The Things That Matter. A Focus On GP Priorities

No matter what stage a GP is at during their life cycle, priorities are always going to change.

This article looks at some key issues during the various stages of the GP tenure. This is such a key area to look at in more detail.

 

Setting The Scene

Different priorities arise at different times. From a young GP to a senior GP, challenges will always be present and need to be prioritised.

One constant will always remain, the need to create space that has generational capability for the delivery of healthcare for a community.

Whether priorities for 2017 and beyond include the £45m for GPs to implement electronic consultations or just simply release the promised money to ensure the existing communities have access to adequate fit for purpose premises delivering Primary Care, the challenge with consistent government variation methods of rationing and constant fiddling with the NHS will always be present.

 

The Government

Today the priority for those trying to deliver fit for purpose premises for local communities is to get the government to actually release the revenue funds to GPs, not just the stupid little bits of capital money that just fritters away the main cash balance and they purport to be doing something.

A GP practice that currently serves 8,000 patients out of a premises currently suitable for 4,000 people surely does not require three levels of detailed business case documents to justify why they should have fit for purpose premises to service the same patients.

Priorities for many GPs are to have the time to spend with patients, to reduce the amount of red tape and procedure that they have to adhere to. If a surgery is applying for new premises funding, limit the CQC inspections to service only issues not premises.

The Business Case issue where the GP surgery is tasked to provide a business case for a new facility, which is fit for purpose, should be done for them by the CCG and be promoted by the CCG as part of an overall strategy, not on this continued ad hoc fragmented process that is so out of date.

Does a surgery business manager need to understand the deeper needs of a community and its needs? If a practice is desperate to move on an application for new premises they have to fund and deliver all the protocol that is seldom read and pulled together to make a comprehensive delivery plan.

The priority for government should be to ensure that GPs focus on the provision of primary care in fit for purpose space for patients (the countries workforce) to be made well quickly and able to work for the growth of the country. This should not be about having to prioritise organising business proposals that have no significant value to the actual care for the local population.

The government priority should be simple, CCG overview, doing a great job in most places, CCG produce a surgery replacement consolidation plan for their area and dump all the exhaustive business plans demanded from the GPs. The priority has to be centred from the CCGs to the government to release finances to invest in the primary health service for this country.

Time must be called on perpetual frittering money and time away on countless business case reports and consultants fees as to what each surgery thinks is best for an area. Does this community need consolidation in its Primary Care facilities and are the existing facilities fit for purpose now and will they be any good in five to 10 or 15 years time? If change is needed then lets get on with planning to deliver it. Finding land and getting planning permission takes time, by the time we have done that the CCG can get the money organised.

 

The Surgery Priority

The new surgeries created today have to prioritise for the needs of tomorrow. This is true value for money.

The 8,000 patient surgery has to be designed and built with the expansion capability for 12,000 to 16,000 patients as the demands within the UK grow.

So when we plan to agglomerate three practices into one super practice of say 30,000 to 50,000 patients we must also allow for growth and age expected demands (old and young).

The site for the new current building dealing with the needs of today and parking requirements must be designed with population expansion, and not just get a site suitable for the now need.

A surgery needs to work and not cause frustration when growth is required. Doctors need to fix people, not address property details (read our recent article on GP surgery maintenance).

As evidence highlights, when the NHS was founded in 1948, 48% of the population died before they were 65, that figure is now 14%. By 2030, one in five people in the UK will be over 65 (House of Lords, 2013).

 

The GP Priority

A new GP surgery can take three to 10 years to open, from finding a site, planning and eventual construction.

When built, one of the priorities for a GP is the well-being of the whole team who are a part of the everyday practice. This is not about the priority of latest design style that is lauded by RIBA (Royal Association of British Architects) but designed for those who work there and those who receive treatment and consultation.

This is not about a beautifully crafted exterior, but limited parking and poor lighting. The priorities have to be centred on the right design within the most suited location with the appropriate building materials that ensure long life, with for planned expansion, a loose fit and low maintenance.

Priorities will change over time but no matter what era for a surgery the ability to design with the future in mind is imperative. An experienced medical architect will understand the staff and patient flow, privacy and also noise that will guide the design to stand the test of time.

Philip Proctor, from chartered architects Proctor Watts Cole Rutter, has been involved in nearly 150 new surgery projects and identifies the priorities from an architectural side. Philip comments, “Occasionally I see plans produced by other architects and I am amazed that they are unaware of the essentials of surgery design.”

“A surgery is a key public building in a community, therefore it should have some presence and character that people can be proud of.”

“The building needs to require low maintenance as GP budgets do not fund building work. The building should be welcoming and provide a reception that is low stress as a stressed receptionist will be unwelcoming. The building’s acoustics are important so that consultation areas are soundproofed. It is no good having soundproofed rooms that let people in the car park hear discussions when the windows are open!”

Philip concludes, “When choosing an architect it is vital to take the time to visit their buildings and view them from a patient and a staff viewpoint, and ask if you would like to work there or be a sick or infirm or stressed patient.”

A GP surgery has a priority to stand the test of time for other people. A building has to be relevant to everybody’s life.

What starts with the release of funds and then the approval for planning and eventual build, the focus then moves to a generational aspect.

The priority becomes who is using the medical facility. This becomes the key to everything, the capability for a surgery to adapt for its successors via the opportunity that is left from a GP to leave a legacy.

 

Retirement Priority

Priorities change towards the latter part of a GPs career, where at one time the ownership was planned for as a boon, an investment asset, now it is often a mill stone around a retiring GPs neck.

Invariably this was down to financial planning objectives at the time not expecting such changes in the future of GP recruitment and lifestyle flexibility. The security of practice income stream makes life easier but passing on the responsibility of the premises in the succession of a surgery can now be a challenge.

Where the focus was predominantly the service in the premises, the future outside of the surgery becomes a greater priority. So now the priority for many GPs is how to get out of this ‘great’ investment that was refinanced to pay off the previously retiring GPs and is now costing more than it cost to build, is out of date and in terms of debt servicing, unaffordable.

Priorities certainly change, but there needs to be someone who has a GPs best interests at heart.

 

Starting A GP Partnership Role

Buy into a freehold, sign up to a lease, prioritise what is important to a new GP partner?

A GP may say, “Well I want to be part of the game, I would like to look to the future and put down some roots and not be the salaried partner or the paid GP.” Often the only way is to buy in to the club. Yes a GP can get a loan, only too easily against the CMR reimbursement process. But then responsible for paying to bring the old place up to meet CQC demands, but they are buying at current valuation which does not really take into account the remedial costs.

If they sign up to a lease they are responsible for the rent for the next 20 years or the remainder of the lease. Will theyhave a replacement GP wanting to take over their slot?

What is the best option, what does a GP get in return. If they sign up to a lease then the retiring GPs don’t walk away with all the cash and they are left holding the baby / responsibility. We all can walk away at the end of the lease and hand back the building, as long as a GP has pick a surgery that has a good landlord who maintains the building and they provide a great service that helps with a greater chance of finding a replacement GP.

Some have very definite ideas about what they want and others have huge deliberations about the role they want to play in the delivery of primary care.

 

To Conclude

When it comes to the priorities there are, like life, various stages of the GP life cycle and adapting ones mind set to prioritise what is important and to plan for these natural changes is important.

Generational planning and to leave a legacy within a community is a constant theme we hear, achieving it is the challenge and takes thought.

Compounded by the ever changing priorities of our government, a growing elderly population including the worried well, a melting pot of priorities continuously bump together to create ongoing issues and wonderful fulfilling opportunities to be harvested.

If you are looking for change and are undecided in your priorities profile and want a sounding board, possibly a discussion about what is your priority and what is important to you right now linked with an abstract discussion about what’s in store in the coming years might mean a conversation with Jon or Philip will top your priorities list. If so give Jon a call on 01202 744990 or email jon@jkwproperty.co.uk