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A faulty production line

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)

  • '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's our money too...London? it's where the politicians and journalists live one else matters just so long as London is catered for. It makes me sick

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  • 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'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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