Editorial: Bricks-and-mortar block to change

The health White Paper vision of 'community care campuses' delivering GP services, dermatology and other ex-hospital care, various therapies and social services in one place, reminds us that the health secretary had a previous job at the Department of Trade and Industry. The word 'campus' probably conjures up for Patricia Hewitt the bright, airy, modern buildings inhabited by US high-tech firms.

On the other hand, in many cases what we have in primary care are over-stuffed surgeries with barely enough space to squeeze in an F2 medic on rotation, let alone a minor surgery facility or a daily rheumatology clinic.

And the idea of using community hospitals - where they still exist - presents equal bricks and mortar problems. Many of these are elderly buildings which will require significant amounts of work if they are to house MRI scanners, X-ray services and modern general surgery units.

There is much to be said for a community-based NHS with more services in the primary care setting. The White Paper offers potential for development for GPs wanting to extend services. The big barrier is facilities in a period when premises funding has all but vanished.

Yes, GPs could go into partnership with developers and assume risk privately but why should individual doctors help fund new facilities to leave other NHS estate - hospitals - partially empty? Until there is a clear plan for premises, the White Paper vision is undeliverable.

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