Premises projects from April 2013

Medeconomics' premises expert John Hearle answers a query which addresses who will be responsible for approving GP surgery developments after April 2013.

The question

Our premises are in an inadequate PCT-owned building. Who, after the PCTs have gone, will decide on premises funding and what will the process be?

Conditions at our surgery are cramped and we serve 11,500 patients in about 130 sq metres of clinical space with one communal office. We are now unable to employ any other members of staff as room usage is over 90% in in working hours.

We approached the PCT who encouraged us to put in an outline business case for a new building. We also found a site to buy, but the day before completion of the purchase the PCT’s estate subgroup management committee' met and decided that they had been earmarking us for capital expenditure in 2014/15.

This was never mentioned before and 2014/15 is, of course, after the PCT’s abolition on 31 March 2013.

No one I have approached seems to be able to offer clear guidance on how exactly new GP surgeries in England will be approved from April 2013.

We still want to finance and build a new surgery. Is this a lost cause?

The answer

I am involved with a number of new development projects for practices where the total focus now is on getting the finances signed off by the PCTs concerned in January/February and before the change of administration at the end of March.

This rush is precisely because of the lack of certainty as to what will happen with new projects from April.

I am joint chairperson of the Primary Care Premises Forum (which offers support on premises to commissioners, providers and investors) and on a more positive front, I know from meetings with the DH that the NHS does not want the change in administration to stop those property projects where there is a clear need and where value for money can be shown. 

There is recognition that during the next couple of years while the administration settles down, GP premises are unlikely to be top of anyone’s list.

Equally, it is highly unlikely that there will be any substantial injection of capital into premises during that.

However, I have been advised that this does not mean that all projects will stop and it is recognised that essential projects must continue.  

Also while from April the PCTs’ premises role will be divided between NHS Property Services Ltd (set up by the DH to manage all the ex-PCT estate not transferred to providers), CCGs and, in part, the local elements of the NHS Commissioning Board and support groups, the intention is that the premises specialists within the NHS will remain.  

So if your PCT has a specialist property development adviser/manager, then in all likelihood that person will move over to NHS Property Services and acting on behalf of CCGs, will continue to advise on new projects.While nothing is yet certain, I think this is a likely scenario.

The most important advice I can give you is not to give up on new premises, and I have been advising a practice in a very similar position to yours – although, luckily they have an option on a piece of land, rather than having actually bought it.  

We are unlikely to get into a position where everything is signed and sealed by the end of March, but I have been working closely with the PCT concerned and advising them of each stage, keeping them up to date with the proposed drawings, getting their agreement on the accommodation, supplying them with appraisals including rental levels and costs and so on.

By providing as much detail as possible now, the hope is that there is a much higher probability of it going across to whatever the new administration will be. 

As to what approvals you will have to gain post April, you will clearly need the support of the CCG to confirm that there is not just a desire for this new surgery but a need, and that the current premises are totally insufficient.  

A CCG is likely to use NHS Property Services as their advisers on property matters which in turn will probably still work with the district valuer’s office to prove value for money.

Ultimately, the necessary funding will have to be signed off by the NHS Commissioning Board or its regional office. 

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