Evidence for this care in depression?
We are a five-doctor PMS practice with a growing list of 7,600 patients. We have a nurse plus a vacancy for a half-time nurse practitioner. We practise in Croydon in south London.
Our current premises are 143 square metres which, according to current NHS premises legislation, is less than the minimum entitlement to a singlehanded practitioner of 155 sq m.
Due to this our rent reimbursement, which we pay to our landlord, is about £12,000 a year. We probably breach all staff health and safety rules, as well as patient confidentiality.
Clinicians have to share rooms and stagger surgeries. We have correspondence back to 1998 with the PCT encouraging us to move and giving approximate cost-rent support of £70,000.
We found a grand old house in the locality in 2003. We agreed a price
and thought the PCT
would jump at the chance of supporting the move, but it gave us no support.
Then last March, when it realised that we would go ahead with the plan, we received a letter from the PCT 'no longer disputing our move'. The new premises will provide seven consultation rooms, two nurse/ treatment rooms, as well as rooms for all members of our primary care team.
In December 2004,when the Department of Health anounced new premises money of £108 million spread over two years, we were told to bid for this money as an improvement grant.
The whole of Croydon has £300,000 this year and a similar amount next year.
We have finally received £50,000, but this is purely for professional fees/expenses, not for capital expenses. Apparently there is money for LIFT projects but this is unattractive to us due to imminent retirements.
We have a good bank manager and have secured the full funding for the house purchase as well as £300,000 of additional loans, but to complete the project my partner and I have raised additional funds personally.
There is also the question of cost-rent or notional rent. The PCT has said it cannot fund any more than the rent we currently receive (£12,000) even though the new premises is four times the size and would, according to the district valuer, attract a rent of £80,000.
We could fund the loan from practice income but this will result in us finding it difficult to recruit a partner if there is an £80,000 outgoing from our accounts.
The PCT stance is that since April 2004 all its money is now in a unified budget and our additional rent cannot be funded unless the department gives it growth money for premises and rent.
We are clearly not one of the 2,500 premises refurbished or replaced by the NHS. If we replace it, it will be mainly because the doctors have taken the risk of taking large bank loans, not the NHS.
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