TMLEP’s lead healthcare investigator Nina Vegad explains how poor infrastructure can lead to clinical failings, miscommunication, and ultimately, harm.
The recent announcement of a £102 million investment to upgrade more than 1,000 GP surgeries across the UK marks a pivotal moment in the evolution of primary care. The move, championed by Health Secretary Wes Streeting, follows growing concern that many GP practices are “unfit for purpose”, with outdated facilities compromising patient care and safety. As a clinical investigator at TMLEP, I have seen first-hand how poor infrastructure can lead to clinical failings, miscommunication, and ultimately, harm.
While discussions around patient safety often focus on diagnostics, communication and care pathways, we must not overlook the silent contributor to many adverse events: the physical environment in which care is delivered.
The safety risks of outdated facilities
In our investigations, we frequently encounter incidents where the limitations of a practice’s infrastructure have directly or indirectly contributed to substandard care. Small consultation rooms limit privacy and restrict proper examination. Poor ventilation and inadequate infection control measures elevate the risk of cross-contamination. Accessibility issues prevent timely care for patients with disabilities. And overcrowded waiting areas delay triage and increase the chance of missed red flags.
Legal and professional implications
From a medico-legal perspective, infrastructure can be a hidden liability. Clinical negligence claims may arise not only from individual decisions but from systemic failings, such as a lack of facilities to carry out routine tests or safely store medications. A robust infrastructure is foundational to a defensible standard of care. When it is lacking, clinicians are often forced to work around risks rather than resolve them.
Burnout and workforce retention
It is also important to consider the toll on healthcare professionals. Investigations increasingly reveal how outdated environments exacerbate staff stress and burnout. GPs and practice nurses are navigating high caseloads in cramped, under-resourced spaces, conditions that affect decision-making, morale, and retention. Good governance demands that the well-being of healthcare staff be treated as a cornerstone of patient safety.
A welcome step forward
The new government funding, if appropriately distributed and monitored, could be transformative. Larger, modernised surgeries will not only accommodate growing patient lists but could also enable multi-disciplinary working and integrated care, both crucial in a system under increasing strain. However, we must ensure that safety is not only about aesthetics or capacity but about embedding clinical risk awareness into design.
Investigations to inform planning
At TMLEP, we advocate for healthcare investigations that do not only look back at what went wrong but also forward, highlighting where risks remain unaddressed. As GP surgeries plan refurbishments or rebuilds, incorporating lessons from clinical investigations can ensure that physical spaces are not just bigger, but safer and more functional.
This investment is an opportunity to reimagine primary care for the better. But unless infrastructure improvements are informed by real-world failings, we risk building new walls around the same old problems.
For more information on TMLEP’s risk management and incident response services, click here. Let TMLEP guide your institution toward a safer, more transparent future in patient care.
