Escalating practice closures overloading NHS

Source: Practice Index

The NHS is failing to adapt to escalating practice closures, which are contributing hugely to falling patient satisfaction, according to the latest evidence on the crisis in primary care.

A major new study has found that funding disappears from areas with practice closures – while a second study links GP burnout to increasing rates of prescribing. They emerged as the head of the Royal College of GPs talk of “unsustainable pressure” on services.

Writing for The New Statesman, college chair Professor Kamila Hawthorne warned of 22,000 doctors leaving general practice in the next five years – and warns about political parties “kicking around” access targets. She wrote: “GPs are morally distressed by this situation, which is out of our control, and is leading many to leave the profession earlier than planned.”

Writing in the British Journal of General Practice today, a team from the University of Manchester say that practices are closing at a rate of two a week in England. Often, after a closure, patients are distributed between other practices – but the study of the year before the pandemic, 2019, found that the affected areas end up with fewer GPs and less funding per patient than before. In Northern Ireland a group of doctors have warned health authorities that they cannot absorb the impact of a closure.

Lead researcher Dr Joseph Hutchinson said: “We looked at the surviving practices and how much the surviving practices had been exposed to closure and whether that impacted workforce, funding, patient list, and patient satisfaction and QOF. We saw that as the exposure to closure increases, practice list size increases, but not proportionate to funding increases. So, there’s a decline in funding per patient. We saw an increase in number of patients per full-time GP and a universal decline in patient satisfaction with the surviving practices. Closure exposure varied by community factors, particularly closure exposure increasing was higher in deprived areas, urban areas, non white areas and more younger areas.”

A second study in the journal linked GP feelings of job dissatisfaction and burnout with increased prescribing of strong opioids and antibiotics. Researchers at the universities of Manchester, Keele and Oxford worked together on the research, which analysed the care of 40,000 patients receiving opioids and antibiotics.

Researcher Dr Alex Hodkinson said: “In this first ever study to assess the association of prescribing of strong opioids and antibiotics with GP burnout as a practice-level problem, we found higher rates of prescribing of strong opioids and antibiotics among GPs experiencing more feelings of burnout, job dissatisfaction and intentions to leave their job.”

Speaking about the closure of a practice in Bournemouth, Professor Hawthorne said: “Sadly, instances of practice closures are becoming all too common. Our own College data shows more than a quarter of practices warning they could be forced to close, with almost 90% citing unmanageable workload pressures as a reason. The loss of a GP practice in any area will have a stark impact on the community, but the effects are often felt the hardest in areas of higher deprivation, where patients often have more complex needs – especially if a closure means patients are forced to travel further to their appointments. This is not what we want to see at a time when we are trying to combat growing health inequalities. While we’ve seen some recent support from the government, in the shape of the long-awaited GP Access Recovery plan, general practice is still facing a fundamental crisis. Until policy makers address the shortfall in the GP workforce, by implementing comprehensive plans to recruit and retain more GPs, we fear more practice closures will be inevitable – so we look to the long-awaited NHS workforce plan with anticipation.”

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