Why Is Your GP Surgery Merging? A Practice Manager Explains

Seeing that small-print notice taped to the reception desk or receiving a letter in the post can be unsettling. “Your GP surgery is merging with…” The words immediately spark concern. Will I still be able to see my doctor? Will I become just another number in a giant, faceless organisation? Will my medical history get lost in the process? These are completely valid worries, especially when you have built a relationship of trust with a small, familiar practice over many years. Many assume these mergers are corporate takeovers, driven by a desire for profit or efficiency at the expense of personal care.

From my perspective as a Practice Manager, I want to offer a different view. For the vast majority of local surgeries, merging isn’t a choice driven by ambition, but a crucial survival strategy. It’s a proactive step we take to protect the very existence of your local primary care services against a backdrop of immense system-wide pressures. The goal is not to lose that personal touch, but to build a stronger, more resilient foundation that can provide you with better, more comprehensive care for years to come. It’s about enhancing our operational resilience so we can be there for you when you need us most.

This article will walk you through the reality of why your small, friendly surgery needs to evolve. We’ll look at the stark financial pressures, how a larger team can actually improve your access to care, what it means for your relationship with your doctor, and the practical steps you can take to navigate this change smoothly. My aim is to demystify the process and reassure you that at the heart of this decision is a commitment to the long-term health of our patients and our community.

To help you understand the different facets of this change, this guide explores the key questions and concerns that arise when GP practices join forces. The following sections break down everything from the financial realities to practical tips for managing your appointments in the new system.

Why Small GP Practices Are Going Bankrupt in 2024?

The image of the friendly, single-GP practice is a cornerstone of the NHS, but it’s becoming an endangered species. The simple reason is that the financial and operational model for small practices is breaking down. The pressures of rising operational costs, staff recruitment challenges, and the increasing complexity of patient needs are creating an unsustainable environment. This isn’t a new phenomenon; a study found that between 2013 and 2020, 694 practices (8.41% of the total) closed their doors, unable to cope. The trend has only accelerated since.

A core part of the problem lies in the funding model. Practices receive a set amount of money per registered patient per year to cover everything: staff salaries, building maintenance, utility bills, medical supplies, and insurance. This figure is surprisingly small. For example, the weighted average NHS funding model allocates around £99.70 per patient to a practice annually. For a small surgery with 2,000 patients, this provides a tight budget that leaves little room for unexpected costs or investment in new services. When a GP partner retires, finding a replacement willing to take on the financial risk and workload of a small, isolated practice is incredibly difficult.

This escalating pressure is why the rate of closures is so alarming. A 2023 study published in the British Journal of General Practice revealed that on average, two GP practices are closing every week in the UK. Merging becomes a question of survival. By combining resources, practices can share the crippling overheads of rent, IT, and administrative staff. It creates the operational resilience needed to withstand financial shocks and ensures that clinical services for the local community don’t disappear entirely.

How to Access Physiotherapy Without Seeing a GP First?

One of the most immediate and tangible benefits of a practice merger is the improved access to a wider range of healthcare professionals. This concept, which we call skill mix enhancement, is designed to get you to the right expert faster. A prime example is physiotherapy. Musculoskeletal issues like back pain, neck ache, and joint problems are incredibly common, accounting for around one in five GP appointments. In the past, the only route was to see a GP for a referral, adding delays to your treatment.

Larger, merged practices now have the scale to embed First Contact Practitioners (FCPs) directly within the team. These are advanced physiotherapists who act as the first point of contact for muscle and joint problems. As part of a national initiative, NHS England announced its plan for 100% coverage by 2024, meaning every adult should be able to self-refer to an FCP via their GP practice. This is a game-changer for getting rapid, specialist advice.

The process is simple and bypasses the need for a GP appointment entirely. Here’s how it works:

1. Contact your practice: Instead of asking for a GP appointment, tell the receptionist you have a muscle or joint problem and would like to see the First Contact Practitioner.
2. Get assessed: The FCP has the advanced skills to assess, diagnose, and provide a treatment plan. They can recommend exercises, provide hands-on therapy, and even prescribe certain medications or order diagnostic tests.
3. Direct referral if needed: If your condition requires further specialist care, the FCP can refer you directly to services like Orthopaedics or Rheumatology, streamlining your entire care journey.
4. Safety is paramount: FCPs are highly trained to spot ‘red flag’ symptoms that might indicate a more serious underlying medical issue, ensuring you are quickly directed back to a GP if necessary.

Personal Doctor vs Multi-Disciplinary Team: Which Offers Better Care?

The biggest fear for many patients is losing their ‘personal doctor’—the GP who has known them for years. It’s a valid concern. However, the reality of modern healthcare is that the traditional model is under strain. As smaller practices close, the patient load on surviving ones increases significantly; a retrospective study found that when practices close, it leads to an average of 86.9 more patients per remaining GP. This pressure makes it increasingly difficult for one doctor to be all things to all people.

This is where we must distinguish between continuity of carer (seeing the same person every time) and continuity of care (ensuring your treatment journey is seamless, consistent, and well-managed by a team). While the former is becoming harder to guarantee, mergers are specifically designed to strengthen the latter. A multi-disciplinary team brings a wealth of expertise under one roof. Your care might be handled by a GP, a clinical pharmacist for medication reviews, an advanced nurse practitioner for chronic disease management, or a physician associate for diagnostics. Each professional brings a specialised skill set that your single GP may not have.

A successful case study from Telford illustrates this perfectly. Three practices merged to form Teldoc, covering 45,000 patients. The primary driver was sustainability. Post-merger, they could offer a much broader range of services that were impossible for the individual practices to provide alone, including dedicated minor surgery clinics and in-house musculoskeletal expertise. This demonstrates how the combined skill mix enhancement of a larger team directly translates into better, more comprehensive services for patients. You might not always see the same face, but the team collaborating on your health is more powerful and capable.

The Admin Error That Happens When GP Practices Merge Databases

One of the most technically challenging aspects of a merger is combining separate patient record systems. It’s a complex process, and despite our best efforts, errors can occasionally occur. This is a major point of anxiety for patients, and rightly so. You need to be confident that your medical history, allergies, and medication list are accurate. Unfortunately, inaccuracies are not uncommon, even without mergers. A 2025 report revealed that 26% of patients report wrong personal details and 16% find inaccurate medication information in their records.

A merger is a critical moment where these issues can be compounded if data isn’t migrated perfectly. An old address might reappear, a resolved allergy might be listed as current, or the dosage of a medication could be recorded incorrectly. While practices have rigorous checking procedures in place, the sheer volume of data means patient vigilance is an invaluable safety net. We actively encourage you to become a partner in ensuring your record’s accuracy during this transition.

The good news is that accessing and reviewing your own record has never been easier. Taking a few minutes to do this after a merger is the single most effective thing you can do to ensure your safety and continuity of care.

When Is the Best Time to Call a Large Practice for Same-Day Appointments?

The infamous “8am scramble,” where dozens of patients frantically call the practice at once to secure a same-day appointment, is a source of immense frustration for everyone. It’s stressful for you and overwhelming for our reception team. A key reason practices merge is to gain the resources and technology to end this outdated and inefficient system. The answer to “when is the best time to call?” is increasingly becoming “you don’t need to call at all.”

Larger practices are rapidly adopting modern online triage systems. Instead of phoning, you fill out a simple online form at any time during core working hours, outlining your symptoms and request. This form is then reviewed by a clinical team (often a GP or an advanced nurse practitioner) who can direct you to the most appropriate care. This might be a face-to-face GP appointment, a phone call with a pharmacist, an appointment with the physio, or advice via a text message. This “digital triage” ensures that GP appointments are reserved for those who truly need them most.

This isn’t just a theory; it’s proving highly effective. The shift to digital is massive, as government data shows online GP appointment requests are surging, indicating patients are embracing this more convenient route. Furthermore, a case study of a London GP surgery that adopted an “always-on” online consultation approach saw dramatic improvements. Patient wait times for an appointment dropped from 14 days to just 3, and 95% of patients were seen within a week. The system significantly improved access while eliminating the 8am phone bottleneck. So, the best time to request an appointment is often first thing in the morning, but using the practice’s online form, not the phone.

How to Request a Referral for Integrative Medicine Within Your Trust?

As healthcare evolves, there’s a growing understanding that clinical treatments are only one part of wellbeing. Integrative medicine, which can include everything from mindfulness and health coaching to community-based activities and wellness support, plays a vital role. A common question is how to access these non-clinical services through the NHS. Many patients assume they need a formal referral from their GP, but this is often not the most effective route.

Merged practices, with their larger staff and closer links to the community, are better placed to support this holistic approach. They have dedicated team members whose entire role is to connect patients with this kind of support. This service is known as social prescribing. It’s designed to help you with the social, emotional, or practical issues that are affecting your health and that medicine alone cannot fix.

The key to unlocking this support is to know who to ask. Instead of booking a GP appointment to discuss a referral, the most direct pathway is through a different member of the practice team. As guidance from NHS England makes clear, the GP is not always the answer:

The best route isn’t the GP, but the Social Prescribing Link Worker whose entire job is to connect patients with non-clinical, community-based support.

– NHS England Primary Care Framework, First Contact Physiotherapy Service Guidance

To get started, simply contact your practice reception and ask for an appointment with the Social Prescribing Link Worker. They will have a dedicated conversation with you about your needs and will have an extensive knowledge of local charities, support groups, and council services that can help you. This is proactive healthcare in action—addressing the root causes of health issues, not just the symptoms.

Why GPs Can Only Address One Problem Per Appointment?

The “one problem per appointment” rule is perhaps one of the most misunderstood and frustrating policies for patients. It can feel restrictive and unhelpful, especially when you have several concerns. From a practice management perspective, however, this rule isn’t about being difficult; it’s a critical safety measure rooted in the reality of the 10-minute consultation.

A standard GP appointment is just 10 minutes long. In that short time, your doctor needs to listen to your story, take a relevant history, perform an examination if needed, consider potential diagnoses, formulate a management plan, explain it to you, write a prescription, and document everything accurately in your medical record. This is a huge cognitive load. Trying to address multiple, unrelated problems in that timeframe dramatically increases the risk of clinical error. A crucial detail could be missed, a serious diagnosis overlooked, or the wrong treatment prescribed.

For example, discussing a skin rash, new-onset chest pain, and a medication query in a single 10-minute slot is clinically unsafe. Each issue requires its own dedicated line of questioning and thought process. The one-problem rule ensures that your most pressing issue gets the full, focused attention it deserves. It also ensures fairness to other patients who are waiting for their appointment. If consultations regularly overrun because of multiple issues, the entire clinic runs late, causing long waits and stress for everyone.

If you have multiple issues, the best approach is to book a double appointment if the practice allows, or to focus on your most urgent problem first and book a follow-up for the others. This respects the clinical and time constraints we work under and is ultimately for your own safety.

How to Get the Most Out of a 10-Minute GP Appointment?

Now that you understand the constraints of a 10-minute consultation, the question becomes: how can you make that time as productive as possible? A little preparation can transform the appointment, ensuring you leave with a clear understanding and a solid plan. The key is to be focused, concise, and collaborative. By presenting your problem clearly from the outset, you help the GP to focus their clinical reasoning immediately, saving precious minutes.

Think of it as preparing a headline for your consultation. Instead of a long, chronological story, start with the single most important piece of information. Similarly, closing the loop at the end of the appointment by summarising the plan ensures there are no misunderstandings about diagnosis, treatment, or next steps. This simple technique, often called “chunking and checking,” is a powerful tool for patient safety.

Here are some practical steps you can take to partner with your GP and maximize every minute of your appointment:

• Prepare a one-sentence summary: Before you go, write down your main symptom, how long you’ve had it, and your biggest worry. For example: “I’ve had a sharp pain in my chest for three days, and I’m worried it’s my heart.”
• Start with your summary: Open the consultation with this powerful sentence. It immediately gives the GP the critical information they need to start their assessment.
• Stick to one problem: Focus on your main issue. If you have a second, related problem, you can try to link them (e.g., “While we’re discussing my tiredness, I’ve also felt quite low in mood – could they be connected?”). Avoid bringing a list of unrelated complaints.
• Recap at the end: In the final minute, confirm your understanding. Say something like, “So to confirm, you think this is muscular, I should take this prescription for five days, and book another appointment if it’s not better by Monday?”
• Plan for routine reviews: If you have a long-term condition, book your routine review appointments well in advance (6-12 weeks). This helps you see your preferred doctor and keeps urgent slots free for acute problems.

Ultimately, the changes happening in primary care are a response to a system under pressure. By understanding the reasons behind them and embracing new ways of interacting with your practice, you can ensure you continue to receive excellent, safe, and increasingly comprehensive healthcare. Your engagement is the key to making this new model work for everyone.