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Two-thirds of surgery closures located in poorer-than-average areas



EXCLUSIVE Around 66% of GP surgeries that have closed since 2013 were based in poorer-than-average regions, according to new research.

Analysis by consumer research company NimbleFins found that for every surgery that closed in an area with a higher-than-average household income, two closed in a region with lower-than-average income levels.

The analysis is based on figures collected by Pulse as part of its recent investigation that revealed UK surgery closures have risen almost eight-fold in six years, hitting record levels in 2018. 

Those behind the new research said surgery closures are ‘harder felt’ in poorer areas because patients may struggle to afford the cost of travel to another practice that is further away, and are also less likely to be able to pay for private healthcare.

Health think-tanks warned about the number of full-time GPs ‘falling fastest’ in the most deprived areas, which in turn risks fuelling rising pressure on the remaining GPs.

They also questioned whether the adjusted income practices receive in relation to deprivation ‘adequately make up for the extra work’ they provide to poorer populations.

Pulse’s figures, obtained through freedom of information (FOI) requests sent to all CCGs, health boards and trusts in the UK, alongside NHS England, showed that in 2018 alone 138 practices shut their doors, estimated to affect a record half a million patients.

Previous FOI requests by Pulse also revealed 445 surgery closures between 2013 and 2017, having an impact on 1.4 million patients.

In addition, provisional data revealed 12 more closures in the first month of 2019, compared with eight at the same time the previous year.

According to NimbleFins’ analysis of the data, 66% of the surgeries that have closed between 2013 and 2019 were located in local council areas with lower-than-average income for the region. The rest were in areas with income levels higher than the regional average. (See chart below)

To determine the income of patients affected by the closures, NimbleFins compared the average gross domestic household income per head in a surgery’s local council to that of the region – based on income data released by the Office of National Statistics –  before grouping each closure into an income band ranging from under 70% and over 130%. The bands compare the income patients earn in their local area against what is typically earnt in the region, 100% being the average. 

Pulse’s investigation revealed the majority of closures were at smaller practices – which GPs said patients preferred due to better continuity of care.

The latest analysis also suggests that in eight regions – North East, North West, Yorkshire and the Humber, West Midlands, East of England, London, South East and Northern Ireland – surgeries closed in poorer areas.

NimbleFins chief executive officer Erin Yurday said: ‘The closing of a surgery typically impacts thousands of patients, who may need to travel further afield to reach the next closest NHS surgery. While this brings inconvenience to all types of patients, closures in lower-income areas can be harder felt as a larger proportion of patients struggle to afford travel costs or pay for private health instead.

‘In some parts of the UK, surgery closures impacted a disproportionate amount of lower income patients. For example, in the East Midlands and Wales the surgeries closed in lower income areas served more patients than the surgeries closed in higher income areas.’

Health Foundation senior policy fellow Dr Becks Fisher said: ‘Practices in deprived areas may be particularly vulnerable for a number of reasons. Recent Health Foundation analysis showed that the number of patients per GP is 15% higher in the most deprived 10% of CCGs than in the least deprived 10%. These patients are also likely to have greater health needs – on average people experiencing socioeconomic deprivation have more health conditions, and at an earlier age.

‘The number of full time GPs is falling fastest in the most deprived areas where recruitment in the face of known GP shortages may be a particular challenge. This risks fuelling a vicious cycle of increasing pressure on remaining GPs, and reduced access to care for patients with the greatest need’.

Nuffield Trust senior fellow and GP Dr Rebecca Rosen said: ‘We have found in our own research that surgeries in more deprived areas have fewer GPs per patient than in wealthier areas – which is no doubt mounting pressure on existing staff.

‘This could be down to well-known difficulties in recruiting doctors to more deprived areas of the country. It is questionable whether the income adjustments that practices receive for deprivation adequately make up for the extra work involved in providing GP services for these populations.’

GP leaders have argued the recruitment crisis is to blame for the closures. NHS Digital figures released last month showed that the number of full-time-equivalent qualified GPs fell by 441 between March 2018 and March 2019.