The 'Planning and Priorities Framework for 2003-06', which recognises the need to make improvements to the organisation of care delivery and quality of healthcare buildings, is having an impact on primary and social care premises in terms of targets to upgrade GP premises and create one-stop primary care centres.
One-stop centres represent a move to greater integration of primary and community services, and social services (where possible). Similarly, improvements to GP premises will see a move towards facilities housing a wider range of primary and community services. The future organisation of care and design of premises should pay attention to the comfort and convenience of patients, with an emphasis on privacy and dignity.
The 'Planning and Priorities Framework for 2003-06' recognises the urgent need for well-designed and located primary care facilities. Targets have been set for up to 3,000 GP premises improvements and 500 new one-stop primary care centres by 2004.
The aim is to shift significant numbers of outpatient appointments from secondary to primary care. This shift will be supported by advancing medical technology and a wider range of staffing expertise in primary care including GPs and nurses with specialist interests. This will allow some transfer of care from the acute to the primary care sector enabling hospitals to concentrate on more serious cases. Many existing health centres and GP surgeries are insufficient to deliver modern day services. Owing to poor layout, there is little opportunity for the greater levels of integration between primary and community services that are being called for. Improvements to GP premises will see existing surgeries and health centres being upgraded and extended to provide GP services alongside other primary care services. In a similar way, one-stop primary care centres will bring together on one site primary and community services (and, where possible, social services) to provide more convenient patient access. A one-stop primary care centre will, therefore, house GPs and their practice team, attached trust staff (community nurses such as district nurses, midwives etc) and one or more extended primary care services such as dentistry, physiotherapy, pharmacy, optometry, podiatry, etc. The size of one-stop primary care centres will vary, as will the range of services provided. There is evidence that greater integration of primary and social care services provides benefits to the local community. Being able to access healthcare and social care advice (e.g. welfare rights) at the same place has delivered improvements to both patients' health and their social circumstances. Some healthcare communities have experienced economic regeneration as a result of extra money coming in from social care services. However, integration of services can only occur where premises offer the necessary capacity and innovative design. Hence the need to both upgrade existing premises and create new premises. Looking at the broader picture, there will be more options for patients to access care – especially primary care – in the future. A new gateway to care is NHS Direct; the nurse-led telephone advice service available 24 hours a day, seven days a week throughout England. Nurses provide a triage service and are quickly able to redirect patients to the most appropriate level of care – from the pharmacist, to the GP, to an A&E department. Emergency care can be accessed at WiCs and MIUs. Nurse-led pilot WiCs offer advice, information and treatment for a range of minor illnesses and injuries (e.g. cuts and bruises, strains and sprains, minor infections, skin complaints). They are complimentary to one-stop primary care centres and can be accessed without appointments for up to 12 hours a day. MIU is the generic name for any local emergency care service that falls short of being a 24 hour consultant-run A&E service. They tend to be nurse-led and often have interactive video links with A&E departments. Regardless of how primary care is accessed, patients should be viewed as customers and their needs put before the needs of healthcare providers. As well as focusing on the delivery of good healthcare, more attention must be given to the comfort and convenience of patients. This is both about the organisation of care and about the quality of the built environment. A particular requirement will be the need to increase privacy and dignity at all stages of primary care – reception, consultation, examination and treatment. Design of buildings should, where appropriate, consider the increasing number of elderly people managing chronic conditions. Such patients will tend to move slowly so convenient access and short travel routes within the building is important.