The Importance of Primary Care and Estate in Neighbourhood Health

Sewell Advisory’s Operational Partnerships Director, Dayle Lynch, looks at the importance of primary care and estate in neighbourhood health.

Primary care has long been the main ‘front door’ to health services. However, accessibility has changed significantly over recent decades, influenced by factors such as population growth, an ageing population, and advances in treatment and care that mean more people are living longer with multiple, complex conditions.

Over the last decade, a range of initiatives have been introduced to improve efficiency and capacity in general practice. While some have delivered benefits for patients and the primary care workforce, none have been without challenges. Examples include the establishment of Primary Care Networks (PCNs), enabling GP services to operate at scale, and the Additional Roles Reimbursement Scheme (ARRS), which introduced funding for roles such as social prescribers, clinical pharmacists, and health and wellbeing coaches. However, these initiatives have often not fully considered critical success factors, particularly the availability of the right type and volume of estate to support enhanced service delivery.

The Government’s neighbourhood health model explicitly recognises the need for ‘coherence between the neighbourhood service model, GP provision and physical estate’. As one of the seven criteria for funding Neighbourhood Health Centres (NHCs), this highlights the crucial enabling role of estate in delivering system transformation, with general practice at its core.

While there are examples of high-quality, modern GP facilities, many buildings remain “plainly not fit for purpose”, as highlighted in Lord Darzi’s 2024 Independent Investigation of the National Health Service in England. Further evidence reinforces this challenge: the 2024 Institute for Government and Assura report found that 22% of GP premises were built before the NHS was established in 1948, with around 2,000 buildings deemed unfit for purpose. Additionally, the 2025 British Medical Association survey reported that 83% of premises are not suitable for future needs. This demonstrates the scale of reconfiguration required if primary care is to lead the neighbourhood health agenda.

It is encouraging that there is now wider recognition that estate is an enabler of improved service delivery, helping to challenge the long-held perception that primary care is the “poor relation” of the NHS and that estate is a barrier rather than a facilitator of transformation.

As neighbourhood health aims to bring together NHS, local authority (including public health) and voluntary sector services around population needs, general practice provides a natural anchor. GPs are uniquely positioned to coordinate care across pathways and partners, with extensive touchpoints beyond the NHS. They are also deeply rooted in communities, representing a consistent, accessible, and trusted point of contact for patients. This role will be critical in reducing avoidable hospital admissions, improving outcomes, and enhancing population health and wellbeing.

However, the ageing primary care estate, combined with limited investment over the last 10–15 years, presents a significant constraint on delivering this model. Traditional service delivery has often been fragmented, and there is now a need to create environments that enable general practices to work collectively as Integrated Neighbourhood Teams (INTs). This requires larger, more flexible spaces that support multidisciplinary working and co-location of services. In many cases, the existing estate is not designed for this purpose, having been built around smaller teams and more limited service offers.

Capacity pressures further compound this challenge. Many practices are already operating at or beyond capacity, particularly following the introduction of ARRS roles. In addition, varied ownership models across GP estates can create complexity, slowing decision-making and hindering transformation at pace. This misalignment between service ambitions and physical infrastructure limits the ability of primary care to deliver at scale, extend access, and fully integrate with system partners.

Within this context, ensuring the estate supports general practice in its role as the anchor of neighbourhood health is critical. Both GP and wider public sector estate must provide flexible, adaptable spaces that enable integrated and co-located care delivery. There are strong foundations to build on, including expanded workforce models through PCNs and ARRS, alongside Government prioritisation of Neighbourhood Health Centres.

There is little disagreement that primary care is fundamental to the success of the neighbourhood health model. It is the essential “front door” that brings care closer to patients and reduces pressure on acute services. However, its effectiveness is intrinsically linked to the quality and configuration of its estate.

Realising this potential requires strategic decision-making and parallel investment in both public and GP estate. This will ensure facilities are capable of supporting both current demand and future models of integrated, multidisciplinary care at scale. Developing fit-for-purpose estate takes time, and it is vital that PCNs and Integrated Neighbourhood Teams understand both how their current estate can be optimised and what gaps need to be addressed to achieve their ambitions.

Without this, the goal of shifting care closer to home and improving outcomes risks not being fully realised.

At Sewell Advisory, we have extensive experience working with PCNs and ICBs to develop estate strategies aligned to service planning ambitions. See our case studies for further examples.