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.