
A record 138 GP surgeries shut down last year as millions struggled to secure appointments.

They closed at the rate of more than two a week, affecting more than 500,000 patients.

As recently as 2013, just 18 surgeries shut across the UK. By last year that number had increased nearly eight-fold, according to figures released today.

It means that over the last six years, 585 practices have gone – covering a population of nearly 1.9million.

More GP surgeries are shutting down than ever before as shocking figures show 138 closed their doors in 2018, a stark rise from 18 in 2013

Areas around the world have been affected by the closure. Pictured are the top ten hardest hit regions, with North Hampshire ranking number one, with almost 62,000 patient affected

The closures come just as pressure on GPs is increasing because the population is both growing and ageing.

Experts believe the rate of surgery closures is accelerating because rising numbers of under-pressure doctors are opting for early retirement – or deciding to abandon their careers.

At the same time, managers are finding it much harder to fill the empty posts and in many cases have no choice but to permanently shut their doors, or merge with another surgery.

THE 10 AREAS WITH THE HIGHEST AMOUNT OF AFFECTED PATIENTS The following are healthboards or CCGs with the highest amount of patients affected by a branch closure or merger. 1. North Hampshire: 61,973 2. Aneurin Bevan University Health Board: 29,476 3. Betsi Cadwaladr University Health Board: 21,594 4. Ipswich and East Suffolk: 20,591 5. Walsall: 16,422 6. Brighton and Hove: 15,819 7. Dudley: 14,370 8. HSCNI, Northern Ireland: 12,440 9. Dorset: 11,922 10. Mansfield and Ashfield: 11,088 10. Gloucestershire: 11,088 Advertisement

Last night, patient groups and GP leaders described the trend as 'incredibly serious', particularly for the elderly and those reliant on public transport.

Pressures on GP services are higher than ever. Since 2013 the number of people living in the UK has soared from 64million in 2013 to nearly 67million.

But the number of GPs has not kept pace, making it harder and harder for patients to secure appointments.

Separate data yesterday showed that the NHS actually lost a net 441 fully-qualified GPs in the last year.

Meanwhile, further surgery closures are planned for the coming weeks in Birmingham, North London, Coventry, Oxfordshire, Cornwall and Dorset.

Patients hit by closures usually have to register with a new practice, which may be further away and involves a complicated journey by public transport.

Data obtained by Pulse magazine using Freedom of Information requests showed that 138 surgeries closed in the UK in 2018, affecting an estimated 519,500 patients. That had risen from 134 in 2017 and compares to 18 in 2013, according to responses from 186 Clinical Commissioning Groups – local health trusts.

There are no official figures on whether any new surgeries are opening up but GP sources stressed that this was unlikely, and numbers would be minimal.

A fifth of the closures in 2018 involved mergers where smaller organisations are taken over by larger ones nearby to form super surgeries. These can still be hugely disruptive for patients.

Rachel Power of the Patients Association, said: 'Patients will be right to feel alarmed. Many may be left wondering if their practice might be next. It's particularly concerning to see smaller practices being forced to shut up shop.

'Many of their patients will have built strong relationships with their family doctor over many years. These closures could leave patients facing long waits, and push more towards A&E – which we know is under severe pressure itself.'

The Cornish fishing village of Mevaigassy is set to lose their only current GP as a wave of closures sweep across the UK

Professor Helen Stokes-Lampard, chairman of the Royal College of GPs said: 'These figures are sad but, unfortunately, not surprising.

'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 doors.

'In some areas, closures are the result of surgeries merging or joining federations in order to pool their resources and provide additional services.

'But when a practice closes … it's heartbreaking for everyone involved, especially those patients who have to travel long distances to their new surgery and get to know new teams.'

Dr Richard Vautrey, chairman of the British Medical Association's GP committee said: 'These figures clearly show the increased pressure that practices have been under over the last decade, as workload mounts, more doctors leave and surgeries struggle to recruit new staff.'

The BMA has warned that growing numbers of GPs and consultants are taking early retirement or cutting back on work to avoid hefty pensions taxes which make it uneconomic to continue practising. Retiring GPs often create a domino effect by leaving remaining colleagues with more work, who in turn become demoralised and quit.

The problem has been compounded by the fact that more doctors are now working part-time.

Data from NHS Digital showed the number of qualified, full-time GPs fell from 29,190 in March 2018 to 28,697.

NHS England, which runs the health service, said it 'refuted' the Pulse figures. It pointed to its own data which suggested the pace of closures was slowing. A spokesman said: 'In England there were fewer closures and patient dispersals in 2017/18 compared with 2016/17.

'Thousands of practices continue to be helped through the GP resilience programme, where investment has been increased from a planned £8million in 2019/20 to £13million.'

HOW MANY PATIENTS WERE AFFECTED DUE TO CLOSURES OR MERGERS IN EACH OF THE CCG OR HEALTHBOARDS? CCG/health board/local area team Country Total number of patients affected in 2018 Aneurin Bevan University Health Board Wales 29,476 Ashford England 3,696 Barking and Dagenham England 2,738 Barnet England 4,790 Basildon and Brentwood England 6,233 Bath and North East Somerset England 6,000 Berkshire West England 8,500 Betsi Cadwaladr University Health Board Wales 21,594 Bexley England 1,000 Birmingham and Solihul England 2,195 Blackpool England 3,696 Brent England 9,548 Brighton and Hove England 15,819 Buckinghamshire England 3,500 Calderdale England 2,063 Cardiff and Vale UHB Wales 3,696 Castle Point and Rochford England 8,597 Croydon England 3,644 Dorset England 11,922 Dudley England 14,370 East Lancashire England 5,930 East Leicestershire and Rutland England 360 Erewash CCG England 7,392 Fylde and Wyre England 3,696 Gloucestershire England 11,088 Halton England 313 Harrow England 3,696 Havering England 2,450 Herts Valley England 5,897 HSCNI N Ireland 12,440 Ipswich and East Suffolk England 20,591 Leeds England 5,566 Leicester City England 2,986 Lewisham England 4,957 Lincolnshire West England 1,706 Liverpool England 10,777 Mansfield and Ashfield England 11,088 Newcastle Gateshead England 6,840 Newham England 5,440 NHS Ayrshire and Arran Scotland 7,487 NHS Dumfries and Galloway Scotland 2,319 NHS England did not specify England 28,161 NHS Greater Glasgow and Clyde Scotland 5,729 NHS Lanarkshire Scotland 1,300 NHS Lothian Scotland 5,447 North - Yorkshire and Humber West Yorkshire England 3,696 North Cumbria England 4,200 North Derbyshire England 7,392 North East Essex England 3,000 North Hampshire England 61,973 North Tyneside England 4,500 Northumberland England 4,804 Nottingham City England 3,661 Nottingham West England 3,521 Redbridge England 4,981 Redditch and Bromsgrove England 2,298 Sheffield England 2,316 Shropshire and Staffordshire England 7,392 South Kent Coast England 3,696 South Tees England 5,402 Southend England 5,257 Southwark England 2,200 St Helens England 2,395 Sutton England 2,253 Swale England 1,767 Swindon England 3,696 Tameside and Glossop England 3,696 Tower Hamlet England 6,532 Vale of York England 3,696 Wakefield England 3,696 Walsall England 16,422 West Essex England 6,795 West Kent England 4,920 Wolverhampton England 1,500

Diary of a GP driven to despair: With 37 patients, 168 prescriptions and 40 blood tests in a ten-hour shift, it's no wonder so many doctors want to quit

How tough is a GP's workload? We asked one, based in the West Midlands, to keep a diary of her typical working day...

8.40am

GPs are being driven to despair by their tough workload which is contributing to the crisis in UK surgeries [File photo]

I'm one of eight GPs who, along with four registrars (GPs in training), look after 17,500 patients — about average for all practices in the UK.

Most appointments are given out on the day. I arrive at the surgery a few minutes before it opens.

8.45am

The doors open. My first appointment is with a lady suffering debilitating migraines. I first check she doesn't have a brain tumour, examine the backs of her eyes and take her blood pressure.

She's on antidepressants, so cannot be given the standard migraine medication. Nor can she have an alternative because she's asthmatic.

Her case takes longer than the ten minutes an appointment is supposed to last. Already I'm running late.

9.20am

The second patient is a much simpler case but I'm further delayed because the practice nurse asks me to look at a patient's skin lesion she's worried about.

It looks like early melanoma so we refer the patient to a local rapid- access cancer clinic.

Three further appointments — including a woman who needs a vaginal examination, which always takes longer than the allotted ten minutes.

10.15am

Macmillan Cancer Support phone to discuss a dying patient who urgently needs end-of-life medication.

It takes a few minutes to fill out the prescriptions and the authorisation form.

I find dealing with bereavement and palliative care increasingly difficult and often need to take a few minutes to refocus.

10.45am

Two patients later, there is an unexpected case: an asthmatic who's disturbingly short of breath. He doesn't have an appointment but needs emergency treatment.

I give him oxygen and medication — and ask a healthcare assistant to monitor him at the surgery.

11.00am

I'm only able to see three more people before I am interrupted again. Our receptionist is struggling to calm down a patient who wants a repeat prescription.

It would take too long to discuss the case in my office so I instruct the receptionist to deal with him instead.

One of the reasons a record number of surgeries is closing down is because many GPs are changing profession due to their workload

11.05am

Four more patients follow, including one who's suffered two mini-strokes and needs to go to hospital. I organise a referral letter and call A&E.

11.53am

Sign a prescription script for insulin: 'Patient forgot to order, leaving for holiday in an hour.'

Frustrating, this steals precious minutes that could be used more productively.

11.55am

Patient appointments should have finished 55 minutes ago but I still have six phone consultations with patients who can't make it to the surgery.

Each should last five minutes. Of the six, one concerns me. A woman complaining of experiencing 'dark thoughts' doesn't answer my three attempts to call her. Worried, I ask the team to keep trying.

12.20pm

The pharmacy has sent a customer with learning difficulties for me to examine.

She has shingles and I book her another appointment for a few days' time.

12.35pm

Morning surgery finishes an hour later than it should, which is typical. I still have four complex tasks to complete with the practice pharmacists, three sick-note requests and three questions from our healthcare assistants about patients' blood pressure problems.

These often require me to review notes, issue prescriptions and decide on any further treatment.

12.55pm

Time for the 'team natter' — the part of the day I most look forward to. Being a GP can be very isolating, so each day we meet in the library for a cup of tea and tackle prescriptions and queries together.

In total, I sign 168 repeat prescriptions and deal with 35 prescription queries.

1.45pm

Time to start home-visits. Luckily, today I only have one: an elderly gentleman with breathing problems caused by lung and heart disease.

He has pneumonia and some heart failure. He could go to hospital for treatment but since he lives with his family, I know he's in good hands.

2.30pm

Back at the surgery, I have 80 blood test results to work through. I manage 40 but leave the rest until tomorrow, otherwise I'd be here until 8pm.

3.10pm

Time for a quick packed lunch.

3.30pm

Next up: assessing the list of patients who've been referred to me. I prioritise four, deciding the rest can wait a few days.

To be an efficient GP you need to know what work needs doing and which can wait.

3.50pm

Evening surgery starts. I deal with a range of problems from child who's a fussy eater to a man with painful genitalia and a woman allergic to hair dye.

I also see a domestic violence victim. Understandably, it takes some time for her to open up. She says her partner is controlling her money so I refer her to the food bank and social services.

Another patient asks me about CBD oil, which contains a chemical found in cannabis.

Many people have read about this and are led to believe it is a magical cure for every disease. It's not.

I have to tell two other patients that I'm busy and they'll have to book another appointment at the surgery.

6.20pm

My last patient of the day fails to turn up. I should be annoyed about them wasting the time but secretly I am grateful because I've been so busy.

I finish evening surgery ten minutes late.

Finally, I read through about 30 documents sent by the hospital, all of which require a range of actions — from reviewing symptoms to checking scan results.

6.45pm

Time to leave. I have three health insurance and two disability benefits reports to complete plus a request from a prison asking for medical information on a patient — but these can wait until tomorrow.

I remind myself that while I'm exhausted, every day is worth it as GPs have an overwhelmingly positive impact on patients.

Villagers are campaigning to save their local surgery after it emerges the practice will close if a new GP can't step in when the current doctor retires in July

Patients in a remote Cornish fishing village are desperately campaigning to find a GP.

The only doctor at the Mevagissey surgery is leaving in July and unless she can be replaced, it will close.

There are 5,300 patients in the village, near Saint Austell, many of whom are elderly and unable to drive.

They have started a 'Will You Be My GP' campaign on social media in the hope of attracting a doctor.

The only doctor at the Mevagissey surgery is leaving in July and unless she can be replaced, it will close, with many residents starting a campaign

Resident Nicola Mason said: 'Me and my son both suffer from severe asthma and require quite frequently the aid of a nebuliser that we can pop down and use as soon as possible when we need it.

'This is – and has been – a life saver to us. Without the surgery we will face longer travel and have to wait to get life-saving treatment.'

Ken Sweet, 86, who lives nearby, but was born in Mevagissey, said: 'My wife and I have been patients for 30 years and it's difficult to get into another surgery.

'As you get older you need more regular care and it's very worrying we might not be able to get it.'