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Sunday 21 July 2019
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NHS to consider taking on GP premises liabilities

The NHS will consider 'relieving GPs' of responsibility for estate liabilities and instead bear most of the costs itself, it has announced.

However, practice managers said the move ‘won’t go far enough’ to allay GP fears about taking on the partnership.

Last year, NHS England launched a review that looked at ownership models, funding and contracting and the utilisation of premises, with the intention to ensure GP premises are 'fit for purpose, both now and in the future'.

In a media briefing last week (26 June), NHS England said that, following the review, it would make 'more sense for the NHS to stand behind the lease and relieve GPs of the worry of the liabilities'.

This is in part to address the problem of 'last partner standing' identified by the NHS England-commissioned partnership review published earlier this year by chief executive of Wessex LMCs Dr Nigel Watson.

In January, Management in Practice reported that an option for an NHS body to take on the lease of such practices was being explored by the BMA GP committee and the RCGP.

One of the new proposals would see the NHS directly pay for the 'core estates provision', while GPs would not have to claim reimbursement.
 
‘Won’t go far enough’
 
Practice Managers Association (PMA) board member Mairead Roche said the proposals would not be enough to help practices recruit partners.

Although practices in her area can attract ‘motivated and committed’ salaried GPs, they cannot replace outgoing partners, she explained.

She added: ‘I’m not sure exactly what ‘core estates provision’ would incorporate as the NHS already pays for rent/rates but it won’t go far enough to allay the fears of new GPs coming into practices.

‘Not only do they not want to buy in and be responsible for premises – especially in places with exceptionally high or low rental values – they also don’t want to be managing staff and all statutory workplace obligations, health and safety, let alone be concerned for all that CQC throws at us.’

Business partner at Court Street Medical Practice in Telford Clive Elliot agreed that problems recruiting partners are not down to concerns about premises liability.

He said: ‘It’s just because no one wants to be a partner. Why would you when you could earn more being a salaried doctor or a locum with no responsibility?’

Last year, it was revealed that only one in 10 locum GPs were interested in taking on a partnership role in the future.

Meanwhile, a survey of over 1,000 practice managers showed that only 7% of practice managers are partners in their practice, although more than eight in 10 think they should be given the opportunity.
 
‘Where it’s the right thing to do’
 
In the partnership review, Dr Watson found that the personal risk has been one of the major reasons for GPs to not join partnerships or leave them prematurely.

Under the current system, practices that lease their premises receive a direct reimbursement from the NHS. Leases tend to last 20 years, with potential break clauses at 10 or 15 years.

Dr Watson warned about the risk of being 'last partner standing' - where one or more partners retire from a practice that is unable to recruit any replacement partners - who remains liable for the full term of the lease.

NHS England primary care strategy and contracts director Ed Waller said the team will be exploring the separation of the partnership model and premises ownership so that new partners can step in and run the contract without taking the estate.

He said: 'There are some scenarios in which people are concerned about entering leases for various reasons, such as the time they’ve got to work before retirement or the length the commitment involves, and that can be a barrier both to lease signatures and people joining partnership where there’s a lease involved.

'It would make sense for the NHS to stand behind the lease and relieve GPs of the worry of the liabilities because we know one needs someone to be there providing primary care and some kind of NHS or estate body could do that subject to having the right capital settlement. So [this] by no means involves us guaranteeing all leases in primary care but where it’s the right thing to do.'
 
‘Deteriorating’ buildings
 
Mr Waller added that guidance was needed to ‘tidy up expectations’ around whether owners or lease holders are responsible for maintenance.

He said: ‘The contract and some of the confusion around that has led to deterioration of the quality of estate needlessly.’

However, Mr Elliot is concerned the proposals will make matters worse because maintenance budgets are ‘easy to cut’.

He added: ‘Relieving GP partners of the responsibility is a good thing but why not make the practice responsible for the building and give them the money to do it.

‘They’re best placed to know what needs doing.’

In February, a BMA survey revealed half of practice buildings are not fit for purpose.
 
Different models
 
Mr Waller said: 'We’ve got a couple of proposals that are about piloting different models of estates reimbursement: one at network level to allow PCNs to think about their estates in the round and be reimbursed in a minimal holistic way, which might help make best use of estates in a place; and another, where we have two pilots involving a more direct provision of estates by the NHS to primary care providers so that they’re not claiming reimbursement but they are offered a free good as they are with their IT systems.

‘They will pay for little bits but not pay for the core estates provision, where we’re just bearing the costs directly.'

Final funding and policy decisions will depend on the outcomes of the Spending Review and discussions with the Treasury, he added.

A version of this article was first published by our sister title Pulse. Additional reporting by Costanza Pearce.