NHS Property Services has a remit to get the most out of NHS estates in order to plough money back into the health service. However its first year of operation has seen much criticism from general practice as it holds the keys to a fifth of such properties. Pamela Chapman, director of asset management discussed the role and vision of this new body
The transfer of GP practice premises from primary care trusts (PCTs) to NHS Property Services (NHS PS) has felt like a wrench for many practice managers. Frustration around a lack of clarity and a perceived apathy toward much needed practice renovations abound. Bringing together 3,700 properties of 161 different organisations for last April’s deadline was no mean feat and Pamela Chapman, director of asset management at the company, led the change.
About a fifth of practices are now in the hands of NHS Property Services, or to use the vernacular, Propco. It is a private not-for-profit company - the Department of Health is the only shareholder - which was set up to take on estates that were previously owned by the PCTs and Strategic Health Authorities. It has 70% of former PCT estate; the remaining 30% either went to sister company, Community Health Partnerships, or to trusts.
Mother-of-two Chapman is responsible for information management, day-to-day property management, disposals and acquisitions and capital investment.
GP practices are a large part of her work as just short of 50% of NHS PS estate is either health centres or GP practices. Offices, community hospitals and some more generalised estates comprise other properties in the portfolio. Chapman and her team work with NHS England’s when planning for strategic estates.
“NHS England, since its inception, has been very keen to start to seize primary care strategies for each area, and those strategies will underpin the overall primary care estate strategy for new capital investment so that you are not getting ad hoc capital but good, focused investment.”
One of the drivers for NHS England is to have a single operating model and,
as Chapman explains, that means “everything is to be embedded in a proper strategic context”.
“It means you get more: more for your money, basically. Making sure that where you have a real need for investment, you are making sure that it happens, rather than maybe investment having been conjured up from somebody’s idea [locally]. I think, historically, some investment happened because an idea would be developed for a new facility in an area, but it was not set in that wider strategic context.”
So perhaps the perceived halt on premises progress is because these strategies are yet to materialise?
“I think certainly those strategies have been required. It is not to say all investments have been halted completely; there were schemes up and running and those are being managed through. But we are looking towards the end of this financial year for those strategies to be developed, not only for NHS England but also for clinical commissioning groups (CCGs) and the wider strategy.”
“The lack of investment goes back many years, well before NHS England appeared. So I think it is obviously a complex issue, but those strategies are not holding everything up.”
NHS PS also handles rent reviews for properties leased from private sector organisations and rent reimbursements.
“Historically, PCTs had responsibility for rent reimbursements, but when we went through the restructure, responsibility for holding the budget went to NHS England. In parts of the country, we provide the technical support for rent reimbursement, even for parts of the estate that are not our own.”
The rent reimbursement is based on the premises directions - the technical base for that calculation. A new set was issued in 2013 and another set is currently in development. The company advises NHS England on rent reimbursement payments.
NHS PS has its own local teams to work with practices and CCGs which marry up with the NHS England regional boundaries. These regions are broken down into 14 areas and these teams are managed directly within the regions, with a professional accountability to the centre. While early inspections from regulator the Care Quality Commission uncovered sorry tales of consultation rooms without doors, Chapman explains that NHS PS has focused on an audit of what is out there in order to establish how to strategically get the most from NHS property.
“I think obviously there is the issue that there has not been the level of investment in the past. We have such a mixed bag of property. We have very, very modern health centres, to GPs who are housed in what would be recognised as a single terraced house. What we are trying to do is undertake an audit so that we have got a thorough understanding of the current need and condition of individual properties so that, again, we can make sure that the capital we invest in terms of repairs for our estate is money well spent.”
Work on the audit started last year and it covers basic information about each property from the site area, the floor areas and the age, nature and condition of the building. Some practices will already have been through a condition survey but the audit is intended to inform the company’s work around regularising leases.
“Very many of our tenants did not actually have formally-documented leases. We are trying to put those on a proper footing which benefits both landlord and tenant, so everybody knows where they stand, what the lease terms are.”
This standard lease contract, which is based on a law society business lease, is available to practices on request. Regional asset managers are encouraged share it on a one-to-one basis with practice managers. NHS PS has two bundles of cash for landlord capital projects and customer capital projects. The budget for landlord capital schemes in 2014/15 is £102.5 million. Such projects are identified, approved and managed by NHS PS to address maintenance issues and to ensure properties are safe, warm and clean.
Customer Capital projects are new schemes - major refurbishments identified by commissioning bodies, and approved by NHS England, before NHS PS commits to the spending. The current budget for such schemes in 2014/15 is £34.7 million.
“The landlord capital is at our discretion. We are dealing with the most urgent first. But beyond that, we are developing our own strategy to ensure we invest properly in our properties, but also appropriately. If you have got property that has been agreed locally will only be used for the next two years, it is a different kettle of fish to one that you know is going to be part of the local health system for the next 25 years.”
Since forming in April 2013 NHS PS has completed seven new build projects and 13 significant refurbishments of health centres or GP practices. Chapman, aware of criticisms levelled at NHS PS, is keen to end by clarifying its role.
“There has been a myth that we own everything. And I do not just mean the primary care estate, but the whole of the NHS estate. The is name perhaps is a bit misleading, in a sense. I think sometimes people have criticised us for things that are absolutely nothing to do with us. By looking at the estate we own, we are trying to get on a really even keel so that it will be best in class. But also working with NHS England to provide them with professional expertise to support the remaining estate as we go forward.”
Photography: Jim Winslett