Pulse investigation: new health centres are GP led in name only
When Lord Darzi handed his new brand of super-surgery the name ‘GP-led health centre’ he did so because ‘polyclinic’ had by then become a dirty word.
But GP-led health centre is not proving the most apposite of names. As Pulse’s investigation this week details, many of the new centres will not be led by GPs.
By Gareth Iacobucci
When Lord Darzi handed his new brand of super-surgery the name ‘GP-led health centre' he did so because ‘polyclinic' had by then become a dirty word.
But GP-led health centre is not proving the most apposite of names. As Pulse's investigation this week details, many of the new centres will not be led by GPs.
‘This will be a nurse-led service,' one provider told Pulse this week. ‘There will be a GP there all the time, but there is much more emphasis on nurse triaging.'
Across the first 17 centres to provide staffing information, there will be an average ratio of 1.3 nurses to every GP.
That is different enough from the ratio across traditional GP practices, of one nurse to every 2.4 GPs, but it masks stark variation between centres. Nurses will outnumber GPs in 10 of the 17 centres, but in three GPs will outnumber nurses.
In Sheffield PCT, there will be eight nurses and five GPs, in Eastern & Coastal Kent seven nurses and five GPs, and in Leicester eight nurses and three GPs.
It is by no means just private providers – winners of a quarter of the Darzi contracts so far – that are pushing use of nurses for traditionally GP roles.
The description of the ‘nurse-led' centre above came not from a private company, but from local GP group Norwich Practices Ltd, which will initially be employing three GPs and 10 nurses.
Dr Richard Pannett, director of NPL, says the high nurse ratio is a deliberate move aimed at avoiding disruption to existing services by focusing the centre on walk-in rather than registered patients.
‘The registered patients are probably going to be a less important aspect. NPL was set up to try and protect local GP services. We saw there would be an element of competition if an outsider came in.'
DH tendering guidance specified the centres had to have a GP on site at all times - and a doctor in charge via some form of clinical directorship.
But our investigation suggests the traditional partner model of general practice will be almost entirely absent in the new centres.
Some 14 of the 17 centres plan a wholly salaried workforce.
During the tendering process, concerns were raised that some providers might struggle to deliver even the minimum DH requirements.
Somerset PCT analysed bids from three providers - Harmoni, Dulwich Medical Centre and Pathways Health and Social Care Alliance, which eventually won the contract.
The trust's tendering debriefing document said: ‘Concerns were identified that both Harmoni and Dulwich Medical Centre will have a heavy reliance on locum GPs to deliver the service in the first year.
‘The staffing model proposed by Harmoni did not provide assurance that it would deliver the requirement to have a GP on site 84 hours a week.'
Harmoni – a private firm which has bid for 56 centres around the country, and has so-far won contracts for four centres – strongly rejects the suggestion that its proposed staffing models are inappropriate.
Dr Tony Snell, medical director of Harmoni, admits the company will initially employ large numbers of nurses, but insists that will change as the number of registered patients increases. ‘We will change our skill mix to meet demand,' he says.
As well as being mostly salaried, providers have also revealed up to 80% of the GPs employed at the new centres will be registrars or GPs straight out of training.
Dr Snell says Harmoni is planning to ‘recruit and retain high quality doctors', but admits many of those applying will be new GPs.
‘I think around 80% are within one year of coming out of their registrar year,' he says. ‘Most of them are struggling to find partnerships.'
This trend is evident elsewhere. Dr Peter Wilczynski, a GP in Corby, Northamptonshire, whose local practice is running a new 8-8 centre in Corby, says doctors working at his centre are ‘all fairly newly qualified'.
But use of partnerships does appear to be one area where the models offered by local GPs may differ from more corporate-style providers.
A centre in Gloucestershire run by a consortium of local GPs is one of those that plans to have partners working in the centre at all times [ check – see panel].
Dr Pannett says Norwich Practices Ltd may also offer partnerships further down the line, but says it is wrong to think a salaried service will mean continuity of care is lost.
‘Although we're starting out as salaried, I'm not quite sure whether it will stay that way. But in primary care, continuity of care is purely the amount of time you're working, not whether you're salaried or a partner.'
But it has been clear from the outset that providing continuity of care is not the main aim of the new centres. With 8am to 8pm, seven days a week opening hours, the availability of walk-in appointments and a far wider range of services than anything seen in traditional GP surgeries, the focus is heavily on access.
Our investigation provides evidence that the new centres will be looking to move well beyond traditional clinical care, with obesity clinics and fitness centres, physiotherapy suites and much closer integration with social services.
One centre is to have its own gymnasium. Others are to run services for the homeless population, child health surveillance services and clinics on workplace health.
Dr Phil Yates, a GP in Kingswood, Gloucestershire, said his practice's new centre will be offering a young person's sexual health clinic, a ‘beefing up' of minor injury services, plus a chiropractor and aromatherapy services.
Three trusts also revealed that new clinics would be offering Zoladex hormone injection treatment for prostate and breast cancer.
‘We are very excited by it [the new centre] because we think it will be quite a step change in local provision,' says Dr Yates.
Just how GP-led health centres will develop will become clearer over the coming months, as over 100 of the centres open up across the country.
Alan Johnson recently hailed the first of the centres to open, in Bradford, as a blueprint for the future of general practice.
If we are looking at a vision of the future, it is one dominated by extended opening, walk-in access, an integration between health and social care – and a workforce of nurses and salaried doctors.
General practice may never be the same again.GP led centres: investigation reveals truth about the rollout GP led centres: investigation reveals truth about the rollout