Exclusive:GP practices may go bust amid 'perfect storm', warn doctors

GP practices in the Lothians may be forced to close as they struggle to withstand a "perfect storm" engulfing the sector, Scotland on Sunday has been told.

Dr Andrew Forder, chair of the Lothian Local Medical Committee (LMC), said the situation was "without question, the worst I've ever known it to be". 

He said some GPs are even looking into restructuring their businesses "so that if they go bust, their houses don't get taken". 

GPs are facing burnout and the risk of insolvency, doctors have warned | PA

Dr Forder said: "Colleagues are facing profound moral injury and burnout and this is compounded by the very real risk of insolvency. Many are now exploring how to restructure their businesses with one eye on the possibility of having to close."

Doctors point to a range of issues affecting the sector, including an inadequate core contract, which they said had failed to deliver the intended benefits.

An increase in facilities management fees charged by NHS Lothian is also causing serious financial concern.

Dr Forder said more than half of all practices in the Lothians operate with a service level agreement (SLA), in which the premises are maintained and looked after by the health board. 

It was previously agreed that a planned increase in payments would be phased in over three years, with a hike due to come into place from this April and again the following year.

"As that reaches its full cost, a number of practices are facing tens of thousands of pounds of additional expenses," Dr Forder said. "I think one is perhaps almost touching on six figures of additional cost. At that level, with no means to increase your income, your only option then is to reduce your costs by that much."

Matt Bulkeley, chair of the Lothian Association of Sessional GPs (LASGP), said the impact of this increase on practices will be "enormous", adding: "It may lead to some practices closing. It certainly impacts the ability to recruit and for many they are not replacing staff that leave just to pay this bill."

Dr Forder said practices are facing a "triple whammy" this April, with the increase in SLA charges, the hike in National Insurance and recent changes to enhanced services. The latter are additional services that practices are commissioned to provide by their health board.

Dr Bulkeley said: "I don't believe there is one solitary factor, more a perfect storm."

Dr Forder said the current funding system for GPs is "inadequate", and called for more money to be invested into general practice.

He said most GP practices operate under a partnership model, adding: "I know a few of them now are looking at becoming limited liability partnerships, so that if they go bust, their houses don't get taken.

"At the point where practices are restructuring their business with the expectation that they might fail - I've never seen it to that degree. I've heard talk about it, and I've heard people saying they might do these things. But people are actually doing them now.

"A lot of people, if a GP leaves they just don't replace them; if a receptionist leaves, they don't replace them. Again, I've heard talk of these things before, but not seen them happening. We've done that, I know others have done that."

A survey by LASGP previously found locum GPs are considering leaving the NHS or moving abroad because they are struggling to find work in Scotland.

Locums fill temporary positions to cover absences, maternity leave or shortages. However, the funding crisis is leaving surgeries without the necessary money to employ more GPs, doctors say.

Dr Bulkeley said: "Between now and October there is one day's or two sessions' work on our jobs board at present. In context, last August there were 171 sessions unfilled. The turnaround has been rapid and stark."

He added: "I just keep coming back to how many more appointments/patients could be seen. How many cancer presentations are delayed. How many patients end up in A&E who don't need to be there but end up delaying the treatment of those that do."

Tory MSP Jeremy Balfour, who represents the Lothian region, said: “These eye-opening accounts lay bare the catastrophic situation facing GP services in the Lothians on the SNP’s watch.

“Their dire workforce planning and chronic levels of underfunding has pushed practices beyond breaking point. Patients who are already struggling to access their GP will pay a heavy price if closures ultimately happen.

“Neil Gray as SNP health secretary cannot ignore this issue any longer. He must urgently address these frontline concerns and ensure that primary care finally has the resources it needs to sustain services for patients.”

Jackie Baillie, Scottish Labour’s health spokeswoman, said: “For most people GPs are the front door to our NHS, but too often getting an appointment is a struggle. General practice is stretched to breaking point and the SNP is failing to deliver on its pledge to boost GP numbers.

“The SNP must work with GPs to chart a way forward that delivers for patients and supports services – from delivering on their staffing pledges to ensuring the GP contract is fit for purpose.”

A Scottish Government spokesman said: “We are significantly investing in general practice and our Budget will provide a record £21.7 billion for health – with £2.2 billion for primary care to improve preventative care in the community.

“GPs play a vital role in our health service and we are investing an additional £13.6 million in general practice this financial year to support GPs to retain and recruit key staff. We are also investing a further £10.5 million through our Budget for GPs to provide targeted support on cardiovascular disease and frailty prevention.

“The UK Government’s rise in employer national insurance could leave our public services, including primary care, facing up to £500 million in extra costs if not fully reimbursed. The Health Secretary has written to his UK Government counterpart on this matter.”

Jenny Long, director of primary care at NHS Lothian, said: “In 2022/23, facilities management charges for GP practices, who contract services from NHS Lothian, were reviewed to ensure they covered significant rises in inflation, energy, staffing and other supply costs.

“Costs to practices had been frozen for some years, which was no longer sustainable due to the substantial increase in actual costs. A phased adjustment to practice charges was introduced to help manage the cost increases to bridge this gap.

“Our aim is to provide facilities management, including cleaning, utilities and essential services relating to each GP practice building’s physical structure, such as reactive maintenance and ongoing repairs, at a fair cost specific to each practice’s needs and use. Practices are responsible for the costs of the services they receive.

“NHS Lothian remains engaged with the Local Medical Committee, the Scottish Government, and individual GP practices to ensure they are supported throughout this transition. We encourage practices to discuss any issues with our land and property team, but systems are also in place for those who feel particularly at risk to raise concerns.”