Building a business case to upgrade GP premises

Money is tight, but PCTs are approving premises projects if practices can make a well-argued business case. Rachel Beverley-Stevenson looks at how to put a proposal together

Pressure on budgets for premises development is already intense, and the squeeze on NHS finances over the next few years is not going to improve matters.

Despite this, projects and grants are being signed off and primary care organisations (PCO) will back a project to refurbish or build premises if they have an innovative and sound business case.

This article will set out how to make a case for funding for new premises projects. It will look at the key features that PCO managers, and later consortia, will be looking for in a business case and how to ensure it has the ‘spark' so they back it.

Audit where you are now

PCOs are looking for a clear demonstration that all options available have been fully considered and that the solutions being put forward provide value for money, so evidence of a full premises audit is crucial.

Firstly, identify physical areas needing improvement. Look at the space you currently have and assess whether it meets the relevant building criteria and regulations. Look at the criteria set out in Schedule 1 of the National Health Service, (General Medical Services – Premises Costs) (England) Directions 2004.

If you are not sure how to interpret this guidance, there are experts – such as specialist premises solutions providers, valuers and so on – who can help you determine whether your building meets these criteria.

Next, you should also evaluate how your surgery buildings are being used. Draw up a room timetable, listing all the rooms available in the building – both clinical and non-clinical – and what happens in them. Don't forget to include evenings and weekends.

This audit will also help you see whether you have any spare capacity, or could create capacity by, for example, rescheduling clinics over lunchtimes, relocating activities (such as telephone triage) or encouraging clinicans to come out of their rooms when they are not in surgery.

If you have considered all these options and there is still a clear need for better premises, then your audit will be a key piece of evidence in your business case for funding.

List your requirements

Once you have analysed where you are now, you need to look forward. A clear plan for the future will show whether you need a new building, an extension or whether a simple refurbishment or reconfiguration will do.

Do a comprehensive needs analysis to identify what you actually require as opposed to what you think you need – many premises projects get stuck at the point of agreeing the amount of space actually needed, so make sure it is realistic.

Look at what services your patients and the local health population need. Is there a particular need that isn't being addressed locally? What commissioning or providing opportunities are there in your area?

Think about what services you could offer if you had the space, including private services and even services that could be delivered by third parties, such as consultant outpatient clinics, physiotherapy or complementary therapies. Are there areas that could be streamlined, improved or even outsourced – for instance, back-office functions including HR or payroll?

Look at funding

At the risk of stating the obvious, another key element to consider in your business case is the funding required.

Include a full financial appraisal of the costs involved – include build costs, consultants' fees, interest rates on loans and so on. Also consider any cost savings or efficiencies that delivering a wider range of services in your surgery could offer the local health economy.

If you are aiming for a new-build project, you will have to show that every square metre asked for has been fully thought out and is really needed.

This is to ensure you get rental approval for the new premises, as this is likely to be considerably higher than that on your existing premises.

Be imaginative

If you can demonstrate your refurbishment or new build will deliver new services to your community and result in cost savings to the PCT, you have a powerful case for extra funding.

PCT managers want to see premises that can do more than simply be a traditional GP surgery. This can include adapting your surgery to deliver secondary care services from a primary care setting, or even providing space for community services or specialists to work from your surgery.

‘Old style' surgeries or single practice developments are becoming difficult to get approved. Therefore, emphasis on collaborative and shared working needs to be reflected in any premises proposal.

Sharing no longer means simply having a joint reception desk or being located in the same building – now, it is looking at ways in which practices and healthcare professionals can help each other and, in turn, offer a more responsive and flexible service to their patients.

For example, can you offer extended hours or GPSI-led specialist clinics in your building to patients from other practices?

The company I run recently worked with four practices to successfully develop a bid for a three-storey, 3,500m2 building serving over 30,000 patients. From the very start, the four practices worked as a team to design the building and decide what services they wanted there, including a pharmacy and an ancillary health suite.

Each practice has its own very separate and clearly identifiable wing within the building, but they also work together to deliver a joint phlebotomy service and minor surgery, running these from the shared area on the ground floor of the building.

Rachel Beverley-Stevenson is chief executive of One Medical, a specialist developer of GP premises

This article is based on a presentation given at a recent Pulse seminar on premises and has been developed in conjunction with Acton Shapiro, health planners who specialise in preparing business cases for GP practices.To register for upcoming seminars click here

Click here to download a sample business case