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University practices consider closing lists to students in order to survive



Exclusive Practices in large student populations have warned they are considering closing their lists, because recent cuts to MPIG and changes to QOF mean it is ‘not affordable’ to treat young adult populations.

The Student Health Association (SHA) – which represents university practices and GPs with large student populations – has said ‘there is a real risk of practices going under’ unless changes are made to the practice funding formula, in a letter to health secretary Jeremy Hunt and shadow health secretary Andy Burnham.

GPs practising on university campuses have warned that students might be forced to use A&E, as neighbouring practices will be unwilling to take them on if they were to close lists.

The GPC has said it is campaigning for ‘groups of practices that have a unique population’, while the SHA’s campaign, which calls on GPs to lobby MPs, has already received support from MPs including Dr Sarah Wollaston and Charlotte Leslie from the House of Commons Health Committee.

The SHA’s letter warns that action is needed to prevent the health service ‘failing an entire generation’, particularly in funding for mental health problems which affect one in four young people.

It highlights that university-based practices have been particularly badly hit by the removal of diseases of low prevalence from the QOF, while the withdrawal of MPIG will not be compensated by an overall increase in the global sum because a young adult is calculated as one-sixth as ‘valuable’ as an over-85 by the equation used to calculate practice income.

The letter argues that large student populations should be included in the updated Carr Hill formula’s measure of deprivation, as they are a ‘vulnerable/low income population’.

The letter states:‘Students and young people in general are frequently dismissed and ignored by those who decide how and where NHS funding should be spent, and over the last few years several changes to the GP contract have undermined our small amount of funding further.’

It adds: ‘Unless significant steps are taken very rapidly there is a real risk of practices going under and no longer being able to provide their expert care to their young adult patients.’

‘We urge concrete action now to ensure ongoing excellent care and prevent our society from failing an entire generation.’

NHS England had promised to support MPIG-reliant practices, at a local level via area teams, but this has failed to materialise prompting a call for action from the GPC in a letter to Simon Stevens, NHS England’s new CEO.

Dr Robin Hollands, who is senior partner of the University of Gloucestershire Medical Centre, told Pulse that they were facing the reality that their university branch wouldn’t be financially viable, but was concerned what would happen to the practice’s 3,500 students.

‘We’re a PMS practice, and we’re protected by PMS funding. But that is being eroded, so we’ve got to look at this global sum issue.’ 

‘And the problem is, the way I calculate it, we get about half the global sum payment – which we don’t think is affordable to run a branch surgery.’

‘Obviously another practice might take up the health centre, but I’d be surprised because it’s not a profitable thing, and if no surgery takes it up the concern is that students will start using unscheduled services because they won’t be registered.’

Dr Dominique Thompson, a member of the SHA’s executive committee and director of the University of Bristol’s Students’ Health Service, said: ‘One in four [students] have a mental health problem, plus all the other problems that afflict young people.’

She added: ‘These are vulnerable people, same as in an inner city; if we’re looking at services we can’t ignore huge chunks of the population. If there are, in this country, 2.34 million students, and about 20% of them from overseas, we can’t ignore that. That’s a huge number.’

Dr Beth McCarron-Nash, a member of the GPC negotiating team and a GP in Cornwall said the GPC had been lobbying NHS England to take action and support practices affected by the MPIG withdrawal.

She told Pulse: ‘There have been some changes in terms of QOF incomes which have hit certain practices extremely hard.’

‘We have been lobbying NHS England extensively around practices which have either a unique population, or characteristics which are not within the  mainstream formula – who may well be providing a range of services which are above and beyond mass of GMS.’

‘And we’re doing everything we can to support those practices, because these students do have very specific needs and that should be commissioned via another route, via a LES or via PMS for example. But it’s one of many groups of practices which are really up against it.’

In April Pulse revealed that CCGs had been making cuts to child and adolescent mental health services, despite GP leaders’ warnings that the NHS would ‘pay in the long term’ for failing to fund services for young people.

GP leaders also warned that MPIG withdrawal would impact on practices who receive a low fee per patient, such as student practices, as well as those in rural areas who care for geographically dispersed populations.