Thousands of patients could be left without a much-needed GP surgery because NHS bureaucrats have decided not to consider applications for new doctors' premises for more than a year now.
The Ashley Centre Surgery, in Ashley Square, Epsom, which has 9,600 patients registered and four full-time doctors, has repeatedly been informed by health watchdog the Care Quality Commission (CQC) that its premises are too small.
At just a quarter of the recommended size for a GP surgery, the practice does not meet the CQC's premises standards or its disability access requirements.
But a potential move to new, larger premises at the Old Magistrates' Court residential development in The Parade - which was completed 18 months ago - has been scuppered by a lack of prioritisation of the issue nationally by the NHS.
Surrey and Sussex Area Team - the local body which decides on applications for GPs' premises in the area following the abolition of primary care trusts (PCTs) last April - has still not made a decision on The Ashley Centre's application to move into the new building, more than a year after it was formed to do so.
The Ashley Centre Surgery, in Ashley Square, Epsom
Surrey PCT had refused to decide on the application before it was abolished, saying that it would soon cease to exist.
And after taking over last year, the Area Team said it would not be making a decision until later in 2013.
But, a decision had still not been made.
In a letter to The Ashley Centre Surgery on June 3 this year, the Area Team said it had been unable to determine the application because it has been "awaiting NHS England's policies on premises".
It said: "It is unfortunate that we are still in a position whereby we have not received these policies which has meant we have not been able to progress this piece of work."
The GPs at The Ashley Centre Surgery fear it may be forced to close
It said it expected to receive the guidance "in the next couple of weeks" and would then start to consider all applications relating to GPs' premises which have been submitted to it.
But it added: "We also have the challenge of revenue funding in the context of a very limited budget, clearly, there will be a determined effort to ensure cost neutral proposals are first explored."
The move to new premises would triple the rent paid for The Ashley Centre Surgery from £100,000 to £300,000 - ruling it out as a "cost-neutral scheme", which the Area Team has said it will prioritise once the guidlines are issued.
But the new premises would enable the surgery to employ another full-time GP and to see up to 12,000 patients.
The Ashley Centre Surgery does not meet any of the Care Quality Commission's premises requirements as it is too small
The new building, which has not been fitted out as a GP surgery as funding has not been approved, would house other health providers on the site such as Marie Stopes termination services, Central Surrey Health and allow for some local anaesthetic procedures to be conducted - a move towards greater integration at the primary care level, something which Surrey Downs Clinical Commissioning Group has advocated.
But the new building was put up for sale by its owners last month, which Andrew Sharpe, a GP at the surgery, fears could sound its death knell.
He said: "This is about funding. There's been an obvious desire not to invest in primary care and GPs' surgeries.
"We want to expand and provide more services but we need a new building to do that.
"As a doctor you want to do anything you can to improve care for your patients and the NHS says 'no'.
"The area team doesn't even want to consider our application even though our business case stacks up perfectly."
The new premises in the Old Magistrates' Court development, in The Parade, Epsom, have now been put up for sale
The surgery, which has been on its current site for more than 20 years, has established itself historically as a 'town centre' surgery and has an ever-increasing list of patients, many of whom are elderly.
Dr Sharpe said: "Our building fails every aspect of the CQC's standards.
"The CQC can put restrictions on our practice to stop us taking on more patients.
"Our list size will decrease as older patients leave and the surgery won't be financially viable.
"The worry nationally is that in the near future practices will close down as they won't have the financial viability to continue.
"We've got one part of the NHS, the CQC, saying 'do this and this' and another part of it saying 'you can't do that'. It's bizarre.
"It's a real threat to the care we can give to our patients. Most of them are quite appalled. They think it's illogical."
Dr Sharpe said MP Chris Grayling has written to the Area Team, to no avail, and that Health Secretary Jeremy Hunt has said it would be "inappropriate" for him to intervene.
In a letter written on Mr Hunt's behalf to Dr Sharpe last October, he said: "The Department of Health is not responsible for the approval of new GP practices.
"The Department recognises that health services are better when management is transferred to the frontline.
"It would therefore be inappropriate for either ministers or officials to intervene in individual cases."
The inside of the new premises in the Old Magistrates' Court development in The Parade
John Geleit, 73, a member of the patient panel at The Ashley Centre surgery, said that the situation there is a "tsunami waiting to happen".
He said: "The surgery is inconvenient and small. It has two floors and no lift.
"Doctors have to come downstairs and see patients who can't come up.
"People get attached to their doctor. I haven't met anybody at the surgery yet that doesn't say they have a very good relationship with their doctor.
"They come out at a drop of a hat. The service is very efficient. You do need that continuing relationship with a doctor to have confidence in the system.
"If it is shut down it would be quite traumatic for quite a lot of people."
The new premises are located in the Old Magistrates' Court development in The Parade
A spokesman for NHS England Surrey and Sussex said: "Our priority is to ensure the provision of safe, effective GP services for patients in Surrey and Sussex.
"We hold contracts with 350 practices working out of 425 sites across the area, and we recognise that a number of practices are facing issues with their premises.
"We must always take decisions based on the best use of NHS funds and we will therefore seek the most cost effective premises solutions for our practices.
"We have received a business case from the Ashley Centre Surgery in Epsom to move to a new building, however, funding decisions for all practices are on hold until new national guidance has been finalised.
"A decision on the new premises will be made once this guidance has been issued."
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