NHS England has decided to close four GP practices in Plymouth because their ‘relatively small size’ is not a fit with the ‘national blueprint’ for ‘the direction of travel’.
NHS England (South West) said it was ‘moving ahead with a series of changes to the way GP care is organised in Plymouth’ which will see the GP practices at St Barnabas, Hyde Park, Cumberland and Saltash Road – which between them have just over 17,500 patients on their lists – close at the end of March.
Among reasons behind the decision, NHS England listed ‘the direction of travel set out in the national blueprint, the General Practice Forward View, which recognises the pressures and points towards a future in which surgeries operate “at scale” rather than as separate, small businesses’.
The news comes despite NHS England rejecting claims last month that it is allowing to fail. As revealed by Pulse, a senior NHS England official said vulnerable practices must ‘transform…or be allowed to fail and wither’, but a press office spokesperson said the comments did ‘not reflect national policy whatsoever’.
A total of seven Plymouth GP practices were at risk of closure, after previous providers handed back their contracts, but NHS England has decided to tender for new providers for the practices at Ernesettle, Mount Gould and Trelawny, and a new practice at Barne Barton.
Access Health Care, a subsidiary of Devon Doctors, is temporarily running all existing seven practices until the contract runs out in March. NHS England is planning for the remaining three practices, and the new practice, to have new contractors from 1 April.
In a statement, NHS England emphasised that the closure decision was taken separately for each practice, but they had some common factors including ‘the relatively-small size of the practices’, which ‘makes them unattractive to would-be providers who would take on the financial risk of running the business at a value of £76.44 per patient per year’.
NHS England also said that the size makes recruitment a difficulty, as ‘young doctors prefer to be salaried or to work as locums, working within larger practices, which makes it particularly hard for small practices to recruit’.
The statement said: ‘In the case of all seven existing surgeries, the previous provider had stepped away because they could not sustain the service. A temporary provider was appointed to provide breathing space, while the longer-term future was considered.’
They decided there was ‘no realistic prospect’ of getting a new provider for the closing surgeries ‘in the face of rising workload and financial pressures’. They also said that most of the patients would be able to move to one of 20 practices within a two-mile radius.
Amanda Fisk, director of assurance and delivery for NHS England in the South West, said they had considered ‘every single comment’ made in a public consultation about the future of the GP practices, which had showed ‘very clearly how much people value their local surgery’.
But she added that ‘unfortunately, when weighing up all the factors, the reality of rising pressure on general practice led us to conclude that we would be unable to find anyone who was both willing and able to keep these surgeries open’.
Dr Stephen Warren, a GP at Hyde Park Surgery, told the Plymouth Herald: ‘I think it’s unwise to close four GP surgeries at once…I did my best to warn NHS England, but my warnings haven’t been heeded.’
‘We were a five-star surgery and yet the current recruitment issues mean long-term sustainability was in question.’
Are small GP practices being run to the ground?
Comments made last month, in a briefing sent out by Paul Twomey, medical director of the Yorkshire and Humber area team, had indicated that NHS England would a allow GP practices to fail if they did not ‘transform appropriately’ in line with Forward View plans.
He said that NHS England is ‘no longer in a position’ to continue supporting vulnerable practices, but NHS England said letting practices fail was not national policy.
The statement from NHS England’s South West regional team refers to the GP Forward View, the general practice rescue package published by NHS England in April.
This said that ‘larger organisational forms will enable greater opportunities’ for GP practices and have them working from ‘a more effective platform’, integrating with other health and social care providers.