While there seems to be a considerable amount of evidence about the impact that hospital design can have on patient recovery there is little equivalent evidence around primary care. 

This new report published by the Patients Association outlines patients’ views, based on an online survey and four focus groups held during September 2018 in order to highlight how significant the physical environment might be in shaping the experiences people have of primary care. What views do people have about the condition of buildings and what are their views about the possibilities for improvements and potential for alternative uses?

The survey and focus groups looked at the internal and external aspects of buildings, including accessibility. Each produced slightly different feedback, which showed some common themes and also some that were distinct to each individual piece of engagement. The main points were that buildings differed greatly in terms of levels of maintenance and the services offered by the practices that use them.

Confidentiality was a key issue especially risks of being overheard at the reception desk or when telephoning the practice. Access for disabled people was often difficult and waiting rooms were the area most in need of updating and improvement.

There was mixed feedback regarding extra services that would be helpful to have in addition to the basic GP and practice nurse, with some people feeling that additional services would place an extra burden on arrangements that were already stretched. There was a general expectation that in the future it was likely that practices would be merged to create larger one-stop type polyclinics. Some people welcomed this as they felt they would get a better and more accessible service, while others believed this would take away from the local nature of a GP practice, which they valued. Most expected that future needs for buildings would be different, with an increased dependence on technology which some welcomed and some did not.

While it was clear from this project how highly patients value the NHS, it was also clear that the buildings that house general practice in particular are often old and in need of serious investment and expansion based on the feedback from the participants of this survey.  If current pressures on the GP workforce are not resolved, at least some care will have to be provided in very different ways in the future, and buildings will be an integral part of that.

There are common threads in the concerns patients have regarding their GP premises but they are also very forgiving of shortfalls in the standards of buildings as the perception is that available funds should be spent on care. This came through in some of the comments made during the focus groups and in some of the qualitative comments in the survey.

Also, people do believe that an agreeable environment implies they are welcome and valued. Conversely, a poor environment can be a source of stress, anxiety and cause increased feelings of ill health as well as doubts about whether lack of cleanliness, tidiness etc. is a reflection of the standard of treatment.

Commenting on the publication of the report, Rachel Power, Chief Executive of the Patients Association, said: 

“It’s a huge concern that the majority of people completing our survey reported issues relating to privacy and confidentiality at their local surgery – this goes against the law and official NHS guidance, and needs to be addressed. Patients who are sick and unwell will already be anxious about going to see a GP – the last thing they should need to worry about is whether their private conversations will be overheard by other people.

“We recommend that all existing and new GP premises should ensure that people with disabilities are able to easily access the building and internal rooms, and that health and safety and disability legislation is always applied. Our other recommendations are based on what patients have told us they want to see: adequate parking and good transport links, improved signage throughout buildings and better air quality control in waiting rooms. 

“Despite the concerns that people have, it’s clear that patients value the NHS and seek high quality care as a first priority when they visit their GP. Funding should primarily go into improving standards of care – and patients agree that this should be the case – but it should not be ignored that many buildings housing general practice are often old and in need of serious investment.”

At a time of pressure on NHS resources, from both limited funding growth and increasing demand, new buildings must offer good value for money when they are built: this means promoting safety and security, ensuring that the needs of the users of the building are met, adopting innovative practices to achieve this as appropriate and making efficient use of resources.

Read more about the report in our news item here.

Download the full report here.