Avoid financial suicide while costing your consultations
PCTs are mistaken if they believe GPs have no role to play in strategic service development plans says Deb Farnworth-Wood, managing partner of a large practice in Somerset
PCTs are required to produce strategic service development plans (SSDPs) indicating how they intend to meet the health needs of their community. These plans have to include an assessment of existing primary care premises. This involves an evaluation of the condition of the premises and its suitability for provision of services.
The SSDP then has to devise a premises strategy for the next five to10 years. PCTs are also required to ensure new primary care premises fit with their strategic aims, and it is against these plans that proposals for new premises developments will be assessed.
Many PCTs believe they are the sole owners of the SSDPs and that they alone are responsible for determining the location and configuration of primary care services. PCTs that think like this are likely to find themselves at a disadvantage.
There is strong evidence that many PCTs do not have the skills, expertise and manpower to drive premises developments forward. Even the few that do will recognise that PCT staff (being employed rather then self-employed) are likely to move on relatively quickly as they follow their personal career aspirations. Premises development can be a lengthy process. There can be many PCT staffing changes before the project is complete.
In addition PCT managers have no long-term commitment to any scheme. Their name is not on the mortgage or lease and their income is unaffected by notional or cost-rents.
GPs tend to move around far less frequently and will look for a sound business investment in terms of their commitment, time, energy and effort. In looking at the business case, GPs have to take into consideration the complexities of demographic changes in their area. They also need to consider local needs and the ability of the development to succeed. This makes them central to the whole planning process.
Most importantly GPs need to be sure that when it is time to retire they have an exit route.
The only acceptable one is having a sustainable business that will attract incoming partners to buy in. GPs also have to make a long-term financial commitment, typically signing up to a mortgage or lease for 25 years. This in itself requires a high degree of personal risk on their part.
PCTs are being discouraged from underwriting GP leases on the basis that it is unrealistic to tie themselves to a 25-year contract when they have no idea what services they will be commissioning that far ahead. Yet GPs are expected to do exactly that.
Under the directions, PCTs have to assess the likelihood of premises proposals coming to fruition. Yet their judgment on this can only be subjective. There are many examples of successful schemes that went ahead, despite opposition and lack of initial co-operation from planners and the local community.
In these cases, it has often been
the tenacity and conviction of the practice that has won through in the
GP practices should therefore be central to premises development. They bring with them a unique commitment that no PCT employee can provide.
They also have a significant contribution to make in terms of local needs, and clear perspective and understanding of their independent contractor status.
Deb Farnworth-Wood is managing partner of the New East Quay Medical Centre, Bridgwater, Sommerset