From the FMS Global News Desk of Jeanne Hambleton

Practices struggling to keep afloat should be allocated emergency funding to help them survive, urges a major campaign launched by Pulse that has the backing of the BMA, the RCGP and many of the leading names in the profession.

The ‘Stop Practice Closures’ campaign is being launched as a result of the Pulse investigation that revealed that LMC leaders are warning of a dire situation in scores of practices across the country, with nearly 100 practices facing imminent closure and more expected to follow.

The BMA and the RCGP have lent their support to the campaign, which complements the BMA’s current ‘Your GP Cares’ campaign, and the RCGP’s ‘Put patients first: Back general practice’ campaign aimed at increasing funding in general practice.

The campaign aims to raise awareness about the precarious state of many practices and the potential effects on patients and the local NHS if they are allowed to close.

As part of the campaign, Pulse will:

  • Lobby ministers to ensure practices facing closure are given emergency support to help them restructure and protect their patients;
  • Begin an e-petition calling for a parliamentary debate on the threat of practice closures across the UK;
  • Bring GP leaders together to discuss ideas on how the morale of general practice can be improved and GPs can be funded more sustainably to prevent more practices going to the wall;
  • And create resources for practices to share ideas and campaign locally for better support so
  • that practices and patient services are protected.

Dr Mark Porter, chair of BMA Council, said: ‘Pulse are right to highlight that GP services are under unprecedented strain from a combination of rising patient demand and falling resources that is leaving many GP practices close to breaking point. As the BMA’s Your GP Cares campaign highlights, we need long term, sustained investment in general practice and not closures that will badly affect patient care.’

On behalf of the RCGP, Dr Helen Stokes-Lampard, RCGP honorary treasurer, said: ‘We are delighted that Pulse is joining us in highlighting the crisis facing general practice by launching the Stop Practice Closures campaign, focussing on one of the many very real current threats to patient care. We look forward to working with Pulse to ensure that general practice receives the resources it needs in order to ensure that decent patient care can continue to be delivered by family doctors in every community across the country.’

Other leading GPs have lent their support, including Professor Clare Gerada, the former chair of the RCGP and clinical chair for primary care transformation at NHS England (London). Professor Gerada said: ‘General practice faces extinction. We must protect what we know works for patients – that is continuity of care delivered by expert generalists in the context of their families and communities. We must fight to protect this. Pulse’s campaign is important and together with the RCGP and BMA campaigns will hopefully alert the public to the risks they and the NHS face if GPs disappear. ‘

Dr Michael Dixon, the chair of the NHS Alliance and Dr Kailash Chaand, deputy chair of the BMA also backed the campaign.

Dr Chand said that general practice is ‘imploding faster than people realise’. He added: ‘In this climate, we should be positively supporting GP practices to weather this storm and not allow them to shut. Every practice is a vital hub for the community and we cannot afford to lose any in the current climate. I congratulate Pulse and fully support its campaign.’

Dr Dixon said that good practices should be given all the support they can to prevent them from closing. He said:  Practice closures are symptomatic of the current strain on general practice more generally . Where a practice is faced with closure due to MPIG/PMS changes we will need local flexibility and sensitivity with a good dose of common sense. At very least any contract changes facing a local GP practice should have the sign off of the local CCG and local clinical leaders.’

Pulse editor Nigel Praities said: ‘We had to launch this campaign. If these closures go ahead, then the effect on then it will be a disaster for the patients struggling to find a new GP, and the local practices left who will be left to mop up the mess left behind. We urge the NHS to look at emergency funding for struggling practices, and in the longer term, as the BMA and RCGP have argued, for more sustainable funding for GP services so that they can offer the kind of services patients deserve.’


From the FMS Global News Desk of Jeanne Hambleton

28 July 2014 | By Jaimie Kaffash  Additional reporting by Christina Kenny

Practices across the country face imminent closure, but the NHS seems happy for them to go to the wall. The time is right to fight back, argues Jaimie Kaffash

General practice is heading towards a precipice. Scores of GPs across the country are facing such hardship that they may be forced to shut their practice doors altogether.

LMC leaders have told Pulse they are aware of more than 100 practices that have either closed or face imminent closure – and this is likely to be the tip of the iceberg.

Local GP leaders say they have ‘not seen anything like it’ and warn of a ‘domino effect’ on surrounding practices if closures cannot be avoided.

‘I think mergers are the only way to keep practices in the hands of the profession’
Dr Robert Morley, West Midlands

Some practices say they have ‘exhausted all other options’ and have no choice but to close, while others are preparing to merge with others in order to continue providing services.

Either way, the grim reality is that, before the year is out, the profession could face an unprecedented mass closure of practices across the UK, unless the NHS steps in with emergency help.

The warning signs were there several months ago. Former GPC negotiator Dr Peter Holden warned in April that there was ‘a year to save general practice’ predicting the profession would see practices going bust within months.

Since January at least 13 have closed, many of which were single-handed practices that had been unable to find anyone to take over their lists. And there are many more that are very close to dropping over the edge.

Pulse asked 47 LMC leaders from across the UK whether they had been contacted by practices that were considering closing. More than half (24) said practices in their area were considering closing, identifying a total of 96 practices.

Dr Mark Sanford-Wood, chair of Devon LMC, says the situation in his area is unprecedented: ‘We have on our radar at least half a dozen practices that we are very concerned about. It is highly likely a good number will end up closing by the end of the year.

‘I’ve been involved with the LMC for 20 years and I’ve never seen this before. For this to start happening now is significant.’

It could get even worse as trainees shun partnerships, Dr Sanford-Wood suggests: ‘I see a lot of bright, young, highly talented GPs. They see
a workforce that is chained to the wheel, and they don’t want in.’

Join the fight to protect your patients

Scores of practices across the country face closure and many more are likely to follow unless better support is given to GPs. If these closures go ahead it will be a disaster for patients struggling to find a new GP – and for all the remaining neighbouring practices who will be left to mop up the mess.
Pulse is launching a campaign to raise awareness of the growing crisis in general practice and to help practices fight for the support they need.

As part of the campaign, Pulse will:

  • Lobby ministers to ensure practices facing closure are given emergency support to help them restructure and protect their patients;
  • Begin an e-petition calling for a parliamentary debate on the threat of practice closures across the UK;
  • Bring GP leaders together to discuss ideas on how the morale of general practice can be improved and GPs can be funded more sustainably to prevent more practices going to the wall;
  • And create resources for practices to share ideas and campaign locally for better support so that practices and patient services are protected.

We are calling on GPs to:

  • Let us know if you are struggling. From your stories we can build up a picture of what is happening across the UK. Email us in confidence at;
  • Sign our e-petition calling for a parliamentary debate on practice closures here;
  • Click here to for regular updates from our campaign and the latest status on practice closures in your area.
Out of options

London has the highest number of practices in danger – with up to 30 practices contacting their LMC regarding closure. In Wales at least 14 practices are preparing to close, while Wessex, Northamptonshire and Devon each have six practices on the brink.

One GP partner, who wished to remain anonymous, says her high-achieving practice has run out of options following struggles with recruitment.

She says:  ‘Despite all efforts to recruit or merge over a two-year period, there is currently one faint hope left. If this goes the way of all past hopes then closure beckons in the next few months.’

She adds that this is not because the practice has failed in any way: ‘This is because of the starvation and withdrawal of primary care funding and resources in the face of the relentless increase in unfunded and underfunded workload.’

Dr Charlotte Jones, chair of the Welsh GPC, says four practices in her area have given notice that they will give up their contract to health boards, while there are ‘more than 10… examples of surgeries that are struggling and for whom the next steps may be that they have to close’.

She adds: ‘Sometimes practices are reluctant to voice concerns; some keep on working over and above what is safe.’

‘I’ve spoken to about six practices who are considering resigning their contract. It’s a mix of practices and areas – it’s a universal problem’ –  Dr Nigel Watson, Wessex

Dr Beth McCarron-Nash, a GPC negotiator and a GP in Cornwall, says there are a clutch of familiar problems that lie behind the closures. She says:
‘I am hearing about more and more practices considering their options.

‘It’s a perfect storm of problems: the contract imposition from 2013, funding swings as a result of MPIG redistribution and difficulty recruiting. That, alongside spiralling workload and increasing demand… is having a catastrophic effect and practices are struggling to cope.’

If significant numbers of practices hit the wall, the level of destruction to the NHS would be unprecedented, with the likelihood of a ‘domino effect’ on nearby practices, GPs say.

Dr Chris Hewitt, chief executive Leicester, Leicestershire and Rutland LMC, says two practices in his region ‘have decided that if their financial situation gets any worse they will formally ask NHS England to take over their contracts’.

But the region is already under strain from branch surgeries closing. He adds: ‘In the past six months, 10 surgeries (out of 152 practices) have been tasked with dealing with a sizeable influx of patients as lists are disbursed as a result of surgeries or branch surgeries closing.

‘The very real threat of practice closures due to retirements or loss of financial viability will start a chain reaction, which impacts on surrounding practices that are only just coping with the demand from their current patient list.’

NHS England unconcerned

But managers seem to be taking a relaxed response. A spokesperson from NHS England tells Pulse that it did not have any intelligence centrally regarding practice closures, as this was a matter for area teams working with CCGs and LMCs.

She says: ‘Practices close – and open – all the time and it should not be assumed that this is a problem or a reduction of service; it needs to be seen in the context of local provision.’

In Wales, on the other hand, the Government is working with the RCGP, the GPC, health boards and deaneries to try to ease recruitment problems.

In Scotland, the Government is directly tackling the problems for dispensing practices with new regulations brought in from last month.

But in England, on the various issues of recruitment, MPIG withdrawal and PMS reviews, local leaders are receiving patchy help from area teams.

‘There are only three health boards where practices are not closing. It is due to an inability to recruit partners – and remaining partners can’t cope’ –  Dr Charlotte Jones, Wales

Dr Robert Morley, chair of the GPC contracts and regulations subcommittee and executive secretary of Birmingham LMCs, whose area has already seen two practices close this year, says the only way for many practices to survive will be to merge with others.

He says: ‘The only way to safeguard the profession and safeguard these practices is for partners to merge. [It’s] the only way forward to keep these practices in the hands of the profession, but also, from a business perspective, to try and work within a business model that allows general practice to continue.’

Other practices have used their relationship with patients to campaign for better support. The Jubilee Practice in Tower Hamlets, east London, has been at the centre of a major campaign in the borough to prevent practices going under.

The ‘Save Our Surgeries’ campaign has already seen marches organised with neighbouring practices, articles in The Guardian, a meeting with health minister Earl Howe and co-ordinated actions with MPs – all with little help from BMA or RCGP. They have managed to win some guarantee of emergency payments from NHS England to protect them from the withdrawal of MPIG, but are continuing their campaign for more sustainable funding in the future.

‘There are several practices that are in trouble and threatened with closure, because of dispensing being withdrawn’ – Dr Alan McDevitt, Scotland

Dr Naomi Beer, a partner at the practice, says: ‘We are having to do the co-ordinating for ourselves – working to get the message across to practices, developing tools for practices to do up to a seven-year forecast on income, pushing for co-ordinated action by local MPs and councillors to press for meetings, raising questions in Parliament and delivering a petition to Downing Street.

‘These ideas all come from us and we have little communication from the BMA or GPC except during an event such as the marches we organised in Tower Hamlets.’

It may be that galvanising local patients in this way can help practices fight back against the threat of closure, and that is why Pulse is launching a campaign to help practices do just this.

For many practices, this could be the last resort.


From the FMS Global News Desk of Jeanne Hambleton

Exclusive The number of doctors applying to the GMC for certificates that enable them to work abroad has increased by 12% in the last five years, figures obtained by Pulse have revealed, leading to fears that GP talent is being ‘lost’ because of workload pressures.

The figures reveal that Certificates of Good Standing (CGS) – a document that doctors must present if they want to register with an overseas regulatory body or employer – were issued to 4,726 doctors in 2012, compared with 4,222 in 2008.

Over the same period the number of doctors on the GMC register during the same period has risen by only 2%.

The number of CGSs issued is the closest measure available of the number of doctors who are considering a move abroad, as official figures are not kept for the number of doctors moving overseas.

Overseas employment agencies said the figures supported their experience that that there had been a ‘significant increase’ in GPs interested in moving abroad over the past few years, with GPs looking at alternative destinations to the more popular Australia.

Pulse has also obtained figures from the Medical Council of New Zealand that show a 49% increase in registrations from the UK and Ireland between 2007/08 and 2011/12, with 624 doctors registered with the council in 2011/12, compared with 420 in 2007/08.

The Australian Medical Council recorded steady numbers of doctors from the UK applying to be registered in Australia, with 974 in 2008 and 939 in 2011.

GP leaders said it was ‘worrying’ that doctors feel their career is best served away from the NHS and said pressure on pay and pensions would only make the situation worse.

Mr Paul Brooks, managing director of overseas doctors recruitment agency EU Health Staff, said he has seen more UK GPs looking for work overseas in the past two years.

He said: ‘We’ve seen a significant increase in the number of UK GPs looking to work overseas in the past couple of years. Australia is the favoured country, but recently, doctors have also been looking to move to Canada and New Zealand.’

Mr Brooks added that all of these countries ‘offer something different for UK GPs despairing of the UK or NHS’ and give doctors the chance to escape ‘NHS bureaucracy and unwelcome changes to the way things are being run’.

These figures come after Pulse yesterday revealed that one in seven GPs had had to make redundancies following the contract changes in April, with many partners also reducing their drawings by more than 20%.

GPC deputy chair Dr Richard Vautrey said some of the departing doctors would be GPs as they were feeling ‘undervalued and unsupported’.

‘It is not all perfect here but it does seem better’

Cornwall to Queensland Australia

Dr Mark McCartney said: ‘It’s worrying that doctors feel their career can be best served leaving the NHS. Pressure on pay, attack on pensions have a negative impact on the morale of doctors.

‘It’s a big waste in the resources that have gone into training the doctors, and they can’t support patients in the UK. Their skills and talent will be lost. We need to urgently address morale so that young doctors feel that NHS best serves their career aspirations.’

Dr Mark McCartney, who left his practice in Cornwall for Queensland, Australia, last year, said part of his reason for leaving was that GPs felt under ‘continued assault’ from politicians and the press.

‘It is not all perfect here but it does seem better, although I am probably still in the “honeymoon” period.’

Moving across the world to work as a GP has given me a new challenge and allowed me to escape the constant denigration of our profession, explains Dr Mark McCartney

Twelve months ago I took the decision to apply for medical registration in Australia. It was big step to leave, with two sons at university and other family too, not to mention the friends, patients, partners and staff at my practice in Cornwall.

I had worked in Australia previously so I knew a little bit about the system, which appeared to offer more opportunity than the treadmill of NHS general practice, which was coming under continued assault by politicians and the press, particularly the Daily Mail. There had also been constant chatter in social media from GPs who are unhappy with their lot in the NHS, talking about employment in Canada, New Zealand or Australia.

I had already left the NHS pension scheme and the denigration by our leaders and managers was beginning to wear me down. My previous commitment to the NHS was beginning to wane.

It was not an easy decision, but there did not seem to be any issues with the paperwork and when I was offered a nice job after an early morning telephone interview I quickly accepted it. From there it was a short period of time before the journey to the Sunshine Coast in Queensland.

General practice here is a lot different and it is a new professional challenge. One thing I don’t miss is QOF, and the pop up computer messages exhorting me to carry out various irrelevant tasks in the consultation. I now realise what a negative effect they were having on me and the way I was consulting with patients.

It is not all perfect here, but it does seem better, although I am probably still in a ‘honeymoon’ period with my new situation. I intend to return occasionally to the UK to work to try to maintain my registration, but it seems that this might be a difficult for me, as there are issues with staying on a performers list.

I have met a few other recent refugees from the NHS and all appear to be settling into professional life in Australia. We have escaped from CCGs, CQC, QOF, LATs, OOH, falling income, pension cuts and adverse taxation changes. No doubt some of these things will catch up with us here in Australia, but we might be better equipped to deal with them.

Some of us will return for the comfort of family and friends, but in the meantime we can enjoy the challenge and adventure, not to mention the outdoor living and the fantastic climate.

I am not surprised to hear that many more GPs are thinking of making the move abroad. For any that are hesitating, I can understand that, especially if there are family ties and commitments. It is a big decision, but sooner is often better and here in Australia at least, you will be made very welcome.

Dr Mark McCartney is a GP who emigrated from Cornwall to Australia last year





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