Shop around: PCNs on the high street

General practice is moving to the high street, with PCNs chasing high footfall and proactively engaging with their community. Could this be a trend which provides a solution to both increasing access and a lack of estates while revitalising the high street? Jess Hacker reports.

The UK high street is not a healthy place by most accounts.

The ‘death of the high street’ is often lamented as another retail chain bites the dust, but there’s no Agatha Christie style mystery as to the culprit of its demise. As technology advanced, so too have shopping habits with consumers choosing the relative ease of online shopping while retailers with shop fronts went bust or packed up en-masse.

According to charity Power to Change, a record-beating 16% of shops on Britain’s high streets were empty as of 2022, with one in every 20 vacant units across the country being shuttered up for more than three years.

And earlier research from the British Retail Consortium (BRC) pointed to the dramatic changes brought about in 2020. They claim that one-in-seven shopfronts across Britain was left empty as of 2021, with around 5,000 fewer stores since the start of the Covid-19 pandemic, as a result of issues exacerbated by lockdowns.

But it was that same period that gave PCNs’ their ‘in’ on the high street. The covid pandemic in 2020 marked the beginning of a real push to get general practice providing care on the high street, with PCNs identifying areas with high foot-fall to base their Covid-19 vaccination clinics.

During the first national lockdown, GP practices had set up ‘hot hubs’ across at least 12 former clinical commissioning group (CCG) footprints to diagnose and advise coronavirus patients in the community. As the NHS progressed through the pandemic, PCNs set up vaccination clinics in places of worship and other community hot spots.

This was the direction of travel three years ago, and in the time since, some PCNs have made the most of the opportunities a high street clinic presents: freedom of choice and flexibility for patients and staff as seen in Manchester

‘We didn’t expect quite how many people would be accessing the PCN – for overflow, wellbeing support or MSK clinics – since we moved here,’ says Healthy Hyde PCN manager Sally Culmer.

Since September 2023, the Greater Manchester PCN’s base of operations has been housed in Clarendon shopping centre in Hyde.

‘If we had been based in practice, or if we did not have that presence in a shopping centre, then we probably would not be meeting a lot of the need that we now know is out there.’

From this base of operations, the PCN offers all of its GP overflow appointments – averaging around 100 a day – and extended access appointments, staffed by six paramedics.

The PCN offers around an additional 50 appointments daily across its wellbeing, musculoskeletal (MSK) clinics and sexual health screening services – with a contraceptive clinic for intrauterine device (IUD) soon to launch – alongside weekly drop-in clinics.

Staffing costs are relatively straightforward. Services managed by staff hired under the additional roles reimbursement scheme (ARRS) are reimbursed, while locally commissioned service (LCS) funding covers the PCN’s nursing staff.

Renting the premise is a thornier issue. The PCN negotiated an initial rent-free period with the owners of the shopping centre. Conversations are underway with NHS England and Greater Manchester ICB regarding rent reimbursement.

‘No funding pot is guaranteed. We haven’t had any money from NHS Property Services so we had to make sure the PCN was prepared to fund this kind of set up. Many PCNs won’t be able to, there’s a real risk involved,’ Ms Culmer says.

‘We have to hope that the NHS estate strategy will at some point will catch up with what PCNs are doing and what patients need. But we had 50 members of staff and nowhere for them to sit and run the services that we’ve employed them for. It was a risk we had to take.’

There are clear financial hurdles to landing a hub on the high street but if a PCN is able to pull it off, it can offer a unique solution to the estates crisis.

The NHS Confederation has repeatedly urged the Government to provide integrated care systems (ICSs) with quicker access to capital funding to invest in the NHS estate with its latest call for funding to nearly double from £7.7bn to £14.1bn to address the maintenance backlog and refurbish buildings which would increase productivity.

Illustrating the crisis for primary care, the Fuller Stocktake, stated that estates in this sector are ‘frankly not up to scratch’. Of the 8,911 premises in England nearly a quarter, around 2,000, have been identified by GPs as not being fit for purpose. The majority of this is owned by GPs (49%), 35% is owned by a third party, and 14% by NHS Property Services.

And for all its benefits, the ARRS has only exacerbated the estates issue. A Pulse PCN survey with just under 200 GP and clinical director respondents found 72.8% do not have the space to house their additional roles staff.

In Rochdale, Greater Manchester, Middleton PCN’s high street foray was primed to tackle this.

Found on the first floor of Middleton Shopping Centre next to WHSmith, the primary care hub, the PCN’s practices benefit from the site’s six consultation rooms – enough space to house the PCN’s ARRS staff.

‘We started from the same position as everybody else with a lack of estates and GP surgeries,’ Middleton PCN clinical director Dr Mohammed Jiva says.

Before the hub launched in May 2023, the PCN had been using the space for free during the Covid pandemic to deliver vaccinations.

With a foot in the door, the PCN pitched the idea to its neighbouring healthcare organisations and recruited three partners in the GP federation – Rochdale Health Alliance, Rochdale Borough Public Health and HMR Primary Care Academy.

Each partner contributes to the running costs with its own funds. The PCN covers costs from the investment and impact fund (IIF).

‘We top slice our annual IIF achievements to keep the whole hub running, and the rest of the IIF is invested in staff and workforce across the PCN,’ Dr Jiva added.

The hub initially offered social prescribing link worker (SPLW) and phlebotomy clinics, and had three mental health staff working on site and an HIV service, with plans to offer broader sexual health services.

Plans are also being developed to turn one of the consultation rooms into a diagnostics centre, to offer spirometry, FeNO testing and ultrasound scans.

There is clear interest among the population to keep high streets at the heart of the community. A 2023 survey of 2,000 UK shoppers, led by Accenture, found that nearly eight-in-10 (78%) of those who visited their high street in the last year would feel sad if was no longer an option for shopping. Nearly half (47%), however, believed their high street was no longer relevant and is prime for change.

There are certain aspects of the high street that cannot be done online such as haircuts, beauty treatments or heading to a coffee shop. Added to this health on the high street is set to get a boost as pharmacies play a bigger role in frontline health services with the Pharmacy First scheme set to go live this month.

The appetite for a revitalised high street had made its way into policy, although tangible results remain a to be seen. In May 2022, the Government announced plans – under its levelling up agenda – that would see landlords in England forced to let out empty shops in a bid to inject new life into high streets. The Department for Levelling Up, Housing and Communities was contacted for an update on progress but it did not provide further information.

And so in 2024 many of these high street properties remain empty, with limited Government action to change that fact. Likewise, general practices across England are struggling through a property crisis of their own.

The Institute for Government (IfG) concluded that capital investment in general practice has been ‘insufficient’ to ensure the primary care estate meets the requirements of a modern health service, in its October 2023 GP performance tracker.

Most GPs will agree that this rings true. As many as 88% say that there are not enough consulting rooms, according to a 2023 Royal College of GPs (RCGP) survey. Two-thirds (66%) say the lack of space makes it harder to train new GPs. And four-in-10 believe their premises are ‘not fit for purpose’.

GPs lack the space they need, but the high street has space in abundance. To some PCNs this is an open-and-shut case.