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.
More news on premises
In 2016, Pulse found that practices were refusing sign new premises leases, which would see their fees hiked by 400%.
Local leaders also warned that practices were being ‘financially crucified’ by a huge increase in service fees.