GP surgery closures affecting 200,000 patients
A rapid rise in the number of GP surgeries closing in 2015 has affected more than 200,000 patients - an increase of 50% on the previous 12 months.
Figures from the NHS reveal that 31 GP practices in England closed and 41 branch surgeries were closed as a result of a merger in 2015. This compares with 11 closed practices and 9 branch surgeries in 2013.
Rising workload, funding cuts and a severe shortage of GPs are cited as the reasons for closure.
The closures mean that some patients face up to an hour's journey to see a doctor after they were obliged to either register with another practice or travel further to see their existing GP.
A severe shortage of GPs
One of the reasons given for the trebling of closures over the last 2 years is the increase in the number of GPs leaving the NHS - either to work overseas or to take early retirement.
This has led to a huge rise in the number vacant GP partner posts, with practices in some areas taking a year to fill a partnership vacancy. Some areas are having to cope with one GP to every 8,000 patients.
Compounding the issue is a reduction in the number of medical students applying for GP training places.
Although in 2013 Health Education England (HEE) pledged to ensure that half of medical students become GPs by 2015, in 2014 only 2,688 graduates were recruited - 12% below the target figure.
The HEE has a mandate from the Government to provide 3,250 GP training places by 2016. So far applications for GP training continue to fall, but it claims it is well on course to achieve that number and is working on a variety of initiatives to ensure general practice is seen as an exciting and interesting career choice for trainees.
Managing the workload
Deputy chair of the GPC (General Practitioners Committee) Dr Richard Vautrey recognised the difficulties, saying it has become more difficult for small practices to cope with rising bureaucracy and to manage the workload.
Funding reductions have meant a lack of investment in some areas; making it difficult to attract new GPs - especially in deprived communities where the work can be quite challenging.
Will the situation improve?
In January 2015 NHS England announced it was investing £10 million to kick start the GP Workforce 10 Point Plan - part of the NHS Five Year Forward View. The plan is a range of initiatives designed to expand and strengthen the GP workforce, and focusses on:
- Increasing recruitment
- Retaining more GPs
- Supporting more doctors to return to general practice.
What does the 10-point plan include?
- A marketing campaign for GP careers, including a letter to all newly qualified doctors
- An additional year of training to study a special interest in medicine or business for GP trainees
- ?Training hubs' for GP practice staff to extend their skills
- 'Golden hello' incentives for GP trainees committing to work in an under-doctored area for at least three years
- A review of retainer schemes and investment in a new national scheme
- New premises funding for training practices
- Incentives for experienced GPs to remain in practice, such as a funded mentorship scheme or portfolio careers
- Pilots of new support staff to take workload off GPs, such as physician associates, medical assistants, clinical pharmacists and advanced practitioners
- Clearer induction and returner scheme for those who have worked overseas or taken a career break
- Financial incentives for returners opting to work in under-doctored areas and reviewing the value of the performers list
With some of the initiatives only recently introduced it will be some time before the results are seen, but the commitment is to provide seven-day access to effective care by making greater use of the skilled workforce and increasing the number of doctors in primary care by 5,000 and other primary care staff by 5,000 by 2020.
Patients at risk
A recent poll published by the British Medical Association (BMA) found that the heavy workload was believed by nine in 10 GPs to negatively impact the quality of care. 37% of GPs who took the survey reported that their workload was unmanageable.
The survey did not establish a link between these issues and the rising cost of clinical negligence claims against the NHS, however Dr Maureen Baker, chair of the Royal College of GPs, has argued that GPs working up to 12-hour days increased the risk of medication errors and other mistakes.