General practice is losing around 200 practices a year as mergers and closures continue to drive down overall practice numbers and numbers of registered patients are increasing.
The change has led to a sharp rise in the average list size of GP practices in England - and in the prevalence of large practices, the latest NHS Digital figures on patients registered with GP practices confirm.
In September 2019, there were 233 practices with 20,000 patients or more - nearly tripled from just 85 in October 2014. But with a reduction of 999 in overall practice numbers over the period, practices with 20,000 patients or more now make up 3.4% of the total - compared to just 1.1% five years ago.
Large GP practices
The number of practices with 15,000-20,000 patients has also increased by more than 50% over the period, while the number of small practices has fallen sharply.
In October 2014 there were 2,923 GP practices with less than 5,000 patients - compared with just 1,820 in September 2019.
In September 2019 there were 6,876 GP practices in England, with an average list size of 8,727, compared with 7,875 practices with an average list of 7,212 in October 2014.
Meanwhile, the total number of patients registered with GP practices in England has risen above 60m for the first time, the latest figures show. There are now 60,006,178 patients registered with GP practices - up from 56,793,044 five years ago - and up more than 700,000 in the past year alone.
BMA GP committee chair Dr Richard Vautrey told GPonline that as the trend towards fewer, larger practices continued it was vital to maintain local services for patients across the country.
He said part of the change in practice numbers and size was driven by 'recognition of practitioners of the need to work in a team and have additional staff to deliver what is expected of them in the 21st century'.
'It's not surprising that practices have come together and that small practices have struggled to cope with what is expected,' he said.
'But we need to be careful that patients have a service local to them. And in rural areas, list sizes may be smaller, but we need to provide the support to maintain those services.'
Primary care networks
He pointed to to the potential for primary care networks (PCNs) increasingly to support practices to work together, and to allow practice managers to 'reduce the individual burden' they face by sharing tasks - and avoiding the need to move to a full merger.
Dr Vautrey said the reasons driving changes in practices were 'very mixed'. He said: 'There are different reasons for practices why they close or merge or change how they work.
'Some smaller practices are recognising that the current recruitment situation is particularly affecting them, when it comes to replacing retiring partners. That can be the catalyst for closing or merging - they think it is no longer possible to find someone to take on what they have been doing.'
He pointed to 'underfunding issues over the last decade or more' as another key factor that had driven up pressure on practices as workload increased - and warned it was difficult to say when practice numbers would stabilise.
'Patients need to feel it is their local practice, and that might be different in rural and urban areas. It is important they are based in the community and have the ability to offer continuity of care.'