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GPs buried under trusts' workload dump

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

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

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  • WHY JUST LONDON?
    WHAT ABOUT THE REST OF US?

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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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  • Vinci Ho

    It is always about north against south, more importantly left against right , isn't it ?
    The agenda is already set for general election in here!
    Please keep sending your comments , all welcome .

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  • Azeem Majeed

    In response to the questions about ‘why London’, the Better Health for London report was commissioned by the Mayor's Office. Other NHS regions are free to undertake their own reports if they wish to do so. The NHS in London does face significant challenges - but so do other regions of the UK.

    A few people asked about resource allocation and whether London received too large a proportion of the NHS budget. The NHS in England operates a need-based system for allocating resources to CCGs based on factors such as age, deprivation and morbidity.

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  • the truth is the rest of the UK is an unproductive mess. Its only London and the south east that has any useful productivity.

    However thats not an excuse to direct resources to London, the NHS is based on need. If you want to do the US system do it fully!

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  • Vinci Ho

    I once heard somebody said ,' sick 0f these socialist b*****d ruining our economy!'
    Well , that's why this government 'needs' to be of the GDP , by the GDP , for the GDP.
    Do you believe in GDP?

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  • Bob Hodges

    GDP figures now include prostitution and cocaine dealing.

    No wonder London contributes so much of the UK's total.

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  • Bob Hodges

    ......and that's not just Westminster.....

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  • Vinci Ho

    Bob , if you watch Game of Thrones?
    Pay attention to what Lord Baelish asked Sansa in episode three , season 4
    '...what did I once tell you about the capital , Sansa?'
    and her response.

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  • Ha ha, once again doctors tear into each other instead of standing united.
    You deserve all the trouble that is being inflicted upon you, you put your individual egos with their short term goals ahead of standing united and getting long term team benefits.

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  • 'the truth is the rest of the UK is an unproductive mess. Its only London and the south east that has any useful productivity. '

    You might want to ask how this has come about when our competitor nations have less unequal economies in their cities. The London centric liberal intelligentsia are too lazy to think about economic development outside of the south-east bubble preferring to scrap whole regions of the formally productive North and hoard NHS resources for themselves.

    'The NHS in England operates a need-based system for allocating resources to CCGs based on factors such as age, deprivation and morbidity'

    That may be so but the weighting is all wrong. You would expect much more funding along the south coast where the elderly are found to retire in large numbers and also the deprived de-industrialised areas where real poverty is found. Instead for some reason unknown to man, a greater proportion of the tax money ends up subsidizing London, a city where billionaires cannot be bothered to pay their workers a living wage.

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  • The City of London does not generate any wealth, not a penny. It steals a lot of money as the wealth created by others passes through its sticky hands.

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  • 'the extra funding amounted to 4% of the total NHS budget'....WTF the whole of primary care in the whole of the UK only gets 8% and these guys what another 4% just for london!? ...and people are listening?...he's a surgeon for the love of God why is he continually trying to reorganise general practice?...why do people keep asking what he thinks?...he screwed up SPECTACULARLY and wasted millions under the last government...what about the rest of the country? ...what about the MAJORITY of the population of the UK? What kind of mad house do we live in? What has happened to government in this sad country?...why is this ***** listened too and every sane voice ignored? Why is this guy advising Boris Johnston and having articles written about his stupid ideas...a billion for London?..yes please and 10 billion for the rest of us while you greedy self interested southerners are at it pease...it's our money too...London? it's where the politicians and journalists live hey...no one else matters just so long as London is catered for. It makes me sick

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  • This comment has been moderated.

  • a billion for londons health care...hang on you're just having 15 billion invested in cross rail...don't you think your getting enough special ivestment already? you want more? The returns come where you invest them..if everything is invested in the southeast it's hardly surprising that's where the wealth will come form...it's a circular self fulfilling argument... it's TOTALLY undemocratic divisive and tearing our sad country apart

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  • Vinci Ho

    'We are united because we share the same principle(s) but we are not obliged to share the same merely for the sake of unity', somebody told me in Hong Kong.......

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  • Lord Darzi makes decisions for London in Primary Care
    Quite frankly he is not in Primary Care so should leave decisions about it to those in the know and stick with General Surgery. He is however right that premises need updating desperately, in order to survive in the next 10-20 years. Forget about 8-8, that's really is playing with politics to try to win votes, but even to sustain daytime working premises are largely creaking at the seams and need updating/expanding to accommodate the mass demand that our current population appear to need. One way of generating this cash is by starting to charge patients, but that really wouldn't win any votes for Lord Darzi. It's about time we got some real truths from politicians and those apparently representing us and not this mind of nonsense statements of 1bn needed for London Primary care. Let's not go down the North/South divide that really does belittle the bigger picture here

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  • How does modernising premises "enable practices to open 12 hours a day"?

    Only way I can see is if cost is too much for individual practices so they are taken over and run on a low-pay salaried shift system and/or nurse-led.

    Why is Darzi still being consulted about primary care issues?
    Hasn't he already tried this idea with Darzi centres?
    Can we not just concentrate on providing a good service in hours with a good out-of-hours service for emergencies and faff about with 7 day a week, 8-8 opening if/when we reach a position of affluence in terms both of funding and GPs? Stretching the current diminishing workforce over longer hours for no good medical reason seems an odd way to go.

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  • Well said at 11:14 anonymous-Spot on re 8-8
    Sort out the core hours and workforce first before we start talking of opening up longer
    Primary Care is officially in crisis- opening longer is not the solution to these problems or patient needs, it's just a game of politics that quite frankly we can do without
    Suggest Lord Darzi becomes an unspoken swear-word in Primary Care unless he wants us to tell him how to do a Lap Chole

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  • Peter Swinyard

    I am sure Lord Darzi means well. Perhaps he is trying to share out the excretions he met in his old day job as a tertiary care bowel specialist.
    His last attempt to foist 8-8 opening across the country through the eponymous Darzi centres was not an unqualified success.
    I do commend the idea of investing in the GP estate though - especially in the inner city areas across the country where land prices are prohibitive and development is difficult to provide in a location convenient to patients - within a pram-push of the surgery.
    Does there need to be a more imaginative use of other public owned/leased buildings which are not fully utilised and create surgery accommodation from them without necessarily having a new build - what about compulsory acquisition from other local and national government departments with unused premises?
    Certainly there is no chance of managing a shift of care from hospitals without a preceding shift of funds to invest in the premises in which to provide the care.
    ......and that is all without even mentioning the elephant of the lack of doctor and nurse and practice manager workforce to staff the service, whether 8-6.30 or 8-8.
    Incidentally, there seems to be a little forgetfulness about the fact that there are GPs on duty round the clock to provide emergency care. GPs do not cease to function at the end of "news at six" in time for the radio 4 comedy slot...

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  • what a change and this is the same person who wasted billions of pounds creating the nonsense Darzi center which have now become the legacy of the CCGs
    surprising and one always said that surgeons could never be savy politicians

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  • 74% of the population believe in capital punishment for high profile murders.

    Does that mean we introduce this in our basements because 92% of London want an 8-8 service?

    Utter nonsense.

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  • The Equitable Access Centres which became the Walk In Centres did not accomplish all of the proposals which Lord Darzi initially proposed - his concept is nearer to the integrated care / out of hospital care programmes which many CCGs are now trialling - the fact that the EAC did not achieve his vision is related to failures of commissioning by the former PCTs - Suggest that contributors to this thread should look at his original report before rubbishing him now

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  • 11am ' Let's not go down the North/South divide that really does belittle the bigger picture here'

    this isn't a 'North/South' issue...I don't live in the north I live in the south ..there's more in the south than London - unless you live in London...then that's the only place there is hey. It's about a London/'rest of the country' issue ..the rest of the country includes thes South West, Wales, Cardiff, Southampton, Exeter, Bristol, Portsmouth, East Anglia, Birmingham, the Midlands and, as you point out 'the North' Manchester, Liverpool, Leeds, Shefield, Newcastle, Yorkshire etc etc...and (of cause) Scotland. Most of the population DONT live in London...this isn't an North/South issue...it's a 'London' issue to be sure. - and it's not a side issue. This guy is setting an agenda that is too London centric and ignors the majority of the population of the UK. It is not right that a London surgeon is trying to lead the debate on the future of general practice ..it's wrong. I agree we need more funding but the debate needs to be about the entire country , not one over inflated self important city. Thanks

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  • Anonymous | Practice Manager | 15 October 2014 1:48pm

    I wouldn 't advise wasting any time on Darzi's report as it was a demonstration of naivete and stupidity.

    Darzi is a very good example of how politicians will go to any length to find someone who's views match their own - in order to push their own vision.

    It failed and not only that - it wasted valuable and limited resources which UK primary care could ill afford.

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  • its a shame when a London surgeon who doesn't even have a grip on London primary care is asked for comment.

    London solutions ( 50,000 person primary care centres) are not relevant for most the country, but politicians are not very bright - they don't understand or care for evidence

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  • Vinci Ho

    Yes. My apology
    When I said North against South before , I was really thinking of 'The rest of the country 'against London .

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  • Aprt from it being fairyland where the NHS will release £1billion for primary care, Lord Darzi as usual misses the point - the buildings will be empty as GPs will have early retired, gone abroad, or young doctors not gone into GP land. Buildings are a very small factor in the current crisis. So once again Lord Darzi proposes big shiny new expensive but empty buildings as being the cure to the problems of primary care. Well at least he is being consistent.
    Wonder how Lord Darzi would feel if a GP told him how to run his private, secondary care, surgery?

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  • I was under the impression that the point of the NHS was to distribute healthcare resources equally across all people based on clinical need.

    Surely taking a disproportionate chunk of the budget is the defintion of such imbalance?

    Per capita, not according to GDP, like someone mentioned earlier is only the fair thing to do.

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  • Pipin Singh

    £1bn solely to London!!! Hmmm.

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  • Sanjeev Junega, why would the NHS pay you to host an LMC meeting?

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  • The comments here are all very interesting, yet any other healthcare provider has to upgrade their premises and improve access/extend opening hours from their existing income, with no additional monies being suggested from anywhere. Still, when they talk about equal access in the NHS, I forget they don't mean "equal access to funding"

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  • can't believe people think darzi was in any way coherent.

    He was pulled apart from the beginning, remember allyson pollock taking apart his report as soon as it was published.

    Solving these issues is relatively easy but we have to recognize what we're aiming for. politicians are held back by their own dogma.. they really don't care about anything outside the electoral cycle

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  • sounds like a good idea but good luck getting 1bn for GP even in that London. We should support it and if it ever happens campaign for funding elsewhere. Not sure its the most important thing to need funding but its better than nothing. How this will enable practices to cover extended hours im not sure though.

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  • 'Report backed by NHS England'. I would say enusre transparency in NHS England and tell us where is the £186000 given by Medway Council for Strood Practices last year. Only when you find that money, entrust NHSE England with the billions.
    NHSE suffers from serious lack of transparency - to put it gently- so watch their hands!!

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  • 'Capitation payment' - is that Darzi paying £180/patient again as per the original APMS contracts to 'stimulate competition where practice has been poor'.

    Of course our practice is worse than you'd like with max £100/patient in deprived areas.

    Why is this chief numpty still around? He's a surgeon for f**k sake? What does he know about primary care?

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