GP surgeries facing perfect property storm

JENNIFER NICOL of Vail Williams

Increasing demand for GP services, declining GP numbers, ageing surgeries and funding challenges are coming together to create the perfect property storm for NHS GP surgeries in England, according to property consultancy Vail Williams.

Demand for GP services has risen exponentially over the past two years, driven not only by the pandemic but also by an increasing – and increasingly ageing – population which is predicted to result in one in four people being aged 65 or older by 2050.

Yet, according to property firm Vail Williams, neither the GP workforce nor its property infrastructure is growing fast enough to meet this rising demand.

With just 35,273 registered GPs in 2020 and patient numbers per practice 22% higher than in 2015 the demands placed on GPs and their ageing premises have never been higher, resulting not only in GP exhaustion and fatigue, but many leaving the profession and surgeries closing their doors.

A recent survey by the British Medical Association (BMA) (April 2021), revealed that BMA members (60%) have been experiencing ‘higher than normal’ levels of exhaustion or fatigue.

In 2020 alone, 546 older, more experienced GP partners left the profession altogether, with around 100 GP surgeries shutting their doors. Since NHS England became operational in April 2013, one in six GP practices have either closed or merged to create larger medical practices, according to GPonline.

Vail Williams says that many of the surgeries that remain are either operating in obsolete purpose-built buildings or unsuitable converted premises which, eight out of ten GPs state, lack space and are not fit to meet future needs.

Dr Dan Bunstone, Chief Medical Officer at PushDoctor

This is particularly true, considering how delivery of NHS healthcare has evolved over the past two years, says Dr Dan Bunstone, Chief Medical Officer at PushDoctor, the UK’s first platform to offer video consultations online and via smartphone.

“The pandemic has shown us how digital technology can help, working alongside face-to-face care to make systems more sustainable, efficient and joined-up, with clear benefits for clinicians and patients alike.

“However, whilst innovations are being made in the delivery of GP services, the infrastructure to support this, including the buildings from which many GP surgeries operate, isn’t coming quickly enough.”

Demand for new clinical premises continues to rise, as both NHS and private healthcare providers seek increasingly innovative ways to deliver on their future property need.

Jennifer Nicol, Chartered Surveyor at property consultancy Vail Williams, said: “Whilst there is strong demand for medical and clinical space from surgeries with older or converted premises, there is currently a lack of suitable supply in the market to answer this.

“Together with funding challenges, this means that many NHS GP surgeries are struggling to operate from premises that are fit for the future. It’s a perfect storm.”

According to Vail Williams, many are turning to office or retail buildings which can now be converted for medical use without requiring a change of planning use, following recent changes to permitted development rights.

Group Practice Doctors Surgery Sign

Smaller GP practices and dental practices are exploring this route, meanwhile larger practice practices offering more comprehensive health hubs, or which incorporate complementary services such as integrated pharmacies, dental services and minor surgical services, look to larger redundant premises, such as former department stores.

Jennifer added: “While this is an exciting opportunity for the healthcare sector, as GP practices benefit from the continued demise of the High Street which has been exacerbated by the pandemic, it doesn’t come without its challenges.”

“Conversion of high street office or retail units for medical use can entail certain planning challenges, including the potential need for prior approval as well as building infrastructure and services, and competition from residential developers who can deliver higher return on investment.

“Whether or not GP surgeries will be able to compete effectively in the market to take advantage of these opportunities, remains to be seen.”

“In most instances, residential use will deliver a higher land value and more attractive yields for developers, so acquisitions for medical use can often be outbid by residential developers and alternative uses.”

The property challenges for GPs don’t end there, as access to Government funding to support property costs continues to be a complicated issue to navigate.

One hundred per cent NHS-funded premises improvement grants are now available following GP contract updates in 2020/2021, and the recent 1.25% tax increase announced for health and social care will deliver additional funding.

The level of funding for which surgeries are eligible depends on a multitude of factors, and contributions will need to be discussed with the NHS during the approvals process, which is slowing the delivery of modern surgery facilities.

Dr Jyotsna Magapu, GP partner at The Chorley Surgery in Lancashire, said: “In the past, partners would buy into the property and take on part of the mortgage, with rent reimbursement from NHS England covering repayments.

“Problems tend to arise with outgoing or incoming partners when costs need to be moved or partners bought out. Maintenance is also a big consideration and partners generally have to find their own extension. If there is no room to grow, many are left stuck in premises that lack that potential, and services have to be farmed out to other practices as a result.”