This site is intended for health professionals only

Can GP practices be brought back from the brink?

Cassandra came in the unlikely form of Dr Peter Holden earlier this year when the veteran GPC negotiator predicted in April that we had ‘a year to save general practice’ and prevent widespread closures.

This is proving prescient. LMC leaders have told Pulse that they are already seeing hundreds of practices across the country teetering on the brink of closure. As Dr Mark Sanford-Wood, chair of Devon LMC, says: ‘I’ve been involved with the LMC for 20 years and I’ve never seen this before.’

The scale of the potential closures is shocking and they probably represent the tip of a very large iceberg. A chronic lack of investment, worsening recruitment problems and exhausting levels of workload mean many good GPs are close to hanging up their stethoscopes.

It would, of course, be carelessly negligent of the NHS to allow this to happen; the ‘domino effect’ would damage patient care, put a huge additional strain on other local practices and potentially destabilise the whole of the local NHS. So far there have only been weak promises that managers will ‘work with’ struggling practices and little sign of the cold hard investment needed to enable them to restructure, merge or federate.

As one LMC leader said recently, they are employing a ‘deliberate ground zero’ strategy.

The funding pot may be empty and – in the current climate – funding increases for GPs are probably politically unpalatable, but there are other options. As one CCG leader put it in a recent blog: ‘CCGs and NHS England should be looking at ways of putting resources into general practice in other ways: management support, better IT and the staff to get the most from it, staff training and mentorship.

‘The list is as long as your imagination and none of it needs to go through the practice books where it can be misconstrued as a pay rise.’

All this is great in principle, but it will have to be fought for. The BMA and the RCGP have launched their respective campaigns, but it will take more than a ‘Your GP Cares’ poster to get area teams to pull their fingers out.

Others have led the way on this – take the fearless campaigning of practices in Tower Hamlets. They have created such a rumpus through talking to the national media and involving their patients that the area team has had to sit up and listen.

And this is the only way that some practices will survive, by galvanising support locally and ensuring that those who really care about them – their patients – know what is going on.

Pulse is going to try and help with this (look out for more resources on PulseToday over the next few weeks), but please do let us know if you are struggling. We are trying to raise the national profile of the current state of general practice and we can only do this with your stories. Email me in confidence at

And take heart. There is time to still prove Cassandra Holden wrong.

Nigel Praities is editor of Pulse