How Scotland's new contract takes the burden of premises off GPs' shoulders

Practice premises are 'increasingly perceived as an unwanted liability by potential GP partners' and have become a barrier to recruitment, retention and retirement, the Scottish government and the BMA believe.

Premises: Scottish contract offers major overhaul of GP responsibility
Premises: Scottish contract offers major overhaul of GP responsibility

In proposals for a new Scottish GP contract that could take effect from 2018, all GP partners who own their premises will be offered interest-free 'GP sustainability loans' to help reduce costs.

For practices in leased premises, regional NHS boards will take over responsibility for their leases - with the Scottish government stating that its long-term strategy is that 'no GP contractor will need to enter a lease with a private landlord for GP practice premises'.

A document spelling out the detail of the new contract says that the Scottish government and the Scottish GPC 'recognise and support a long-term shift that gradually moves towards a model which does not presume GPs own their practice premises'. The shift will be achieved under a National Code of Practice for GP Premises - a 25-year plan to move general practice to the new premises system.

How will interest-free premises loans work?

GP partners will be offered interest-free 'GP sustainability loans' worth up to 20% of the 'existing use value' of their premises - even if they are in negative equity, with additional loans from regional NHS boards in exceptional circumstances.

Every GP partner who owns their own premises will be offered one of these loans by 31 March 2023, to be paid for by a GP sustainability fund that will make £30m available by 2021. This will mean £10m per year is available for three years from 2018 - a 24% rise in funding for GP premises in Scotland - to support the transfer of premises risk away from GPs.

Read more
>
 How the GP role will change under the new contract
> Scottish contract guarantees partners £80,000 earnings
> Read the proposed Scottish contract deal in full

But rather than being a short-term offer of financial support, the loans are part of a long-term scheme to strip away partners' responsibility for owning premises.

Practices judged to be in the greatest need will be offered the loans first, but all parners who own premises will be eligible, and further waves of funding support are planned after 2023 to continue 'until the transition to the new model where GPs no longer own their own premises is complete (by 2043.'

Loans would be repayable if the premises are sold or no longer used for GP services, and receiving them will not affect notional rent or other payments to practices.

How will GPs in leased premises be supported?

The Scottish government plans to end the current model in which many GPs lease premises from private landlords. Regional NHS boards in Scotland will gradually take control of these leases, and will take responsibility for ensuring that GP practices have 'fit-for-purpose accomodation'.

For existing leases due to expire by 1 April 2023, boards are likely to negotiate a new lease for practices' premises naming the board as tenant, or to provide new premises.

For leases expiring after April 2023 boards will take on the existing lease for practices if a series of criteria are met - including suitability of the premises, value for money of the lease, and agreement of the landlord.

All GP premises in Scotland will be surveyed in 2018/19 to inform the plans to overhaul premises arrangements. Practices will be contacted by a government-appointed surveyor.

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