These Q&As will be updated on a regular basis in response to further questions and developments.
- What is the Estates and Technology Fund (Primary Care)?
- Can schemes that involve a wide range of providers be funded?
- How is funding being distributed?
- What is the process for bids currently in the pipeline?
- What criteria is NHS England using to determine which bids can receive funding?
- What type of schemes would be considered?
- These schemes may require a GP to enter into a lease. How do we give GPs the confidence to sign up to a lease and mitigate the risks involved?
- How can a scheme be 100% funded when there is a revenue consequence?
- Will funds be evenly distributed between CCGs?
- How will the NHS England get best value for money particularly on LIFT schemes?
- Is it possible to bid for a future population or service growth and a requirement for the space to accommodate this?
- Who funds the multi-partnered care proposals?
- Are NHS procurement routes such as LIFT looked upon more favourably than 3PD at scheme assessment?
- How can a CCG make best use the capital funding available in order to minimise the revenue impact of the projects?
- Will the fund support the cost of accommodation for third sector (voluntary)?
- Will CCGs have to sign up to the revenue consequences of developments, improvements, extensions and new builds?
- What’s the maximum capital investment for a new build?
- Is there a view that the scheme will be oversubscribed?
- The Guidance makes no mention of security of tenure of properties or abatement of rents, will there be any change?
- How will bids pass due diligence process if the revenue consequences are deemed not affordable or allowable because the CCG is in financial recovery?
- What is the criteria for 100% grant funding?
- How can a practice obtain funding for Estates and Technology if it fails to secure funding under ETTF?
- What is the likely frequency and format of NHS England’s reporting on this funding programme?
- How will grants for new builds work and how much can they be?
NHS England’s Estates and Technology Transformation Fund (ETTF) is a multi-million pound investment (revenue and capital funding) in general practice facilities and technology across England (between 2015/16 and 2019/20).
It is part of the General Practice Forward View commitment for more modernised buildings and better use of technology to help improve general practices services for patients.
The ETTF funding comes out of the £1bn Primary Care Infrastructure Fund which as well as providing a funding boost for estates and technology has invested in other areas of general practice such as workforce.
We will work as flexibly as possible in reviewing estates and technology developments which support primary care working at scale and also in partnership with a range of providers and stakeholders. CCGs may wish to submit schemes on behalf of others, for example where a technology development covers a wider population.
The options for delivery will be developed with the CCG and lead partner should the application be suitable to move to the next stage following initial review.
The early stages of the programme focussed on improving and expanding the size of existing GP facilities.
Building on this, local Clinical Commissioning Groups (CCGs) submitted recommendations to NHS England for further investment, in line with their local estates and digital plans. This includes proposals for new buildings and technology schemes.
This funding scheme is not a quick fix. It is an investment which requires considerable planning and design to deliver effectively. Schemes can be a variety of sizes and different types. The main aim is to develop more modernised infrastructure in general practice to improve and expand services for patients. The development of some schemes may involve a wide range of different organisations and the delivery time for each scheme will vary. Building a new, purpose built health facility for example will take considerably longer than small changes to increase the capacity of a practice.
NHS England has published details on the process and criteria for funding. Every scheme, proposed by CCGs, will need to go through a review and detailed due diligence checks including checking whether the schemes is value for money and feasible. A decision will then be made on whether funding is approved.
- NHS England published details on the criteria for funding with the key criteria being: Improved access to effective care
- Increased capacity for primary care services out of hospital
- Commitment to a wider range of services as set out in the CCG’s commissioning intentions to reduce unplanned admissions to hospital
- Increased training capacity.
CCGs were asked to prioritise the schemes which they recommended for support. NHS England discussed these schemes with CCGs and has agreed the pipeline of potential investment for the next three years.
Typical schemes may include, but not be limited to:
- Improvements or extensions to existing facilities used for primary medical care services
- Refurbishment of unused or under-utilised premises to increase clinical capacity
- Refurbishment of unused or under-utilised premises to increase clinical capacity
- Construction of new premises; for example for the co-location of practices to facilitate primary care at scale or to promote patient access to a wider range of services
- Implementation of IT systems which support the development of primary care at scale and integrated working practices; for example to support integrated care models and record sharing
- Technology which enables the public to have better access to services; for example to enable electronic prescribing, new forms of clinical consultations, via email, webcam, telephone or clinical decision support.
The majority of investments will be subject to the NHS (PMS Premises Costs) Directions. The Directions enable NHS England to make grants to GMS/PMS contractors and sets the conditions within which such investments can be made. One such condition is that a practice which is a tenant, there must be an agreed and formalised lease in place. This is to ensure that taxpayers’ money is invested safely with adequate safeguards in place. GP providers that do not have such a lease are urged to enter discussions with their landlord so that an investment grant can be made.
100% funding is subject to a period of abatement dependent on the value of the grant – currently 5, 10, 15 years. This means that the revenue costs for commissioners will be reduced or zero. At the end of the abatement period a reimbursement commitment will commence. CCGs will need to estimate and commit to this future need for revenue funding.
All schemes were ranked in priority order by CCGs when they submitted recommendations for investment. NHS England discussed these recommendations with CCGs and confirmed the pipeline of schemes which would go to the next stage of due diligence, for formal approval. Confirmation of the pipeline took into account the limitations of the overall funding available and the fact that some schemes would change or be withdrawn during the due diligence stage.
A Value for Money (VfM) test will be applied to all schemes. LIFT schemes are obliged to deliver VfM to the NHS in the same way as any other project.
Yes but the funding of empty space would not be supported. It is probable that CCGs would need to underwrite the space unless a third party is willing to take the risk. Such a scheme should be recommended in the CCG’s local estates plan.
Integrated care models could be supported via the fund, however the fund is focused on investment in primary care services, with a need to support reductions in unplanned hospital admissions.
The most appropriate funding route would be determined as the scheme is developed. A lead ‘partner’ would need to be identified through which the money would flow and it may be that ETTF is not the most suitable funding route. For example if the building is going to be part owned or leased by an NHS trust or council, then they may be required to raise a share of the capital required to fund the scheme.
Should that be the case, advice and guidance will be offered to the CCG.
The NHS does not have a preference and at this stage, schemes will not be tested on this basis.
Each scheme will require, as part of the due diligence process, a Value for Money test that will look at the best level and source of funding to achieve best value. A reduction in revenue costs would form part of that test.
The ETTF is intended to support and facilitate access to wider range of public and voluntary services. A decision about how best to fund schemes which plan to accommodate voluntary services will be the result of detailed discussions in each case. The decision will need to take account of the proposed arrangements for letting space and guaranteed usage and the specific circumstances of the scheme.
CCGs will need to support the revenue consequences of any scheme and the submission of the application by the CCG provides this assurance in principle. The due diligence stage will allow CCGs to define those costs and to reconfirm their commitment to the scheme.
There is no upper limit on the level of investment however the time limits of the fund may restrict the ability to deliver very large scale schemes. Investment levels of up to 100% of costs will be dependent on parameters such as rent abatement, deliverability in timeline, scheme benefits and Value for Money.
Significant funding has been made available for investment. The demand for investment in premises and technology in general practice is significant and it is acknowledged that the ETTF programme will not solve the challenge which is being faced. There are other sources of capital funding which CCGs and their partners may want to consider, including capital from NHS Property Services, LIFT, other NHS England capital funds, Section 106 and Civil Infrastructure Levy (CIL) and third party developers.
Security of tenure is required for any Grant made by the NHS.
Abatement periods will be set in line with the advice laid down within the NHS (PMS – Premises Costs) Directions.
CCGs are expected to consider long term affordability and agree a funding model which they can commit to. CCGs have produced local estates strategies which should have taken account of opportunities to increase the efficiency of existing premises.
The benefits of all schemes will be tested; a VfM test will look at estates affordability including revenue consequences and it will be for the CCG to confirm a commitment to ongoing revenue for any scheme.
CCGs will need to consider the outline costs of schemes at the point of submission with due regard to the revenue consequences of those schemes.
This will be defined in the latest iteration of Premises Costs Directions. Revisions to the Premises Directions (2013) are currently being negotiated and changes to the level of contribution are expected and will set the criteria upon which full grants can be made.
CCGs are advised to consider the outline costs and revenue implications of all schemes at the point of submission.
Other funding sources may be available to practices to support such developments including Minor Improvement Grants, Section 106 or Community Infrastructure Levy contributions, or via a revenue funded scheme through a third party (e.g. landlord, NHSPS or CHP).
We will publish a report showing the outcome and benefits of the fund to date, every six months.
The financial viability and deliverability of each scheme will be tested through a robust due diligence process. Each scheme will be assessed to determine both the funding source and the level of funding which enables the scheme delivery. Large grants from the NHS are expected to be secured, to protect the investment of public monies.