NHS primary care estate needs major investment to deliver 10-Year Health Plan, CBRE warns

England’s ageing primary care estate and a widening gap between construction costs and rental growth are threatening the delivery of the NHS 10-Year Health Plan, according to new analysis from property consultancy CBRE.

The research identifies a significant requirement for new development and refurbishment as the NHS seeks to shift more services from hospitals into community settings through its planned network of Neighbourhood Health Centres.

However, primary care development remains close to historic lows, with construction costs rising by approximately 95% over the past two decades, compared with nominal rental growth of around 50%.

CBRE warned that the disparity is undermining the financial viability of new healthcare developments, limiting the sector’s ability to attract investment and expand capacity.

The analysis found that half of GP premises are more than 30 years old, while 83% are considered unsuitable for future healthcare delivery. Meanwhile, GP appointments have increased by 37% since 2020, against a 6% rise in registered patient numbers.

CBRE estimated that refurbishing and reconfiguring around 500,000 sqm of recoverable NHS estate could create capacity for an additional 2.9 million patient appointments annually.

The report also identified substantial potential savings from transferring suitable hospital activity into community settings.

Its modelling suggests that 62% of outpatient consultations, 89% of diagnostic procedures and 69% of day-case activity could be delivered outside hospitals, potentially releasing between £4.4bn and £6.6bn annually for reinvestment across the NHS.

However, it said that while successive policy initiatives have consistently highlighted the need to modernise the primary care estate, existing funding and approval mechanisms have not evolved at the same pace. It concluded that current delivery models also fail to provide the flexibility, operational integration and scale required to support the NHS’s neighbourhood healthcare ambitions.

Creating greater income certainty through measures such as indexed rents, more direct NHS-landlord relationships and streamlined reimbursement processes could help unlock institutional capital and accelerate investment into new developments and refurbishments, said the report. Future models will also need to combine capital, development expertise and long-term estate management capability.

Sarah Livingston, head of healthcare at CBRE, said: ‘The NHS 10-Year Health Plan sets out a clear ambition to move more care into communities, but the primary care estate has not evolved at the same pace as healthcare demand.

‘With much of the estate ageing and development remaining well below historic levels, modernising primary care infrastructure will be critical to delivering neighbourhood healthcare at scale.’