The Lothian region needs 33 new GP surgeries to cope with an ageing and growing population.
Nearly a third of existing practice buildings need extending or modernising as part of an £84 million project to tackle the growing GP crisis.
The Evening News revealed in March how family doctors were struggling to deal with escalating patient rolls and a rapidly growing number of older patients, often requiring more attention and home visits. NHS Lothian has conducted an extensive review of its primary care services which found:
* 38 practices have been identified as having issues with capacity or needing improvements to the building;
* 19 of Lothian’s 127 practices have declared full or restricted lists – all in Edinburgh – with Lothian GPs under similar capacity pressures;
* The population in Lothian is predicted to grow by more than 165,000 – surpassing the one million mark – by 2030;
* The number of people aged 65-plus will have increased by more than a quarter by 2020.
The health board has now drawn up priority lists for investment based on factors including current capacity, location, and recent and projected population growth. The general condition of buildings – and their compliance with legislation such as the Disability Discrimination Act – have also been assessed as well as the opportunities for further development at each of the sites.
Since 2009, practice list sizes across NHS Lothian have risen by more than 29,000 – the equivalent of six decent-sized surgeries, swamping doctors in large residential areas such as Leith and forcing many to close their doors to new patients. Elsewhere, government requirements to build about 30,000 homes in the region by 2024 are likely to heighten the need for more health facilities.
Professor Alex McMahon, director of strategic planning for NHS Lothian, said the plans were part of the ten-year vision of the health board.
He said: “GPs and community staff have a vital role to play in delivering our strategic plan and our vision for the future of healthcare in Lothian.
“As part of this plan we are looking in detail at the capacity and quality of premises for GP surgeries across Lothian. This work is in the very early stages, and we will be working with the Health and Social Care Partnerships and the individual practices to agree any future developments.”
Funding will be split between NHS Lothian’s capital cash pot – used for building projects or repairs – with bigger projects by agency Hub South East Scotland. The public/private partnership, part of the Scottish Futures Trust, has been responsible for projects including Wester Hailes Healthy Living Centre and the East Neighbourhood Office and Library at Craigmillar.
The review, which focuses on buildings, gives no suggestion about how the new premises will be staffed, with NHS Lothian reflecting the national struggle to recruit sufficient qualified professionals.
Dr Richard Williams, who works at Restalrig Practice, insisted improvements to existing surgeries should be the priority, with many already at “breaking point”. He said: “Our population is shooting up and most of us are in premises that need expansion or refurbishment. This work needs doing now, not further down the line. We are at breaking point.”
Dr John Gillies, chairman of the Royal College of General Practitioners, Scotland, added: “Many Lothian practices are already at capacity and simply do not have the space to register more patients.”
The Capital is the fastest growing city in Scotland – predicted to swell to 600,000 people in the next 20 years.
GP list sizes have gone up by nearly 5000 patients each year since 2009, taking the total number of registered patients up to nearly 530,000 last year.
National Records of Scotland projections suggest that the city’s population will increase by about 52,000 over the next decade and will need the equivalent of one new GP practice per year until 2024.
Edinburgh’s ageing population is expected to rise by more than 20 per cent by 2020. While, it is the smallest increase of the Lothians, it shows a potential increase of more than 14,000 people, heaping pressure on its surgeries. There has also been a rise in the number of foreign nationals moving to the city, with many adding to the usually relatively stable student population.
Developments are being looked at to increase capacity within existing practices where possible but health chiefs say this alone will not address the expected population increases.
The current plan is considering a range of options from relatively minor works, to improve space utilisation, to the extension or re-provision of individual practice premises, the re-provision of multiple practices within single buildings and the need to create new and additional practices within Edinburgh.
This initial blueprint affects 19 – or 27 per cent – of the 71 GP practices which equates to 17 premises within Edinburgh HSCP, over the short, medium and long term.
Overall costs are estimated to be between £25m and £30m capital expenditure.
The mixed rural and town nature of Midlothian means it and existing surgeries are likely to feel the impact of planned housing developments.
Overall, between 2010 and 2013, the GP list population has increased by about 4000 patients, enough it says, to justify the creation of a single practice.
National Records Scotland projections suggest the Midlothian population will increase by around 4000 over the next ten years.
However, the Housing Land Audit predicts it will be far higher with an estimated 6000 houses, suggesting a minimum population increase of 15,000 in that period.
Looking further ahead to 2024, this would equate to 9000 additional dwellings with an estimated population increase of 21,000 compared with 2014.
This will require an extra four or five new GP practices through to 2024 or the significant expansion of existing practices and their facilities.
The Shawfair housing development could lead to 4000 houses with an additional population of 9000. While there are few capacity issues now, demand is expected to rapidly outstrip the current capacity of current practised.
The priorities within Midlothian, driven by the above, include:
* Dalkeith, Bonnyrigg and Newtongrange triangle to relieve pressures created by completed and anticipated additional housing
The overall costs to address immediate capacity issues are estimated to be £10m-£15m.
West Lothian’s population boom is set to be the largest of all the Lothians, with a predicted increase of 20 per cent in the next ten years.
It has already grown by ten per cent in the last decade and now stands at 175,990 and is set to be around 208,285 by 2024.
The projected population increase will require the equivalent of an additional six GP practices with average list sizes of 5500.
Between 2009 and 2013, the West Lothian GP list population has increased by 3920, equivalent to an additional two-partner GP practice.
This has been absorbed by existing practices expanding their lists and increasing manpower. Its elderly population is set to increase the most, with a more than 36 per cent rise.
An audit of practices and existing premises has identified the following priorities for development to manage service integration and capacity issues:
* Armadale Surgery
* East Calder Partnership Centre
* Linlithgow Surgery
* Winchburgh Partnership Centre
* Murieston Medical Practice
The Health Centre stock in West Lothian is aging and the following have been identified as needing refurbishment to ensure statutory compliance and meet required standards and demand.
* Dedridge Health Centre
* Carmondean Health Centre
* Whitburn Health Centre
The overall capital needed is still to be determined by NHS Lothian.
With a similar make-up to Midlothian, new housing developments are also expected to impact on East Lothian.
Between 2010 and 2013, the GP list population has increased by about 2000 patients, enough, it says, for a single new practice. Again, National Record of Scotland projections suggest that the East Lothian population will increase by 12,000 over the next ten years. However, the Housing Land Audit suggests there are plans to build 4000 houses by 2020 with a predicted population influx of 8000.
Looking further ahead to 2024, this would equate to 6000 additional dwellings with an estimated population increase of 13,000 compared to 2014. It means an extra two or three additional GP practices through to 2024, or the significant expansion of existing practice and their facilities.
The forecast does not address the potential of the Blindwells development, with the initial phase delivering 1600 houses with an additional population of 3500.
Additionally, the elderly population here is set to soar, with a 25 per cent increase over the same period, creating an increased demand on GP and Community services.
The forecast increase is expected to rapidly outstrip the current capacity and suitability of practice premises, including:
* North Berwick
* Cockenzie and Port Seton
Overall costs are estimated to be between £6m-£9m.