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GPs divided on spread of supersurgeries

Gillian Brooks suffers from major spinal problems. She visits her GP regularly and her family has been with the same practice for 30 years. But she believes this continuity of care and personal touch is under threat because Warrington PCT wants to amalgamate health services at five APMS 'supersurgeries', opening every day from 6am-10pm.

The centres would provide everything from initial contact with health services to an outpatient appointment and diagnosis. There would be GPs, an urgent care unit, a pharmacy, dentistry and services in ENT, community mental health, orthopaedics, sexual health and podiatry. Plus there would be a gym and branch of the Citizens Advice Bureau.The problem is that GPs transferring to the centre may not keep their original patients. Warrington LMC is concerned that those arriving at the surgery will be seen by whichever GP happens to be around – a 'taxi-rank' service. The situation is a microcosm of what has been happening across the country, with more than 600 supersurgeries now in operation. The Government sees them as a key plank of its strategy to tackle health inequalities.Now Ms Brooks's name is alongside 21,000 others on a petition handed to Warrington PCT in opposition to its plans. 'We are not just numbers to our doctors,' she says. 'Everyone at my practice knows me.'Dr Tony Rimmer, a Warrington GP and LMC member, says: 'GPs do not want this homog-enised, Stalinist service.'It also irks him and other GPs that they were not consulted before the PCT drew up the plans. Doctors will not be forced to move to the new centres, but it may not be economically viable for them to stay put, he adds.The PCT argues that its strategy ties in with the Government's drive to keep more patients out of hospitals and treat them in the community instead. PCT acting chief executive Jon Tomlinson believes the centre will have much improved facilities and give patients what they requested in a consultation – more services under one roof, shorter waiting times and long-er opening hours. Patients who previously required separate visits to a GP, social services, a community care centre and hospital will have one journey instead of four because all these services will be on the same site, says Mr Tomlinson. This will be especially beneficial for older patients.GPs remain unimpressed. They are pushing for formal meetings with senior PCT managers, who are set to consider their next move when a consultation ends later this month.Some GPs elsewhere say it is pie in the sky to think patients will see a variety of professionals during a single visit.Dr Peter Swinyard, a GP in Swindon and honorary secretary of the Small Practices Association, says: 'Consecutive appointments are not going to happen. Some doctor would be away or having meetings. If you believe all these people will be there on the same day, you are as naive as the health secretary.'Centralising services in one building will mean bus journeys rather than a walk for many patients, and 'the buses are not brilliant any more', warns Dr Swinyard.

ModernisationThe first in a £1bn wave of supersurgeries opened in November 2004 in Newham, east London. John Reid, health secretary at the time, said it was the start of the 'largest and most sustained programme of modernisation in the history of the NHS'.

Many GPs have had happier experiences than their Warrington counterparts.Dr Martyn Ellis is glad he moved into the LIFT-funded £6m Tower Hill Primary Care Resource Centre in Kirkby, Merseyside. It has two GP practices, dentists, baby clinics, speech and language therapy and other facilities. And if he or his patients fancy a kickabout, there are floodlit synthetic sports pitches on site.He says: 'I had poor premises before. Trying to manage them and do clinical care was a strain. Now we do not have to worry about vandalism or running the place because it is done by someone else.'Patients are generally supportive, though some may prefer the intimacy of smaller practices, he adds.A new supersurgery is planned for Sandown in the Isle of Wight. Similar centres have already been built on the island. Dr George Thomson, a GP in West Wight and joint chair of the Isle of Wight PCT PEC, says: 'The GPs are very supportive. We feel it makes absolute sense to have all these services under one roof. If a carer has medical problems a team containing a GP, district nurse and social worker can visit in one go to assess the needs of carer and patient.'GPs in other areas such as Warrington may agree with this sentiment, but it is often the details that are all-important.

pulse@cmpmedica.com

On offer at supersurgeries

• general practice• social care• district nursing• speech and language therapy• dentistry• pharmacy• mental health

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