Exclusive: GP who revived struggling practice driven out by cuts and APMS merger

A GP who spent over a decade turning around a struggling practice in Sunderland has had to walk away after the local CCG slashed its funding and merged its APMS contract into a deal that encompasses practices up to seven miles away.

Dr Ashley Liston told GPonline he had decided not to rebid for the APMS contract of a practice he worked at for over 12 years after Sunderland CCG decided to merge it with two other struggling practices ‘out of the blue’.

The Sunderland GP's concerns come just days after GPonline revealed that an Essex practice is to be taken over by private provider Virgin Care after £400,000 funding cuts forced the existing partners to hand in their notice.

After initially joining the Encompass GP Surgery as a salaried GP in 2004, Dr Liston re-established personalised care and continuity of care at the practice.

Located in a deprived area of Sunderland, it had been entirely reliant on locums for over two years before he arrived, after failing to fill vacancies.

GP contract

He went on to secure the practice’s time-limited APMS contract and establish a traditional partnership model with a colleague to turn its fortunes around.

But when Sunderland CCG put the contract back out for tender last year, it decided to merge the practice with two other APMS practices in a move Dr Liston and other GPs at the practice described as ‘completely unexpected’.

It also ruled that the provider would have to manage the violent patient scheme for the whole of Sunderland.

Dr Liston said the new offer was ‘beyond anything I could consider in terms of resources’.

The practice’s contract will be taken over by the Sunderland GP Alliance from 1 October. Although the new provider - a GP-led organisation with 41 member practices that cover most of Sunderland - said services would not change, Dr Liston fears the personal focus he cultivated at the practice will be undone, warning his approach would not be possible after the practice had been merged.

One of the practices involved in the merger – Barstom Surgery – was fairly nearby, but the other – Pennywell Surgery – is almost seven miles away from the Encompass GP Surgery.

Funding cuts

The merger was coupled with a ‘draconian reduction in funding’, he added, which amounted to a reduction of funding by a third.

Dr Liston said: ‘To me, this is just not general practice as I know it – personal care to a list of patients I know. I can't do that with a city-wide list.

‘The CCG has pursued this decision to merge the practices and follow a different model of general practice that fits in with a city-wide GP alliance agenda.’

He warned that the merger and expanding the patient list to include more patients over a wider area could ‘jeopardise’ a rapid response telephone service he had developed at the practice.

‘It won't be able to work in the same way after the merger and our patients really love that system. It’s complicated to introduce and it does revolutionise access to general practice. I'm really proud of that – it would be heart breaking to see the service I built up over several years be dismantled.’

Debbie Burnicle, deputy chief officer at Sunderland CCG, said: ‘As NHS commissioners, we have a responsibility to review all contracts as they come to an end. We understand that this process can be unsettling for providers, but this is an important part of our commitment to commissioning quality services while making the best possible use of NHS resources.

GP quality

‘95% of the criteria for awarding the contract were focused on quality. The combined contract will help to ensure that services are more sustainable, at a time when practices are struggling to recruit and demands on them are increasing.

‘The procurement strategy and transitional budget were revised to take account of feedback from potential providers, and this will provide a strong basis for future service provision. The core funding is in line with funding all other practices receive across the city.

‘There is no change to the service to be provided under the new contract, and care for all the patients affected has been our overriding concern throughout this process.’

A spokeswoman from Sunderland GP Alliance said: ‘Sunderland GP Alliance are delighted to be named as the preferred bidder for this contract, and are looking forward to working with staff and patients to further develop GP services in Sunderland.

‘Sunderland GP Alliance is a GP-led organisation with 41 member practices, covering over 85% of the city’s population, formed with the specific purpose of improving primary care within the city. Across the federation, we have a high level of clinical knowledge and experience on which to build.

‘We understand a change in contract holder can be unsettling for both staff and patients and wish to emphasise that the services to be provided under the new contractual arrangements have not changed.’

Photo: iStock

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