Premises and staff
To conclude our series on key areas of the
Wynne-Jones looks at the proposals
The options on your premises
The contract promises to encourage the provision of modern primary care premises, with a new degree of flexibility that will maintain GP investment options and provide funding parity. These include:
· Grants to meet mortgage deficit costs if GPs cannot afford to move because their mortgage exceeds the potential sale price of the surgery, primary care organisations will be allowed to make up the difference. This appears to be discretionary and of little help to GPs who have shouldered negative equity themselves.
· Grants from the PCO to meet mortgage redemption costs again, apparently not guaranteed.
· Allowing PCOs to take an option on land so that prime sites are not lost while PCOs deliberate.
· Cost-rent payments for GPs buying small practices so they can match the price the current owners would get by converting the premises to residential use.
· Reviewing cost-rent payments when GPs remortgage at lower interest rates to free up money for extra GMS services (the GPs would not gain).
· Reimbursement of legal and professional fees for GPs in new premises developed through public-private partnership (already applies to GPs financing their own premises).
· Paying notional rent as well as cost-rent when premises are modernised or extended (not currently allowed).
· Abatement of notional rent if premises or extensions are partly funded by NHS money, such as improvement grants, notional rent will no longer be paid on that proportion of the cost or on the running costs.
· Payment of notional rent to leaseholder GPs who improve their premises removes the disincentive for these GPs to invest in their surgeries.
· Extending the timescale for repaying improvement grants to 10 years for owner-occupier GPs and 15 years for GPs who rent their premises.
· Direct reimbursement of service charges.
· Frequent reviews of building cost location factors.
· Index-linked leases to support capital investment and rent reimbursements.
· A revised premises schedule and revised commentary.
· Safeguards and security for GPs signing leases with PCOs so that an outgoing GP will be able to assign the lease temporarily to the PCO.
Under the contract, funding for new premises and improvements will be drawn from a budget which PCOs will bid for, then allocate and manage locally.
Running a tight ship on staff
The contract recognises that the quality elements require expenditure on infrastructure which in some cases will be considerable. It also acknowledges that the working time of clinical members of the practice team is a finite resource. But it does not specifically mention ancillary staff. Some functions such as IT may be managed across the PCO and between practices.
GPs will receive a global payment for essential and additional clinical services (such as immunisation and chronic disease management) based on patient numbers and needs. These will be negotiated and priced nationally, and paid directly to practices through the PCO, with no top-slicing allowed. Staffing levels will therefore compete with other demands on practice resources to a greater degree than at present.
Practices will also have to decide how much money to allocate to additional staffing if they receive an additional payment for providing enhanced clinical services. Payment will be nationally negotiated and priced, but locally commissioned from the PCO's unified budget; a protected expenditure floor will prevent diversion of these funds.
GPs will have to run a very tight ship if they are to deliver the standards demanded by the contract. No mention is made of whether redundancies will be necessary, and how they will be paid for.
Whether these changes to premises and staff arrangements are to be welcomed will, of course, depend entirely on how they are priced.