GP surgery closures across the UK have reached an all-time high, affecting an estimated half a million patients last year, The Guardian reports research has found. An investigation by the medical website Pulse found 138 doctors’ premises shut their doors in 2018, compared with 18 in 2013.
GPs said under-resourcing and recruitment difficulties were forcing surgeries to close. They said many smaller practices were merging with others to survive, which allowed them to avoid having to disperse their patient list to other practices much further away.
The report says data released by 186 out of 217 clinical commissioning groups and health boards, following freedom of information requests, revealed that smaller surgeries – those serving 5,000 or fewer patients – were the worst affected in 2018, accounting for 86% of closures.
Pulse calculated that last year’s closures affected about 519,500 patients – 31 of the 138 surgery closures in 2018 came as a result of mergers, the figures showed, which affected an estimated 161,126 patients.
Professor Helen Stokes-Lampard, chair of the Royal College of GPs, said in the report that the figures were sad but unsurprising. “GPs and our teams are working to our absolute limits to provide safe, high-quality care, while general practice is under intense pressure, and this is resulting in some GPs leaving the profession, and in other cases forcing them to close their surgery doors,” she said.
“In some areas, practice closures are the result of surgeries merging or joining federations in order to pool their resources and provide additional services in the best interests of their patient population.”
Stokes-Lampard said it was heart-breaking for everyone when surgeries closed, but especially for patients, many of whom had to travel long distances to a new surgery and get to know new teams, something that was particularly difficult for more vulnerable people.
Dr Jackie Applebee, a GP and the chair of the Tower Hamlets local medical committee, said: “The system is creaking. The smaller practices – which patients prefer and which have good outcomes – are being lost because of the under-resourcing.”
Dr Alan Woodall, chair of the pressure group GP Survival, said the merger of practices was “a sticking-plaster solution” that was often used as a cover for the closure of branches.
But, the report says, NHS England said it did not recognise Pulse’s figures. “In England there were fewer practice closures and patient dispersals in 2017/18 compared with 2016/17 and we continue to support all general practices to help them thrive,” it said. “Thousands of practices continue to be helped through the GP resilience programme, where investment has been increased from a planned £8m in 2019/20 to £13m.”
NHS England’s figures are for England alone and cover the financial year, whereas Pulse’s figures are for the whole of the UK and cover calendar years.
The report says NHS England’s figures show that while the number of practice closures fell in 2017/18, the overall number of closures of GP contracts was up, due to the high rate of mergers. There were 179 closures of GP contracts in 2017-18, compared with 107 the year before. Of all the 2017/18 contractual closures, 62% (111) were due to mergers and the remaining 38% due to practice closures. In 2016/17, 23% (25) contractual closures were due to mergers and 77% to closures.
Pulse argued that measuring site closures was a more revealing measure of how pressure on services was causing disruption to patients, as many were being forced to travel longer distances for medical care.
The report says Pulse’s closure figures add to recent research detailing staff shortages and a rising demand for care within the NHS. Analysis by the Nuffield Trust earlier in May found that the number of GPs per 100,000 people had shrunk from nearly 65 in 2014 to 60 last year, the first time this had happened since the 1960s.
Figures from NHS Digital, released recently, showed there were 312 more family doctors working in England in March this year compared with the same time last year. Dr Nikki Kanani, acting director for primary care for NHS England and a London GP, said: “While the GP numbers show some encouraging signs, recruiting, retaining and supporting more doctors into practice remains an absolute priority for us.”
[link url="https://www.theguardian.com/society/2019/may/31/gp-surgery-closures-in-uk-hit-all-time-high-in-2018"]The Guardian report[/link]