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Investment needed to ensure practice premises are fit for purpose, say primary care leaders

by Beth Gault
9 November 2022

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Additional funding must be made available for GP premises that are unfit for purpose and therefore risking patient safety, primary care leaders have said.

The NHS Confederation has highlighted these concerns as part of a report into the progress of PCNs since 2019, which also suggested that NHS England should guarantee PCNs will exist beyond 2024 to allow for better long-term planning.

It said infrastructure continues to be a ‘limiting factor’ and that the lack of fit for purpose premises is risking patient safety and worsening waiting times, as primary care teams are unable to work efficiently.

Data from the Fuller stocktake previously suggested that around 2,000 of the almost 9,000 GP practice premises in England are not fit for purpose.

The NHS Confederation report, which engaged with almost 200 PCN clinical directors and managers, as well as other leaders within primary care, found that some were unable to recruit more staff because they could not offer them a place to work.

It added that while contracts such as the Additional Roles Reimbursement Scheme (ARRS) have enabled some practices and PCNs to recruit additional staff including physios, dieticians and occupational therapists, rundown buildings and basic IT equipment have been barriers. In some cases, they are preventing staff from seeing patients properly.

One GP and PCN clinical director in Hertfordshire said in the report: ‘I have stopped recruiting because I have nowhere to put any more staff’.

Another PCN clinical director in the south east told NHS Confederation in a separate survey: ‘We’re working in a 1950s tin roof health centre. Our ability to meet patient expectations and political promises is impossible unless significant investment in infrastructure is made.

‘It is like promising the public a safe, effective, modern car and when they go to collect it, they find a 1970s Ford Escort, with rusting roof, wheezy engine, designed to take four people, but being required to carry 10, and with no one to service it or drive it.’

The report called for national primary care policy to focus on measures that create capacity within primary care, including ‘providing adequate funding’ and increasing support for management, leadership and transformation.

It said: ‘Although this [support for management, leadership and transformation] has been acknowledged in part through the new ARRS digital and transformation position, the funding for management and leadership remains inadequate for the size of the roles now being undertaken.’

Other recommendations included capital investment in technology to increase efficiency and more solutions to help manage patient flow, record keeping and sharing and clinical care.

Ruth Rankine, director of primary care at the NHS Confederation, said: ‘The ability of primary care to improve access, deploy new roles and see patients in a safe environment is being badly hindered by a lack of adequate estate.

‘Primary care leaders are committed to doing all they can to see patients and help tackle the backlog, making sure that patients are seen as quickly and safely as possible, but they are being hamstrung in their attempts by a lack of investment in buildings and IT equipment that means many primary care staff simply can’t do their jobs properly.

‘A real lack of investment in primary care capital over the last decade means that rundown buildings and antiquated technology has left primary care leaders despairing of how to recruit the additional staff they so desperately need.’