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How your premises could be affected by the GP Forward View

We understand that GP practices are currently facing a number of challenges –  the drive to modernise the primary care estate; workforce shortages; and increasing levels of stress and burnout within the profession, to name but a few.

In a series of short articles we help you to examine some of the ways that NHS England’s ‘General Practice Forward View’ (GPFV), published in April 2016, aims to tackle these issues, and what this could mean for your own practice and daily working life.

Here, we look at how GPs feel about the current condition of primary care premises, how the GPFV plans to increase levels of investment in this area, and what this could mean for you.

How GPs’ feel about the condition of the primary care estate

More than 3 in 5 GPs (62%) surveyed by the BMA in 2015 supported maintaining a model of primary care delivery where GPs are able to own their own surgery. In fact, over half (56%) had ambitions to own and work in owner-occupied premises. However, 'increased and sustained premises funding’ was cited by 23% as an essential factor in enabling GPs to better deliver essential services (The Future of General Practice, 2015).

And there are concerns amongst those in the wider profession that many owner-occupied GPs premises are currently not-fit for purpose:

“Too many GPs are struggling to provide even basic care because their premises are too cramped and small.”  Chaand Nagpaul, Chair of the BMA GPs Committee

How the GPFV aims to help

The GPFV highlights that GP practices may choose to come together to deliver innovative models of care, at scale (for example, in the form of super-partnerships practices). It recognises that new facilities may be needed to accommodate multi-disciplinary teams servicing ever growing and demanding populations.

To facilitate this, the GPFV aims to make it easier to develop or re-build existing premises. Together with the Department of Health, NHS England are planning to introduce rules (possibly as early as September 2016) which allow them to reimburse up to 100% of the costs of premises redevelopment.

As well as capital investment, (amounting to over £900 million over the next five years), project support will also be available - helping primary care service providers to move through the associated financial, legal, and design processes as quickly as possible.

NHS England will also be looking to make more effective use of existing GP premises so that they are used as productively as possible. This includes working with NHS Property Services to explore opportunities to buy out GP-owned premises where it is advantageous to do so. 

Key considerations for your practice

Understanding Partnership Agreements

You may be considering the possibilities of merging with other practices. This can have a number of advantages such as:

  • having greater capacity and flexibility to deliver services
  • access to a broader range of skills, facilitating service developments
  • making more efficient use of resources through economies of scale

GPFV also confirms that super-partnership practices are set to benefit from a streamlined Care Quality Commission inspection regime.

However, there are a number of potential issues that need to be considered, for example:

  • merging with other practices is likely to require a significant initial investment of time and money
  • joining with other practices can mean an initial decline in income depending on the profit sharing arrangement agreed
  • being part of a larger organisation, with more stakeholders, may mean having less influence over decision making

You will also need to consider what any changes might mean for your relationships with existing patients in terms of the continuity of the service you deliver to them.

Entering or changing an existing Partnership Agreement may also have an impact on a practice owner’s personal finances (such as entitlement to share of profits, liability to debt, or retirement plans).

Access to funding for premises developments

There is likely to be a high degree of competition for the funding being made available through the GPFV. If you do make a successful application there is no guarantee that 100% of the capital required for a premises development project will be secured.
Where initial capital, or additional sources of funding are needed you will need to think carefully about how to bridge any finance gaps without causing cash-flow problems for your business.  This could include considering:

  • commercial mortgages – which can be used to raise capital against a premises in order to purchase new equipment, as well as moving or extending a practice
  • commercial loans – which can be used for practice acquisition, equity buy-in/out, practice refurbishment, cash-flow support, and capital expenditure.

Consider your changing insurance needs

If you are planning to develop your premises, you will need to be mindful of your changing insurance needs.

Your buildings and contents cover will need to be reviewed to ensure it still offers the appropriate level of cover.  A surgery insurance policy should protect your business against the most common incidents such as escape of water, theft, smoke and fire damage, loss of income and public/employers liability.

If you'd like to discuss any aspect of your professional or personal finances please arrange an appointment with your local Wesleyan Financial Consultant –email or call 0800 980 1277 quoting reference 45936. They are specially trained to understand the financial circumstances of GPs and will be happy to meet you, under no obligation, at a time and place that suits you.

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