Following one of the most-unpredictable general elections in recent memory, the focus is now back on the NHS estate. There were a number of features in the Five Year Forward View which will continue to set the agenda and be supported by the Conservative Party majority government.
The Secretary of State for Health, Jeremy Hunt, said that he wants the NHS to be the safest, most-caring and highest-quality healthcare system in the world and that a step change in services offered through GP surgeries, community care and social care, is needed. In terms of spending commitments, many healthcare providers' view is that the investment numbers are just not big enough. The Chancellor’s announcement of £1billion investment over four years in GP services is simply not enough, even with the new £8billion NHS spending pledge. The money will run out – it’s when, not if!
I for one agree that we need the best healthcare service in the world, but I worry that the headline-grabbing seven-day GP care pledge is not the answer to deal with the demand and financial challenges facing the healthcare estate.
We are part of a complex health market and premises are at the heart of the solution and we believe innovation, patient needs, collaboration and space maximisation are key to delivering our goals.
Innovation within centres
I passionately believe that before we look at changing GP opening hours to seven days, we first need to educate patients to choose the most-appropriate care option and signpost patients to the correct care giver. We have recently developed Support and Advice Hubs (S&AH) with dedicated patient advisers, which are currently being embedded across the whole group. The S&AH are an additional access point to care for all of our patients and, crucially, give our patients the time and the non-clinical support which is vital to delivering a comprehensive care pathway, addressing all aspects of patient’s health and wellbeing needs.The S&AH space within the health centres is designed to showcase family, lifestyle and health issues and signpost the patient to the correct advice and most-appropriate use of their NHS system – providing a different informative point of access for the patient. We all know we face a huge battle against rising patient demand and 30% of patients, as a minimum, are not choosing to the right option for their care. We believe our S&AH could be a solution to demand pressure and be integrated to premises design in the future, reinventing the doctor’s office.
Addressing community needs
A primary care premises scheme, whether it is a new development, improvement or renovation, in my view, needs to address the local need of the patients it serves.
Improving the patient experience should be the overarching purpose of any changes to healthcare premises. The importance of conducting a thorough analysis of a practice’s current position, both culturally and financially within the market place and community, cannot be underestimated. If we understand patient needs first, it is possible to look at the opportunities for practice growth and development and invest in the estate in a better way for a new generation of fit-for-purpose primary care facilities.
As a sector, if we are to meet market challenges, as stated in the Five Year Forward View approach, practices will need to work in collaboration with other local primary care services such as pharmacy, dentistry or optometry, community health provision, local authority, secondary care provision and the third sector to accommodate the rising demand by benefiting from economies of scale. The key to future success will be to deliver a proposal for a modern, bespoke, multi-tenanted, multi-service buildings, so premises can become the hub of a community, addressing a number of needs across the patient population.
Looking at gaps in surgery service provision is also key; CCG locality and patient demographics differ and their individual needs must be addressed. Any multi-purpose collaborative development also needs to allow for flexibility of space, helping to future proof the site and allow for further development based on changing needs.
Time and space
Practices should also undertake an exercise to fully understand how they are utilising existing space. Many practices feel they have no spare capacity. However, our experience has shown, when we fully analyse the space utilisation, nine out of ten cases have spare clinical space that can be used to increase capacity. There are, of course, different ways to define areas and we need to challenge the norm and think differently in designing clinicial space for the future.
Many practices could also consider how they currently deliver clinics and if any changes could be made to increase capacity without structural alterations.
Time is money is an old adage and, simply, if a room is utilised from 8.30am to 11am, then from 3pm to 5.30pm, it’s worth just stepping back and considering whether someone can use it in those in-between times. Are there any rooms where the use could be changed? For example, if there is a room used to store records could this be adapted into clinical space and the records be stored off site? Sometimes some simple remodelling of existing space and looking at how premises are designed can increase capacity tenfold and develop a new revenue stream.
Having a strong accountable government that sticks to its pledges is key for the future of the NHS and I firmly believe premises are a vital part of the solution. We all then need to work together to meet increased demand. Only then will we deliver and improve patient care. Whether it is in five or seven days does not matter. It is the quality of patient care that does and that we have the right premises to deliver.
In order to improve services and respond to the challenges the health sector is facing, we need an estate that is well thought out, well utilised and efficiently run, putting the patient at the heart, whoever is in Downing Street.