Newsflash: Private GP Services – not under my roof!
The recently published NHS England guidance on the new GMS contract outlines a new blanket ban on GPs advertising and hosting private GP services from within their surgery premises. The changes mark a sea change and are potentially a major threat to a number of existing practice business models.
The regulations and directions governing GMS, PMS and APMS contracts respectively have never included specific contractual restrictions on offering private GP services. GPs would of course need to ensure that any private services did not conflict with their contractual obligations to the NHS and their registered patients but beyond this, and so long as the contract was being performed, practices had relative freedom to design their businesses to include a private GP element if they so wished.
The only element of restriction was found in the 2004 Premises Costs Directions which provided that so long as no more than 10% of a Practice’s profit comprised private work undertaken within the surgery premises, it would not suffer any loss of NHS premises funding. However, the express 10% tolerance did not appear in the 2013 PCDs and, where they apply, GPs are required to include within their application for premises funding, the actual amount of private work undertaken from within their premises.
So until now practices meeting their contractual obligations have been free to host private GP services in their NHS funded premises albeit with a potential risk of losing some of that premises funding.
Following the publication of the Guidance, it seems we are now moving towards a zero-tolerance approach, whereby any housing of private GP services in the same building as the NHS practice would amount to a breach of the contract itself.
The rationale and broad principles of the changes are set out in section 3.3 of the Guidance:
“to safeguard the model of comprehensive NHS primary medical care, from 2019 it will no longer be possible for any GP provider either directly or via proxy to advertise or host private paid-for GP services that fall within the scope of NHS funded primary medical services”
The ban is to be qualified to the extent that:
“This policy will not prevent individual GPs from offering purely private GP services to non-registered patients outside of times they are contracted by an NHS provider of primary medical services and on alternative premises which are not NHS-funded.”
Whilst this seems to leave the door ajar for Practices to offer private GP services outside of their contracted hours, crucially it appears that these services must be provided on alternative premises (i.e. not on the surgery premises).
Is this a total ban on private GP Services from anywhere under my roof?
Unfortunately it is not clear whether private GP services will be permitted in other parts of the practice premises that do not qualify for NHS premises funding (e.g. because they are vacant, let to someone else or just simply underutilised so as not to qualify for NHS funding).
The Guidance does offer the following commentary on how the ban will apply:
- A Practice will not be able to house an NHS and private GP service in the same building as this would amount to hosting a private GP service. The only exception mentioned concerns leased premises where it recognises the leaseholder (i.e. the Practice) has no influence over how the landlord chooses to use other parts of the building. However, where the GPs owns the building they will clearly have influence and control over all parts, not just the NHS funded part.
- A Practice may rent out parts of the practice premises to, for example, a pharmacist, optician or dentist who provide some private services as those providers could not offer private GP services either physically or digitally. However, this implies that a Practice will not be permitted to either use themselves or rent out part of the premises for private GP services.
An urgent need for clarity?
The Guidance perhaps poses more question than it answers and we are unlikely to gain further clarity until the new GMS Regulations are published later this year. The key point that has to be addressed is whether the ban is to apply to:
- Only those parts of the practice premises for which NHS premises funding is provided; or
- Each and every part of the practice premises regardless of current use and funding.
Clearly those offering private GP services will be hoping the first scenario applies. The second is perhaps harder to rationalise as it would restrict the use of premises which presumably have already been deemed to be surplus to the needs of the NHS service. It also seems difficult to justify why it should be permissible for a Practice to occupy two adjoining buildings, providing NHS services from one and private services from the other, but not for a Practice to divide its building horizontally with the offerings separated, perhaps between the ground and first floor, and accessed by separate entrances.
Either way the ban is a potential cliff edge threat to a number of existing business models and those Practices affected will need to watch this space carefully and plan as best they can, perhaps with engagement with their CCG.
If you have any queries or would like to discuss these issues further, please contact one of our specialist team.