We have reported on practice closures for the past eight or so years. This coverage has gone from disbelief at a possible 60 closures to more than 800 actual closures in nine years.
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.
Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at editor@pulsetoday.co.uk
READERS' COMMENTS [4]
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i qualified in 1976, and was a single handed, rural, dispensing gp in wales till 2007.
i had a dvt in my right arm, and a Hb of 5, with a serum iron too low to record. four consultants told me that if i continued to work as i was, i was asking for problems, and i needed help. i told our LHB this (same as PCT in england), and their response was “either you’re working, or you’re not – get on with it”. so i resigned.
the LHB then closed the practice, and merged it with the patch four miles away, despite offers from a GP who wanted to take it over (good swimming, cycling, fishing etc etc).
their excuse was “it’s not financially viable” – despite me having several classic cars and bikes, three houses, and an aeroplane !!!
i had a much higher elderly, frail, population than average. they now have to arrange their own transport to the “local” surgery – no bus service, and lousy train service.
the upshot is that the practice now has a load of extra housecalls from patients who are elderly, frail, and now really ill because they couldn’t get to the surgery. most could have got a lift to my surgery, but asking your equally frail, elderly neighbour to give you a lift to the surgery four miles away, with limited parking, and wait there several hours while you’re seen is not going to happen.
i am still working two days a week as a locum – which is what i wanted to do in 2006 !
i am 72.
Nice investigative journalism – much appreciated by the profession I’m sure. Time for facts and brutal honesty.
There is an air of catastrophe lurking in the UK. They’ve all scuppered. They’re all hiding. “They” took the money. “They” shut you down. “They” named and shamed you. “They” lied to you in the pandemic. “They” signed those contracts. “They” ridiculed and erased your colleagues. That game of fear and control is old and past it’s time – a comedy narrative, petty and small. And now it’s going to come to haunt and burn “Them” – the public is unsettling – they don’t like to wait this lot – and all General Practitioners should be making way, opening the NHS floodgates and figuring out their own individual plans for the new future and new world – calling out the Institutes and telling the public exactly what is going on and who is here to takeover. Build some hobbies, rise above the fear and control they command you under and be free in the knowledge that no gimmick or innovation or technology they fantasize about is going to stop it or save “Them”.
You can’t retrain this country’s mindset – the public are breaking down mentally and physically and “Their” false promises are coming to surface. You can’t deliver it anymore and you know you sold it off.
The turd and tied are coming to shore.
And hopefully Pulse will carry on do what they can.
The stealthy but deadly demise of the Partnership Model over the last decade……..
First they came for the single-handers, but I wasn’t a single-hander so I did nothing.
Then they came for the inner city partnerships, but I wasn’t an inner city partnership so I did nothing.
Then they came for the Northern Irish GP partners, but I wasn’t a Northern Irish GP partner so I did nothing.
Then they came for practices who failed CQC, but I didn’t fail CQC so I did nothing.
Then they came for Last Man Standing partnerships, but I wasn’t a Last Man Standing partnership, so I did nothing.
Then they came for those who lost their MPIG, but I didn’t have an MPIG so I did nothing.
Then they came for those who refused to join a PCN, but I did join a PCN so I did nothing.
Then they came for me, but there was nobody left to save me.
Touching note David – I would propose that they’re coming for those that joined a PCN. In subversive and occult ways. Await contract variations, mandatory schemes and merged patient lists with vertical integration. You can get rid of your receptionists – they’re coming for them too.