In documents published today, NHS England said that existing practice leases would be assigned to 'NHS bodies or other appropriate entities'. The details of which leases are deemed to be of 'strategic importance' and covered by the plans will be subject to further discussions between the GPC and NHS England this year.
Limiting the financial risk associated with premises was one of the key recommendations of the GP partnership review, led by Dr Nigel Watson, which reported earlier this year. That review warned that many partners who lease premises fear that if they are forced to hand back their contract, they could be left with full financial liability for a lease with many years still to pay. Dr Watson's report said that this was a major obstacle to GPs becoming partners.
Following its premises review, NHS England said that it planned to continue to support the option for GPs to own their premises, but it added that 'over time we expect more practices to want to separate the decision to enter premises ownership from the operation of primary medical services'.
The review said that a model where the choice to own a premises is separate to becoming a partner 'could support the future development of the partnership model in general practice'. NHS England said that some partnerships already operate in this way and it would 'support a shift' to this becoming more widespread.
The documents said that any future investment in practice premises owned by GPs would be contingent on practices having ‘robust governance arrangements’ in place relating to premises. 'Separation of the premises-owning and partnership entities could be one way of demonstrating good governance,' the review said. NHS England added that it would be developing 'best practice guidance' on how practices could do this.
New guidance on the 'expectations of owners and occupiers around maintenance and standards' of premises will also be produced following the review.
The review did consider the option of the state buying GPs out of their premises, but it concluded that this would be 'prohibitively expensive' at a minimum cost of £5-6bn. It also concluded that a state-backed loan system 'would cement the current model of new partners taking on significant debt rather than support new, more flexible partnership models.'
NHS England also plans to pilot an alternative premises reimbursement system at network level, which it said would 'give networks greater autonomy to manage and minimise their costs relating to estates across their premises'.
It will also pilot a model that would see the NHS directly ‘bear the cost of premises in multi-use new build premises, removing the need for bureaucratic premises reimbursement systems.' NHS England said that this would help to promote service integration.
In terms of future investment into GP premises, the review concluded that NHS England did 'not have a complete picture of the current general practice or wider primary care estate, and this is a significant barrier to proper future estate planning.' As a result, the NHS Property Board will be collecting data about primary care premises during the rest of this financial year, which will be used 'to help drive strategic planning, inform investment, and deliver efficiencies'.
NHS England said it would also encourage PCNs to start working out their future premises needs striaght away, 'taking into account joint working and the estate of their community partners'.
It added that it planned to develop 'greater support' to ensure primary care was fully engaged in STP and integrated care systems' bids for funding in future and said it would be looking to secure funding to ensure GP premises were fit for purpose as part of the next spending review.