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Survey of GP practice premises

May 2006

Unlike the rest of the NHS, the premises from which GPs provide health care are usually owned or leased by the doctors themselves. Traditionally, most practices owned their surgeries buying them with a mortgage and receiving reimbursement from the NHS to represent the use of the buildings. In simple terms, the GPs raised the money for the buildings and took on the problems of ownership and the public purse paid for their use via regular revenue reimbursements. For many years this worked well and cost-efficiently but the BMA's GPs committee (General Practitioners Committee (GPC)) has been aware for some time of increasing problems with the provision and development of premises.

GPC commissioned a survey to find out what issues practices are facing with respect to their premises and to discover any future problems they anticipate in their ability to deliver and develop further, high quality general practice care to patients.

Since the mid 1990s there has been no large-scale, sustained, integrated government policy of premises development in primary care. Instead, in England at least, the Department of Health has focused on high-profile, individual developments generally using LIFT (Local Improvement Finance Trust) schemes involving a joint venture between the private sector finance, the public sector and Partnerships for Health. These developments are concentrated in discrete areas of high deprivation or urban regeneration. Outside such priority areas it has been almost impossible for general practitioners to secure the necessary funding streams to generate new premises building provision. Where LIFT schemes are operating, many GPs have found that funding for other types of premises development (eg schemes involving third party developers) is limited or non existent due to investment in the LIFT scheme.

More than nine out of ten consultations in the NHS take place in primary care, usually in a GP surgery. Good quality premises that are big enough for practices to provide patient services are vital to the delivery of modern healthcare. There are many surgeries which present a face of a pleasant well-maintained environment but which, in fact, are concealing very significant overcrowding. Inside the walls, GPs and their staff are “hot desking”, converting storage rooms into consulting space and even using kitchens and coffee rooms for immunisations. The BMA survey reveals that three quarters of the practices felt their premises were not suitable for their future needs and six in every ten practices worked from premises unsuitable for their current needs.

General practice has changed since the regulations covering most of the current building stock were laid down. These regulations were based on the number of doctors consulting at one time. Modern team working has greatly expanded the number of non-doctor staff in surgeries. The BMA survey showed an average practice size of 4.1 full-time-equivalent (fte) GPs working with 2.5 fte nurses, alongside 8.35 fte other staff

Overall the survey paints a picture in which, for many practices, there is a complete inability to absorb any further work simply because of the lack of space and room availability. This is despite the fact that four in ten practices have tried to improve premises in the past five years securing funding from a variety of sources including loans and mortgages, practice savings, private finance initiatives, one-off grants and borrowing costs reimbursement schemes. Many had had planning applications refused or had expanded as far as they could on the current site.

GPs have amply demonstrated that, given secure funding streams, they will make the necessary premises investments. However, even the most entrepreneurial GPs, acting alone or with third party developers, need long term security or suitable break clauses in contracts (with Primary Care Organisations becoming leaseholders of last resort) in order to commit funds to development projects. What is needed is a sustained and consistent government commitment to recurrent revenue to back up capital investments. Without such arrangements, plans to shift patient care from hospitals to the community, such as those described in the White Paper, Our Health, Our Care, Our Say, will remain largely unfulfilled.