Is there a simple way to choose the model of property ownership that will enable greater integration, better customer experience and increased flexibility in your area? Of course not, but by examining a number of key considerations, GPs, CCGs and trusts can start to remove estate barriers – eventually even turning them into opportunities.
Based on his experience of delivering complex healthcare property projects, Phil Holland, Chief Investment Officer at Prime, looks at the pros and cons of six different GP property approaches.
It started as long ago as the Second World War. The government simply did not have the finances to own doctors’ surgeries, so GPs paid for their own premises and the state provided an annual contribution towards the cost.
Fast-forward and we may be in very different times but the majority (57% ) of GP properties are still owned by the partners themselves. There are now a number of significant drivers for change in primary care, including the need to modernise facilities, the NHS Long Term Plan, new GP contracts, partners wanting to retire, the push for integration… The list is endless.
With the pressure well-and-truly on, this article is designed to be used as a starting point for discussions between GPs, CCGs and other interested parties as they navigate the property ownership models that could help them meet the challenges of today.
We see that there are six tried-and-tested GP ownership models, each with their own positive and negative aspects. There is no one right answer for which is the best value, most future-proofed or most innovative as every areas’ healthcare structure and financial situation is so different. Having said that, there are a number of universal considerations.
Model 1. GP freehold
Considerations:
- How are decisions made if not all partners own the property?
- Will partners want to put money into transforming property if there is no guarantee they will get out what they put in?
- With greater control, will it be easier for GPs to integrate the property and make sure the right changes happen?
- Who will be the “Last Man Standing” and are there succession plans in place?
Model 2. Private ownership
Considerations:
- Is it beneficial for financial support to be available quickly?
- Are you happy to work with an investor’s preferred developers? Or will investors work with your chosen developer
- Investors understandably want a commercial return and to please shareholders, so will your objectives match?
- Will the approval process be more complex as there is a third-party involved?
Model 3. NHS Trust Owned – Leased to GPs
Considerations:
- Will you build greater understanding and common interests, as you will all be part of the integration process?
- Can you get greater efficiencies by integrating some budgets and resources?
- Will Trust challenges outweigh plans for primary care provision?
Model 4. NHS Property Services Owned – Leased to GPs
Considerations:
- How is your relationship with NHS PS?
- Do you know what they will charge now and for the future?
- As they are part of the NHS family, will they have a stronger understanding of the process that could benefit you?
Model 5. LIFT Owned – Subleased to GPs
Considerations:
- Will rents be seen as high, which could mean bringing in new services from a different budget pot is difficult?
- Is it beneficial to use LIFT companies’ wealth of knowledge, expertise and commitment to the assets?
- Could a proactive maintenance regime protect or improve the standard of accommodation?
Model 6. GP provider propco
Considerations:
- Would concentrating non-clinical back-office functions into fewer buildings improve efficiencies?
- Could property usage be planned on an area-wide basis from your own estate?
Creating your roadmap for change
All these models can coexist within one system or as part of a hub-and-spoke model, so there are several options for GP premises ownership and many paths forward. It can seem impossible to find a way through but it’s essential: property planning could well be the answer to enabling integration and urgently needed new models of care.
To understand the best options for you, the first step is a structured conversation facilitated by a trusted professional who has worked within these models and can offer practical guidance on how to fit the pieces of this complex jigsaw together.
For a more in-depth conversation, get in touch and I’d be more than happy to help.
