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rise in closure of GP practices

5 April 2018

Over the last year it has become more apparent from news articles in the online press and from other journals and publications that there is a large increase in the number of GP surgeries closing down across the UK. NHS Digital’s data shows that 202 practices closed down or merged between July 2016 and June 2017, whereas only 8 practices opened during that same time period. These closures have resulted in serious concerns for local communities with thousands of patients having to change practices, sometimes having to travel further distances to receive health care from their GP.

But why are GP practices closing down?

There are potentially numerous reasons. In some cases the reason for a practice closure could be down to a single isolated issue. In others, there could be multiple reasons all contributing to the ultimate decision for the practice to close. In this article we seek to discuss some of the reasons why GP practices across the country may be closing. The suggestions we have discussed will of course not cover every case and there may be many more reasons for individual practices to close. We would therefore welcome comments and views on the thoughts we have set out below.

Super hubs / practices

There seems to be a rise in GP practices merging together to form 'super hubs' with a view to providing an increased number of primary care services under one roof. These types of practices can cope with a higher number of patients, and the figures made available by NHS Digital data show that a quarter of GP practices now look after more than 10,000 patients, with some of those looking after more than 20,000. This can be highly convenient for patients, because they do not need to travel to separate surgeries or health facilities in order to receive different categories of care, such as sexual health care, mental health support and so on. Some larger practices also have the ability to provide space for community services, such as health and wellbeing sessions and even yoga and pilates which promote health and wellbeing in the community. In addition, larger surgeries of this type can be more flexible in terms of opening hours and as a result, more accessible for some patients who either work lengthy hours or have commitments during usual business hours.

The number of super hubs is likely only to increase with the NHS reforms being proposed at present and in some instances, is already taking place.

STPs and ACSs

Sustainability and transformation plans (STPs) and accountable care systems (ACSs) are currently in the early stages of implementation in certain areas of the country. These STPs and ACSs are set to encourage health and social care providers to collaborate together more closely, to integrate services and provide more focused and localised care. From discussions we have had with practices there seems a general concern and uncertainty about how the ACS will work and what effect it will have on the current contracting arrangements with GP practices.

Ageing population

A further issue for many practices is that it can be a struggle to support and provide care at the level expected with increasing high levels of patient numbers, which is partly due to increasing demand with an ageing population. In addition to this, there is increasing pressure from regulators to demonstrate a high level of quality but at the same time drive costs down and maximise efficiency. Some practices are suggesting that unsustainable workloads can produce difficulty in recruiting and retaining GPs and rather than face implementing new changes, some GPs are simply deciding to retire.

Change in perspective

In discussions we have had with practices and from general discussions with primary care commentators it seems to be accepted that many GP partnerships are struggling to entice young GPs to enter into equity partnership, with many young GPs wanting to either remain as salaried partners or to carry out locum work. The more this trend continues the more we may see practices struggling to replace equity partners from their practices and ultimately it may be that as time goes on the traditional form of GP partnership falls away and is replaced by different structures and organisations.

NHS data shows that where contracts have been terminated, approximately two thirds of those involve mergers or take overs, and one third involves practice closures.

In light of the points made above, and particularly as there are proposals for STPs and ACSs to continue to be implemented further across the country over the next few years, it is possible that the current trend will continue for the near future and the number of GP practices in the UK will continue to decline.

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