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Pulse 2018 review: General practice on the edge across UK towns



The good old-fashioned British seaside was once the heart and soul of generations of family holidays.

But for many resorts, decades of change have chipped away at their sheen.

Alongside areas of poverty, transient populations and rising socio-economic problems, a new challenge faces a number of these coastal towns, in the shape of general practice closures.

Take Brighton, for example, where nine GP surgeries have closed in three years. That was one of the stark headlines arising from Pulse’s ‘Postcards from the edge’ investigation earlier this year.

The result is mounting pressure on the practices that remain, with GPs spread increasingly thinly among Brighton’s 270,000-strong population.

Average list sizes have risen from 6,900 to 8,700, and with a tenth closure in the pipeline things look set to go from bad to worse.

Brighton is possibly the hardest-hit town in the UK, but the picture is illustrative of what’s happening from coast to countryside across Britain, where practice closures have reached epidemic proportions.

As Pulse reported back in May, nearly 450 surgeries have closed in the last five years, displacing some 1.3 million patients who have had to find a new family doctor.

The trend is particularly marked in a handful of towns and cities with similar profiles: they are typically in coastal or rural areas with a high proportion of elderly residents, and populations that come and go with the seasons.

GPs in these locations also tend to be older, and attracting new staff to fill the gaps is nigh-on impossible.

These areas where general practice is on the brink of collapse include, among others:

  • Plymouth, southwest England, where a fifth of practices have handed back their contracts in the past three years
  • Portadown, Northern Ireland, where all four GPs at a 5,200-patient practice left (two on maternity leave, one who opted for a career change, and the remaining part-timer who resigned, unable to cope with being left to shoulder the burden)
  • North Ayrshire, Scotland, where eight practices – totalling 57,000 patients – had their lists closed last year, but where now, practices are recruiting new clinical roles and specialist interest GPs to tackle workforce problems

NHS England has thrown some semblance of a lifeline, in the form of a £56m support package for struggling practices as part of the GP Forward View.  Recruitment drives offering £20,000 ‘golden hello’ deals to get GP trainees into rural areas have been introduced in England, and a similar scheme, offering £10,000 to GPs taking up their first post in a rural practice is in place in Scotland.

Yet, practice closures continue to gather pace.

And without government resolve to boost investment and a clear commitment to making the profession more attractive, it remains to be seen whether general practice can be brought back from the edge.


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