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GP practice numbers could be cut by up to two-thirds under CCG draft plan

A CCG has included a cut of GP practice numbers by up to two-thirds in its draft primary care strategy, based on a ‘national trend’ towards larger practices.

NHS Southampton City CCG, which currently has 32 GP practices, has published a draft strategy on its website proposing this would become as few as 10.

The document said that the strategy, for which there was no timeframe, ‘will deliver the principles of better care’ by ‘joining up services seamlessly around the patient’.

It comes as the city’s primary care services have already been divided into six clusters, each serving around 30-50,000 people and based upon existing groupings of GP practices and community nursing teams.

NHS Southampton City CCG said it has ‘no plans’ to ‘enforce the closure or merger of any GP practices’ and said that the paper was based on ‘trends observed around the country’.

The consolidation proposals come as elsewhere in the country GP practices of an industrial scale are emerging, including the 275,000-patient Our Health Partnership across Birmingham and Sutton Coldfield and the 100,000-patient Lakeside Healthcare super-partnership in the East Midlands, both formed via massive mergers last year.

This year, there is also the proposed mega-merger of a 540,000-patient practice across Suffolk. Meanwhile, a year ago Pulse revealed a 500% rise in practices telling NHS managers they wish to merge or close.

Suggestions in the Primary Care Strategy for Southampton include:

  • ‘The patient will have a choice of practices, we anticipate eventually between 10-20 practices across the city’;
  • ‘Care will be outcome-focused, with appropriate services being available seven days a week’;
  • ‘Practices in each cluster will work together with other services such as social care, housing, education, voluntary sector, community navigator, and the police (multi-disciplinary team)’.

NHS Southampton City CCG told Pulse that this was not the finalised primary care plan for Southampton, which would be published later this year, but confirmed it was ‘working intensively with a number of GP practices in the city that are experiencing workload and staffing pressures’.

A spokesperson said that ‘in certain cases this means that mergers or closures may be proposed by the practices themselves’, but added that patients would be consulted before any such decisions were taken.

The spokesperson said: ‘We are committed to ensuring that high quality, accessible GP services are available across Southampton and have no plans to reduce the number of GP practices in the city. Our draft strategy for primary care remains a work in progress at this stage.’

The Southern Daily Echo newspaper, which first reported on the plan, warned it would lead to closing of surgeries and reduced access and continuity of care for patients – suggestions the CCG strongly rejected.

It quoted an anonymous primary care worker who said ‘changes would put the welfare of thousands of patients in jeopardy and would lead to a further crisis for the GP service’.

But Wessex LMC leader Dr Nigel Watson said that Southampton general practice was currently ‘running at 10% vacancy rates’ with ‘a number of practices imploding’.

He said: ‘The CCG can’t make any of the practices merge under their current contracts but they can provide incentives, and if it does happen it might work to patients’ benefit… We’ve not had this discussed with us directly but it’s based on a lot of things we have already talked about with the CCG.’

Consolidation of GP practices

Although not all practice mergers lead to the behemoth size of Our Health Partnership or Lakeside Healthcare, the Government has mandated NHS England to ensure that 50% of patients are registered with at-scale new models of care by 2020.

The new voluntary GP contract, for practices with at least 30,000 patients, will underpin this when it is rolled out from next April.

The move towards consolidation is further underlined in NHS England’s GP Forward View, which ties many funding streams to at-scale operating models.

And NHS England has already incentivised its pilot projects with £37m for 2016/17 to work up larger GP practice models that can be replicated elsewhere.