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Improving the primary care estate

The pressures facing general practice such as increased workload, an ageing population, responding to the pandemic and the need to extend access to primary medical services has put significant strain on existing infrastructure including premises. The introduction of primary care networks (PCNs) and the additional roles reimbursement scheme (ARRS) which is incentivising a rapid expansion of the primary care workforce, is putting extra pressure on the availability of fit for purpose premises from which to deliver modern primary care services.

PCC recently supported a clinical commissioning group (CCG) in the North of England to improve their governance processes to receive, validate and consider applications from GP practices for funding support for the development and improvement of their premises.

Steve Maleham

GP premises improvements

GP premises procurements, development and improvements can vary in size and complexity including:

  • improvements to existing facilities
  • new premises for GP contractors and their practice staff
  • premises to accommodate a wider range of services and additional roles

The NHS (General Medical Services – Premises Costs) Directions 2013 set out the arrangements for NHS England and NHS Improvement (NHSE&I) and CCGs with delegated commissioning responsibilities to fund premises improvement grants for contractors to extend or improve their premises and, in some instances, financial assistance for the development of new general practice premises.

Responding to an expected increase in applications from practices, the CCG wanted to improve the way in which bids for premises funding are managed and establish a fair and transparent governance process to evaluate applications from GP practices.

The CCG is also working with PCNs to assist them developing their clinical strategies and supporting estates strategies for each PCN. This will strengthen the CCGs ability for decision making, using the new governance processes when strategically assessing applications for investment in the primary care estate.

GP premises funding: application and evaluation of bids

The process and arrangements for GP premises funding support can be summarised as follows:

Responding to an expected increase in bids from practices, the CCG wished to strengthen its internal governance arrangements for managing, evaluating and prioritising applications for funding support, in a systematic, fair and transparent way.

The enhanced governance arrangements introduced are characterised by the following key features:

  • A structured approach to considering applications with clear decision points supported by a range of approved guidance and templates
  • Establishment of a CCG Infrastructure Steering Group to act as initial screening panel for applications but also to provide general premises advice to the CCG
  • Stratification of applications into one of four categories to reflect scale, complexity and risk profile, with each category having specific requirements for documentation required to support the application.
  • Distinct phases in the process, including an initial ‘informal’ phase whereby the GP contractor and the CCG work collaboratively to develop a credible and eligible bid for formal consideration later in the process. Early engagement is particularly important in the context of the Premises Costs Directions, as any costs incurred by a GP contractor that are not agreed in advance with commissioners (including increased recurring premises cost consequences) will not be eligible for retrospective funding support.
  • Robust and effective reporting and tracking of applications at all stages of the process, establishing an effective audit trail of application status, decisions and timelines.
  • A partnership approach between the CCG and relevant PCN leads, the NHSE&I primary care premises team and Strategic Estates Advisors within NHSE&I, supported by effective consultation with key stakeholders including the Local Medical Committee.

This process for GP practices bidding for premises funding support together with effective commissioning arrangements for considering applications should be relevant to all CCG’s.

We would be pleased to provide further information on how PCC can provide a wide range of premises related support and expertise, including estate strategy development, the application of the NHS (General Medical Services – Premises Costs) Directions, and focused training for staff working in commissioning functions with responsibility for premises. For further information please contact enquiries@pcc-cic.org.uk.