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GP-led health centres one year on ...

Marilyn Eveleigh
Consultant Editor

One year ago in this column, I outlined the national preparations being made to establish GP-led health centres (GPLHCs) in 150 primary care trusts (PCTs) across England and 31 polyclinics in London. With his recent resignation as Gordon Brown's Health Minister, they will be a lasting legacy of Lord Darzi's 2007 healthcare plan, Our NHS, Our Future.
The centres promised to improve access to primary care services with 8 am to 8 pm opening hours, having a walk-in facility, with a GP available for registered and nonregistered patients, offering health promotion, screening and general medical care to the well and unwell. Patients can be registered with the practice if they choose. I predicted they would need nursing skills and organisation – and suggested it was a real opportunity for nurses to take a leadership role in designing and managing a service.

In reality, what has happened in this last year? Remember that, nationally, these centres were a very comprehensive and non-negotiable commissioning requirement of PCTs, with considerable political pressure and high public expectations.
Though it is too early to measure the longer-term impact on patients, and in many areas the centres are not yet operational, there have been grumblings about the concept.  
We now know that a significant number of the contracts for the GPLHCs were awarded to private companies, reflecting a fear voiced by many that the NHS ethos was being eroded by profit. However, many were awarded to GP partnerships, social enterprise organisations and NHS providers. It will be interesting to analyse the outcomes for patients and the NHS when these different provider models are reviewed in the next five years.

The location of the centres, urban and rural, has been controversial. GP organisations have had concerns, especially where the centres are located not in areas of greatest need or deprivation but in those places offering the best transport routes, thereby giving equality of access to the greater population. For some GP practices, there are real fears that registered patient lists will fall as patients migrate to the GPLHC. For many commissioners, justifying a location has been a major headache.

Have nurses taken on key leadership or clinical roles? No, this has clearly not happened and where it has, it has been around health promotion and public health. Was I wrong to predict this? Or maybe it is too soon to tell? What has blocked a real opportunity for nursing is the nationally adopted GPLHC contract that required the centre to be staffed by a GP at all times. There is scant opportunity for senior nursing in decision-making and management while the walk-in service is being developed and registered patient lists are building; providers will want to use their GPs cost-effectively. But watch this space …

What has surprised me is the relatively low pay rates offered by the GPLHC for nursing staff, considering the shortage of experienced nurses in primary and community care. Unless they are a NHS organisation, there was no requirement for providers to adopt the Agenda for Change pay scales and conditions of service. This may have lowered their tender price but it is unlikely to draw skilled and experienced nurses away from their relatively generous NHS remuneration.

I'm not aware of any GPLHC being unable to open due to lack of staff, but there has been a move of experienced practice nurses and nurse practitioners away from independent contractor GPs to these centres. It's not for the money; they appear to be attracted by the client group that requires transient and undifferentiated healthcare in a 8 am to 8 pm walk-in facility. However, this dominance will change as the centre builds its registered patient list.

For patients, these centres are the government's real live commitment to improving access to healthcare. And so far, they seem to like them because attendances are growing on a daily basis. It seems readily accessible and responsive care is a fair substitute for continuity of care. Patients like them because the hours and walk-in option are convenient, you do not need to be registered so you can even try them out before you commit to registering – plus you can get a free second opinion on what your existing GP/nurse has said! Their early spare capacity may be a necessity in the increasing pressure of pandemic flu management.

Will the new GPLHCs deliver improved access to primary care? Although national polls indicate high satisfaction levels with GP services, if my straw poll of friends and family is anything to go by, a lot of us will be trying them out as a promising alternative to the frustrations of traditional general practice. These days, the "proof of the pudding" is in the quality of patient experience. Let's see what the public think this time next year.