GP leaders have launched a major policy drive to improve GP premises as figures obtained by Pulse reveal three quarters of GP practices could be not fit for purpose.
The GPC has accused the Government of leaving GP premises to ‘fossilise’ over the past decade with its ongoing freeze on investments and has demanded immediate action to address the ‘live crisis’. It told Pulse that it planned to map the urgent needs of GP practices through a UK-wide campaign, launched this week, which it plans to present to a health minister next month as part of its push for a national investment programme.
The warning comes as NHS Thurrock CCG revealed in its recently published five-year plan it would be addressing substandard premises, with a survey conducted by the former PCT finding 75% of GP practices across south west Essex were not fit for purpose.
NHS England announced in February it had put the vast majority of GP premises investment on hold while it develops a ‘consistent’ national process to evaluate bids for funding. It also planned to withdraw many of the discretionary services that had been provided by PCTs, including the removal of trade waste and guaranteeing reimbursements related to stamp duty land tax on lease arrangements of eight years or longer.
But GPC chair Dr Chaand Nagpaul warned that patients are suffering on a daily basis because GPs are working in premises that are not able to meet their needs.
He said: ‘We believe that premises is a live crisis. Therefore there is a need to tackle this, to have an immediate strategy as well as perhaps any longer term approach. This is not something that can wait – there is a pressing need to address a crisis in premises which is affecting GPs and patients at this very time, on a daily basis.’
‘Since 2004 there has been absolutely no strategy for funding of GP premises, full stop. Before [the new GMS contract] there was not just a premises strategy but also a scheme for premises reimbursement. From 2004, that came to an end and it changed to being discretionary funding. However that has actually meant no funding at all because of the financial pressures. So while the rest of the NHS, hospitals et cetera, have been invested in, in effect GP premises have been fossilised for a decade.’
He added: ‘[The situation in Essex] ties in with the premise behind the survey we have launched [which] will inform the need for an investment programme that we will demand to be implemented. This is something that, in fact, the Government has to address. If it doesn’t then all of its plans really will not be possible because we will not have the premises to deliver general practice or expanded general practice.’
Dr Nagpul said the GPC would be launching a survey of GP practices across the UK this week to seek their opinions on premises. The results will be presented to health minister Earl Howe in July along with proposals for what the government needs to do to address the problem.
Medicine is a rapidly advancing science. Biuoldings and plant need to change regularly to meet the new technologies that apply. This means that all medical buildings, whether they be for Primary or Secondary care, are out-of-date within 10 years. Governements think in 4 year cycles, and see no political reward in planni ng further ahead. Medical buildings are expensive and need a 5 year lead in to be planned effectively, even though theyare then largely defunct. One suggestion is for buildings to be deliberately made of plastic and cardboard, with plenty of parking and ground space for the next development or even replacement in 5-10 years. The services can remain in ground ducts, so it is only the superstructure which would need to change. Low medical buiildings are happier places than tall ones in skyscrapers – you only have to ask the 60s/70s qualifying generation who largely worked in mission huts to confirm this.
GP buildings are of several varieties. Health Centres owned by local authorities or trusts, Premises leased or rented from private capital providers on long term arrangements, and Premises owned by the GPs themselves. In all these options there are many which are out of date and need refurbishigng or replacement…
I was very lucky to have three practice built or adapted premises. Once these buildings meet the approved criteria the government provides “rent” as income for the partnership, and the rent usually goes a long way to covering the interest on any loan. Once the debt is paid off the rent continues in perpetuity or until the building fails a standards inspection. This is really a form of Private Finance Initiative, but because it is on a small scale, it has not distorted overhead. As more and more services are moved out of hospitals, GP premises need to expand and keep up with demand and standards. Whatever political party is in power, this will be a big financial hit, and NHSreality predicts they will ignore the BMA demands….
This is another reason to put health services at arms length from politicians – so that it is the principles and philosophy which are applied by a dispassionate body. The media should make politicians debate the philosophy and the principles. We the voting public can then vote on the differences in emphasis..
Burns – retired GP.