Assura : Buildings for the next 70 years of the NHS

It's hard to imagine now, isn't it? Waiting to see the GP in the living room of their own home, before being shown into their dining room for your consultation. Yet it was a typical picture of general practice before 1948, when the NHS began. Family doctors most often ran their surgery single-handed under their own roof, but as demand for their services grew and as more GPs began to work in groups, the physical space in which they delivered care began to change in earnest.

A Nuffield Trust report from 1988 describes: 'The first health centre was an enormous one at Swindon, built in 1892 by the Great Western Railway Medical Fund Society.' By the late sixties, more purpose-built and converted buildings for general practice had begun to appear but their maintenance was sometimes patchy, and the level of investment in premises varied hugely.

Today, GP surgery buildings are where 90% of all patient contact in the NHS takes place. But it's estimated that 18% of NHS buildings still pre-date the start of the health service; an estimated one-third of GP premises are still conversions from residential or former office buildings.

40% of GPs say their premises aren't fit for purpose, and seven in ten say they don't have enough room to offer any more services. It's a challenge we work on every day: finding ways to give practices more space using the building they've already got, and patients a more pleasant environment for their experience of primary care. Wideway and Heckmondwike are recent success stories, but there are many other buildings in need of improvement, expansion or replacement.

In 2014, the Five Year Forward View stated that the future of the NHS 'no longer sees expertise locked into often outdated buildings'. Investment from the Estates and Technology Transformation Fund, NHS capital, partnership finance schemes and from our model of third party development are all helping to improve existing GP premises and develop new spaces fit for the future of primary care. Here at Assura, we've invested £28m in improving existing GP premises over the last 15 years, creating more space and building extensions to give the NHS better infrastructure without having to start from scratch. But where new buildings are needed, we've invested more than £307m in that time to create modern, fit-for-purpose premises for GPs and other primary care staff.

There's still a long way to go before all GPs are working from fit-for-purpose buildings. The NHS at 70 is looking at how to further expand access to primary care; how to deliver a greater range of services in communities rather than only in hospitals; how to use digital technology to improve our experiences as patients; and how to better integrate primary and social care. Given the level of change expected over the next 70 years, the NHS' physical infrastructure has never been more in need of the right support to keep pace.

Spencer Kenyon is our Head of Property