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Practice not to blame for deregistering patients, council admits

A council that launched a formal investigation into the deregistration of 1,500 patients by a Norfolk GP practice has concluded that a widespread regional recruitment crisis is to blame, despite originally claiming that the practice had ‘betrayed the trust’ of patients.

A Breckland Council committee tasked with investigating the decision of Watton Medical Practice to remove patients from its list found that a 10% regional shortfall in the number of GPs required was at the root of problems affecting the practice.

However, the chair of the council’s scrutiny committee had originally claimed that the practice’s decision was a ‘betrayal of patients’ trust’, leading to the Daily Mail running a story saying that vulnerable patients were ‘kicked off’ the list to ‘make way for migrants’.

It comes as Pulse has launched its campaign to Stop Practice Closures, in which GP leaders have cited recruitment issues – as well as cuts to MPIG and PMS funding – as one of the main factors for upwards of 100 practices closing or potentially closing.

Local leaders said that Norfolk is particularly struggling with recruitment issues, and warned that they expect practice closures ’18 months down the line’.

The Watton Medical Practice is the first practice known to have removed patients from its list as a result of recruitment issues, citing ‘significant issues with capacity’ for closing its list in June.

The 1,500 patients who were affected all fell within the catchment areas of other surgeries and were informed by the practice that they would have to register with alternative GPs.

The council first became involved in early June, when news outlets reported that the deregistration exercise had left some patients with journeys of up to 13 miles to their nearest GP, costing up to £50 in taxi fees for some patients.

In a statement made in June, Cllr Phil Cowen, chair of Breckland’s overview & scrutiny commission, said that the practice’s actions had been ‘a betrayal of the trust that patients place in their local medical services’ and concluded that the practice should take deregistered patients back on.

The story was subsequently picked up by national news outlets including the Daily Mail, which reported in June that vulnerable patients had been ‘kicked off’ the list to accomodate ‘migrants’.

However, a subsequent report made to Cllr Cowen’s committee in late July found that migration was not to blame for the deregistration of patients.

The council’s latest report, which was published in late July following consultation with Watton Medical Practice and other local stakeholders, said it was ‘clear’ that the practice’s issues were instead due to problems with the recruitment and retention of GPs across Norfolk and East Anglia, as Pulse reported in June.

The council’s ‘high level research’ revealed that Norfolk had around 50 GP vacancies, representing a shortfall of around 10% overall, while a number of GP training posts in Norfolk and neighbouring Suffolk also went unfilled.

Watton Medical Practice is currently running on the equivalent of five and three-quarters GP partners, two of whom are due to leave the practice by January 2015.

In June this year, Pulse reported that the departure of two GPs had left their remaining colleagues’ workloads at a dangerously high level. The departure of two further GPs means that the ratio of patients to partners will be over 3000 to 1, even with a reduced patient list – far above the levels considered clinically safe.  

The surgery says it is currently relying on locum support, which at up to £800 per locum, per day, is putting the practice under ‘severe pressure’.

The practice’s manager, who did not want to be named, said that the situation was ‘unsustainable’. She said: ‘Our list is already closed, and while there’s been talk of merging, we can’t find any practices who want to merge with us.

‘Another option is deregistering more patients, and another is that the practice could close. We have a meeting with NHS England and the LMC scheduled for a few weeks’ time where we’ll review the situation.’

She added that that while Breckland Council had ‘eventually’ been supportive, their initial comments had been ‘very disconcerting’.

She added: ‘The council held their initial meeting without us and then went straight to the press. But then they held a meeting which we did attend, and their report showed something very different – that there is a national crisis and there is a problem.’

‘But the council aren’t going to be able to take any meaningful action. We’re happy to talk to the council and to partake in their reviews, but there’s nothing they can do. It’s about NHS England and the LMC supporting us.’

Dr Tim Morton, chair of Norfolk and Waveney LMC told Pulse that the Watton Medical Practice was ‘surviving with a lot of locum support, but barely surviving’.

He said: ‘ It’s the cumulative effect of everything which is going to start to happen over the next two years… practice closures are going to happen, I reckon, about 18 months down the line.

‘We’ve seen quite a few practices come for advice about merging, as a way of surviving. It’s still early days, but certainly it’s being talked about a lot more than ever before. Like nationally, there’s a lot of practices really struggling on recruitment.’