Too good to be true – says who?

Shopping cart with many colourful pillsSainsbury’s has come up with the bright idea of offering GPs free premises in their stores or on their property.  Currently there are 27 such surgeries across the country and there are more to come.  The Man from Sainsbury’s has been asking people what they think of it so far: “Customers tell us they really value having this service on site and GPs tell us that the feedback they have had from patients has been overwhelmingly positive”.

Well done Sainsbury’s.  Surely this is something that GPs should welcome: free premises, which if the stores are anything to go by, are very likely to be modern, clean and accessible; free parking and, perhaps most importantly, a familiar environment where people feel comfortable. It might even do something healthy to the customer/provider relationship.

I know the idea of the “patient as consumer” is anathema for some professionals but whether they like it or not, that is how many patients see themselves and it’s about time all GPs came to terms with the changes in their relationships with patients.  We do not want to be dependent – we want an efficient service that puts our needs and, yes, our convenience sometimes, at its heart.

Management won’t like it (but patients might)

So where are the welcoming words from the forward looking, patient-focused GPs?  Let’s have a look at their trade mag. Pulse:

Dr Tony Grewal, medical director of Londonwide LMCs, said: ‘It sounds too good to be true. If they are providing free premises then it’s an action of such altruistic magnificence that I can’t criticise.

Oh, go on Tony, I am sure you can.  He goes on:

For a fully functioning surgery you would need six to 10 rooms – it seems unlikely that Sainsbury’s will be able to perform or deliver that. Branch surgeries do have problems – such as system communications. They’re not always encouraged by management.

GPs should consider the security of tenure and duration – will it be reviewed every year? If they’ve got a site which is fit for these loss-leaders, Sainsbury’s could be earning notional rent. It might be another string to their bow.

Be Afraid GPs, be Very Afraid.  Patients may like it but Management won’t.  It will all end in tears.

Dr John Etherton, a GP in Rotting Dean near Brighton, said opening a practice in Sainsbury’s meant general practice would become an add-on to shopping.

I do not feel that a supermarket of any kind is a suitable place to have a GP surgery. It distorts the public’s perception of the service provided.

It it surely no coincidence that Dr Etherton lives in Rotting Dean.  Come on Dr John – this is not about “distorting” the public’s perception of the service you want to provide.  It is about working out what patients want and CHANGING the way YOU respond to it.  If GP services cannot change to meet the needs of patients they will surely rot.  And frankly they deserve to.  He goes on:

The provision of primary care historically was and needs to be in dedicated premises where that is the main function provided. Other facilities can be added on, but it shouldn’t be the other way around where the surgery is the add-on.’

Some issues are phenomenally serious, [such as] a life-threatening illness or a major problem.  The place where that takes place should be dedicated. If you are going to register a death you need to go somewhere which is private, serious and dedicated. It’s better psychologically.’

At our convenience?

Whilst it is certainly true we don’t want single-handed GPs operating out of a one-room shed in the car park, the principle that healthcare should be delivered in a location that is convenient to patients should be welcomed.  Sure “historically” we have all been required to receive our primary care in “dedicated premises” but who’s to say that in 2013 a GP practice next to Sainsbury’s could not be just as dedicated to the care of its patients as the crumbling, stinking, damp basement premises I had to visit down a grim back street when I was a non exec on the local Primary Care Trust a few years ago? Dedicated service and dedicated staff matter more than dedicated premises.

Why exactly is it all right to attach services to a GP practice but not to attach a GP practice to a service that is well-used and well-liked by people? Who is to say that if your car is safely parked, there are plenty of other people going about their normal daily business just outside, where you can get there easily on a choice of buses, you can pick up a decent sandwich and a drink for the kids while you wait and use the cash machine, you might not actually find the experience of going to see the doctor a whole lot pleasanter and less threatening? I don’t want to trivialise the role of primary care but to base your view of what works for primary care patients on how it might feel when you are registering a death seems a bit desperate to me.

Convenience of access for patients and decent premises are surely assets for any good GP practice and will contribute to high quality care and a good patient experience. It is clear from what Sainsbury’s is saying that what happens in clinical and managerial terms in these surgeries will be up to the professionals who work there, and that is as it should be. It is disingenuous, unfair and scaremongering of doctors to suggest otherwise.

Great offers

I can’t help thinking there might be a thing or two that GP practices could learn from supermarkets.  Who knows, if supermarkets can get people to buy three bumper packs of crisps when did not really even want one, then perhaps they might have some good ideas about how to get people to get their kids vaccinated or start eating more fruit.   It may even be time  for doctors to come to terms with the fact that sometimes, when it comes to behaviour change, supermarket psychology may even trump a lecture from the GP.  And just imagine what could be achieved if GPs and supermarkets worked together.

The Millar Adamson Craig Partnership supports user and public participation,  trains lay representatives and develops responsive  health, care and education organisations.  Feel free to contact us to discuss the opportunities.  Follow MAC on Twitter @publicinvolve





  1. Nick Kirk says

    In a time when the NHS primary care estate is no more, having been packaged and shipped to a wholly owned subsidiary of the SoS for Health, off book so the costs are now revenue, the prospect of future capital investment from any where other than the private sector is highly unlikely. The only money NHS Property Services will have is that aligned to backlog maintenance until the balance of property (now Lift has gone and PFI’s are next) is sold off for pension investment funds. I like my Sainsburys and it’s more accessible than my GP’s, even though it’s a very nice building. Sainsburys is clean, smart and relatively new with good parking (2hrs free if you spend £10 in store) and very good public transport access. In a time of no money to spend on new developments and a completely fractured primary care estates delivery, expect to see more crop up in the months and years to come.

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