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One In Five Gp Surgeries In London May Close Within Three Years

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http://www.theguardian.com/society/2016/feb/13/gp-surgeries-london-planning-to-shut

One in five GP surgeries in London could close over the next three years because of crushing bureaucracy, the relentless demand for appointments and a shortage of family doctors.

A survey of almost half the practices in the capital also shows that two in five are relying increasingly on temporary locum GPs, while one in eight is considering scaling back the services they offer.

Research among 644 surgeries, 48% of the 1,330 across the city, found that 19 (3%) – which care for 116,491 patients – definitely plan to close by 2019, and another 109 (17%), which between them have 802,384 patients, have not ruled out doing the same.

“These sad and distressing findings tell us that practices are under huge strain, to the point where they are making career-changing decisions to give up. These decisions will impact on patients, who hugely value the relationships with their GPs and the continuity of care they have had, perhaps from when they were born,” said Michelle Drage, chief executive of Londonwide local medical committees, who commissioned ComRes to undertake the survey.

Still I'm sure Mr Hunt can come to the rescue....

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Nothing to worry about. The country is in fine shape. Everything is getting better and we are heading for a magical time of peace and prosperity for all!

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"the relentless demand for appointments...."

The horror of it! All those patients queuing up to see their GP. I mean won't somebody think of the doctors. Why can't those ill people just stay at home at let the doctors get on with their paperwork and leave them time to go and play golf.

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Or may not.

One of the problems of having a massive, bloated public sector healthsystem is that where do these GP go to work?

If the NHS blob had allowed competition then there may be somewhere else to work.

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I suppose they're all planning on moving to switzerland. That's the usual line.

Yes, then they say its too boring and come back.

For the record I love Switzerland - I like the tains and moutains and can be in Northern Italy pretty quick.

As far as entertainment - i grew up making my own entertainment!

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It's inevitable that London will become a desert if house prices continue to soar. In the same way as idyllic little villages are abandoned to 2nd home owners because no-one can afford to live there.

It can't be crazy house prices as the guardian doesn't mention it ;)

Edited by billybong

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It can'y be crazy house prices as the guardian doesn't mention it ;)

Oh they will when the layoffs start ramping and the salaries are cut.

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GPs, surely they can be replaced by a large flow diagram.

You jets but the quality of GPs varies massively.

My Nan used to organise a health cooperative in the years before the NHS was formed.

When the NHS started she was optimistic.

Then she ran into a number of its short comings.

She moved to be near my Mum when we were growing up. Our local GP was a useless drunk.

She spent years trying to get him removed.

Got nowhere. She was furious with the NHS by the time she died.

She started off from a position of workers collective but she was very hire em fire em on the people providing the services.

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It's inevitable that London will become a desert if house prices continue to soar. In the same way as idyllic little villages are abandoned to 2nd home owners because no-one can afford to live there.

Someone must be living there or there wouldn't be the overcrowding.....

Must be the Polish 25 to a room........... Can't knock free healthcare............

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"the relentless demand for appointments...."

The horror of it! All those patients queuing up to see their GP. I mean won't somebody think of the doctors. Why can't those ill people just stay at home at let the doctors get on with their paperwork and leave them time to go and play golf.

Obviously you dont live in London. Can sometimes be 2 weeks before you get the chance to Queue.

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Obviously you dont live in London. Can sometimes be 2 weeks before you get the chance to Queue.

Not a unique London only thing.

Our GPs is in special measures.

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That is a useless article.

3% planning to shut in the next 3 years - how many usually shut in that time-scale? how many new ones usually open in that time-scale (not mentioned at all)?

17% have not ruled out shutting down in the next 3 years - what sort of talk is that? - which organisations plan to not shut down? - meaningless.

Relying increasingly on temporary locum GP - isn't that the modern NHS? - work as a locum for increased £

This just looks like all the surveys that come from all sorts of public sector workers - they're always planning to leave and get a new job elsewhere but amazingly when the time comes they decide that actually they'll just stay anyway.

That isn't to say that there isn't a problem - but this kind of research is really weak and just looks biased.

Edited by dgul

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A friend of mine was telling me how her GP had retired early in his 50s 'because of the stress'. He's now travelling the world as a freelance wildlife photographer (his hobby before he retired).

I'm guessing that he's got 30+ years of NHS pension under his belt, his house is paid for, and he's retired early because he can, and there's no real financial risk in doing so. This is in Yorks, but I assume that if you have a similar profile in London you can do the same, especially if you're prepared to bail out of the smoke and take the money and run.

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A friend of mine was telling me how her GP had retired early in his 50s 'because of the stress'. He's now travelling the world as a freelance wildlife photographer (his hobby before he retired). ...............................................

..that is style ...suffering stress he lost the enjoyment of the job...self prescribed his cure (probably not NICE approved) ..bet it works... :rolleyes:

Edited by South Lorne

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I dont get this.

"Demand is massively increased!"

"Well lets stop providing the supply"

How is that the logical result? Surely someone who can run a surgery and employs proper management/admin and not their relatives will take over? Or a new surgery will open .. cos' demand is there right?

If the payments are truly too low, no matter how well run the surgery is, then shouldn't all GP's inside the England NHS zone be shutting up shop?

Someone please explain.

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Nothing to worry about. The country is in fine shape. Everything is getting better and we are heading for a magical time of peace and prosperity for all!

The population is not healthy, never been so sick and needy.....never before have so many, taken so many pills and potions....not made them any healthier it seems.

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A friend of mine was telling me how her GP had retired early in his 50s 'because of the stress'. He's now travelling the world as a freelance wildlife photographer (his hobby before he retired).

I'm guessing that he's got 30+ years of NHS pension under his belt, his house is paid for, and he's retired early because he can, and there's no real financial risk in doing so. This is in Yorks, but I assume that if you have a similar profile in London you can do the same, especially if you're prepared to bail out of the smoke and take the money and run.

Plenty doing that.....life is short, and a healthy life is even shorter.

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I dont get this.

"Demand is massively increased!"

"Well lets stop providing the supply"

How is that the logical result? Surely someone who can run a surgery and employs proper management/admin and not their relatives will take over? Or a new surgery will open .. cos' demand is there right?

If the payments are truly too low, no matter how well run the surgery is, then shouldn't all GP's inside the England NHS zone be shutting up shop?

Someone please explain.

I'll have a go. There's many factors at work but I'll use 2 aspects to illustrate a bit.

Unfortunately due to the way that GP services are funded, there is no complete mechanism where increased demand leads to a supply side response. The practice gets about £75 per person, per year as something called the "Global Sum". This is adjusted by a formula taking into account age/sex/some selected local disease levels. On top of this there is a performance-related pay aspect that brings the income to about £130 per patient, per year, to provide as many GP appointments and services as they need. If patient demands increase, such as higher consulting rates (as has occurred over the past decade), this funding remains the same.

Now somewhere like London has seen a large increase in population in recent times. So increased patient numbers in a practice area should bring in the £130 per patient, per year and hence allow some kind of supply-side response. However this brings in the other issue which is recruitment and retention. From a peak around 2004-2005, the popularity of GP as a career choice has declined to the extent that many GP training schemes are half-empty. In addition, most GP practices are structured (due to NHS contract requirements) as unlimited liability partnerships. If the practice folds then you may well end up being made bankrupt and losing your home and savings, as well as your job.

So what has been happening is demand goes up, but there aren't enough GPs to meet it, and the funding is not proportional to the demand increase even if more GPs were available. The existing GPs in practice then have to work harder to try and meet the demand, but there's obviously a limit to how long this can continue. The practice becomes unstable and any problem - such as a GP becoming unwell or burning out - could lead it to collapse. Faced with this possibility, the existing partners in a practice would make an assessment that the practice is becoming unviable. Closing the place in an orderly fashion may enable them to escape without bankruptcy. Hence what you are seeing.

Edited by Breowan

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I'll have a go. There's 2 aspects at work here

Unfortunately due to the way that GP services are funded, there is no complete mechanism where increased demand leads to a supply side response. The practice gets about £75 per person, per year as something called the "Global Sum". This is adjusted by a formula taking into account age/sex/some selected local disease levels. On top of this there is a performance-related pay aspect that brings the income to about £130 per patient, per year, to provide as many GP appointments and services as they need. If patient demands increase, such as higher consulting rates (as has occurred over the past decade), this funding remains the same.

Now somewhere like London has seen a large increase in population in recent times. So increased patient numbers in a practice area should bring in the £130 per patient, per year and hence allow some kind of supply-side response. However this brings in the other issue which is recruitment and retention. From a peak around 2004-2005, the popularity of GP as a career choice has declined to the extent that many GP training schemes are half-empty. In addition, most GP practices are structured (due to NHS contract requirements) as unlimited liability partnerships. If the practice folds then you may well end up being made bankrupt and losing your home and savings, as well as your job.

So what has been happening is demand goes up, but there aren't enough GPs to meet it, and the funding is not proportional to the demand increase even if more GPs were available. The existing GPs in practice then have to work harder to try and meet the demand, but there's obviously a limit to how long this can continue. The practice becomes unstable and any problem - such as a GP becoming unwell or burning out - could lead it to collapse. Faced with this possibility, the existing partners in a practice would make an assessment that the practice is becoming unviable. Closing the place in an orderly fashion may enable them to escape without bankruptcy. Hence what you are seeing.

GPs are private contractors to the NHS.

If they were funded correctly i.e. not allowed in the NHS pension as they *are* contractors, you would find a lot of GPs working a lot longer rather than going off on their unearned, lucrative pensions.

There should be no requirement to buy into an existing partnership.

It ought to be possible to set up a new practice.

Its possible that the entire GP system is badly structured for modern UK.

Money should follow the patient and GPs should compete to offer service.

Giving a GP 200/year per patient can add up - most people do not use their GP for years.

Personally, I think GPs should charge per appointment.

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GPs are private contractors to the NHS.

If they were funded correctly i.e. not allowed in the NHS pension as they *are* contractors, you would find a lot of GPs working a lot longer rather than going off on their unearned, lucrative pensions.

There should be no requirement to buy into an existing partnership.

It ought to be possible to set up a new practice.

Its possible that the entire GP system is badly structured for modern UK.

Money should follow the patient and GPs should compete to offer service.

Giving a GP 200/year per patient can add up - most people do not use their GP for years.

Personally, I think GPs should charge per appointment.

I'd agree, the NHS pension scheme arrangement is odd, but then the whole way services are structured is also odd. Certainly I don't think removing GPs from the NHS pension scheme would stop them retiring early. The older GPs have already made enough anyway. The remainder, well, paying £30k a year into any pension scheme for 30 years would probably allow an early retirement.

If the set-up was changed to money following patients/charge per appointment then some of the problems could well be sorted out.

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