In Pulse’s most ambitious investigation yet – which will be released over the next week – we have looked at the reasons some practices close, never to open again. There are some fascinating findings, including the role of deprivation, list size and funding. And what is clear to me is that they are a symptom of what is happening more widely in general practice.
A practice doesn’t close because there is something inherently wrong with it, or because its circumstances have led to partners handing the contract back. No, it closes because the pressures hitting the whole profession reach a level that practice can no longer withstand. These pressures are systemic.
A partner’s resignation or retirement shouldn’t necessarily lead to patients having to travel further, or to struggling neighbouring practices having to absorb their lists. Indeed, for many practices, even singlehanded ones, commissioners often find GPs to take over the contract.
But in areas where the pressures are particularly severe, such an event is far more likely to result in closure. This is especially true where the pressure relates to deprivation, funding problems or a small list size (we know commissioners frown on smaller practices).
While this might not surprise you, it does have major implications. First, funding to help distressed practices, as introduced when Jeremy Hunt was health secretary, will only go so far. This is giving an anti-emetic to someone vomiting – it only treats the symptom. It might work in the short term, but the symptom will soon recur. Which is not to say distressed practices shouldn’t be given urgent support, of course.
Second, most practice closures are bad for everyone. This might sound self-evident, but a number of commissioners have responded to our investigation by saying practices closing in their region were replaced by more modern premises that were in everyone’s best interests. I think this is only rarely true. Because closure is a systemic problem that predominantly affects practices in deprived areas with lower funding, it tends to leave a hole in the community, even if modern premises pop up elsewhere. And practices taking on the patients are likely to have to do more time-consuming home visits.
I would venture that – despite the push for larger groupings – most patients would prefer small practices in rickety buildings closer to home. Take a look at the backlash in Shrewsbury where six small practices propose to move into a new hub.
So what can be done? Well, like our vomiting patient, we need to treat the causes – the shortage of GPs, the impossibility of the full-time role and the funding shortfall. But this isn’t anything we don’t know.
At Pulse, we will do what we can. We will shout these results from the rooftops. We will make sure everyone knows why practices close and what happens when they do.
I do have a glimmer of hope. Last month, when plans leaked about making GPs offer prescriptions to help people with the cost-of-living crisis, the response from across the political spectrum was ridicule, and importantly, that GPs don’t have the time to take this on. There is a growing acknowledgement that general practice is in crisis.
Closures are emotive, tales of elderly patients having to take two buses to the nearest practices carry weight. If no one listens now, I don’t know when they will listen.