A design diagnosis: reinvigorating the primary care estate
Today’s report, A design diagnosis: reinvigorating the primary care estate, finds that private sector finance can upgrade the primary care estate at value for money for the taxpayer. Private funding can help build bigger GP surgeries to provide better patient care.
General practice is not equipped to deliver the new care models set out in the Five Year Forward View. Infrastructure is a barrier, with four in ten GPs considering their practice not fit for purpose and 70 per cent saying their practices are too small. GPs need new buildings that can deliver primary care at scale. A recent CQC report found larger practices with diverse teams delivered higher quality care, providing integrated services to the community.
GPs have a number of different financing options to consider when upgrading their estate. These include working with local authorities or property companies to borrow funds. General practice has a long history of working with industry partners. The Local Improvement Finance Trust (LIFT) programme, created in 2000, was the original means for attracting private finance into the primary care estate. This option now works in parallel with third party development (3PD) schemes, where private investors construct new surgeries that GPs then lease over a fixed period.
The report found examples of privately funded buildings delivering value for money in primary care. One practice has used additional space to provide a minor injury drop-in service. Another practice has doubled its list size and extended its training practice. This practice has also reported better staff satisfaction because of improved service quality and the opportunity for more teamwork.
To guarantee new buildings deliver value for money, developers and GPs must ensure buildings are used effectively. Estate design should be flexible, so space in buildings can be used for multiple services and adapt to changing practices brought about from technology. One LIFT funded practice has doubled its service offering to patients by renting space out to other providers. NHS Property Services is developing an online portal where unused practice rooms can be booked by the hour or half-day. GPs can make the most of these apps to better use space and raise revenue.
GPs need to be well-informed on financing options and building design to ensure public-private partnerships deliver value for money. STPs have a critical role in supporting GPs when they are interacting with estate developers. The report praises Greater Manchester STP for designing a capital financing strategy to advise GPs on the best funding options available to expand services.
1. The primary care estate needs to upgrade to deliver the new model of care set out in the Five Year Forward View: patient-centred, coordinated care, delivered through an integrated set of services at community level.
2. Private funding from 3PD schemes is one of several funding options for upgrading the primary care estate. 3PD schemes are arrangements where a private firm funds the construction cost of a large, modern GP premise and the NHS leases it over an agreed period of time. 3PD and PFI schemes are distinct. In 3PD schemes, GPs retain full control of all internal repair and maintenance.
3. There are examples of existing 3PD buildings successfully delivering primary care at scale, increasing community provision, reducing running costs of buildings and improving staff morale.
4. New buildings must improve on existing utilisation to deliver value for money. Estates must be designed to be ultra-flexible. Practices should look to innovative solutions to improve efficiency, including renting out extra space to other service providers and using technology to decrease demand on the estate.
5. National bodies should provide expert guidance and examples of best practice to GPs, similar to the Education Funding Agency for schools. STPs should then have a critical role in ensuring GPs are well-informed about the best design and appropriate running costs before they work with private partners.