Next government must urgently modernise old and cramped NHS GP buildings

If general practice is the front door of the NHS then it is currently a door that is hanging off its hinges, warns a new Institute for Government paper.

Published today, Delivering a general practice estate that is fit for purpose says GPs and the rest of the general practice workforce are working in buildings that are often too cramped, too old and too inflexible for a modern health service – with a quarter of GPs’ buildings built before the NHS was founded.

The Conservatives have pledged to build 100 new GP surgeries and refurbish a further 150, but the new IfG report shows how small this commitment is compared to the scale of the problem – and says the size and state of the NHS’s general practice estate is undermining the delivery of high-quality healthcare.

Warning that the NHS won’t meet its Long Term Workforce Plan target of growing the number GP trainees by 50% – from 4,000 in 2022 to 6,000 by 2031/32 – without substantial increases in the amount of space for GPs to work in, the new IfG report shows that:  

• As of 2022, 22% of 8,911 premises in general practice were built before the establishment of the NHS in 1948
• GPs reported that 2,000 (22.4% of the premises) were not fit for purpose
• A recent survey of GPs saw 88% of respondents claim they did not have sufficient consulting room.

Drawing on roundtables with senior representatives from central government, the NHS, the private sector and elsewhere, the report recommends a number of ways to modernise and expand the general practice estate and meet the NHS’s 21st century needs, including:

• Turning the tide on the exodus of GP partners from the service and support them to make the necessary investment in the estate.
• Giving integrated care boards more powers to allocate capital spending appropriately across general practice, wider primary care and community care in their areas. 
• Relaxing rules about rates to allow GPs to rent out unused space in their premises to other parts of the NHS. 
• Providing private investors with increased certainty – such as on future rents – to enable greater investment in the sector.  

Stuart Hoddinott, IfG senior researcher and report author, said: 

“GPs are often working in spaces that are old, cramped and inappropriate for the type of care they are supposed to deliver. The current GP estate lets down both the staff who work in it and the patients who rely on the service. Without a change in approach the next government will find it difficult to achieve its ambitions for better integrated care that is provided closer to home.” 

Jonathan Murphy, CEO from Assura, who supported this report, said:

“There is cross-party consensus that our health system needs to be re-orientated towards a preventative model in which more care is provided in the community. As the IfG makes clear, this will be impossible to achieve without drastic measures to overhaul the buildings that many GPs describe as not fit for purpose. Developers like Assura are standing by to invest hundreds of millions of pounds in rolling out state-of-the-art GP practices across the country. But, as this important report lays out in great detail, we are being held up by a system that prevents local NHS organisations commissioning the new buildings that are so vitally needed in their area.”