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​ GP Practice Closures at Record High as Primary Care Hits Another Wall of Crisis

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At its June conference, the BMA told delegates that the number of GP practice closures had hit record levels. In all, 201 practices have been forced out of business in the previous 12 months. The reasons for this have been cited by the BMA as:

- Soaring demand for services

- Lower numbers entering the profession

- A deteriorating workforce

- Increasing workloads

- An ‘unforgiving climate of blame’

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The BMA confirms the King’s Fund’s findings

The BMA said that the viability of many GP practices is threatened. Many are finding it impossible to recruit new GPs. Coupled with the use of locums, this is creating “a toxic mix from which existing GPs can’t wait to escape, and which many young doctors will not join,” said the GPC chairman, Dr Chaand Nagpaul.

As more hospital work is transferred out of hospitals, doctors are being asked to handle highly complex clinical issues. They have ten minutes to do work that used to take hospitals hours of consultation time. Litigation cases have rocketed as a result.

These views echo those of the King’s Fund. In its May 5th 2016 research report it said that:

- Face-to-face consultations had increased by 13%

- Telephone consultations had increased by 63%

- Consultations of over-85-year-olds had increased the most

- Numbers of complex cases had increased

- Fewer GPs are choosing to do full-time clinical work

- Only 1 in 10 GP trainees planned to remain in general practice after five years

- Almost half of retiring GPs are now under 50 years of age

How to halt the downward spiral

Dr Nagpaul has demanded a national campaign to promote self-care and better use of GP resources by patients and the NHS more widely. He has also called for an immediate injection of cash to fund extra staff, from “practice pharmacists, to paramedics, to advanced nurse practitioners”. He says that this will plug the gap left by a reducing number of GPs.

However, some of these measures have already been put forward. When unveiling the GP Forward View in April, NHS England CEO Simon Stevens said an additional £500 million in funding for CCGs was being made available by 2020. This is specifically earmarked to fund additional capacity. Further, he said:

“You have to sync up the workforce expansion of GPs and other primary care clinical professionals with redesign of local GP hubs, federations, the out-of-hours services, urgent care centres − all work together, and if you do that, then there is absolutely no reason why this should be imposing higher burdens on individual GPs. But, it can’t be done overnight.”

If this sounds like Mr Stevens has a non-committal approach to funding, and that he believes there needs to be cultural focus shift, you may be right. However, when presenting the Forward View, he also said:

“There is no great surprise that if you under-invest in primary care, pressures show up in other parts of the system. And it is unreasonable to ask GPs to take on more when they’ve not got the resource and backing to do it.”

We’ll wait to see how that works out in practice. Meanwhile, it’s likely that GP practice numbers will continue to fall as pressure on practices continues to rise.

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