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GP partner and PCN clinical director Dr Sarit Ghosh offers strategic advice on acquiring extra premises space to suit your PCN needs
Notwithstanding the pandemic, the network DES has presented a significant challenge for practices over the past two years.
Taking on additional roles reimbursement scheme (ARRS) staff has been resource intensive for PCNs, further complicated by the shortage of adequate primary care estate.
Treasury constraints have prohibited any funded expansion of estate and the nascent ICSs are still catching up to address this gap. Meanwhile an update to the premises cost directions (PCDs), making provision for up to 100% capital grants, has yet to be published.
The process for assessment and approval of estate proposals is opaque and varies between regions. Criteria for successful practice expansion still seem largely to be centred around Health Building Note 11-01 guidance, which models space based on core primary care activity only, with outdated assumptions on list size and activity.1 More recent guidance from Community Health Partnerships in partnership with the National Association of Primary Care2 is helpful, but only touches on how to take a business case forward and access any available funding.
With all this in mind, here are some tips for acquiring new estate based on my PCN’s experience of planning and securing funding to provide a dedicated shared space for our ARRS staff in north London to deliver services.
1 Take ownership of your estates review
First, it is crucial to undertake a comprehensive review of the available estate. This is often done in conjunction with local estates teams, but practice partners or managers should take ownership of the process, as assumptions may not reflect the reality. For example, the modelling used for average contacts and patient attendances underestimates current levels of activity.
2 Allow for supervision and face-to-face contact
Be prepared to challenge any assertion that significant numbers of staff can work from home. We find most ARRS staff need constant supervision, and this requires them to be in the same location as their supervisors. In addition, some patients need face-to-face consultations. Also, there has been general feedback that staff want to work as part of larger teams rather than be isolated at home, so remote working arrangements are not always suitable.
3 Match your estate expansion to the delivery mode
We already had a progressive estates strategy in motion, with a super-practice of 15 sites in the process of consolidating and merging into nine premises, on a completely cost-neutral basis to commissioners. As part of this, we decided that building remote consultation hubs at several of our sites to house groups of ARRS staff, supervised by GPs, would allow us to accommodate the necessary teams. Staff can then rotatebetween these ‘e-suites’ and also hold face-to-face consultations at the practice sites.
4 Consider self-funding to get the estate you want
The next step is to create and submit proposals to the local commissioning team. In our case these were only approved on the basis that the PCN would take on all capital and revenue implications for these expansions.
The system reported that it could not support us financially in any way in view of the current PCDs. However, our member practices and landlords have agreed to self-fund, the former out of shared PCN income streams, with the hope that legislation may change down the line with respect to funding of PCN space.
5 Seek out alternative funding options now
Other PCNs may not be willing to take this approach, so you may need to explore other innovative options – for example, capital funding options through Section 106 (Town and Country Planning Act 1990) monies from the local authority, use of void space in the ICS footprint or an arrangement with a local trust.
It is likely that if they have not already, networks will run into real consulting space issues in the next year and it is important to raise this early, as most estates projects take years to get off the ground.
Dr Sarit Ghosh is a GP partner at the Medicus practice in north London and CD at Enfield Unity PCN
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