Salaried GPs on Isle of Skye are 'specialists in generalism'
The GPC's lead negotiator on premises is committed to getting more money out of the Government he practises from a pokey hole himself. By Rob Finch
Dr Peter Holden knows from personal experience just how much GPs need him to win the battle with the Government for extra premises money.
His consulting room is a 'pokey hole' of eight feet by six, plus a narrow strip of corridor leading to the fire door.
To make matters worse, Dr Holden, who practises in the picturesque spa town of Matlock, Derbyshire, now also has to hot-desk. 'Premises are a disaster area at the moment,' says the GPC's lead negotiator on the issue.
'We have to have a rooms schedule and I have to see 40 people a morning. If I overrun I'm stuffed and so is the nurse who follows me.
'I'm a senior partner and I'm hot-desking anyone at my level in business wouldn't stand for it.'
The GPC's recent election manifesto failed to mention premises, but Dr Holden insists it will be one of the top issues for negotiation in the next 'settlement' for 2006/9.
He puts the blame for the current crisis facing thousands of GPs squarely at the door of the Government.
Figures released in February showed that since Labour came to power in 1997, overall funding for premises fell by 7 per cent, with discretionary funding dropping 44 per cent.
Dr Holden says ministers then attempted 'emotional blackmail' during the contract talks by insisting GPs choose
a pay rise or improved
Funding for premises from the new contract is therefore at least 20 per cent lower than required, he says.
And the £108 million extra given to PCTs last year to invest in premises has been diverted by managers to cover massive budget deficits.
'If the Government wants to shift stuff out of secondary care we have to have the space and we haven't got that,' he says.
'At the moment there is no capital around PFI and even then it's got to be supported by the PCTs, but as PCTs don't have the cash the chances are nil.
'The situation at the moment is one of complete despair and frustration.'
Dr Holden adds: 'Outside LIFT you haven't got a chance.'
LIFT the Local Improvement Finance Trust was supposed to be the answer to GPs' premises woes, enabling PCTs to link with private providers in PFI schemes to update their entire primary care estate.
It has certainly brought in vast amounts of cash nearly £1 billion since its inception in 2001. Of this, £800 million has come from private developers. The Government invested the remaining £195 million, passing it on to 120 PCTs taking part in the 42 schemes.
This level of investment sounds impressive.
Dr Lis Rodgers, professional executive committee chair at Doncaster West PCT one of three PCTs in the town involved in a fourth-wave scheme says LIFT has been 'a huge bonus' for the deprived areas of Doncaster.
It is helping the trust amalgamate some small practices, she says.
Jo Webber, policy manager at the NHS Confederation, added that the scheme had
not only helped with 'like-for-like' replacement of practices across the UK, but also with the shift of resources from secondary to primary care and new out-of-hours services.
Yet the level of investment through LIFT compares with £17 billion spent on secondary care PFI schemes. The £195 million for PCTs also equates to just over a £1.5 million each not a huge amount when a new practice can cost more to plan and build.
And although 120 PCTs are involved, that leaves more than 180 who are not and who cannot draw on the kind of resources available to LIFT areas.
Most damningly of all, though, is that fact that only nine LIFT practices have been built in the four years since it was brought in. If the scheme is working, it is taking a very long time to get going.
The Government also remains off target on its NHS Plan pledge on premises. Of the 3,000 surgeries meant to have been 'substantially refurbished or replaced' by the end of 2004, 2,850 had been.
Dr Michael Taylor, chair of the Small Practices Association, believes 'institutional sizeism' in the NHS is also scuppering practices premises plans.
'In terms of refurbishment small practices probably get our fair share. The problem is that, overall, the money available is inadequate and there's the question of supersurgeries taking up all of it,' he says.
Certainly the Government's PR spin for LIFT was that it would enable the creation of these 'super surgeries and one-stop shops'.
Even though she is a LIFT enthusiast, Dr Rodgers admits that decisions on premises funding in Doncaster have become more difficult because the money allocated to PCTs is not ring-fenced any more.
Finding the cash for more routine renovations, she says, has become far more problematic. 'The big thing to hit us recently is the Disability Discrimination Act legislation and that's meant the PCT had to find money for their own premises and the GPs' surgeries,' she adds.
Ms Webber says practice-based commissioning may be one way GPs can find more money to invest in their own premises. 'The technical guidance says you're able to use any savings you made on your services to improve premises,' she says.
'The savings will need to be sustained, but I think it's something GPs need to grasp.'
But this is still money
GPs have saved through their own efforts and does not address the issue of Government funding.
GPs' options to improve or replace their premises
replace their premises
·NHS Local Improvement Finance Trust (LIFT) Not universal, slow and mainly for larger practices
·PCT funding for PFI-style schemes Funds are being used to pay off deficits and other budgets
·Self-financing Costly and risky, property prices can go down, premises becoming more specialised and therefore of lower potential market value
·Sale and leasing back Attractive in the short-term but could lose the investment potential of property
·Practice-based commissioning 'Savings' from commissioning would need to be large and sustained to cover costs