Only half of GP practice buildings in England are fit for purpose, with surgeries too small to meet the demands of growing populations, a major survey on practice premises from the British Medical Association (BMA) has found.
The survey of more than 1,000 practices in England asked doctors and practice managers about their experiences with property ownership and management.
One of the main findings is that eight out of ten GPs said their premises are not fit to meet anticipated future needs.
The findings present a snapshot of the GP premises landscape, as well as the issues faced by family doctors, staff and their patients. Key findings include:
- Only half of practices said their premises were suitable for present needs.
- Around eight in ten practices said their practices were not suitable for future needs or anticipated population growth.
- GP premises are on average 35 years old, having been first built or converted in 1984.
- Eight in 10 practices are in purpose-built premises.
- The last significant modification or extension to premises took place in the mid-2000s (2005), on average, pre-dating many of the increases in patient demand and population growth witnessed over the last decade.
- When asked what would make premises more suitable for present needs, most practices noted that more space is needed, including by extending the premises, more consulting rooms to manage a growing patient list, improving access including for disabled patients, and expanded and improved patient waiting and reception areas.
- Of those respondents who said they had applied to NHS England for improvement grants, the majority reported waiting in the region of three to six months to receive information on the status of their application. However, some reported waiting more than two years with the process ongoing.
- Eight in 10 practices leasing from an NHS organisation said they had been invoiced with charges that were inaccurate in the last 12 months, with only 5% reporting these issues had been resolved.
In light of the survey’s findings, the BMA is now urging the government to use next month’s spending review to invest in GP premises. The BMA is also calling for health bosses to remove bureaucratic barriers that can often prevent practices carrying out the improvements that they need.
Dr Richard Vautrey, BMA GP committee chair, said: ‘GPs have been telling us for years that their practice buildings are not up to scratch, and now we have evidence showing just how serious the situation is.
‘Despite their best efforts, GPs and their teams are ultimately limited by space, and cannot meet the growing needs of their patients without an urgent increase in capacity.
‘What is most worrying is how few practices feel their buildings are prepared for the future, with just two in 10 saying they are fit to meet anticipated future demand.
‘Without more space and the ability to add rooms and facilities easily, patients will continue to face long waits for appointments, as GPs and their wider practice staff can only work with what they have.
‘The BMA recently came to a significant agreement with NHS England as part of contract negotiations to expand the primary care workforce – with groups of practices employing pharmacists, physiotherapists and other professionals – but for patients to benefit from this expanded team, they too will require space to work.
‘Our research shows that the solution to this problem is not as simple as partners adding rooms or extending their surgeries to meet demand, with approval processes arduous and NHS grant applications not always running smoothly.
‘GPs who lease their buildings from the NHS face their own set of problems, with rocketing and unwarranted service charges and management fees often not met with adequate maintenance. At a time when GPs are facing extreme financial pressures, these unilateral price rises could push practices to the brink.
‘NHS England is due to publish the findings of its major review into GP practice premises, and we hope that it will provide some solutions to the problems persistently raised by our members.
‘More broadly the government must use next month’s spending review to urgently invest in practice premises – as well as wider NHS infrastructure – to bring facilities up to 21st century standards and ensure that GPs and their colleagues throughout the health service can guarantee the best care now and in the future.’
Dr Roberta King, a partner at the Panton Practice in Bournemouth, said: ‘When I started in 1991 we had 7,000 patients – that has grown to 15,000. We have been looking for a new site to rebuild for the past ten years but it’s just been impossible. Even back then we realised that we didn’t have enough space and we have continued to grow.
‘I think it does impact patient care and even if we were to have another three more doctors to care for patients and bring down our waiting times, we would have nowhere to put them. We have to optimise our space as much as possible – we even have doctors working in old admin rooms and occasionally in the loft.
‘I would love a bigger building where we can offer all the services that patients need in one place, with district nurses, physios and all staff under one roof. All this talk in the Long-Term Plan of social prescribing and a recruitment drive for more NHS staff but I have no idea where I am going to put them – that is just not happening in my practice.’
Tracey Rymer, practice manager at Byfield Medical Centre in Northamptonshire, said: ‘Our premises were built in 1981 and renovated in 1992. We are a fairly remote practice, with a limited bus service, and the nearest other practice is eight miles away.
‘The population has grown significantly from 4,500 to 8,200 and we simply do not have enough space to provide ample resources for residents here, many of whom are elderly and without access to transport.
‘There is no dedicated area for staff to rest or eat, nor are there any meeting rooms or space for training.
‘NHS England are looking for practices to form Primary Care Networks and share resources such as paramedics and other health professionals. We do not have room to share this resource – we are constantly having to juggle rooms to accommodate our staff. Our dispensary is unable to take advantage of cheaper bulk ordering as we don’t have enough storage space.
‘We have put in two bids to NHS England for funding for a new practice but were told on each occasion we were not a priority despite having the backing of our local group of GPs.’