1. A framework for assessing the sustainability of GP practices has been in place since April 2015. Whilst the sustainability assessment framework has provided for a consistent decision making process, concerns have been expressed by some GP practices about the effectiveness of delivery.

2. The revisions to the sustainability assessment framework streamlines the process to enable a GP practice request for support to be reviewed on a more effective and efficient basis.

3. The revised sustainability assessment framework continues to prioritise the criteria for assessment to include practices at risk of closure within 12 months and/or those at risk of a reduction in the range of services provided through external factors which may impinge on the sustainability of the practice - for example :  

  • An unavoidably small GP practice may be unable to achieve an economy of scale if its location prevents the expansion of its practice list, and there is no viable option of merging with another GP practice.
  • The Carr-Hill formula does not fully meet the funding needs for unavoidably small GP practices.
  • The Carr-Hill formula does not compensate multi-site GP practices which have higher fixed costs than single site GP practices. Maintaining branch surgeries involves additional staffing requirements and office costs
  • Dispersed and deprived populations have specific management features.
  • The challenges of GP recruitment and retention can place significant pressure on GP practices in Wales (and across the UK).        

4. Sustainability support for GP practices may involve:

  • Short term, intermediate management and workload support for practices through cluster networks or directly to practices through, for example, health board employed health care professionals (who may form part of the health board’s Primary Care Support Team); health board employed back office support.
  • Short term, intermediate management and workload support for practices through financial support.
  • Longer term support consistent with the strategic aims of the primary care plan and health boards’ three year strategic plans.
  • Health board support to identify potential other income streams the practice can access.

5. Any GP practice support as part of transformational change will need to be consistent with health boards’ three year strategic plans and will be exceptional in nature and any practice support is not a replacement for any income loss arising through MPIG redistribution.

6. The revised sustainability assessment framework includes the following changes: 

(a) A request for sustainability support will distinguish a request for urgent short term operational support which will not require a Local Assessment Panel decision where the health board is able to take a quick decision, and a request for support which will require a Local Assessment Panel decision.


(b) Where a request for sustainability support requires a Local Assessment Panel decision, the Local Assessment Panel will make an in-principle decision, subject to a financial assessment.

(c) To ensure effective health board support a GP practice is required to provide to the health board a summary of the sustainability actions already undertaken, together with the further sustainability actions demonstrating how the practice will return to being sustainable. 

(d) A small number of changes have been made to the risk matrix indicators and supplementary information.  

  • In relation to the risk matrix new indicators have been introduced to cover demographics ( application submitted to close patient  list; practice population age spread ; Premises ( capacity of premises) ; workforce general; ( patients per WTE senior clinician ) ; ( number of unfilled clinical sessions per week ).  The workforce indicators have been amended to include General Practitioners; reliance on locums.
  • In relation to supplementary information the following changes have been made  to Premises ( lease terms to include issues / concerns ); Workforce (  new information for number of consulting hours  per / 000 patients ); Access to services (new information for any proposed changes for opening hours per site ; clarity on appointment book activity).

7. The revised risk matrix is detailed at Annex 1. The supplementary information is detailed in Annex 2; the revised sustainability assessment process and flowchart is detailed at Annex 3; Local Assessment Panel guidance and the Appeals Process is detailed at  Annex 4