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How can it be right to hit us with a £265k bill for premises costs?

Dear Sir/Madam,

Complaint regarding NHS England and NHS Property Services handling of Lease Agreement for the Wellspring Surgery, St Anns Valley Centre

Seven years ago we were approached by the former Nottingham City PCT about moving from their existing health centre accommodation into a new purpose-built shared building and in 2012 we were presented with an estimate of the revenue costs for the new premises (see attached). It was on this basis that we worked out our business plans for making the move and budgeted accordingly. This was in accordance with the planning process adopted by the PCTs and the Health Authority prior to the last re-organisation.

We moved from St Anns Health Centre to the new building in April 2012 and to date we do not have agreement or signed lease in place despite numerous attempts to sort this with NHS England, NHS Property Services and Nottingham City CCG. Our main issue and concerns are around service charges/non-reimbursables being charged to the practice with no breakdown and increasing values year on year; in 2012/13, 2013/14 and 2014/15 the practice paid, as per original agreement, non-reimbursables of £25,408 per annum. Prior to the move, the practice paid £11,905 for non-reimbursables.

In 2015/16 the practice originally received an invoice for £51,447.80 and then informed months later that this should have actually been £125,721.86. This accounted for £112,424.32 rent and £10,787.89 for corporate overhead and management fee. The CCG informed us on 3rd October 2017 that we were responsible for £64,579.99 non-reimbursable costs.

In 2016/17 the practice was informed that non-reimbursable costs had increased to £145k.

We have now received 2017/18 (6 months after April 2017) actual non-reimbursable costs which have now increased to £265k.

St Anns has a population of 10,000 (weighted list size of 11,100). We are the largest deprived practice in Nottingham with a mobile, high need population often with complex problems i.e. high consultation rates; 25 different non English speaking nationalities; safeguarding issues; mental health, substance misuse and relationship deterioration. We have the highest annual turn-over of patients within Nottingham City; 3,000 more patients than the national average and 4,000 more patients than the CCG average and the only practice still open in the St Anns area.

Financial restraints within the PMS budget and ongoing problems with increase charges from accommodation costs has resulted in the practice losing one of their most popular GPs and not being able to recruit a replacement due to financial instability caused by the above.

We have been working with the CCG and NHS England over the many years, attending various meetings, huge amounts of communication and still the issues in the last 5 years are unresolved. In June 2015 with the closure of NDU (the second practice to close in St Anns) the CCG assured us once again that “their priority is to ensure that the practices non-reimbursable costs are negotiated with lease arrangements in place”.

On 6 October our Practice Manager received an email from the CCG stating agreement that the non-reimbursable costs are out of proportion to what other practices are paying. The CCG state that they have raised these concerns at every level and opportunity and have initiated dialogue between NHSPS and Nottingham City Council requesting that an alternative option be sought such as the Council leasing direct but with the practice. This option is currently being reviewed by NHS Property Services; how many years will this take as we are apparently already in debt for £475k (we do not have this amount of money as we have budgeted based on the information originally received and the amounts paid within the first 3 years).

NHS England and the CCG have failed to recognise that we work in one of the most challenging parts of the country and the way this issue has been handled has had a detrimental impact on the running of the practice, and impacted personally on the individual GPs. The significant increases in accommodation costs will destabilise the practice financially, and have a knock on effect on the ability to deliver services to our patients.

The practice is now at the stage where we need to consider alternative accommodation with a more realistic financial impact or serve notice on the PMS contract if the situation is not resolved imminently. Obviously this will leave 10,000patients without a GP and put unsustainable pressure on surrounding practices.

We trust that you will investigate and help us resolve this matter for the sake of our patients, staff and surrounding practices, not to mention GP partners with the utmost urgency.

Yours sincerely

Dr Teed & Partners

In response to the Pulse story on service charges, NHS Property Services said: ’We do not recognise the figure quoted. In many cases there has been no significant change in the total amount we have invoiced on a property. Changes to local subsidy arrangements by commissioners mean that some GPs are receiving bills for their own costs which were previously met by other NHS bodies.

’We will continue to work positively with the BMA, GP practices, commissioners and NHS England on this issue.’

NHS PS have been contacted about the letter from Dr Teed.