Baroness Joan Walmsley writes…150% rise in patients forced to move GP surgery as practice closures hit record levels

One of the jewels in the NHS, for as long as I can remember, has been the family GP. My GP looked after my mother before I was born and looked after me until I moved away from home. In those days the GP’s long acquaintance with my whole family was important to us. Everyone had a “family doctor”. They even did home visits!

Things are very different now. We still have primary care and acute care, but many more community nurses, health visitors, therapists and care workers, not forgetting the wide range of services offered by community pharmacists and local authorities, where they can still afford it.

Demographic change and rising demand have put enormous pressure on GPs and, in some areas, people turn up at A&E rather than wait for an appointment. However, the role of the GP is still critical to the NHS and it is important that the system enables them to play their part in preventative medicine as well as diagnosis and signposting to other services.

Unfortunately, the demand for a seven-day service, without enough extra money to pay for it, and the enormous pressures on GPs time has made it a less attractive option for newly-qualified doctors. This has led to problems recruiting enough doctors to keep practices going and an increasing retention problem. Many GPs, especially partners who have extra duties and responsibilities compared to salaried GPs, are retiring early. In the last quarter of 2016, there was a net loss of 390 GPs in the NHS. This gives us no confidence in the government commitment to recruit 5000 more GP’s by 2020. According to the BMA, even the 5000 extra training places will only allow us to break even in GP numbers.

On the positive side innovative ideas are being developed, with GPs at the heart of “health hubs”. At a minimum level a number of practices share their back office services where administration is done centrally, while patients are still seen by their local doctor. In other places they go further. The local surgery is still the first port of call, but services such as physiotherapy or mental health therapies are offered in local health centres. At the other end of the scale there are full mergers where several GP practices join together to widen their range of opening hours, out of hours cover and specialist services.

Older patients often have a wide range of medical and care needs, but a well-coordinated team of GPs, nurses and care workers can deliver a package of care that is much better for the patient and reduces expensive hospital admissions. This is a fruitful approach adopted in some areas. There are lots of imaginative local solutions based on the GP practice.

The alternative, which is an option apparently favoured by government, is the privatisation of general practice, with large private companies winning bids to run chains of health centres. Here continuity suffers. Doctors, deployed to meet the needs of the company rather than the community, may only see a patient once, relying on the previous doctor’s notes. There has been an increase in such private companies taking over primary care when a GP practice closes. If all the partners retire and the contract is handed back, it has to go to commercial tender. It is little surprise that these companies, with their economies of scale and commercial expertise, usually outbid NHS groups for the contracts. Liberal Democrats should be concerned about this. The profits, made from a service designed to meet the minimum standards demanded by the contract, will not be spent in the community: they will be used to swell the corporate balance sheet.

Is this what we want? Or would we prefer NHS England to ensure that GP practices have the headroom and seed corn funding to adapt their services to today’s needs. They are actually small businesses but GP practices see themselves as part of the NHS and they have a real stake in their local communities. I think we should support them in their efforts to adapt.

* Joan Walmsley is a Liberal Democrat member of the House of Lords

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  • David Evershed 7th Apr '17 - 6:13pm

    Most GPs are private businesses owned by the partners, employing other doctors, nurses and other surgery staff.

    So it is not possible to privatise what is already private.

    There may be economies of scale by GP practices merging but they can also outsource IT and other services to obtain economies of scale. Best to let each business decide the best way to run its own practice rather than impose some central model on GPs based on an ideology. Being liberal means letting businesses run themselves to best suit the local circumstances.

  • The problem with leaving GP provision to the market and the invisible hand is that most people don’t have any real choice in where they go, and do not have the level of knowledge to know if they’ve got a good deal. The competition is not for the benefit of the patients. Economies of scale might save some money on the ordering of bandages, or chairs for the waiting room, but it doesn’t solve the fundamental problem of a shortage of suitable staff that are willing and able to provide the service.

    The problems of moving GP are not exclusive to NHS England. There is a chronic shortage In my Scottish city, and according to the local paper, virtually very practice has at least one vacancy. One practice in the poorest area had to close for a few months, because no-one wanted to work there when there were plenty of vacancies to chose from. My own practice won’t let you make an appointment unless there is one available within the next week, which there usually isn’t. There waiting time stats look good, but it took me months to get an appointment to get some crème for my eczema.

    I’m sure that many GP consultations could be tended to by suitably qualified specialist nurses. A&E nurses are allowed to triage patients, so why not at the larger GP practices in the big cities? Some people wouldn’t like it, and there will be some appointments where it’s clearly not suitable, so it could be voluntary.

    I’d like to see more imaginative use of drop-in, take-a-ticket sessions designed for working-age people who might struggle to make a regular appointment. These could be held near where people work, rather than where they live, or by super-markets etc. especially in areas where GPs are struggling. You could have a couple of nurses who are trained to check moles, lumps and veruccas, who can provide reassurance, advice or pass onto a GP, who can also do the basic triage work if time allows. This could help spot some serious conditions before they get too far, especially amongst those who don’t feel they can afford to take a day off work for something that might be nothing.

  • I agree with Fiona about having nurses triaging patients at GP surgeries.

    At the moment at my local surgery, patients are triaged according to thier willingness and ability to engage in a prolonged battle with receptionists who appear to consider it their job to keep patients away from the Doctors. This can’t be a clinically sound way to run things, and I know for a fact it results in patients ending up at A&E instead.

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