200 English GP surgeries closed between 2018 and 2022. As the current contract risks pushing more GPs out of practice, and the ongoing GP shortage makes it harder to operate a surgery, it may well get worse before it gets better.
So, what happens when a partnership collapses, how can we stop that happening so much, and is there a better way to manage it when it does?
Rescue
Ideally, there will be a solution that will save the surgery. If the partners were to wind up the practice, then they would be responsible for any redundancy payments, lease liabilities, or any associated expense, and that could be financially ruinous.
From the commissioner’s perspective, keeping the surgery open after the partners hand back their contract is a long and expensive process, so a rescue is infinitely preferable. The commissioner keeps the GMS contract live by arranging a merger, so that a nearby practice takes over the surgery.
It’s not without its challenges, of course. It tends to be a long process, and the commissioner will provide help, support, and funding for the merger’s due diligence. The hope is that once the merger completes, there is continuity for staff and patients.
However, what are the options when it’s too late, and the practice has already handed back its contract?
Options after a practice hands back its contract
In the case that it’s too late for a merger, and the partners have already handed back their contract, there’s a notice period in which the commissioner must find a solution to keep the practice open. Those options are the highest risk or most expensive.
Managed dispersal
In an urban setting, nearby practices may be able to take their share of the patients of a closing surgery. Those practices may be paid a premium for taking on those patients. It’s likely that this option will only work with very small practices, because there is a risk of a domino effect. Handing out a surgery’s worth of patients can easily overwhelm other practices, increasing the risk of additional collapses.
Procurement
The commissioner needs to find another provider, through an open and transparent procurement process. A new APMS contract will then be awarded for a fixed term, at which point it will be retendered. What sort of organisations might tender for the contract?
- A private business. A private medical provider could be awarded a contract.
- Secondary care. A nearby hospital may set up a company to manage the practice, thereby broadening the available resources for the practice care and better linking primary and secondary care.
- Community. If the patients of the surgery can find the funds e.g. through grants and donations, they may be able to establish a company to run the surgery and employ GPs.
- Employees. Often referred to as the ‘John Lewis model’, the practice’s owners sell their shares to an employee-owned trust, free from capital gains tax.
Can the NHS prevent surgeries from collapsing?
The average of 50 closures per year between 2018 and 2020 is an excessive and avoidable rate, and the NHS and government can address that.
Stop imposing unreasonable contracts
It would be an understatement to say that the latest imposed contract was contentious. Its emphasis on stringent patient access targets and lack of support for GPs is likely to push out any primary care professionals who were already thinking about leaving their roles. It is not wise to increase the pressure on GPs when stress and burnout are already increasing the shortage.
Make the job appealing to retain and recruit more GPs
Better pay would be welcome and fair, but it would be a slow, bureaucratic, and politically charged process to get there. It is, however, inexpensive and impactful to give GPs credit for the hard work they do, rather than leaning in to the false media narrative about doctors who choose to live an easy life rather than caring for the patients who need them.
Offering esteem and thanks rather than criticism and pressure would at least stop some GPs from becoming so demoralised that they quit, and would discourage fewer doctors from the GP pathway.
If your partnership is in danger of collapsing for any reason, please speak to your LMC and your commissioner. Their support could ensure that you resolve the issues before crisis point, and prevent your liabilities from presenting serious personal risk.
For our part, MCG Healthcare will always champion GPs, practice managers, and their colleagues in primary care, and continue to work to match healthcare workers with practices where they will flourish.
If you’re a GP looking for your next salaried, partner, or locum role, or a practice hoping to fill a vacancy, call 0330 024 1345 or email hello@mcghealthcare.co.uk.
