Londonwide LMCs chief executive Dr Michelle Drage welcomed recognition that general practice needed investment in plans published by the London Health Commission, chaired by former Labour health minister Lord Ara Darzi.
But she warned against repeating mistakes of the past by focusing on new premises rather than upgrading existing practices.
Recommendations in the report - commissioned by the mayor of London - risked becoming a ‘GP bashing exercise’, requiring practices to relocate because their current premises do not tick all the right boxes, said Dr Drage.
Rebuild or refurbish all practice premises
The commission, which included GPs Dr Sam Everington, chairman of Tower Hamlets CCG, Dr Tim Spicer, chairman of Hammersmith and Fulham CCG, and Dr Caz Sayer, clinical lead at Camden CCG, called for a £1bn investment to rebuild or refurbish every GP practice in the capital.
‘What we need to see is the money,' said Dr Drage. ‘What often happens is, this is the tease: we don't know where that money is coming from. We have a situation in London clearly where the rest of the service is under strain, so if this is just taking money out of something else to pass on to us and it puts everything else under strain.’
She warned against a repeat of Lord Darzi's Healthcare for London initiative, which moved some GP services into polyclinics.
Support for the plan would depend on how it was implemented, said Dr Drage. ‘If this is money, let's say, that is taken out of dead estates and it's sensibly planned to go into improving and upgrading practice premises and possibly new builds, that's a good thing. The problem with the way it's written is it doesn't really talk about upgrading existing premises. It only talks about moving people into new buildings.’
‘This is the trap they fell into last time with Healthcare for London. And in a way it's also the trap they fell into during the better times with Tomlinson, because, what they mean by that is, the cynical view is: "let's have something grand that ministers can cut ribbons on".’
Practices blamed unfairly
Practices that have been underfunded for many years could end up being blamed for the condition of the premises and forced to move. ‘This is risky business,’ added Dr Drage. ‘The headline is there is loads of money, but the reality is we don't know where it is coming from. If it does come, we don't know what the strings are. And in any case, they seem to have already decided what they are going to do.'
Requirements to provide 8am to 8pm access as a condition for new investment would also be problematic, said Dr Drage, without support services, diagnostics and community staff in place to cope with the increased traffic and referrals it would drive.
'That is one of my big, big disappointments with the report,' she said. ‘It doesn't really address those need. We need a massive investment in locally based diagnostics, one stop access for those, direct access to decent district nursing and community services, and many more social workers and mental health workers. Where is that in the report?’
Dr Drage said the commission’s call for an ‘ambitious new service and quality standards for GPs’, was ‘classic mayor talk’ which ‘panders to the name, blame and shame thing’.
‘The professional job GPs do, if allowed to do it and supported properly, would deliver standards far above what they are expecting. There are standards we would aspire to do, that are not deliverable unless you are properly supported.’
Londonwide is already working with NHS England London on new specification for general practice which Dr Drage said must be ‘realistic and deliverable’.
‘Any additional resources will need to underpin the ability to deliver those specifications,' she said.
Overall the report was ‘a bit of a mixed bag’, said Dr Drage. ‘The message is, what we have to do as GPs is make sure the values of general practice are solidly maintained through whatever changes they bring in, but not be seduced by the £1bn, when it may not be there.’