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Practices could close or reduce services this winter as pressures mount, warn LMCs

by Nicola Merrifield
4 August 2021

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GP practices face the ‘very real prospect’ of having to close temporarily or permanently this winter among rising workload and staffing issues, GP leaders have warned.

One LMC is predicting a third of GP practices in its region will soon be on the highest alert levels for workload pressures.

And GP leaders in other areas said they expect practices to be operating ‘skeleton services’ this autumn as appointment levels rise during the traditionally busiest parts of the year.

They have warned staff absence due to annual leave and Covid-related isolation is adding to the problems – despite new government guidance saying healthcare staff can continue working if identified as a Covid contact. 

Devon LMC said it expected a ‘significant rise’ in GPs reporting their practice as reaching ‘red’ or ‘black’ alert status, which respectively mean they are either under significant pressure and require immediate action to stop services becoming unsafe, or it is unsafe to continue services.

Its modelling predicts that, by Christmas, 35% of the region’s practices – representing 43 surgeries out of 123 – will have reached the two highest alert levels under the grading system it uses to assess workload safety.

GP practices in the region are already under strain from delivering Covid-19 vaccines on top of their core work, said the LMC, warning there will likely be no capacity to deal with rising Covid cases and an expected increase in respiratory viruses later this year.

Kent LMC warned it also expects its GP practices to be in a similar situation, with both temporary and permanent closures occurring, unless ‘drastic’ action is taken before the winter.

Dr Andy Parkin, medical director for Kent LMC, said: ‘We are setting up measures with the CCG to try and reduce pressures on general practice. One of which is having an alert/OPEL [or operational pressures escalation levels] system in place.

‘Preliminary data suggests most practices are at level 3-4 [of that system] so, unless something drastically changes before the winter, I would think we will be in a similar boat to Devon [LMC].’

He added: ‘Both temporary and permanent closures are a very real risk going into the winter, without swift action to relieve the pressures on general practice.’

Meanwhile, Cambridgeshire LMC recently reported that 58% of its GP practices had reached its own two highest levels for workload pressures between 17 and 22 May.

A total of 44% GP practices in Cambridgeshire and Peterborough said they were reaching unsafe levels, with GPs having 36 to 45 contacts per day, while 14% reported unsafe working including clinicians dealing with over 45 patients a day.

Cambridgeshire LMC chief executive Dr Katie Bramall-Stainer told Pulse pressures are continuing to affect the region: ‘We’ve never been advertising quite so many vacancies and posts across our system. Practices are struggling for locum cover so the workforce is being spread very thin.’

‘People are very tired and protecting their own mental health for their own sanity and are taking their annual leave, but trying to find cover for it is very difficult so we’re seeing people having to cancel leave to maintain services – which isn’t sustainable going into the autumn ahead of phase three [of the Covid-19 vaccination programme].’

She added the LMC had ‘not yet seen a positive impact’ on general practice staffing levels from the change in the Government’s rules that now mean vaccinated healthcare workers do not have to isolate if they are in contact with a Covid case.

Doncaster LMC chief executive Dr Dean Eggitt said in his region region the majority of GP practices are reporting ‘red’ or ‘amber’ level – the highest ratings of the LMC’s grading system – for practice manager workload, volume of phone consultations, and staff shortages. 

The LMC expects GP practices to see ‘significantly worse’ levels of appointments in the autumn, which will compound ongoing staffing challenges due to Covid isolation, sickness and annual leave.

He said: ‘At the moment, appointment levels are probably as quiet as they are going to be and we expect it to get significantly worse the end of September / beginning of October to the point where most practices will be running a skeleton-type service.’

He added: ‘If practices don’t have the infrastructure available for to provide a service from people working remotely then there will be so many people off at the practice then they will only be able to do the bare minimum.

‘That will usually be emergency telephone consults and provision of prescriptions.’

In Devon, LMC chair Dr Rachel Ali said the body was calling for ‘urgent support’ from ‘local health system partners’ to help GP practices deal with the capacity issues ad avoid closures.

She said: ‘Unless urgent action is taken, many local GP surgeries will be on the brink of collapse in the coming months… Some GP practices will face a very real prospect of having to run reduced services, close temporarily or even permanently.’

She added: ‘The LMC is calling for urgent support from our local health system partners to help manage demand, stabilise the workforce and release capacity for the emerging work associated with Covid-19 and flu and to find ways to plan ahead for crisis points.’

NHS Devon CCG chair Dr Paul Johnson said all parts of the health and care system are ‘under extreme pressure’.

He said: ‘GPs and their teams have been working tirelessly throughout the pandemic responding to a 14% rise in demand for primary care, as well as vaccinating hundreds of thousands of people against Covid-19. They have played a huge part in the vaccine programme, which is allowing lockdown restrictions to be lifted.’

He added: ‘We work closely with colleagues across our health and care system, including GPs, every day to tackle the pressures NHS and care teams are currently facing.’

Management in Practice‘s sister title Pulse’s annual investigation into GP surgery closures revealed 96 practices shut across the UK in 2020 – a similar figure to the previous year.

A major survey by Pulse in the spring revealed GPs are working 11-hour days and dealing with an average of 37 patients in that time – far more than the 28 patients they believe is the safe daily limit in the pandemic.

It follows data which showed increasing levels of burnout among GP trainees could risk undermining recruitment and retention.

This story first appeared on our sister title Pulse.