Dated: Sunday 28th February 2010
I wish to start this letter by stating how very sad and disappointed I feel about having to write it. I hope that anyone who reads it will, having considered its contents, understand 1) that current circumstances mean that I have to write it, and 2) that I am hoping to act in the best interests of the LSE community, its students and staff , past and present. Given my status as an NHS GP Principal I also feel that there is the potential issue of general public interest(due to the large amounts of public money involved) at stake, which I feel will add justification to my actions. I apologise for any faults in style or structure of my writing – I am not used to writing this sort of letter.
1) IMMEDIATE THREAT FACED BY THE MEDICAL CENTRE
The future of the medical centre is at great and imminent risk. Current plans to develop the St. Philips Building which houses the medical centre (and also the Leach and Ede Dental Practice) entail the demolition of the existing building and its replacement with a new Students’ Centre which will NOT include space for either a medical or dental practice. Despite written assurances from the LSE that the medical centre would be relocated, at present there is no realistic likelihood that this will happen before the proposed demolition is scheduled to begin. The lack of a premises from which to deliver the requirements of the NHS GMS contract would cause the practice to be dissolved and its registered patients to be dispersed to practices throughout London. I have been advised that the proposed schedule for redevelopment cannot be delayed and the plan is that the process of physically decommissioning / dismantling the building will be in June 2010. Given the requirement for due notice to be given to current patients regarding the closure of the practice a decision to either resolve the current impasse or to confirm the confirm the closure of the practice will have to be made as soon as possible. I am writing to request that the Council of the LSE will consider this question at their next scheduled meeting (Tuesday 2nd March 2010) rather than delay to the next (provisionally scheduled meeting) on the 27th April.
The LSE states in the Project Update of February 2010 that “intensive consultation with the Students’ Union, Chaplaincy, Residency & Careers Service and the Estates Division” has occured. While such intensive consultation has involved the intended occupiers of the new building, I feel there has been a lack of adequate consultation with the current users (particularly the patients of the medical centre) of the facilities that will be ousted as a result of the demolition of the existing building. In the past months I have spoken to hundreds of student who were not aware of plans to demolish the building and for the medical centre to no longer feature within the LSE campus (let alone cease to exist altogether). I have been struck by the intense and genuine desire of the Estates department to provide a building that will improve the “Student Experience” at the LSE, and, as one their people told me, to provide students with the “Student Experience that they deserve”. I obviously endorse their general wishes; however, I am disappointed that the provision of accessible and relevant medical services are not at least as important to future students’ experiences as access to (yet another) pub and an inter-faith prayer centre. This is obviously my personal view and may or may not be shared by others. The other services that are to be housed in the new building are currently provided within the LSE campus and their location would, I believe, not be subject to the same statutory requirements of a NHS Primary Care service (and so could, if necessary, be kept in their current locations until the final fate of the St. Philips Building and its possible replacement is known).
In the past ten and a half years 54,000 people (95% of whom are/were students) have accessed medical services at this centre. In the past twelve months 5,872 patients have accessed care at this centre. In any given year the number of members of the LSE community who present themselves with very grave medical problems (e.g. Cancer, HIV, Tuberculosis, Meningitis, severe Psychiatric illness) is not great. However, every year such conditions do occur and for these students, access to relevant medical care is vital. While the conditions and health issues affecting the majority of students may seem more prosaic, I believe that the presence of an accessible and relevant Primary Care service can and does enhance the “Student Experience” of current and future students. It is my understanding that the other major educational institutions in the UK and abroad, which the LSE aspires to compare itself to, DO provide its students with such facilities.
I would request that the Council of the LSE considers this issue at their next meeting.
2) THE RELATIONSHIP BETWEEN ST. PHILIPS MEDICAL CENTRE AND THE LSE.
St. Philips Medical Centre is an NHS Primary Care practice which provides General Medical Services to eligible patients under the terms of the new GMS contract that exists between the practice and Camden Primary Care Trust. The practice also delivers services outside the NHS contract to students, staff and visitors to the LSE. Under the terms of the GMS contract, the practice provides NHS services to local residents (i.e. people who live in the “practice area” who may have no connection with the LSE. The local residents are made up of the full social spectrum, from Judges and Newspaper Editors to individuals who require supported housing (due to histories of rough sleeping or serious mental health issues) – many of these patients are very vulnerable individuals with complex health needs. The practice is funded by the NHS and currently (although this was not the case previously ) receives NO financial payment from the LSE. The practice has paid rent to the LSE in return for occupying the current practice’s premises in the St. Philips Building since its inception. The historical relationship between the LSE and St. Philips Medical Centre was and remains highly abnormal. Attempts to “normalise” the relationship have been ongoing in one form or another for (at least) the past five years. The lack of a “normal” relationship is, I feel, the root cause of the most important problems facing the practice today. While the LSE have consistently expressed their volition to achieve a “normal” relationship, I feel that the approach taken by the LSE management elite (and the different lawyers they have instructed) has, in practice been overly aggressive, adversarial and often unhelpful. This has resulted in progress being very slow; the process has also been attritional and demoralising, the financial expenses (in terms of legal fees) unacceptably high.
Against this background a very important development has taken place this weekend: the publication in the British Medical Journal (340:431 – 486 No 7744 Clinical Research ISSN 0959 8138) of an item of news relating to the release (for the first time) of figures by Camden Primary Care Trust (PCT) relating to the value of basic contract payments made to individual practices. This has occurred following a request made in 2008 under the Freedom of Information Act, by a Camden resident in connection with the award of a practice contract to an American private healthcare company. The article, which is entitled “New Figures show glaring discrepancies in GPs funding”, states that “The lowest funded practice is St. Philips… a special case because it is the practice that serves the London School of Economics”. The article does not go into further detail about the “specialness” of St. Philips’ case but it goes on to quote Dr Paddy Glackin, the medical director of London-wide Local Medical Committees (who is acquainted with the history and circumstances of this practice) thus, “It’s down to all sorts of accidents of history. Some practices were favoured in the past; some new practices were well looked after, some weren’t. It’s often down to quirks.”
The figures show that St. Philips receives 51 pounds per patient (this is compared with 74 pounds for the Gower Street Practice, which is most similar in terms of history and demographics of practice population). The highest funded practice per patient (which is in fact the closest Camden practice to St. Philips) receives 145 pounds per patient.
Now that these figures are, for the first time, in the public domain, it is my belief that were the process of “rerum cognoscere causas” be applied to the relative lack of funding of St. Philips, then Dr Glackin’s views will be borne out.
I would urge the LSE to take it upon itself to establish the true reasons for the problems of their past governance of St. Philips Medical Centre and for the School to reconcile itself with the need to derive ideas that are positive and helpful to the medical centre and its current and future patients. Prior to the publication of the BMJ article, I am guessing that it would have been possible for the LSE to have pursued a course of action (had it so wished) to bring about the closure of the medical centre (say, due to lack of suitable premises) and, in a manner of speaking, put all the problems of the medical centre’s history in a box and throw away the key. The figures relating to the funding of the practice (which could given an indication of the possible historical factors, “ accidents” and “quirks” cited by Dr Glackin) would never have been in the public domain. I welcome the action taken by Camden PCT in response to the Freedom of Information Commissioner’s judgement. I hope that all other PCTs follow their lead, and I hope Camden PCT’s actions will, ultimately, bring about improvements to all aspects of healthcare delivery in the UK (and possibly beyond). Given that the LSE has a global reputation for delivering advice regarding the delivery of healthcare and has received so much funding from the NHS for consultancy work over the past decade, it would be potentially damaging to its reputation if it were left to other institutions to take the lead in analysing the causes for the governance and financial problems facing the School’s “own” medical centre. Incidentally, given the recent demands for a reduction in the budget deficit by LSE Economists including Sir Howard Davies, the Director, I feel it would be quite ironic if the medical centre (probably the cheapest per-patient NHS practice in London if not in the UK) were to be closed due to the lack of a suitable building.
3) LAST WORDS
I imagine/expect that many of the management-elite at the LSE will react angrily, defensively, robustly and even aggressively to this letter – it is their prerogative to do so. There are many other factors, details, sub-issues and viewpoints to be expressed. I welcome the LSE management-elite’s response, which I hope in due course will be made available to everyone involved. I would urge the LSE Council to use whatever influence it may have over the management-elite at the LSE to consider instilling an approach which is more conciliatory, constructive, pragmatic and hopefully useful in order that a resolution to the problems outlined above may be obtained. This will, I feel, be in the best interests of the LSE community and St. Philips Medical Centre, which I would like to feel is part of it too.
Dr ROM Naidoo – GP Principal
Related posts:
- Confusion surrounds potential closure of St. Philips
- New Students’ Centre on track for December 2012
- New Students’ Centre on track for December 2012
- Labour MP wishes to see resurgence of centre-left
- WFC slash the Vets wide open
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