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When choosing a new care model organisations need to analyse where best to deliver the services from, which delivery partners will deliver those services and how they will own or occupy the relevant premises.
The first thing organisations need to do is articulate their objectives. Once that is clear then the parties can work out whether any services need to be re-located and, if so, consider the transactions that might be necessary to make this happen. Decisions about the estate should be made early on or there is a risk of ending up implementing avoidable estate stop-gaps.
Integrated new care models may create new opportunities to escape from the constraints of some of an organisation’s current service environments, but escape to where? Different new care models may imply different premises outcomes, for example:
- Expansion of primary and community services at a hospital site: This may involve Trusts taking on employment of GPs to deliver services at their sites. In this case the Trusts and GPs will need to consider how to deal with GPs’ existing freehold and leasehold premises and other liabilities
- Expansion by Trusts of primary and community services in GP premises: Trusts and GPs will need to consider the implications of the Trust acquiring freehold premises from GPs, which may require capital investment, or taking on leases, which may mean acquiring leasehold liabilities. In addition, since GPs operating under a GMS contract receive rent reimbursement (so that all property costs are passed through to the commissioner), Trusts and GPs will need to consider how the Trust can continue to be reimbursed for costs of property that transfers to it
- Expansion by GPs and other providers of services in community and home settings: GPs and other community providers may take over the running of community hospitals and expand the services provided at those hospitals and in other community and home settings. This may involve Trusts disposing of such hospitals to GPs or other providers. Any disposals will need to comply with restrictions on disposals of NHS estate (including Monitor guidance and Estatecode) and EU State Aid restrictions (see complying with competition law above).
Equally, new care models present a tremendous opportunity to rationalise estate and create efficiencies – but only if achieving those estate efficiencies is an objective in itself, alongside patient-facing priorities.
Making the most of estates opportunities – key questions
- Have you analysed you estate requirements for your care model?
- Once you have identified the optimal delivery solution, have you collaborated with delivery partners, commissioners and estate owners to make sure the right premises will be available on commercially viable terms?
- What investments and disposals do you need to implement; when and how will you action them; have you considered the impact of regulatory constraints on the disposal of any properties?
- How do you intend to manage estates liabilities (including backlog maintenance and securing capital investment) and is there a proper mechanism for occupancy cost recovery?
- Have you taken expert estates advice and could a Strategic Estates Partner deliver valuable estates expertise; access to commercial funding and revenue–generation?
The government’s health and care white paper “Integration and Innovation: working together to improve health and social care for all” was launched last week. It paves the way for a Health and Care Bill intended to increase collaboration and co-operation across the health and social care services.