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Estate of the future

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The NHS Long Term Plan (2019) sets out an ambitious 10-year agenda for change across the NHS in England. The aim is to deliver a new service model for healthcare and strengthen the contribution to the prevention of illness and addressing health inequalities.

For primary and community care it proposed a transformation in services, providing more co-ordinated delivery, offering patients more choice, better support and properly joined-up care at the right time and in optimal care settings. The ambition is to avoid up to a third of outpatient appointments, saving patients 30 million trips to hospital.

Primary Care Networks (PCNs) are central to this transformation. They will drive change and collaboration across General Practice to rise to the demands on primary care and extend the range of local services by creating integrated teams of GPs, community health and social care staff.

The estate is a key enabler to primary care transformation, acting as a catalyst for changing the way services are delivered locally and support greater care in community-based settings. Integrated primary care provision needs modern, efficient buildings equipped with the latest technology to support the development and expansion of services.  Evidence tells us that building quality is positively correlated to staff morale, retention and patient experience.

The future estate must evolve in line with service developments. The buildings need to be reliable and well maintained with the capacity to cope with future demands.

Estate planning tools

CHP in collaboration with the National Association for Primary Care (NAPC) have produced a practice guide for PCNs.  It is designed as a starting point for networks embarking on and grappling with future estate needs.


Technology is changing the way care is delivered. The NHS Long Term Plan sets out that every patient will have the right to be offered digital-first primary care by 2023/24 where they can easily access advice, support and treatment using digital and online tools.

As these new digital-first consultations and interventions become embedded in models of care the requirements on the physical estate will change rapidly.

At CHP we are using digital technology to manage our buildings better. For example, building sensors are capturing data on how the estate is used. Analysis of the data is enabling us to work in partnership with the NHS to make more efficient use of space, which ultimately is better for patients and staff.

Impact of Covid-19

The coronavirus pandemic has reshaped healthcare delivery in England. During the national emergency the NHS has pulled together, and organisational barriers that once limited innovation and transformation have come down. Across the NHS we have seen more co-ordinated, integrated care and better collaboration.

Technology has played a big part in the NHS response to Covid-19, especially in primary care. Pre-pandemic 90% of GP consultations were seen face to face. During lockdown this reduced to 5%, with 95% of GP consultations conducted via telephone or video call.

We have been working nationally and locally with NHS partners to understand what the lasting legacy on NHS service delivery will be post Covid-19. We are already hearing that there is no going back to the ways things were, especially in primary care.

Covid has given us an opportunity to cement real transformational change. We must not allow ourselves to go back.” 

“Covid has forced both GPs and patients to adopt video technology and this must become the new norm with fewer face to face appointments.”


Improving efficiencies through better utilisation of the NHS estate was a key message from the Carter Report (2016) on NHS efficiencies and The Naylor Review (2017) of NHS Property and Estates.  While the challenges facing the NHS estate are great there are recognised opportunities to make running cost savings and to cut out waste through better utilisation of existing premises. This will produce a fit for purpose, more cost-efficient future estate, which enables better patient care.

CHP has developed a collaborative approach to improving utilisation, called Dynamic Capacity Management (DCM).  We have been working with a number of pilot areas to improve utilisation of NHS LIFT buildings.  We will shortly be rolling out a toolkit of our learning.