15.10.14
Small GP practices not sustainable and mergers inevitable – NHS England
Small-scale GP practices are not sustainable and will have to merge into super-practices covering up to 100,000 patients in order to offer seven-day care, according to NHS England.
Speaking to The Times, Dr Mike Bewick, deputy medical director at NHS England, who was a GP for 26 years, said there is a “sustainability issue” with practices who have three doctors or fewer. He said the aim is to have fewer but larger practices, covering 80,000 to 100,000 patients, so that there are more doctors available to cover the extended hours. “We need to make sure that patients are covered seven days a week, but you can deliver that in different ways.”
“If practices join together and federate or merge we can deliver evening and weekend consultations with a GP, but not a named GP,” he added. “I don’t believe the current model of small practices working on their own will continue. We need to recognise that things are different now. Working-age people and students want access when they need it and they don’t mind which doctor they see. People with long-term conditions need consistency.”
As NHE previously reported, the Royal College of GPs also believe practices will have to collaborate to meet the target of extended hours and seven-day opening.
Dr Maureen Baker, chair of the Royal College of GPs, said: “To meet this new aspiration practices will need to collaborate in federations. Whilst we feel this allows greater flexibility of workforce and premises, it will mean that patients cannot expect access to their own practice or their own GP for these extended hours.”
Compounding the problem, hundreds of GP surgeries have been deemed not good enough and many will have to close, according to Professor Steve Field, the chief inspector of family doctors.
Speaking to The Times, he warned that after inspecting more than 1,700 practices so far the quality is too varied. Although the vast majority are good, several hundred are providing inadequate cover and a fifth of surgeries do not follow basic safety procedures such as cleaning properly, storing vaccines in a fridge or checking that medication is current:
“For too long, practices that everybody has known are poor have been allowed to carry on,” Prof Field said. “In a hospital if you kill somebody, it’s high profile. In a GP’s surgery, if your fridge is not working it may not be immediately apparent, but you can affect hundreds of people. A child might get meningitis if the vaccine doesn’t work.”
Recognising the problem in the capital, a report released today from the London Health Commission calls for £1bn of funding over five years to renovate and upgrade GP practices, a third of which are “very poor” or “unacceptable”.
Lord Darzi of Denham, the surgeon and former Labour minister who chaired the commission, says: “All of us should be ashamed at the state of many of London’s GP practices. The condition of most practices is poor or only ‘acceptable’. This is the sign of chronic underinvestment from a capital expenditure system that has fundamentally failed.”
He added that family doctors are more important than ever. “The biggest burden on the NHS now is long-term conditions. The only way we are going to cope with that is to think about creative delivery models in primary care.”
Dr Baker welcomed the promise of funding but said that it should not be a trade-off to force overworked GPs to work 12 hour days and weekends. “Seven-day working may be right for some areas, but it needs to be properly funded and we need at least 8000 more GPs to do it,” she said.
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