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Premises priorities

Q: I have always assumed that where a new building is needed, there would be an order of preference; that if GPs expressed an interest in building a surgery or finding their own developer, this would take precedence over PCT-led or LIFT alternatives. Our PCT has failed to progress a number of proposed GP premises and extensions in the time it has been in existence. These schemes were 'approved' by the previous PCTs. One of them (ours) is now urgent and, although the GPs have always led on this and wanted to organise and finance the new building, the PCT says it is its decision that the project must be a PCT-led build. What are our options?

A: All PCTs should have clear priorities and a strategic services development plan, or at least a strategic estate plan, that shows where existing services and properties are and where future services are needed and where properties need to be provided, refurbished, extended and so on.

But there are a number of PCTs without such plans and where development is on an ad hoc basis.

If a PCT has opted to form a LIFT company it will have agreed with the LIFT company that it will undertake all PCT projects within the area.

While this does not prevent GPs undertaking their own projects, it does mean that the PCT cannot involve itself with taking space from the surgery or running services itself at the surgery. This tends to stop the practice from offering much more than GMS/PMS services and so approving the project becomes lower priority.

Where the PCT has not formed a LIFT company, it would not normally involve itself directly in building property. So it would work with GPs in respect of GP-led projects, or with third party developers where GPs want to take leased premises.

In such circumstances, conflicts do occur where a GP practice wants to undertake its own project to run GMS/PMS services, but where the PCT has something more extensive in mind - for example, bringing two or three practices together and potentially linking them with accommodation for PCT use.

If the PCT puts one of these joint projects high on its priority list, then it is clearly going to try to dissuade practices from undertaking their own project.

A: I have not heard them and they may have been incorrectly assumed from comments in the White Paper. This does note that on the abolition of PCTs by 2013, the new NHS Commissioning Board will allocate and account for NHS resources. This body will provide funding to the GP commissioning consortia.

The stated intention is that the DoH will allocate funding through the NHS Commissioning Board to the consortia according to population health needs. This implies patient numbers will be taken into account. However, there is nothing to suggest such a means of budgeting will be passed on by the consortia to individual GP practices.

The system of cost rent (now borrowing costs) and notional rent reimbursement is sanctioned by the NHS (GMS - Premises Costs) Directions 2004 and I think it is highly likely the consortia will continue to adopt these directions.

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