GP practices must make sure that they are receiving optimum income and part of this is ensuring that the notional rent you receive is fair and reasonable in comparison with other surgeries.
The notional rent valuations that practices receive from NHS England are normally carried out by the district valuer and are purely their opinion of the value of your premises. Under the terms of your contract, you are entitled to get a second opinion from your own specialist surveyor.
Following the assessment carried out by your surveyor, you will then either be given reassurance that your reimbursement is at the correct level or you will be advised that an appeal would be worthwhile.
When should practices seek a second opinion on their notional rent?
GP practices should seek a second opinion from a specialist surveyor every time they receive a new notional rent figure from NHS England – even if the practice received a large notional rent increase last time.
This is because the market can change significantly over a three-year period and your surveyor will have gathered a lot more up-to-date comparable evidence during that time that can be used to support an appeal for an increase.
Even if you haven’t made any physical improvements to your surgery premises, its value can be increased by other external factors such as new housing or retail developments in the area.
What if you want to appeal your notional rent?
If your surveyor believes that your practice is being underfunded, they will advise you to notify NHS England that you plan to appeal. You will need to provide NHS England with details of your surveyor so that they are authorised to proceed with the case on your behalf.
It makes sense to notify NHS England of your appeal as soon as possible after you have received your new notional rent figure.
NHS England will sometimes inform you that you must submit your appeal within three months in order to speed things up, however, contractually you have three years in which to do this. A recent legal ruling confirmed that this was the case.
If NHS England tells you that you cannot appeal because you have not notified them within the correct timescale, please speak to your surveyor who will be able to advise you further.
What does the notional rent appeal process involve?
Once you have notified NHS England that you plan to appeal and have appointed your surveyor, the practice doesn’t need to have much direct involvement with the appeal process.
Your surveyor will present your case for a notional rent increase to the district valuer using comparable evidence, for example the notional rent of similar surgeries in similar premises and in similar locations. Therefore, it is a good idea to use a surveyor who has worked on notional rent appeals in the past to ensure that they have the necessary comparable evidence available.
These negotiations will continue until an agreement has been reached with the district valuer or the rental is determined by the NHS Litigation Authority (if deemed necessary) at which time your surveyor will notify you of the final outcome.
What happens if the appeal is successful?
If the appeal is successful, NHS England should begin to pay you the increased notional rent accordingly. However, it can sometimes take a few months for this to happen and you or your surveyor may need to chase them.
If it is a retrospective appeal, you should receive back pay up to the review date in question. If the appeal is successful two years after you were initially given your new notional rent figure, then you should receive back pay for those two years as a lump sum and an increase in monthly payments up until your new review in a year’s time.
How much can practices expect their notional rent to be increased by following a successful appeal?
In the last three years (2012-2014) GP Surveyors negotiated average increases of 10% per surgery (over and above NHS England or the health board's initial valuation). This amounts to an average increase of £2,520 per year and £7,560 over the three-year notional rent period.
Some of our notional rent increases have been five-figure sums which goes to show the importance of seeking a second opinion.
What should practices do if they are unhappy with the result of the appeal?
If your surveyor says they will be unable to achieve a reimbursement increase for you following their initial valuation (before entering into negotiations with the district valuer) and you aren’t happy with their assessment, there is nothing stopping you from speaking to another specialist for their opinion.
It is important that you are confident that the notional rent you are receiving is fair and reasonable in comparison with other surgeries.
If your surveyor takes on your appeal but is unable to reach an agreement with the district valuer, they can refer the case to the NHS Litigation Authority (NHSLA) for a decision. The NHSLA will check that all possible efforts have been made to resolve the case at a local level before providing a final determination. This process should not require any time or effort from the GP practice as it is usually managed by the surveyor directly.