BMA urges caution as developers offer £3.3bn primary care premises overhaul

BMA leaders have urged caution after developers offered £3.3bn to build 750 'state of the art' primary care centres over the next parliament if the government will commit to a £200m-a-year bill for rent.

BMA premises lead Dr Gavin Ralston

Three major primary care property investment funds have put forward the offer in response to a government-backed review published earlier this year.

The review of NHS estates by Sir Robert Naylor called for a £10bn injection of capital funding and at least a further £5bn to cover 'backlog maintenance' costs, to come from a mix of private investment in primary care estates, new funding from the Treasury and sale of NHS estates. The review also said that nearly a third of existing primary care premises were too small, and suggested the NHS could 'force the pace' of moves to larger units by cutting rent reimbursement for small practices.

The 'primary care buildings pledge' put forward by Primary Health Properties (PHP plc), Octopus Healthcare and Assura plc says that a £3.3bn investment in new primary care buildings 'would require less than £200m of rent per annum from the NHS'. The trio say that investment on this scale could deliver 'as many as 750 state of the art primary care centres through third party investment'.

GP premises

However, the BMA said the offer should be 'treated with a high degree of caution', warning that 'PFI-type deals' may not deliver value for money. It called for the government to focus on delivering the £1bn funding promised for primary care through the estates and technology transformation fund (ETTF).

GPC executive member and GP premises lead Dr Gavin Ralston said: 'There is little doubt that many GP buildings are in urgent need of refurbishment as many are too small or cramped to provide first class patient care. Some are sadly in a state of considerable disrepair.

'This situation is increasingly preventing GPs from meeting the increasingly complex needs of patients, especially the heightened demand for more appointments and expanded services. Following lobbying from the BMA, the government announced in 2015 a £1bn package of infrastructure upgrades, which has resulted in some improvements, but this programme has been marred by unnecessary bureaucracy and unrealistic timescales. This has resulted in key projects stalling and a significant amount of the money not actually being spent.

'Urgent investment is undoubtedly required, but we should treat these proposals with a high degree of caution. A considerable question mark exists over whether PFI-type deals deliver good value for money to the taxpayer in the long term. Ensuring that the government’s promised £1bn investment programme is implemented and works properly would be a much more efficient use of time and resources.'

Capital investment

The RCGP's recent evaluation of the first year of the GP Forward View also hit out at poor implementation of premises funding pledges, warning that 'some practices have struggled to access much-needed capital investment'. The report said ETTF funding 'was very complicated to apply for and communication throughout is reported to have been poor' It added: 'Funding, where it has been released, has taken a long time to get through, and where practices have failed to secure funding many have been left unsure as to why and without any source of alternative funds.'

The developers say that more than £270m per year could be saved by investing in the new premises by enabling primary care centres to take work away from A&E and easing pressure on hospitals.

Author of the government-backed premises review Sir Robert Naylor said it was 'encouraging to see the private sector step forward to play their part in meeting the recommendations set out in my review', calling proposals for third-party investment 'a step in the right direction'.

He added: 'Investment to improve and grow a fit-for-purpose NHS estate is absolutely critical after years of underinvestment. Capital investment for refurbishments has tended to focus on big hospitals but it is crucial this is done in tandem with improvements to the primary care estate. Only with this will we have a system that treats people effectively in the community to prevent hospital admissions and further strain on already stretched secondary care services.

Developers have said that the ETTF funding is not enough to cover the cost of premises investment needed in primary care.

In 2011, then GPC premises lead Dr Peter Holden called for the DH to commit to an annual investment of £250m to fund third party investment in primary care estates, suggesting this could attract around £2.5bn from property developers.

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