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A joint report{1} published by the mayor and London Assembly reveals that London faces huge challenges before patie...
A joint report{1} published by the mayor and London Assembly reveals that London faces huge challenges before patients in the capital will see any real improvements in their ability to access services from GPs, community nurses and pharmacists.

Widespread recruitment and retention difficulties and inadequate premises all have a negative impact on the quality of healthcare services in London and inhibit the primary care sector's ability to deliver on key NHS targets. In addition, the NHS is grappling with the challenge of providing the range of services necessary to meet the needs of London's diverse communities sensitively and effectively.

Elizabeth Howlett, chair of the Access to Primary Care advisory committee, said:

'The NHS is undergoing an enormous structural and cultural change, moving from an acute service to one that is primary care driven.

'Already, several London PCTs are saying they are experiencing greater difficulties in meeting the NHS targets on waiting times. To make it work, London must attract and keep skilled healthcare professionals, and receive funding for the improvement of surgery premises. Access to primary care services should be equal for all Londoners and there must be an end to GP closed lists.'

Ken Livingstone said:

'Primary care is the way into the health system for most patients, which is why it is gratifying to learn that primary care trusts and frontline staff are working hard to find better ways of meeting the needs of non-English speakers, refugees, disabled people and others who face barriers to care.

'But it is also clear that the staffing problems in the sector are growing to crisis proportions. We will soon need to replace the GPs who are coming up to retirement age, including a large number of south Asian doctors who have sustained the health service since the 1960s. Their loss will be a real blow to the NHS in London, and if the problem is not tackled urgently, it could well store up long-term problems for t he health of Londoners.'

The year-long investigation into Access to Primary Care found that the biggest restraint on progress is the difficulty in recruiting and retaining the full range of primary care staff, as well as receptionists and practice managers, leading to closed GP lists and selective registration, and limited consultation times. Transport difficulties, the cost and availability of housing, the threat of a looming GP retirement crisis, and the challenge of working in deprived areas all contribute to the staffing crisis.

An alarming 70 percent{2} of London's GP premises fall below the Department of Health minimum standards on areas including safe storage for records, disabled access, heating and having a proper treatment room. According to the report, several primary care trusts experienced problems with a shortage of sites for development, the expense involved in acquiring land, and the complexity of dealing with planning issues, making it difficult to provide extended healthcare services.

With two out of five of London's GPs working alone in their practices, the enquiry heard concern over whether they will be able to deliver the NHS plan for the primary care sector. Although it was acknowledged that there were advantages to single-handed practices, evidence taken during the investigation suggested that they would need to find new ways of working with each other so they could provide a wider range of specialist services to patients.


1. Access to Primary Care report - April 2003

2. GP Census for 2001

3. The Access to Primary Care advisory committee was made up of:

  • London Assembly members - Elizabeth Howlett (chair), Trevor Phillips, Lynne Featherstone and Jenny Jones

  • mayoral representatives - Dr Sam Everington, Ruth May, Mansukh Raichura and Neale Coleman

  • special advisors - Professor Adrian Eddleston, Elizabeth Manero, and Professor Brian Jarman
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