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At the heart of general practice since 1960

GPs 'completely stuffed' in battle to improve premises

For years, Dr Sanjoy Kumar's 1950s-built practice was too small.

Clinical staff had to juggle rooms. Patients either had to wait in corridors, from where they could overhear consultations if they listened hard enough, or outside, where they got wet when it rained.

'It was actually quite laughable,' says Dr Kumar. 'I used to have to consult wheelchair-bound patients in the car park at a time the Department of Health was shouting about the fact there were loads of funds.'

Now the practice has a brand-new extension, giving it more consultation space and a bigger waiting room. It can even accommodate disabled patients.

But the development has come despite, not as a result, of Goverment assistance. Dr Kumar says his PCT refused him any help.

So he and his partner were forced to take out a £150,000 personal loan to finally get the extension built.

These GPs' actions certainly do not fit with the department's accusation last week that GPs were often a 'barrier' to surgery development.

Dr Kumar says: 'Premises is not the least of their priorities ­ it's simply not a priority.'

His experience is, unfortunately, shared by many GPs.

The results of a BMA survey, which prompted the department's touchy comment, revealed 60 per cent of GP premises are unsuitable for current needs and 75 per cent are

unsuited to taking on more

services.

One in three could never meet disability discrimination Act requirements. One in four is a health and safety hazard.

And it is not just those practice in converted old houses that are suffering. More than half of the GPs responding to the BMA worked out of premises built in the last 25 years.

Dr Prit Buttar, a GP in Abingdon, Oxfordshire, is 'completely stuffed' for rooms, he says, even though his practice had a large extension built 16 years ago.

'The thought of doing anything under practice-based commissioning is a non-starter,' he says.

'Every room is in use unless someone's on leave. Even if we could buy next door who is going to pay for it? I can't imagine a lawyer or accountant working like this.'

Dr Buttar approached his PCT for help but it refused. 'They didn't just say there may not be any funding, they said we guarantee there will not be any increase in notional rent,' he says.

This absence of revenue funding is at the heart of the problem for many GPs who want to retain ownership of their premises, but need to extend or move.

Creating a plan, and capital to build the premises, is relatively easy. Getting the rent reimbursed is next to impossible.

Dr Nick Gilbert's surgery

in Tufley, Gloucestershire, is spread over four floors. It has no lift. His branch surgery, is in a 1960s bungalow.

It is so cramped that nurses often take blood or give injections in its tiny kitchen, in between a kettle and a peddle bin.

'It's a surgery lost in time, completely unmodified, and in 2006 seems incongruent with modern health care,' he says.

'But the PCT told us in February that it did not have any funds so we've more or less resigned ourselves to the fact it's not going to happen in the near future.'

The flat roof on Dr Phil Speakman's 1970s premises in Buckley, Flintshire, leaks. The tiny, airless waiting room is freezing in winter and boiling in summer.

A portable building outside is used for administration.

Plans to develop the current site were vetoed by district valuers. Dr Speakman said a staged redevelopment, allowing the practice to continue while development took place on the site, was too expensive. Plans to integrate two sites have also foundered.

Ten years on from the start of the process, the Welsh Assembly recently decided to invite new expressions of interest to develop primary care for the whole locality.

'We're now back to square one,' Dr Speakman says. 'We struggle for rooms and we can't take on any more services.'

Government claims that the public-private NHS LIFT initiative is resulting in a new surgery being opened once a week cut no ice with these GPs.

LIFT funding is not available everywhere. Where it is, LIFT is the only show in town. It soaks up all premises funding to the detriment of those practices wanting to expand and to attract a rise in notional rent.

Dr Eric Rose, chair of the GPC's practice finance subcommittee and a GP in Milton Keynes, describes LIFT as 'a limited answer in certain areas'. He argues that Government funding should once again focus on notional rent.

'Home-grown things have always been the way general practice has expanded,' he says.

'If the Government really want general practice to continue to deliver they have got to put more money into premises and it must not get diverted for other purposes.'

Another option for GPs is sale and leaseback, with a growing array of companies now offering to buy out GPs and build new premises.

Where GPs are in negative equity this can be an appealing option.

But on the flipside, ongoing costs can be expensive. And, fundamentally, the GPs no longer own their premises.

The Government claims it does not recognise the 'unremittingly bleak' picture painted by the BMA of the condition of the GP estate.

For many GPs 'unremittingly bleak' is an all too accurate description of the building in which they have to work.

icameron@cmpi.biz

Premises ­ the options and

the problems

Cost-rent

Problem: PCTs have little or no cash for reimbursing rent

NHS Lift

Problem: Not available to all;

can be costly; fixed maintenance costs, LIFT company may refuse

to help

Personal loans

· Personal liability; no guarantee of recouping costs through extra work

Private investment

· Likely to focus on larger developments, may have to share space, loss of ownership

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