to offer large incentives including a salary of £130,000, a QOF bonus and paid indemnity for a nine-session salaried GP to attract staff.
In March, two practices announced plans to merge amidst the possibility of further retirement of senior partners.
A statement to patients said: ‘The partners of both practices are concerned there is not just a shortage of GPs, there are recruitment problems across the whole of the NHS, with community nurses also stretched and overworked.’
They said the proposed merger would allow both practices to survive and be more resilient.
It is clear that practices in the town, where lists were closed until the start of this month when NHS England forced them to be reopened, remain under immense pressure and the decision to scrap the premises plans will have done little for morale.
One GP contacted by Pulse was so furious about the premises decision he felt unable to speak about it at all.
Meanwhile Dr Alan Francis, vice chair of the Hull and East Yorkshire LMC and a GP in Bridlington, says there are no quick solutions to the problems facing the town, but that the next steps are being considered.
‘It’s not a particularly desirable area to live, as there are no big cities nearby’
Dr Alan Francis
‘Recruitment is a big issue and it is not just GPs, it’s other staff such as advanced nurse practitioners.
‘It is a very small pool of staff in the area and it’s not a particularly desirable area to live, as there are no big cities nearby,’ he says.
‘Our own practice strategy is to get more involved in training but that is a long-term strategy,’ he adds.
There is also a relatively elderly GP workforce in Bridlington, often working 12-hour days to deal with a high proportion of patients that have complex chronic conditions, he adds, noting this was not reflected in funding.
Dr Zoe Norris, the BMA GP Committee’s lead on salaried and sessional GP issues, has worked as a locum in the town and says the problems faced by Bridlington are the same as those seen in many areas – but there has been a ‘perfect storm’ which has heightened its effects.
‘There are a number of extremely good GPs but there needs to be investment’
Dr Zoe Norris
‘There was a relatively stable population of doctors for a number of years followed by some retirement and problems with recruitment partly because of the location and the fact it is quite isolated.
‘It is a knock-on effect of not having enough trainees coming through and newly qualified doctors may be choosing to work in bigger places,’ says Dr Norris.
She says the new investment the town had hoped for was not just about new premises but GPs being able to offer more portfolio working and different ways of working.
‘That could be the final death knell and it is hard to know what is going to happen now.
‘There are a number of extremely good GPs but there needs to be investment so they can sort things out and move forward,’ she says.