GP practice closures 'at record levels', GPC chair tells BMA annual conference

GP practice closures hit record levels over the past year with 201 forced out of business, GPC chairman Dr Chaand Nagpaul will tell the BMA annual representative meeting in Belfast on Wednesday.

GPC chairman Dr Chaand Nagpaul
GPC chairman Dr Chaand Nagpaul

In a bleak conference speech just a month after LMCs called for a ballot on industrial action and possible mass resignation, Dr Nagpaul was expected to hit out at soaring demand, a deteriorating workforce, increasingly complex workload and an 'unforgiving climate of blame'.

The GPC chairman will call for CQC reports on GP practices to acknowledge specific difficulties they face, such as unfilled vacancies or underfunding.

He will demand a national campaign to promote self care and wise use of overstretched GP resources by patients and the wider NHS.

Dr Nagpaul will back increased skill mix in general practice and an immediate injection of funding to enable practices to take on staff from 'practice pharmacists, to paramedics, to advanced nurse practitioners' to plug the growing GP workforce gap.

GP crisis

He will say that pressure on general practice reached new heights over the past year, with the 'unabated' transfer of work out of hospitals and falling numbers of GPs per patient 'drowning our capacity to cope'.

Citing GP data published in April by the Health and Social Care Information Centre (HSCIC), Dr Nagpaul will warn that practices have been closing in record numbers. The data show a fall of 201 practices in the last financial year.

Although some of this reduction may be accounted for by mergers, the BMA believes many of these will have been forced into drastic action because they are struggling to remain viable.

GPonline revealed earlier this year that NHS England has identified up to 20% of GP practices in parts of England as vulnerable. BMA polling suggests that one in 10 are financially unsustainable.

High levels of GP vacancies and many practices' inability to recruit locums have created a 'toxic mix from which existing GPs can’t wait to escape, and which many young doctors will not join', the GPC chairman is expected to say.

GP workload

Using the example of an elderly patient, Dr Nagpaul will hit out at unsafe demands for GPs to handle hugely complex clinical issues that in the past might have been dealt with over several hours of hospital appointments within a 10-minute consultation.

'Far from the being thanked for working against all odds, there’s an unforgiving climate of blame,' he will say. 'Litigation against GPs has rocketed, no doubt contributed by us not being able to work safely. CQC adds further insult by crudely judging practices rather than recognising our impossible context.

'General practice desperately needs more resources, but not by robbing Peter to pay Paul, but from a larger NHS pot that provides the level of care that befits a civilised state. This is everyone's fight, from doctors to patients and the public as taxpayers, to challenge politicians who are irresponsibly trying to squeeze a quart into a pint, while savagely slashing NHS funds under self-proclaimed austerity.

'GPs will play their part in this fight and we’ll fight every day until we resurrect our proud profession. Because if general practice fails, the NHS fails, but I’ll turn that to a positive - if general practice succeeds, the NHS succeeds.'

Dr Arvind Madan, NHS England director of primary care and a Tower Hamlets GP, said: 'We are acutely aware of the pressures GPs are facing right now and the need to get on track as quickly as possible. This means that practices, working together, will benefit from access to support if they are struggling to meet patient’s needs, reductions in unnecessary workload, more opportunities to recruit staff and a chance to improve use of their technology or premises.

'We know this is just the start of the journey but we are determined to get this right for the benefit of patients, GPs and the wider healthcare system.'

The DH has said funding and policy set out in the GP Forward View are a 'significant step forward' for the profession. Ministers have pledged to recruit new staff including 1,500 clinical pharmacists to work in GP practices, and point to £206m in the plans set aside to expand the GP workforce.

The government has made clear it remains committed to its manifesto commitment to increase the GP workforce by 5,000 by 2020, although this figure includes some existing GPs it hopes to persuade to delay retirement and a significant number of trainees.

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