Answer
The 2004 Premises Costs Directions do allow this extra reimbursement under paragraphs 46 (payment in respect of).
All PCTs should have a clear priority of projects. Indeed, they should have prepared a Strategic Services Development Plan or at least a Strategic Estate Plan which shows where existing services and properties lie and where future services are needed and thus properties provided, refurbished, extended etc. Having said this, there are still a number of PCTs where such plans do not exist and where development is still on an ad hoc basis. I do know that the Department of Health are trying to stem this and are in the process of preparing guidance for PCTs on estates and premises matters which we hope will be released early in the New Year.
I should mention LIFT as if a PCT has opted to form a LIFT Co (and gone through all of the selection and tendering that that entails), then the PCT will have entered into an agreement with that LIFT Co that they will undertake all PCT projects within the area. Whilst this does not prevent GPs undertaking their own projects, it does mean that the PCT can’t involve itself with taking space from that project or running services themselves from that project which tends to very much reduce the new building from doing much other than GMS/PMS services and thus, in turn, tends to automatically reduce the priority.
Where the PCT has not formed a LIFT Co, it would be very unusual for the PCT to involve themselves directly in building property and normally they would work with GPs in respect of GP led projects, or Third Party Developers where GPs and/or the PCT want to take leased premises. In such circumstances, conflicts do occur where a GP Practice wants to undertake their own project to run their GMS/PMS services, but where the PCT have something more extensive in mind often bringing two or three Practices together and potentially linking it with more PCT accommodation. If the PCT puts one of these joint projects high on its priority, then it is clearly going to try and dissuade any GPs from undertaking their own project and technically, whilst they can’t force the GPs into the larger scheme, they can use such arguments as the smaller scheme does not comply with their Estates Strategy or allow the PCT to provide required services etc. You note in your letter that the PCT say that they want to build which, as indicated above, would be unusual. If it is in a LIFT area, then it could be the LIFT Co requiring to build (which if they are providing non GMS/PMS services such as intermediate care, is going to be difficult to get out of). I do know of some cases in non LIFT areas where GPs have themselves got together and agreed to provide joint premises often with additional accommodation from the PCT (i.e. which the PCT would rent from them) which circumvents all the PCT arguments about falling outside of the Strategic Estates Plan and/or not providing adequate services and then makes it very difficult for the PCTs to refuse. If you are looking to this sort of route, then first of all establish that your PCT does not have an overriding agreement with a LIFT Co, and then get from them a copy of their Strategic Estates Plan (or at least that from your particular location). You then need to determine whether your Practice, or yours and another Practice, can provide the accommodation and make allowances for any additional services required. Outside of LIFT Co areas, the PCTs can still be very dominant and prescriptive over what primary and intermediate services are provided from allocated locations and this, in turn, will allow them to determine the size of any new premises. However, outside of a LIFT Co, I do not believe that the PCT can determine who will physically provide those buildings. |
