GP surgery closures across the UK have reached an all-time high, affecting an estimated half a million patients last year, research has found. An investigation by the medical website Pulse found 138 doctors’ premises shut their doors in 2018, compared with 18 in 2013.

GPs said under-resourcing and recruitment difficulties were forcing surgeries to close. They said many smaller practices were merging with others to survive, which allowed them to avoid having to disperse their patient list to other practices much further away.

Data released by 186 out of 217 clinical commissioning groups and health boards, following freedom of information requests, revealed that smaller surgeries – those serving 5,000 or fewer patients – were the worst affected in 2018, accounting for 86% of closures.

Pulse calculated that last year’s closures affected about 519,500 patients. Thirty-one of the 138 surgery closures in 2018 came as a result of mergers, the figures showed, which affected an estimated 161,126 patients.

Prof Helen Stokes-Lampard, chair of the Royal College of GPs, said the figures were sad but unsurprising. “GPs and our teams are working to our absolute limits to provide safe, high-quality care, while general practice is under intense pressure, and this is resulting in some GPs leaving the profession, and in other cases forcing them to close their surgery doors,” she said.

“In some areas, practice closures are the result of surgeries merging or joining federations in order to pool their resources and provide additional services in the best interests of their patient population.”

Stokes-Lampard said it was heartbreaking for everyone when surgeries closed, but especially for patients, many of whom had to travel long distances to a new surgery and get to know new teams, something that was particularly difficult for more vulnerable people.

Dr Jackie Applebee, a GP and the chair of the Tower Hamlets local medical committee, said: “The system is creaking. The smaller practices – which patients prefer and which have good outcomes – are being lost because of the under-resourcing.”

Dr Alan Woodall, chair of the pressure group GP Survival, said the merger of practices was “a sticking-plaster solution” that was often used as a cover for the closure of branches.

NHS England said it did not recognise Pulse’s figures. “In England there were fewer practice closures and patient dispersals in 2017/18 compared with 2016/17 and we continue to support all general practices to help them thrive,” it said. “Thousands of practices continue to be helped through the GP resilience programme, where investment has been increased from a planned £8m in 2019/20 to £13m.”

NHS England’s figures are for England alone and cover the financial year, whereas Pulse’s figures are for the whole of the UK and cover calendar years.

NHS England’s figures show that while the number of practice closures fell in 2017/18, the overall number of closures of GP contracts was up, due to the high rate of mergers. There were 179 closures of GP contracts in 2017-18, compared with 107 the year before. Of all the 2017/18 contractual closures, 62% (111) were due to mergers and the remaining 38% due to practice closures. In 2016/17, 23% (25) contractual closures were due to mergers and 77% to closures.

Pulse argued that measuring site closures was a more revealing measure of how pressure on services was causing disruption to patients, as many were being forced to travel longer distances for medical care.

Pulse’s closure figures add to recent research detailing staff shortages and a rising demand for care within the NHS. Analysis by the Nuffield Trust earlier in May found that the number of GPs per 100,000 people had shrunk from nearly 65 in 2014 to 60 last year, the first time this had happened since the 1960s.

Pulse published a survey of family doctors in May showing that GPs were seeing up to 60 patients a day, double the number they considered safe. Doctors reported working an average 11-hour day, seeing patients for eight hours of that time.

Another recent report from the Royal College of GPs said the 10-minute appointment that was usual across the NHS was no longer adequate, given the growing number of people who have several long-term illnesses.

Figures from NHS Digital, released on Thursday, showed there were 312 more family doctors working in England in March this year compared with the same time last year. Dr Nikki Kanani, acting director for primary care for NHS England and a London GP, said: “While the GP numbers show some encouraging signs, recruiting, retaining and supporting more doctors into practice remains an absolute priority for us.”

‘We gave the staff six month’s notice and walked away’

Philip gave up his GP surgery in Brighton after 26 years in 2016. “The money was just falling away,” he said. “We couldn’t afford the staff and we worked from this really lovely house which needed a new floor and no one would help us with that.”

He and his partner were looking after 6,500 patients between them and working all hours of the week, said the 59-year-old. “You couldn’t see the wood for the trees. It was like being on a hamster wheel … I told my partner I’d had enough and I was going to leave and he said he’d go too. We gave the staff six month’s notice and we walked away.”

Philip’s story is not uncommon. According to research by the medical website Pulse, 138 doctor’s premises shut their doors in 2018, compared to just 18 in 2013. The data revealed smaller surgeries – those serving 5,000 or fewer patients – were the worst affected in 2018, accounting for 86% of closures.

Leyla, a GP in her 40s and a partner at a surgery in Manchester, said she felt stuck as she was too old to do locum work and too young to retire. “I’ve been a partner for 14 years,” she said. “I owe it to the patients who I’ve looked after for all these years to keep the practice going, but at the same time it’s becoming so difficult because I just don’t have the manpower around me.”

“If I gave up, I think the practice would close because we’ve been trying to recruit doctors for months and nobody’s coming forward. It’s too stressful and the workload is too high,” she said. “We’re doing the work of five or six partners between three of us. Why would anyone come into this mess?”

Leyla said her practice had been approached by other struggling practices that wanted to merge. “How can we take on more patients when we don’t have enough doctors for our own patients? Struggling practices coming together doesn’t make them any better.”

* Names in this article have been changed