Private finance as an option to fund an upgrade of primary care estate can deliver value for money for the taxpayer and significantly improve patient outcomes, writes Maisie Borrows
Last week, Jeremy Corbyn announced a Labour government would end outsourcing public services to the private sector, in the midst of the Carillion collapse. There is, however, a contradiction between this aim and Corbyn’s other key aim of greatly improving NHS service quality. Indeed, Reform research published today finds that private sector funding is one practical financing solution for upgrading the primary care estate and delivering better patient care.
GP buildings urgently need reviving. Many buildings are not capable of delivering the new models of care set out in the Five Year Forward View, with four out of 10 GPs saying their buildings were inadequate. GPs need new buildings that can deliver primary care “at scale”.
This means multiple healthcare professionals, delivering integrated care, under one roof. These buildings can play a key role in reducing accident and emergency pressures. In the US, the primary care group ChenMed reduced A&E visits by a third through expanding care services in the community.
Third party development schemes
In the November 2017 Budget, the government recommended that £10 billion of new capital expenditure on the NHS should be funded from three sources: private companies, government borrowing and land sales.
Larger practices can lead to higher staff satisfaction because of improved service quality and the opportunity for more teamwork
The Reform report considers private finance from third party development (3PD) schemes as a feasible funding option for primary care. 3PD schemes are arrangements where a private firm funds the construction cost of a large, modern GP premise and the NHS leases it over an agreed period of time. The 3PD schemes mean GPs are responsible for keeping maintenance costs of buildings low, something private finance initiative deals in the acute sector have not always been able to.
The research found examples of 3PD buildings already delivering value for money. One GP practice, which moved from an old Victorian House to a state-of-the-art, modern surgery, doubled its list size and extended its training practice.
Another practice introduced new services, including a pharmacy and minor injury drop-in clinic. Larger practices can lead to higher staff satisfaction because of improved service quality and the opportunity for more teamwork. This should help current workforce issues in general practice by attracting a new generation of doctors.
Design and space
New buildings in the acute sector have been criticised for inefficient design leading to underutilisation of space. A priority for developers and GPs is to ensure space is ultra flexible and used effectively.
The Reform report praises Greater Manchester STP for designing a capital financing strategy to advise GPs on the best funding options available to expand services
One medical centre has built movable walls to adapt rooms to patient flow. Another public-private building has increased occupancy to 92 per cent by renting space to a pharmacy and outreach clinic. “AirBnB” type apps are in development so that practices can advertise free space to rent online, thereby raising revenue for the practice.
Innovative technology solutions are changing how patients engage with GPs. At one practice, the online GP service, eConsult, resulted in 74 per cent of users not needing a face-to-face GP appointment. In the long term, technology will significantly reduce demand on the estate. Going forward, building design should factor in this changing practice.
To ensure private-public partnerships deliver the best value for money, GPs need to be well-informed on financing options and building design. Sustainability and Transformation Partnerships have a critical role to play here in providing expert guidance.
The Reform report praises Greater Manchester STP for designing a capital financing strategy to advise GPs on the best funding options available to expand services. STPs should support GPs to negotiate contract length with developers and design practical buildings, which avoid high running costs.
There are a number of financing options available to primary care to fund a much-needed upgrade of its estate. Private finance is one such option that can deliver value for money for the taxpayer and significantly improve patient outcomes. In light of this, Jeremy Corbyn should reconsider his commitments.