Let’s Learn To Value Our GPs Again, The Spaces They Work In & The Services They Provide Us

There are almost 3,500 NHS doctors that have started the process to look overseas for work. These are predominantly young recently trained. Why?

2014 saw strikes from nurses, occupational therapists, paramedics and healthcare assistants, the first in the health service since the 1980s. We are now once again in a conflicted /unrest over the planned introduction of a seven-day service from doctors and changing the hours doctors work. Why?

One of the solutions must be for us to look at creating environments for GPs and the community that can plan for the future on a generational service, not as a quick fix.

A future that can be achieved for the good of the community and more importantly for the long term.

 

THE SCENARIO

We have a shortage of GPs. We need to make our community more attractive than another area.

 

Where Do We Start

We seem to have lost this awe and respect as the GPs have been made to justify their role in terms of financial targets.

We have too many financial targets to be met by people who want to spend their time doing good for the community. The current trend is that they have to be businessmen first and GPs second.  This loses the air of exclusiveness and respect from a community. This needs to be restored.

The role of the GP has a more unusual responsibility when compared to other professions. On top of the additional pressures to look after patients throughout the week, there is also a business to run and financial responsibility for a building, which is fundamentally a community facility.

Young GPs are just as, if not more aspirational than the rest of us. It is tough to qualify and takes a lot of investment and dedication. They have a desire to be rewarded well and to have a fair work life balance.

When they need to try out a location to see if they want to settle in a new community, how do they?  An answer might be the provision of residential accommodation within a medical centre development so that the pressure is off the hunt for accommodation we can incentivise the remuneration package for the GP.

 

Asking A Question

The whole objective starts with asking the question, ‘how do we engage to get the best doctors to become more enthused and settled and to help our community?’

This all acknowledges the need for change in our understanding of what a GP is expected to provide as a job for the community they serve and how this person’s willingness to be doing the job impacts on that community.

 

THE ISSUE

 

It Just Doesn’t Fit

What doesn’t fit well in today’s Primary Care delivery environment is the ‘old senior partner’ ownership regime.

The whole GP property owning reward system has failed to deliver in so many cases especially for those practice participants who are holding the debt at the end of the GP surgery buildings usefulness as a surgery.

With many bitter and twisted arguments along the way, it only benefits the few who are brought in to umpire the divisive debate.  It cannot seem attractive for a new GP to buy into hugely expensive premises and then be expected to be responsible for the payment of the servicing cost of delivering that building for the benefit of the community and not have a reward for that risk, the capital gain at retirement time.

So often there is not a financial gain to the GPs having been sold the dream of riches in old age, now we have a shortage of GPs. Who is going to help make the dream come true?

 

No Winner

Who loses out when the day of reckoning coms? It is not the NHS / Government they have no responsibility for ‘not fit for purpose premises’. They have even got the CQC coming around to bully the doctors to invest in the buildings to provide the service the NHS is under a duty to provide.

Not a cost to the NHS, not a risk to the NHS.  Not a financial cost to the local community. However, there is certainly a very high cost to the community if the facility is so unattractive in terms of finance and quality of premises they cannot attract a replacement GP.

An alternative is for the GP to rent a building and then only needing to find a replacement GP to take over the responsibility for security reimbursement when they want to move on.

This does not look the most attractive proposition either when there are a lot of years left on the lease. It is possibly better than having a huge debt on an evergreen loan or/and negative equity admittedly but certainly easier to transfer to a new GP who wants to join and live in a new location (if the premises are fit for purpose and with a loyal community).

If the community being served has changed and all the NHS trained GPs have fled the country to better funded and provided with greater rewards for their labors, the last GP is expected to carry the risk. Not the NHS. Not the Government. Just the last GP who is working from a dysfunctional, not fit for purpose building. How is that fair?

The thing to note here now is that there is a cut off with this type of plan. At the end of the lease, the GP walks away. No further responsibility. No negative equity. No work to do. Up to the landlord owner to sort out the building and what happens to it.

 

A SOLUTION

 

A Suggested And Appropriate Model?

 We want GPs to be there for us in our hour of need.

We want to have good quality fit for purpose premises, so even when we have to go the premises it has a good impact on our wellbeing. We want GPs to want to come and live in our community and are part of it to look after our family friends and relatives.

How do we work in a system that wants to be independent and yet does not want to take on the responsibility? How do we address the needs of the community and the NHS ‘value for money’ mantra? It is a very challenging conundrum that many brains better than mine are still pondering over.

Yet, I think we have at Jerrard Keats & Wolley found a possible way forward but it is a generational cultural solution that we would like to share.

The local community is at the heart of the solution. The jobs and environment that a facility that is loved and cherished by the community creates its own health and wellbeing. It becomes a place that is attractive to work within not only for the GPs but also for all the support staff that go to make up the functioning service.

 

Our Surgery Mentality

Let’s try and build a community around ‘Our Surgery.’  Let’s include a Café, a Theatre, a Food Store, why not some accommodation for the less well-paid staff in the NHS.

Lets create a plan to spread the model around the country that helps us build value for the community and ensure that if there is a shortage of GPs to look after us in our old age at least our community will have a better than even chance of be selected by those GPs wanting a nice place to settle and make it their home.

This model of working is already been pioneered by the Charles Higgins Partnership as evidenced by developments in Shelley Manor Medical Centre (Bournemouth, above) and Sturminster Newton Medical Centre (North Dorset).

Both examples represent a commitment to a community and a purpose beyond bricks and mortar. The neighborhoods have been built around the axis of the surgery and have been planned from the very early stages. The role of the GP within these sites is to play a central role for the community and supported by its additional services and spaces.

 

The Right Facility, Planned

Young and progressive doctors do not want degraded and work out of run down premises.

Spaces and centers need to be rejuvenated to tackle plummeting morale and the exodus of people because of better environments and less pressure.

Countries such as Australia and New Zealand rely heavily on migrant doctors from the UK. Within New Zealand, the UK is the main source of overseas doctors, contributing to half of its international medical workforce.

Encouraging more doctors to feel part of a community and the modern infrastructure to support them takes time and they have to become enthused. It is not a case of simply stating that ‘we need doctors.’ We need to address the service that is being asked of the individual GPs to deliver the National Health Service.

A solution is to place GPs in a space that they feel part of and have an emotional responsibility for.

 

Bringing To A Conclusion

The purpose and change for a more meaningful future for GPs is evident.

Whilst the short-term issues are clearly evident, when planning for generational interaction and creating key community spaces, becomes a discussion to build on.

Jerrard Keats and Wolley are an experienced medical property adviser. We are here to shape, create and deliver a clear strategy for GPs so they can achieve peace of mind.

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Whilst we acknowledge a testing time for GPs, we are a trusted resource for the medical community. To communicate with a team who know your industry very well, give Jon a call on 01202 744990 or email jon@jkwproperty.co.uk