Wednesday, July 23, 2008

'Build it, and they will come'

Before I kick off, I'd better say that these are my views and I try to represent the positions of everyone there as I saw them.

Today was my second Health Overview and Scrutiny Committee and I think everyone there would agree that passions were running high. The main business was scrutinising the proposals for the new GP-led health centres that are being planned by Birmingham's Primary Care Trusts.

I don't think that there was much disagreement on the Committee that some people do have problems in accessing GP services. I myself have had the experience of phoning at precisely 8am to try to get an appointment, only to find that the phone rang so long that BT disconnected the call. All subsequent calls were met with the engaged tone and when I paid a personal visit a few minutes later, I was told that all appointments had already gone. But that's not the point.
Why does this happen? Is it government targets creating a narrow time window that GPs are then judged against? Is it GPs not responding to patient need? Are there too few GPs?

Well, whatever the cause, the government and Birmingham's Primary Care Trusts think they have the answer. It's 'GP-led health centres'. These are something of a departure from traditional GP surgeries. They're commissioned and funded directly by the Primary Care Trusts. Any company can bid to run one. They will probably have some kind of walk-in facility and maybe a pharmacy.

So far, so good you might say. Here are some of the reservations I have.

First of all, the Primary Care Trusts have basically been told to implement them by April 2009. It was quite clear to me that exactly what services these centres should be providing hasn't been worked out first. The whole idea seems to be, 'build it, and they will come'. There's also the issue of whether April 2009 is a realistic timescale.

On a similar note, we were told that there was nothing to stop existing GPs from forming companies and bidding for the work. We were also told that there was nothing to stop GPs from expanding their existing surgeries to provide the services that are being put to tender. However, the Primary Care Trusts already seem to have decided that these will be new centres, new buildings, new facilities. They're already scouting for locations. Perhaps it was always the intention to build new buildings, because that's the easiest way of showing the public that there's been an improvement in an area. The GPs that presented to us clearly thought that there was no prospect of successfully bidding for the work to be provided from existing, expanded surgeries.

Another issue is patient records. There's an intention from the Primary Care Trusts for patient records to be available in the new centres, but no apparent detail of how they will make this happen. Clearly the government's grand Connecting for Health programme won't be finished by April 2009 so personally I think there's little or no prospect of this.

Finally, there's a serious question over whether this will really increase the amount of GP services in any area over the longer term. It doesn't necessarily take a large number of people leaving an existing surgery (maybe for good reason, maybe not) for that surgery to become unviable and to close altogether. This would force the rest of the patients, who may well have been happy with the service, to seek an alternative. In the end, all we may be left with is the closure of most of the 'traditional' GP surgeries in the area, leaving people with no choice but to go somewhere where they see a different doctor every time and which may end up being as busy as the surgeries they were supposed to augment.

It's particularly interesting that one of the new centres is likely to be built in Selly Oak, with a large, transient student population. At present, the surgeries there are dependent on the influx of new students replacing the efflux. If a brand spanking new attractive centre is built, the existing surgeries may see a decline in their numbers of patients through no fault of their own.

One of the Councillors said that she'd received an assurance from the Primary Care Trusts that no existing GP surgeries will close as a result of all of this. I don't think that the Primary Care Trusts are in a position to give that assurance. A surgery might close for all sorts of reasons - is the Primary Care Trust going to stand up on every occasion and say, 'That's down to the new Health Centre, so we'll accept responsibility and help them?'

The only 'assurance' that I could get was that the PCTs will 'work with' existing GP surgeries. I must say that I was surprised that such an explicit assurance was necessary - I would have thought that it would have gone without saying!

In the end, this is all supposed to be about choice. My concern is that, in the rush for more choice, we will ultimately end up with less.

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