Small practices could face premises funding cuts to 'force pace' of NHS reform

NHS commissioners could cut premises reimbursement for practices that do not fit with future NHS strategy to 'force the pace' of moves to larger primary care units, according to a review that warns 30% of practices are 'not large enough'.

The proposals came in a major review of NHS estates published days before NHS England set out plans to incentivise every practice in England to join 'local care networks' serving 30,000 to 50,000 patients. GPonline understands local care networks are set to be renamed 'primary care networks'.

Major investment in primary care estates is required to build new models of care that can cope with rising numbers of older patients with multiple long-term conditions, according to the independent review of NHS estates by Sir Robert Naylor.

The review, commissioned by health secretary Jeremy Hunt, warns that overall the NHS estate needs a £10bn injection of capital funding plus at least a further £5bn for 'backlog maintenance' costs and a 'similar sum required to deliver the Five Year Forward View'. NHS England's current 'small programme of capital grants' to support primary care premises development 'will be inadequate' to hit Five Year Forward View objectives, it warns.

Primary care premises

Sale of NHS property, private investment in primary care estates and new Treasury funding could deliver the required funding, the Naylor review suggests.

Around 43% of NHS trust premises are more than 30 years old, the report says, a key factor in the multibillion-pound backlog of maintenance costs. 'Anecdotal evidence suggests the age and condition of the primary care estate is no better than that owned by NHS provider trusts,' it adds.

The report warns that the 30% of GP practices 'having a list size under 4,000 patients are unlikely to be large enough to meet the vision of person-centred care set out in the Five Year Forward View'.

The report says: 'We know patient access to primary care is highly variable across the NHS and many single-handed practices, which might be appropriate in rural areas, remain in urban conurbations. This pattern of provision is unlikely to promote the vision of the Five Year Forward View.

'The model preferred to meet the future vision of care by this review is the creation of a network of large primary care partnerships, particularly in urban areas. These networks would have a sufficient numbers of practitioners to ensure easier access for patients across the extended working day and on a seven-day per week basis. Community nursing services should be realigned with these larger practices.'

NHS integration

The Naylor review also calls for greater incentives for providers to drive integration between primary, secondary and community healthcare.

It suggests that the formation of accountable care organisations - with primary care providers 'incorporated into ACOs or contracted to them via confederations of primary care providers' - could strengthen population healthcare, break down conflicts of interest between organisations and create incentives for hospital trusts to 'invest their property assets in primary, community and mental health services.

'A key goal for estates planning in primary care is for the transformation of facilities to meet the vision of the Five Year Forward View and support the co-location of services to support the health needs of the population,' the Naylor review says.

'Given the independence of the primary care sector, which is largely already privately owned, active consideration should be given to how GP practices can be given incentives to move into new facilities, supported by substantial private sector investment.'

It suggests that NHS commissioners and regulators have 'considerable latent authority to insist that premises be fit for purpose'.

'These powers could be used far more explicitly to ensure that new investment is in line with the Five Year Forward View and to force the pace of investment in or exit from inadequate premises. There is also a case for changing the reimbursement payments of primary care practices for example by reducing payments for properties not meeting the future service strategy to encourage moves.

'Active engagement with the British Medical Association and Royal College of General Practitioners will be essential to driving real change on these issues, as the status quo will not deliver the change needed in this sector.'

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