Investment in primary care estate 'vital' to future of NHS

Experts warn health service is reaching saturation point and call for increased investment in primary and community care facilities

More investment is needed to enhance the primary care estate, experts say

Increased investment in primary care facilities is vital if the NHS is to cut back on the use of expensive walk-in centres and reduce pressure on hospital A&E services.

Andrew Darke, managing director of property at Assura Group, warns that the health service is reaching saturation point, with emergency departments under increasing pressure as patients seek medical advice outside of GP hours.

The problem was exacerbated when doctors’ GMS contracts changed in 2004, forcing almost all GPs to opt out of weekend and out-of-hours service provision. With no adequate alternative, the pressure fell on 24-hour accident and emergency departments.

Now, two decades later, there has been huge investment in acute hospital sites, but GP clinics and community health centres have largely been ignored.

If we want to invest in bricks and mortar then the place to do it in the future will be in primary care. It gives you more bang for your buck

Darke said: “Unfortunately, over recent years GPs have had to act as brokers, sending patients to hospitals because they do not have services within the primary care setting. Even small things like blood tests and scans could be done much more cheaply and efficiently within health centres and doctors’ surgeries, leaving the acute sector to deal with planned operations, overnight stays and emergency care.

“However, due to the underinvestment in primary care over the years, while some premises may be OK for injections or blood tests, there is no real capability to take on more work and this means it will go to the acute sector.

“In the long-term this is not economical.”

The past decade has seen a lot of activity in the acute hospital sector, with new multi-million pound hospitals being built up and down the country. However, with public cash dwindling, it is time to switch attention to long-forgotten primary care facilities.

Darke said: “Compared to secondary care, primary care schemes are much smaller capital value projects, often £5m-£10m instead of £100m-£300m. The money goes that bit further.”

This is why the primary care sector is currently within the radar of a number of private developers.

Due to the underinvestment in primary care over the years, while some premises may be OK for injections or blood tests, there is no real capability to take on more work and this means it will go to the acute sector

Darke said: “The majority of contracts now do seem to be in primary care rather than building more big hospitals. If we want to invest in bricks and mortar then the place to do it in the future will be in primary care. It gives you more bang for your buck. They are cheaper to build and easier to run and, if we do it well, it will take pressure off hospitals and save money in the long-run.”

And he said private developers were willing to put their money into projects at a time when public capital is scarce.

“There are enough private companies and developers around the country who are more than happy to invest in the NHS without providers having to enter into controversial PFI agreements,” he added.

“If we could reduce the number of people walking through A&E, then we would save money. But we need to have suitable primary care premises and we need them to open for longer.

“Ninety per cent of all patient contact with the NHS is with GPs. They are gatekeepers and they are more than capable of carrying out a greater range of services if the environment is right.”

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