Consequences of the closure of General Practices: a retrospective cross-sectional study

Abstract

Background: Two general practices close every week in the UK. Given the pressure on UK general practices, such closures are likely to persist. Yet we know little about the consequences. Closure refers to when a practice ceases to exist, merges or is taken over. Aim: Does practice funding, list size, workforce composition and quality change in surviving practices, when surrounding general practices close? Design and Setting: Cross-sectional study of English general practices, using data from 2016-20. Method: The exposure to closure for all practices existing on 31.03.2020 was estimated. This is the estimation proportion of a practice’s patient list that had been through a closure in the preceding three years, between 01.04.2016 and 31.03.2019. The interaction between our exposure to closure estimate and the outcome variables (list size, funding, workforce and quality) was analysed through multiple linear regression, whilst controlling for confounders (age profile, deprivation, ethnicity and rurality). Results: 694 (8.41%) practices closed. A 10% increase in exposure to closure results in 1925.6 (1675.8, 2175.4) more patients in the practice with £2.37 (£4.22, £0.51) less funding per patient. Whilst numbers of all staff types increased, there were 86.9 (50.5, 123.3), 4.3%, more patients per GP. Increases for other staff types were proportionate to increases in patients. Patient satisfaction with services declines across all domains. No significant difference in QOF scores was identified. Conclusion: Higher exposure to closure was leading to larger practice sizes in remaining practices. Closure changes workforce composition and reduces patient satisfaction with services.