BMA demands Government intervention over ‘unaffordable’ GP premises charges
Exclusive The BMA has demanded urgent Government intervention over ‘unaffordable’ GP premises service charges, which have caused deep financial instability and forced some practices to hand back their contracts.
The union’s GP committee pointed out ‘ongoing and unresolved issues’ faced by practices over service charges levied by NHS Property Services (NHSPS) and Community Health Partnerships (CHP), which together own 15% of NHS estate in England.
In a letter addressed to health minister Karin Smyth, GPC chair Dr Katie Bramall and premises policy lead Dr Gaurav Gupta said that many practices remain burdened by historical service charge debts, ‘often contested, unverified, and in some cases dating back several years’.
They warned that, without urgent reform, more practices could be forced to hand back their contracts due to ‘unaffordable’ and ‘excessive’ service charges.
The letter added that NHSPS ‘lacks the evidentiary rigour’ necessary to justify changes and that the situation is ‘undermining confidence’ in NHS estates management.
It said: ‘These issues continue to cause deep instability across general practice, and we believe decisive government intervention is now urgently required.
‘The wider implications of this issue are deeply troubling. We are aware of practices that have been forced to return their contracts due to unaffordable service charges. Without urgent reform, more may follow, and continuity of care will be adversely affected.’
The letter also pointed to previous legal challenges to NHSPS service charges, including one case where a claim was reduced by over £400,000 – more than 80% less than NHSPS originally demanded.
It added: ‘These settlements confirmed longstanding concerns that NHSPS routinely overstates liabilities and lacks the evidentiary rigour necessary to justify changes.
‘They also reinforce our advice that practices should not accept such demands without proper scrutiny.
‘Swift and meaningful action is essential not just for the stability of practices, but for the
sustainability of the NHS.’
The GPC requested a meeting with Ms Smyth and primary care minister Stephen Kinnock following publication of the union’s new premises survey next month.
The previous BMA premises survey, conducted in 2018, found eight in 10 practices leasing from an NHS organisation had been invoiced with inaccurate charges in the last year.
NHSPS said they ‘continue to work closely with GP practices’ to ensure billing is ‘clear, accurate, and fair’.
A spokesperson said: ‘Since 2021, we have implemented a standard occupancy documentation programme to formalise arrangements and improve transparency where leases or agreements are not in place.
‘This initiative, alongside our Annual Billing Schedule check-ins, enables practices to review and understand their charges in detail.
‘We encourage any practice with concerns to contact us directly so we can review their circumstances and provide clarification.
‘While progress has been made, we recognise there is more to do and remain focused on improving our processes and maintaining constructive engagement with our customers.’
A CHP spokesperson said: ‘Tenants of NHS Local Improvement Finance Trust (LIFT) buildings are charged in line with national policy. These are calculated on a cost recovery basis in line with the terms of the lease or the percentage of space occupied.
‘The report: “The NHS Local Improvement Finance Trust (LIFT): Occupancy Cost Assessment” found that headline costs can be misleading and value for money needs to consider wider factors including maintenance behaviours.
‘LIFT costs include maintenance and lifecycle and provide value for money through ensuring there is no backlog maintenance reducing the significant and increasing cost and risk of maintaining an ageing NHS estate elsewhere.
‘We understand the pressure facing general practice and continue to work closely with stakeholders to help resolve issues and identify solutions that support long-term sustainability.’
DHSC said it was important GP practices engage with property companies to settle inherited, undocumented terms of occupation by agreeing new leases.
A DHSC spokesperson said: ‘This Government inherited a crumbling hospital and primary care estate.
‘Our decisions at the Budget meant we have been able to invest £100 million this year into GP estates across England to carry out vital upgrades – providing a better service for patients.
‘Primary care services will be the cornerstone of neighbourhood health services under our 10 Year Health Plan.’
Earlier this year, the Government announced a £102m capital fund for upgrades initially earmarked for 200 practices would be stretched to cover 1,000 surgeries.
And the NHS Confederation said the Government should consider ‘abolishing’ NHSPS and writing off GP debt.
It called for integrated care systems to have ‘greater control over the assets’ in their area by moving the ‘ownership and management functions’ of NHSPS buildings to ICBs.
