Every practice in an under-doctored seaside town in Kent has restricted new patient registrations due to concerns over patient safety.
Five practices in Ramsgate are refusing new patients and redirecting them to the local CCG – which then assigns them to a practice that has capacity – after struggling to attract staff for a number of years.
It follows a similar situation for practices in Folkestone, Kent, last year, where several practices were allowed to refuse to register any new patients, due to recruitment and funding problems.
‘Managing’ patient lists
Three of the practices said the decision to refuse patients was as a result of concerns for patient safety – with one pointing out its patient list of 8,000 is served by just two GPs, far above the national average of 1,800 per GP.
They have adopted a system known as ‘managing’ patient lists, meaning GPs are not in breach of their contract and can avoid applying to NHS England to close their list entirely.
Local commissioners said recruitment of GPs ‘remains a significant challenge for Thanet’s GP practices’ and that the CCG is supporting practices to develop new models of care.
In letters sent to patients, and seen by The Isle of Thanet News, Newington Road Surgery, Dashwood Medical Centre and The Grange Practice said they had taken the decision to refuse new registrations due to safety concerns caused by unmanageable patient demand.
GPs at Newington Road Surgery said: ‘We came to this decision based on clinical safety reasons. We currently have nearly 8,000 patients and just two GPs, almost 4,000 patients per GP. The national average is 1,800 per GP.
‘We have been advertising for a new GP to join our team since August 2015 without success. This is a situation echoed in practices locally and nationally.
‘Junior doctors do not see general practice as an appealing prospect and many experienced GPs are burnt out through pressure of work and are leaving the profession. Some local surgeries have closed down recently, adding additional pressures on the remaining few.’
Similarly, a letter from Dashwood Medical Centre said the surgery has 10,400 patients for just three full-time equivalent GPs.
Meanwhile, The Grange Practice, with 12,000 patients, said in a letter: ‘We have been advised by NHS England’s Kent and Medway area team, that we may register new patients but we are not obligated.’
The practice added it will only accept new patients every month that coincided with the number of patients deregistering over the same period.
‘One of the most under-doctored areas’
Kent LMC medical secretary Dr John Allingham told our sister publication Pulse that Thanet is among the regions in England that have suffered the most from GP shortages.
He said: ‘Kent as a county has struggled to recruit GPs for many years. The Thanet area, which includes Ramsgate, is one of the most under-doctored areas in the country and also has areas of significant deprivation similar to many other coastal communities.’
He said the LMC had been advising practices for many years on how to ‘list manage’, and that a similar situation had occurred in Folkestone a few years ago.
He added: ‘Kent LMC are engaging with the practices and the CCG and a meeting has been arranged to consider what support can be given to the practices to try and manage this situation.’
Kent CCGs’ managing director Caroline Selkirk said: ‘The recruitment of GPs remains a significant challenge nationally, and for Thanet’s GP practices. Although GP practices are responsible for recruiting their own staff, NHS Thanet CCG continues to support all our practices to develop new models of care to support GPs and help improve patient access to healthcare.
‘The five GP practices in Ramsgate have all been “list managing” since 2017, although not all of these practices have seen an increase in their list sizes over the last year.
She added: ‘Practices can refuse to accept new patient registrations but this must be all new requests to register to avoid any discrimination.’
Ms Selkirk said the opening of the Kent Medical School in 2020 ‘will support our efforts to recruit more GPs locally in the future’.
A Pulse investigation earlier this year revealed GP surgery closures have risen almost eight-fold in six years, hitting record levels in 2018, with GPs pointing to recruitment issues and escalating workloads as the reasons for the rise.