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£1bn premises fund may not cover all approved projects, NHS England concedes

Exclusive GP practices may see their approved funding for premises upgrades snatched away again, Pulse can reveal.

NHS England has announced nearly 900 projects that have been approved in principle for the Estates and Technology Transformation Fund (ETTF), but Pulse has learned these are split into ‘tranche one’ and ‘tranche two’ projects – the latter which will only be funded if there is money left over.

It comes as the £1bn fund, previously called the primary care infrastructure fund, was overhauled last year with NHS England rescinding millions already pledged to practices.

GPC deputy chair Dr Richard Vautrey said: ‘NHS England have told us that the number of applications exceeds the budget for this year and so they are having to prioritise the bids.’

He said this was ‘a sign of how much need there is within general practice for premises development and why it is urgent that the full fund is utilised’.

NHS England has been overwhelmed with demand for the money, with director of primary care Dr Arvind Madan telling a Westminster Health Forum earlier this month that the fund was ‘eight times’ over-subscribed.

Doncaster LMC medical secretary Dr Dean Eggitt said: ‘Some [GP practices’] bids have been accepted not in tranche one but tranche two, and tranche two is “if there’s any money left next year”.’

NHS England confirmed that there was ‘a pipeline’ of schemes, but declined to tell Pulse how many were in ‘tranche 1’ and how many were in ‘tranche 2’.

An NHS England spokesperson said: ‘Since 2015, over 560 schemes have been completed, with 316 schemes close to completion.

‘In addition, we have now published a pipeline of schemes. There will be those that can be progressed more quickly and those that, due to the stage they are at or their complexity, will be planned over a longer timeline.’

Dr Vautrey said this was one of two issues the GPC has raised with NHS England regarding the ETTF, with the other problem relating to the proportion of project funding NHS England is willing to cover.

The GP Forward View pledged earlier this year that practices could receive funding of up to 100% of costs related to premises upgrades, but GP leaders said this was not happening on the ground because the Premises Cost Directions have not been updated from stating a ceiling of 66%.

Dr Vautrey said: ‘This has not materialised because the premises cost directions are yet to be enacted.’

Dr Eggitt said that this comes as practices have already invested in architects and planning.

‘That has really put people off after they had spent thousands of pounds on architects [and] quantity surveyors,’ he said.

But NHS England’s spokesperson said it would only fund at 100% ‘in appropriate circumstances and subject to affordability’.

They added it could still fund projects while the ‘legal process’ to amend the Premises Cost Directions is underway.

The spokesperson said: ‘No project will be disadvantaged by the delay in the changes to the Premises Costs Directions and we will continue to support the development of the detail of those schemes in the meantime, seeking alternative routes for approval, should it be required.’

The fund, first announced by chancellor George Osborne in 2014, was launched as a four-year programme to invest in GP premises upgrades.

The GPC has previously highlighted concerns that the fund was being underspent, with one in five approved projecets at risk of collapse.

The GP practice operating out of portakabins

One GP practice which is having just 40% of a £1.9m premises upgrade funded under the ETTF is the Glebe Surgery in Storrington, West Sussex.

The practice – orgiginally built for a popoulation of 4,500 patients – now has 12,000 patients and operates in two portakabins in the practice car park, since taking on 3,500 new patients when a neighbouring practice closed in 2014.

Due to the pressure on the practice, NHS Coastal West Sussex CCG says the practice ‘is forecast to require another portakabin within the year’.

But, despite this, the CCG and practice ‘are now working on the affordability of the project and revenue costs in light of the lower funding award’, say CCG board papers.