This week Hugh Robinson - gbpartnerships Group Business Development Director - had the ear of politicians and industry leaders on the subject of primary care in England at the All-Party Parliamentary Group for Healthcare Infrastructure in Westminster.
Hugh shared gbp’s experience in the primary care sector in recent times, read his full statement is below.
"Effective Primary care keeps people out of the acute hospital setting – that is widely accepted. But it remains the poor relation in terms of investment. We have a primary care estate that is, largely, not fit for purpose; and that lacks sufficient space. Its not fit for purpose because:
it is largely inaccessible,
it’s not of capable of industry space, acoustic, ventilation and safety standards and
it’s not performing to the levels of energy efficiency and carbon required.
The 2018 BMA survey found that only half of GP premises were deemed fit for purpose by the GPs who worked in them– and things will only have deteriorated in the time elapsed since then given the lack of a primary care focussed building programme.
Examples I’ve personally seen include consulting rooms up-stairs in converted Victorian houses. A GP in Dartmouth, Devon that we worked with, who had been forced to undertake consultations in a quiet corner of the waiting area if a patient couldn’t get up the stairs!
This is perpetuated by the legacy system – with many GPs owning the premises which they practice from. A crunch point looms as a generation of GPs approach retirement age, with younger partners in the practice not wanting to buy them out, tying up their capital in poor premises
So its not fit for purpose.
But what about the space?
Well, most ICBs are forecasting population growth in their areas. We help many systems plan their strategy based on demographic needs and most of the new build requirements are in direct response to large scale residential developments.
Additionally, NHS England has a target of recruiting another 6,000 GPs by 2031-32.
Adding to that space requirement is the fact that Modern health infrastructure for primary care should also be seeking to integrate the additional roles. These roles include services such first-contact physiotherapy; pharmacists; or social prescribing and 31,000 roles have been hired since 2019.
gbpartnership’s work with PCNs revealed that there is very little space in existing premises to house these roles. In one ICB area we found 117 new staff employed for additional roles – with insufficient space in existing buildings. Our researchers were told tales of staff using their cars as additional meeting space as a result!
So, how are we getting to grips with these issues?
The advent of ICBs in 2022 in England should seek to solve this issue yet their depleted budgets and maze of stakeholders means most are struggling with day-to-day fire-fighting and lack capital for integrated primary care schemes.
To put that into context:
The Health Services Journal back in October reported a £1bn deficit across all 42 ICBs – with every one of them in deficit.
And in terms of stakeholder organisations.
Using simple averages – each of the 42 ICBs in England has 7.5 Local Authorities and 5.5 NHS Trusts to share resources amongst.
At gbpartnerships we also work in Scotland, and there is an interesting comparison with the equivalent Scottish Health and Social Care Partnerships. They, on average, have 1 Local Authority and 1 health board (i.e. Trust). That’s a vastly simpler stakeholder map!
Encouragingly, we’ve seen examples of Trusts innovating by taking the lead on integrated primary care projects, where the Trust takes a long lease on excellent new primary care centres and subletting to GPs;
And we’ve also supported NHS Property Services delivering excellent, fit for purpose schemes for system partners.
But these are relatively isolated examples outside of a central programme.
Even these isolated examples are under pressure. A Trust (or any other NHS body for that matter) now needs the “CDEL cover” for the scheme. CDEL being Capital Departmental Expenditure Limit. This is because a long lease on a building now sits on the government balance sheet due to the application of IFRS16 in recent years.
As with any new regulation, there is also varying knowledge between Trusts and ICBs of the methods of application of the new rules (noting that the ICB controls the purse strings for CDEL).
This fact is largely preventing the use of long-term leases by the NHS – despite the benefits that it would bring in terms of high-quality, purpose built health infrastructure without the need for public sector capital.
My three asks:
1. Utilisation: I ask that existing high-quality estate is fully utilised and that the barriers to this happening are addressed to avoid the fact that there are separate public sector budget holders getting in the way of long-term benefits to the communities and the tax payer.
2. A programme for primary care: I ask for a programme, and a programmatic approach, to primary care that will provide fit for purpose, integrated centres – with programme derived efficiencies
The Cavell Centre programme pioneers were looking at that but as we know now, they had no capital funding allocated and so have not progressed – and nothing is in its place since.
3. Review the CDEL issue: I ask for a review of the application of IFRS16 given the disastrous impact it is having on funding innovation and the delivery of essential primary care projects."
Follow or connect with Hugh on LinkedIn: https://www.linkedin.com/in/hughrobinsongbpartnerships/