Shrewsbury Health and Wellbeing Hub: Open letter to councillors 

Dear Shrewsbury Councillors:  Chris Lemon, Julia Evans, Kate Halliday, Alex Wagner, Julian Dean and Bernard Bentick, 

Thank you for your letter that you sent to all the GP practices involved in the proposed Shrewsbury Health and Wellbeing Hub. We hope that this reply will answer some of your questions and provide factual information about the hub and the situation that primary care finds itself in.   

There have been problems with providing buildings for GP surgeries for many years. There are issues with the current model that fundamentally restrict our ability to undertake day to day duties as a GP.   

As has been mentioned in the information about the hub, the six practices that are looking to relocate have issues with their buildings. But perhaps it would be helpful to understand what is and isn’t possible when it comes to the buildings that GP surgeries operate out of. Historically, the partnership model of general practice was set up with the requirement that GPs would provide their own premises, and these were usually part of their own homes. As time went on, practices grew and took on premises., but the variety of these premises is perfectly demonstrated by the practices looking to move into the hub.   

The GP practices looking to relocate are either rented from landlords or the partners have mortgages on the buildings, thereby taking a significant, personal financial risk. Their rent or mortgage is paid by notional rent which is reimbursed to them by the NHS – this is assessed based on the value of the building and the footprint that is given over to NHS provision. Most of the time the notional rent only just about covers the cost of the mortgage or rent. This system of reimbursing what is deemed to be an appropriate “market rent” to landlords or to cover the mortgage is commonplace, at considerable cost to the NHS, throughout England. 

The personal liabilities incurred by individual partners when signing a lease with landlords or a mortgage with a bank, is causing a national crisis in recruitment and retention of GPs. A GP may find themself in a situation where their partners leave the practice, perhaps due to retirement, relocation or illness, and they are left with sole financial responsibility. They are faced with the impossible decision to struggle on continuing to provide NHS services for the remainder of their lease term, or to hand back their NHS contract and be personally liable for future rent payments to their landlord for the remaining duration of the lease. In some circumstances such leases can be as long as 25 years.  

The proposed hub will enable the NHS to save money. It will be owned by the local NHS (the Integrated Care Board) and will enable them, for the first time, to link the budget holder (the commissioner) with estate ownership, supporting the alignment of clinical and estate priorities across a given locality and meeting the needs of an individual community. PCNs and commissioners can drive improvements in the quality of the buildings that services are being provided from and tailor those services in a way that responds to local needs and enables genuine improvement in the support and wellbeing of patients. 

Development of these bespoke centres will enable the phased disposal of sub-standard accommodation, and act as an exemplar for others in the primary care sector.
But it will also reignite a sense of pride in the role of the ‘family doctor’. A desire to work consistently within and for a community of patients and know that there is no personal financial liability one incurs by doing so. The interest shown by the practices involved is indicative of the appetite for change, and the direction of travel in primary care service delivery.  

The building will be owned by the ICB, and spaces will be shared between all practices, as well as other external allied service providers to support the wider (social) determinants of health. It will be community-facing and community-activating, and the hope is that it will be filled with energy and life. A place of wellness, not ill health. This model of ownership will also allow practices to focus on patient care, the reason we were first attracted to a career in general practice, rather than estate issues and landlord complications. 

There are no other sources of funding currently available in the NHS that would enable practices to expand, assuming that they had the space to do so. If we do not explore the options of this hub, the six practices would therefore struggle to deal with an ever-increasing population in Shrewsbury. GPs are already working over capacity, and we are going to lose practices if we cannot support them by providing space to work in.   

We know that transport is a concern for some of the population. We are working with Shropshire Council to provide a solution to public transport provision for this area.   

Regarding your query on appointment numbers – by providing better space for practices recruitment can occur (many practices can’t recruit as they don’t have the space for a new healthcare professional). The evidence for this in the Case for Change document that is available here.  

We are working with our local partners in the ICB regarding the range of services. This is also going to be put to the public when this project goes to public consultation later in the year.   

The practices that relocate to the hub will continue to function as independent practices with discrete geographical areas. This is not a polyclinic as suggested by some recent sources and there is no private funding or private involvement in this project. Mytton Oak Surgery and Radbrook Green Surgery may provide some limited services from the hub but will continue to operate from their current locations. They did consider going into the hub but decided that they did not need to relocate at this time. It is proposed that there will also be a variety of Primary Care Network (PCN) services that will benefit all the patients registered with the practices in Shrewsbury PCN (covering around 120,000 patients). The branch surgery and dispensary for Beeches Medical Practice will continue to operate from its site in Dorrington. 

We would like to highlight again that the hub is a proposal. It is not a done deal. The outline business case hasn’t been submitted. The ICB is following all the procedures laid down by the NHS around engagement and consultation. There is no secret committee that is plotting and planning to do things in secret (as suggested by some local sources on social media recently). But the practices looking to relocate are struggling in their current buildings. And primary care is struggling to recruit because young GPs don’t want to take on a mortgage that is bigger than the mortgage they have for their house. Is the proposed hub a perfect solution? No but nothing in life is. However, it does give us all an opportunity to continue to work together to provide a high standard of primary care and work with our population to improve their general health and wellbeing.   

Signed by 

The partners of Beeches Medical Practice, Belvidere Medical Practice, Claremont Bank Surgery, Marden Medical Practice, Marysville Medical Practice, Mytton Oak Surgery, Radbrook Green Surgery and South Hermitage Surgery 

& 

Dr Charlotte Hart (Clinical Director, Shrewsbury PCN)