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The changing GP surgery

Dr Mike Shillingford considers how primary care premises are evolving to deliver not just GP services, but a range of community-based services.

The Mary Seacole Centre houses a GP practice, a library and a café (Image: MedicX)
The Mary Seacole Centre houses a GP practice, a library and a café (Image: MedicX)

General practice in the UK is changing at a faster rate than at any point since the NHS was formed over 60 years ago. 

A far more open and competitive healthcare market, massive demographic change, a rapidly increasing elderly population and a surge in chronic disease are all feeding a huge increase in demand and, hence, demand for suitable, up-to-date premises from which GP practices can deliver healthcare.

Funding squeeze

The NHS is also facing a period of financial constraint.

Historically, the budget for healthcare has risen by 4% above inflation each year for the last 20 years. But the NHS is now faced with efficiency savings of £20 billion by 2015 and a capped budget of 0.1% above the rise in the Retail Price Index.

Lytham Primary Care Centre, Lancashire (Image: MedicX)

Co-located services

There is real need to provide integrated care for patients along cost-effective pathways supported by a real evidence base for every healthcare action.

Inevitably this will be a driver for greater co-location of services, including moving many services provided in hospital settings to sites shared with primary care services.

In future, a wider range of professionals, supported by sophisticated IT/online services will deliver primary care. GPs will possibly become sub-specialists, and nurses and healthcare assistants will have larger roles.

Flexible premises

What about the buildings that will be needed? This is not simply about building larger premises.

The requirement is for buildings that:

  • Will support services as they continue to evolve.
  • Are efficient and inexpensive to run
  • Provide pleasant environments for patients and staff alike
  • Can transform the delivery of care to the local community.

That a pharmacy should be included is almost a given. Looking at wider community needs, tomorrow’s premises should, I believe, incorporate retailing and local services such as libraries and local council offices as well as community healthcare such as district nurses and physiotherapy.

In addition, patient time spent waiting to see a GP in a practice reception area could be better used if internet access and educational resources are available.

Raynes Park Health Centre, London (Image: MedicX)

Future premises funding

In England there is still uncertainty about how exactly GP premises funding will be allocated for new projectsfrom April 2013 when PCTs are abolished.

The NHS Commissioning Board or its regional outposts will ultimately approve projects, and it seems that practices will need their CCG’s support to confirm there is a need for a new building and that the current premises are deficient.

CCGs will have to focus on an effective estate strategy if they are to achieve sound and successful cost-controlled pathways for patients. To do this they will need buildings that allow for services co-location and integration at key locations in each community.

But the likelihood is that funding will be scarce over the next two years or so while the new administration beds in.

CQC registration

However pressure for change may build when the CQC begins visiting GP practices in England from April 2013, if there are many instances where surgeries do not meet its standards for safety and suitability of premises.

The results of a GP magazine survey published in January 2013 revealed that more than a third of GP practices across the UK have been unable to take on new services because their practice premises are inadequate. Also, more than a quarter said they did not believe their premises would comply with CQC requirements.

Property developers

Who will develop GP premises in future? Specialist third party developers have been successful in supplying high quality buildings over the last 10 years.  

Their expertise and experience places them in a strong position to provide the right buildings, in the right locations, delivering the best possible facilities for patients and communities.

The big challenge will be to ensure there continues to be adequate NHS funding.

New age premises

Lytham Primary Care Centre
In Lytham St Annes, Lancashire, this is an example of a building constructed for the future. It includes a pharmacy and café as well as the local district council. Two practices that share facilities work from the centre and there is further expansion space. The building is located alongside a community hospital, providing the key link for intermediate care.

Mary Seacole Centre
This recently opened centre in Clapham, London includes a new medical centre with a GP surgery and has high street frontage that incorporates a library and a café. The GPs additionally have extensive diagnostic facilities and there is expansion space available for other healthcare providers.

Raynes Park Health Centre
GP practices will soon be moving into this new centre in Raynes Park, London that will incorporate a variety of primary care services (including physiotherapy and pilates), a pharmacy, and providing space for the local foundation Trust. There is also ‘satellite space’ for a secondary care private provider’s community outpatient suite.

  • Dr Shillingford is head of healthcare at healthcare property developer and investor MedicX  www.medicx.com

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