When it comes to premises, the new NHS authorities (CCGs, NHS England and NHS Property Services) introduced in April 2013 have not worked as well as many had hoped. The lack of funding for premises improvement and development has continued to dog primary health care.
Since April 2013 there seems to have been a reduction in the number of new or improved primary care centres. Most of the projects that were granted funding under the old PCTs have now finally fought their way through the red tape and are progressing. But, with a few exceptions, post-April 2013 projects have been well and truly placed in the pending tray waiting for monies to be released. But is a solution now to hand?
Primary care infrastructure fund
For those projects pending, the NHS England's announcement of the £1bn Primary Care Infrastructure Fund could indeed be the money they so desperately require
All GP practices have been invited to bid for funding by 16 February 2015. Applications must include a full project initiation document (PID) if a new project or full grant documentation if for an improvement grant. The extra funding, therefore, is intended to enable practices to progress previously submitted proposals for improvement or development over the next five years.
I know many GP practices are frantically filling in the forms and dusting off their old business plans with an intention of hitting the deadline. The funds are undoubtedly a great benefit, but their release four months before a general election does hint at them being rather politically motivated. What’s more, it still leaves the problem of long term funding of primary health care premises very uncertain.
To meet the 16 February deadline, projects will have to already be well advanced, whereas a substantial number of GPs gave up progressing their project due to the continued bleat from NHS England of ‘we have no funds’.
For many practices their projects will not be far enough advanced to comply and many have barely started. What is to become of them?
Other funding solutions
Prior to the announcement of the £1bn infrastructure fund, hope had rested with the many learned bodies seeking a funding solution. The Nuffield Trust had put together a think tank to look at the problem, the BMA held a property seminar last summer to investigate possibilities, Boris Johnson contracted McKinzies to prepare the London Health Care Initiative. Lots of thoughts, lots of ideas but, as yet, no real solutions.
The NHS appear to have ‘the wrong sort of money’, i.e. capital, when it needs increased revenue and monies that are locked away in secondary care to move to primary care.
More powers are going to CCGs, who will take on more funding responsibility for premises. There also appears to be a resurgence in enthusiasm for premises improvement, despite the fact one is sure where the money is coming from. However, enthusiasm is the first step and I have high hopes that more funding will eventually be released.
Advice for practices
Since April 2013 my advice to GPs has been for them to proceed and put together the basics of a new project. Practices would not be able to commit to anything but they could prepare business cases and plans showing their requirements.
It has proven to be good advice as such practices are now in a position to bid for the new infrastructure fund. To practices that are not in this position, I would still encourage them to move forward with their plans. Discuss the plans with the CCGs and build a business case to include additional services and facilities that could be locked in with new primary care premises. When new funding is released they will be ready to pounce.
Where will that new funding come from? Inevitably it must come from savings elsewhere but the general concept of moving services from secondary care to primary care is now an NHS priority.
The NHS has recently been fighting to bring down its very large rates bill. This does not just apply to health centres owned by the NHS but to all GP premises as the NHS reimburses these rates to practices.
A recent case has challenged the way by which the Valuation Office Agency assesses the rateable value on medical centres, which could halve the amount the NHS pays. Whilst this still could be challenged through appeal, it could result in the saving of hundreds of millions of pounds. Such money could easily be redirected towards new development and improvement grants for primary health care property. We live in hope.
- John Hearle FRICS MCIArb is chairman & head of healthcare at Aitchison Raffety and joint chair of the Primary Care Premises Forum.
- John is also Medeconomics' premises expert. Ask your premises questions.