ESTATE DEVELOPMENT & STRATEGY


Helping shape the estate of Greater London’s PCNs


Elisa Berry BA(Hons), BArch(Hons), RIBA, Director and architect at Howarth Litchfield, explains how the Durham-based architecture and interior design practice has been leading work with some of Greater London’s Integrated Care Boards (ICBs) in response to the revised NHSE/I PCN Estates Guidance of 2020, which required PCNs to have a PCN Estate Strategy, supported by a PCN Clinical Strategy.


The Additional Roles Reimbursement Scheme (ARRS) was introduced in England in 2019 to improve access to general practice, and allowed Primary Care Networks (PCNs) to claim reimbursement for the salaries of 17 new roles within the multidisciplinary team – such as paramedics, pharmacists, physicians, and associates etc. The intention of the scheme was to relieve pressure on GPs and improve access for patients, support the delivery of new services, and widen the range of offers available in primary care. As of 2024, PCNs can appoint up to 20 full-time


members of staff. This fits the vision of ‘integrated care’ as set out by the Fuller Stocktake Report, Next steps for integrating primary care (published in May 2022), through ‘streamlining access to care’, and ‘providing more proactive, personalised care with support from a multidisciplinary team’. However, the report also called for conditions ‘to enable locally led change and the supporting infrastructure to implement it’. There is no funding available to support the PCN estate in accommodating the new appointees – no support for expansion or redevelopment of the estate – and instead, PCNs are expected to accommodate the additional staff within the existing estate. The result is further increasing pressure on an estate that was already at breaking point.


Investment ‘hard to come by’ Investment in the primary care estate has been extremely hard to come by over recent years. While some funding is available through improvement grants, these are generally


1


Kick start Catch-ups


Desktop data review Review of ICS Estates Strategy Arrange site visits Arrange CDs Interviews with CDs – 17 Discussions with borough leads Capacity modelling Report drafting Interim presentation 1 Interim presentation 2 Final presentation Site visits 3 teams – 77 sites


Table 1: The project plan and timelines required to develop and produce the final PCN Estate Review reports and presentations. These include desktop data capture and site visits for each GP practice, stakeholder interviews, and data modelling per GP practice.


October 2024 Health Estate Journal 119


for small improvements and essential compliance upgrades, skirting around the basic question about whether they are actually fit for purpose. Even funding for the digitisation programme has dried up, which would have offered immediate, albeit short-term, assistance, to relieve pressure. On the strength of our delivery of healthcare projects


across South East London, Howarth Litchfield was approached by South East London ICB to assist in the assessment of the PCN estate and a review of what would be needed to address the ‘fit for purpose?’ question. South East London ICB paved the way in supporting its PCNs in the review, together with the preparation of individual PCN estates strategy reports tailored to each PCN. We began this first piece of work in June 2021, and concluded it in September that year.


Smoothing the process The Estates Strategy involves several strands to assess the portfolio: 1 Modelling capacity – is the estate big enough to accommodate the demand of basic primary care? What space is required to accommodate the ARRS, and is that available across the PCN?


2 Clinical considerations – does / could the estate support the integration recommended through the Fuller Stocktake report? What are the aspirations of the PCN?


3 Site surveys of the physical environment. 4 Forward planning to ensure we can shape the estate to be more ‘fit for purpose’. Let us examine each in turn in more detail.


March April 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8


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