More than half of GPs do not want to own practice premises

More than half of GPs do not want to own practice premises, according to a GPonline survey that highlights a key factor behind the rapid decline in numbers of GP partners.

Dr Krishna Kasaraneni: For young GPs owning premises 'not feasible' (Photo: BMA)

Of 450 GPs who responded to GPonline's latest opinion poll, 54% said they did not want to own GP premises now or in the future.

Meanwhile, 41% said partnership roles would be more attractive if premises responsibility was taken away - a figure that increased to 49% among GP partners.

Nearly half of partners (49%) said they did not want to own practice premises - and although 74% of all GP respondents said the profession should retain the right to own their premises, among partners this figure fell slightly to 71%.

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GPC workforce lead Dr Krishna Kasaraneni told GPonline that for younger GPs, owning premises was 'simply not feasible'.

He warned: ‘Premises have become a liability owing to years of underinvestment and cumbersome regulation. Ownership is often complicated, requires long-term commitment and considerable financial investment from the individual GP. For younger doctors, who have lower incomes and high levels of debt, premises ownership is simply not feasible.’

Earlier this year, GPC chair Dr Richard Vautrey described premises as 'one of the biggest problems facing practices', warning: 'Many trainee GPs are steering well clear of any partnership offers and choosing to be salaried GPs instead... simply because of the risks of premises ownership or being tied in to long-term leases.'

Official data show that numbers of GPs in partnership roles have dropped sharply in recent years - with headcount numbers of GP partners down more than 2,500 between September 2015 and June 2018.

Career choice

A GPonline survey earlier this year found that just 20% of GPs view partnership roles as the most attractive career option.

Many GPs taking part in the survey echoed Dr Kasaraneni’s concerns, saying there was simply too much risk involved with taking on premises in the current climate. One GP wrote: ‘The really big issues relate to last person standing liabilities on leased and owner-occupied situations.’

Another GP said: ‘We own our premises, but younger GP's don't want to.’ One respondent said younger doctors were wary of buying in to practice premises because of the risk that they would be left holding the responsibility when older partners retired - and older GPs were unable to get out because it was hard to recruit a replacement.'

The findings suggest many GPs may favour a contract deal similar to the one being developed in Scotland, which will see regional NHS boards take over responsibility for leases so that ‘no GP contractor will need to enter a lease with a private landlord for GP premises’.

The Scottish government described practice premises as an ‘unwanted liability’ for GP partners, saying this has become a ‘barrier to recruitment, retention and retirement’. A 25-year plan for Scotland will transfer premises risk away from GPs.

GP premises review

Dr Kasaraneni said the finding that many GPs were keen to retain the right to own premises showed that GPs 'clearly recognise the benefit of working in a building that their GP colleagues have control over, as opposed to a remote landlord who does not invest properly in the property'.

He added: 'For those who are able to make long-term plans there are sound reasons for premises ownership. It means GPs are able to make changes to the building’s structure and allows flexibility of use, which can benefit the NHS as a whole. It also encourages a commitment to partnership and firmly embeds the GP within the local community. For these reasons the option must stay.'

Earlier this year, NHS England and the GPC agreed to carry out a review of GP premises policy to ensure that the system was 'fit for purpose both now and in the future' as part of the contract negotiations for 2018/19.

The review aims to explore how barriers, such as ‘the liabilities for GP partners associated with estate ownership or occupation’ and ‘a perception that estate ownership is unattractive and may be a factor in declining interest in GP partnership’ may be addressed in future models.

Dr Kasaraneni added: ‘NHS England’s premises review is a welcome step, but it must address the fundamental issues facing partners, including "last person standing", difficulty in accessing investment and all the added regulatory aspects that have turned premises from an asset into a liability.’

The review began in June 2018 and is expected to run for six months. A report, including recommendations, is due to be published in early 2019 and will feed into contract negotiations for 2019/20.

NHS England says there has been nearly £400m investment in GP premises in the past three years.

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