Collapse of vulnerable GP practices risks 'domino effect', NHS official warns

Even high performing GP practices can rapidly become vulnerable and closures risk triggering a 'domino effect' among neighbouring GP services, a senior NHS official has warned.

Dr David Geddes, NHS England head of primary care commissioning

Speaking after a discussion at the RCGP annual conference in Harrogate on Friday, NHS England head of primary care commissioning Dr David Geddes highlighted the 'critical nature' of primary care.

'It is often very vulnerable. We know that practices can be excellent on CQC rating but lose a practice manager or a partner through sickness or ill health and you can end up suddenly losing a lot of organisational knowledge which can make the practice plunge into a difficult situation.'

Problems for practices in this type of situation can often 'spiral', Dr Geddes warned, and become 'self fulfilling' as local people, other practices and doctors begin to see them as 'a practice to avoid'.

GP funding

The NHS England primary care commmissioning lead told the conference discussion that the NHS needed to find ways to make better use of local knowledge, data held by health service watchdogs or CCGs to spot emerging difficulties early.

The NHS needed to identify better ways to use GP resilience programme funding to target support at whole areas rather than just individual struggling practices, and to create incentives for neighbouring practices to offer support, he said.

'There is an awful lot of knowledge which may be held in different groups,' Dr Geddes said. 'Locals may know a practice is going under, primary care support services may know if they have claims that are late from that practice, the CCG may know - individually they may not be surprised when a practice goes under, but together we are not collecting that information in a way that is helping us to triangulate that information at an early stage so that we can take action.

'We need to somehow crack how we get that information sharing more productive.'

GP resilience

Dr Geddes said there were two possible reactions for practices with a neighbour that was in difficulties. 'There are two reactions - let's keep out of reach, keep ourselves safe; or can you reach out - support that practice in a way that helps them become more sustainable. There is a risk in that - but there is a risk that if you don't do that, that practice B goes under and those patients will flock to you and you then will be come vulnerable.

'That domino effect can be very real. We need to think more about how we develop as a system this resilient programme funding into a way that helps whole systems, not just individual practices.'

NHS England was working on how it could help practices to support struggling neighbours by targeting funding better.

'We are making sure that CCGs and LMCs will be aware of the named person in NHS England holding the purse strings.' With £16m in resilience funding available this year, and £8m in subsequent years, the scheme was not a case of 'this year or nothing'.

The funding scheme should help general practice 'become more responsive so that as a community of clinicians we are more able to help ourselves on the ground'.

Full coverage of RCGP annual conference

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