How can we improve the lot of inner-city GPs?
An equally important question is how can the NHS improve the lot of those who live in inner cities?
Our policies are aimed at achieving mutual benefits for all through quality services that will also be likely to take pressure off the system. Good responsive general practice is a must for all the population but is even more necessary where need is greatest.
There is ample evidence for my claim. Barbara Starfield's and Martin Roland's seminal research, Commonwealth Fund (2007), and Carol-Ann Hooper's less well known work on the powerful impact of GP's relationships on coping abilities of those in poverty (2007) are just two examples. But the 'inverse care law' is true of general practice because it has remained maldistributed for all the NHS's existence.
So what are we doing now for inner city GPs? Better remuneration for general practice, so we are now among the best paid GPs in Europe is one area. The contract of 2004 is now further improved for those in high demand areas. This was always the intention, but implementation had to be gradual as there would have been too much volatility in the remuneration of practices, which could have financially destabilised many.
What has been the outcome of this year's financial changes? The QOF changes, in combination with global sum changes, benefit the most deprived practices the most. The QOF prevalence changes benefit practices with high prevalence so should act as an incentive to practices in areas of social deprivation, which tend to have a higher incidence of long-term conditions.
We have had a major investment in primary care premises. More than 3,000 GP premises have been improved over the past decade or so.
A most significant development is LIFT. Nearly £1.6 billion has been invested in 207 new buildings that are fully compliant with the Disability Discrimination Act and it has provided opportunities for practices to co-locate with other primary care contractors and community-based services in multi-functional facilities.
These facilities are designed to adapt to changing and additional service delivery requirements and be a community resource. LIFT is focused on areas of deprivation, where scarcity of land and negative equity are major problems.
The claims that the scheme is prohibitively expensive are not true if the whole package of comprehensive maintenance and insurance and the scope for extended services are taken into account.
It is not only general practice but other primary care disciplines that are so necessary in areas of social deprivation.
The role of community nursing, working closely with GPs, in the care of patients with long-term conditions is hugely relevant. A pro-active approach to such care has been proved to lessen unplanned work in both primary care and hospitals.
These policies will aid existing practices, but more services are needed. So extra practices are being opened in areas of social deprivation to make inroads into the maldistribution of general practice.
And can we in primary care do more in terms of scope and ambition?
Practice-based commissioning (PBC) should enable us to channel general NHS funds into better primary care - not least through better care of those with long-term conditions. PBC will also help good-quality smaller practices retain their important individuality and still provide extended services.
Clinician-led initiatives such as working in consortia or in federated practices will provide the 'bottom up' support required.
Of course there will always be more to do but I feel good progress has been made so far. PBC is the test of whether we can progress more as the power and influence lie within the capacity and capability of GP practices. True of inner cities as much as elsewhere.
- Do you think the government is doing enough to help inner-city GPs?