Revealed: more surgeries than ever closed last year

Surgery closures have risen almost eight-fold in six years, hitting record levels in 2018, a major investigation by our sister publication Pulse has revealed.
 
Nearly two million patients have been affected by surgery closures across the UK – including full practice closures, branch closures and surgeries that closed following a merger – since 2013.
 
Figures obtained by our sister publication Pulse, where this article was first published, showed that almost 140 surgeries closed last year, estimated to affect a record half a million patients – more closures than in any previous year and almost eight times the number seen in 2013.
 
In addition, provisional data revealed 12 more closures in the first month of 2019, compared with eight at the same time the previous year.
 
According to GP leaders, the recruitment crisis is to blame for the closures.
 
NHS Digital figures released yesterday showed that the number of full-time-equivalent qualified GPs fell by 441 between March 2018 and March 2019.
 
The pace of closures has not slowed despite national attempts to address the problem.
 
In 2015, NHS England set up funding for vulnerable practices, which later became the ‘resilience fund’. Similarly, the other devolved nations brought in their own versions of emergency funding but failed to address the closures.
 
Pulse’s figures, which were obtained through freedom of information (FOI) requests sent to all CCGs, health boards and trusts in the UK, alongside NHS England, showed 138 practices shut their doors in 2018, affecting some 519,500 patients.
 
Previous FOI requests revealed 445 surgery closures between 2013 and 2017, having an impact on 1.4 million patients.
 
However, the data could be an underestimate as some of the health bodies failed to respond to the FOI request.
 
NHS England said that in the financial year of 2017/18 there were fewer closures than the year before, according to NHS Digital figures – although these do include mergers where no surgery has been shut.
 
A spokesperson said: ‘We continue to support all general practices to help them thrive. 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.’
 
As part of the new five-year GP contract, NHS England is hoping that the move to larger groupings of practices through the primary care networks – serving between 30,000 and 50,000 patients – will promote ‘resilience’.
 
The BMA argued the networks will halt the number of closures by ‘reducing the need for formal mergers, and addressing some of the pressures’.
 
BMA GP Committee chair Dr Richard Vautrey said: ‘As with all those that have had a challenging time in recent years, we hope smaller practices will receive greater mutual support from others with the development of the new networks.
 
‘These networks, built on top of existing contracts, mean practices can support one another with workforce and resources, which may reduce the need for formal mergers, and address some of the pressures behind closures.’
 
But GP leaders expressed concerns that the proposals will not suffice to reduce the number of closures, with some being worried that the extra money available in the contract – which includes £1.50 per patient from CCGs – will not fully materialise.
 
Tower Hamlets LMC chair Dr Jackie Applebee said: ‘Primary care networks certainly won’t save general practice. We’ve been told there’s all this extra money coming in but the CCGs have to find the £1.50 per patient from their budgets.They haven’t budgeted for that and didn’t know this was happening until January of this year.’
 
Liverpool LMC medical secretary Dr Rob Barnett said the requirement in the new Network DES for surgeries to offer extended hours in exchange for funding is also a problem.
 
He said: ‘If the workforce is already stretched in relation to the in-hours contract, we’re going to stretch it even more and I’m worried that will pose additional strain on the system. It’s almost as if one good initiative is counterbalanced with something that hasn’t been properly thought through.’
 
‘Adding one pharmacist or a paramedic to a population of 50,000 patients is a drop in the ocean and that’s not going to prevent practices closing.’
 
In an interview last year, Pulse revealed NHS England’s then director of primary care Dr Arvind Madan had suggested GPs should be ‘pleased’ when small practices close as there are ‘too many small practices struggling to do everything patients want for their families in a modern era of general practice’. 
 
This article was first published by our sister publication Pulse.