I have been the BMA GP lead on premises for only a few months, so the government's announcement today of a four-year £1.2bn funding boost for GP infrastructure is a very kind welcome present. But it is one I am treating with a healthy dose of caution.
Today’s words from the chancellor could actually have been written by the BMA, given the campaigning we have been doing for some time on this subject. This year saw the launch of a major BMA survey that was answered by half of all practices in England. It laid bare the immense problems in this area, with seven out of 10 GPs saying they had no chance of delivering extra services in their cramped facilities, while four out of 10 said they were struggling to provide even basic care.
Bigger, modern buildings
This is the fact missed by a generation of policymakers: with rising demand and politicians' uncontrollable urge to put more services into the community, you need bigger, more modern buildings. We said this directly to ministers at a summit we hosted in the summer, at meetings behind closed doors and to MPs at an event in parliament. So maybe the message is finally getting through, and if it is, my predecessor Dr Peter Holden deserves credit for his work on getting ministers finally to listen.
But as always, the devil is in the detail. Promises don’t mean anything if they are not delivered. Once the media moves on and the focus shifts elsewhere, we need to begin the nitty gritty of working out how this £1bn-plus lifeline is going to be delivered. This will need to include proper scrutiny to ensure everything is delivered on schedule and in budget, something the NHS does not have a great track record of doing.
We must also make sure that this money is not diverted away onto other pet projects of the health secretary. In his speech to parliament on Monday, it was noticeable that the term 'GP infrastructure' seemed to apply to a much broader range of issues than premises, which had appeared to be the main focus just 24 hours earlier.
Emphasis on premises
To clear this up we need an agreed, focused strategy that puts the emphasis on premises – and we need it pretty quickly. Another paramount issue is that any new strategy cannot become a Whitehall-driven process where GPs and patients are supposed to be the grateful recipients of the wisdom of NHS managers. We need the holders of the purse strings to talk to all interested groups across England so that upgrades to premises actually reflect what each GP practice needs for its patients, and not what someone in an office in London thinks they need.
This is an encouraging announcement, but really it’s the beginning of a long road that all GPs, and especially the BMA, will need to keep a close and watchful eye on.