Exclusive A major Pulse investigation has revealed that 474 GP surgeries across the UK have closed in the past nine years without being replaced, with small practices on lower funding in more deprived areas most likely to be affected.
Pulse’s Lost Practices investigation – which will run throughout this week and next – examined for the first time the number of GP surgeries that have closed for good, the reasons behind the closures and the effect on the 1.5m patients that have been displaced.
It found that the final straw for the majority of practices that have closed for good have tended to be recruitment issues, although CQC ratings and the ending of APMS contracts were major factors too.
Previous investigations by Pulse and other groups have looked at the number of practices where GP partners have handed their contracts back, or closed branch surgeries, but this latest investigation is the first to focus only on those where a surgery has not been replaced, leaving patients to travel further to see a GP.
The investigation found:
- There were 474 surgeries that have closed in the UK since 2013, leaving 1.5m patients having to travel miles in some cases to new surgeries and placing other GP practices under even greater pressure;
- For more than 40% of the 162 surgeries we identified triggers for, recruitment issues were the final straw for the practice;
- These surgeries had markedly smaller list sizes than average – a median list size of 2,738, compared with a median list size of 7,904 in England in 2020-21;
- They were in postcodes that were in more deprived areas than other average surgeries – with a median deprivation score of 3.81 compared with 4.41 for an average practice (with 1 most deprived and 10 least deprived);
- 69% of practices that closed for good in England received lower funding per patient the last full financial year before they closed than the average funding for that financial year;
- A number of surgeries have closed with no other surgery within miles.
Pulse has found that smaller surgeries are far more likely to close. However, patient satisfaction scores have routinely found that patients prefer smaller practices and they are more able to provide continuity of care.
Practices in deprived areas are more likely to close. They have told Pulse their workload is higher, their patient population is less prone to self-care but they also miss out on funding that practices in more affluent areas receive.
Pulse has also produced a map plotting practices that have closed for good and currently active practices, which has showed pockets where there is no surgery because of a practice closure, which will be released later this week.
Professor Martin Marshall, chair of the Royal College of GPs, said: ‘The impact a practice closing on its patients and neighbouring practices can be considerable. As such, a decision to close a practice will be one of the most difficult a GP partner can make. There may be many reasons for a practice to close, in some instances it maybe that it is merging with another in order to pool resources, but when the reason for closing a practice is workload pressures, and not being able to fill vacancies, then this needs to be addressed as a matter of urgency.
‘General practice is the bedrock of the NHS with GPs and our teams making the vast majority of patient contacts and in turn alleviating pressures across the service, including in A&E. It works by providing cost-effective care close to home in patients’ communities. But it is a service that is struggling and it needs support. We don’t want to see patients having to travel for miles to be able to receive GP care.
‘This is why the College is calling on the Government for a new recruitment and retention strategy that goes beyond the 6,000 more GPs pledged in its manifesto, plus investment in our IT systems and steps to cut bureaucracy so that we can deliver safe, high-quality care for our patients.’
Pulse will be running findings from its investigation throughout the week on its dedicated section.
Additional reporting: Madeline Sherratt, Rhiannon Jenkins and David Burns
Please note, this piece originally said 474 practices had closed across England. But this should have read ‘across the UK’
READERS' COMMENTS [6]
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Abolishing Appraisal and Revalidation would improve retention, improve morale, and free up GP time equivalent to 500+ full time GPs. Win-win.
Not only have we lost practices but also GPs. There are 4.5m people who have lost their GP and not had them replaced leaving the remaining GPs with more work.
But worse is the fact that the current ruling party said we needed 5000 more GPs in 2015 but we have 2000 fewer so there are 15m people who ‘do not’ have their own GP but have to ‘share.’
Small practices struggled because of Carr-hill formula payment where weighted list is down simply because practice has younger population.. mpig was abolished . Gps took extra necessary staff based on mpig and it disappeared. Seniority allowance was abolished . Some practices have high number of temporary residents but not rewarded financially.
Threat to small practices closer caused concern to practices about futures of practice owned purpose built premises. Now locum pay is much better than being a partner so gps are choosing that option..
i qualified in 1976, and was a single handed, rural, dispensing gp in wales till 2007.
i had a dvt in my right arm, and a Hb of 5, with a serum iron too low to record. four consultants told me that if i continued to work as i was, i was asking for problems, and i needed help. i told our LHB this (same as PCT in england), and their response was “either you’re working, or you’re not – get on with it”. so i resigned.
the LHB then closed the practice, and merged it with the patch four miles away, despite offers from a GP who wanted to take it over (good swimming, cycling, fishing etc etc).
their excuse was “it’s not financially viable” – despite me having several classic cars and bikes, three houses, and an aeroplane !!!
i had a much higher elderly, frail, population than average. they now have to arrange their own transport to the “local” surgery – no bus service, and lousy train service.
the upshot is that the practice now has a load of extra housecalls from patients who are elderly, frail, and now really ill because they couldn’t get to the surgery. most could have got a lift to my surgery, but asking your equally frail, elderly neighbour to give you a lift to the surgery four miles away, with limited parking, and wait there several hours while you’re seen is not going to happen.
i am still working two days a week as a locum – which is what i wanted to do in 2006 !
i am 72.
But this is the real Long Term Plan.
Don’t worry – the Professors of General Practice will perhaps say something. You don’t need a BMA strike – just give back the contract when you feel the time is right, and you have better things to do with your life.
The grass really is probably greener.
In other news – George Galloway wrote a nice piece on the imperialist mindset and chasing the American dog’s tail. “The scorpion stings because it is a scorpion”. That old charade is coming to an end.
Recruit nothing.
Retain nothing – fairy tale is over.
Like Prof Marshal knows – start thinking like a dentist.
https://www.globaltimes.cn/page/202206/1269310.shtml
Covid payments and lockdown locum reductions may have papered over the cracks, but soon soaring energy costs and unfunded staff pay awards will decimate partners’ profits, who will then look with envious eyes at their salaried/locum colleagues and wonder why on Earth would they keep all the hassle for a lower income.