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Aside from the critical maintenance backlog issues the primary and community estate will be a fundamental enabler of integrated care and primary care networks and there is an urgent need to invest in and develop fit for purpose premises given the poor quality, limited capacity/size, lack of spatial flexibility and rising costs of the existing buildings as pointed out by Sir Robert.

The existing financing models used by NHSPS, CHP and private investors etc add significant costs and are unaffordable for commissioners and only generate a return for the private sector or Treasury.

However there are some very interesting locally owned, innovative and affordable models emerging that could be the solution, such as the Newham Health and Care Space - a tenant (local authority and NHS) owned alternative finance organisation that has raised over £60m and has a 40 year plan to acquire and re-develop local health care properties and build new integrated care hubs....its worth a look -

https://www.newham.gov.uk/Pages/News/Green-light-for-new-multi-million-pound-health-and-care-facilities.aspx