Entire city's GP services almost 'unviable' as 22,000-patient provider quits

General practice is at risk of becoming unviable across a whole city in the south west of England, GP leaders warned after a major provider resigned its contract in response to a 'severe' workforce crisis.

Dr Mark Sanford-Wood: Plymouth general practice nearly unviable (Photo: Wilde Fry)
Dr Mark Sanford-Wood: Plymouth general practice nearly unviable (Photo: Wilde Fry)

LMC leaders said they were ‘extremely concerned’ after Ocean Health quit its contract for three GP practices serving 22,000 patients in Plymouth, Devon in a move which raised questions over the long-term viability of general practice in the city.

NHS England and local CCGs said the contract resignation meant they could now deploy extra resources to the practices, claiming the demise of the practices opened ‘exciting opportunities’ for developing new ways of working.

Commissioners want to appoint an interim provider on an APMS contract within weeks, with a package of ‘immediate measures’ with extra short-term resources to ensure patient appointments.

GP services at scale

A procurement process will begin in April 2018 to find a long-term provider for the practices. A new contract could be combined with a further three practices in Plymouth that have been run on an interim basis since 2016 while commissioners struggled to find a provider for them. Officials believe this would allow them to provide services at scale, increase access and provide a greater range of services.

Three practices closed in the city in March and a further one is due to close in September.

GPC executive member and Devon LMC medical secretary Dr Mark Sanford-Wood said there were further practices in the city ‘close to crisis’. Commissioners' 'default' policy of re-allocating patients of closed practices to other GP services around the city risked destabilising remaining providers, he warned.

Unless commissioners managed the situation ‘extremely carefully and innovatively’, Dr Sanford-Wood said, ‘it is almost certain that other practices will follow the same route’.

It was ‘not certain’ NHS England would find even a short-term caretaker for the practices, he said. ‘But the real question is the long-term viability of general practice in Plymouth.’

Patient safety

‘We are extremely concerned at the move, but also the environment that has precipitated it,' he said. ‘We know the partners at Ocean have been exploring every possible way of keeping their service running. That they were left with this preferred decision is extremely concerning. The real worry is how these patients will be cared for properly.’

The ‘severe’ workforce crisis in the city, Dr Sanford-Wood added, was ‘a direct consequence of seven years of austerity in general practice’.

Ocean Health partner Dr Rachel Tyler said in a statement: ‘This is a time of great change for all of us at Ocean Health and for primary care as a whole. General practice is facing unprecedented GP shortages and as a result we have been unable to recruit sufficient doctors to meet the rising demand.

‘We’ve put in a huge amount of effort to try and cope with this, but ultimately we felt it was too big a task. It is not a viable prospect for a partnership of only four doctors to support a population of nearly 22,000 patients, so we were unfortunately left with no choice but to hand back our contract.

'All our energy will now go into supporting our patients through a period of change. We’re committed to staying here, working as part of a bigger team to get the practice into a stronger position for the future.'

Head of primary care at NHS England Devon, Cornwall and Isles of Scilly and joint director of primary care at South Devon and Torbay and NEW Devon CCGs Mark Procter added: ‘We recognise that the partners at Ocean Health have been trying for some time to recruit additional GPs and other clinicians. We’ve been closely supporting them, but after significant effort from everyone at Ocean Health, they’ve decided it would be in the best interests of patients to let another provider take on the contract.

‘We recognise that this was a difficult decision to make, but it does mean we can now deploy extra resources in the short term so people can get the appointments they need.

‘And in the long term, it means we can look at exciting opportunities for developing new ways of working that offer real benefits to patients. That might mean integrating more closely with other services, for example, as well as bringing in a wider range of staff and extending opening hours.’

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