A design diagnosis: reinvigorating the primary care estate

Modern care, modern premises 

The GP estate is failing its patients and clinicians. GP practices are too small to bring more services into the community. Four in ten GPs go as far as saying their practice is unfit for purpose. It is time for investment in the estate to create bigger, modern practices. This will enable patients to be diagnosed, treated and discharged in the community.

Bigger practices already deliver better care

Larger practices often lead to higher staff satisfaction because of this improved quality of work. This investment therefore will be critical to attracting and retaining doctors in general practice.

GPs have a range of investment options available. Local authorities are investing in primary care; GPs are forming property companies that can borrow and public-private partnerships have long been active in property in the most deprived communities. The 2017 Naylor review recommended that the NHS "should be taking advantage of private sector investment". The November 2017 Budget also identified private investment as one of three funding streams for capital expenditure.

The report has identified that private finance from third party development (3PD) schemes can deliver value for money. One GP practice which relocated to a 3PD site doubled its list size and extended its training capability. Another was able to introduce new services, including a pharmacy and minor injury drop-in clinic.

At present there is underutilisation of space and resources. Our study found one practice which had average utilisation over a month of 42.1 per cent during working hours. Too many rooms are too often left vacant and not enough old admin space has been converted into clinical use. 

A priority for developers and GPs is to ensure space is ultra-flexible and used effectively. One public-private building has increased occupancy to 92 per cent by renting space out to a pharmacy and outreach clinic.

This will become even more important as technology changes how patients use the NHS. Using the GP app, eConsult, one practice found three quarters of users did not need a face-to-face consultation. This will enable GPs to treat the most serious patients and should mean the estate should become geared toward treating more urgent cases.

These changes require leadership across the NHS. To make the improvements necessary to transforming the estate, STPs must provide expertise and guidance to GPs wishing to expand services. The report identifies Greater Manchester as an example of this, designing a capital financing strategy to advise individual GPs on what their best funding options are. The NHS should also be financially rewarding those GPs best using their existing estate to deliver care.

The estate is an undervalued resource in transforming models of care in this country. By using the best of private sector investment, technology and NHS leadership the estate can help deliver value for money whilst enriching patient experience.