For an issue described as second only to workforce in ensuring a sustainable future for primary care, it was interesting timing for the publication of a national review.
Sir Robert Naylor’s long-awaited report on NHS property and estate was released into the fray after a morning exploding with headlines from the Next Steps for the Five Year Forward View report: targets to increase access to general practice services, to grow the primary care workforce, to modernise primary care premises and encourage GP surgeries to work together in hubs or networks.
With the ‘next steps’ report highlighting on the one hand that: “General practice is undeniably the bedrock of NHS care…so if general practice fails, the NHS fails,” Sir Robert’s diagnosis that: “given the emphasis on expanding and strengthening primary and out-of-hospital care, it will not be possible for the NHS to achieve its vision without changes in the estate…” was the second opinion needed on a problem which is becoming ever more acute.
The original Five Year Forward View stated that the future of the NHS “no longer sees expertise locked into often out-dated buildings,” and promised the expansion of funding to upgrade primary care infrastructure. The GP Forward View went even further: “Investment…is needed not just to improve or extend existing facilities. We also need to increase <their> flexibility to accommodate multi-disciplinary teams and their training, innovations in care for patients and the increasing use of technology. And new premises may be needed to cater for significant population growth, and to facilitate primary care at scale or enable patient access to a wider range of services.”
40% of GP practices say their premises are inadequate – making it a struggle to provide even basic GP services. Six in ten GPs report having to share desks or consulting rooms, and four in ten say this limits the number of appointments they can offer. Seven in ten said their premises are too small to deliver more services.
The Estates and Technology Transformation Fund promised to ease the symptoms with a welcome, £1bn capital shot in the arm (though analysis claims that only 5% of outlay so far has gone into improving GP premises).
So on a day when the NHS was focusing on the next steps for change, Naylor set a cautionary tone – particularly for primary care. Because while Sustainability and Transformation Partnerships are leading the way for care closer to home, Sir Robert makes clear that without the right primary care buildings in the right places for patients, they can’t achieve that full vision.
Yes, we’ve got to make sure existing estate is used to its full potential. In some places surgery buildings can be improved and expanded; in others brand new premises will be needed if GPs are going to have the infrastructure they need to deliver the shift they’re being asked to make.
But to do that, Sir Robert calls for better guidance on building standards, with primary care facilities first in the queue. He’s flagged the need for evidence on which estate models work best. Perhaps most crucially, he recommends that a range of capital sources will need to pitch in to meet the likely £10bn needed to get the NHS estate into shape.
It’s a huge prescription, and we don’t yet have the government’s response.
But read the two documents together and the treatment is unavoidable: primary care of the future will need the right buildings to help it grow. The King’s Fund assesses estate as a key enabler of transformation: can Sir Robert’s recommendations enable the enabler?
Jonathan Murphy is our CEO.