Premises funding

During May we ran premises events just as NHS England published guidance on how to apply to the Estates and Technology Transformation Fund (ETTF). At workshops in Leeds, Manchester, Birmingham and London, our premises experts Bill May and Mike Simpson explained the regulatory context and policy aims that commissioners will need to consider when making funding applications. One CCG delegate said the event provided an “excellent overview highlighting key issues to take back to the CCG to action”, but another remarked that it was “frightening to hear the complexity [of the issue] and lack of expertise we have in CCG land”.

ETTF (originally known as the Primary Care Transformation Fund) provides £1bn to improve premises and other “infrastructure” (principally IT) until 2019. Part of the wider funding arrangements for sustainability and transformation plans (STPs), the ETTF should be seen both as new money to develop premises to support new care models and top-up funding for modernisation of the existing primary care estate, though there can be little doubt that schemes that are seen to support transformation will be favoured over those that maintain the status quo.

The deadline for applications is tight, as is the timetable for approval of business cases, release of funds and start of works.

ETTF timeline

Phase 1: Applications from CCGs need to be submitted by the end of this month (June)

Phase 2: NHS England will review applications during July and August, with feedback on submissions planned by the end of July, leaving August for decisions to be taken about which applications are to progress to the next stage

Phase 3: Due diligence will begin in September to provide the detailed information in support of each scheme, including evidence of benefit to patients and improved access to care

Phase 4: NHS England will make final decisions on business cases as soon as possible after the end of phase 3.

One reason for the urgency is that works funded under ETTF must be complete by the end of March 2019, leaving less than three years or considerably less in cases where planning permission must be sought first.

Bill and Mike provided the following advice for CCGs currently submitting applications:

• Remember that funding priorities you set now can’t be changed later. Don’t base priorities on affordability or guesswork about levels of funding you expect to receive, prioritise projects you can’t afford not to do
• Start looking for people now with the project management skills to support you in phases 2 and 3. They will typically have “surveyor” on their CV
• Remember that the funding picture is likely to be fluid for a few months. After the portal closes for applications (30 June) and NHS takes its initial decisions, the due diligence round and subsequent business cases are likely to result in a number of drop-outs. That means the funding pipeline could reopen for another round at a later date
• Premises funding creates fresh threats of potential conflict of interest as CCGs pursue applications on behalf of member practices
• Finally, remember that although ETTF provides a significant boost to premises funding, CCGs will face ongoing premises management issues. They need to be clear of their obligations to support practices but also where they need to push back and remind practices of their own statutory obligations. That means understanding the regulations and in some cases being prepared to apply the rules robustly.

Bill May said: “The pursuit of funding shouldn’t distract commissioners from their real purpose. Premises plans must flow from transformation strategy. If you don’t have a plan for primary care, you don’t have a plan for premises. Some commissioners appear to have forgotten that it’s the contractors’ responsibility to ensure that premises meet minimum standards. It’s the commissioners’ job to provide reasonable support, but it’s not their job to conjure up improvement cash on demand.”

Look out for further workshops on premises later in the year and talk to your local adviser about networks in your area where premises issues can be discussed.  You can also use our helpdesk to find answers to premises related questions.

To continue to get updates, email karen.topping@pcc.nhs.uk and share this newsletter with your colleagues.