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Independents' Day

GPs should be offered £1bn to improve premises and open 8 'til 8, says NHS England-backed report

A £1bn investment to modernise GP premises in London over the next five years would enable practices to open 12 hours a day, says a report by former health minister Lord Ara Darzi for the London mayor’s office.

The Better health for London report, led by Lord Ara Darzi for the London Health Commission, part of the London mayor’s office, says that GPs would have to adopt extended eight till eight opening hours to be provided across local practice ‘networks’ as part of the investment package.

It also recommends greater competition between GP practices by offering ‘capitation premiums’ to practices, who could include private sector providers, to set up where GP care has been ‘persistently and unacceptably poor’.

The NHS England local area team has said that it will now take the recommendations on premises into discussions with the Department of Health, and said it supports the recommendations ‘absolutely’.

Lord Darzi – who has previously led on the development of walk-in ‘Darzi’ centres - said the extra funding amounted to 4% of the total NHS budget, the ‘equivalent of one big hospital’, and suggested the money could come by appropriating NHS surpluses claimed by the Government.

The London Health Commission was set up last year to develop strategies for healthier London, and has also proposed wide ranging public health measures such as banning smoking in London’s parks and preventing fast food restaurants from opening within 400 metres of a school.

In the report, Lord Darzi states the current funding model for general practice has ‘fundamentally failed’ and says the lack of investment in premises is disadvantaging patients and GPs.

He says: ‘London needs a £1 billion programme over the next five years to rebuild or refurbish every GP practice in the capital.’

The report also recommends that commissioners ‘should increase the proportion of total London NHS spending dedicated to GPs and primary and community services and facilities’.

As a result of this extra funding, practices will be able to offer greater access, the report adds.

It says: ‘NHS England and CCGs should allow patients to move freely within GP networks, so those registered with one GP practice are able to access services from other practices within the same network.’

The report claims that GP networks ‘help to provide seven-day care by sharing workloads’ and, in its poll of Londoners, 92% saw seven-day services as important.

It has received the support of the NHS England London area team, with Dr Anne Rainsbury, regional director for NHS England (London), saying: ‘I think it’s very important report and very exciting recommendations. Clearly there are a lot in there which require NHS England to do things, and CCGs to do things, and we’re going to receive them and consider them.

‘But yes we support the report, absolutely.’

She added: ‘We said we’d want to talk further with the Department of Health on how we build the recommendations, and implement them.’

Dr Tony Grewal, medical secretary of Londonwide LMCs told Pulse: ‘In many, many years, I’ve never been able to say, simply “whoopee, great!”

‘They are absolutely right that one of the single most significant limits to what general practice can deliver, are the shambolic state of our premises, which we acknowledge.’

Dr Grewal added: ‘I thoroughly support this, and I look forward to working with whoever is involved in ensuring delivery, and I look forward to general practice in London being given the opportunity to show what it can deliver if it’s properly resourced and supported.’

Lord Darzi said of the need for premises investment: ‘I think London is much more challenging on the issues of the estate in primary care than the rest of the country, the dynamics in London are very different, the property prices in London are very different. So I think we’re in a much worse state in London than outside.’

‘We know the Department of Health’s capital expenditure, there have been some surpluses over the last few years. We have made the DH and NHS England aware of this, and all the signals that I have seen [ …] there’s a very strong desire for enhancing the provision and quality of care in primary care.’

The call for increased investment in GP premises comes as Pulse revealed in February that NHS England had frozen all premises improvement requests while it carried out a funding review, and only approved 13% of applications in the whole of 2013, a spend of just £14 million.

Practices are also being forced to close over inadequate premises, while the GPC has said the increasing shift of work into primary care cannot continue without investment.

Readers' comments (43)

  • His last plan to do just that failed spectacularly, with an enormous waste of money being poured into Darzi centres which were not generally supported by patients. This man should be held to account for what he has done in the past, not allowed to walk away and pop up again unscathed. He has no idea about general practice at all.
    Where is the accountability for these people?

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  • Vinci Ho

    It is about London , always about London, isn't it?

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  • Vinci Ho

    You see.
    When I used to tell relatives outside UK (especially the older generations) that I have been living in England , the immediate response was 'which part of London do you live?' When I said I live in Liverpool 'proudly' , the response then was ' Ooooh , Liverpool!!'

    I think NHSE should change name to NHSL

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  • I wonder who is going to be paying the extra rent, costs , charges for this investment... It will be like pfi

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  • London does contribute over 35% of GDP, hence it should have 35% of primary care funding.........cue angry responses from my northern colleagues....facts are fact, without london the north has nowt....

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  • Una Coales. Retired NHS GP.

    And where will this £1billion materialise from? Remember the Nicholson Challenge is taking and took £20 billion away from the NHS up until 2015. Remember the MPIG income slashes.

    Sounds more like electioneering again but this time by another voice representing the government.

    Agree PFI for GP surgeries will ensure the final nail on the coffin as GP surgeries will be unable to repay the HUGE mortgage for a state of the art architectural masterpiece on an NHS income. Sounds like more profits for private contractors.

    Fancy buildings and no one willing to work for less than a living wage in them. Hm. Sounds very logical, not.

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  • 'London does contribute over 35% of GDP'

    No it just hoovers up people and money from the rest of the UK, contributing to our grossly distorted economy. London simply could not exist as an international centre if commerce without England's other towns and cities that supply it with skilled staff and resources, it is in no way self sustaining.

    ‘I think London is much more challenging on the issues of the estate in primary care than the rest of the country'

    This is complete and utter nonsense, the real primary care crisis is happening in regions that cannot recruit because of lack of training capacity. London will never be short of doctors because for some inexplicable reason people want to work there and live in grossly over-priced shoe-boxes. Fortunately there is more than enough cash sloshing around the place to fund GP premises, especially in roads where the residents live in million pound houses.

    London already gets far more of our tax money per capita for the NHS, it's long overdue that the people of the UK were treated equally! London should be getting less not more.

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  • 'London does contribute over 35% of GDP'

    Thats like saying higher rate tax payers should have better access to health care because they contribute more

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  • I have capacity for 5000 more patients but underfunding at every step. The NHS Trust refuses to pay for a PMs room which is in full time use and houses the Emis server.
    The meeting room has been used byt Trust/LMC?commissioner for multiple meetings and there are other meetings clinical and non clinical. They won't pay for this because it has to be used every day - how many hours a day ???? nobody knows.
    When we asked for this to be reviewed, the lady involved first asked proof of occupancy. When provided with proof she began to question the already paid consultation rooms. At a meeting recently with LMC/KPCA/NHS England the person responsible asked me to log every entrance to the rooms already paid for and how much time each person entering spent in the room.
    Lack of transparency is the main problem in NHS and till you root that out, don't entrust a billion to Propco or NHSE.
    A £186000 paid to NHSE in Medway by the Council as part of the Section 106 moneys has never seen the light of day. NHSE has refused catergorically to the ICO to reveal who it' unofficially consulted' - my Surgery was given appointments twice byt the said lady who now sits in Propco and of course, she failed to turn up, She did consult with another Practice though - on what grounds, we'll never know.
    A Speaker from Invicta Surveyros in a meeting organized by LMC, gave a clear message - NHSE can do whatever it wants for moneys allocated for Practices under Section 106 and GPs can't do anything about it. Very heartening and LMC was a silent spectator at this meeting.
    Welcome to Medway the opaque patch of England.

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