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'GPs should give up their role in diagnosing COPD'

GPs are trapped in cramped premises and see no way out because the Government refuses to invest ­ by Ian Cameron

Dr Stephen Fox is organising an anniversary party. On April 1, he will have practised for 10 years from his premises.

But this will be no celebration. Dr Fox's practice in the Lancashire town of Leigh is based in a wooden-walled temporary hut which was built to last for a year, not a decade.

It is as far away from a state-of-the-art modern health centre as it's possible to imagine.

During the recent cold snap, patients huddled around heaters in the reception area. On hot summer days, temperatures inside the hut soar to over 35 degrees. The walls are so thin receptionists have to play music to prevent consultations being overheard.

Despite these obvious privations, and the Government's supposed commitment to improving GP premises, Dr Fox has been unable to secure the funding to move his practice to a new site.

His plight is typical of thousands of GPs who are trapped in unsuitable buildings and see no way out of their predicament.

Recent Government figures showed a massive drop in cost-rent projects since 1997.

GPs complain the only money being made available is for capital projects, not long-term rent reimbursment, or for schemes under the NHS Lift private finance initiative, which are not suitable for many practices.

Dr Fox had expected to move into brand-new, purpose-built premises in 1997. Four sets of plans have since fallen through.

Although his PCT has spoken more positively since they withdrew the last promise of funding, Dr Fox remains

sceptical.

He says: 'Nothing tangible has happened. I'm fed up.'

What has made the situation even more galling is that several practices in neighbouring Wigan have moved into new buildings. Wigan is covered by NHS Lift. Leigh is not.

Dr Fox says: 'These schemes were not even a tremble in somebody's kneecaps three years ago but have already opened.'

GPs complain that NHS Lift is the only option on offer if they want to move. But many do not want to give up owning their premises.

Finding a third-party developer to build new premises has not been a problem for Dr

Peter Gill's practice in Manchester. But his PCT's decision to rescind funding has meant long delays in getting construction under way.

In the meantime it has been standing room only in the tiny waiting room. As consulting rooms are on the second floor of the 1960s building, patients unable to climb stairs have to be treated in smear rooms where there is no desk or computer and only one chair.

'We should have been moving into a new building this summer, but work hasn't even started,' Dr Gill says. 'In the past we've also had a scheme to improve this building but could not get grants. Patients are understanding but it's their biggest complaint.'

Like Dr Fox, Dr Gill is frustrated that despite fresh assurances about money for the development, he has to spend so much of his time on the issue. 'Should a full-time GP have to do that sort of thing?' he says.

Mike Wallace, a practice manager in Buckley, Flint-shire, spends at least half a day a week pushing the surgery's plans for redevelopment, now eight years in the making.

An original plan to redevelop its existing site and its 'disgustingly small' consulting rooms was deemed too expensive by the district valuer.

An alternative, to develop a separate site 200m away, has foundered since 2003. One reason is because the local health board wants the two practices moving in to merge. Neither wants to.

The health board also has to submit its estates strategy to the Welsh Assembly before work can begin. The document is 10 months late.

Dr Peter Swinyard, chair of the GPC premises sub-committee, says wranglings over funding mean practices lucky enough to have a third-party developer and a potential site run the risk of losing one or both. He says a new business case must be made to ministers to convince them to invest more in premises.

In the meantime, GPs like Dr Fox will try to provide high-quality care from buildings more likely to make people sick than help them get better.

The situation

around the country

West Midlands

'There are a lot of rundown ''front-room'' practices and GPs working in buildings that are falling down. But there's a lack of clarity in most areas regarding how the additional £100 million in additional premises money is being spent and whether it is being spent in priority areas. If the PCTs don't have the money you don't tend to put bids in.'

Dr Grant Ingrams, secretary West Midlands Regional LMC

Buckinghamshire and Berkshire

'It's difficult to know what demand for improvement there is because people have got used to hearing there is no money. GPs have become disillusioned as cost-rent has diappeared. All people can do is put their request in to the PCT which sends it to the strategic health authority. That mechanism is a recipe for doing nothing.'

Dr Paul Roblin, Berks & Bucks LMC medical secretary

Avon

'Somewhere between new contract negotiations and Government policy something has gone wrong. There's a grave danger that the good quality we've achieved through GP entrepreneurship supported by notional rent will decay. We have a number of GPs in city-centre practices where the impact of the cost-rent cap and disability discrimination legislation means they may not be viable in the future.'

Steve Mercer, chief executive of Avon LMC

East Yorks and Northern Lincs LMCs

'To any GP inquiry that comes in we have to say there's no chance for a few years. Practices have to let sites go because they haven't got funding. Anybody else decides not to bother applying but I can guess the demand is a lot more than the projects they are going to fund.'

Dr Russell Walshaw, East Yorks & North Lincs LMC chief executive

Manchester

'If you discuss anything you are told there's no money. I suspect there's zero chance of getting funding and no one is making any bids as far as I'm aware. Elsewhere I've heard practices have had their rent go up after a review but their PCT is cutting cost-rent and telling practices it is included in global sums.'

Dr Charles Simenoff, Manchester LMC executive member

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