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Editorial: Premises hold key to the future

In this week’s opinion section, King’s Fund chief executive Professor Chris Ham lays out a bold future for general practice. Practices should, he says, federate together to create modern, multi-purpose hubs, kitted out with the latest diagnostic equipment and designed to be the focal points for a new NHS drive on integrated care.

It sounds great, and Pulse has for some time been an advocate of the potential benefits of loosely federating, provided of course it is a purely voluntary process. But there is a problem or, as the GPC puts it this week, an ‘elephant in the room’. There is a huge gap between the grand rhetoric of policy makers, who dream of GP practices taking on swathes of work from hospitals and evolving into high-tech community providers, and the reality at surgery buildings across the country. Many GPs continue to work out of ageing and under-funded premises, which are unsuitable even for their existing work, let alone the flights of fantasy of the future gazers.

GP premises have, of course, been a longstanding problem. A Pulse investigation in 2010 found as many as one surgery in seven was judged ‘below minimum standard’ – almost exactly the same as in a previous survey in 2006, and providing precious little evidence the previous government’s much-vaunted upgrade programme had delivered any results. In parts of London, a third of surgeries were rated ‘dangerously below standard’.

But while the problem is not new, a combination of circumstances is making it more pressing than ever that a solution is found. As of last week, the health bill finally completed its tortuous path through Parliament, and enshrined a new position for GPs in the NHS. GP practices will now be component parts of statutory commissioning organisations, and are being lined up for a raft of new provider opportunities. It will not be appropriate in that new world for some GPs to be working from two-up, two-downs with no disabled access. From autumn, practices will start on the exhausting road to registration with the Care Quality Commission, complete with its separate, specific requirements for GP premises. And yet just at the moment when the case for investment in GP premises is at its strongest, the existing system for funding appears at the point of collapse. A 2010 Pulse investigation found LIFT funding had dramatically slumped since 2004.

The GPC is right, then, to identify GP premises as towards the top of its list of key priorities. It is currently in negotiations with ministers over a new system of premises funding, as the DH redrafts the GMS Premises Costs Directions ahead of next April. Ministers may well push for GPs to provide much of the cash for premises upgrades themselves, but GP negotiators must make clear how unrealistic that is in these times of such sustained pressure on practices. The Government must be persuaded it needs to invest in GP premises for the benefit of the NHS – to allow general practice to build itself that bold future.