Why are so many GPs shutting up shop?

This article was taken from: https://www.theguardian.com/society/2017/sep/27/gps-surgeries-shutting-brighton-family-doctors

By: Tim Friend

Brighton and Hove has lost a quarter of its surgeries in two years, as pressure on the primary care sector takes its toll on family doctors across the country

A chilly autumn wind is blowing across the Brighton suburb of Woodingdean, tucked into the South Downs on the eastern edge of the city. It is a busy and unpredictable time for family doctors: flu prevention clinics, falls and respiratory complaints and the prospect of another winter crisis for the NHS.

So the timing couldn’t be worse for the nearest GP surgery to close. Yet Woodingdean’s Ridgeway practice will shut its doors for the last time on 31 October. More than 2,000 patients will have to find another family doctor further away. Not easy if you are frail, without transport or a parent struggling with a buggy and young children.

“It’s like starting all over again after 18 years at the surgery,” says Kay Charnley, aged 38, (pictured, above left) picking up her two children from primary school. “The doctor at my old surgery was really good on women’s health. It really counted during my pregnancies. Now I’m not sure who I will see. OK, they’ve got your records, but the relationship with a family doctor is about more than that.”

Instead of a short walk to the surgery, Charnley now faces a two-mile round car journey to Woodingdean medical centre, with parking in short supply. For older patients, the prospect of changing doctor is even more daunting. “My wife’s just had a stent fitted: she was livid that we were losing the family doctor,” says Victor Neale, aged 83, who lives just across the road from The Ridgeway practice. “It was a well-equipped surgery. Now we’re in for a bus ride or long walk up a hill.”

Ridgeway will be the eighth GP practice in Brighton and Hove to close since February 2015. The local health watchdog estimates that up to a quarter of the city’s surgeries have shut since 2015, with more than 33,500 patients being forced to change GPs during that time. David Liley, chief officer of Healthwatch Brighton and Hove, says: “We have a situation where growing demand is being met by fewer people. We’ve heard of people who have had to change GPs not once, not twice, but three times.”

Brighton and Hove’s clinical commissioning group says: “It’s mainly due to the rising demand on services and the challenges being faced with recruitment and retaining GPs. This pressure is particularly felt in small single-GP practices and, of the eight recent closures, five had patient lists that were relatively small in number.”

The situation in Brighton is by no means unusual. In the year to June 2017, NHS Digital figures show that 202 practices in England closed or merged: 64 in the north of England, 54 in the south of England, 46 in the Midlands and east of England and 38 in London. According to the British Medical Association, the number of surgery closures is a particular issue in less well-off rural and coastal areas such as Lincolnshire, Essex and along the south-east coast.

In Folkestone, seven out of the town’s eight practices this month asked for permission to formally close their liststo new patients, over concerns about patient safety. Folkestone’s surgeries have a shortage of 16 full-time equivalent GPs and are having to take on 4,700 extra patients after a practice shut in May.

And many doctors fear their surgery might not survive long. According to the Royal College of General Practitioners’ (RCGP) latest survey of its members, 6% of GPs think it is likely that their practice will close in the next year.

The worrying rise in closures is symptomatic of the workforce crisis in primary care. “What we are seeing now is the result of nearly a decade of under-investment in our family doctor service, one consequence of which is a serious shortage of GPs,” says Helen Stokes-Lampard, chair of the RCGP.

Latest figures from NHS Digital show that nationally, there was a decrease of 350 full-time equivalent GPs in England between September 2015 and June 2017, down from 34,592 to 34,242.

And the exodus is set to continue. Nearly 40% of GPs say they are unlikely to be working in general practice in five years and 8% are unlikely to stay one year, the RCGP survey shows. Although nearly half the departures will be due to retirement, 47% say this is because they find it too stressful.

“Workload in general practice has risen 16% over the last seven years. We are seeing more patients than ever before and dealing with more complex disease than ever before, but GPs are only human and there are limits beyond which we cannot guarantee safe care,” says Stokes-Lampard.

“There’s huge pressure, not just because of underfunding,” agrees Richard Vautrey, chair of the BMA’s GP committee. “Consultations are at a more frequent rate, and this is coupled with the move to treat more cases at primary care level such as diabetes, heart disease and chronic lung disease.”

But younger family doctors are unwilling to pick up the slack. “Younger doctors are reluctant to take up partnerships as older doctors retire. There are fewer tangible rewards, increasing demands, and it’s your own money on the line,” says Liley.

Dr Darren Emilianos, a partner at the Woodingdean Medical Centre, agrees that workload and long hours are to blame. “Increased workloads threaten to make the job less and less safe. And instead of becoming a partner, many GPs now prefer locum work where they stand a chance of getting home to see their children.”

Brighton and Hove clinical commissioning group is all too aware of the problem. Dr David Supple, the CCG’s clinical chair and a local GP, says there are plans for new walk-in-centres to alleviate the pressure on practices. The CCG is also encouraging surgeries to work more closely together to share resources such as pharmacies.

But he concedes that recruitment and retention is the biggest challenge. “By addressing the workforce and workload pressures and giving practices more stability, we expect this will have the knock-on effect of making becoming a GP in Brighton more attractive for young doctors,” he says.

Nationally, NHS England insists the GP five-year forward view will address the problem. “As part of our plans to improve GP services, many practices are choosing to merge rather than simply closing, in order to offer patients a much greater range of services and benefit from more efficient ways of working,” says an NHS England spokesman. “The NHS is on track to deliver more GP recruits than ever before as we implement the measures set out in our five-year action plan, which has also seen over 1,000 practices across England being supported by £26m of resilience funding,” says an NHS England spokesman.

The first £16m was allocated in the financial year to April 2017, with funding going towards human resources, IT, and management support, with a further £8m allocated this year.

A spokeswoman for the Department of Health says: “We are continuing to back primary care services, with 5,000 more doctors in general practice by 2020.” But there are doubts that the targets are achievable, with 3,000 new GPs due to be recruited mainly from mainland Europe. “Brexit is causing many European doctors to have second thoughts about coming to the UK,” says Vautrey. “They need reassurance, we know that Brexit is causing them concern.”

Back in Woodingdean, residents do not blame the two Ridgeway doctors for shutting up shop after 17 years at the practice. One is retiring and the surgery was unable to continue as a single-handed operation. But there is a sense of being messed around by a system that is bordering on dysfunctional. “People just panicked and they didn’t know what to do,” says Bobby Dalby, aged 78. “I think the whole thing has been handled badly by the NHS.”

And with so many patients having to transfer, some fear that they won’t be accepted at Woodingdean medical centre. Emilianos, whose surgery has a current list of 7,100 patients, thinks an extra 1,600 patients could register the coming weeks following the Ridgeway closure. He is in the middle of a recruiting campaign, already interviewing three potential new GPs, two nurses and increasing the surgery administration team. “The surgery has a good reputation and we want to keep it. I think we are making the best of the bad situation that the politicians have put our patients and the NHS in.”

The remaining 400 Ridgeway patients will transfer to surgeries in Rottingdean and Saltdean, three miles along the coast. Anna Ashley, aged 38, (pictured, above right) says the process has been fraught for many. “Everyone has to register in person which makes it tricky for people who commute. They are having to take time off work.”

Neale, like Charnley and Ashley, still doesn’t know who his new GP will be. “We’ve filled in the forms for the new doctor but we’re still waiting to hear for sure,” he says. “It’s worrying.”

Additional reporting by Mason Boycott-Owen