As we start to progress plans for Neighbourhood Health Centres (NHCs), one question continues to come up: should we make better use of existing estate or invest in a new build?
It’s a decision that can have significant implications for cost, delivery timescales, patient experience and future service provision. Yet there’s rarely a one-size-fits-all answer.
Our estates experts advise that the best solution depends on local need, the capabilities of the existing estate and the long-term ambitions of the local clinical service.
In this blog, we’ll explore factors to consider when deciding between adapting your existing estate for Neighbourhood Health or investing in a new build.
Why the existing estate should be your first consideration
When discussing NHC delivery, it’s easy to assume that creating something new requires a new building. However, the existing NHS estate can often offer similar results with lower costs and far more quickly.
If your healthcare building is in a central location within communities and well connected to local services, adapting your site for neighbourhood health may be a great option for you. Especially if your site is generally robust, well-maintained and doesn’t carry significant backlog maintenance issues and costs. Making relatively modest changes to how your space is configured, managed or used can unlock additional capacity and support a broader range of services.
Optimising the existing estate can also offer practical advantages. Refurbishment projects are often quicker – and cheaper - to deliver than new developments. This means you can make an early start at integrating services and testing new ways of working without having to wait for a new development. Transforming your existing site into an NHC also means that the location will already be familiar to the local community.
Therefore, understanding the capacity and utilisation of sites that already exist should be an important first step before considering additional infrastructure. Technology like NHS Open Space's utilisation monitoring and building management systems (BMS) can help you keep track of your building’s usage. So, you know exactly how your spaces are being used and how they could be adapted to support Neighbourhood Health.
Read more: Simon Taylor explains the importance of estate optimisation for delivering Neighbourhood Health.
Read our report on 'Making Neighbourhood Health Centres a Reality': Packed with insights, evidence, and case studies to show how we can adapt the existing estate to support Neighbourhood Health.
When a new build may be the better option
While existing estate should always be explored, it won’t always provide the right answer.
If your site is underused, dilapidated or costing more than it’s worth in backlog maintenance, investing in a new build might be a better option. By selling a surplus and underused site, you can unlock funding to put towards a new, fit-for-purpose NHC.
Or if your site just isn’t suitable to accommodate integrated services and support future demand, developing a new NHC will better meet the needs of your local community. In some cases, NHCs will be needed in areas where there’s no current health infrastructure so a new build will help expand available healthcare.
Take Trowbridge Integrated Care Centre as an example. We’ve developed a new integrated care centre opposite the town’s existing community hospital to replace it. It’s purpose built to have capacity for community services, a minor injuries unit and mobile diagnostic units.
Another example is Chiswick Health Centre. We replaced a dilapidated 1970s health centre with a modern, fit-for-purpose four-storey health hub serving over 60,000 patients whilst enabling delivery of 55 social rented homes for NHS key workers. By delivering a new health centre aligned with the neighbourhood health model, we eliminated £12m in backlog maintenance and increased GP & community health clinical capacity by 1,000sqm. This created room for additional services such as physiotherapy, mental health counsellors, primary care plus, wound care, and community-based activities.
While these new developments offer increased clinical capacity for Neighbourhood Health, they also use technology to take it a step further. Both Trowbridge and Chiswick Health Centre offer telehealth appointments. This means patients can have consultations remotely without having to come in. This not only offer convenience to patients but also increases capacity of the health centre with some appointments taking place virtually.
A purpose-built NHC will allow services to be designed around patient needs from the start. So, you can create flexible environments that support collaboration between providers and can adapt as healthcare requirements change.
Watch more: Conor Doyle explains how we tackled challenges and managed the end-to-end delivery of Chiswick Health Centre in a recent webinar.
So how do you make the right decision for your estate?
It’s important to start with population needs, rather than buildings. Before assessing estate options, you need a clear understanding of the services you want to provide, the population you’re serving and how their needs may evolve over time.
This approach helps make sure your estate decisions are driven by healthcare requirements. Alongside understanding demand, factors such as utilisation data, estate condition, location, accessibility and future flexibility should all inform decision-making.
By taking this broader view, you can assess whether the existing estate can meet your requirements through optimisation and adaptation, or whether new infrastructure is needed.
Read more: Andrew Strange shares six simple steps to understand demand, review your estate, and figure out what space you actually need.
Read more: Rajiv Tyagi outlines nine steps for using utilisation monitoring to realise the true utilisation of your existing estate.
Whatever option you choose, flexibility is key
Whether you’re adapting existing estate or investing in new developments, the goal remains the same: creating flexible spaces that support integrated care and can adapt to changing community needs.
Healthcare planning is a key part of this process. It puts patients at the heart, aligning clinical demand with space design to guide investment. This saves time and money later on.
Spaces that are designed with flexibility from the start can also be used by multiple service providers more easily. NHS Open Space enables this by allowing health, wellbeing, and community services to book flexible, affordable rooms across England on a pay as you go basis.
Read more: Emma Hau shares three areas to consider as you create your plans to deliver Neighbourhood Health Centres.
Turning decisions into delivery
Choosing between existing estate or new build both needs more than a simple estate review. You need a clear understanding of local demand, the strengths and limitations of your current estate, and a practical route to delivery.
That’s why we’ve developed a four-step handbook to help you assess, plan, deliver, learn and maintain when delivering Neighbourhood Health Centres. Packed with real life examples to show how we can help you at every stage. Whether that’s assessing opportunities within the existing estate, securing funding for a new development or the day-to-day running of your NHC.
