Incredibly, five years have now passed since the publication of Sir Robert Naylor’s national review of the NHS property estate.

Jonathan Murphy

Jonathan Murphy

Its arrival in 2017 was on a morning exploding with headlines from the ‘Next Steps for the Five Year Forward View’ report: targets to increase access to GP services; to grow the primary care workforce; to modernise primary care premises; and to encourage GP surgeries to work together in hubs. For an issue often described as second only to workforce in ensuring a sustainable future for primary care, it was interesting timing.

Naylor’s diagnosis that “it will not be possible for the NHS to achieve its vision without changes in the estate” was the expert second opinion on a problem that has only become more acute.

Since 2017, we’ve had the end of the Estates and Technology Transformation Fund for primary care – its projects delivered, but 80% of GP practices responding to the BMA’s most recent premises survey still say their buildings aren’t fit for the future of care.

Integrated care systems have formed, perhaps well positioned to take the long-called-for more strategic view of NHS estate needs and challenges in each defined patient area – but with a lot on their plates after a global pandemic.

We’ve had a national Health Infrastructure Plan, which began work on 40 hospitals but has yet to outline the plan for the primary care estate – arguably the more transformative tranche of long-term investment that could be made, given that the NHS Long Term Plan is predicated on capacity of primary and community health services and access to mental health support.


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More recently, we’ve had the plan to increase diagnostic capacity in the wake of waiting lists stretched by Covid – using a range of public locations large and small. And let’s not forget the NHS’s response to climate change since Naylor’s report: its estate will need to rise to the challenge of becoming the world’s first net zero health system.

So which policy areas might push Naylor’s recommendations back up the agenda? Levelling up could be one: recent research by the British Journal of General Practice highlighted how people living in areas of greater deprivation can find it more difficult to see a GP or other primary care professional.

The study reveals that workforce shortages including GPs, paramedics and other NHS roles are disproportionately affecting more deprived areas, where people are more likely to experience poor health due to living, employment, education and financial circumstances.

The space and premises that GP practices have at their disposal are a contributing factor to their recruitment challenges: infrastructure continues to be one of their biggest investment asks, with regular reminders that there is “no room for growth at general practices.”

A new BPF report takes a detailed look at government’s progress on Naylor’s recommendations through a 2022 lens. But you don’t have to be a real estate expert to see that Naylor’s characterisation of the NHS estate as “one of the key enablers to change in the health system…[which] directly contributes to the delivery of high-quality healthcare to patients” is more relevant post-Covid than ever.

Jonathan Murphy is chief executive of NHS premises specialist Assura and chair of the BPF Healthcare Committee