GPs working in 'sub-standard' buildings

MANY doctors' surgeries in east Suffolk are in sub-standard buildings and urgently need redevelopment just to cope with existing demand, health trusts have warned.

Most practices in the area at least need to expand or modernise their existing site but an estimated £1.44million every year is needed in Ipswich alone.

A report to the Suffolk East Primary Care Trusts' (PCTs) joint board said the lack of investment, partly because of its financial dire straits, means there is now a “significant risk” that existing primary care services and future delivery are being compromised.

Pressure is set to increase on doctors' surgeries, with practice-based commissioning, services moving out of hospitals and into the community and primary care, and the population rapidly increasing.

But with GPs surgeries taking three years or more to plan and build, the PCTs have stressed that work needs to start now.

The report said: “Some primary care premises are insufficient to cope with current demands, let alone the shift of services away from the acute sector into a community or primary care setting and are effectively sub standard and not fit for purpose.

“There is a big risk that these premises will not be able to cope with this and the rapidly increasing population.”

Many of the practices are working from adapted residential buildings, the report said. Ground floor extensions provide some of the clinical space and what were living rooms give waiting and reception areas. In many cases upstairs consulting rooms have no lift.

Because rooms are adapted rather than designed for modern health purposes, they are often too small for their purpose and lack flexibility.

While this means that there is poor access for patients and practices cannot provide the range of care they want to, their “poor condition” could also be breaking the law.

Compliance with the Disability Discrimination Act is “generally poor”, the report said, but the surgeries could also be risking a violation of human rights and health and safety legislation.

A number of premises in Ipswich, as well as Leiston, have been identified as urgently needing redevelopment.

Of the highest priority are the Lattice Barn, Stoke Park, Burlington Road, Deben Road and Hawthorn Drive practices in Ipswich as well as Leiston Surgery and Clinic.

Ipswich, which the report identified as having the most severe problems with its existing estate, is likely to have the highest population increase, with the local authority area predicted to see the number of people rise by 38,500 by 2021.

The Ipswich PCT area alone needs £1.44m in “recurring revenue”, with an extra one-off payment of £270,220 needed for equipping, excluding IT.

With further allocations from central Government becoming less likely, the report said PCTs will need to look at their own accounts to fund developments.

But it said: “Such a huge increase in recurring revenue is not sustainable at the current time.”

The problem has arisen as the PCTs' financial position has not enabled it to commit to any developments other than vital health and safety work and that funded by the County Premises Group.

The joint board, which met on May 24, welcomed the report. It acknowledged the risks that the current situation presents and agreed a set of criteria to enable developments to occur. These included only supporting developments that are seen as a high priority and reflect the greatest need.

All developments should also seek to minimise PCT costs by seeking funding from developers to help with set up costs, it agreed, and a letter will be sent to practices explaining the approach.

The Burlington Road Surgery in Ipswich is an attractive Grade II-listed Victorian building with a garden and a curved staircase.

It currently has 15,500 people on its lists, covers the whole of Ipswich, and has around 60 staff on the premises, including 10 doctors, health visitors, district nurses, a phlebotomist and secretarial support.

But although it is a pleasant building it costs a lot to maintain and was not designed as a doctors' surgery. In fact, it is two homes that have been knocked through, with a large single-storey extension at the back to offer more ground floor space.

However, it does not have a lift and its steep staircase is difficult for older people, or those with mobility problems, to negotiate.

So, if a disabled person needs to see a doctor based on the first floor, that GP has to move from his room and borrow one of the spaces on the bottom floor.

Although it has a ramp leading up to the building, it has recently been told that it does not comply with the Disability Discrimination Act as it is too long.

There are no dedicated rooms for the clinics and instead nurses have to use whatever desk is available while health visitors have a cramped room in the basement.

While patients with minor lumps and bumps can conveniently have small operations in the building, the room is small and cannot fit in all the required technology.

There will need to be another two Burlington Road surgeries to deal with the increase in population expected in Ipswich. Although it is keen to take on more doctors and provide more services, it literally has no room for them at the current site.

A planning application for a development in Ipswich was submitted 18 months ago and was given permission on the basis that a new surgery would be provided there for doctors at Burlington Road.

However, without the PCT's approval and funding, the 106 agreement could be lost. For there are only three and a half years left for the go-ahead to be given. After that the developer is free to approach another organisation to sell the land to.

Dr Hubert Lelijveld , who has been a GP at the practice for 12 years, said: “We appreciate the PCT is hamstrung financially but it does not take away our need.

“It is a disappointment when we want to provide a gold standard service and have the best and nicest environment for both our staff and our patients.

“The PCT recognises the problem and is taking it forward and we are grateful for that.”