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NHS England ‘twisting arms’ to get practices to sign disputed premises leases

Practices who have been waiting more than a year for premises investment have been told by NHS England their funding could be pulled unless they sign new leases which are currently being disputed.

One practice, which has invested thousands in contractors and surveys for NHS England due diligence requirements in order to complete work this financial year, said they were having their ‘arms twisted’.

The issue focuses on practices in NHS Property Service premises which last year began a programme to standardise its leases, many of which transferred over on long-standing, informal PCT arrangements in 2013.

NHS England has said it needs to guarantee practices have ‘security of tenure’ before investing funding committed via its delayed £1bn Estates and Technology Transformation Fund.

But practices have complained of ‘financially crucifying’ service charges which would come into force under the new arrangements, and contesting future increases would become more difficult once signed up to the new lease.

GP leaders said practices needed time to ensure they were satisfied with the lease and said they should not be ‘cajoled into taking shortcuts’ when signing a legally binding document.

Dr Gaurav Gupta, a GP partner in Faversham and a vice-chair of Kent LMC, told Pulse his practice started applying for ETTF funding in February 2016 and had completed bids and project initiation documents.

Last November they were told they were in ‘cohort one’ for funding, which means they have a deadline of April 2017, pending due diligence checks.

Dr Gupta said these checks required architect’s plans, asbestos surveys and thousands in professional fees but they are now ready to go in a week’s time – ahead of the end of financial year deadline.

He told Pulse: ‘Now, six weeks before year-end they’re coming to us to say “you need to sign this”.

‘They’re not saying we will stop you if you don’t sign this. But they did say: “Can I please reiterate that this ETTF-funded project is at risk without the necessary security of tenure”. But it’s the same thing.’

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‘NHS Property Services actually belongs to the Government, but one arm doesn’t know what the other is doing and they’re trying to gang-up on practices to make them sign things. They’re twisting our arm.’

The end of year deadline adds pressure to get the issue resolved, and Dr Gupta says he thinks ‘around 150’ NHS Property Services practices are in a similar situation.

He added: ‘Most NHS PS buildings are struggling for space, they haven’t had any investment for a while, so in terms of need they might be some of the highest need practices.’

His practice is looking to renovate six rooms and is set to cost less than half a million pounds, but Dr Gupta says with all the bureaucracy ‘you’d think they’re making the Gherkin in Faversham’.

Pulse has previously reported the underinvestment in premises being a sticking point in lease negotiations for practices when confronted with a 400% hike in service fees last year.

The GPC’s premises policy lead, Dr Ian Hume, said NHS England did need to have ‘appropriate assurance’ that premises would continue to be used for sufficient time to justify investment.

This would be key when the building was owned by third-party developers, but NHS Property Services is part of the NHS and should already be able to make these assurances.

He told Pulse: ‘At the present time there is no risk of the property leaving the NHS and we need to decouple the lease issue from the ETTF as practices need to get on with investment in their buildings – failure to invest will affect patient care.

‘Practices need sufficient time to ensure they’re happy with the details in their lease… and need to take independent advice, and should not be cajoled into taking shortcuts when entering into a legally binding agreement.’

Last year the GPC and NHS Property Services agreed a ‘template lease’ which aimed to boost transparency of service charges and allowed the lease to be broken if a practice lost its core contract. But the GPC added at the time this was no magic bullet, there would always be local issues that needed to be negotiated with practices.

An NHS England spokesperson said: ‘While no agreed scheme has had funding withdrawn, by definition if taxpayers are about to invest substantial new funding in upgrading surgeries it is right to ensure that their landlords can’t then evict GPs from their modernised premises – hence the need for proper leases in line with the BMA endorsed model.’