NHS England has committed to over £900m of capital investment in premises and infrastrcture over the next five years as part of the General Practice Forward View.
The document says that NHS England is asking all CCGs to put forward recommendations for investment in primary care infrastructure in future years by the end of June.
The £900m is not necessarily ‘new’ money. Some £750m had already been committed to the Transformation Fund over the next three years. The Transformation Fund replaced last year's Infrastructure Fund, which had attracted criticism for only providing support to developments for one year.
John Hearle, chairman and head of healthcare at specialist surveyors Aitchison Raffety, believes that the Forward View is a positive step for premises.
‘There have been some positives in the past 12 months with the Infrastructure Fund, which has developed into the Transformation Fund. But before that the answer to everything was "sorry we don’t have any funding". The Forward View shows that NHS England has realised that premises is important,’ he says.
However, Mr Hearle says it is vital that long-term funding is made available for premises.
‘The Transformation Fund is great, but the funding currently only runs over three years until March 2019,’ he says. ‘It’s not quite clear whether this is going to continue going forwards. Ongoing funding and investment is what’s important, for example ongoing rent reimbursement.’
Premises Cost Directions
The Forward View also says that new Premises Cost Directions will be published in September 2016. These have been long-awaited after many complaints from GPs and experts that the 2013 directions were problematic and certain aspects actively hindered property development.
The new directions have been in development for some time, but the Forward View confirms that one of the major changes will mean that NHS England will fund up to 100% of the cost of premises development rather than the current cap of 66%.
Mr Hearle believes this will make a big difference. ‘It sounds like the new directions will rectify the mistakes in the old ones and add improvements, such as the 100% reimbursement,' he says.
‘This is obviously going to help – it is going to encourage some GPs to do the work that is necessary to improve their premises.’
There are also some positive developments for practices that are tenants. From 1 May 2016 to 31 October 2017 NHS England has said it will provide ‘additional support’ for stamp duty land tax and ‘transitional support’ where practices see a significant increase in cost of facilities management on leases held with NHS Property Services and Community Health Partnerships.
The NHS already pays stamp duty land tax for GPs who take on a lease on a new development. The plans in the Forward View suggest this may be extended to practices signing up to leases on existing buildings.
Mr Hearle suggests that this move, along with the plans for support for service charges, are aimed at encouraging practices that are tenants in NHS Property Services buildings and have yet to sign a lease, to do so.
‘The two biggest problems NHS Property Services has in getting doctors signed up to leases is firstly they don’t want to sign up because they will have to pay a big chunk of stamp duty land tax. And secondly they may do their own services and repairs and see that if they move into an NHS Property Services building or sign up to one of its leases they will have to pay a huge service charge.
‘These changes seem to be there to address these issues and to help NHS Property Services get those leases in place.’
However, while help with services charges is welcome it is unclear how long this will last for given it is billed as ‘transitional support’.
The GP Forward View also suggests a number of other more vague plans for premises.
There is a suggestion that NHS England will consider underwriting lease arrangements or buying out GP or third-party owned premises if there are ‘wider commissioning gains’ to be had.
The document also suggests that public private partnerships, possibly in the form of the LIFT programme, could be revived in primary care.