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Unfit premises and broken promises

The latest Pulse investigation into GP premises has found as many are substandard as four years ago – so where have all those promised refurbishments gone?

Promises, promises. When Pulse first exposed the shocking state of GP premises, four years ago, PCOs were indignant. They were, they insisted, planning 389 new-builds and 338 refurbishments or extensions over the next two years. The Department of Health, for its part, and perhaps revealing more than it intended about its priorities, announced it would be opening 125 ‘health centres' in the next year. The implication was clear – we had surveyed the GP premises stock at the wrong moment. It would, any time, be transformed into a network of shiny new buildings, even if some housed polyclinics and walk-in centres, rather than actual GP practices.

Our latest investigation reveals just how false those pledges of change were. Back in 2006, we found 14% of premises were considered substandard – 1,092 at those PCOs providing figures. But 727 of those – exactly two-thirds – were supposedly due to be replaced or revamped over a two-year period. We might, then, have expected to find sweeping improvements by 2010 – yet in fact the proportion rated substandard was again 14% – precisely as appalling. Where, then, have all those fancy refurbishments gone? And how have NHS managers allowed GPs to languish in buildings not only unfit for purpose, but in some cases ‘dangerously below standard'?

One clue, perhaps, is in the DH's response four years ago. Health centres are what it wanted, and health centres are what it has gone all-out to build. In some cases, funding has been lavished on Darzi centres few patients want to register with. In others, cash has been earmarked for large-scale, ill-conceived polyclinic plans that have become quagmired in protests from GPs and patients. How much money has been wasted on consultations on the future of primary care, when GPs need new consulting rooms right now?

And then there are serious doubts over the DH's preferred method for upgrading premises, via the public-private NHS LIFT scheme. Back in 2006, there was little enthusiasm for LIFT, with only 12% of those planned refurbishments due to use it. Since then, the Government has launched Express LIFT in an effort to give the scheme new life, only to be undone by the financial crisis.

A Pulse investigation last year found investment through LIFT had slumped by half. Private firms may be the DH's preferred partners, but they are apparently not to be relied on when the going gets tough.

Nor, though, are PCOs, many of which are cancelling upgrades as their purse-strings tighten. That might be excusable where practices are waiting for a new paint job, but not where premises are dangerous or wholly unsuitable for healthcare. The budget for upgrading unsafe buildings is not the place to look for savings.

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