Primary care has been run down under successive Tory governments

Protest against the takeover of GP surgeries by the giant US private health company, Centene

THE GPs’ magazine Pulse has published the results of a major survey of GP surgeries, showing the extent to which primary care has been run down under successive Tory governments.

‘A major Pulse investigation has revealed that 474 GP surgeries across England have closed in the past nine years without being replaced, with small practices on lower funding in more deprived areas most likely to be affected.
Pulse’s Lost Practices investigation – which will run throughout this week and next – examined for the first time the number of GP surgeries that have closed for good, the reasons behind the closures and the effect on the 1.5m patients that have been displaced.
It found that the final straw for the majority of practices that have closed for good has tended to be recruitment issues, although CQC ratings and the ending of APMS contracts were major factors too.
Previous investigations by Pulse and other groups have looked at the number of practices where GP partners have handed their contracts back, or closed branch surgeries, but this latest investigation is the first to focus only on those where a surgery has not been replaced, leaving patients to travel further to see a GP.
The investigation found:

  • There were 474 surgeries that have closed in the UK since 2013, leaving 1.5m patients having to travel miles in some cases to new surgeries and placing other GP practices under even greater pressure;
  • For more than 40% of the 162 surgeries we identified triggers for, recruitment issues were the final straw for the practice;
  • These surgeries had markedly smaller list sizes than average – a median list size of 2,738, compared with a median list size of 7,904 in England in 2020-21;
  • They were in postcodes that were in more deprived areas than other average surgeries – with a median deprivation score of 3.81 compared with 4.41 for an average practice (with 1 most deprived and 10 least deprived);
  • 69% of practices that closed for good in England received lower funding per patient the last full financial year before they closed than the average funding for that financial year;
  • A number of surgeries have closed with no other surgery within miles.

Pulse has found that smaller surgeries are far more likely to close. However, patient satisfaction scores have routinely found that patients prefer smaller practices and they are more able to provide continuity of care.
Practices in deprived areas are more likely to close. They have told Pulse their workload is higher, their patient population is less prone to self-care but they also miss out on funding that practices in more affluent areas receive.
Pulse has also produced a map plotting practices that have closed for good and currently active practices, which has showed pockets where there is no surgery because of a practice closure, which will be released later this week.
Professor Martin Marshall, chair of the Royal College of GPs, said: ‘The impact a practice closing on its patients and neighbouring practices can be considerable. As such, a decision to close a practice will be one of the most difficult a GP partner can make. There may be many reasons for a practice to close, in some instances it maybe that it is merging with another in order to pool resources, but when the reason for closing a practice is workload pressures, and not being able to fill vacancies, then this needs to be addressed as a matter of urgency.
‘General practice is the bedrock of the NHS with GPs and our teams making the vast majority of patient contacts and in turn alleviating pressures across the service, including in A&E. It works by providing cost-effective care close to home in patients’ communities. But it is a service that is struggling and it needs support. We don’t want to see patients having to travel for miles to be able to receive GP care.
‘This is why the College is calling on the Government for a new recruitment and retention strategy that goes beyond the 6,000 more GPs pledged in its manifesto, plus investment in our IT systems and steps to cut bureaucracy so that we can deliver safe, high-quality care for our patients.’ ’
The Pulse investigation includes some explanation of the sources of its information:
We used official papers and contemporary local newspaper reports to determine the trigger for the closure. We only used reasons that had been given directly by the practice’s partners or commissioners.
Our aim in researching practice closures every year has been to look at the physical premises that had closed. This is not the same as comparing the number of practices in 2013 with the number of practices in 2022 – in many cases, a reduction in the total number is meaningless. They might be mergers where nothing materially changes.
To find out premises closures, since 2014 we had been submitting freedom of information requests to CCGs and health boards in the devolved nations, as well as NHS England. We asked about full practice closures (where they hand back their contract and close their only surgery), branch practices and surgeries that had closed as a result of a merger.
This year, we reviewed all the information we have collected over the past eight years. We realised there were examples of CCGs and NHS England sending us the same practice with different names and in different years, so we removed these.
To get the list of ‘lost practices’ we collected the data on active practices and branch surgeries from all four UK nations. We compared this list to our list of closed practices and removed instances of duplicate postcodes. This left us with 474 practices or branch surgeries that had closed, and there is no current surgery in the same postcode.
Amongst the responses to the investigation there is one from David Jenkins dated 30 August, which illustrates the conditions that many GPs have to endure and which drive them out of the service:
‘I qualified in 1976, and was a single-handed, rural, dispensing GP in Wales till 2007.
‘I had a dvt in my right arm, and a Hb of 5, with a serum iron too low to record. Four consultants told me that if I continued to work as I was, I was asking for problems, and I needed help. I told our LHB this (same as PCT in England), and their response was “either you’re working, or you’re not – get on with it”. So I resigned.
‘The LHB then closed the practice, and merged it with the patch four miles away, despite offers from a GP who wanted to take it over (good swimming, cycling, fishing etc etc).
‘Their excuse was “it’s not financially viable” – despite me having several classic cars and bikes, three houses, and an aeroplane !!!
‘I had a much higher elderly, frail, population than average. They now have to arrange their own transport to the “local” surgery – no bus service, and lousy train service.
‘The upshot is that the practice now has a load of extra housecalls from patients who are elderly, frail, and now really ill because they couldn’t get to the surgery. Most could have got a lift to my surgery, but asking your equally frail, elderly neighbour to give you a lift to the surgery four miles away, with limited parking, and wait there several hours while you’re seen is not going to happen.
‘I am still working two days a week as a locum – which is what I wanted to do in 2006!’

  • The Royal College of Nursing says: ‘We’re encouraging eligible members to vote in favour of strike action when the ballot opens on 15 September.’

The ballot will be the biggest ever for the union.
Nursing staff in Northern Ireland will join colleagues across the UK as the RCN ballots members on strike action.
The ballot is being launched in response to this year’s NHS pay award in England and Wales, and the NHS pay offer in Scotland. Nursing staff in Northern Ireland have yet to receive a formal pay offer for 2022/23 due to the absence of a functioning Northern Ireland Executive.
RCN Council agreed that members in Northern Ireland will join the ballot, which will ask RCN members working for NHS and HSC employers on Agenda for Change contracts if they will take strike action, which involves a complete withdrawal of labour. The RCN is campaigning for a fully-funded pay rise for nursing staff of 5% above inflation.
If members support strike action, it will be the first ever strike by RCN members in England, Wales and Scotland, following the historic 2019 strike in Northern Ireland.
Rita Devlin, Director of the RCN in Northern Ireland, said: ‘It is quite unbelievable that three years after we took industrial action for the first time in the RCN’s history, we’re asking members if they will take strike action again.
‘Serious shortages of nursing staff are putting patient safety at risk. Governments across the UK have failed to take action on this issue and in Northern Ireland, with no functioning Northern Ireland Executive to appeal to, nursing staff have not received a pay offer at all.’
At least 50% of eligible members must vote in the ballot, with the majority voting in favour, for strike action to be legal. In England and Scotland, there are further thresholds that would need to be met on top of this one for strike action to be legal.
Pat Cullen, RCN General Secretary & Chief Executive, said: ‘There’s never been a more urgent time to fight for fair pay and patient safety. From severe staff shortages to a decade of underpayment, we can’t continue like this.
‘Nursing staff will stop at nothing to protect their patients. Staff shortages are putting patient safety at risk and the failure of governments across the UK to listen has left us with no choice but to advocate for strike action.’
The ballot will run across the UK from 15 September until 13 October.