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The waiting game

NHS to consider taking on GP premises liabilities

The NHS will consider 'relieving GPs' of the worry of estate liabilities and instead bear most of the costs itself. 

Last year, NHS England launched a review that looked at ownership models, funding and contracting and the utilisation of premises, with the intention to ensure GP premises are 'fit for purpose, both now and in the future'.

In a media briefing attended yesterday by Pulse, NHS England said that, following the review, it would make 'more sense for the NHS to stand behind the lease and relieve GPs of the worry of the liabilities'. 

This is in part to address the problem of 'last person standing' identified by the NHS England-commissioned partnership review published earlier this year by Dr Nigel Watson, chief executive of Wessex LMCs.

One of the proposals would see the NHS directly pay for the 'core estates provision' while GPs would not have to claim reimbursement. 

In the partnership review, Dr Watson found that the personal risk has been one of the major reasons for GPs to not join partnerships or leave them prematurely. 

He suggested NHS England publish guidance on how to separate property ownership from other aspects of the partnership model.

Under the current system, practices who lease their premises receive a direct reimbursement from the NHS. Leases tend to last 20 years, with potential break clauses at 10 or 15 years.

Dr Watson has warned about the risk of being 'last partner standing' - where one or more partners retire from a practice that is unable to recruit any replacement partners - who remains liable for the full term of the lease. This in turn mean all the risk and liability held by the partnership can sit with the remaining individual.

NHS England primary care strategy and contracts director Ed Waller said the team will be exploring the separation of the partnership model and premises ownership so that new partners can step in and run the contract without taking the estate.

He said: 'There are some scenarios in which people are concerned about entering leases for various reasons, such as the time they’ve got to work before retirement or the length the commitment involves, and that can be a barrier both to lease signatures and people joining partnership where there’s a lease involved.

'What the review has concluded is that we would do a further bit of work to precisely define the circumstances about the where GP primary care premises is bound to be part of the feature - ie, it’s a strategically important place to provide primary care services.

'It would make sense for the NHS to stand behind the lease and relieve GPs of the worry of the liabilities because we know one needs someone to be there providing primary care and some kind of NHS or estate body could do that subject to having the right capital settlement. So by no means involves us guarantying all leases in primary care but where it’s the right thing to do.'

He added: 'There are some things which we think are important to tidy up expectations like guidance on who is actually responsible, between owners and lease holders, for maintenance because the contract and some of the confusion around that has led to deterioration of the quality of estate needlessly.

'We’ve got a couple of proposals in here that are about piloting different models of estates reimbursement: one at network level to allow PCNs to think about their estates in the round and be reimbursed in a minimal holistic way, which might help make best use of estates in a place; and another, where we have two pilots involving a more direct provision of estates by the NHS to primary care providers so that they’re not claiming reimbursement but they are offered a free good as they are with their IT systems. They will pay for little bits but not paying for the core estates provision, where we’re just bearing the costs directly.'

Final funding and policy decisions will depend on the outcomes of the Spending Review and discussions with the Treasury, he added.

Readers' comments (11)

  • GPs are giving up any vestiges of being self employed professionals. They have to be salaried and PAYE under tax rules as business expenses fall too low. GPs no longer have to contract for out of hours, no longer responsible for their computers, some given up looking after their staff. Young GPs want part-time big team working, so never have the burden of personal responsibility for anything, even patients. Conclusion: as I wrote in RSMJ all primary care should move into hospitals and GPs be salaried there. Patients want to go to where the scanner is anyway. We cannot fight this trend that arises from within the profession, er trade.

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  • They also want it locally and visit which doesnt fit in with this model.Patient and the establishment want it both ways personal and at scale, visits and the all you can eat GP buffett and this is going to cost a lot more.Who will foot the bill?The service will rapidly deteriorate into an Yankee model of health care where a significant proportion of folks will get NO care at all.

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  • As a GP Partner at 43 I am happy in Scotland that the burden of owning your own building should be lifted ( by 2042). When I did the MRCGP there was never any teaching about owning premises, being an employer or any IT. Young Doctors don't want the burden and I don't blame them

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  • Yeah roof blows off i pay , boiler breaks i pay , lift chuffing breaks down every bloody month i pay, service charge has quadrupled. PFI on a 300 year old building would anyone in their right mind sign up to that!

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  • ..of course now that the NHS owns the computers they all work perfectly...

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  • One suspects the Yankee venture capitalists are getting a bit jittery about a lot of GPs not renewing the PFI leases over the next few years and they have had a little talk with with George Osborne at Blackrock et al to have a word with his mates at NHSE and the DoH to parasite the good ol UK tax payer to continue to subsidise their profit.But I may be a little cynical moi no!

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  • The headline looks great.. a lifeline to a drowning profession.. until you read on. I'm concerned that this scheme will not be open to all practices.
    In particular I'm unsettled by the phrase related to defining how practices will be chosen & how practices being "a strategically important place to provide primary care services" will be measured.
    I suspect this may become a 'qualifying' feature that rather too many GP partnerships will be found to fall short of.
    Sadly,since the huge expense of implementing this across the whole UK has already been rejected, I think the lucky practices selected, (no doubt the usual'high profile' practices with 'Top GPs'), will be a gesture to the profession to show that 'something is being done' but the scheme will be a mere pipe dream for the bulk of GP practices.

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  • Rogue1

    The devil will be in the detail/numbers. A recent offer here was for 2/3 of the market value! I don't see many people wanting to sell off their assets with that kind of loss.

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  • 2/3 the value is better than being offered 1/2 the value because your rent revision has been minimal. Properties in the area have doubled in value during this time but your market value is based on the rent reimbursed.
    This will help only the connected and lickers.

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  • Only premises in “select locations” so only large practices, and only the buildings not the staff.
    Last man standing risks are about redundancy as much as about premises.. all this is saying is that big practices are too big to fail.. and that won’t stop GPs in small practices quitting in ever increasing numbers as the writing is so clearly on the wall.

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