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Premises left to crumble as PCTs scrap upgrades



By Gareth Iacobucci

Exclusive: The Government’s much-vaunted programme of investment in GP premises has made almost no impact on the quality of surgery buildings, with PCTs now cancelling upgrades in the wake of the financial crisis.

A Pulse investigation finds as many as one practice in seven is in premises judged by PCTs to be ‘below minimum standard’, including every surgery in some parts of London, where as many as a third are ‘dangerously below standard’.

Almost half the PCTs surveyed had at least one substandard premises. Overall, PCTs classed 14% of premises substandard, a figure the GPC described as ‘desperate’, which is almost exactly the same as in the last survey in 2006.

Yet PCTs across the country are cancelling upgrades or attaching conditions before they will release funding, as a result of the ‘biggest financial challenge the NHS has ever faced’.

GPs in one PCT have been told they will be forced to remain in substandard premises unless they sign up to tough new targets to cut their referrals and drug bills, while practices elsewhere have seen long-promised funding withdrawn.

But trusts admit GP premises are often in a desperate state. Across London, 59% are below minimum standard. In NHS Hammersmith and Fulham all 27 practices are below statutory requirements, eight ‘dangerously below standard’. Nine buildings are so bad the PCT admitted ‘nothing but a total rebuild or relocation will suffice’.

An NHS Hounslow strategy document states the condition of its primary care buildings is ‘generally poor’. It says: ‘More than 20 have known contraventions of one or more regulatory standards. Seven are dangerously below standard.’

But the problems are not restricted to London. In Manchester, 40% of GP premises are ‘significantly below required standards’, and require ‘very high levels of capital investment in relation to asset value’.

NHS Worcestershire, one of 51 PCTs to respond to Freedom of Information requests, has said it will only provide promised funds for premises upgrades unless GPs can make a raft of contractual savings.

Paul Bates, the PCT’s chief executive, wrote to GPs: ‘The board will want to consider the premises schemes given the biggest financial challenge the NHS has ever faced. A new approach is needed… any investment must produce savings.’

He added: ‘Practices and PCT must agree terms that see them improving quality and reducing referrals and prescribing. Reimbursement of rent will depend on achieving targets.’

Dr Catherine McGregor, a GP in one of the affected practices in Redditch, Worcestershire, said: ‘It’s been devastating. I feel bitter, because they’ve changed the goalposts. We’re in a Catch 22. It’s difficult for us to improve performance unless we are in a new building.’

NHS Kirklees has put six GP premises schemes on ice because of the credit crisis, despite admitting the decision posed ‘a risk of damage to the PCT’s reputation’ by cancelling plans they had previously supported.

Pulse revealed last year that funding for LIFT schemes had slumped since the credit crisis.

Dr Peter Holden, GPC negotiator with responsibility for premises, said: ‘This really isn’t acceptable. PCTs are burying their heads in the sand. My concern is that if the CQC gets its teeth into this and says “you’re not up to scratch” it could put people out of business. We desperately need better premises.’

A Department of Health spokesperson said: ‘Since 2000 about 3,000 GP premises have been refurbished or replaced, 750 primary care centres created and £1.7bn invested via LIFT into 219 premises. We recognise historic problems still exist, particularly for inner-city PCTs, but progress has been made.’

An NHS Hammersmith and Fulham spokesperson said: ‘The quality of some local GP surgeries is unacceptable. We know this and are working with GPs on investing more than £20million over the next four years to fix it. Improving the quality of GP surgeries is essential if we are to offer more care close to people’s homes.

‘Our own review of local surgeries is an honest assessment against tight national standards. The reality is that only new builds can meet all of the standards. Of our 32 local surgeries the majority are perfectly suitable for delivering high quality GP services from, however 13 do need relocating or significant refurbishment work. By 2013 no local GP services will be delivered from non-compliant buildings.’

Dr Catherine McGregor: caught in Catch 22 of trying to hit targets to earn surgery upgrade in below-par premises How do premises in your area compare?

You can use Pulse’s interactive map to see how GP premises in your area compare with the rest of the country.

To view the map please click here.