GP Access and Polyclinics
29 July 2008
In response to genuine concerns that there are some areas with low numbers of GPs where there are relatively high mortality rates, the Government has brought forward proposals to increase access to GP services.
However, I have received a large number of letters from constituents, including local GPs, who are worried about the Government's proposals. I took up their concerns in a letter to the Health Secretary, Alan Johnson and my letter is reproduced below.
I also contributed to a debate in the House of Commons on polyclinics on 17 June and used my oral question to the Secretary of State on 22 July to ask about this issue:
Health Questions - 22 July 2008
Oral question to the Secretary of State
Polyclinics debate - 17 June 2008
My earlier intervention on the Health Secretary
Meeting with the Minister to discuss local concerns
In the afternoon, after my oral question on 22 July, I and other South Birmingham MPs met with the responsible Health Minister, Ben Bradshaw MP and are pictured outside the Department of Health after our meeting.
At the meeting, I explained that whilst the provision of Government money for additional GP services is very welcome, I did have concerns that the model advocated by the Department of Health for these new services may not be the best way of filling the gaps in GP provision in our locality (as my contributions in parliament and in correspondence with ministers referred to above demonstrated).
I am now pleased to say that, after the meeting with Ben, it has been made clear that the PCT does have flexibility to provide these services in the best way. For example, some GPs have claimed that they are not allowed to bid for these extra services, nor use their existing premises. After clarification, it has been agreed that this is not the case but the Government wanted to make sure that the extra money would be used to provide new services not just allow GPs to expand the size of their practice. In fact, most of the bids received by the PCT have been from GPs!
Current Primary Care Trust (PCT) consultation and proposals for South Birmingham
South Birmingham PCT is holding a consultation on the proposals for South Birmingham, which ends on 8 August – details of which can be found by clicking here and the following link will take you directly to the consultation document:
To be fair to the Government, there are no plans to close any existing services (other than in London where there are unique issues). The fact is that additional money is being made available to open a new health centre and one or more GP surgeries in each Primary Care Trust with the aim of addressing so-called "underdoctoring" and ensure everyone has good access to a GP at a convenient time.
What is proposed for the South Birmingham area, is a new Health Centre (not a polyclinic), which will be open 8 till 8, 7 days a week, and an additional 3-GP practice. Surveys of patients have shown that there is a need for these additional hours of service when a person’s own GP may be closed. Also a lot of people are turning up at Accident and Emergency services when it would be more appropriate for them to see a GP or practice nurse. For some services (eg sexual health) people (especially young people) may prefer not to go to their family doctor.
The PCT has also identified some groups of vulnerable people that are not registered with a GP (eg people with mental health problems) and there are some areas where an additional burden is placed on the local GPs (eg where there are a lot of residential homes nearby) and the idea is to plug these gaps.
I know that many constituents were worried about the proposals but I hope that the information I have provided gives some clarification. If constituents have any further comments or questions please do feel free to email me.
Letter to Alan Johnson of 10 June 2008
Alan Johnson MP
Secretary of State
Department of Health
Date: 10 June 2008
NHS Next Stage Review: Leading Local Change
Thank you for your letter of 9 May 2008 regarding the above. I was pleased to note the five pledges on change in the NHS which PCTs will have a duty to have regard to, which were:
1. change will always be to the benefit of patients;
2. change will be clinically driven;
3. all change will be locally led;
4. patients and key partners will be involved;
5. and no existing services will be withdrawn.
However, it would appear that these pledges have not been upheld in the practical arrangements being driven forward through the Next Stage Review.
A few days prior to receiving your letter, I had also received a letter from Ben Bradshaw informing me of the proposal to establish new GP practices in South Birmingham as part of the £250 million access fund you had announced in November. Although Ben pointed out that the DH is not looking to force a fixed model of primary care for local communities, it seems clear from the ensuing report of 16 April to the Board of the South Birmingham PCT that the additional funding is only available for commissioning a new three GP practice and a GP-led health centre, even though their report shows that there is no need for this pattern of additional provision in order to improve access to primary care and to reduce inequalities. Furthermore, the timescale imposed for the deployment of the additional resources, requiring services to be up and running by 1 April 2009, is, in itself, incompatible with the above-mentioned five pledges. For example, the PCT is being forced to search for buildings in their ownership to use on a temporary basis.
Since the announcement of these additional practices, local GPs, who are clearly unhappy with the proposals, have been instigating local campaigns that have resulted in my receiving the enclosed communications from my constituents.
The Government has a great deal to be proud of in the improvement in GP services - the increase in their numbers by over five thousand and a significant increase in the length of the average consultation time. However, I do feel that, in your haste to respond to concerns expressed by a minority of patients about out of hours access, and the Darzi “one size fits all” recommendations, which have little rationale, you are rushing to impose new establishments in every PCT rather than consulting with PCTs about exactly what measures would best meet local needs. You have imposed a universal solution for every area which is not the ideal solution having regard to local circumstances. In South Birmingham there is no obvious gap in provision centred on any particular locality and, indeed, in the preferred location for the ‘GP-led health centre’ planned expansion of an existing GP practice is already taking place and due to open on 12 September. This will double the capacity of this practice to see patients, as well as providing extra services. In practical terms, established NHS practices have been excluded from tendering as the presumption (and practice in terms of how the tendering is taking place) is that new services must be set up by “private providers” and there can be no sharing of facilities or staff. This established practice claims to be able to expand to meet Government needs and at less than the money being put in under the central arrangements through the PCT.
The Local Medical Committee (LMC) say that they were not consulted on the proposal to establish new GP practices and there is real concern that the additional provision will destabilise existing GP provision. For example, how will funding for the health centre continue after the initial 5 years if they do not register the 6000 designated patients. After reading her report, I have spoken to the lead officer on the PCT and it is quite clear that the PCT could make better use of the additional resources being provided were the changes to actually be “locally led, clinically driven and involve key partners”. Although the PCT has included an LMC nominee onto their steering group for the project, they tell me they have also expressed reservations about the model being imposed upon them. This has apparently been via the SHA, through which the tendering is being organised. I understand that the contract for new practices will be allocated by the standard procurement procedure, which gives large Alternative Provider Medical Services (APMS) bidders an administrative advantage. It appears that the Government has an agenda to ensure additional capacity through large multi-national providers that has little complementarity with existing provision but which will undermine the very aspects of our current provision that attract widespread admiration and are most valued by patients.
On 20 June I will be meeting with the LMC and GPs from my constituency. Many GPs feel bullied by the Government and that policies are knee-jerk and inconsistent (see for example the enclosed copies of letters sent by two GPs to yourself and the Prime Minister). It really beggars belief that morale is so low when remuneration has never been higher. I should be grateful for your response to the concerns expressed by my constituents and also local GPs and hope you may be in a position to respond before 20 June.
LYNNE JONES MP