Primary Health Properties : Financial Document

Investing in primary care estate promotes reductions in secondary care utilisation.

Research on A&E attendance rate by PHP in conjunction with Professor Mark Ashworth, King's College London

10th December 2022

The NHS strategic context

• Moving patient treatment away from secondary care into the primary care arena is a familiar and universally accepted NHS strategic objective, articulated in policies such as The NHS Long Term Plan.
• The transfer of services will generate significant cost savings for the NHS.
• With a primary care portfolio of 513 facilities across the UK and the Republic of Ireland, PHP is in a unique position to augment and illuminate the relationship between secondary care utilisation and investment in the primary care estate.
• Working with Professor Mark Ashworth of King's College London, this paper seeks to explore the said relationship as well as observe the impact across areas with varying levels of deprivation. This will help inform future research and policy making, including the Levelling Up agenda.

Executive Summary

1. The research reviewed c150 PHP medical centres built or refurbished since 2009 across England, and compared their A&E attendance rates1 against national average before and after building completions.
2. The results identified reductions in secondary healthcare utilisation after a purpose-built medical centre is opened following development completion or refurbishment.
3. The reductions are particularly prominent in areas of deprivation2. The greatest reductions are found in the most deprived areas, this supports the ambition of Levelling Up.
4. Based on estimated cost of A&E attendance of £1803 per visit, and estimated cost of GP appointment of £394 per visit, the reduction in A&E attendance provides cost savings in secondary care, and it benefits where care is needed the most.
5. Similar trends are found in emergency admission and Ambulatory Care Sensitive Conditions (ACSC) admissions, further supporting the observation.

Source: 1 NHS Digital; 2 English indices of deprivation 2019, NHS; 3 NHS FY19/20 Cost Schedule; 4 King's Fund 2020

Statistical findings

A&E attendance rate reductions after completion

• This research is based on standardised data using Z-scores for national A&E attendance rates per 1,000 registered patients; data for all new- build/refurbished PHP practice in England during 2009-2021, which are compared with all other practices
• Overall, the reduction in A&E attendance in the year after a new/refurbished medical centre is introduced is measured to be a Z-scorevariance of -0.01,or -7% on a standardised basis (adjusted for year-on-year change of overall attendance rates.)
• Of note, half of the top 10 reductions are found in the most deprived area.
• For simplicity, the below table presents non-standardised data (ie reduction before adjusting for overall attendance increase)

Top 10 reductions

10%
5%		5%		5%		5%	5%	5%
	2%			2%	2%
0%
-5%					-2%
					-5%	-5%	-5%
-10%		-9%	-9%	-9%	-8%	-7%		-10%
-15%
-20%		-18%
-25%	-22%	-21%

PH012	PH442	PH365	PH370	PH301	PH170	PH480	PH454	PH422	PH162
Bolton -	Peterborough Nottingham	Raynes Park	Swindon -	Sheerness -	Grimsby	Maidstone -	Northfleet	Coventry
Lever	-	- Grange		Islington St	St George's	- Raj	Albion Place		- Allesley
Chambers	Boroughbury	Farm

Reduction in A&E attendance in the year after PHP centre opened - in most deprived areas

Reduction in A&E attendance in the year after PHP centre opened - in least deprived areas

National average year-on-year change of A&E admission

What this means for the NHS…

Cost savings

Estimated cost of A&E attendance is £180, and estimated cost of GP appointment is £39. Previous research by PHP, based on Freedom of Information responses from Clinical Commissioning Groups, showed that 1 in 4 of all GP practices in England work out of former residential buildings. These premises are not fit-for purpose and, based on the KCL findings, their replacement with modern medical centres would:

• Reduce A&E visits in England by 280,000 a year;
• Cost savings of c.£39m per annum, equivalent to;
• Additional hire of 1,200 nurses.

Budgeting implications

System-wide savings could be reallocated to further enhance NHS primary care service provision:

• Generating a virtuous cycle facilitating further reductions in expensive secondary care utilisation.
• Making existing NHS budget more efficient and effective.
• Increase capital and revenue primary care funding to support an improved and extending primary care estate; a particular opportunity as 1 in 4 GP surgery premises are converted houses.
• Promote levelling up agenda and healthcare infrastructure in areas of deprivation.