NHS Estates

Russell Burns
The NHS’s recent primary care focus has highlighted GP commissioning and the resulting structural, financial and cultural changes. But where does this leave the NHS property portfolio?

Primary care trusts (PCTs) own community hospitals, clinics, some walk-in centres and some GP surgeries. The dissolution of PCTs and strategic health authorities in 2013 means that the ownership of an estimated £6billion of property is undecided.

The land and buildings which form the estate are one of the biggest capital assets of any PCT. The government’s 2010 White Paper proposes radical restructuring of the NHS and aims to transform how health care is commissioned, with around £80billion being transferred to new GP consortia.

These plans make no specific mention of the estate. Nor do they suggest any plan of action to deal with the task of transferring healthcare buildings from the PCTs to their premises' successors.

Who might these successors be?

Past thoughts have been:

  • The message from the Department of Health (DoH) is that operational issues concerning primary care estates should be handled at local level 
  • Some regions have clear plans to move to GP-led commissioning based on a single consortium

  • Others have less developed plans, and possibly conflicting views about the best future configuration

  • Moves have begun to form 52 groups of GP practices – ‘pathfinders’ – to start testing the new commissioning arrangements before more formal arrangements come on board.

Commissioning in the NHS is a complex activity and Britain's 40,000 family doctors will have a tough task ahead. The Royal College of General Practitioners has highlighted (PDF, 236KB) that many GPs currently lack time, skills and capacity for commissioning. Public service union Unison additionally points out that there may be a tension between GPs’ roles as providers and purchasers of health care.

However, in August 2011 the DoH issued PCT Estate: Future ownership and management of estate in the ownership of Primary Care Trusts in England. This document has attempted to clear some of confusion about the future of the estate, using five principles to underpin its guidance:

  • Protecting assets and maintaining future flexibility
  • Ensuring efficiency
  • Supporting the provision of safe, fit for purpose buildings
  • Ensuring value for money
  • Observing effective estate management

The guidance states the estate can transfer to Aspirant Community Foundation Trusts (aCFT), other NHS Trusts (NHST) and Foundation Trusts (FT) who will be given the opportunity to acquire part(s) of the PCT Estate deemed ‘service critical clinical infrastructure’. However, this is not mandatory, and only if the aCFT / NHST or FT is a majority occupier of the building. If not then its recommended that the estate stay within the PCT for the time being. Also vacant or surplus property is recommended to stay with the PCT, again for the time being.

Other parts of the PCT estate are also exempt from this guidance, primarily LIFT / PPP / PFI buildings are all excluded.

As can be seen, the further guidance above provides some information, however, there is still a great deal not yet known. Perhaps the formation of the local Commissioning Boards will be more involved in retaining appropriate estate, it remains to be seen.

Uncertainty

The sternest critics called for the government to abandon the plan to force GPs to take over all commissioning by April 2013, because some will simply not be ready. Others want PCTs to continue in some form to minimise disruption to services or loss of skilled staff. PCTs have been told to cut their management costs by over 45%, signalling huge redundancies on the commissioning side. This is already impacting on the viability of PCTs to manage the transition period.

An uncertain and fragmented picture looks likely until the decision making is completed and the new organisational framework for the NHS becomes fully embedded.

Challenges

Developing the balance between patient care, service delivery, clinical control and value for money will be complex. The commissioners face challenges in

  • Dealing with ‘Any Willing Providers
  • The potential input of the private sector
  • The new registration and compliance procedures (regulated by the Care Quality Commission)
  • Developing non-core business management skills previously provided by other organisations
  • Taking responsibility for maintaining statutory compliant estates and premises
  • Efficiently managing non-medical issues
  • Working not only as a new business but also as part of consortia, rather than as individuals.

Faithful+Gould has 50 years of health sector experience, spanning all aspects of capital development, facilities management, strategic investment planning and environmental support. Our expertise encompasses all procurement models employed in the healthcare environment. In meeting the sector’s latest estates challenges, we envisage supporting existing and new client bodies with exploratory, preparatory and operational aspects of meeting their new responsibilities.

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