We have one of the best new premises in South London, but in the past 14 years we have received virtually no increase in rental income.
This is despite rocketing property and rental prices around us and I am advised that there is now a decree from central Government to local negotiators not to agree any uplifts in rental for premises; in other words, the NHS is artificially keeping GP premises values at low levels.
We were lucky enough to be able to fund our own premises improvements, but those GP practices that engaged in LIFT, or other third party developer schemes, now face the real dilemma that under the new rules their landlords will have the right to charge a rent which exceeds that which the NHS will reimburse the practices.
That means that once again NHS GPs will be paying for the privilege of going to work. At some point this will be challenged through the courts and the NHS may well be required to reimburse any backlog of underpayments, but in the meantime corporate groups are buying up GP surgeries at a rate of knots as they have been made very affordable by artificially depressing their value.
There will come a time soon when the organisations busy buying up these properties suddenly decide that they are sufficiently ahead of the market to pull out all the stops and challenge the system. They will be in a position to fend off new challenges and achieve an enormous increase in their asset values by challenging the rental returns and seeing a legitimate increase in both their rental returns and in the asset value of their property portfolio. We are not far away from that time; a ticking time bomb is about ready to explode.
More worrying still is the fact that the massive changes in our NHS have increasingly relied upon primary care expanding the extent and range of services offered to their local community of registered patients. With major failings in secondary care being reported daily there is yet ever increasing pressure on primary care to come to the rescue.
The infrastructure needs of primary care have therefore continued to increase enormously. With large swathes of practices now being owned by a few key corporate players and with these corporates now showing interest in operating practices as well as owning practices one might (perhaps somewhat cynically) question whether we are witnessing the silent set-up of widespread takeover of the NHS by the private sector via the primary care route.
Individual practices, perhaps out of necessity have been selling out their own assets to the corporate sector, but is this perhaps a somewhat naïve misunderstanding of the importance of retaining autonomy by keeping ownership of infrastructure within their own partnerships? If we are ever to preserve the true value of independent practice necessary to support the future of the NHS then our autonomy remains the single most important feature.
The alternative is a de-professionalised corporate structure delivering services. Any true professional GP knows only too well that the ‘group think’, protocol-driven, management-controlled service that comes from the corporate sector is destructive to the personal and very individual doctor-patient relationship that underpins professional NHS services especially at primary care level.
Fortunately for our practice and our patients, we own our own premises and will resist the controls of the corporate sector. It would be nice to have a just and reasonable return for our efforts, but we are not dependent on it.
But many other GPs are rapidly approaching a point where there would be a better return from virtually any other use of their property. It is time for a more honest, open, sustainable and sensible approach to setting rents and funding new GP premises.
Dr Chris Peach is a GP in south London