NHS England premises policy review and NAO report on NHSPS

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On 27 June, NHS England published its premises policy review.

The full document is available here.

The accompanying NHS England board paper summarises the review’s proposals as follows:

  1. assign existing practice leases to NHS bodies where they are of strategic importance, and where their length and liabilities prevent the healthy renewal of partnerships and the estate. The detail of which leases are of strategic importance will be subject to further detailed discussions with GPC and within NHS England and Improvement during 2019. The capital DEL cover which would be required to enable this will be dependent on discussions with HM Treasury, the outcome of the Government’s spending review, and a relative prioritisation process;
  2. support the availability of an ownership model which continues to make sense for GP practices, but over time we expect more practices to want to separate the decision to enter premises ownership from the operation of primary medical services. We will develop best practice guidance on this for all property-owning GPs. Future NHS capital investment would come with a requirement to demonstrate robust governance around property ownership
  3. provide clearer guidance on the expectations of owners and occupiers around maintenance and standards, as part of professionalising property ownership and management
  4. pilot alternative premises reimbursement arrangements at network level, to give networks greater autonomy to manage and minimise their costs relating to estates across their premises
  5. pilot a simpler model of premises provision in which the NHS directly bears the cost of premises in multi-use new build premises, removing the need for bureaucratic premises reimbursement systems, promoting integration of service delivery and optimal use of space
  6. develop a package of support relating to primary care engagement in STPs’ and ICSs’ capital strategies and the capital allocations process
  7. encourage networks to start now working out their future estates needs, taking into account joint working and the estate of their community partners
  8. focus our primary efforts on understanding what it would take to ensure we have premises that are fit for purpose, as part of the Spending Review
  9. following the Spending Review, develop and publish a premises implementation framework. 

NAO investigation into NHS Property Services

On 26 June the National Audit Office published its report into NHS Property Services (NHSPS).

The full document is available here.

The report’s recommendations are:

Diagnosing and addressing the challenges facing the Service is a collective enterprise, which needs to involve all parties to be effective.

The Department, in collaboration with national bodies and the Service should:

a. develop a plan to ensure that the Service and all tenants of the Service’s premises will agree tenancy details and amounts by 31 March 2020; and
b. put in place an efficient dispute resolution process whereby all disputes are settled within 90 days of invoicing and agree a plan to clear outstanding disputes including a service-level agreement for responding to queries from tenants in a reasonable time so that there is agreement on the nature and value of the disputed amount before entering the arbitration process.

The Department and national bodies should:

c. examine ways to encourage occupiers and local health economies to take greater ownership of paying for the Service’s estate.

The Department should:

d. provide stronger challenge to the Service’s process for setting directors’ bonuses, so that bonuses are paid for achieving genuinely stretching and important targets; and
e. complete the strategic review of the Service in time to inform decision-making in the expected 2019 Spending Review.

The Service should:

f. build on its existing quality metrics, with input from stakeholders, so that its performance can be monitored, including the accuracy of billing;
g. continue to reduce the time it takes to issue bills; and
h. review its capacity to deal with queries in an effective and timely manner.

In addition to these recommendations, page 21 includes an ambition to be “able to sell the company on the open market if desired.”

Page 31 states that: “Other activities aimed at reducing debt include: piloting direct payment from CCGs to the Service in respect of GPs’ rent and national bodies asking commissioners to stop withdrawing subsidies without adequately assessing whether the tenants will be able to afford the rents in future.”

On 26 July the BMA wrote to NHSPS, identifying the areas in which it felt NHSPS was acting unlawfully.

Last updated : 16 Jul 2019