Autumn Statement is key opportunity for Chancellor to invest in ‘inadequate’ and ‘unsafe’ GP infrastructure

The Royal College of GPs has laid bare the risk posed to general practice and patient care by ‘inadequate’ and ‘unsafe’ GP infrastructure – including the buildings GP teams work in and equipment they use - and is calling on the Chancellor, Jeremy Hunt, to address this and other shortfalls in general practice funding, in his Autumn Statement on Wednesday.

The College is calling for £2bn in general practice infrastructure investment as one of seven steps to save general practice and safeguard our NHS, set out in its recently-launched manifesto ahead of the next General Election.

It is also taking the opportunity to call on the Chancellor to redress the exclusion of general practice in any additional winter funding plans, ahead of what always an incredibly busy time for GPs and their teams.

The College’s infrastructure concerns are based on a recent survey of 2,649 general practice staff, predominantly GPs, that found two in five considered their premises not fit for purpose, with 88% of whom citing an insufficient number of consulting rooms.

Staff also raised concerns about the suitability of access to practices for patients with disabilities (32%), the condition of old buildings and equipment, and structural problems such as water leaks, mould, mildew and drafty windows (25).

The survey found that of those who reported that their premises were not fit for purpose, one in three said that this is because the space for patients is inadequate.

Commenting on the findings of the survey, RCGP Chair Professor Kamila Hawthorne, said: “General practice infrastructure - the surgeries in which we care for our patients - is simply not up to scratch. Many GPs are dealing with inadequate buildings which in some instances, frankly, are unsafe. 

“We’ve heard stories from GPs of temporary portable cabin extensions now in their 18th year of use with rotten walls and cramped consultations rooms. Our members have told us of leaky roofs and draughty windows. These are conditions which you would not associate with 21st century healthcare, but they’re the reality for a substantial number of practices in the UK, and make neither for a safe or healthy environment in which to work, or deliver care to poorly people.

“These significant failures in infrastructure are not only disruptive for present care, but they also pose a serious risk to the NHS long-term workforce plan. It's imperative that GP trainees are able to learn in a general practice environment, but GPs are telling us this often isn't possible with two in five reporting that their practices aren’t fit for purpose and unable to accommodate trainees due to a lack of space. 

"This needs to be addressed which is why one of the key asks in our recently-launched manifesto is for £2 billion worth of funding in infrastructure, addressing the longstanding underfunding we’ve seen in our premises, and the forthcoming Autumn Statement is a key opportunity to do this.   

“There has been little recognition from the government for the risks posed by underfunding general practice – not only to the profession but also to patients. General practice missed out on funding in the government’s Winter Relief Plan despite the fact we’ve seen a dramatic increase in demand that is simply unsustainable – in September 2023 we delivered 5 million more appointments than in September 2019, but with 827 less fully qualified GPs. If we’re simply unable to meet the demand for care, many patients will be forced to seek help in more costly secondary care.

“Similarly, a crucial asset to the NHS last winter was the introduction of Acute Respiratory Infection (ARI) hubs which will not see enough funding to operate in all areas of the country this winter – even though the NHS estimated that last winter, where they were implemented, they prevented 360,000 extra A&E admissions and 360,000 GP appointments, saving the NHS over £4 for every £1 spent. 

“The Autumn Budget on Tuesday is a final chance for the Chancellor to address this short-sighted approach to healthcare funding. Our funding asks are not a luxury, but a necessity. In the shorter term, some of these actions are important just to help the NHS to get through this coming winter. But longer term, there are areas of investment which are absolutely necessary to ensure we are able to care for patients in surgeries that are safe and fit for purpose."

Sarah Powell, Head of Patient Services at a group of GP practices in Yorkshire, gave a first-hand account of the infrastructural issues one of the practices she oversees: “Our main site is a converted house which the practice acquired in the 60s and is now seeing a litany of structural issues. The older parts have frequent leaks, damp walls and build ups of mould on the inside. Our staff room has a leaking gutter pipe attached to it and water soaks through the walls – the smell of damp can be very unpleasant and a source of distress for our team members and some patients. 

“The size of some of our consultation rooms is also a real issue, they’re small and cramped with damp walls, they make for challenging working conditions when treating patients. We’re always hesitant to touch the wallpaper or take up any of the flooring due to our fears of finding the extent of the problem lurking beneath. The property is grade 2 listed which makes repairs expensive and difficult – for example, to change the old leaking wooden window frames for UPVC requires pre planning application.  

“We just don’t have enough funds to address the glaring issues in our building. As a practice we’ll always aim to ensure patients get the care they need, but these conditions are far from adequate and they’re only getting worse each year.

“Over the last few years, we’ve expanded our workforce through the recruitment of new roles through the ARRS Funding Scheme (Additional Role Reimbursement Scheme) so suitable space is now even more difficult to find.  We want our patients to have the best experience possible, but this is often hampered by the difficult conditions we’re working in.”

The College’s recent manifesto outlines seven solutions that will help improve patient access to safe and timely care and ensure that there are enough GPs and other primary care professionals to safeguard the future of general practice and the wider NHS.

Further information

RCGP Press office: 0203 188 7659

Notes to editors

The Royal College of General Practitioners is a network of more than 54,000 family doctors working to improve care for patients. We work to encourage and maintain the highest standards of general medical practice and act as the voice of GPs on education, training, research and clinical standards.