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Stewart Gregory

Partner - Brighton & Hove

GP Premises Policy Review is published

GP Premises Policy Review is published after a six month delay

The much-awaited review of GP premises was published on 27th June. It was actually conducted in tandem with Dr Watson’s GP partnership review (published in January 2019), but publication was delayed. This was because the publication in January of the NHS Long Term Plan, and the Five-Year Framework for GP contract reform, added further context to the premises review and brought about a six-month delay.

The review document carries weight as it will determine the future approach to the development of the primary care estate.

Initial recommendations from the Partnership Review

Dr Watson’s partnership review had identified an increasing level of personal risk as being a major factor influencing GPs’ decisions not to join partnerships, or to leave them prematurely. Premises risks were singled out as being of particular concern, and the need for action was highlighted, to reduce the risk for GPs owning practice property or holding premises leases.

In addition, several surveys have shown that in many places, primary care premises are not fit for present purposes, never mind the future role they will need to play in delivering the NHS Long Term Plan (LTP).

Funding will be key to implementing the Premises Review recommendations

The premises review recognises these twin issues and the need for NHS capital for estates to be deployed in tackling them. However, it also notes that future spending will have to be aligned with the LTP and developed alongside the forthcoming government spending review, which will determine what resources are available. Successful implementation of the review’s recommendations may therefore be largely dependent upon the case that NHSE and the GPC can make to government for capital investment in the primary care estate.

Premises Review key recommendations

We intend to return to some of the detailed findings of the review in due course but bring attention here to some of its key recommendations that are to be carried forward to the “implementation stage”:

  1. There is a need to reduce the risk associated with holding leases of GP premises. It is therefore proposed that in appropriate cases, where lease length and terms for strategically important properties are discouraging GPs from joining partnerships, an NHS body (or other entity) will take an assignment of the lease.
  2. There is an expectation that, over time, practices will separate the decision to enter premises ownership from the decision to enter into partnership. Whilst premises ownership may continue to make sense for some practices, future NHS capital investment is going to have to come with a requirement to demonstrate sound governance around ownership. NHS England will develop best practice guidance for property owners.
  3. There is a need to get higher levels of professionalism into property ownership and management. NHS England will therefore develop guidance on the expectations of owners and occupiers around property maintenance and standards required.
  4. There is a need to simplify the model for payment of premises costs, with the current Premises Costs Directions considered to be too complicated, misunderstood, lacking in flexibility, and liable to create barriers to efficient space utilisation. NHS England will therefore pilot network level premises reimbursement arrangements giving networks greater autonomy to manage and minimise premises costs across their estate. NHS England will also pilot a simpler model of premises provision in multi-use new buildings to remove premises reimbursement systems and promote integration of service delivery.
  5. There is a need to develop greater support for community and primary medical care in local estates planning and to develop strong and future-facing integrated care system capital funding bids. NHS England will therefore develop a package of support for primary care engagement in STPs’ and ICSs’ capital strategies and capital allocation process.

State ownership of GP premises will not be taken forward

The review did also look at proposals for state ownership of the primary care estate or state-backed loans to GPs. This would follow a similar move in Scotland where the aim is to move GPs towards a model that does not require them to own their practice premises. Those proposals are not being taken forward as a recommendation of the review. The stakeholders in the review considered the cost of doing so in England would be prohibitively high and it would also remove flexibility for GP partners to choose their model of estates provision.

The aim of the recommendations being carried forward is to help ensure that future investment is made in a coherent and strategic way into a professionally-managed estate. We cannot however forget the fact that capital is required to both bring the current estate up to standard and to transform it so it can deliver the service vision of the LTP. The next step is therefore to develop a framework for the implementation of the review’s recommendations, informed by the next government spending review, to start the delivery of that transformation.

For more information on managing GP Premises effectively and reducing GP liability and expose to risk email stewartgregory@rixandkay.co.uk

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