The basis of the Notional Rent scheme for GPs is that premises will last for longer, and be better maintained, if there is an incentive for the owners (The Doctors or public/private finance ) to look after them well. GPs being self employed, are businesses that take profits. When a GP starts he may incur a debt to buy into a premises, but this debt reduces as he progresses. The interest is tax deductible, and if any profit is made on sale it is subject to business entrapaneurs tax relief. The financial incentives apply to GPs who commit to and stay in a community. The new GPs do not think they will stay in the same practice or job for life. They will need flexibility and the scheme for purchase does not lend itself to short term posts (less than 10 years). There is an argument that the Notional Rent is a form of PFI, and as companies use it to make their profits, the argument becomes stronger. If the state were to build GP premises I would recommend a good concrete slab with all the services ducted in, and above ground a plastic and cardboard structure designed to be ripped down and replaced every 10 years. Whatever the criticism of the current scheme, premises have lasted longer without changes than PFI hospitals. What GPs need is either more doctors, or less patients… I suppose letting a practice become a ruin could mean less patients attended…. a long term argument for state ownership?
The NHS is in talks with private GP landlords over increasing rents to fund a £3.3 billion overhaul of crumbling surgeries, despite fears of a repeat of the private finance initiative controversy.
Some health chiefs believe that private money is the only way to fund super-surgeries where specialists can be based to help to keep people out of hospital. Others fear that the deal could lead to a repeat of the deals that have lumbered the NHS with years of inflated payments to private companies.
Simon Stevens, the chief executive of NHS England, wants to put therapists, pharmacists and diagnostic tests in GP surgeries to ease pressure on hospitals and help to save £22 billion.
However, this would require upfront cash to improve cramped or poorly maintained buildings, at a time when infrastructure budgets have been raided to bail out overspending hospitals.
An official review by Sir Robert Naylor, the national adviser on NHS property and estates, concluded that £10 billion in capital funding would be needed to implement Mr Stevens’s plan, but Philip Hammond, the chancellor, is loath to add such a large sum to the government balance sheet. The Times disclosed in April that health officials had discussed raising some of the money from hedge funds.
Now three big landlord companies have said they are willing to spend £3.3 billion on 750 new medical centres in exchange for being allowed to raise rents by £200 million a year. Between them they own 850 surgeries that care for nine million patients.
Tim Meggitt, director of Octopus Healthcare, which is proposing the deal with Primary Health Properties and Assura, a healthcare property investment trust, said: “This investment in the primary care estate could ensure that government priorities of delivering necessary efficiency savings and keeping people out of costly hospital wards and in the community are met.”
Some officials involved in discussions with the companies have privately expressed nervousness, comparing the offer to the Blair-era initiative that led to the NHS being locked into long-term payments to the companies that rebuilt hospitals. Such deals will cost £2 billion this year, rising to £2.6 billion in 2028.
The companies insist that the latest offer is different because they will be responsible for all risks and maintenance.
Gavin Ralston, head of GP premises for the British Medical Association, said that many GP buildings were too cramped to provide first-class care but that ensuring money promised in the past by the government was properly spent would be a better bet.
“Urgent investment is undoubtedly required, but we should treat these proposals with a high degree of caution,” he said. “A considerable question mark exists over whether PFI-type deals deliver good value for money to the taxpayer.”