Wide ranging proposals to improve the accommodation, services and facilities in GP Practices across Forth Valley over the next five years have been unveiled.

The Forth Valley Primary Care Premises Programme, aims to tackle rising demand for GP services and address the size, condition and layout constraints faced by many GP Practices across the area. It sets out proposals for a major programme of investment to improve local GP premises and associated healthcare facilities to ensure they can accommodate the staff and services required now and, in the future, as well as redesign the way a number of existing GP services are delivered and developed to meet the commitments of the new national General Medical Services Contract.

Kathy O’Neill, General Manager for Primary Care and Mental Health, NHS Forth Valley, said: “These are ambitious and wide-ranging plans which will ultimately benefit all 50 GP Practices in the Forth Valley area. We have already made a significant investment to recruit more than 200 additional healthcare professionals to support local GP Practices. We therefore need to ensure that there is suitable accommodation and facilities to accommodate these staff who provide thousands of healthcare appointments every month alongside their GP colleagues.

“This will support the future expansion of community-based health services and ensure we are able to keep pace with rising demand for local services as the population of Forth Valley continues to increase.”

Detailed work has been undertaken over the last 18 months in partnership with local GPs, primary care staff, patient representatives, staff from both local Health and Social Care Partnerships and NHS Forth Valley’s estates team to identify the most appropriate way of delivering the services provided within GP Practices. For example, which services need to be provided by each individual practice and which could be shared between practices. The final stage involved identifying the specific requirements of each locality within NHS Forth Valley taking into account levels of deprivation, new housing developments and opportunities to upgrade, expand or replace a number of GP premises.

These future plans would ensure all existing GP Practices continue to provide a wide range of core health services (including urgent on the day care and care for patients with long-term health conditions who require longer-term care and treatment). It would also see the ongoing

development and delivery of multi-practice services to enable healthcare staff employed by NHS Forth Valley to provide support to a number of GP practices in the local area and the development of locality hubs where a number of services for some GP practices are provided within larger premises, freeing up space within individual GP Practices to accommodate more local staff and services. This approach already works well for a number of services such as podiatry services where the majority of clinical sessions are delivered in a smaller number of locations but with a larger number of sessions provided to increase capacity for patients across the local area.

An Initial Agreement, which describes the need for change, preferred service model and benefits for local patients, staff and communities, was approved by the NHS Board at its meeting on 31st May 2022. It will now be submitted to the Scottish Government for consideration. If approved, the next stage will involve the development of a series of Business Cases which will set out more detailed financial plans, service models and timescales for the proposed improvements in each locality area, which would be delivered on a phased basis over the next few years.

Additional Information

There are currently 50 GP practices within 45 buildings with over 1,000 staff based within the premises plus a number of visiting community-based services. Significant housing development is planned in many areas across Forth Valley (up to 12,000 new homes with many more planned over the next few years). This increase, combined with the significant growth in the number of local residents aged over 65s from 1 in 6 to 1 in 4 to 2035, means that the existing GP premises and workforce would be unable to meet future demand for local healthcare services without significant investment and redesign of the way current services are delivered. Failure to plan effectively for future growth could lead to rising unmet need, growing health inequalities, poorer health outcomes and rising demand for acute care.

Some GP practices have challenges in providing suitable accommodation and facilities for additional healthcare staff. This means some are unable to routinely accept new patients, resulting in some people having to travel further to access GP and primary care services.

NHS Forth Valley has recruited more than 200 additional healthcare professionals (including Advanced Nurse Practitioners, Mental Health Nurses, Physiotherapists, Healthcare Support Workers and Pharmacists) to support GP Practices across the area as part of its Primary Care Improvement Plan. These staff are already making a positive impact on GP workload and helping to provide more care closer to home, reduce pressure on the Emergency Department at Forth Valley Royal Hospital, prevent hospital admissions and reduce the number of referrals to hospital-based services. This also means patients have direct access to expert advice and treatment at an earlier stage which prevent their problems from becoming more severe and requiring more intensive and costly treatment. In addition, it reduces pressure on GPs and frees up more of their time to support patients with more complex health conditions. However, due to size, condition and layout constraints, many local GP Practices are unable to accommodate all of the additional new healthcare roles which could make a real difference to local patients and GP workload.

Lack of space to expand and poor IT infrastructure means many GP Practices may be unable to implement new digital developments for both staff and patients or support the delivery of new healthcare services which many patients expect. Restrictions in size, layout and capacity mean that many GP Practices are able to unable to maximise the benefits of health and care integration

as they are unable to accommodate multidisciplinary teams or social care colleagues. This means many of the benefits of joint working across local health and social care are not currently able to be delivered resulting in a more limited and fragmented services for some patients.

The benefits of these proposed programme are many and wide-ranging including:

• Improved access to a wider range of community-based services
• Ability to meet current and future demand for GP and primary care services
• Reduced waiting times for mental health support and physiotherapy
• Reduced pressure on hospital services – fewer referrals to hospital-based outpatient clinics and fewer ED attendances
• Reduced health inequalities
• Improved health outcomes
• Increased staff recruitment and retention
• Improved patient experience
• Improved working environment for GPs and healthcare staff
• More joined up and integrated working across health and social care
• Improved information sharing
• Increased training, learning and development opportunities for local staff
• Improved economies of scale
• Reduced costs associated with increased referrals and unmet need
• Ability to deliver aims and objectives of local and national policies