Last week (23 September 2025) the BMA published the findings of its GP Premises Survey, and the message is clear: our estate is struggling to keep pace with the demands placed upon it.
“50% of GP practices reported that their premises are not suitable for current needs, and 83% said they are not suitable for future needs.”
These findings resonate strongly with the themes I explored in my earlier article, “Readiness is Everything: Making Primary Care Estates Fundable.” Then, I argued that without clear ownership models, robust business cases, and alignment with system priorities, practices would struggle to access the funding needed to modernise. The survey now shows what happens when those structural barriers remain unresolved.
A System Falling Behind
The survey highlights familiar but pressing realities:
- Many premises are cramped, outdated, and unable to accommodate the multidisciplinary teams envisioned in the NHS 10-Year Forward Plan. “74% of practices said they did not have sufficient space to train additional GPs.”
- Too many buildings remain inaccessible, with narrow corridors, steps and small consultation rooms limiting inclusive design at exactly the point when we face an ageing population with complex needs.
- Practices are locked into premises that are neither fit for purpose nor financially sustainable. Service charges, coupled with mounting backlog maintenance, only add to the pressure. Among tenants in NHS Property Services and Community Health Partnerships buildings, 65–74% reported incorrect service charge invoices, many of which remain unresolved.
- And while the NHS has made a clear commitment to Net Zero, most GP estates have very little scope to address energy efficiency or sustainability without considerable investment. Until the fundamental issues of suitability, accessibility and financial viability are resolved, the environmental agenda will remain out of reach for many practices.
Ingenuity Isn’t Enough
To their credit, practices have adapted and innovated at every turn — repurposing rooms, outsourcing records, sharing space, and bending over backwards to make the most of what they have. But there is only so far local ingenuity can stretch.
From my own experience, I know that many practices already have robust business cases and an urgent need for improved premises. What holds them back is not a lack of readiness, but the layers of process and red tape that make it almost impossible to move schemes forward.
The limitations are not local. They are systemic. Without reform, we risk asking GPs to care for patients in settings that don’t even meet the essential standards of safety, accessibility and dignity. As the BMA notes, some practices have even considered handing back their contracts because of unsustainable service charges.
Why It Matters
This is not just about bricks and mortar. It is about:
- Patient access, dignity, and safety.
- Staff morale and the ability to train the next generation.
- The credibility of national policy ambitions when the physical infrastructure simply cannot support them.
The BMA survey is a wake-up call. It underlines that while practices can (and will) continue to innovate, only a national solution — on funding, ownership, and long-term investment — will unlock the kind of primary care estate we need.
Where Next?
So where does this leave us? For policymakers, the message is simple: investment in premises is not a luxury or a secondary concern. It is the foundation for delivering care closer to home.
For practices and PCNs, the challenge is to keep estates planning live and aligned — not waiting for the next funding round, but preparing strategies and business cases that will stand ready when the opportunity comes.
The survey is sobering, but it also provides clarity. We know the scale of the problem. The question is whether the system will act on it.