Key takeaways
NHS long-term plan drives estate transformation
Practices may need to adapt premises for integrated care models.
Funding routes and property ownership under review
Commissioners and landlords should prepare for structural changes.
Collaboration and flexible space will be key
Shared facilities can support workforce and patient demand.
Earlier this year the eagerly awaited NHS 10 Year Plan was revealed, following the results of the Darzi investigation which carried the stark message for the NHS, of ‘reform or die’. The resulting Plan places a significant emphasis on the provision of joined up community-based care which is ‘fit for the future’. It aims to ‘revitalise’ general practice and to refocus care from hospitals, back into the community by way of a Neighbourhood Health Service.
The Neighbourhood Health Service clearly has potentially significant consequences (and opportunities) for general practice from a contracting and commissioning perspective (as summarised here), but what difference will it make to real estate, and the buildings out of which these services are run?
The most significant change is the introduction of Neighbourhood Health Centres. Recent years have seen an increased effort to provide more effective and encompassing community-based healthcare, from Community Diagnostic Centres to Health Hubs. A key element of the 10 Year Plan is the introduction of Neighbourhood Health Centres (NHCs), intended to act as a ‘one-stop-shop’ for multidisciplinary care. The goal is for NHCs to be open for at least 12 hours a day, 6 days a week – a significant increase on the usual general practice operating hours across the country. Whilst this would undeniably improve accessibility to critical healthcare services, there will be practical considerations to be had. Many GP practices are currently inadequate in both their size and condition, due to a historic lack of funding, with the Royal College of General Practitioners noting that 34% of GPs reported that their practice building was not fit for purpose. Recent government initiatives will go some way to plug these gaps (The Primary Care Utilisation and Modernisation Fund (UMF) | Hill Dickinson), but in order to meet the ambitions of the 10 year plan, significant investment will be required to develop new purpose built spaces, or to reutilise and redevelop existing NHS property stock. This investment, will need to extend to technology, especially given the 10 Year Plan’s other aim of transitioning from ‘analogue to digital’.
Many GP’s occupy their buildings on the basis of a lease. These leases are likely to contain restrictions on works, sharing occupation and opening hours. In order to implement the Governments plans, thought will need to be given to the most suitable way forward and whether existing occupational arrangements remain fit for purpose if those buildings are to be used as Neighbourhood Health Centres. Where the Landlords of these spaces are other public sector or NHS adjacent bodies, pragmatic solutions will likely be easily reached, but more significant challenges may be faced when commercial Landlords and private funders are involved. Of course, not all properties will be suitable for use as modern multidisciplinary spaces, and appropriate exit strategies will need to be considered, possibly along with the availability of PFI style funding, where acquisitions or redevelopments are needed.
All in all, the 10 Year Plan landscape is both exciting and uncertain for general practice – we will be in attendance at Best Practice Exhibition and Conference from 8-9 October, and look forward to discussing the many opportunities and questions that this ambitious Plan creates with you all then.
