In a Q&A session at the RCGP annual conference in Liverpool, outgoing chair Professor Helen Stokes-Lampard and her successor Professor Martin Marshall responded to a question from the floor about practice closures and the impact of changes in funding.
A GP in the audience said practices in deprived areas had been 'hit hard by changes in the way general practice is funded' over recent years. He said he had personally 'seen practices go to the wall', something he said was a great shame, warning they were allowed to fail sometimes because of a 'lack of imagination' about how to support general practice in deprived areas.
Professor Stokes-Lampard told the conference: 'Once a practice goes under and hands back the keys, the cost of replacing it is two to three times as much in the first few years. We should absolutely have a system that throws support at practices that are struggling.'
She pointed out however that many practices had 'left it very late' to admit they were struggling, and needed to be prepared to seek support sooner.
Professor Marshall said the Carr-Hill formula that underpins the distribution of much of GP practices' core funding was 'far from perfect'.
'Something needs to be done about the Carr-Hill formula,' he said. 'It is inequitable in so many ways.'
Professor Marshall, a GP in Newham, east London, said that colleagues in nearby Tower Hamlets received more funding per patient despite serving a very similar population. He added that when he worked in Devon previously it had been well funded but funding had since shifted to other areas.
'Devon is now struggling,' he said. 'It is very difficult to shift money around the system - it is much easier to when new funding comes into the system, and you put it preferentially into areas where you can have most value. But we are not operating in that environment at the moment.'
The college leaders accepted a point from another GP on the need for the profession to do more to retain not only doctors at the start or end of their careers, but also those in the middle.
Professor Marshall said it was 'not fair' that the focus in recent years had been largely on first 5 and GPs at the end of their careers. He said it was important to work on retention of GPs in the middle of their careers by ensuring their jobs were 'doable', that they felt valued and that there was a clear career structure for them.
He suggested it was important for the profession to acknowledge that many doctors wanted portfolio careers rather than solely working in frontline general practice in the same place.
'Perhaps part of this is about encouraging people to have that, and changing roles more frequently than they have in the past. In the US this is seen as perfectly legitimate, but it tends to be regarded with suspicion in the UK.' He said this was going to change.
Professor Stokes-Lampard agreed that 'more established' GPs needed to be more flexible in their approach to newer colleagues - warning that 'we are putting people off'.