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LMC saves ‘one practice a week’ from closure as partners struggle to stay afloat

One GP practice is being saved from closure each week in London, according to LMC leaders running a rescue programme across the city.

Practices facing closure or the termination of their contracts have been able to access help from Londonwide LMCs as part of the programme to stem a crisis which could still see one in 20 practices in the capital close in the near future – potentially leaving nearly 200,000 patients without a GP.

Londonwide LMCs chief executive Dr Michelle Drage said that around half the interventions meant that practice contracts were saved, but she warned that the LMCs’ figures were only indicative and likely did not reflect the full extent of the problem.

Dr Drage told Pulse: ‘We can confidently say that last year our assistance helped the equivalent of around a practice a week through significant, serious risks to their contracts.

‘Contracts were saved through mergers, partnerships, transfer, the lifting of CQC suspension or a return to “normal” practice ranking after being put in special measures.’

In one example, Dr Drage said that Londonwide LMCs had used its extensive networks to identify GPs willing to take on partnership as well as bring in an experienced manager as a non-clinical partner, to rescue a large training practice that faced closure after losing a ‘significant’ number of GPs in the past year.

The LMCs body then worked with the practice and NHS England to put a ‘robust turnaround plan in place’ to help get the practice back on an even keel and enable the new partnership to implement the necessary changes to begin stabilising the practice.

Dr Drage said the this in turn also helped to prevent further pressures on other practices in the area, where a number of practices had already closed in the past year.

But according to Londonwide LMCs, pressure is sustained on practices – and in some cases it was too late to help.

Its latest data collection shows that 35 practices have closed their doors in London over the last  year, and 45 closed since the general election in May 2015.

Dr Drage said: ‘Not every practice comes to us when they are facing closure or termination and sometimes we find out when it is too late, or the contract has already been handed back and the commissioners come to the borough LMC to consult about the future of the list.’

And a new survey of practices conducted by Londonwide LMCs found that a further 30 practices look set to close.

The survey received responses from 552 of the total of 1,295 GP practices across the capital and found that the 30 practices – around 5% – are either considering closing, to manage current or future vacancies, or are already in the process of terminating their contract.

This could affect an estimated 185,000 patients, the survey report said.

Only 70% of practices responding to the survey were able to say that they definitely did not intend to terminate their NHS contract in the next three years. 

That suggests further destabilisation from this time last year when London LMCs reported that one in five GP surgeries in the capital could not rule out closing in the next three years as a result of the crisis.

Dr Drage said: ‘Our current active caseload covers a wide range of circumstances which can, if unresolved, lead to practice closures.’

GP practice resilience programmes

A number of schemes have been launched to help struggling GP practices in England.

NHS England is putting £40m into the GP resilience programme over the next four years. In 2016/17 there is £16m available, with £8m in the years afterwards.

Meanwhile, NHS England’s pre-runner – the £10m vulnerable practice scheme – identified around 800 practices across the country as being in need of support at the start of 2016, but LMCs across the country have said that practices have not yet received material support.

A report on the GP Forward View published by RCGP in January found that NHS England has failed to implement measures to support practices in danger of closing.

NHS England had then spent only £6m of the £10m pledged as urgent support for vulnerable practices in 2015, despite their most senior GP saying last year the whole fund should reach practices by the end of 2016.

NHS England’s director of primary care, Dr Arvind Madan, has said that almost 2,000 GP practices will have benefitted from NHS England’s resilience programmes by the end of this month.

Meanwhile, under the terms of an RCGP scheme announced last month, practices at risk will pay around £9,000 to access help from the RCGP involving visits from a 70-strong team of GPs, practice nurses, practice managers and pharmacists to struggling practices.