Unresolved Problems with GPs’ and Dentists’ Premises
2nd May 2019
Ensuring the viability of doctors’ and dentists’ practices is an obvious social good, since it protects the health and welfare of people across Scotland. GPs and dentists like everyone want a good livelihood, not one impaired by financial instability or unexpected expenses.
A constant concern of GPs and dentists is the cost of repairing and maintaining surgery premises. Not only do such costs put pressure on practices’ finances but the uncertainty can be a huge disincentive to the recruitment of new practitioners, particularly in rural or deprived parts of the country.
For GPs a raft of new measures is beginning to address this. Over the last few weeks letters from the Scottish Government awarding new NHS sustainability loans have begun arriving at GP surgeries. These loans represent a new stream of funding for GPs, with further phased loan rounds to follow.
In total, the Scottish Government has allocated £30 million by 2021 to making such loans available. This implements in part on undertakings given in the Code of NHS General Practice Premises of November 2017. The Code, negotiated as part of the latest GMS Contract, is designed to reduce the risks to practices owning or leasing premises. Measures include local health boards taking head responsibility for leases of new GP practices as well as assisting with terminal lease repair costs.
Some GPs had expressed scepticism when the Code was announced whether these measures would ever come to fruition. Similar commitments in the past have failed through lack of funding and sometimes GPs not knowing what they can claim.
Moreover, other problems remain, particularly in relation to practices, both GP and dental, within health centres or new primary care multi-disciplinary buildings.
First, practices when taking up occupation of premises in publicly owned or financed health centres often have little clarity on occupancy costs, because there is no standardised national occupancy agreement in place. Too often, practices move in to new premises and only after many months learn the true occupancy costs. Resulting disagreements with health boards on such costs are not uncommon.
In the case of GPs, the Code contains little of assistance to practices struggling to meet ongoing running costs for shared parts of health centre buildings. Yet often repair and maintenance costs for shared parts exceed those for the practice premises themselves: in older health centres leaky roofs and broken boilers typically fall within the shared parts; in newer centres of the type most recently built under 3PD leases and the Scottish Future Trust scheme, a high standard of maintenance and generously sized reception and other public areas can mean far higher service charge costs than practitioners would have expected before moving into the building.
A further difficulty is the opaqueness of language used in existing government premises directives. As a consequence, NHS premises manager have an unenviable task of discerning these rules.
Dentists, for example, under their NHS financing rules are entitled to reimbursement of rent for premises which is to be ‘adjusted’ to take account of liability for common areas. There is no guidance, though, of the criteria to be applied by health boards in making these adjustments.
For GPs the premises directions are more detailed but some of the service charge reliefs appear ignored in practice. Rules that give a GP practice a reduced service charge for the first three years of occupation of a new health centre never seem, in the writer’s experience, to have been implemented nor are GPs made aware of it.
There are two clear ways in which these issues could be addressed.
First, there ought to be a modern style of standard agreement between GPs/dentists and health boards to regulate occupancy of health centres. Existing government circulars date back to 1980 and are outmoded. South of the border nationally agreed style agreements exist and something similar could be replicated here.
The second is to offer GPs and NHS-committed dentists greater protection from running costs of shared parts of buildings. Practices taking up occupation of health centres should be given in advance a detailed breakdown of costs. These costs should be restricted and, as a minimum, boards should both fund and inform GPs of their rights to transitional service charge relief.
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