Hot-desks the future as PCTs 'sweat the assets'
By Anna Hodgekiss
The pictures on the desk, the overflowing in-tray and the post-it note collage around the computer screen could soon be a distant memory for many GPs.
PCTs' increasing need to get value for money is triggering demands that GPs must hot-desk, stay open longer and share their space with other organisations if they want new premises.
GPs in east London, who will have to come to terms with such requirements in order to move into NHS LIFT-funded premises, are sceptical to say the least.
'We were told we'd have to work later hours because the PCT had to prove value for money, and wanted to "sweat the assets",' Dr Sheila Cheeroth, a GP in Tower Hamlets, says. 'But we want at least one corridor of the building we can call our own, and to have a work-life balance.'
Dr Fay Wilson, secretary of Londonwide LMCs, has nothing but bad memories of having to hot-desk. She describes it as a 'highly unsatisfactory' way of working. 'I had to carry equipment around in a trolley and something that resembled a joiner's bag. That didn't help in providing high-quality care.'
But with the cost of new buildings rising, more and more GPs are going to have to find a way of making these systems work.
So how can GPs help PCTs 'sweat their assets' without going through the pain barrier?
Dr Sam Everington, a GP in Bromley-by-Bow, east London, has used a shared-space model in his surgery for the past nine years. Everybody shares rooms. The surgery is paperless and generic equipment is installed in every consulting room. Forms can be printed off any computer. The doors have changeable name signs.
Dr Everington insists hot-desking can work. GPs just have to stop being 'possessive' about their space. 'It doesn't make sense to leave rooms empty if people aren't there,' he says.
'Shared space also means you have to be more vigilant with smart cards and confidentiality, which can only be a good thing.'
Setting ground rules at the outset for other organisations that share the building, such as social services, was also crucial in making this aspect work, Dr Everington says.
'We eat in the on-site cafe every day, which we share with the other organisations and the patients. There's never been any problems because we made it clear at the start that confidentiality was paramount.'
Tom Stewart, joint managing director of ergonomics consultancy System Concepts, agrees hot-desking can work. For instance, it can aid concentration because it prevents 'post-it-note panic' and clutter.
He says: 'Your desk is no longer a nest, and you tend to finish tasks off that day to avoid carrying the paperwork around with you.'
But Stewart sees a major problem with the way it is being foisted on GPs. Hot-desking can save money, he says, but could cause problems if those responsible for the savings fail to see any financial reward. 'People don't like it if their discomfort is for the benefit of someone else, which seems to be the case here with GPs and PCTs.'
Hot-desking can also cause musculoskeletal problems if chairs, foot rests and computer screens are not adjusted for each user, says Vicky Ball, a risk management ergonomist. She says: 'Too often people just put up with furniture at the wrong height and then end up with posture problems.'
The prospect of having to put up with such problems for 12 hours a day and on Saturdays as well is adding to the concern among GPs.
Waltham Forest PCT in east London was one of the first in the country to pilot extended opening hours for practices. The Grange Park surgery in Leyton was involved, opening its doors from 8am to 8pm seven days a week. But it soon stopped when PCT funding ran out.
Dr Dinesh Kapoor says: 'We carried on for over a year but it became unsustainable from a cost point of view, having to employ the extra staff.'
Dr Gabriel Ivbijaro, a GP in Walthamstow, had a better experience. By introducing a flexible shift pattern and employing a salaried GP who started later in the day, his practice has continued to offer extended opening to patients.
'We're looking at it as something that will pay off in the future,' he says.
Getting this combination of organisation, patient and staff satisfaction and, as always, finances, right is at the heart of making longer opening hours, or hot-desking work.
For some it will be far too much hassle. But for those determined to make it work, or who have no choice, there are GPs who have shown it can be done.
How to make hot-desking work:
• check workspaces regularly to ensure they stay tidy
• monitor smart card and records use closely as confidentiality is more at risk
• have removal nameplates on doors
• install generic equipment in all rooms
• finish tasks off where possible to avoid carrying around paperwork