Supplementary memorandum submitted by
the Department of Health
QUESTIONS 74 (MR
AUSTIN MITCHELL)
AND 159 (MR
IAN DAVIDSON)
Improving GP services in deprived areas
Despite recent increases in the primary care
workforce, there are still significant variations across the country.
For example, the PCT with most GPs and nurses for its population
(Cambridge PCT with 124 GPs and practice nurses per 100,000 weighted
population) has almost twice those of the least (Barking and Dagenham
which has 64 GPs and nurses per 100,000 weighted population).
Research (by U.S academic Barbara Starfied)
has shown that increasing the number of primary care clinicians
is the most effective way of improving the health of a population.
Yet when we look at those parts of the country with
worse health outcomes and high levels of deprivation, we find
they have fewest primary care clinicians. This also means that
GPs in deprived areas tend to be spread more thinly and be more
stretched than colleagues elsewhere. Amongst other problems, this
can make it difficult for patients to book convenient appointments.
Where there are fewer GP practices, this also gives the local
public less choice (or no choice) over which practice they register
with.
This is not a new problem but one that has persisted
since the inception of the NHS and one that has been the subject
of many attempts by past Governments to attract more GPs to work
in these areas.
The interim report of the NHS Next Stage Review,
"Our NHS, Our Future", acknowledged these issues
and committed to improving access to primary care for those living
in more disadvantaged or deprived areas. This also means making
services more personal and designing them to fit with people's
often busy lives.
The interim report set out a number of commitments
to make services more equitable and to ensure patients have real
choice. These included a commitment to invest extra resources
to bring new GP practices into the 25% of PCTs with the greatest
need for extra primary care and to develop GP-led health centres
in all PCTs.
NEW GP PRACTICES
We subsequently developed a set of criteria
to identify the 25% of PCTs that should benefit from investment
in new GP practices. The main criterion was the number of GPs
and practice nurses per head of population, but the criteria also
gave some weight to health outcomes and to patient satisfaction
with access to GP services. These criteria were developed in consultation
with SHAs and PCTs to help make sure that we targeted additional
investment on those areas where it is most needed.
Annex A sets out the 38 PCTs (25% of all PCTs)
identified as having the greatest needs. These PCTs will between
them be procuring the hundred new GP practices to which the Government
committed in the interim report.
These new practices will not only increase the
availability of primary care services in places that need it most.
They will also all have extended opening hours, wide practice
boundaries to give the local public greater choice of which GP
practice they register with, and will have a particular focus
on reaching out to local communities to promote good health.
HEALTH CENTRES
The additional investment is also being used
to enable all PCTs to develop additional primary care services
for their area that will be based in GP-led health centres. These
health centres will be open from 8.00 am till 8.00 pm, seven days
a week. They will include GP services that offer both bookable
appointments and walk-in services, both for patients who want
to register with the health centre (as their local GP practice)
and for patients who are registered with other GP practices but
would benefit from also being able to use these new services (eg
commuters). In most cases, these core GP services will be co-located
and increasingly integrated with other community based services,
such as pharmacy, urgent care, dental services, diagnostic facilities,
and social care.
INVESTMENT
On 10 October the Secretary of State for Health
announced a package of new financial investment to support PCTs
in developing these new GP practices and health centres. Over
the five years from 2008-09 to 2012-13, this investment will total
over £1 billion (£60 million in 2008-09, £200 million
in 2009-10 and £250 million annually thereafter).
LOCAL FLEXIBILITY
This investment is designed to help the NHS
new services that are responsive to local needs, increase patient
choice and promote innovation. The Department has established
a small number of core features that we expect PCTs to reflect
in their specifications for these new services.
In the case of GP practices, we would typically
expect the practice to have the capacity to service a registered
list of at least 6,000 patients, to offer extended opening hours,
to have wide practice boundaries, to be fully engaged in practice
based commissioning, and to plan to be a training practice.
In the case of health centres, we have indicated
that the centres should be in easily accessible locations, be
open from 8.00 am to 8.00 pm, seven days a week, provide services
for both registered and non-registered patients, and offer both
bookable GP appointments and walk-in services. We have also indicated
that PCTs should maximise opportunities to integrate and co-locate
these core GP services with other community based services such
as pharmacy services, diagnostic services and social care.
Beyond these core requirements, it is for PCTs
to develop the specifications for these services locally, in consultation
with the public and with local clinicians. We are looking to PCTs
to identify how best to use the investment to improve access to
primary care, promote more integrated services for patients, and
achieve a stronger focus on promoting health and reducing health
inequalities.
OPEN AND
TRANSPARENT PROCUREMENTS
We have asked PCTs to undertake open and transparent
procurements for these new primary care services. This is to ensure
that the fullest possible range of potential service providers
are able to put forward innovative proposals, including existing
GPs, voluntary and third sector organisations, and independent
sector organisations. PCTs will award contracts to those providers
who can offer both high quality services and value for money.
Annex A
| Rank | PCT
| SHA |
| 1 | Manchester PCT | North West SHA
|
| 2 | Barking and Dagenham PCT
| London SHA |
| 3 | Knowsley PCT | North West HSA
|
| 4 | Sandwell PCT | West Midlands SHA
|
| 5 | Wolverhampton City PCT |
West Midlands SHA |
| 6 | Heywood, Middleton and Rochdale PCT
| North West HSA |
| 7 | Liverpool PCT | North West SHA
|
| 8 | Sunderland Teaching PCT
| North East SHA |
| 9 | Birmingham East and North PCT
| West Midlands SHA |
| 10 | Halton and St Helens PCT
| North West SHA |
| 11 | Heart of Birmingham Teaching PCT
| West Midlands SHA |
| 12 | Barnsley PCT | Yorkshire and The Humber SHA
|
| 13 | Leciester City PCT |
East Midlands SHA |
| 14 | Oldham PCT | North West HSA
|
| 15 | Blackburn with Darwen PCT
| North West SHA |
| 16 | Stoke on Trent PCT |
West Midlands SHA |
| 17 | Hounslow PCT | London SHA
|
| 18 | Hull PCT | Yorkshire and The Humber SHA
|
| 19 | Nottingham City PCT |
East Midlands SHA |
| 20 | Blackpool PCT | North West SHA
|
| 21 | Ashton, Leigh and Wigan PCT
| North West SHA |
| 22 | Dudley PCT | West Midlands SHA
|
| 23 | Bolton PCT | NorthWest HSA
|
| 24 | Greenwich Teaching PCT
| London HSA |
| 25 | Sefton PCT | North West HSA
|
| 26 | Medway Teaching PCT |
South East Coast SHA |
| 27 | Salford PCT | North West SHA
|
| 28 | Hartlepool PCT | North East SHA
|
| 29 | Tameside and Glossop PCT
| North West HSA |
| 30 | Walsall Teaching PCT |
West Midlands SHA |
| 31 | Newcastle PCT | North East SHA
|
| 32 | Redcar and Cleveland PCT
| North East SHA |
| 33 | South Tyneside PCT |
North East SHA |
| 34 | Calderdale PCT | Yorkshire and The Humber SHA
|
| 35 | North Lancashire PCT |
North West SHA |
| 36 | Luton Teaching PCT |
East of England SHA |
| 37 | Havering PCT | London SHA
|
| 38 | Hammersmith and Fulham PCT
| London SHA |
| 
