GP PRACTICES across three towns in Scotland have been forced to close their lists to new patients amid ongoing GP shortages.
Three towns in North Ayrshire have closed their lists for an entire year to help ‘relieve pressure caused by recruitment difficulties’. Savage cuts to the NHS, funding cuts to GP surgeries, the fact that many older GPs are retiring, and the huge costs involved in training to become a GP have created a major recruitment crisis.
The Health Board and LMC made a joint decision to close lists across eight practices in the Three Towns area, West Kilbride and Kilwinning, covering 57,000 patients. It comes after a surgery in West Kilbride was taken over by the Health Board at the beginning of August following resignations from all the doctors at the practice, leaving the town with no full-time GP.
Newborn babies, and adopted or fostered children will be able to register with their parents’ practice, but people moving into the area will be not be able to choose their GP, and will have one allocated by the Health Board.
The area has struggled to recruit GPs in recent months and the LMC has been working with several practices facing difficulties. The move ‘allows practices to anticipate the capacity of their service’, NHS Ayrshire and Arran said.
A recent report on workforce issues in North Ayrshire calculated that two newly qualified GPs are needed for every experienced doctor that retires because of young recruits opting for ‘portfolio careers’.
It pointed to high levels of stress among remaining GPs because of pressures caused by recruitment and retention issues. Eddie Fraser, director of East Ayrshire Health and Social Care Partnership, said: ‘Some GP practices within the North Ayrshire area have experienced recruitment difficulties following the retirement and resignation of some GPs. To help reduce pressure on practices while they recruit GPs, we have agreed with the LMC and with the practices themselves, that they maintain their current practice list.’
He added: ‘We apologise for any inconvenience this may cause. However, this process will ensure our GP practices continue to provide a full and robust general practitioner service to their patients.’
Dr Chris Black, joint secretary of Ayrshire and Arran LMC, said a number of practices in the areas affected had been having difficulties. We wanted to find a solution that would bring stability to the region and reduce the burden of new patient registrations.’
He said they discussed a range of options with the health board but this was the only step they could take within the regulations. This is a unique situation with a group of practices who have shared boundaries,’ he added. ‘Practices are just trying to find ways to deal with the day to day pressures they are facing.’
Meanwhile, GPs are being asked to urgently come forward to work in the prison health system and help ‘shore-up’ the service against ‘very significant risks’, according to the community health trust responsible. In a letter, Bridgewater Community Healthcare NHS Foundation Trust is requesting GPs able to work day time shifts at HMP Wymott, Leyland, Lancashire Monday to Friday.
Bridgewater, which took over health services at HMP Wymott and nearby HMP Garth in April this year, said the workforce is in a ‘very fragile state’ with a scarcity of experienced staff to deliver very complex care.
A spokesperson for the Trust said that recruiting to GP posts in prison is a challenge nationally and it is doing its ‘utmost’ to address problems in HMP Wymott that became apparent in the contract handover. It added it was in ‘close contact’ with the prison governor and CQC on their plans for a long-term turnaround of the service.
But GP leaders said the problems in prisons are ‘yet another alarm bell warning’ of the acute workforce crisis facing the UK and leaving GPs too stretched to take on additional roles. In the letter sent by interim operations director Caroline Williams, the Trust says that significant risks have led it to ask for extra GP support. Funding will be available to practices to cover GPs working in the prisons.
The letter says: ‘I really do appreciate the fact that every provider is enduring its own staffing pressures, particularly during peak holiday periods, and I would not ask for this assistance were the risks not very significant in this service.’
The same appeal also asks for practice nurses, and advanced nurse practitioners, who can offer support with long-term conditions management. The letter sent to local commissioners this month says: ‘The services at HMP Wymott are in a very fragile state in terms of the numbers and experience of clinical staff compared to the levels and complexity of demand for health care services. Recruitment to the service is very difficult, and the systems and processes supporting the delivery of high quality care are in need of significant remedial attention.’
A spokesperson for Bridgewater Community Health NHS Foundation Trust told Pulse: ‘During the transition period we identified issues that we are doing our utmost to address. Recruiting to prison healthcare and GP positions is widely acknowledged to be challenging, and due to the current significant demands on the health service in HMP Wymott we submitted a genuine appeal to partners and other NHS providers with a view to providing a short term solution whilst we work to bring more stability to the service in the longer term.’
Dr David Barrett, a portfolio GP who works in offender health at prisons and secure sites in the Midlands, said HMP Wymott is far from an isolated case. He warned: ‘I am being overwhelmed by emails and text messages from prisons and locum agencies with long lists of empty rota slots to fill. Rates of pay are increasing but even then I avoid certain prisons as it is just not worth the personal risks.’
Dr Richard Vautrey, BMA GP committee chair, said: ‘This is yet another alarm bell warning of the GP recruitment and workload crisis. There are far too few GPs and those that are available are far too overstretched and far less able to take on additional roles such work in prisons. There is an urgent need to invest in general practice right across the board, not only in practices but in prison, out-of-hours services and other areas that depend on GPs to deliver services.’
The worrying state of the nation’s GP workforce has been highlighted again this week. The BMA warned that a reported increase in GP numbers in the three months from March to June mask the fact that nearly 450 qualified, full-time equivalent GPs have been lost since 2015.
Meanwhile, it was revealed that NHS England is ramping up its recruitment of GPs from overseas, with 600 to be ready to recruit by April 2018 and 2,000 by 2020 – rather than the 500 originally planned.