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| FEATURES | FORUM - Opinion in the CNJ |
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Over the last 117 years work as a GP has changed considerably. The pace of change has been greatly accelerated by the advent of computers and their widespread adoption over the last 15 years. Sadly, however, premises across many parts of Camden have not kept up with the changes. Like many London GPs, Camden GPs are still working from outdated and inadequate premises which are not fit for delivering modern day primary health care. The James Wigg Practice has moved several times since then, most recently into purpose-built premises in the early 1970s. Now, this building, too, has outgrown itself and is inadequate for the 21st century. Part of it has been condemned as unfit for habitation – it has not been used for many years – and the rest of the building is too small. We want to provide a new health centre where our patients will be able to access more than just a doctor. We have been working on our proposals for this exciting project for 10 years now. One of the biggest obstacles has been the question of how it could be funded. We were ambitious about what we wanted for our patients but were determined that we would do everything we could to provide the first-class service that we all dreamt of. The government has devised a formula for GPs who find themselves in our situation. It’s known as a Local Improvement Finance Trust (Lift). Camden Primary Care Trust, who run local NHS services including GPs, was one of the first Lift areas to be announced, together with the neighbouring trust in Islington. The Department of Health has agreed further Lift projects; making a total of 42 areas nationally. Inner city deprived areas are targeted where premises are the least satisfactory. Lift is a partnership between a group of companies who come to the table with the money and property development expertise, and the NHS group who need premises built. It is an opportunity to, at last, tackle the huge buildings problems we have been living with for the last 50 years. The money needed to start up schemes, build them, move the GPs and other services in, is there. Redundant premises can be sold off and the money used to offset the costs of new developments. In some cases there will be the opportunity for the Lift company to build key-worker or affordable housing above the premises to help towards costs and accommodation. One of the main problems for the NHS in the past has been maintaining its buildings. Constant budget squeezes have meant that a coat of paint, or much needed repair, may be put off. In future, the Lift company which builds the buildings has to maintain them. This is usually for a lease of 25 years. The building must be made available to the NHS at the end of the term in an almost ‘as new condition’. This is a clever switch of responsibility, normally held by tenants, to the landlord. It will mean properly maintained premises remain fit for purpose throughout their life. What will these new GP premises contain? Certainly much more than Dr Wigg could ever have dreamed of. The first two Lift schemes locally are being built now. The first is a GP practice in an area currently without enough doctors. The second is a GP centre with community centre on a housing estate. Lift is set to deliver elsewhere over the next 20 years. A plan drawn up by the PCT lists a number of poorly organised premises – none of which comply with new disability discrimination legislation – all needing replacement or refurbishment. At Kentish Town, one of possibly three Integrated Care Centres, planned for Camden will be built. This will be a state-of-the-art GP and community building. Work with the Citizens Advice Bureau in Kentish Town has shown that for every £10,000 we spend on welfare rights advice, there is an increase in income for the local population of £100,000. We have just secured lottery funding which will allow us to spend an additional £50,000 a year on this. If your child has been in hospital and wants to come home early to continue treatment at home, this is now possible. Not thanks to doctors, but because a team of specialist children’s nurses work in homes continuing intravenous drugs or dressings normally done in hospital. Similarly, an elderly person may be able to access physiotherapy and nursing help in their home from the elderly nursing assessment team – often preventing a distressing hospital stay. This is only possible where GPs can work closely alongside these teams to help communication and share the workload and responsibilities. Locating all these teams under one roof revolutionises the delivery of care. Dr Wigg worked out of his sitting room in 1887. When you visit the doctor in 2007 there will be the opportunity to meet many different professionals in the same building. The warmth of that sitting room can be captured by both good architecture and the atmosphere created by staff. Having improved premises not only allows us to offer an improved range of services, it also helps to recruit and retain the essential staff needed to deliver those services. n Dr Roy MacGregor is the senior GP at the James Wigg Practice |
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