patient record which was kept in a "Lloyd George envelope" and would be transferred if necessary to another practice if the patient changed practice. In the UK, unlike many other countries, patients do not normally have direct access to hospital consultants and the GP controls access to secondary care. Practices were generally small, often single handed, operating from the doctor's home and often with the doctor's wife acting as a receptionist. When the NHS was established in 1948 there were plans for the building of health centres, but few were built. In 1953, general practitioners were estimated to be making between 12 and 30 home visits each day and seeing between 15 and 50 patients in their surgeries. Current practice Today, the services are provided under the General Medical Services Contract, which is regularly revised. 599 GP practices closed between 2010–11 and 2014–15, while 91 opened and average practice list size increased from 6,610 to 7,171. In 2016 there were 7,613 practices in England, 958 in Scotland, 454 in Wales and 349 in Northern Ireland. There were 7,435 practices in England and the average practice list size in June 2017 was 7,860. There were 1.35 million patients over 85. There has been a great deal of consolidation into larger practices, especially in England. Lakeside Healthcare was the largest practice in England in 2014, with 62 partners and more than 100,000 patients. Maintaining general practices in isolated communities has become very challenging, and calls on very different skills and behaviour from that required in large practices where there is increasing specialization. By 1 October 2018, 47 GP practices in England had a list size of 30,000 or more and the average list size had reached 8,420. In 2019 the average number of registered patients per GP in England has risen since 2018 by 56 to 2,087. The British Medical Association in 2019 conducted a survey for GP premises. About half of the 1,011 respondents thought their surgeries were not suitable for present needs, and 78% said they would not be able to handle expected future demands. Under the pressure of the Coronavirus epidemic in 2020 general practice shifted very quickly to remote working, something which had been progressing very slowly up to that point. In the Hurley Group Clare Gerada reported that "99% of all our work is now online" using a digital triage system linked to the patient's electronic patient