From The FMS Global News Desk of Jeanne Hambleton                                                                        Pulse Today 26 August 2014 | By Christina Kenny

A group of patients and residents in Hartlepool has launched patients and residents in Hartlepool patients and residents in Hartlepool, claiming that NHS managers’ arguments for closing the practice are ‘unadulterated rubbish’.

The Fens Residents’ Association have distributed posters in the town’s shopping parade and in a popular local pub calling for residents to take action against the proposed closure of the Fens Medical Practice.

The posters read: ‘The NHS has done enough damage to our town already by stripping Hartlepool Hospital of essential services. Enough is enough, this time they have to be stopped.’

The news comes as Pulse has launched a campaign to Stop Practice Closures after revealing that more than 100 practices across the UK had either closed or were actively considering closing as a result of funding cuts and a recruitment crisis.

The Fens Medical Practice has a list of nearly 3,000 patients and opened in 2009 as part of a national initiative aimed at improving access and choice of GP services for local communities.

The practice’s APMS contract comes to an end on 31 March 2015 and residents fear that the surgery will be merged with a nearby practice on Wynyard Road (which is also under review) and the Fens premises closed.

The NHS England local area team for Durham, Darlington & Tees say that there are five other primary care providers within a two-mile radius that have ‘limited capacity’ to accept new patients. They argue that the practice’s current premises, a converted dentist practice, is neither accessible nor visible due to its position behind a row of shops and a stairwell.

However, the Fens Residents’ Association described the area team’s assessment as ‘unadulterated rubbish’, arguing that the premises are ‘superbly accessible’ with free parking and access to public transport. They suggest instead that additional signage should be provided at nearby roads and pathways.

NHS England’s local area team have opened a survey to get residents’ views, which closes on 29 September. In a statement put out alongside the survey, NHS England said: ‘The information that we have reviewed to date suggests that we need to consider setting up a new contract for a provider within the local area from 1 April 2015 to replace Fens Medical Practice and Intrahealth Wynyard Road.

‘It costs more to provide services to a smaller number of registered patients, and the type of contract that this GP practice operates under often costs more per patient than other local GP service contracts for the same or a very similar level of service. This does not represent the value for money that we aim to achieve.

‘Should a new contract be introduced, it may be with the existing provider or a new provider. We would not expect the change in contract to significantly alter the current GP services that are offered.’

The Fens Medical Practice and Wynyard Road practices are two of nine across Teeside and Hartlepool that NHS England has announced could close when their APMS contracts expire in late 2014 or early 2015.

An APMS practice at a nearby retirement village has also recently been threatened with closure as it has not reached the level of patients needed to fulfil its contract. The Hartfields Medical Centre is situated on-site at the Hartfields Retirement Village, but many of its 2,000 patients come from the surrounding area.

A spokesman from the Joseph Rowntree Housing Trust, who run the retirement village, said that closing the practice would have a ‘detrimental effect’ on residents, the vast majority of whom are registered with the practice.

They said: ‘The trust does not want to see Hartfields lose the GP surgery located here. Hartfields is an innovative model of how we can provide quality care and support for the future, linked to essentials services like the on-site GP surgery. Closure could mean our residents lose some of their independence, and it could also result in residents requesting more home visits from GPs, which may have higher financial costs for the NHS.

‘Joseph Rowntree Housing Trust is formulating a formal response to the consultation being conducted by the Durham, Darlington and Tees area team of NHS England.’



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
From The FMS Global News Desk of Jeanne Hambleton                                             PULSE TODAY 15 August 2014 3:18pm By Jaimie Kaffash

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’ said 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 do not 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;
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 have spoken to about six practices who are considering resigning their contract. It is a mix of practices and areas – it is 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 cannot 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.

  • Additional reporting by Christina Kenny



From The FMS Global News Desk of Jeanne Hambleton                                  PULSE TODAY 22 August 2014
Dr Naomi Beer’s anger at Government policy on struggling GP practices saw her lead a campaign forcing a crucial concession from NHS England. But, as she tells Sofia Lind, the battle to prevent closures goes on.

CV….Age: 51

Family: Four children of ages ranging from 16 to 24, the youngest aspiring to be a doctor herself

Education: Trained at Guy’s Hospital and did her general practice vocational training scheme at the Royal London Hospital and at Jubilee Street Practice.

Career: 1992 – present: GP at Jubilee Street Practice, including being a GP tutor. Elected to Tower Hamlets LMC, effective this month

Career high: Leading the east London Save Our Surgeries campaign alongside Jubilee Street practice manager Virginia Patania to secure funding for 22 GP practices at risk of closure because of MPIG funding withdrawal. The campaign has won the support of local patients, MPs and Tower Hamlets Council as well as the RCGP and BMA

Other interests: Frequent attender at the National Theatre, enjoys the ‘rare treat’ of reading a book and is an active member at the local church, where music is ‘another passion’

In the space of just a few months, east London GP Dr Naomi Beer has gone from being a low-profile, hard-working GP partner to spearheading the fight against the destabilisation of general practice in England.

In that time, Dr Beer’s impassioned campaigning has succeeded where official GP representatives have failed since the announcement almost two years that the minimum practice income guarantee (MPIG) would be withdrawn over seven years, in winning support for practices faced with funding cuts.

By mobilising patients onto the streets of the London borough of Tower Hamlets and leading a rally to 10 Downing Street, the Save Our Surgeries campaign has challenged the portrayal of GPs as overpaid profiteers. And it has prompted the Government to take real action, with NHS England last month offering a two-year reprieve to those practices most heavily affected by the seven-year phase-out of the MPIG.

With her dignified and determined approach, Dr Beer has become the human face behind that success – helping the public to understand the plight of practices and how it will eventually affect their ability to see a doctor when they need one.


While the concession is not exactly what Dr Beer was fighting for – her campaign specifically calls for a long-term funding solution and not a ‘sticking plaster’ – this represents an undeniable victory for GPs and patients in Tower Hamlets.

Dr Beer particularly believes it sends a message to those disheartened GPs  who argued when Pulse launched its Stop Practice Closures campaign last month that ‘we should let practices close’ to make the Government learn the hard way how their policies affect their voters.

‘GPs have been backed against the wall and are angry at the position we have all been put in and the way we have been treated. I can understand some people saying, out of desperation, that isn’t it better that some practices fail,’ she says.

‘But I would argue so strongly against that because the practices that initially are going to be affected are serving very vulnerable populations.

‘If you let those practices go you cannot replace the level of care that we are giving and that means that you are condemning a whole group of the population to having a lesser standard of care than they are receiving at the moment. I think that is totally irresponsible and we cannot let it happen.’

With admirable calm, Dr Beer explains how she and her practice manager had to move quickly when they discovered in March – three weeks before she was due to sign her new contract – that the practice would be forced to close within a year on its current level of funding.

They secured a meeting with the NHS England local area team, at which the stark truth emerged that the area team could do nothing at all to help.

‘It was very clear that there was no money and no support because we had already done everything they considered relevant to support ourselves.

‘We are a practice that is already working in a network and that has already trimmed down a lot of our staff to create a good skill-mix and reduce the cost of having a lot of GPs. We have invested heavily in our staff to have a physician’s assistant, a healthcare assistant and highly trained nurses. So we have done pretty much everything we could have done to ensure efficiency.’

Drastic action

Faced with two options of either closing or drastically reducing staff, the practice went with a third – to make as much noise as it could.

After approaching local Labour MP, Jim Fitzpatrick, Dr Beer was amazed when he was able to organise a meeting with health minister Earl Howe and NHS England.

Dr Beer recalls: ‘We presented our very detailed position papers, and Earl Howe was very sympathetic. He said: “Clearly you are an excellent practice, clearly you are delivering a high quality of care. No, I am not sending you back to make more efficiencies because I can see that there aren’t any to be made. I am committed to finding a solution for you”.’

NHS England had originally promised to support practices as it phased in changes to the MPIG, but Pulse later learned that area teams had failed to offer any extra funding to those affected by the swingeing cuts. Dr Beer said a representative from NHS England visited the practice but was only interested in what made their surgery unique.

She says: ‘We felt that this was potentially a rather divisive manoeuvre but we agreed to describe what our practice did, and we let other practices in our area know what was going on.’

That was the last the practice heard from NHS England until last month’s announcement of the two-year reprieve. Despite the U-turn, however, Dr Beer is clear that the fight is not over.

High on her agenda, she says, is to ensure the Government sorts out the Carr-Hill formula, which decides weighting of GP funding based on demographics.

‘Equity is a meaningless word when you are talking just about age and numbers of patients, because that is clearly not the whole picture. Healthcare needs surely depend on how sick your population is. If you’re only basing it on age, and especially patients over 75, and our patients are dying 15 years younger than that, it is very clear that we will be massively disadvantaged.

‘None of this formula actually makes sense.’


While the Government began working on the Carr-Hill formula to take account of deprivation back in 2007 and announced a fresh review in 2012, nothing has yet happened to change it and the latest review group had yet to commence its work in earnest on Pulse’s last check.

‘This evidence has been around for some time but, for whatever reason, nothing has changed as yet,’ says Dr Beer. ‘Frankly the Government has shown no interest in areas of deprivation because they have allowed this to happen. They have done nothing until we pushed them, absolutely nothing.’

So with one win under her belt, Dr Beer is determined to pursue her battle. Asked if she wishes to add any other messages, she fixes her gaze earnestly and says: ‘I would like to encourage people that it is possible.’

PLEASE Sign our e-petition calling for a parliamentary debate on practice closures here –

WELL DONE DR. BEER. KEEP UP THE GOOD WORK.   Back tomorrow. Jeanne









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