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GPs go forth

Practices fear closure after nine-fold increase in bills

A cluster of practices in one region have warned they may have to close after a change in the management of their premises left them with bill increases of up to 900%.

The practices in Staffordshire have been told that they will have to pay expenses for the cost of utilities, maintenance and cleaning their buildings, which had been previously subsidised by PCTs under the NHS ‘Local Improvement Finance Trust’ scheme.

NHS England says that this is to bring them in line with other practices in the region.

However, the affected practices say that they had originally moved to the premises as part of an agreement with the PCTs, and they may have to close as a result of NHS England’s decision.

The GPC says that practices across England are starting to feel the pressure from the removal of these subsidies.

The change in billing has arisen following the switch in management of the LIFT building programme from PCTs to Community Health Partnership (CHP) in 2013.

The charges were subsidised by the PCTs in the past ‘to encourage practices to locate to improved premises and to foster greater integration with other healthcare services’, which transferred to NHS England when CHPs took over the management.

But in April 2014, NHS England removed the subsidised funding.

Dr Chandra Kannaganti, a GPC member who works at the Goldenhill Medical Centre in Stoke-on-Trent, says that practices are starting to see the results now and many practices are fearing they may have to close.

He told Pulse: ‘I believe there will be closures…it will have a huge impact on practices and they could become non-viable.’

Dr Kannaganti’s own non-reimbursable expenses bill appears to have shot up from £5,000 a year to £22,000, and he said that the GPs took on the practices without being aware that the bills could increase this much

He added: ‘We were never informed of the real costs and we signed the leases based on these original costs. They changed it without informing us.

‘If I’d known before, I would have factored this into my original business plan and bid.’

Other practices in the area have been hit hard, including:

  • Dr Phil Turner, a partner at the Biddulph Primary Care Centre in Staffordshire, said non-reimbursable charges have rocketed from £4,000 a month to £7,000. He adds that it feels ‘like a whole row of nails in the coffin’ and there could ‘uddenly be 21,000 people in our town without a GP’
  • Jenny Manley, practice manager at Alton surgery in Stoke-on-Trent, said ‘we were being charged £3,134 (net of VAT) per year and are now being charged £2,259 a month (£27,108 a year)’.
  • Julie Shaw, practice manager at the Westen Coyney Medical Practice, Stoke on Trent, says that last year non-reimbursables were charged at £1,200 and now that are £2,600 per month. She adds ‘we don’t know what we are being charged for’.

GPC premises lead Dr Brian Balmer said: ‘This is going to happen to lots of practices…they are going to say, ‘where did this come from?’’

Dr Balmer has been approached by a number of practices in Staffordshire. ‘It is an issue there but it is also being experienced all over England,’ he adds.

‘CHP has said openly, in face-to-face meetings, that it is working to properly identify the costs involved (in LIFT buildings) and cover all those costs. The big one to watch for is the management and service charges.’

A spokesperson for NHS England (North Midlands) said: ‘NHS England fully reimburse the costs of rent, business and water rates of all GP practices in Staffordshire – including those occupying CHP buildings.

‘In common with all practices in Staffordshire, those practices occupying CHP buildings will have to bear the cost of utilities, maintenance and cleaning. These costs are not reimbursed by NHS England. 

‘Whilst there may have been some historic subsidy of these non-reimbursable costs, this has not been the case as of April 2014  to ensure that all practices in Staffordshire are treated equally and charged in the same way.’

Readers' comments (17)

  • This needs heavy weight coverage

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  • although this will bring it in line with other practices in the area, it is a kick in the teeth for practices that based their decisions to open here because of those incentive.

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  • Fairly simple solution....
    cut the service provision in half.
    Less doctors sessions + less nurse sessions.

    Tell everyone else to go to A+E. make it clear to those paying the bills in A+E that this is the reason they can expect an increase in cost/ workload.

    Once a practice starts to be bullied by either NHSE or CCG they should immediately withdraw any work/ goodwill or attempts they make to reduce NHS costs overall.

    You can set a deadline to change their decision after which you start prescribing only the expensive branded drugs --seretide all round.

    If they learn that bullying practices ends up costing them more money - they will stop doing it.

    They will not stop doing it based on a few whines and complaints.

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  • Anonymous | GP Partner | 30 July 2015 3:37pm

    absolutely correct approach

    cut your cloth accordingly
    cut appointments
    refer more
    no extras

    this will happen to all practices eventually as NHSE directed property services to be financially independent.

    Although they are dragging their feet on increasing notional rent to market rates!

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  • This must have been in the lease agreement that you all signed and hence agreed to.

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  • Though it is hard and perhaps we don't know the inside story, my experience is that Practices in our area have historically even had their lawns mowed at PCT expense while others have had to pay for repairs of leaking roofs in PCT premises. I highlighted this issue a few years ago but nobody ever gave a damn. Transparency is the issue in NHS and it's difficult to understand that cleaning expenses of some Practices were indeed paid by the government - on what grounds?

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  • this is sad, unfortunately nothing will be done until this sort of thing becomes common place, which it soon will be;

    Britain is in terminal decline and the health service is deliberately being run into the ground;

    I would certainly echo the response of some of the above in advocating non cooperation with the powers that be. Goodwill should be reciprocated, as should dissent! for years this service has been subsidized by goodwill from its millions of staff and its their voices that are constantly ignored;

    I cant believe this is happening so quickly and without widespread resistance; as the respected colleague at 5:37 pointed out, mass referrals and prescribing of expensive medicines will have the desired approach!! and its not as if patients will complain either!!!!-- if you give them branded Viagra they might get an extra jump or two out of it compared with its generic version and leave you all alone for a week or two!!

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  • This story underlines a major failing of the Five Year Forward Plan, which would have us all working in groups within large premises. The government fail to see that the traditional 'cornershop model' of GP actually works and is efficient/affordable. Once GPs all become salaried they will effectively 'work to rule'. Therefore we will need more GPs (more shifts) and the expenses, much like the 'management costs' in these LIFT premises, will spiral completely out of control.

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  • @Sanjeev

    you are right that there might not be a level playing field. But there never is in general practice.

    dispensing V non-dispensing
    brand new building V 30 year old converted house.
    English speaking patients V language line every other appointment
    etc etc.

    The bigger issue is:
    - why cut this funding instead of levelling the playing field by providing the same funding to the under funded practices.
    - or what is going to happen to the money saved through this change. It does not sound as though it is going to be kept within primary care.

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  • Are the premises occupied by anyone other than the practices, and if so, how are the maintenance fees & rent allocated?
    Isn't this a bit like PFI? The initial contract prsumably allows the landlord to increase fees at will - and with no redress - while the tennant is tied into an unbreakable contract?

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