Open-but-full list ban sparks retention fears

Proposals to end open-but-full lists could push many GPs into leaving the NHS.

Calling a halt to open-but-full lists could backfire, GPs have warned.

The move, which is outlined in the health outside hospitals White Paper and will be introduced in England by 2007/8, could trigger a mass exodus of GPs who are approaching retirement age in some of the most deprived areas of the country.

Birmingham LMC has warned that many single-handed GPs with large lists are close to retirement but might go earlier if the government forced the issue (GP, 3 March 2006).

More than 20 per cent of GPs in the UK are over 55, according to DoH figures from September 2004. But in some parts of the country, up to 37 per cent of GPs are in this age group.

These include several regions where GPs are operating open-but-full lists in the face of mounting workload pressures and a GP recruitment crisis.

GPs nearing retirement

In Liverpool about 27 per cent of GPs could retire in the next five years, according to LMC secretary Dr Rob Barnett. 'We have a large proportion of small, single-handed practices,' he added.

Leigh GP Dr Stephen Fox said that more than 37 per cent of GPs in his area of Lancashire were over 55. Ashton, Wigan and Leigh PCT could not provide exact figures on closed or open-but-full lists because a PCT spokesman said 'the position is changing all the time'. But he acknowledged there was a problem.

'Our main problem is allocations,' said Dr Fox. 'We can deal with patients who choose to walk into our practices, but not those allocated by the PCT. That isn't patient choice.'

GPs in more prosperous areas are also struggling because of under-capacity but this is being caused by an influx of new patients. In the south-east, demand is outstripping capacity.

Kent LMC vice-chairman Dr Stephen Meech said: 'The whole situation is bad. We don't feel good about having lists that are open but full. Our practice is in an area where a lot of new people are coming in and we are trying to provide a quality service.

'On the one hand, the government is imposing new quality standards, then it expects us to take on more patients without increased resources.

'The real issue is that there are not enough GPs. You can bring in alternative providers, but that will not solve the problem because it will not increase the number of GPs.'

Dr Barnett said that PCTs should work with practices to try to keep lists open where possible, but face the reality that sometimes they needed to close.

The regulations allow primary care organisations to stop practices with closed lists doing enhanced services. 'Eighteen months ago, some PCTs in Liverpool tried to do that, but they stopped when they realised it was not good for PCTs or patients,' he added.

The problem of practices with open-but-full lists is significant. According to a GP survey, it affects more than 5 per cent of practices in England, while a further 2.5 per cent of practices have lists that are formally closed.

Changing the rules according to the White Paper proposals would treble the number of practices with closed lists to almost 8 per cent. LMCs say the real figures could be even higher because many PCTs refuse to acknowledge that practice lists are full.

In Birmingham, 40 out of 76 practices have open-but-full lists, while eight have closed lists. The area has such severe GP recruitment problems that the PCT has now opted to put some GP services out to tender.

The PCT has invited expressions of interest in running two practices.

One is where the GP is retiring and the other is a new practice in Aston, for which purpose-built premises are due to open next year.

According to Dr Vijay Bathla, chairman of Heart of Birmingham PCT professional executive committee, the GP shortage has been compounded by a lack of training places and funding, 'although we have trainers if the funding was there'.

Dr Bathla said the PCT has tried to address the shortage, but there are continuing problems. As a result, the PCT decided to resort to open tendering to run the two practices. He said: 'GPs and anyone else can apply.'

Managing workload

Barry O'Neil, commissioning manager for Heart of Birmingham PCT, said that GPs had been struggling with workload pressures for some time. 'There is a high workload and having open-but-full lists is a way of managing that.'

He said that by opening up the tendering process, the PCT is looking to find new providers, rather than recruit from within its own boundaries.

NHS Alliance chairman Dr Michael Dixon said practices where lists are full will have to think carefully about whether they want people to come in under the national procurement scheme or to expand their practice through a branch or sister surgery, or some other way.

'Where there are closed or open-but-full lists, that's where the government wants to identify new providers so patients can register. That will concentrate GPs' minds when considering what to do about their lists. The government has a point. Ultimately, it's a question of whether patients can register.'

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