In my article in September last year - The Neighbourhood Health Plan – a primary care perspective – I expressed the view that the cornerstone role of primary care cannot be overstated in the delivery of the government’s Plan and that the need to provide for capacity has never been more vital.
Estate concerns are far from being a new issue. The recently published Independent investigation into maternity and neonatal service (the Amos report) notes that Lord Darzi, for example, in his Independent Investigation of the NHS in England in 2024, “described a system that has received too little capital funding for estates and IT infrastructure, with outdated estates, obsolete digital infrastructure and constrained capital spending directly undermining productivity, safety and care quality. These structural and system-wide constraints continue to shape what services are able to deliver ...”
While the Amos report is focused on maternity and neonatal services, the estates findings are highly relevant to wider NHS estate planning, including primary and community care. Recommendation 8 of the report states, “DHSC/ NHSE must deliver estates and digital systems that are fit for modern maternity and neonatal care with 12 month, five-year and 10-year investment commitments and implementation deadlines.”
This message builds on that of Lord Darzi - estates are no longer viewed as a background operational issue but as a patient safety issue in their own right.
The Amos report emphasises themes that depend on effective estate planning so, from a primary care perspective: improving integration between hospital, community, and primary care services ; supporting workforce development and multidisciplinary working, which often requires suitable clinical space and the right physical environment to support staff wellbeing, patient flow and staff facilities.
The report’s recommendations on improving maternity and neonatal services, integrating care, and ensuring safe, high-quality environments implicitly rely on effective estate planning to provide the infrastructure needed to deliver these improvements.
Amos conclusions
As far as estates are concerned, Amos concludes that estates and digital infrastructure provide the "foundations of safe care but they have not received the sustained investment required". Recommendation 8 is that,
“Clear, enforceable standards for estates must be set out in the Modern Service Framework. Health Building Notes (HBNs) 09-02 and 09-03 for Maternity Care and Neonatal Facilities, published in 2013, are no longer fit for purpose and must be comprehensively revised within 12 months. Updated standards must reflect the operational realities of modern service delivery, mandating safety for women, families and staff at all times. The government must set out 12-month, five-year and 10-year investment plans for long-term capital investment. These should deliver the revised standards for new and existing estates, including tackling the immediate maintenance and refurbishment backlog.”
Key takeaways
From an estate’s perspective, the Amos report's implicit message is that physical environments are critical enablers, along with multidisciplinary team working, of safe care. While most references relate to hospital maternity units, the report also implicitly supports greater investment in community and primary care estates generally, particularly where this can improve coordination between primary care and hospitals, continuity of care, neighbourhood delivery models and postnatal support.
The Amos report's findings on maternity and neonatal estates provide a lens through which to consider recent comments by NHS England Chair Dr Penny Dash at the Company Chemists’ Association conference on 30 June that primary care may have "twice the space it needs", coupled with her observation that much of the existing estate is both in poor condition and poorly utilised. At first glance, the argument appears counterintuitive against a backdrop of longstanding complaints about inadequate primary care premises. However, Amos raises a broader issue: the challenge is often less about total floor space and more about whether estate is configured, located and used in a way that supports modern models of care. The report posits that infrastructure should be judged by its ability to deliver safe, integrated and patient-centred services rather than by simple measures of square footage. Seen in that context, Dash's comments may be less a critique of investment in primary care estate and more a challenge to rethink how existing assets are deployed. Her suggestion that diagnostic centres, primary care, pharmacy and wider community services should be better co-located mirrors the wider policy direction towards neighbourhood health services and integrated care hubs.
If there is a wider lesson from Amos, it is that the NHS can no longer afford to treat estates as a secondary consideration that can be addressed once workforce, finance and operational pressures have been resolved.
The danger for primary care is that estate continues to be viewed as a cost pressure rather than a strategic enabler of reform. Delivering neighbourhood health services, multidisciplinary teams, prevention-focused care and greater integration between general practice, pharmacy, diagnostics and community services will require appropriate physical environments in which those models can operate and improve service delivery.
The policy debate should therefore move beyond the binary question of whether the NHS has too much or too little estate. The more important question is whether it has the right estate, in the right places, configured to meet how care will be delivered over the next decade.
Amos is a timely reminder that estate investment is not an alternative to service transformation; increasingly, it is a prerequisite for it.
Do get in touch with our Primary Care team if you have any questions.
