The amount of underused space in the NHS estate has dropped by more than a third over the past three years, according to a report by a leading property consultancy.

However, EC Harris found that 1.9 million square metres of floor space was still underused – of which 1.2 million is in the acute sector.

Shaped for the Future: reforming the NHS estate “conservatively estimated” that NHS bodies could release £1bn in capital and save a further £1bn in revenue if they disposed of just half of their underused assets.

It also urged NHS providers to collaborate. It said “‘competing’ trusts in localities should consider working together” to strategically assess the combined asset requirements of their area and dispose of what is no longer needed.

EC Harris said trusts should investigate using their estates as collateral to set up joint ventures and local asset backed vehicles with the private sector. This would save money by managing their estates more effectively, the report argued.

The study also identified a “structural issue” in primary care, and called for GPs to work together to set up “major primary care hubs”. “Aside from rural practices, what is the benefit of very small GP practices?” it asked.

Report author Conor Ellis, a partner at EC Harris, told HSJ that because of delays to the passage of the Health Bill there had been a lack of clarity over the future of NHS organisations.

“Estates directors have not been able to plan… some are merging into other organisations and others didn’t know where the land was going to go. This has not had the focus it should have had.”

In contrast, local government has embraced imaginative use of its estate.

Mr Ellis also argued that the autonomy of foundation trusts in managing their own finances meant that the NHS as a whole “does not punch its weight” in getting value out of its property portfolio.