'Domino effect' fears as GP practice closes after third provider walks away

An MP has called on NHS managers to resolve problems with primary care in her constituency after the announcement that a practice will close just a year after a new provider took over.

The 5,000-patient St Martin’s practice in south Bristol will close in January after the provider Crest Family Practice handed back its contract.

Crest is the third provider in three years that has said the practice is unsustainable.

The original GP partners at the practice are understood to have handed back their GMS contract two years ago because of workload pressures and recruitment problems.

An NHS England South West spokeswoman told GPonline the practice had been difficult to run and recruit to because of its small size. The average patient list in England is around 7,000 patients.

GP contract

The current APMS contract that the practice operates under was awarded following a procurement process in October 2015. The previous interim provider said it told NHS England that the practice was not viable with the funding it would receive under the new contract.

According to NHS Digital data the practice was receiving £105 per weighted patient under a GMS deal in 2015/16.

Dr Simon Bradley, a GP at Concord Medical Centre in north Bristol, which stepped in to run the practice for a year, told GPonline his practice advised NHS England they could not continue to run St Martin’s because it ‘wasn’t viable under the GMS price’.

‘We advised NHS England of that reason,' he said. ‘We said we didn’t feel it was viable at that sum of money.’

Dr Bradley said that local NHS commissioners were constrained when procuring the APMS contract by the national equitable funding policy which meant the contract funding could not be more than GMS equivalent. What was needed, he said, was an increase in core funding.

Practice closures

He warned of a ‘domino’ effect in the local area as neighboring practices struggled to cope with the additional workload from St Martin’s patients. 'I expect to see a knock-on effect on other practices. It wouldn’t surprise me if this was the first of several in the local area.’

The warning that a practice closure could trigger problems at others nearby echoes fears aired by a senior NHS England official at the RCGP conference earlier this year.

Dr Bradley said it was ‘a very sad day’ for the St Martin's practice and its patients.

Karin Smyth MP (Lab, Bristol South), a former manager at Bristol CCG, said ‘It is deeply unfair on patients to have been given such a short amount of time to find another GP.

‘Primary care in south Bristol is at a critical point and while I currently have little confidence the situation will be resolved, I do expect health managers and government ministers to sort it out. That is the challenge I put to them on behalf of the people I represent.’

NHS England South West head of primary care Laila Pennington said: ‘We have written to patients to explain the decision and we will be working closely with Crest Family Practice to support patients registering at other practices, with particular emphasis on identifying vulnerable people who might need special help – perhaps because they have dementia or are on continuous medication.

‘We would advise patients register with another practice by Christmas to ensure continuity of their care and we are confident that there are good alternatives locally, with most patients having at least five surgeries within a two-mile radius.’

GP partner at Crest Family Practice Dr Lesley Ward said: ‘I acknowledge the turbulent time that St Martin’s surgery has been through over the past few years and also the loyalty of its patients. It is therefore with sadness that we announce the fact that Crest Family Practice is no longer able to continue working from two sites.

'We will continue to practice from William Budd Health Centre and would be honoured to care for the St Martin's patients there if they wish. There will be a patient participation event at The Park Centre on 1December and we will be there to answer any questions and as a practice will do whatever we can to help patients re-register and smooth their transition of care.’

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