Britain's disappearing GP surgeries: A special report | Top Doctors UK (2024)

Across the UK, aprofound transformation is taking place. GP surgeries – one of the few gatewaysto healthcare – are shutting down at an increasing rate. Some are merging intolarger practices,others simply ceasing to exist. In 2018 alone, 138 GP surgeries closed their doors. With patient numbers continually on theincrease – there are now almost 60 million patientsregistered with a GP – andthe result is that GP patient lists have ballooned.

For those who havetried to book a GP appointment recently, this news comes as no surprise. Manyof us have become accustomed to the 8am phone rush to book same-day slots,freed up by other patients’ cancelled appointments. Those who cannot secure asame-day appointment face increasing wait times. According to figures releasedby the NHS, one in five patients now has to wait over two weeks to see theirGP.

Although the closure of GP practices has been well-covered in the national news, there has so far been very little analysis of how declining access to primary care is playing out geographically. GP surgeries are disappearing in dense urban areas and driving up patient lists, but they are also disappearing from small villages and towns. As a result, the UK is increasingly home to “dark spots” of care where the nearest GP surgery is now many miles away.

Using Catalyst data provided by the NHSBusiness Services Authority, we have been able to visualise the changing faceof GP access across Britain for the first time. The maps below compareEngland’s GP surgeries in January 2014 with April 2019:

Mapping GP surgeries in this way reveals a stark picture of the state of primary care in England. The red parts of the 2014 map indicate the GP practices which have since ceased to operate. Although many more surgeries have closed within the UK’s biggest cities, this map aims to highlight which areas have been left without a nearby GP surgery as a result of the recent closures.

In total, more than 1,000 GP surgeries have closed over the last five years. Back in January 2014, England had a little over 8,000 GPs across the country. As of April 2019, that number had fallen to 6,914.

It’s clear that areas such as Devon, Cornwall and Somerset have been the most severely affected, whereas parts of Cumbria and Northumbria have had significant dark spots in GP provision for a number of years. You can compare the two periods yourself by hovering over the map below:

The impact of GPclosures in rural areas is an important factor to consider when looking at howaccess to healthcare is changing. For someone managing diabetic foot, highblood pressure, or an infection, easy and regular access to a GP is vital. Inmany rural areas, the closure of the local GP service has been compounded by theclosure of essential local bus routes, with 7.8% of all rural bus routes cut since2014. These routesoften served as lifelines to the elderly, disabled, or those otherwise unableto drive – populations who arguably need access to healthcare the most.

The problem is that whilethere is a GP recruitment crisis across the country, the hardest areas to recruit for arerural areas. Due to thesmall and disparate nature of the local population, it is also harder for GPsto stay afloat by pooling resources and undergoing practice mergers – a commonstrategy in larger towns and cities.

So what does thefuture look like for healthcare provision in local areas?

Remote consultation to the rescue?

A lot of noise hasbeen made lately over the NHS’s plan to give every patient in England theright to a remote consultation within the next five years. This would allow patients to speak to theirGP using a service similar to Skype or Facetime.

If this goal isachieved, the way we access our GP could change dramatically. Already, patientsliving in certain areas of London are eligible to sign up to GP At Hand, a service that lets you video call a GP atany time of day. The GP At Hand homepage features a number of reviews frompatients praising the speed with which they were able to speak to their GP.Babylon, the company behind GP At Hand, hopes to roll out the service acrossthe UK in the next few years.

Other organisationspromise to bypass GP surgeries entirely and connect patients directly withspecialist consultants. Top Doctors, for example, is currently the only company inthe UK enabling patients to consult with specialists through video conferenceor live messaging. For those patients living a significant distance from theUK’s top hospitals and clinics, this may be the fastest way to see aconsultant.

Still, remoteconsultations have their limits. Currently, there’s no way to conduct aclinical examination over video chat or take a blood test. Moreover, we are yetto see comprehensive outcome data comparing remote consultations withface-to-face appointments. Until we know that remote consultations result incare that is as good as or even better than face-to-face appointments,widespread adoption is unlikely.

The UK’s health system stands to benefit hugely from the latest technological innovations. But it will take some time to get there. Meanwhile, the lights are going out in GP surgeries across the country – and many people risk being left in the dark.

How the data was gathered:

• We used Catalyst data on GP practices, filtering out practices which don’t have a patient list. These are generally other practices which prescribe medication but aren’t GP practices.
• The data covers only GP practices in England, not Scotland, Wales or Northern Ireland.
• These were plotted on a map. The whole of England is shaded according to the distance to the nearest GP practice.