A design diagnosis: reinvigorating the primary care estate (II)
At a time when there is such focus on the clinical struggles for the NHS, with hospitals at full capacity and a flu outbreak adding to the long list of year-round pressures, it may seem incongruous to be talking about the primary care estate. Yet investing in GP premises offers a significant opportunity for the NHS. Better buildings for primary care allow for scaled-up healthcare closer to home, and can help relieve some of the current pressures.
Inadequate infrastructure is a barrier to better patient care with four in ten GPs saying that their surgery premises aren’t fit for purpose. The type of building traditionally used for general practice, often former terraced houses and bungalows, cannot deliver the integrated, community-based care the NHS is pushing for. Indeed, not-fit-for purpose premises can impact on staff morale, the services a practice can offer, keeping patient lists open and the quality of the experiences patients have when they come to see a doctor.
Given that most contact with the NHS happens in primary care, getting the primary care estate right is a goal acknowledged across the political spectrum. Both the 2017 Naylor Review and the 2017 Autumn Budget flagged the need for significant investment in NHS infrastructure. In practice, however, things aren’t moving quickly enough. Demand for a share of the Estates and Technology Transformation Fund, a welcome source of public money to improve surgery premises, has far outstripped supply.
Dotted around the country, however, are examples of the difference which can be made when GPs are working from fit modern, state-of-the-art premises. Frome Medical Centre in Somerset, a building which houses three GP practices, outpatient appointments, minor surgery and mental health services, alongside space for community groups and a pharmacy, has been a conduit to help reduce hospital admissions for some of their most vulnerable patients. Another example is Clanricade GP practice, which moved from an old Victorian house to a modern medical centre, Abbey Court. This practice can now see almost double the patients its used to, and has extended its training practice for staff. Again, different teams have the space to work alongside each other – offering a holistic approach to patient care. But these sorts of buildings are the exception rather than the rule – so we need to accelerate investment.
Giving GPs the infrastructure they need will never eliminate pressure on hospitals at this time of year. But creating the right facilities and space so that more patients can be diagnosed and treated away from hospital, and using them effectively – whatever the season – is an effective way to ease it.