Answer
Unfortunately, the PCT have rebuffed all your proposals on the grounds that they are not able to financially support such a move. I suspect that this relates not to capital but revenue costs as rent per m² for new purpose built and fully compliant premises could itself represent a 50% increase and then if you are for example looking to quadruple the size of your premises, the total affect for the PCT would be to multiply their rent and rates costs eight fold. Thus, whether you develop yourselves or get a third party developer to procure a new medical centre, the affect on the rent reimbursed by the PCT will be noteable.
I am afraid that the malaise of your PCT is not uncommon and indeed is probably more prevalent throughout the south of the country where many a PCT is suffering severe financial limitations which, in turn, has resulted in the finance department domineering over that of service provision and, in many areas, taking a very short term outlook, with numerous new development projects being cancelled.
This short term approach is causing a Catch 22 scenario where the PCTs do not have the forward planning in place (in the form of a strong Strategic Services Development Plan) to see the light at the end of the tunnel. If PCTs are preventing the creation of new and improved medical centres, then Practices like yourselves will no doubt continue to be forced to make substantial referrals through to secondary healthcare and, furthermore, be unable to take on any additional secondary healthcare services for the locality. Without this move in services, the NHS will fail to “bring healthcare to the community” and fail to make the substantial cost savings that all believe should be available. As a rule of thumb, I understand that 30% saving in costs could be made by such services being run from Practice premises rather than the hospitals.
Having regard to the above, and in order to move forward, I think your Practice needs to put together a total business plan, not just dealing with the proposed new premises but showing that within such new premises, whilst the cost of rent and rates may increase substantially, they can be balanced against savings within the Practice resulting from the substantially reduced need to refer patients to secondary care, potential cost savings from running secondary healthcare services from the centre, and other things such as proposed well-being clinics that will cut down future treatment costs.
I note that your PCT is in a LIFT area and they will therefore have an exclusivity agreement with LIFT Co, but this only relates to the PCT where they are involved in premises or where they are going to run services from premises. In respect of yourselves as a GP Practice, you cannot be forced to exclusively use LIFT Co and, for your own GMS or PMS services, can either develop yourself or indeed use a third party developer to develop. However, you do need PCT approval in that they must agree to your proposed business plan and be happy that it falls in line with their own Strategic Services Development Plan. With PCT approval, they must then reimburse the full and proper rent on the premises as set by the District Valuer. If you develop without PCT approval, they are under no obligation to increase rent reimbursement. |
