Recognising “ongoing issues around” general practice premises, NHSE led the General Practice Premises Policy Review agreed with DHSC and GPC England following the 2018/2019 GMS contract. In January the context for the Review changed with the publication of The NHS Long Term Plan and the Five-Year Framework for GP contract reform. These set out the ambitions for the next decade with Primary Care Networks (PCNs) as the foundations of Integrated Care Systems. It is acknowledged that these developments will have implications for primary care estate as the full implications of PCNs become clear as they develop. The findings of the Review have now been published and set out a series of policy responses to the matters explored but, “[s]ome will need further work before implementation begins, and where there are new financial commitments these will be dependent on the capital available. Where necessary, details will be subject to negotiation with GPC England.”
The scope of the review included the “last partner standing” problem, the perception that interest in ownership of premises is declining and is one reason for the relative decline in the choice of a career as a GP, lease liabilities and duration, the best use of properties and complications with the mixed use of new builds for finances and the revenue implications of changes. Nigel Watson’s Partnership review was also considered.
Hedging their bets the policy conclusions are described as only one part of what is required. NHSE admits that primary care premises in many places are not fit for purpose now let alone for particularly for the implementation of the LTP. We are promised an “implementation framework” which will describe how NHS capital for estates will be used to support the LTP alongside the forthcoming government spending review. NHS England and GPC England will work together to describe the case for capital investment in primary care, recognising the importance of this to the success of the LTP and the future of general practice without which, as we have on the highest authority, the NHS will fail.
The key policy conclusions from the Review are as follows with the first being perhaps the most longed for by GPs but predictably well-guarded with caveats:
• assign existing practice leases to NHS bodies or other appropriate entities where they are of strategic importance, and where their length and liabilities prevent the healthy renewal of partnerships and the estate. The detail of which leases are of strategic importance will be subject to further detailed discussions with GPC England and within NHS England and Improvement during 2019. The Capital Departmental Expenditure Limit (CDEL) cover which would be required to enable this will be dependent on the outcome of the government’s spending review and a prioritisation process; NHSE will focus its efforts on understanding what it would take to ensure we have premises that are fit for purpose as part of the spending review and following the spending review, develop and publish a premises implementation framework.
• support the availability of an ownership model which continues to make sense for GP practices, but they expect more practices to want to separate “the decision to enter premises ownership from the operation of primary medical services.” Best practice guidance on this for all property-owning GPs is promised. Future NHS capital investment would come with a requirement to “demonstrate robust governance around property ownership”;
• provide clearer guidance on the expectations of owners and occupiers around maintenance and standards, as part of professionalising property ownership and management – this is clearly aimed at the rapacious NHS PropCo;
• pilot alternative premises reimbursement arrangements at a network level, to give networks greater autonomy to manage and minimise their costs relating to estates across their premises;
• another potentially important idea is to pilot a “simpler model of premises provision in which the NHS directly bears the cost of premises in multi-use new build premises, removing the need for bureaucratic premises reimbursement systems, promoting integration of service delivery and optimal use of space”;
• More vaguely NHSE promises to “develop a package of support relating to primary care engagement in Sustainability and Transformation Partnerships’ (STPs) and ICSs’ capital strategies and the capital allocations process” and to “encourage networks to start working out their future estates needs now, taking into account joint working and the estate of their community partners.”
I hope that this is helpful. It will be interesting to hear what Mark S-W thinks.