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We often talk about general practice being the foundation on which the NHS is built. But what happens when the literal foundations – the bricks and mortar of practice buildings themselves – show signs of cracking?
With the number of GP partners continuing to decline due to the mounting pressures of unmanageable workloads and increasing bureaucracy, the added burden of owning and maintaining practice premises is doing nothing to attract newly trained GPs to the model of care that has been the basis of general practice for the last 70 years.
This blueprint may be unique – after all, our hospital colleagues are not expected to buy into the walls and roof of the building in which they work – but we know it works, and we know that the profession still values it. Two-thirds of our members tell us they support maintaining the model of GPs being able to own their surgery premises.
But they also tell us they want change. Three-quarters want to work in premises with other community-based staff, be they pharmacists, physiotherapists or nurses, providing diagnostics and extended care in their local area.
For this to happen, there needs to be significant investment in the premises themselves. Many aren’t up to scratch – and not capable of housing the multi-disciplinary team and services needed to provide the kind of community care that is expected in the 21st century.
Investment in GP premises will allow more care away from hospitals and reduce the significant pressures on secondary care we’ve seen repeated each winter, extending further into the year each time.
The direction of travel on this issue is positive, and it seems we are finally being listened to. During this year’s contract negotiations, we secured changes to the premises cost directions (PCDs) and a commitment from NHS England for a fundamental review of GP premises.
We therefore welcome the review’s ‘call for solutions’ this week, which asks key stakeholders to come forward with their ideas for addressing the issues facing GPs who own or lease their buildings. We would encourage LMCs, and GPs in particular, to make their views and potential solutions clear to NHS England.
One key issue is the exorbitant service charges faced by practices in NHS-leased buildings. It’s appalling that, given the underfunding of general practice over the last decade, that we’re hearing some practices have seen these charges go up by 400 per cent in a matter of months.
And what happens to those GPs who are the ‘last partner standing’? While the PCDs will lay out explicit options, more reassurance is needed to ease the anxieties around liability.
The BMA GPs committee will shortly launch a survey of its members on premises, to gauge how these issues and more are affecting them, and to shape our approach to the review from NHS England, in which we have an important role to play.
What is already clear, however, is that if NHS England and the Department of Health and Social Care do not address these concerns, the very building blocks of the health service risk crumbling beneath it.
Krishna Kasaraneni is BMA GP committee executive team premises lead
NHS England’s General Practice Premises Policy Review – Call for Solutions
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