By Robert Campbell

The ‘heyday’ of purpose-built surgeries

One of my first jobs was visiting and plotting on a map every surgery in Inner London, and later supporting doctors to bring their premises in Dudley, Wakefield, and Leeds up to standard. The premises varied from old church halls to enormous new buildings. This was when the Cost Rent Scheme was predominant and building Health Centres had declined. Health Centre buildings suffered from ‘square-ness’, proliferation of doors, and flat roofs. Internal ‘garden’ quadrangles would’ve been better filled with rooms, and at one surgery in Leeds we filled this with a records room and admin area, providing better access to the consulting rooms.

Enough ‘hassle’ without premises too! 

We’ve entered a phase of privately financed initiatives (PFI), which were built independently and leased back to practices. These new buildings are enormous. Often, several practices share the building but on different floors. This immediately presents a problem when practices on upper floors try to accept new patients.  Although allegedly built with a ‘green’ view in mind, the running costs are terrifying.  New doctors don’t want the hassle of managing and owning huge premises, and the trend toward salaried contracts and a four-day week demonstrates this.

The ‘management’ problems 

Some practices have two practice meetings, a clinical meeting and a management meeting, showing the change in the day-to-day management of GP Surgeries. Some leave management to an accomplished manager while GPs take an interest in specific areas in others, such as personnel, finance, clinical performance and ‘premises’ issues.  Time is eaten away by ‘clinical’ management issues, such as the Quality Framework and Enhanced Services, leaving little time for the premises. Each doctor could likely justify blocking out 1-2 clinical sessions weekly to concentrate on ‘management’ issues.  Even the largest, well-managed practices are trying everything to deal with clinical worker load, including telephone consultations, triaging requests for appointments, and nurse practitioner appointments. Practices embargo appointments until today and split sessions into urgent and regular appointments. Vacancies for GPs go unfilled and the remaining doctors increase their sessions back to full-time.

Using Other Premises

Practices are working together in ‘groups’ or ‘hubs’, using under-utilized buildings in evenings and at weekends to provide Extended Hours for patients.  The premises might not be nearby but at least they are no longer white elephants.

Nowadays, any thought about new ‘surgery premises’ is last on the to-do list and keeping the premises maintained can be a nightmare, with security and maintenance issues abounding. Where are the funds anyway?

Future proofing GP premises

What’s the future for GP premises? Maybe a surgery building with a built-in pharmacy? Or, a 24-hour walk-in centre in a city centre? There should be one surgery that provides 24-hour cover in any area. There are already examples of ‘open all hours’ surgeries and having used one in Scarborough I was impressed. Either that, or the general medical services must be split into a daylong urgent care service and a daytime ‘routine’ care service bookable in advance. Isn’t that what Darzi Centres were about? I think it already happens in the US!