General practice closures or mergers: a survival analysis of contributing practice

Background 20% of general practices in the England have closed or merged since 2013. Little is known about factors that are associated with these closures, despite evidence on their negative impacts. Understanding these risks is important for recovering general practice. Aim Describe how differences in the patient mix, practice location, workforce, funding and quality are associated with the future risk of closure Design and Setting Multilevel survival analysis of all general practices in England. Method All practices open on 1st April 2019 were followed until 1st April 2025 or closure. We gathered data on practice population characteristics, workforce, funding and quality. Cox proportional hazards models were used to analyse how these measures were associated with time to closure. Results Practice contract type and geographic location (region and rurality) were key factors associated with closures or mergers. For example, rates ranged from 3.7% to 19.7% by geographic region. Greater risk was associated with smaller practices, with a practice at the 10th percentile (3,032 patients) having 253% (95% CrI: 200%, 312%) higher risk of closure or merger than the median (7,256 patients). Greater risk of closure or merger was associated with losing or failing to gain patients (hazard ratio v medium increase 1.68 (95%CrI: 1.44, 1.96), lower baseline funding, poorer clinical quality, higher socioeconomic deprivation and certain contract types, but not the supply of general practitioners or nurses. Conclusion The practice contract, relevant region, practice list size, funding and quality are key hazards for the subsequent closure or merger of general practices.