Test 23 January, 2018

Fit for purpose: the future of the primary care estate

Last year I reached my quarter century milestone in general practice. At this late stage of my career I now work across a number of practices in London. My consulting rooms vary from a converted cupboard, which can only accommodate one patient at a time, to a high tech, large consulting room located within a state of the art new health and well-being centre. I can tell you which premises I, and no doubt my patients, feel more comfortable and most likely conducive to better care.

Sadly, across the country, due to a combination of lack of funding combined with an increasing population, the GP estate is increasingly unfit for purpose. Practices are running out of space. The GP estate has to cope with the foot fall of over one million patients per day and any relatives, carers or other individuals attending with them. There is a vast and increasing number of practices who are unable to provide the consulting room or waiting room space to meet this demand.

There have been major rebuilding programmes during my career, responding to the changing nature of general practice. For example, a major building programme starting in 1980’s created modern health centres. These allowed not just GPs to work together in groups but also created the space for other practitioners, such as nurses, pharmacists, midwives, to co-locate. These modern centres also provided the space for education, training and team events. In the 2000’s, an injection of money into the NHS allowed for practices to develop their existing premises or build new community hubs.

Now is the time for another rebuilding programme which recognises the changing nature of general practice. GPs now work together in either federations, multi-practices or super practices. GPs are also taking on different aspects of patient care. For example, by creating access hubs, groups of GPs and nurses across different practices see patients with acute injuries or illnesses in and out of hours. Other practices are developing group consultations for treating patients with similar conditions (for example, diabetes, chronic airway diseases) or for specific age groups (for example, parents and babies, the elderly).

Although digital solutions, such as e-consult, might reduce the foot fall coming into a practice, these new services require space which is fit for purpose. As more and more care shifts out of hospitals, this requirement will grow. The issue of premises is also one of the root causes of why young doctors and even older doctors don’t want to become GP partners. A hospital consultant is not expected to buy into the lease of his or hospital and, yet this is level of commitment is expected from GP partners.

Without investment in new primary care premises, the NHS will not be able to grow the general practice workforce or deliver the out-of-hospital services it needs to.

What is needed now is a national, cross party commission on GP premises to address leases, rents, improvement and development of new and older premises. The Reform report, A design diagnosis: reinvigorating the primary care estate, which is published tomorrow (24 January 2018),  is an important first step in this regard.