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Investment in GP premises has been inadequate during the last decade despite the boost from the Estate Transformation and Technology Fund.
The BMA welcomes the investment articulated in the NHS Long Term Plan, and the specific commitment to implement the premises review. High-quality, fit-for-purpose buildings in the correct location is vital to cement general practice at the heart of primary care delivery.
The BMA is aware of the effect inadequate premises have on the delivery of services to patients, the strains on GPs and their staff operating from substandard buildings, the frustration with the complicated bureaucracy around estate planning and development, and the lottery of securing investment.
The partnership review has identified the changing attitude to the risk of the profession. In the past, owning GP premises was seen as a wise investment decision, while now it is often viewed as a risk, destabilising the very fabric of the partnership model.
The BMA policy team has been working to address these issues, and several strands of work are coming to fruition. Changes cannot come soon enough, particularly as many practices find themselves in awkward intractable circumstances and we desperately need the underpinning resources and commitments from the NHS via the vehicle of the long-term plan.
The GP premises review is expected to be be published in March 2019. This is part of the commitment made by NHS England to the BMA as part of the 2018 contract deal. The BMA along with other stakeholders has been meeting regularly during the last six months to progress his work. The recommendations of the review will need to be considered alongside the partnership review and the long-term plan. It is also essential we see the publication of the updated premises cost directions to underline these commitments and allow implementation.
As part of the premises review, the BMA undertook a premises survey. This provides a stocktake of the present view of the profession and the state of the GP premises. The survey provides evidence for ongoing negotiation. It also builds on results from previous surveys and informs policy decisions.
The headlines convey a stark message. Only half of the practices consider their buildings are fit for present needs, which is a deterioration in the last decade. These questions were asked before considering the effect of the new network DES (directed enhanced service), which will only add to the demand for space. It is likely that this will add even more pressure, with the need to hot desk, and share space for many practices. The NHS often expresses concern about poor utilisation of the GP estate, but this survey puts paid to those concerns and shows that many practices operate at full capacity or overcapacity. Of even greater concern is that only 20 per cent believe their building is fit for future needs. Given population growth and demographic changes and the shift of activity from secondary to primary care, this represents a significant risk in implementing the long-term plan. It is crucial that steps are taken now to plan for the future. It is encouraging that practices are looking forward to developing their services and embracing the opportunities afforded by the contract changes, but it does mean that the resources need to follow.
Typically GPs want to develop their buildings to have more consulting rooms, improved access and better-waiting areas. Patients and doctors deserve an excellent working environment. Some need to relocate to new purpose-built premises but a large number want smaller-scale development to ease immediate pressure. It shows that we need a plural approach to GP premises, with good-quality buildings in the heart of communities acting as a focus for care, yet also supported by larger multifunctional structures. It's vital that the results of the surveys are considered at a national and local level, particularly as strategic transformation partnerships have all published their primary care premises strategy and these will need to be updated in the summer.
When I started in practice 30 years ago, we had individual practices, health centres with attached and co-located primary care teams and cottage or community hospitals. It seemed to work quite well. Collectively GPs as individual providers and as partners in networks need to work with commissioners to ensure that the primary care's estate strategy is fit for purpose; remember what worked well in the past and incorporate this with modern developments and technology.
Thank you to all practices who participated in the survey which provides the hard data to support the BMA’s policy discussions and shows the need for sustained capital investment in the GP premises.
GPC practice finance policy group chair Ian Hume
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