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Cash and decisions on primary care investment ‘at a virtual standstill’

This will stymie needed shift of care from hospitals, warns NHS Alliance chair

Caroline White

Friday, 24 January 2014

The development of GP and primary care premises, needed to shift care away from hospitals, has all but ground to a halt, with decisions and cash availability at “a virtual standstill”, the chair of the NHS Alliance, Dr Michael Dixon (pictured), has warned.

This lack of progress threatens to undermine the healthcare reforms and save the NHS much needed cash, he said.

“The current system for developing premises to look after patients outside hospital is not fit for purpose and threatening to slow down much needed NHS reforms,” said Dr Dixon, speaking at a meeting on primary care estate in London yesterday.

Without appropriate buildings and facilities in primary care, the NHS would be unsustainable, he said, as it would be impossible to move services out of hospital, and where appropriate, provide them in communities for the convenience of patients and the benefit of the public purse.

“The dreadful irony at present is that, at a time when it is most important we have systems and money for investment in primary care premises, their development has all but ground to a halt,” he suggested. “Decisions and money for development of GP and primary care premises are virtually at a standstill.”

Several factors were to blame, he suggested, including centralisation of decision making from primary care trusts to NHS England, which was strangling the development of primary care premises with red tape.

Development plans were now “becoming a bureaucratic long-winded process, insensitive to local needs and concerns,” he said, adding that “it is unclear who is actually making the decisions.”

To make matters worse, NHS England appeared to have no money to invest in primary care. “Without leadership, money or a will, it is hard to see how general practice and primary care will get the much needed investment in premises that is required,” he declared.

This reflected the inherent bias in the system in favour of specialist treatment in hospitals, he said, alluding to the facility that foundation trusts have to own and sell their own property and redesign their estate themselves.

Although non-foundation trusts have to hand the monies from premises back to the Treasury, they are often able to access this cash for further development further down the line, he said.

“These are luxuries that primary care does not have. Consequently GP practices that are desperately in need of improvement or renewal are unable to get funding from NHS England,” he added.

And the chances of external private investors stepping in were vanishingly small, he said. Few investors are brave enough to take on property or leases for redesigned services in primary care, in the hope that their local CCG would be able to stump up the cash and the will to commission their services in the long term, he said. They consider it too great a risk.

In the past, GPs were often prepared to take on this risk. But “the probability of anyone undertaking such a risk in the current financial climate is less than ever,” he suggested.

In a bid to address the shortfall, Dr Dixon suggests that decision making about new GP premises and other primary care facilities should be more local, with CCGs firmly in the driving seat.

Secondly, more money has to be made available to support primary care, not only for NHS England's coffers, but also for a new commissioning framework to develop out of hospital services, while giving private investors assurances that they stand to make a return on their investment.

He recommended that a “fighting fund” be set up for CCGs to access specifically for the development of new premises. In view of the fact that these premises would be used to carry out tasks previously done in secondary care, it would seem appropriate for this money to come from unused capital in that sector, he suggested.

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