The crown jewel of the NHS is in crisis. The workload has increased and is more complex due to our ageing population and the drive to move care from secondary care to the community. With increased patient expectations and chronic underfunding (at just eight percent of the NHS budget), GP practices are struggling. GPs are stressed, making it difficult for practices to recruit and retain GPs. Dissatisfaction is rife, with average appointments lasting ten minutes, and long waiting times to see both GPs and secondary care specialists.
With funding issues unlikely to be remedied, we need innovation and creativity to deliver the Five Year Forward View (5YFV). Suitable GP premises are necessary if we are to embrace integrated care – which will better serve the elderly, those with chronic conditions and deliver improved preventative medicine.
Modern, safe, ample-sized buildings for GPs would provide a firm foundation from which to coordinate local services, centralise resources and drive efficiency. If premises remain poor, services are likely to remain scattered, making the 5YFV harder to realise.
Upgrading GP surgeries will be crucial in enabling GPs to work in harmony with other disciplines, allowing for the development of the multi-speciality community provider. Without suitable premises, forging such partnerships will be difficult from a practical point of view. Lack of suitable buildings will also render it harder to harbour modern treatments and technology and thus could become a barrier to primary care sustainability.
For many practices, efficient collaboration with other specialities is lacking, leading to 27% unnecessary GP appointments. Outdated means of communication such as letters and faxes lead to delays, missed appointments and repeat GP appointments (around 15 million annually) for re-referral. If GP premises allowed for more physical contact between GPs and specialists, referral processes would be far more streamlined.
Which other pressures on GPs can be helped by better surgery buildings? A few examples:
- Diabetes, which has a prevalence of around seven percent in London, is set to rise to around ten percent by 2030. With serious health sequelae such as heart disease, stroke, blindness, amputation and kidney failure, there is much to gain by radicalising preventative medicine. Current preventative measures are often limited to leaflets or an old fashioned structured education course. In house experts on the premises - nurses, dieticians, exercise specialists - are needed to turn diabetes management around on its head
- In 2016 approximately 30 million working days were lost due to back pain, with around £14bn lost from the UK economy. These patients would be better served with rapid access to physiotherapists on the practice premises, rather than frustrating repeat appointments for analgesia and inappropriate referral requests for scans and to orthopaedic specialists
- Around a fifth of GPs’ time is spent dealing with patients’ social problems including debt, social isolation, housing, work, relationships and unemployment, yet half of GPs lack contact with local social care providers. Many of the above issues can be tackled with fit for purpose buildings, which have the space and equipment, by which improved and integrated health and social care can be delivered.
There are exciting times ahead for GP services, as government recognises the need to invest more into primary care infrastructure. The radical upgrade that the government aims for in the 5YFV relies on break down of barriers between GPs, hospitals and community services. This calls for a renewed energy and investment into transforming GP premises.
We know that modernising hospital buildings has enabled NHS services to adapt, evolve and engage better relationships with our patients. Likewise, good quality primary care premises would provide a platform from which GPs could deliver excellent holistic medicine. Furthermore, decent buildings will boost staff and patient morale - and restore their faith in the government’s commitment to deliver good quality universal care to all.
Dr Nisa Aslam is a salaried and out of hours GP in Tower Hamlets who trained at UCLH, The Royal Free, Guy’s and St Thomas’ and The Royal London. Her interests include women’s health, diabetes, sexual health, preventative medicine and medical education. Away from work she is mum to two girls and enjoys learning new skills including cookery, photography, skiing and Bollywood dance.