Moving into a new surgery leased from a third-party developer can be the solution for GPs in inadequate premises.
But practices in parts of England where there has been comparatively low investment in primary care infrastructure are more likely to be offered accommodation in a private/public sector LIFT scheme.
Here, the PCT holds the headlease from the LIFT company that built the property. GP practices and other tenants, take on an underlease. Compared to leasing from a third- party developer, LIFT rent is likely to be higher as a result of basing property valuations on whole-life costs rather than construction costs.
As protection, GPs need to negotiate break clauses to end their lease should reimbursement be reduced or withdrawn.
The length of leases, typically 25 years, can be daunting.One of the aims of LIFT is to provide flexible lease arrangements, so it may be possible to negotiate break clauses that can be triggered by specific events - such as there being a solo GP left due to partner retirements - or at set intervals during the lease. Practices should ensure that they can assign their lease to another tenant.
In third-party schemes the practice is responsible for interior repairs but, with LIFT, the LIFT company will carry out all repairs and maintenance.
The cost is included in the rent. The PCT should reimburse this cost but GPs are stripped of control, and cannot put right any problems with their accommodation.
There may be provision in the headlease for the PCT to receive compensation if the LIFT company does not meet its responsibilities, but this may not be passed to the GPs. Making even small alterations requires the PCT's and LIFT company's consent.
PCTs should reimburse GPs for all the costs they incur in relation to a LIFT lease but there will be variation in how this is implemented at local level. The main differences that tend to arise are over services, such as cleaning and security, that are provided by the PCT rather than the LIFT company.
Ideally, practices should pay no more for such services than in their previous premises, with any additional costs borne by the PCT. But the standard underlease does not cover additional services so there is nothing to commit the PCT to providing them for the life of the lease. The practice should therefore make sure that services to be provided by the PCT and amount charged are added to the lease.
LIFT developments are designed so that more healthcare services can be offered at one centre. This creates problems with shared space, car parking and common areas.
To avoid disputes, all occupants need to be clear about which areas they can use, when, and which are private to individual practices. If practices are to share treatment rooms, it is worth setting up a committee to manage this or drawing up an agreement setting out the room booking system.
GPs are unlikely to be able to choose between a third-party developer and a LIFT project. While LIFT appears to be higher risk and practices have less control over their premises, it does enable them to continue to grow in purpose-built new premises.
Ms Lewis is a solicitor with George Davies Solicitors, http://www.georgedavies.co.uk
For more about LIFT visit http://www.dh.gov.uk
POINTS TO CONSIDER
LIFT operates in England only although a similar scheme for Scotland (visit http://www.show.scot.nhs.uk/pfcu) is in its early stages.
- Custom-built facilities are a big improvement for practices in cramped premises that do not comply with the Disability Discrimination Act.
- The LIFT company pays for building upkeep (although this cost is added to the rent).
- Patients will benefit from the variety of other health and social care services available in the LIFT centre.
- GPs used to owning and maintaining their own surgery may feel that they have lost control.
- The rent is often very high and, although it is reimbursable, this can be daunting.
- The lease period is long and often inflexible. Checking the assignment clauses and ensuring that there are opportunities to break the lease is advisable.