The last 10 years in the policy environment for primary care property? “Plus ça change” is the phrase which springs to mind, says Jonathan Murphy, chief executive of Assura.
While NHS structures and governance arrangements have come and gone, challenges of recruiting and retaining doctors have increased and demand for GP appointments has continued to explode, the constraints and failings of many of our country’s GP surgery buildings have stood firm.
First, let’s go way back. 2007 saw Professor Sir Ara Darzi introducing the idea of ‘polyclinics’; centres which would bring together services like general practice, outpatient services, minor operations and diagnostics under one roof. The need for the right spaces in the right places was fundamental to the plan.
The Health & Social Care Act of 2012 made clinical commissioning groups key decision-makers on surgery building projects. Too many GPs struggling with the perennial problems of access to capital for improving premises and getting approval for development projects had to continue to make do with their existing space, a problem for many still today.
2014’s research by the British Medical Association with almost 4,500 GP practices found that 40% felt their premises were inadequate, making it a struggle to provide even basic GP services. Six in ten GPs reported having to share desks or consulting rooms, with four in ten reporting that this limits the number of appointments they can offer. Seven in ten said their premises are too small to deliver more services. Today, we estimate that more than one third of GP surgery buildings are residential conversions.
Along came the Five Year Forward View, which stated that the future of the NHS “no longer sees expertise locked into often outdated buildings”, and promised the expansion of funding to upgrade primary care infrastructure. The GP Forward View, published in April 2016, also included a focus on estate: almost £1bn of capital funding for improving primary care buildings and technology through the Estates and Technology Transformation Fund, and a pledge to change GP Premises Costs Directions to help primary care developments move through more quickly.
And so we reach 2017. While 2012’s inaugural NHS mandate made no mention of buildings, this year’s set a clear expectation for a strategic estates strategy in every clinical commissioning group. Sustainability & Transformation Partnerships across England are grappling with the fact that their estate can make or break their progress. Sir Robert Naylor’s independent review concluded that “without investment in NHS estate, the Five Year Forward View cannot be delivered”. Coupled with a specific call for private sector investment to bring primary care premises up to scratch, and pledges to improve NHS buildings in the election manifestos of both the Conservative and Labour parties, you might say that while the last decade hasn’t seen improvement at the pace GPs need, we have finally reached a tipping point.
By designing GP surgery premises for the job they’ll be doing in future, we can help the NHS deliver on its plans to cut pressure on hospitals, by giving family doctors the infrastructure they need to offer extended appointment hours, digital consultations and more services, tests and treatment in the community.
The right buildings for primary care aren’t just a nice-to-have; they’re critical to NHS transformation. But we don’t have another ten years to play with: GPs and their teams need new buildings now if they’re going to deliver the changes the NHS is pushing for. For the next decade, the watch words must be “en marche”.
- To take part in the Place10 series reflecting on the decade since Place North West was first published in August 2007, send your stories and memories to firstname.lastname@example.org headed ‘10’.