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GP practices could close or reduce services this winter as pressures mount, warn LMCs


NHS England negative


GP practices face the ‘very real prospect’ of having to close temporarily or permanently this winter among rising workload and staffing issues, GP leaders have warned.

One LMC is predicting a third of GP practices in its region will soon be on the highest alert levels for workload pressures.

And GP leaders in other areas said they expect practices to be operating ‘skeleton services’ this autumn as appointment levels rise during the traditionally busiest parts of the year.

They have warned staff absence due to annual leave and Covid-related isolation is adding to the problems – despite new government guidance saying healthcare staff can continue working if identified as a Covid contact. 

Devon LMC said it expected a ‘significant rise’ in GPs reporting their practice as reaching ‘red’ or ‘black’ alert status, which respectively mean they are either under significant pressure and require immediate action to stop services becoming unsafe, or it is unsafe to continue services.

Its modelling predicts that, by Christmas, 35% of the region’s practices – representing 43 surgeries out of 123 – will have reached the two highest alert levels under the grading system it uses to assess workload safety.

GP practices in the region are already under strain from delivering Covid-19 vaccines on top of their core work, said the LMC, warning there will likely be no capacity to deal with rising Covid cases and an expected increase in respiratory viruses later this year.

Kent LMC warned it also expects its GP practices to be in a similar situation, with both temporary and permanent closures occurring, unless ‘drastic’ action is taken before the winter.

Dr Andy Parkin, medical director for Kent LMC, said: ‘We are setting up measures with the CCG to try and reduce pressures on general practice. One of which is having an alert/OPEL [or operational pressures escalation levels] system in place.

‘Preliminary data suggests most practices are at level 3-4 [of that system] so, unless something drastically changes before the winter, I would think we will be in a similar boat to Devon [LMC].’

He added: ‘Both temporary and permanent closures are a very real risk going into the winter, without swift action to relieve the pressures on general practice.’

Meanwhile, Cambridgeshire LMC recently reported that 58% of its GP practices had reached its own two highest levels for workload pressures between 17 and 22 May.

A total of 44% GP practices in Cambridgeshire and Peterborough said they were reaching unsafe levels, with GPs having 36 to 45 contacts per day, while 14% reported unsafe working including clinicians dealing with over 45 patients a day.

Cambridgeshire LMC chief executive Dr Katie Bramall-Stainer told Pulse pressures are continuing to affect the region: ‘We’ve never been advertising quite so many vacancies and posts across our system. Practices are struggling for locum cover so the workforce is being spread very thin.’

‘People are very tired and protecting their own mental health for their own sanity and are taking their annual leave, but trying to find cover for it is very difficult so we’re seeing people having to cancel leave to maintain services – which isn’t sustainable going into the autumn ahead of phase three [of the Covid-19 vaccination programme].’

She added the LMC had ‘not yet seen a positive impact’ on general practice staffing levels from the change in the Government’s rules that now mean vaccinated healthcare workers do not have to isolate if they are in contact with a Covid case.

Doncaster LMC chief executive Dr Dean Eggitt said in his region region the majority of GP practices are reporting ‘red’ or ‘amber’ level – the highest ratings of the LMC’s grading system – for practice manager workload, volume of phone consultations, and staff shortages. 

The LMC expects GP practices to see ‘significantly worse’ levels of appointments in the autumn, which will compound ongoing staffing challenges due to Covid isolation, sickness and annual leave.

He said: ‘At the moment, appointment levels are probably as quiet as they are going to be and we expect it to get significantly worse the end of September / beginning of October to the point where most practices will be running a skeleton-type service.’

He added: ‘If practices don’t have the infrastructure available for to provide a service from people working remotely then there will be so many people off at the practice then they will only be able to do the bare minimum.

‘That will usually be emergency telephone consults and provision of prescriptions.’

In Devon, LMC chair Dr Rachel Ali said the body was calling for ‘urgent support’ from ‘local health system partners’ to help GP practices deal with the capacity issues ad avoid closures.

She said: ‘Unless urgent action is taken, many local GP surgeries will be on the brink of collapse in the coming months… Some GP practices will face a very real prospect of having to run reduced services, close temporarily or even permanently.’

She added: ‘The LMC is calling for urgent support from our local health system partners to help manage demand, stabilise the workforce and release capacity for the emerging work associated with Covid-19 and flu and to find ways to plan ahead for crisis points.’

NHS Devon CCG chair Dr Paul Johnson said all parts of the health and care system are ‘under extreme pressure’.

He said: ‘GPs and their teams have been working tirelessly throughout the pandemic responding to a 14% rise in demand for primary care, as well as vaccinating hundreds of thousands of people against Covid-19. They have played a huge part in the vaccine programme, which is allowing lockdown restrictions to be lifted.’

He added: ‘We work closely with colleagues across our health and care system, including GPs, every day to tackle the pressures NHS and care teams are currently facing.’

Pulse’s annual investigation into GP surgery closures revealed 96 practices shut across the UK in 2020 – a similar figure to the previous year.

A major survey by Pulse in the spring revealed GPs are working 11-hour days and dealing with an average of 37 patients in that time – far more than the 28 patients they believe is the safe daily limit in the pandemic.

READERS' COMMENTS [14]

Patrufini Duffy 3 August, 2021 4:27 pm

They shut the walk-in.
They re-directed A+E and 111 into you.
They re-directed the ambulance into you.
They pushed mental health, sexual health, palliative and social care down your throat.
They re-directed e-Consult and Doctorlink into you.
They allowed the apps to make money, and end their consult with “see your GP”.
They re-directed vaccine queries into you.
They threatened you with patient online booking again.

And you keep signing up.
And you keep leaving late. And you keep receiving complaints.
And they keep monitoring remotely.
Like you’re the problem.
And those leaders are sitting around the table thinking – what needs to change?
Not a lot apparently – just increased access, that’s their only solution.
Over-promised lies and scapegoating.

Create demand. Create private solutions.

Michael Mullineux 3 August, 2021 4:42 pm

Spot on PD. Which is why we say no. No to the PCN project with it’s ridiculous attached additional requirements. No to poorly evidenced DES’s. No to eConsult. No to patients wanting vaccine passports. No to Ambulance colleagues deflecting responsibility for clinical decision making on to us. No to 111 requesting 2 hour reviews. No to secondary care colleagues asking us to follow up investigations they have initiated. No to re-referring patients to secondary care who had their appointments cancelled due to Covid. No to infantilising our patients. No to most NHSE directives. No to poorly considered NICE guidelines. No to endless PCN/locality meetings. Do yourselves a favour GP colleagues – familiarise yourselves with your GP contract and learn to say NO

Anonymous 3 August, 2021 5:08 pm

Problem is we have no effective union
Our BMA reps are colluding with the DOH
Aided by rcgp
Sorry to say

Anonymous 3 August, 2021 5:09 pm

Sorry above comment should not have been anonymous
Janine O’Kane
NI
We are all too scared here to speak out

Simon Ruffle 3 August, 2021 5:30 pm

Blaming the BMA is an old tactic of the disaffected. I was one. I re-joined the BMA, became a local LMC representative, the got onto the board and became board chair of 3 County LMCs. I am now on GPC as Northeast Hampshire and Berkshire rep to the GPC. Since becoming this rep not 1 GP has contacted me, via the LMC or otherwise for me to lobby on their behalf. I am a grassroot GP and try to agitate at GPC level as one but unless BMA members actively take part in badgering their LMCs and thus through to the BMA GPC, I do not expect anything to change?

Anonymous 3 August, 2021 5:56 pm

I am not using old tactics but I am disaffected
Some lmc reps are great but I wonder if your GPC forced colleagues to work in a covid centre service that they designed with the rcgp and the doh
It took a legal challenge for us not to be made to man these hugely expensive centres In the ooh
This is not what I, who have always been a member of the BMA, pay for
I expect a union to act as a union
JOK

Mark Cathcart 3 August, 2021 6:35 pm

Well said janine o’Kane:
General practice is in a knife edge in the southwest of Northern Ireland
We are drowning here and yet……,
No life jackets are being dispatched to us
I reckon this winter really will see the death of rural primary care in Northern Ireland as the exodus of senior primary care physicians escalates and there is no one to replace them because the support systems are not robust enough to care and nurture young doctors into gp land

David Church 3 August, 2021 6:36 pm

‘struggling’ practices may be forced into onerous additional ‘supportive meetings and monitoring arrangements’, (in addition to workload, of course), but this is not the problem, and threats of ‘breach of contract’ for closing ‘in-hours’ will be of no help at all when an unpredictable additional problem, like a need to isolate for IPC occurs at no notice and with no availability of alternative USEABLE support, like qualified staff helicoptered in to manage the day-to-day work untel recovery.
Nobody can promiss to do the impossible with nothing.
but what you are saying is that it come to it easily during this winter.

John Graham Munro 3 August, 2021 8:52 pm

Time for the locum workforce to move in—-(those Drs. whom no one wanted recently)—-the problem is, they don’t come cheap——I know lazy incumbent G.Ps think they should—–after all they’ve got to pay for their long awaited holiday, PCR/LFT and ?quarantine as well ——and you can be sure on return they will pick holes; despite a locum having done their best to bring a practice back to some sort of normality——believe me, most staff are glad to see the back of these so called stressed out G.Ps for a while——-I’ve been saying for months stop– whining and vote with your feet—– but no—now you’ve got what you deserve.

I’m now off to play the Russian National Anthem and calm down

A non 4 August, 2021 12:14 am

No one will thank you for flogging yourself to death propping up a ludicrous primary care system..really, out there in the world of the non medic, the GP service is generally unappreciated and moaned about…and in the publics’ perception, by and large, you are the ones they hold responsible. Step outside the bubble of primary care and many of your ‘colleagues’ working elsewhere in the NHS also genuinely believe failures in general practice, caused by inefficient and poorly run practices, are one of the main causes of the woes of the whole NHS – they hold you responsible. We need to leave en mass ..let the system collapse – work as a locum. Its the only position in primary care in which you are truly an independent entity. Refuse to work where its not safe to do so. The system does not care about you..you have to make sure you take care of yourself. But alas it wont happen, the system will continue to limp on, on the back of the naive, the newly qualified who don’t know better, and those who are willing to sacrifice themselves for others, like its a religious thing. enough said, time to shut up. Maybe I’ll log in and send my own GP an eConsult, surely there’s something they can do about this ..I’ll drop them a message

terry sullivan 4 August, 2021 12:52 pm

just say no

Dave Haddock 5 August, 2021 11:21 am

Hopefully the slow implosion of NHS GP will lead to increased opportunity for Private GP services, with the opportunity for at least some doctors to escape the ghastly clutches of the NHS. Perhaps knowing that opportunity existed outside the NHS might even make go a more attractive career option for the best and brightest, who currently mostly go elsewhere.

john mackay 5 August, 2021 4:32 pm

We’ve given up contacting the BMA/LMC/GPC because when we do nothing happens and anyway we are all too busy. And surely we shouldn’t have to do that anyway, are the BMA/LMC/GPC unable to see what’s happening themselves? The lack of challenge to NHSE is probably the worst aspect of the current crisis, many colleagues feel completely abandoned. Where is our voice? Where is the challenge? The silence is absolutely deafening……

John Graham Munro 7 August, 2021 3:38 pm

A non——-spot on–I’ve been saying this for months and getting a lot of flak