A primary care trust (PCT) in the East of England has faced criticism over plans to save £6m by closing up to nine GP practices, with local providers claiming this would lead to a "dangerous shortfall in GP provision".
NHS Peterborough launched a consultation over its "overarching vision for primary care" in May 2011, which will close on Thursday (18 August 2011).
The document outlines three options to alter GP primary care services in the city, with the PCT's preferred third option involving closing several smaller surgeries and improving remaining larger surgeries' capacity to take on the additional patients.
But Amanda Harrington, Practice Manager for the Burghley Road Practice, which faces closure if the plans go ahead, told GP Online: "There is no way our patients can be absorbed in and around the local area."
NHS Peterborough says the financial climate means the situation needs to be addressed.
"We need to release savings to invest in the GP practices in Peterborough to ensure they can meet future healthcare needs, " the PCT said. "The current economic situation in this country has presented the NHS with a huge challenge, which is to continue to improve the quality of services with a limited budget."
However, a report submitted to the PCT consultation from GP-led providers 3Well Medical, which runs one of the surgeries facing closure, said the proposals could put patients' health at risk and lead to an increase of 20,000-30,000 A&E visits per year.
It claims that shutting the smaller surgeries would leave the remaining enhanced surgeries needing to take on 80,000 more appointments, while claiming that their capacity would be 53,000.
The 3Well Medical report says: "There is a significant risk that there will be a potentially dangerous shortfall in GP provision under this [PCT-preferred] option".
In response, Peter Wightman, Interim Director of Primary Care at NHS Peterborough, told the city's Evening Telegraph newspaper: "The analysis undertaken by 3Well is unclear because it mixes current and future population requirements. We are confident there are good alternatives for these patients."
Peterborough has the third highest spend per person on primary care in England, which the PCT says is largely due to the high number of smaller practices in the area that are on average 30% more expensive to run than larger practices.
What do you think? Generally speaking, do you believe that the current economic climate is putting smaller surgeries at risk? Your comments (terms and conditions apply):
"Looking from a purely financial perspective, the overall NHS footprint of a practice is more important than the cost of the practice itself, which is a very small proportion of the total cost to the NHS of treating each patient. We are a small rural practice with a branch surgery. Consequently we cost ~£20 per patient p.a. more than urban practices. Our NHS footprint is ~£500 per patient lower than some urban practices. In our PCT, all the lowest overall spenders are small practices" – Clive West, Yorkshire
"As a singlehander I accept that there is a lot of prejudice against me and my lot – most of it anecdotal and based on simple statistics. Variations in any healthcare variable measurable, be it cost, service delivery, quality of care will follow a gausian (or bell shaped) distribution curve. The lowest cost prescribing practices will tend to be the single handers (and or course the highest cost prescribers) the same with referrals, lowest referers will be the single handers and highest in any speciality. Big group practices of 10 or more partners will fall in the 95% of the others in the middle – and pretty much half of the single handers will to. What is more interesting in comparing variables is to look at individual GP data (because that's what you are doing effectively looking at single handers) across all practices – the variations increase and 95% of the single handers fall in the middle and the extreme outlyers then turn out to be individual partners previously hidden in the average figures of their large group practices. Small practices – despite what one of your correspondents [see below] alleged – are actually better placed to respond quickly to change – there is inertia amongst big practices and their internal management structures, layers of clerical and administrative staff in a hierarchy not to mention inertia of GPs and practice nurses to change" – Nigel, Southampton
"If the economic climate is risking surgeries this should not be based on size alone but surely on care and performance? If the main aim of surgeries at present is to reduce the amount of patients going to A&E, surely the locality of the surgery and access to care is one of the main factors in doing so? I am Practice Manager at a new growing practice in a deprived area previously without a local GP and we have some of the lowest A&E attendance rates in the Borough due to the standard of care offered in the locality. Closing small practices just because of their size is surely a false economy" – Jenny Webster, Oldham
"I feel that the nGMS contract despite reassurance from others was always going to be the way that smaller practices would be forced out particularly the single handed GPs and I am surprised that it has taken them so long before they tried it. QOF, Additional Enhanced Services and GMS contract changes have always been developed with the bigger practices in mind who can easily absorb changes within the bigger staffing levels and without incurring extra staffing costs and can put things into place quicker than the smaller practices, ultimately though they do not always provide the continuity of care and the welcome that patients like and get from the smaller practices" – Susan Riley, Liverpool
"Yes, definitely. Also older surgeries are going to need financial assistance in order to comply with the specifications of the CQC" – Julie Swaffer, East Sussex
"We have to recognise that keeping single handed or very small GP practices open is neither cost effective or provides the level of services that a larger practice can bring. Therefore although this may raise concerns, it is part of the changes required within the NHS as it evolves to meet both the needs and budget requirements of this sector. Another requirement to look is the need for larger practices to merge across current geographical boundaries to again make GP practices more cost effective and increasing the portfolio of skill sets and resource the "super practices" could then provide over a number of locations" – Moira Moore, Wales
"Yes, but patient outcomes at smaller practices tend to be better because of stronger doctor/patient relationships" – Patrick Jordan, Manchester