Primary care trusts may close practices with poor premises

Primary care trusts (PCTs) could use poor premises as an excuse to decommission poor practices, according to the DoH.

Photograph: istockphoto/Bruno Uhernik
Photograph: istockphoto/Bruno Uhernik

GP reported last summer than some north London PCTs were threatening to withdraw GPs’ contracts because their premises were not up to scratch.

Now the DoH has condoned this practice. In a world class commissioning document sent to all PCTs, it suggests that the obligation for GPs to have ‘adequate and suitable premises’ was ‘in itself a significant commissioning lever’.

If buildings are not brought up to scratch, it could be grounds for terminating a contract, the document says. PCTs could also use ‘premises incentives... to drive changes in the pattern of primary medical care provision, and to… implement new models of provision’.

The document, ‘Primary and Community Services: Improving GP services’, offers PCTs guidance on how to develop and commission local health strategy. The present ‘location, size and make-up of GP practices,’ it argues, ‘reflect historical business decisions made by GPs and do not adequately meet current needs’.

To rectify the situation it calls on PCTs to work with practices to develop measures on the quality and accessibility of services. Suggested metrics include the length and quality of all primary care consultations, the average patient list size per GP practice, and the value for money of the services they provide.

The document also suggests the PCTs could define ‘geographical access standards’, such as the maximum distances patients are expected to travel to a practice or the number of practices they can choose to register with.

It adds that PCTs should develop a ‘close working relationship with every GP practice’. It calls on them to abandon the current system of risk-based performance, and instead conduct regular and intensive performance reviews on all providers.

PCTs should also monitor patient complaints about practices, and find ‘proactive ways’ of distributing information about the range and quality of services they provide.

They should also use ‘mystery shopper’ techniques to check whether practices are accepting new patients, it says.

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