What are Neighbourhood Health Centres and will the Plan see investment in GP premises?
For the Thursday edition of our weeklong daily insights into the NHS 10 Year Plan, the team looks at what the Plan means for GP premises within the context of Neighbourhood Health Centres.
In case you missed any of the previous daily insights, the articles are all available at the bottom of the page, in the ‘news’ section.
What are the Neighbourhood Health Centres?
Neighbourhood Health Centres (“NHC”) received a significant proportion of the press when the Plan was first announced.
NHCs are presented as a ‘one stop shop’ in which patients can access a range of services from a multi-disciplinary team for at least 12 hours a day and 6 days a week. This potentially includes services from general practice, outpatient services, dental, community, social and voluntary sector services. They may also include some diagnostic services.
Where and how many NHCs will there be?
The Plan states that there should be one NHC ‘in every community’. It does define a community or give any indication as to how many will be developed. However, in a statement to Parliament, Wes Streeting targeted the creation of 50 NHCs by the end of the current Parliament in 2029 and between 250 and 300 by 2035.
Given there are approximately 1250 PCNs serving around 50,000 people, this would indicate that the term “community” may be intended to cover populations in the region of 250,000, a similar footprint to that expected to be covered by the new Multi Provider Contract. However, there are bound to be variations depending on local needs and the geographical spread of each population.
Refurb, expansion or new build?
In some areas the Plan indicates NHCs may result in new developments with new service pathways being developed. In others the Plan states that the NHS will ‘maximise value for money by repurposing poorly used, existing NHS and public sector estate.’ So where possible it is likely that the system will look for existing premises with the potential for growth rather than commission more costly new build projects.
How much will the NHC programme cost and how will it be funded?
Wes Streeting indicated in his statement to Parliament that the cost of each NHC would range from the low millions to £20m, depending on whether it is an upgrade, a refurb and expansion or a new build. It appears that works to existing estate are likely to be funded by NHS capital.
Where new buildings are required, the Plan states that the Government is ‘committed to evolve its infrastructure finance models and set out that it will consider the use of Public Private Partnerships (PPP) in projects and sectors where there is a revenue stream, appropriate risk-transfer can be achieved, and value for money for taxpayers can be secured.
The Government is engaging with the market with the intention to ‘progress rapidly, working across government, on a business case around Neighbourhood Health Centres that sets out the potential and an assessment of value for money so that a final decision on the approach can be taken by the time of Budget 2025 in the autumn’.
With a nod to widely held concerns on the potential cost of these contracts, the Plan states that the Government ‘will learn from previous experience with the Private Finance Initiative (PFI) particularly where PFI was a costly mistake which represented poor value for money’ and resulted in contracts that were ‘too complex and lacked proper transparency’.
Should GP Practices be expected to lease space in new NHCs once built, it will be important that the lease liabilities are understood and costed. Clear agreements, negotiated by primary care specialist surveyors and lawyers, are essential before taking up occupation of any new premises. Otherwise, as unfortunately seen with some NHS Property Services and LIFT estate, significant issues and disputes can arise over service charges and other unforeseen costs.
What about development of new GP surgeries and improvements?
Beyond the creation of NHCs, the Plan is relatively silent on upgrades to the existing primary care estate. Given the age of large parts of this estate, significant investment is likely to be required in the years ahead and GPs will be concerned the NHC programme does not divert finance away from these schemes.
Earlier this year, the Government announced the Primary Care Utilisation and Modernisation Fund of £102m for 2025/26 and we are assisting a number of practices with funding agreements required to release this investment into existing surgeries. Future provision of capital and revenue for ongoing premises costs (such as rents) will be a key factor in terms of the extent and pace of improvements to traditional surgery premises.
What can Practices do to position themselves for the advent of NHCs?
Practices will need to work with the Multi Neighbourhood Providers once they are established to develop their estate strategy before they can be certain that additional development support will be made available to them.
Under the Plan, Multi Neighbourhood Providers may be GP or Trust led. If you are not leading, it will of course be important to have dialogue with and forge relationships with those who are leading or are likely to lead in your area.
The Plan states that they will start with pilot sites in areas of the most need. They will then roll out a national program ‘by 2030’. The NHCs will not therefore be a rapid solution but there is a benefit to developing local plans and identifying opportunities. Five years in the context of estate strategy and business planning is a relatively short period of time and it is anticipated that there will be opportunities for early adopters to lead on these pilot programs.