One of the biggest myths is that “every cloud has a silver lining”. The cloud that was the pandemic did have some silver linings. One of these was opening the world up to different ways of living and working. Of course, that comes with some additional clouds of its own for the economy and social interaction. It does, however, mean that there are opportunities to re-examine the public estate and its use. Durham County Council’s decision to sell its newly built office building to Durham University because of a change in working patterns is a sensible reaction and is now being mirrored elsewhere in a response to more blended working approaches.
Working within primary care over the past few years one thing that is striking are the problematic primary care estates. The addition of Primary Care Network staff to the mix has exacerbated the lack of space and shone an unforgiving light on the condition and suitability of many of the buildings. A recent calculation suggested that if all additional roles (ARRS) were to be employed, which would require on average 8 square metres of space, that would be a pressure of up to 256,000 square metres or 35 football pitches!
A place-based estates strategy for public services therefore seems appropriate. For instance, are there underused local authority buildings that could have space reconfigured for clinical or back-office space for primary care?
The issues around budgets and ownership interests in the current primary care estates – medical centres that may also be someone’s pension fund for instance – may stop the more radical approaches. Surely, however, there must be an opportunity to use vacant and/or under-used public sector accommodation to improve services, as well as free up some of the value in existing primary care buildings. Would anybody like to buy a “converted” Victorian terraced house with a retro avocado bathroom suite?
How successful has the One Public Estate initiative been in repurposing empty facilities and using void space for general practice? Can there be a re-energisation of that initiative? The Fuller Stocktake, being led by Dr Claire Fuller, has recently asked some ambitious questions about physical access and estate in primary care and signals optimism that the answers will lie in strategic planning at system level, as well as new provisions for ownership. Place-based partnerships may well allow for creativity in premises solutions as those relationships mature. It will be interesting to see the outputs of this stocktake and to get a better sense of the appetite to tackle the challenges of the primary care estates and the collective solutions that can address them.
The NHS have produced a useful guide on using your building to support social prescribing.