Super[store] surgery

IT all started with parking – or more a lack of parking.

Peterloo Medical Centre is located on a busy main road in Middleton, North Manchester. Back in 2008 a senior partner in the practice, Dr Mohammed Jiva, was hearing an increasing number of patient complaints about the lack of parking in the area, especially at busy times of the day.

It seemed apparent to Dr Jiva that the practice would need to find an additional location but he knew funding from a cash-strapped NHS was not going to be easily had. So he sat in his office and pondered the question in general: how can we make life more convenient for patients and the public at a reasonable cost?

“The common sense approach to me was superstores,” he says. “They have long opening hours. It’s a place where people go out anyway – they have to shop and the vast majority shop in a superstore.”

Dr Jiva decided to run with the idea. He phoned three large supermarket chains. Only one took him seriously and that was Sainsbury’s.

“This is the bit that I’m still gobsmacked about,” he says. “Essentially I’m this GP ringing a big chain store at their home office in London. And I thought, I’ll possibly get invited down to present my case. They’ll then discuss it and give me feedback in a month or two months. It’ll be a waiting game.”

Dr Jiva got through to the professional services manager at Sainsbury’s, David Gilder. “This was Monday and he said, okay, I’ll be up there on Wednesday. I did a short PowerPoint presentation – about six or seven slides – to show what the model would be. How we could work with the PCT providing NHS services within the store. He liked it. I think within a two or three week turnaround period the Sainsbury’s Board had approved the model.”

EVERYTHING COVERED

I speak to Dr Jiva in the small, single consulting room of his branch surgery in the pharmacy section of a vast Sainsbury’s superstore at Heaton Park in Manchester. Five years on now Sainsbury’s has 35 branch GP surgeries across the UK operating either inside a superstore or on the premises. The company recently announced its intention to open more in-store surgeries in the coming year.

The announcement follows on from a report published last year by The Kings Fund which asserted that “the current cottage industry model of general practice is not fit for purpose”. It called for radical changes in the delivery of healthcare and among a number of recommendations suggested that primary care services could be offered in more convenient settings such as supermarkets.

The deal Sainsbury’s is offering GPs is hard to fault from a business point of view. Dr Jiva and his partners are allowed the use of the in-store consulting room rent-free. They also pay no business rates and nothing for clinical waste or water and other amenities.

“Everything is covered – so really what is there to lose?” says Dr Jiva. In addition the pharmacy staff at Sainsbury’s act as receptionists in the three clinical sessions conducted at Heaton Park – two on weekday evenings and one on a Friday morning. The five GPs at Peterloo Medical Centre work at Heaton Park on a rota – and sometimes combine this with doing their own shopping.

“It virtually runs itself,” says Kath Oldham, practice manager at Peterloo. “Most patients are happy to go there because the parking is extremely good. It’s also quite safe for out-of-hours sessions. We can secure the building here at half-past six when we close and don’t need extra staff working late. We use the Sainsbury’s staff there. It’s a great benefit.”

In addition to the parking there are other benefits to patients. The in-store pharmacy means that patients can have prescriptions fillled immediately. This is especially helpful after hours as the pharmacy is open until 11 pm on weeknights.

And what do Sainsbury’s get from the arrangement? “There is the extra footfall and increased prescription sales,” says Dr Jiva, “but for the kind of retail site we’re talking about it’s a drop in the ocean. From my experience over the last four years, they’ve valued the relationship a lot higher than any monetary gain.”

David Gilder of Sainsbury’s agrees. “We want our stores to play a positive role in the local community and feedback from our customers told us that this is a service they would really like. Patients can access both medical and pharmaceutical services under one roof, something that is really convenient for them.”

SUPERMARKET OFFERS

The notion of in-store GP surgeries is, of course, not without critics. In 2010 the chair of the RCGP Dr Clare Gerada was quoted as saying: “Supermarkets should stick to selling fruit and vegetables. General practitioners would be sanctioned for selling tobacco products, alcohol and high calorie foods or advertising and selling products of limited medical value within their surgeries. Yet, supermarkets can do all of these alongside providing pharmacy and now, general practice care.

“Access to services is of course important and it is right that GPs think imaginatively about the settings they work in so they are able to serve the public. However, we would urge any GPs tempted by supermarket offers of ‘no rent’ and ‘no overheads’ to take a step back and consider how they are able to provide excellent generalist care in such environments.”

Dr Jiva finds that the notion of in-store GP surgeries often gets wrapped up with the perceived commodification of healthcare and creeping privatisation in the NHS in England. He has himself been subject to some criticism.

“I’ve had comments from GPs about working with the private sector. Questions like – are you defecting to the other side? This is nothing about defecting. This is about collaborative working.”

Operating a GP surgery in a retail environment does come with some practical difficulties. In 2011 NHS North Lincolnshire rejected an application by local GPs to practise in an in-store surgery in Scunthorpe. An audit of the facilities cited concerns about patient confidentiality and the possibility that a consultation could be overheard by customers in the pharmacy, as well as worries about infection/decontamination and the fact that there were no toilets separate from those used by shoppers.

EXPANSION PLANS

Dr Jiva admits that his branch surgery at Heaton Park is very much a limited adjunct to his main surgery at Peterloo and that there are certain things he would not do in the in-store consulting room, such as any invasive procedures or “cutting” and certain intimate examinations such as taking vaginal or cervical swabs. It would also not be an appropriate setting for breaking bad news or other more serious discussions.

More often than not patients book into the Heaton Park surgery for things like repeat prescriptions or acute health problems like coughs, colds or rashes or to discuss test results. The consultation room has a computer with a secure link to the server at the main practice that allows the GPs to call up patient records.

“We log on here exactly the same way as we do at the main surgery,” says Dr Jiva. “So we are not walking away with any information.”

The practice is currently developing plans to extend the services at the branch surgery including an expanded rota to accommodate other days or evenings. Dr Jiva has also considered starting a travel clinic there. Even more ambitious are his plans to link Heaton Park to the main surgery at Peterloo using secure teleconferencing technology.

He believes that to keep up with the fast pace of change in society and increasing patient expectations general practice needs vision and a willingness to innovate.

“It doesn’t matter who you are or where you are,” says Dr Jiva. “If you think there is mileage in a vision – pick up the phone and ask the ques- tion. What’s the worst that can happen?”

Jim Killgore is an associate editor of MDDUS Practice Manager