Exclusive More than one in seven GP practices say they may have to turn new patients away over the next six months because they are facing unsustainable workload demands, according to a Pulse survey of grassroots GPs.
The survey of 493 also revealed that around 21% of practices are having to consider mergers – an increase on the 16% who said they were considering such a measure in November 2014.
GPs cited massive increases in patient numbers on a backdrop of a declining workforce for wanting to close their lists, with the rise in more complex care leading to concerns they can no longer deliver safe, quality care.
Pulse can also reveal that commissioners are also raising concerns about the numbers of practices looking to informally close their lists.
However, the numbers of practices thinking of taking other measures – including cutting clinical and administrative staff, and cutting down on routine appointments – decreased slightly.
The survey found 15% of respondents said they were considering applying for a temporary list closure in the next six months, with GPs in some cases fearing closure of nearby practices would force them to close their doors to avoid collapse of their own services.
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The figure marks a distinct jump in planned list freezes since November last year, when one in 10 GPs said they were thinking about closing their practice list to cope with demand, and comes after a Pulse investigation revealed requests for temporary list freezes was growing year on year, with a 160% rise in requests over the past three years.
And while some pressures have stabilised slightly, notably concerns about staff cuts, one fifth of GPs still said they were considering cutting routine appointments and around 30% that they were looking at discontinuing clinical services.
GP leaders said the moves showed practices were under ‘extreme pressure’ and struggling to sustain workloads – and called for an ‘injection’ of resources to put practices back on a sustainable footing.
It comes as one health board in Scotland is launching a £1m rescue package for GP practices in an area where one in six practices has a closed patient list.
One GP from Scotland, who did not want to be named, told Pulse his practice may soon have to close its list because of impending practice closures nearby.
The GP said: ‘Two neighbouring practices are possibly on the verge of collapse and if either did we would need to close our list to prevent becoming overwhelmed.’
Dr Krishna Kasaraneni, chair of the GPC education, training and workforce subcommittee and a GP in Sheffield, said his practice was looking at closing its list as the ‘last option’ available to deal with an ever increasing workload and the loss of several GPs over the past few years.
Dr Kasaraneni said: ‘The only way for use to sustain staying open is to say we can’t take any more patients. That is our last option now, we’ve tried everything else, we’ve tried our best to control our workload and this is the only option we’ve got left.’
Pulse has also learned several practices in the Birmingham area have applied to formally close their lists, while Birmingham Cross City CCG has reported that nursing residents were ‘routinely’ being turned away by practices.
Recent board papers from the CCG said there ‘have been widespread anecdotal reports of practices refusing new patient registrations on the basis that their list is full’ and that ‘this is routinely reported as an issue during nursing home assurance visits’.
NHS managers have already been clamping down on list freezes in some areas, with reports they have been increasingly blocking requests for temporary closure, and even threatening GPs with breach notices for informally closing their lists despite following correct protocol.
In a statement, Birmingham Cross City CCG said: ‘There are currently no practices in the NHS Birmingham CrossCity CCG area with closed practice lists. Three of our member practices have indicated their intention to ask to close their list, however we have not received any formal applications.
‘At our Primary Care Committee meeting on 12 August, it was agreed that the CCG would start a dialogue with practices to openly discuss issues around patient registration requests to enable a more detailed assessment of the extent of any issues. This would allow us to engage with our members to explore possible solutions.
‘We take the ability of our patients to register with primary care services very seriously and residents who are not registered with a GP practice are able to access a patient registration helpline.’
Survey results
Which of the following measures are you considering over the next six months?
Temporary list closure
Yes – 14.6%
No – 75.9%
Don’t know – 9.5%
Shrinking your practice list
Yes – 11.2%
No – 79.9%
Don’t know – 8.9%
Cutting staff hours
Yes – 17.0%
No – 71.2%
Don’t know –11.8%
Cutting routine appointments
Yes – 21.1%
No – 66.3%
Don’t know – 12.6%
Discontinuing clinical services
Yes – 28.2%
No – 59.2%
Don’t know – 12.6%
Redundancies of clinical staff
Yes – 7.5%
No – 83.2%
Don’t know – 9.3%
Redundancies of administrative staff
Yes – 11.2%
No – 76.9%
Don’t know –12.0%
A merger with another practice
Yes – 20.7%
No – 67.1%
Don’t know – 12.2%
Federating with another practice
Yes – 45.6%
No – 41.2%
Don’t know –13.2%
Closure
Yes – 3.7%
No – 90.1%
Don’t know – 6.3%
The survey was launched on 9 June 2015, collating responses using the SurveyMonkey tool. The 34 questions asked covered a wide range of GP topics, to avoid selection bias on one issue. The survey was advertised to readers via our website and email newsletter, with a prize drawer for a Samsung HD TV as an incentive to complete the survey. A total of 493 GPs answered this question.
