Closures continue to put pressure on neighbouring practices as over a third of GPs responding to Pulse’s latest survey report absorbing extra patients in the last three years.
The snapshot survey found 40% of 469 GPs had taken on extra patients at their practice over this time period.
Some GPs responding to the survey said they had added 1,000 or more new patients to their list due to local closures, with one commenting: ‘Our list size has increased by over 1,000 but we have lost half of our clinical workforce. The situation is abysmal.’
Another GP said: ‘Three local practices have closed; we have taken bulk of patients’.
Meanwhile another GP said there had been ‘multiple closures’ in their area, leading their practice to consider ‘shrinking [its] boundary’. They added: ‘Typically [it is] the most complex/demanding patients that are registering or moving from merged practices.’
This comes as a Pulse investigation earlier this year found 474 GP surgeries have closed in the UK in the past nine years without being replaced. The Lost Practices investigation revealed that smaller practices on lower funding in more deprived areas were most likely to be affected.
It also found that recruitment issues tended to be the final straw for the majority of practices that had closed for good. CQC ratings and the ending of APMS contracts were also major factors.
Pulse’s latest survey revealed that some GPs have not seen full closures in their areas, but they are taking on extra patients from other local practices that are in difficulty.
One GP commented: ‘Numbers have gone up due to an exodus from two other practices that are really struggling’; another said they had taken patients from ‘a struggling neighbourhood practice’.
Other survey respondents suggested that neighbouring practices opting to close their lists was having an impact: ‘All others have closed their lists, so we are taking extra,’ one GP said.
Leeds GP and former chair of the BMA England GP Committee Dr Richard Vautrey told Pulse there is an ‘increasing number’ of practices seeking to close their lists mainly due to workload pressures and lack of space in premises, which is hampering practices’ ability to recruit the staff they need.
He said: ‘The huge workload pressures which are recognised right across the country are having an impact on individual practices and where once practices could cope with spikes in demand and recuperate in between those spikes, now it is a spike every day.
‘One of the results of that is practices seeking to close their lists to try and manage the workload in the best way that they can – still providing services to their existing patients but trying not to take on further patients because they are worried about the safety of doing so.’
GP practices have to go through a formal process with NHS England to close their list, otherwise they are at risk of contractual breach.
Dr Vautrey added that list closures have a ‘domino effect’ and put added pressure on remaining practices ‘who could potentially seek to close their lists if they find themselves struggling as well’.
‘This is a fundamental issue that the Government, NHS England and others need to be tackling and need to be creating long-term investment to do so,’ he added.
Dr Hadrian Moss informally closed his Kettering-based practice’s list in 2015 – prompting a breach of contract notice from NHS England at the time – in a bid to maintain a personalised list and continuity of care for patients, as well as protect staff mental health.
Now retired, Dr Moss told Pulse: ‘The whole reason for us closing our list was because we felt that the quality of service to our patients was being eroded and also because we were a partnership and at the time, we were struggling to recruit.
‘We felt compelled to say no we are not going to take on more patients because the workforce is being diluted so much that mistakes are going to happen, and we are not prepared to take that step – and that was the situation up until I retired in 2016.’
Commenting on the survey findings, Dr Moss added: ‘I would imagine that the financial pressures are more difficult to deal with now and also the recruitment problem – I have read of some practices where there has been one partner left carrying the can and that must be an incredibly difficult situation to be in, you can’t maintain that level of workload. All of these things went through our minds at the time, we wanted to preserve our mental health, but the overriding driving force was the safety of our patients.’
GPs responding to the survey also reported an influx of patients as a result of new housing developments is putting pressure on practice lists. One GP said they had seen a ‘40% list size growth’ due to new housing.
Another GP, based in Wiltshire, told Pulse that this is an ongoing issue in their area and ‘seemingly nobody at a local level has the ability to solve it’.
They said: ‘It appears there is no obligation on any new development proposal to have compulsory allocated adequate space for new primary care estate to cater for the needs of new residents. Existing practices, even those that may have moved into larger premises three to five years ago, are struggling to look after these extra people due to lack of physical space and workforce.’
The GP added: ‘My own practice has been very short of physical space for over 10 years [and] we need over double the space we currently have for our increasing patient list and all members of our team. This is by no means an isolated case, there are many similar others in our county.’
Last month, Pulse reported on a Suffolk GP practice that had lost half of its GP partners in the last year at the same time as taking on 2,000 extra patients.
Meanwhile in October two Northern Irish practices handed back their contracts after workload and workforce pressures became unsustainable.
The survey was open between 23 November and 5 December 2022, collating responses using the SurveyMonkey tool, with GPs across the UK asked to respond to these particular questions. It featured a range of questions on various topics. The survey received 1,182 responses in total. The question on practice closures was answered by 469 GPs. The survey was advertised to our readers via our website and email newsletter, with a prize draw for an £250 John Lewis voucher as an incentive to complete the survey. The survey is unweighted, and we do not claim this to be scientific – only a snapshot of the GP population
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