What is the DH's strategy to improve GP premises?

The latest headline grabbing news revealing GP practices in disrepair has shown the media is quick to point the blame at primary care providers for the lack of adequate premises available.

But in reality how is the future of GP premises actually shaping up?

• Dominance of small GP practices undermines push for extended providers

The funding future

NHS England made it clear that it has no funding available for building improvements before April 2014 and the de facto freeze on funding new projects may well continue beyond that date.

Yet, new Ofsted style audits of practices have been launched in the full knowledge that many premises are substandard.

‘New Ofsted style audits of practices have been launched in the full knowledge that many premises are substandard’

NHS England is nearing completion of a national audit of development bids including many held over since before last April when primary care trusts were abolished and the approval of schemes was handed over.

The Care Quality Commission has now registered all 7,607 practices in England and during this process 810 surgeries were declared to be non-compliant in terms of the suitability and safety of the premises.

Targeted inspections have already begun and the CQC has shown that it has teeth, closing a practice recently in part due to non-compliance issues and the quality of the surgery premises.

The non-compliant quandary

As the CQC is gradually rolling out its inspection regime, many practices are already expressing concern about how they can comply with a set of requirements that have little or no regard to matters such as the practicality of altering a property, let alone where the funding would come from.

Indeed, as part of the registration process many practices have felt the need to put resources into assessing premises’ deficiencies, despite not having the resources to remedy them.

Leaving aside new developments, even the alternative of applying for financial support for improvements such as extensions or other minor works is problematic because funding for grants is also in short supply.

Clearly, health services should only be delivered from premises that are fit for purpose and compliant with national minimum standards.

Patient expectation, the drive to move care out of an acute setting, and now pressure from the CQC, all highlight the necessity of continued and significant investment.

This is only going to be exacerbated by the consolidation of larger practices, the provision of a wider range of services and the need to expand and evolve to cope with a changing population.

GPs are now in a tricky position with the real risk of buildings that are not fit for purpose being closed down.

At the same time, NHS England has indicated that only strategically important development bids are being approved at the present time.

A sensible scenario?

While in the past some practices have been able to find innovative ways to move forward with their own initiatives, these are still dependant on the commissioner having funding to reimburse increased premises costs.

Some practices have borrowed to build, on occasion creating a company to carry out the development and then renting back from that company.

In other cases, links have been made with specialist developers who will build and then lease premises back to the practice. With a dearth of premises funding in the system, practices will not be able to innovate.

Instead, some practices will be driven to dip into other income streams to fund a fairly minimal level of improvements simply to ward off the attention of the CQC.

‘It is increasingly difficult to see the long term strategy underpinning Department of Health decisions’

The question may be whether putting the squeeze on GPs to improve premises at the same time as NHS England has tightened up the approvals process for any expenditure on premises is a sensible decision.

Lack of vision

It becomes increasingly difficult to see the long term strategy underpinning Department of Health decisions.

GPs are now effectively stuck between a rock and a hard place: between the CQC inspections demanding investment in more suitable buildings and the lack of funds.

At the same time there is pressure on GPs to do more to alleviate the strain being felt as patients clog up accident and emergency.

It remains to be seen whether the drive to improve the quality of GP premises is running out of steam in the face of financial constraints or whether the CQC inspections will provide new pressure to force a solution.

One thing we can be sure of as we head towards an election year and the NHS once again finds itself in the political spotlight is that this contentious debate will continue and no doubt lead to some more unpleasant headlines.

Graham Dupree is head of healthcare property at Mills & Reeve