Primary Medical Care Premises – Update Ian Turnbull Interim Strategic Primary Medical Care Premises Manager Ophthalmic Contract Manager

Current Situation No posts in NHS England structure for primary care premises work Many residual priorities remain from previous organisations – some time limited approvals will be up for review shortly National Principles of Best Practice guidance being developed – anticipated launch event in April 2014

Devon premises size guidance Devised and agreed with LMCs in 2004, used across Devon since that time  Directly linked to previous size schedules which used to exist in old SFA Based on patient list size rather than number of Practitioners Ensures we don’t plan buildings for now, allows some growth Allows dialogue with planners regarding new housing developments

Devon premises size guidance - continued 500m 2 Gross Internal Area (GIA) for 6,000 patients - up to 10,000 patients 250m2 GIA for 6,000 patients – after 10,000 patients to reflect economies of scale Allows for comparison of capacity across Area Team geography

Priorities – first look Geographical gaps in service provision  Main surgeries which are 50% or more undersized Branch surgeries which are 75% or more undersized Surgeries with unsatisfactory functionality and/or condition

Example Estate Profile

Process for Reviewing Premises Business Cases

Premises Directions 2013 Sale and lease back implications - VAT  Car parking - dual parking Private use of buildings – private income percentages Abatement of notional rent - revised time periods Future negotiations

Notional rent reviews Schedule of reviews due sent to SBS – Jane Hoy  CMR 1/1a form sent to practice for completion Completed forms returned to SBS Forms sent to NHS England for checking and sign off Forms returned to SBS SBS submits paperwork to District Valuer DV visits and issues report SBS advise practice of valuation and invites them to accept valuation figure

Notional rent reviews - continued Practice accepts valuation offered and revised reimbursement commences Practice rejects valuation and gathers comparable evidence to support appeal  DV instructed to liaise with practice regarding appeal evidence  DV advises SBS of outcome of negotiations If still unagreed, matter can be referred for Dispute Resolution

Known issues with revised Premises Directions 2014 Borrowing costs scheme still doesn’t work Lack of clarity about use of rooms by 3 rd parties Service charges versus rents for non GMS use of building  Directions don’t address backlog maintenance issues They don’t address issue of practices borrowing on interest only basis Premises ownership – Partnership Agreements

The future? NHS Property Services - implications? Minimum Standards compliance visits? Ad-hoc reimbursements? CCGs investing in primary medical care premises? New monies?

Questions? ?