The average pencil is seven inches long, with just a half-inch eraser - in case you thought optimism was dead. Robert Brault

Premises:

As you will recall our plans to relocate to more patient friendly premises have been dragging on for some time (more than 12 years!) but with the change in organisational structure to the NHS new people and departments are responsible for making these decisions. There are new priorities and targets for them. This is an extract of an e-mail received from NHS England updating us on their view of our current application for a new surgery premises.

“The vision for future Primary Care provision is that it must be available from:

·         modern fit for purpose buildings under current regulations and guidelines

·         wherever possible practices should co-locate to reduce operating costs and overheads, benefiting from economies of scale

·         multiple providers should operate from single locations to provide a variety of patient services

·         building should support the out of hospital agenda, offering an increased range of services within the Primary Care setting such as diagnostics etc

Additionally, there is very limited funding available for capital projects, and only those classified as high priority, are likely to reach the approval stage of the stringent process. Non-recurring costs will now be considered in line with the new NHS England premises discretionary funding policy rather than the previous Cluster policy.

The business case you are presenting is an anomaly to what I have previously described. If it is to be recommended for approval, it must be the most cost effective option, provide significant added value, and stack up in all areas. This is not currently the case.”

We sought a meeting with representatives of the new primary care commissioners and received the following response:

“I am fully aware of the history which dates back to around 2002 and ****** and I reviewed the Business Case (BC) together. In fact, I still have the historic audit trail! With the greatest of respect to all parties, because of the financial situation and strategic drivers that now impact upon premises development BC decisions across London, and the fact that each BC must compete against a set of London priorities (e.g. New GP premises within the former Olympic Park to serve the significant new population), as ****** says, only BCs that can tick as many boxes as possible will be accepted. As much as it pains me to say it, the historic facts will not make a difference in themselves, BUT, coupled with a BC that responds to as many strategic deliverables as possible, will be something we (senior commissioners) are able to support. I therefore suggest that before any meeting is convened, you consider our comments and seek to amend the BC.”

This week we are meeting again with the Development Executive of GPI who has been supporting our application and a representative of the Bromley CCG. We hope we can revise the business case to "tick as many boxes as possible".