ࡱ> WYVy -bjbjEE *<''% ,5555555555555$609;5;555P5R5555R3450z45f50549(9<494$Zj@4;5;5 59 :  Somerset LMC Position Paper on Reimbursement to Practices for Costs of Accommodating Attached Staff Background GP premises in Somerset are now all privately owned, for the most part by the medical partnerships that occupy them. The costs of providing GMS out of these buildings are primarily met by cost or notional rent payments which are applied according to a national formula. This formula includes an element for the building costs of accommodating some attached NHS staff, but it does not cover the running costs of so doing. Current Reimbursement Arrangements In the absence of any formal regulations, ad hoc arrangements to pay for the difference have grown up across the county. These were derived from bipartite negotiations between the practice concerned and the main Trust employing the attached staff. Consequently there are wide variations in the amounts paid by the relevant Trust to cover the expenses incurred by the practice. It now appears that for the most part these amounts no longer reflect the actual costs of accommodating the staff concerned. Furthermore, staff from several different NHS Trusts and the PCT may work in any given practice. Need for Review of Reimbursement There are a number of reasons why a review of the reimbursement arrangements is timely 3.1. Inequity between practices Anecdotally it appears that the difference in amounts received by practices for providing similar accommodation is increasing. 3.2. Move to PCTs The change in employment arrangements of attached staff from Secondary to Primary Care Trusts provides an opportunity for renegotiating their accommodation costs. 3.3 Increasing Expectation that Staff will be Accommodated. The welcome trend towards deploying a larger proportion of NHS staff in the community means that practices are being asked to host more attached staff. Unfortunately many NHS Trusts do not understand the contractual position of GPs, and expect their employees to be accommodated for nothing indeed, this is seen as a money saving opportunity that allows them to reduce their own estate costs. At least two worthwhile ventures in Somerset have foundered on this misunderstanding in recent years. 3.4 Rising Costs of Accommodating Staff As the technical base required to provide NHS services has become more sophisticated; and more health and safety and other regulations need to be met, the true cost of accommodating staff has risen significantly. Practice managers now spend a significant amount of time dealing with these issues. 4.0 Elements to be Considered in Costing Occupancy Apart from a rental cost which may be applicable when staff are occupying areas of a building that are not cost-rented, the following elements need to be taken into account: Any furnishings provided, including non-fixed floor coverings, curtains, furniture, plumbed fixtures. Heating, lighting, hot water. Cleaning internal, windows, floor covering maintenance. Access to internal telephone system and computer network. Receptionist time, appointments, messaging, office support. Security including an element of running costs of internal and external security systems, provision of reception cover for extended access (e.g. evening parentcraft clinics), monitoring of itinerary for staff doing domiciliary visits, emergency backup for staff working alone. Access to office equipment fax, photocopier, practice library, information sources and non-clinical databases. Kitchen facilities, wear and tear on appliances. Element of the cost of maintaining the external environment car park, planted areas, boundaries. Calculated percentage element of rolling redecoration programme Management time in co-ordinating support services. Technically rates, water service charges & waste disposal should be included, but as these are reimbursed by PCTs already this element is cost neutral to practices Proposals for Change A county wide agreement. This revised position paper to be sent to all PCTs with a request that a collegiate view be formed on an appropriate standard calculation for a reimbursement rate for attached staff. This rate should be flexible to allow special circumstances to be taken into account. Reimbursement to be applied to all attached staff PCTs to be requested to verify any new arrangements with all NHS Trusts who deploy staff into GP premises ( including mental health organisations), and also social services. 6.0 Rental and Occupancy Cost distinction. This paper assumes that attached staff are occupying areas of the building for which the practice receives either cost or notional rent payments. 6.1 To make the best use of space premises are often now used in a more flexible way than defined in the Red Book. However, practices should be able to demonstrate from a room usage plan that the use of space is equivalent to the arrangements allowed under their rental scheme. 6.2 Some practices may accommodate attached staff is areas that are not covered by NHS rental reimbursements. A case by case rental agreement will have to be made in such circumstances. The LMC strongly recommends that a formal contract be drawn up. Possible Models for Calculating Occupancy Cost Notional Sessions Occupancy cost could be calculated on the basis of the number of notional days that the premises are used by attached staff. Since costs are mainly dependent on the number of individuals involved, this is a better proxy than using the space occupied. 7.1.1 Whole time staff are assumed to work for 10 sessions, and part time staff pro rata. Occasional attached workers e.g. CPNs, Social Workers, Benefit Advisers etc are assumed to work for 1 session at a time. 7.1.2. On this basis the LMC view is that the starting point for an equitable charge for accommodation would be 50p per session (2001/2002) 7.1.3. This sum should be adjusted to reflect economies of scale of having several people working in the building. We would suggest it be adjusted according to practice size as follows: 1-3.9 WTE staff: 60p per session per person 4-7.9 WTE staff: 50p per session per person 8+ WTE staff: 40p per session per person 7.1.4. The reimbursement is the responsibility of the employing organisation unless they have previously negotiated a payment arrangement with the PCG/T. 7.1.5 Practices providing extended facilities over and above those listed will need reach a separate agreement with the employer concerned. Comment: This model has the virtues of simplicity and being sensitive to the number of individuals involved. Calculating charges and billing is easy. However, it does not reflect the actual area occupied by staff, nor the true costs of providing the accommodation. Actual Cost Basis Model This model requires an agreement on what percentage of each of the elements listed under paragraph 4 will be allowed. The cost adjusted expenditure is then totalled and the proportion that relates to the floor area occupied by attached staff is reimbursed. 7.2.2 Clear agreement will have to be reached on the cost heads allowed with guidance on floor and ceiling expenditure. Care will have to be taken not to include any elements that are reimbursed through other channels, whilst still retaining flexibility to meet actual local costs. 7.2.2 It may be sensible for the PCT to act as agent for the practice in dealings with NHS Trusts and Social Services so that the number of transactions can be minimised. 7.2.3 A formula would have to be agreed for the use of common areas. The latter would include all parts of the building not exclusively used by practice employees. Comment: This model is complex and the formula may lead to very different reimbursement rates between practices. There is potentially a need for several renegotiations of the agreement as attached staff come and go and proportions therefore change. The reimbursement sum will need to be recalculated at least annually but would reflect the true costs that the practice has incurred. District Valuer Calculated Cost Basis Model This model applies a standard formula determined by the DV to an agreed list of cost heads produced by the practice 7.3.1 Each practice has an independent cost assessment made on the same three yearly cycle as the current rent assessment. This would be the basis for the calculation until the next review, but allowing an annual inflation uplift across the board. 7.3.2 The floor space occupied by attached staff is calculated as under 7.2. An element would need to be included for regular users of the building who do not have a dedicated working area ( e.g. midwives, CPNs, Social Workers) The PCT would also need to agree on a charging arrangement with the relevant employing body to recognise this. 7.3.3 Some minor elements of the cost heads could be rolled up and included as an agreed percentage increase in the total sum, so as to avoid negotiations over small items of expenditure. Comment: This model has the benefits of objectivity and, once calculated, relative simplicity. It can be made to reflect both the numbers of attached staff and the floorspace they occupy. It is relatively inflexible within the three year cycle. Conclusion The District Valuer Calculated Model has been proposed by Taunton PCT who have been leading for Somerset in this area. It has significant advantages over the alternatives for both parties, and the LMC has resolved subject to agreement on the cost heads it should be adopted. 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P`P^P``o(....... ^`o(........hh^h`o(. hh^h`OJQJo( L=g^TX>Eb,ftU^5DL!$qx5At_{Y Vc .Y`(^%%@8%@UnknownG* Times New Roman5Symbol3. * ArialA BCambria Math"Ah&&eDD!24dn%n%2HX(?(^2!xx1Position Paper on Remuneration for Attached StaffPre-Install User Dr Anne Hicks<         Oh+'0 4@ ` l x 4Position Paper on Remuneration for Attached StaffPre-Install User Normal.dotmDr Anne Hicks2Microsoft Office Word@@h_q@[@[՜.+,0$ hp  Somerset LMCDn% 2Position Paper on Remuneration for Attached Staff Title  !"#$%&')*+,-./0123456789:;<=>?@ABCDEGHIJKLMOPQRSTUXRoot Entry FzZData 1Table(2:WordDocument*<SummaryInformation(FDocumentSummaryInformation8NCompObjy  F'Microsoft Office Word 97-2003 Document MSWordDocWord.Document.89q