Costing primary care facilities
An area of growing focus for NHS investment is the improvement of primary care buildings. Healthcare specialists Jason Pearson and Ian Mitchell explore how facilities can provide modern fit-for-care environments for patients as well as safe and supportive workplaces for staff.
The NHS is under immense strain, battling staff shortages, historic underfunding, and a growing UK population with complex health needs. Until recently, the majority of spending has been applied to areas in acute need as well as day-to-day running costs. But attention is now turning to improving primary care buildings that house vital front-door services such as GPs, community pharmacies, dental and health services.
The NHS Long-Term Plan, a 10-year blueprint, sets out commitments that will fundamentally change how these services are delivered. The goal is the creation of “fully integrated, community-based healthcare”. It’s a concept designed to make physical assets work harder and more effectively, while encouraging a more holistic, preventative approach to the nation’s health.
As a result, primary care funding is on the rise. The planned distribution of NHS funding for 2019/20 will see almost £80 billion allocated to Clinical Commissioning Groups (CCGs) across England for local health services. This represents a chance for primary healthcare buildings to receive the investment they need to meet localised healthcare demands.
The digital opportunity
The NHS has called for a complete overhaul in how primary care is accessed, with a digital-first approach. However, successfully integrating digital services into physical infrastructure is one of the biggest tasks facing developers of new primary care projects. To make digital consultations become the new normal, primary care physical assets now need to enable this.
Shortening the patient journey through the physical health space via digital technology can have major health implications by saving time and enabling more accurate diagnosis, thus improving health outcomes and patient satisfaction. Furthermore, effectively incorporating digital services into physical assets can also mitigate two of the biggest issues facing the NHS: staffing and funding.
Flexibility is imperative
There is now a shift towards bigger, more flexible and interactive buildings that can be repurposed quickly. For example, a primary care building could be used as a community meeting space in the evening but if there’s a sudden, pressing need and demand for evening appointments increases, then the space could be freed up for treatment instead. As the coronavirus has made clear, there is a public health imperative to be able to reduce or expand the number of people visiting physical primary care facilities.
However, providing such high levels of adaptability brings challenges. Flexible spaces still need to be able to offer appropriate levels of containment and privacy quickly so healthcare providers can engage with their patients one-on-one or in confidence if required.
Sustainability
Sustainability is a key driver of change in the design and costing of the NHS’s primary care assets. As environmental scrutiny is heightened and zero carbon goals emerge, standards have rapidly shifted from design nice-to-haves into essentials. New-builds have different sustainability criteria to refurbishments: newly built facilities need to achieve a BREEAM Excellent rating whilst a refurbished scheme has to achieve Very Good.
Furthermore, new models are emerging to improve the sustainability of all asset types. Community Health Partnerships (CHP) has spent more than three years working with a team of advisers, including AECOM, researching the potential benefits of ultra-sustainable design not only to improve the user experience but also to reduce whole-life cost of ownership.
NHS England is thought to be the only healthcare system in the world that is routinely reporting on its greenhouse gas emissions. This year it is due to release a report examining the scale of its carbon footprint, which will also provide a timeline and plan towards the organisation achieving net-zero carbon emissions. It follows that CCGs will be increasingly expected to account for and reduce their energy usage and carbon output.
Cost breakdown for an example fit-out
Our cost model is for a Category A fit-out of a shell and core development into a primary care health centre in England, for GPs, community nurses, midwifery services, mental health services, social services and support services. View and download the cost model here.
An edited version of this article first appeared in Building magazine in June 2020.