Whilst all healthcare providers need premises to operate from - even purely digital providers have to have property of some sort - premises issues and the costs associated with them are often the last things to be addressed when the NHS introduces change.
Many GP premises are already overcrowded and not all are fit for purpose. With 20,000 new people likely to be recruited as a result of PCNs, there needs to be somewhere to put them.
Existing GP premises are not always the most flexible for uses outside the core GP contract. This is due to the way in which premises costs are reimbursed, and the restrictions on use and sharing of occupation which comes with that reimbursement. Many are held on leases which have provisions restricting shared use.
An interest in premises also comes with liabilities attached, whether to pay a rent under a lease or due to borrowing costs for a freehold. Whilst GPs premises costs are reimbursed for core contract use, it is unclear whether property costs for PCN use outside of just delivering the DES requirements will be reimbursed, a factor in acquiring new space.
Whilst some answers may be given when the NHS England Premises review is completed and when the new Premises Cost Directions are finally issued, we don't know when this will be. This makes it very difficult to predict with any certainty how premises issues can be dealt with.
In the meantime, we can only go back on what we know.
New space for PCNs and how this is procured depends on how PCNs are structured and premises costs are funded. It may be that the lead practice can take an interest in new space, subject to indemnities for the PCN but where a new company is formed (rather than the more likely PCN model of a contractual joint venture) and wishes to lease space, a Landlord may look for additional security by way of guarantees for the rent from partners of constituent practices.
We are already considering how these issues might be addressed in current transactions and are taking a cautious approach and seeking to build in additional flexibility in the legal documents to allow sharing of space. There is no one answer and premises issues should be addressed on a case by case basis, depending on what the existing arrangements are and the proposed use.