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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)

  • 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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