GP practices and hospitals across the UK are experiencing an ever-increasing demand for services. A national annual survey conducted by NatCen published earlier this year showed that satisfaction with GP services is now the lowest of any NHS service with the exception of dentistry. This is part of a wider fall in satisfaction with the NHS altogether, where overall satisfaction has fallen to 36% – the lowest level recorded since 1997.

The cause for these negative results can be attributed in part to a lack of investment in GP surgeries and the NHS estate, which according to NHS leaders is hindering their efforts to reduce the size of waiting lists – the main source of dissatisfaction.

There are currently more than 6.6 million people waiting for hospital treatment in England – one in nine of the population – and ministers have warned it could be 2024 before the numbers start coming down.

Pressure on premises

Hospitals such as St Helier in South West London, where 90% of the buildings pre-date the foundation of the NHS in 1948, are a prime example of healthcare being hampered by the confines of its bricks and mortar. In the Trust’s ‘Strategic outline case for investment in our hospitals 2020–2030’ report, it was acknowledged that a significant part of the estate is not functionally suitable for modern healthcare delivery. The themes covered will most likely resonate with other NHS Trusts, ranging from building design and proximity of beds making infection control difficult to inefficient practice due to the difficulty in co-locating services together when required. Consequently, patients are often transferred distances, sometimes outside, from one department to another.

Building issues are just as relevant for many GP surgeries who are struggling for space. A recent British Medical Association (BMA) survey found that only half of GP practices considered their premises to be fit for their needs. It was found that in many current buildings, the environment for patients is poor, access for people with disabilities is difficult and layouts are seen as unhelpful and confusing.

The demand on primary care premises will only increase with population growth. NHS England recently allocated funding for another 26,000 primary care staff by March 2024, which the government is over halfway on delivering according to data published in May. Such a recruitment drive will require expanding existing facilities or relocating to larger spaces in order to accommodate both increasing numbers of staff and patients. 80% of practices in the BMA survey said their current premises would not be able to cope with expected future growth in demand.

Investing in fit for purpose healthcare buildings

The funds needed to address both primary care and hospital maintenance and improvement have previously come from a dwindling public purse but also the now abolished Private Finance Initiative (PFI), where contracts set to expire over the next few years have yielded mixed levels of success. One solution is the Third Party Development (3PD) delivery model, which eliminates the risk of escalated public spending to benefit the NHS. Notably, 3PD differs from PFI in that under PFI the whole asset is paid for plus interest by the NHS, whereas under 3PD investors take the residual liability risk of the land and buildings and would commit further capital to modernise the existing estate. In practice, this means 3PD investors do not charge additional fees back to tenants for maintenance.

Hollis are a trusted adviser to the two leading primary care property investor REITs who have committed to 3PD – Assura and Primary Health Properties – across the UK and Ireland. Whether this be on the acquisition side, providing services such as Technical Due Diligence and Measured Surveys, or conducting refurbishments through Project Management and M&E,  our experts require sound understanding of health publications such as Health Building Notes and Health Technical Memoranda, which set out space standards, accommodation requirements and environmental targets in the sector.

A key trend now being delivered for clients is adaptable space that can expand the health offering from within the primary care setting to reduce demand on hospital services. The need to invest in existing or new premises to make property a flexible enabler rather than an impeder to better healthcare has never been greater.