As part of the GP contract agreement for 2018/19, NHS England and the GPC agreed to carry out a review of GP premises policy to ensure the system was ‘fit for purpose now and in the future’.
GPC chair Dr Richard Vautrey has described premises as ‘one of the biggest problems facing practices’, warning that young GPs are ‘steering clear’ of the risks involved - namely lack of funding, financial liability and the threat of 'last partner standing'. It may not be just young GPs, either - GPonline’s latest survey found that the majority of GPs do not want to own their own practice now or in the future.
Premises are a key factor behind the rapid decline in numbers of GP partners - down more than 1,400 since 2015. GPonline's most recent poll also revealed that 40% of GPs thought partnership roles would be more attractive without responsibility for premises - a figure that rose to 49% among GP partners.
Our poll found that most GPs are keen to retain the right to own premises - but the numbers who don't currently want to suggests many GPs could favour a Scottish-style approach to the premises problem.
Under a new contract that took effect in Scotland this year, regional NHS boards will take over responsibility for leases so that ‘no GP contractor will need to enter a lease with a private landlord for GP premises’. GPs who own premises will be offered 'sustainability loans' to ease cost pressures, and over the longer term, the NHS plans to adopt a model that 'does not presume GPs own their practice premises'.
Another major problem facing general practice is the state of existing GP premises. According to GPonline’s survey, one in three GP partners and one in four GPs say their premises are not fit for purpose.
In addition, 33% of GP partners and 22% of all GPs said the premises they work in hadn’t been updated in over a decade.
Findings from the GPonline poll are broadly in line with an earlier BMA survey that found four out of 10 GP practices in England did not have adequate facilities to deliver services to patients and more than half of practices had received no investment in their premises for more than a decade.
GPC workforce lead Dr Krishna Kasaraneni said: ‘Many practice buildings are dated and in a poor state of repair due to the considerable bureaucracy associated with improvement grants and the failure of revenue support schemes.
‘This lack of investment and over-regulation stifles innovation... Without the space and facilities to accommodate staff patients will not be able to access the full range of services they need.’
A spokesperson for NHS England said the GPonline survey ‘does not reflect’ the £160m invested in 2017/18 through the Estates and Technology Transformation Fund (ETTF), a programme of funding launched as part of the GP Forward View (GPFV) in 2016 that aims to deliver £900m investment into practice facilities and technology between 2015/16 and 2019/20.
However, a BMA assessment of the GPFV in June found that many schemes funded by the ETTF have been delayed and that securing funding for large-scale projects has been difficult. This was reinforced by the RCGP's latest assessment of the GPFV, which found that there was ‘more demand on the ETTF than it can deliver’.