In this co-written post, Dr James Kingsland and Graham Roberts, managing director of Assura Group explain why the Five Year Forward View must revolutionise primary care estates

In anticipation of the Five Year Forward View, healthcare professionals across the UK are assessing the gap between where we are and where we hope to be, examining the potential models of care delivery that could enable us to bridge the existing gulf. This invites discussion of what factors unify the NHS, and begs the question whether a one-size-fits-all model of primary care is feasible.

There are three strategies that could establish a strong model of primary care, all of which would work together to create an integrated system, sharing the problem of needlessly duplicated services.

The first of these reforms that would cut costs and establish a more effective model of care is the introduction of a tariff that pays less in patient care, or does not pay for unnecessary services. This would alleviate a great deal of strain on both primary and secondary care, and would transfer vital services to local medical centres.

The second transformative action would be to redeploy, rather than reduce, the NHS workforce. Allocating medical professionals to different sectors or levels of care would utilise the diverse skill set present in the NHS and enrich the quality of treatment available to patients.

Recent initiatives to distribute services and NHS employees across secondary and primary care units demonstrate the rising concerns about pressure on A&E. Although the expansion of medical premises to accommodate pharmacies, dentists, and optometrists has proven very effective in retaining patients and easing the strain on other primary care providers, it is the redeployment of secondary services to frontline care that will have the most significant impact on the NHS.

The third means of releasing funds and consolidating care is the disposal of NHS assets. This is controversial, due to the prevalent misconception that closing medical facilities equates to job losses. The reality is that the UK health service is in possession of a number of valuable assets locked up in estates that are not fulfilling their purpose in an efficient way.

The financial constraints imposed on the NHS means that the gap between the vision and the reality remains a significant one, particularly for healthcare premises development. The freeze on premises funding continues to put pressure on both primary and secondary care providers, with social care premises remaining largely unfit to meet the needs of its patients. 

However, without appropriate facilities for primary and elderly care, it is inconceivable that we will adequately manage the every increasing number of people cared for in the community. 

We need to open the dialogue on these issues and solve the vicious circle where patients inevitably seek care in hospitals that are not designed for their needs. What the legislators need to keep in mind for the Five Year Forward View is that more efficient premises make for a less expensive service.

The three-strand strategy for rebuilding the NHS is not a simple one, nor is it a quick fix. It requires some difficult decisions for healthcare legislators and providers as well as a seismic shift in public attitudes to seeking medical attention. However, it is feasible and it is the necessary route towards a sustainable, valuable future for healthcare.