The various details are:
7.3. Heat and Light.
7.5. Our of Hours Services.
7.9. Disabled Services.
The usual ways of funding GP owned surgeries had been by either Notional Rent or Cost Rent. Cost Rent is divided into fixed and Variable, the former being by far the more common.
In the days of GMS, Cost Rents were funded from the Cash limited GMS fund and Notional Rents from the Non-Cash limited GMS Fund. The Cash limited Fund was essentially fixed and it also had to fund practice staff budgets, practice computers and improvement grants. So, when, as was usual, after a few years of receiving cost rent, practices changed over to notional rent this was to PCTs’ advantage and released funds to be used elsewhere.
Under the new regime, since 2004, all practice Rents – Notional, Cost, Current Market, Local Authority and Health Centre, come from the same allocation, adjusted appropriately for approved growth caused by new schemes or extensions and increased each year for inflation. In this situation, it is, generally speaking, to a PCTs advantage for Cost Rent funded practices to remain on Cost Rent as Variable Cost Rents only move in accordance with movements in interest rates – which have tendered not to be significant over the last few years – and Fixed Cost Rents do not move at all. As the whole of the Rent payments made by a PCT is inflated, this releases funds to pay for unusual increases in other rents or even some small developments.
There remains, however, one circumstance in which a practice moving from Cost to Notional rent can still be to the host PCT’s advantage.
A common way of setting up a cost rent funded surgery was to agree a fixed rate cost rent and to take out a fixed rate mortgage, usually with GPFC. Then, no matter what happened to interest rates, the cost rent would pay the mortgage giving the practice some long-term security.
Some of these Cost Rents were agreed at, and are still at, very high rates– 15% or even more than 20% with mortgages to match. However, there may be practices who are still in receipt of a high fixed cost rent but who have re-mortgaged to a more reasonable rate.
PCA is responsible for making Rent and Rates payments including Notional Rents, Actual Rents and Cost Rents to practices on a monthly basis with the Global Sum and PMS payments.
In addition PCA is responsible for ensuring that GP premises are reviewed on a three yearly basis and when a new rent has been assessed by the District Valuer and approved by the PCT, PCA pay the new rent to the practice and pay any rent arrears that may be due.
PCA also make direct payments for Non-Domestic Rates and water charges to Council and Water Companies on behalf of the practices. These payments are made on the Integra payments system.
The Council levies non-domestic rates and these have to be paid by the surgery and it becomes part of its expenses. PCA makes the payment to the surgery vi\a Integra system.
7.3 Heat and Light
Also paid by PCA. The service provider had to be arranged by the surgery like any other business but make a claim for reimbursement.
7.4 Communication Systems
Sections 8.1 and 8.2 deals with all the relevant aspects.
7.5 Out of Hours services
If one is ill or get injured outside normal working hours there are a number of different ways one can be treated.
The following information gives advice on where you can get help for health problems outside of normal working hours depending on the nature and severity of your illness or injury’s.
* Call or visit NHS Direct This service is available 24-hours a day, seven days a week. It gives advice on what to do if you’re feeling ill and you’re not sure what to do. They can also give you details of local services from late night pharmacists to emergency dentists. Visit www.nhsdirect.nhs.uk or call 0845 46 47.
* Visit your local community pharmacist Community pharmacies are open longer than your GP. They are often open at weekends, and can be open late at night or on a bank holiday. Pharmacists are qualified medical professionals and can give you advice about common symptoms, medicines and healthy living. NHS Direct 0845 46 47 can tell you where to find your nearest community pharmacy. Pharmacies with early and late opening times. Some pharmacies are open 100 hours a week, when many other pharmacies are closed. The names, address, hours of opening with dates and telephone numbers would be displayed in the surgery at the entrance.
If one urgently needs a prescription at a time when no pharmacy is open please call NHS Direct on 0845 46 47 who will be able to advise you on the best course of action.
Out of hours GP services:
GP practices are generally open between 8am – 6.30pm, Monday to Friday. The services provided, when your GP is closed, are called out of hours GP services. If your GP surgery is closed and you need to see a doctor or nurse urgently, please phone the out of hours GP service for the area where you live. The telephone number to contact should be displayed in the surgery. When you ring the out of hours GP service, you will be asked to give your details and to describe how you are feeling. The out of hours service advisor will tell you what care you need based on this information. A doctor or nurse may need to talk to you over the phone, you may be asked to go to an out-of-hours centre or a doctor may come to see you at home.
A doctor would visit patients who are seriously ill or who cannot leave the house because of their health or other issues. The out of hours service advisor would tell you about home visits and what time you could expect the doctor or nurse at your home.
The out of hours GP service will not issue repeat prescriptions. These need to be ordered from your own GP and pharmacy and collected during normal working hours.
If you do run out of medication your local community pharmacist will provide an emergency supply. Please take empty prescription medicines with you to show the pharmacist what you had been prescribed along with some identification.
NHS walk-in centres and primary care access centres.
At walk-in centres and access centres you can be seen for minor injuries such as coughs, cold, flu, cuts, sprains, minor burns and broken bones. At most walk-in centres you do not need to make an appointment but it is worth telephoning in advance to check that you can be treated – particularly for young children. At nurse led clinics you can be treated for minor conditions, have dressings changed and wounds checked. Call ahead for a full list of the services available. There are walk-in centres and drop in services at locations near the surgery should also be displayed. The minor injuries units near the surgery should also be indicated clearly.
Accident & emergency and 999 services:
Please only dial 999 or go to your nearest Accident & Emergency if the illness or injury is life threatening or can’t wait. Unless you need urgent medical attention it is best to avoid A&E as it keeps the service free for those with critical injuries and illnesses. You should dial 999 immediately if you or someone else is seriously ill, for example, if someone:
- Has had a major accident
- Has problems with breathing
- Has severe chest pains
- Is unconscious
- Has lost a lot of blood
The local accident and emergency departments are based in the area have to be mentioned and details to be given with telephone numbers to contact.
PMgr must make sure that routine maintenance is carried out on all appliances and utilities. For these he must set up service contracts with most of them like electricity, gas, building insurance etc. PMgr should also ensure there is an indemnity insurance and cover for fire, theft etc. The cover should also include accidents and injuries to patients and all visitors to the surgery. Water leaks and all plumbing work should be given top priority due H&S hazards.
The surgery has may communication equipment and the suppliers of the equipment provide advice on how to maintain the units, cleaning, solutions to be used and general upkeep of he units. These web sites are a source of information and the procedures to follow are not dealt with here. For example, people should not eat food or have drinks near the computer vicinity due to spillage and damage to electrical components. Kitchen is the right place to go for food and drinks.
The surgery may be required to be painted inside and outside, say, once in 3-4 years and the costs may be covered by PCT. PMgr should be aware of making claims for such work by contacting contractors, getting 3 best quotes and submitting to PCT for approval. There should also be a guarantee that the patient’s interests would not be compromised when the work is finally approved for carrying it out.
PMgr should have all the contact numbers of contractors, architects, designers, plumbers, electricians, odd-jobs men etc. The surgery on a day to basis must be kept immaculately clean and ensure the cleaners do a proper job. This includes the standard of WC’s – should be clinically clean. It is better to have disposable paper towels than cloth towels due to infection.
Fire Safety for first day arrival of new staff is detailed in Section 2.2.10.It is now compulsory by law for all businesses that operate using business premises to conduct a fire risk assessment, as outlined by the Regulatory Reform (Fire Safety) Order 2005.The UK Fire Risk Advisory Service (UKFRAS) undertakes comprehensive fire safety risk assessment to provide you with information and written documentation to make your business fire risk and fire safety compliant. Under the Regulatory Reform (Fire Safety) Order 2005, surgeries are legally obliged to comply with a number of national fire safety regulations if you are responsible for the whole or any part of your GP premises.
The responsible person must carry out a Fire Safety Risk
Assessment and implement and maintain a fire management plan. If required, all businesses must be able to provide proof that they have done this, and many insurers will ask to see documented proof that businesses are compliant with UK regulations.
- Provide surgeries with a thorough Fire Safety Risk Assessment tailored to specific GP surgery and individual requirements.
- Point out areas of strength and areas of non-compliance.
- Provide with a realistic and cost effective action plan, which, once implemented, will mean surgery, is compliant with fire safety law – protecting the premises, staff and patient.
All medical equipment including BP monitors should be routinely checked and calibrated.
All changes and modifications to the surgery buildings should be dealt through PCT Planning section and approval obtained for compliance with their codes and also for any funding they might give. A good PMgr would have prioritized the surgery needs for modifications with budget costs and keep in constant touch with the planning section personnel for any funds available immediately or due to be released soon and if so make the earliest application so that the ‘early bird catches the worm’.
Surgery security is of paramount importance and suitable alarm system should be installed and annual contracts should be in place for its routine maintenance. The local company should be able to provide good service when any trouble with the system is experienced. Surgery has details of patients in the computer systems and any break-in would mean valuable personal data not only lost but liable to be misused. However, there is one major issue regarding false alarms. Should 3 false alarms occur then the police would not provide cover for a period of 6 months and restart only after proof of no false alarm during the last 6 months. A tough call and generally the systems might not be connected to the police at all. There should be enough video cameras provided in the surgery – near the entrances and in reception room and the tapes should be stored for at least a period of 6 months before reused.
In case of violent patients attacking GPs, Nurses, HCA or PMgr, panic buttons should be provided in all the tables for easy and discreet access for outside help.
Also, a panic button in the form of a long pulling cord should be provided in disabled toilets should they experience any problems and seek help.
7.9 Disabled services:
All surgeries must provide sloping disabled access (in addition to steps for other able patients) to enter the surgery and the doors and pathways wide enough to allow wheelchairs to pass through easily. There should be at least one toilet for disabled people and a panic pull up cord in case of emergencies. The WC facilities should be checked and kept immaculately clean.
There are a number of insurances a PMgr should make sure the surgery has:
- Liability Insurance and displayed in the reception area
- Building insurance
- Fire and theft cover insurance
- Copyright cover insurance for playing music in the reception area.
For the premises owned by the GP partners they may seek mortgage from lenders and PMgr should be able to handle this requirement. Having good contacts with Banks and bui9lding Societies would be a great help. Generally GPs would not have any problems in getting loans as they are viewed as very secure customers due to their income being derived through the government i.e. NHS. Still practice accounts for last three years would be sought and if the Partners have good income then it is mere formality.