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COVER STORY THIS MONTH


Surgery closures hit three-year high Number of surgery closures 41 Number of patients displaced 148,625


Key Full practice closure Premises closure as a result of a merger


21 73,637 30 9 11


29,075 14,574


2013 2014 2015


In Scotland, ministers have committed £60m over three years for practices facing ‘challenges’. In Wales, where several large practices have closed and 10 practices covering 50,000 patients have fallen under health board control, the Government runs a scheme that allows vulnerable practices to apply for support that could include funding, more training or additional staff, such as a practice nurse.


But in England, the situation has been


made worse by the time it has taken NHS leaders to acknowledge the true scale of the problem.


Sudden move Despite NHS chief executive Simon Stevens’ personal stake in expanding general practice – through the ‘new models of care’ in his Five Year Forward View – executives have been slow to develop any scheme to support struggling practices.


The £10m fund for vulnerable practices in England was announced as part of health secretary Jeremy Hunt’s ‘new deal’ last July. But it was six months before area


teams were told to come up with a plan to ensure the ‘sustainability and quality’ of general practice. Guidance issued last December to all CCGs and local area teams says this must address ‘workforce and workload issues’ in general practice in 2016/17.


18 February 2016 Pulse 2013 2014 2015


GPs hand back contracts after ‘impossible’ PMS cuts


Pulse has learned that a couple of large practices are handing back their contracts as area teams finalise their PMS funding reviews. Four senior partners at a practice


rated ‘outstanding’ by the CQC have been forced to quit after an NHS England PMS review saw funding for the surgery cut by £400,000. NHS England has put a tender out for the 12,000-patient Sutherland Lodge Surgery in Chelmsford, after the partners said the cuts would double their GP-patient ratio and that they would ‘not be comfortable providing the significantly reduced level of service the new contract would require’. A GP provider company has also announced it is handing back a joint contract for five GP surgeries after it was told it faces funding cuts of up to 20%. The Practice Group, whose five GP surgeries across Brighton – including one for homeless people – have 11,400 registered patients combined, said it would be ‘impossible’ to continue running them after the proposed PMS funding cuts.


31 64,241 63,841


All regions were tasked to draw up lists of their most vulnerable practices over Christmas using an NHS England ‘vulnerability risk matrix’ and submit them by last week. Practices were scored using measures such as the number of patients per GP, CQC ratings, QOF achievement and the number of sessions not routinely filled (see box, overleaf). Pulse understands from instructions sent to area teams that practices that qualify will receive ‘externally facilitated provider support’ designed to build ‘longer-term resilience rather than deliver short-term quick fixes’. This could include financial incentives to help them retain GPs near retirement or adapt clinical roles to allow GPs to spend more time with complex patients. The details are still being finalised, but it appears NHS England is using as a model a small scheme that began in the South region last July. This scheme appointed 21 organisations, including superpractices, foundation trusts and three private companies – among them corporate giant Virgin Care – to assist struggling practices.


Source: Freedom of information request to NHS England, and Health and Social Care Information Centre figures on numbers of patients per practice.


The fund only goes to the worst-affected while ignoring the iceberg below


Dr Chaand Nagpaul


Tipping point But GP leaders warn many practices have shifted into the ‘vulnerable’ category over the past year, due to ongoing funding cuts, and workload and recruitment problems. Pulse has learned a number of practices are intending to hand back their contracts in April, including two practices with in excess of 10,000 patients hit by PMS funding cuts (see box, right). GPC chair Dr Chaand Nagpaul tells Pulse the £10m fund is ‘far too low’. He adds: ‘It’s only going to be targeted at a small number of the worst-affected practices, while ignoring the iceberg underneath – the large number of practices reaching their tipping point. ‘What we really need is proper resourcing if we’re not to continue seeing more and more practices becoming unsustainable.’ Dr Nagpaul says he has advised NHS England that there should be funding for ‘resilience teams of GPs, practice managers and nurses’ to support practices going through difficulties. He adds: ‘We shouldn’t be waiting for a crisis, we should be trying to prevent it and that needs much more than £10m.’ The NHS England scheme expects practices that receive support to contribute matched funding on a 50:50 bases as a ‘measure of their commitment to improvement’ – a stipulation GPC deputy chair Dr Richard Vautrey describes as a ‘big issue’ for the effectiveness of the scheme. Dr Vautrey says: ‘Even if you were to identify practices that might benefit from support, would they be willing to accept that, bearing in mind they’d have to find 50% of the funding? That has to be recognised as a big constraint in being able to support the right practices.’ Many practices may be unaware that they will qualify for additional





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