5. CAPITAL EXPENDITURE AND
INVESTMENT
5.2 Primary care capital investment and facilities
5.2.1 Could the Department provide an
account of capital allocations for primary care investment and
the sources of funding (both HCHS capital and revenue and Family
Health Services budgets) over the last eight years for England
and by health authority? Can they reconcile the General Medical
Services budgets against the HCHS and Family Health Services budgets?
[5.2.1]
1. The majority of funding for capital in
GMS or PMS is made available through revenue funding streams:
HA revenue allocations which includes GMS discretionary and PMS
funding and GMS non-discretionary spend. Capital related expenditure
in the discretionary element includes cost rents, improvement
grants and computer purchases and PMS funding, while the non-discretionary
element includes GMS notional rents.
2. GMS capital is allocated as revenue because
HAs do not own the assets acquired. A transfer from HCHS capital
to revenue is made each year to fund an element of the total discretionary
GMS provision.
3. The table below shows the transfers of
funds made for year's 1995-96 to 2003-04. Details of transfers
for earlier years are not available.
Transfer of HCHS Capital for HA Revenue
Allocations for 1995-96 to 2003-04
|
| 1995-96 | £23 million
|
| 1996-97 | £24 million
|
| 1997-98 | £25 million
|
| 1998-99 | £26 million
|
| 1999-2000 | £26 million
|
| 2000-01 | £27 million
|
| 2001-02 | £27 million
|
| 2002-03 | £28 million
|
| 2003-04 | N/A*
|
|
| *2003-04 already in settlement received from Treasury.
|
5.2.2 Could the Department provide a trend analysis
of the costs of the rental reimbursement schemes (in graphic form)
by category (eg notional, actual etc) and an explanation for any
changes? [5.2.2]
1. The information requested is provided in Table
5.2.2 and Figures 5.2.2(a) and (b)
Table 5.2.2
SPEND ON GMS PREMISES (ENGLAND) 1995-96 TO 2001-02
| | |
| | | | £ million
|
|
| 1995-96
| 1996-97 | 1997-98
| 1998-99 | 1999-2000
| 2000-01 | 2001-02
|
|
| Non Discretionary (Non-Cash Limited) |
| | | |
| | |
| Notional Rents | 48.7
| 56.4 | 68.2
| 75.9 | 85.6
| 93.6 | 87.4
|
| Actual rent | 22.5
| 23.2 | 18.2
| 24.7 | 28.2
| 18.6 | 17.3
|
| Actual rent—*Health centres (incl Lease and Licence payments only)
| | | 18.1
| 20.7 | 19.8
| 37.5 | 36.1
|
| Rates/water/sewage | 44.2
| 52 | 56.9
| 63.6 | 68.1
| 71.8 | 72.5
|
| *Health centre Rates/water/sewage |
| | 7.1 |
8.1 | 7.1
| 5.7 | 6.3
|
Ongoing rental on vacated premises,
SFA para 55
| | | | 0.1
| 4 | 0
| 0 |
| Non Discretionary Premises total | 115.4
| 131.6 | 168.5
| 193.1 | 212.8
| 227.2 | 219.6
|
| Discretionary (Cash Limited) |
| | | |
| | |
| Cost Rents and LA Economic Rents | 94.5
| 96.4 | 96.3
| 98.2 | 88.9
| 85.6 | 65.1
|
| Improvement grants | 41.3
| 28.8 | 20.3
| 22.2 | 16.9
| 16.9 | 14.2
|
| Improvement grants *(for Health centres) |
| | 7.1
| 5.6 | 2.9
| 4.5 | 3.6
|
| Grants to surrender leases on poor premises under SFA para 55
| | | | 0.2
| 0 | 0
| 0 |
| Discretionary Premises total | 135.8
| 125.2 | 123.7
| 126.2 | 108.7
| 107 | 82.9
|
|
Footnotes:
1 Non Discretionary—non-cash limited.
Please note that from 1997-98 Actual rents was split to additionally
show introduction of Health Centre rents incurred.
Health centre rates were created in 1997-98 to identify costs
incurred.
2 Discretionary—cash limited.
Again with the introduction of monitoring Health Centre spend
from 1997-98—Improvement Grants have been split to separately
identify Health Centre and Other spend.
3 Please note that 2001-02 information is based on provisional
FIS discretionary and non-discretionary outturn.
4 All data is unaudited and is based on FIS(FHS)4 part B and
part C non cash limited and cash limited returns respectively.
5 Data up to 1995-96 is based on the returns of the former
90 FHSAs up to 1996, the 100 England HAs and PCTs from 2000-01.
Data from 1996 onwards is based on HA returns.
6 Data on PMS premises spend is not collected centrally.
7 Decreases in all premises spend in 2001-02 are due to the
impact on increases wave 1-3b PMS pilots.
5.2.3 Could the Department provide an account of the
total value of the asset base in primary care by category of owner,
eg HA, LA, GP, private provider? [5.2.3]
1. The total value of premises occupied by GPs is around
£2.06 billion. This comprises £1.53 billion owner-occupied
premises, £173 million rented from the private sector and
£361 million for NHS-owned health centres. These figures
are based on an amortisation of actual, notional and cost rents
reimbursed to GPs providing GMS. We do not collect information
on PMS practice premises centrally.
2. These figures are lower than last year due to the
impact of PMS.
5.2.4 Could the Department provide an account of estimates
of backlog in repairs and maintenance for primary care nationally
and by health authority? [5.2.4]
1. Financial data on the value of backlog repair and
maintenance for the GP estate is not held centrally. However,
from a total of around 11,000 premises, analysis of a sample of
3,912 rented (excluding health centres) and notional rented premises
showed the following:
5.2.5 Could the Department provide baseline data on
the changing ownership of primary care premises and provide details
of the top 10 new provider companies? [5.2.5]
1. The ratios for GP premises are 63% owner-occupied,
21% private sector owned and 16% are NHS-owned health centres.
To date, premises built by third party developers have mainly
replaced existing premises already rented in the private sector.
It is expected therefore that the above ratios currently remain
constant.
2. The leasing of purpose built premises to GPs is still
a relatively new concept involving an increasing number of developers
with varying numbers of completed projects. A "top ten"
list of companies is not yet feasible in this maturing sector
of the GP estate. However, the Department has issued standards
of size, design, construction and lease terms that all third party
developers should give regard when building premises suitable
for modern primary care.
5.2.6 Could the Department please provide data on
all grants, public loans and capital receipts used to fund or
finance primary care facilities on an annual basis since 1997.
[5.2.6]
1. The majority of funding for capital in GMS or PMS
is made available through revenue funding streams: HA revenue
allocations which include GMS discretionary, PMS funding and GMS
non-discretionary spend. Capital related expenditure in the discretionary
element includes cost rents, improvement grants and computer purchases
and PMS funding, while the non-discretionary element includes
GMS notional rents.
2. Up to 2002-03 a transfer was made each year from HCHS
capital to revenue to fund an element of the total discretionary
GMS provision—the sums are shown below. From 2003-04 onwards
the GMS element is fully met from the Department's revenue stream
following the introduction of a further stage of Resource Accounting
and Budgeting (RAB).
Transfer of HCHS Capital for Unified Revenue Allocations
for 1997-98 to 2002-03
|
| 1997-98 | £25 million
|
| 1998-99 | £26 million
|
| 1999-2000 | £26 million
|
| 2000-01 | £27 million
|
| 2001-02 | £27 million
|
| 2002-03 | £28 million
|
|
3. In addition, £30 million of public capital has
been invested during 2002-03 in the most under doctored areas
of the country to improve up to 400 practice premises to accommodate
550 new GP Registrars. £22 million of public capital was
allocated to PCTs in 2002 to develop 100 existing GP surgeries
to one-stop primary care centres by 2003 in the most under doctored
areas of the country. These centres bring primary and community
services and, where possible, social services and other primary
care providers together on one site to make access more convenient
for patients.
5.2.7 Could the department please provide a list of
primary care premises which have signed or in the process of signing
up for the use of PFI, together with their total capital cost,
the length of contract, the annual unitary charge and availability
fee and FM fee. Where projects are bundled with non-NHS facilities,
could they also provide details of the other income streams eg
from commercial and retail, local authority. [5.2.7]
1. PFI is not currently used for the provision of primary
care premises in the NHS. NHS LIFT is a new form of public-private
partnership which aims to develop new primary care facilities.
A list of the 42 schemes currently being developed under the NHS
LIFT initiative is included at Table 5.2.7.
Table 5.2.7
NHS LIFT SCHEMES
| Public Body | Status Capital value (£m)
|
|
| First wave | |
|
| East London and City | LIFTco established
| 62 |
| Manchester, Salford and Trafford | Preferred bidder—ExcellCare Ltd
| 49 |
| Barnsley | Preferred bidder—Community Solutions for Primary Care Ltd
| 10 |
| Sandwell | Preferred bidder—ExcellCare Ltd
| 16 |
| Newcastle and North Tyneside | Preferred bidder—Robertson
| 15 |
| Camden and Islington | Preferred bidder—Community Solutions for Primary Care Ltd
| 17 |
| | |
|
| Second Wave | |
|
| Liverpool and Sefton | Shortlisted—ExcellCare Ltd, 1st Health Solutions Ltd, Findlay, Galliford Try
| 25 |
| North Staffordshire | Shortlisted—ExcellCare Ltd, Jarvis Primary Health Ltd,
Prime
| 20 |
| East Lancashire | Preferred Bidder—Eric Wright Group
| 15 |
| Bradford | Shortlisted—B & N Group Ltd, Community Solutions for Primary Care Ltd, Jarvis Primary Health Ltd
| 16 |
| Hull | Shortlisted—Amec, Prime, Sewell
| 18 |
| Birmingham and Solihull | Preferred bidder—Carillion Prime
| 50 |
| Coventry | Shortlisted—ExcellCare Ltd, Prime, GB Consortium
| 43 |
| Leicester City | Preferred bidder—ExcellCare Ltd
| 25 |
| Medway | Shortlisted—Capita, Mount Anvil, Ryhurst
| 22 |
| Redbridge and Waltham Forest | Preferred bidder—Ryhurst
| 27 |
| Cornwall and Isles of Scilly | Preferred bidder—1st Health Solutions Ltd
| 14 |
| Barking and Havering | Preferred bidder—Primaria
| 47 |
| | |
|
| Third Wave | |
|
| Greater Nottingham | Shortlisted—ExcellCare Ltd, Group4 Falck, Primaria
| 27 |
| Wigan | Shortlisted—Eric Wright Group, Galliford Try/Noble Health Partnership, Prime
| 15 |
| Derby | Shortlisted—Infracare, ExcellCare Ltd, Prime
| 21 |
| Doncaster | Shorlisted—Community Solutions for Primary Care Ltd, Infracare, Jarvis Primary Health Ltd
| 16 |
| North Nottingham | Shortlisted—Infracare, Jarvis Primary Health Ltd, ExcellCare Ltd
| 20 |
| Leeds | Shortlisted—B & N Group Ltd, ExcellCare Ltd, William Pears (Family Holdings)
| 28 |
| Oldham | Shortlisted—Bowmer and Kirkland Ltd, ExcellCare Ltd, 1st Health Solutions Ltd
| 17 |
| South East Sheffield | Shortlisted—1st Health Solutions Ltd, Prime, Community Solutions for Primary Care Ltd
| 16 |
| St Helens, Knowsley, Halton and Warrington |
Shortlisted—William Pears (Family Holdings), ExcellCare Ltd, Jarvis Primary Health Ltd
| 22 |
| Tees Valley | Shortlisted—B&N Group Ltd, William Pears (Family Holdings), ExcellCare Ltd
| 21 |
| Wolverhampton | Shortlisted—Group 4 Falck, Carillion Prime, Jarvis Primary Health Ltd
| 30 |
| Barnet, Enfield and Haringey | Shortlisted—Group 4 Falck, Galliford (ex GB Consortium), Building Better Health
| 29 |
| Bristol | Preferred bidder—Infracare (South West) Ltd
| 31 |
| Bromley, Bexley and Greenwich | Shortlisted—Carillion Prime, Group 4 Falck, Mill Group
| 50 |
| Ealing, Hammersmith and Hounslow | Preferred bidder—Building Better Health
| 47 |
| Lambeth, Southwark and Lewisham | Shortlisted—Group 4 Falck, Mill Group, Building Better Health
| 43 |
| South West London | Shortlisted—Jarvis Primary Health Ltd, Building Better Health, Ryhurst
| 23 |
| Dudley South | Shortlisted—Jarvis Primary Health Ltd, AWG, Infracare
| 30 |
| East Hampshire, Fareham/Gosport | Shortlisted—Carillion Prime, Community Solutions for Primary Care Limited, Infracare
| 41 |
| Plymouth | Shortlisted—Guildhouse Investment Management & Hamilton Corporate, Infracare, Midas
| 15 |
| Brent, Harrow and Hillingdon | Shortlisted—ExcellCare Ltd, Group4 Falck, PC2
| 20 |
| Oxford City | Shortlisted—Carillion Prime, Community Solutions for Primary Care Ltd, Infracare
| 40 |
| Norfolk | Shortlisted—Capita, Guildhouse Investment Management & Hamilton Corporate, WSA.
| 20 |
| Colchester and Tendring | Shortlisted—Mill Group, Amec, Community Solutions for Primary Care Ltd
| 28 |
|
5.2.8 Could the department provide data on practice
premise size (single handed, 1-4, 4-8, 8-12, 12 plus and average
list size) by ownership category? [5.2.9]
1. We do not hold complete data. The survey/sampling
exercise is a only a partial survey and is not robust enough to
indicate proportion/numbers of different sized practices occupying
either leasehold or freehold property.
|
