Overview and context

Premises review

1. In June 2019, NHS England published the General practice premises policy review, as agreed with the British Medical Association’s General Practitioners Committee England (GPC England), Department of Health and Social Care (DHSC) and wider stakeholders.
2. The review made several recommendations which NHS England sought to address in consultation with the BMA, including:

• provide clearer guidance on the expectations of owners and occupiers around maintenance and standards, as part of professionalising property ownership and management
• encourage networks to start working out their future estates needs now, taking into account joint working and the estate of their community partners
• focus our primary efforts on understanding what it would take to ensure we have premises that are fit for purpose, as part of the spending review

New directions

3. The National Health Service (General Medical Services Premises Costs) Directions 2024 (‘the Directions’) come into effect on 9 May 2024 and can be found at NHS primary medical service directions – GOV.UK (www.gov.uk). The Directions replace The National Health Service (General Medical Services Premises Costs) Directions 2013 (‘2013 Directions’), which are revoked.
4. All applications and payments will now be made under the new 2024 Directions.
5. To ensure continuity, when determining the extent of financial assistance to be made, NHS England will apply the terms of the 2013 Directions to applications which have already been made for financial assistance in respect of costs (or the relevant part thereof) which were incurred before the entry into force of the new Directions. Any payment made as a result of such application will, nevertheless, legally be made under the new Directions.

Key changes

6. The Directions allow commissioners to make larger investments in GP practices in a more flexible way and seek to provide contractors with some reassurance about their premises liabilities. They also deliver some significantly improved terms for contractors, as well as technical updates.

Improvement grants

7. A long-standing restriction on commissioner contribution to premises improvements has been removed. Commissioners can now award GP grants funding up to 100% of project value, where appropriate and subject to business case assessment and local prioritisation. Grant values have been increased, and abatement and guaranteed periods of use have been reduced.

8. Improvement grants can now also be awarded to purchase the land specifically required to build a premises extension, and for tenant fit-out works of new builds.

Improvement grants and premises liabilities

9. To provide reassurance to contractors applying for improvement grants, several changes have been agreed to support those contractors in receipt of a grant who may wish to retire but cannot find a successor partner from within the practice.
10. Owner/occupiers in receipt of a grant have these options if they wish to relinquish their core contract during the grant abatement/guaranteed period of use:

• Remove the premises from NHS use, sell and repay the rest of the grant.
• Remove the premises from NHS use, retain and repay the rest of the grant.
• Offer continued use of the premises for another practice to lease – the lease would reflect the required abatement.
  11. Leaseholders in receipt of a grant have these options if they wish to relinquish their core contract during the grant abatement/guaranteed period of use:
• Offer to assign the lease (and any grant agreement) to another practice.
• Surrender the lease if landlord agrees (with possibility of assistance with any related repayments).
• Apply for NHS England to assign the lease to its nominee.
• Apply for NHS England to waive repayment of any residual grant amount.

Other changes

12. Some significant further changes are:

• Rent reviews will not require contractors to undertake their own valuation, just evidence of a negotiation with the landlord.
• Rent reviews will not lead to varying lease terms.
• Leaseholders must attempt to ensure landlords do not add VAT to rent; but where it is added, the commissioner will reimburse it.
• Reimbursement of stamp duty land tax (SDLT) on acquiring land or premises.
• Looser restrictions around grants to assign or surrender a lease.
• More formalised arrangements for third-party use of premises, with protections for the contractor and reimbursement of legal expenses.
• Improved provisions for minimum standards reviews.
• Reimbursement of business improvement district (BID) levies.
• Rights for NHS England to reclaim overpayments.

Changes to the directions

Details of the key changes to the 2024 Directions (when comparing these to the 2013 Directions) are set out below.

Due to the addition of a new Direction 13, the numbering of subsequent directions has changed.

Part 1 – General

Direction 1

• All references to the NHS Commissioning Board (‘the Board’) in the Directions have been changed to ‘NHS England’ to reflect the Board’s formal change of name from 1 July 2022.
• The Directions continue to apply only to contractors under a GMS contract, but this is now more clearly stated in Direction 1.

Direction 2

• Direction 2 incorporates a new definition of ‘appointed valuer’ in line with that provided by the Premises Costs (Amendment) Directions 2013 and an amendment to the definition of ‘district valuer’. These amendments allow other suitably qualified professionals to support ICBs in their work, where appropriate. Further guidance will be issued on this.
• Direction 2 incorporates a new definition of ‘guaranteed period of use’, replacing the definition previously appearing in Direction 12. This supports the application of the guaranteed period of use throughout the Directions. The definition has been amended to take account of updated build costs since 2013, and to align minimum use periods with both abatement periods and triennial rent reviews.

Direction 3

• NHS England now has greater power to reimburse professional costs incurred by a contractor who is taking a new lease or entering into an agreement to take a new lease, in certain circumstances. These powers are described further at Direction 14.

Direction 4

• This Direction limits a contractor’s entitlement to reimbursement in respect of premises which are unsuitable for the delivery of services or insufficient to meet the reasonable needs of the contractor’s patients. This Direction has been updated to reflect the entry into force of The National Health Service (General Medical Services Contracts) Regulations 2015.

Direction 5

• NHS England is now required to consider, with the contractor, multi–functional use of the premises before making payments. This is to ensure practice premises are used fully to maximise delivery of health and care services that can be delivered from them. This change reflects the changing nature of service delivery and the NHS Estate since the 2013 Directions.
• Direction 5 has been updated to support the commitment within the NHS Constitution to ensure that contractors comply with their duty to staff and patients to provide services in a clean, safe, secure and suitable environment that is fit for purpose. Schedule 1, which covers required minimum standards, has also been updated.

Part 2 – Premises development and improvement

Since 2013, NHS England has played a greater role in delivering the improvement of existing premises, as well as providing a wider range of support for the acquisition and development of new premises. The changes to this Part reflect that changed role.

Direction 7

• Direction 7 has been expanded, to clarify NHS England’s powers to make grants and reimburse certain costs but this is subject to certain procedural requirements including a capital grant agreement being entered into where capital is provided.
• Direction 7 now expressly confirms that NHS England can reimburse costs incurred in relation to bare land, where that land is to be acquired, developed and used for providing primary medical services. A related amendment has been made to Direction 8(1)(a).

Direction 8

• Contractors are required to ensure that their practice premises meet the minimum statutory requirements for the provision of their services. Failure to do so should not enable a contractor to apply for an improvement grant to rectify this. Direction 8(2) (read together with Direction 9(i)) now expressly confirms that NHS England is only permitted to make a premises improvement grant in respect of works required to ensure statutory compliance where the works are necessary to take account of recent changes to the law or statutory guidance only, and that grants will not otherwise be permitted where premises otherwise fail to meet the relevant minimum standards. This reflects the existing intention of the 2013 Directions. As a result:
  • Direction 8(1)(b) no longer refers to the Equality Act 2010, as it is no longer a recent change of law and forms part of existing required minimum standards
  • The former Direction 8(f) (which referred to provisions to meet the needs of children and elderly or infirm people) has been deleted, as it is part of the existing required minimum standards
  • Direction 8(1)(f) and Direction 8(1)(i) have been clarified accordingly
• Correspondingly, Direction 8(1)(l) now expressly confirms that NHS England can make premises improvement grants where improvements are necessary due to [new] regulatory changes affecting the provision of primary medical services. Previously, Direction 8 only expressly referred to national changes applicable to all commercial premises and/or employers.
• Direction 8(1)(e) has been amended to ensure that, in appropriate cases where car parking is particularly limited (such as in metropolitan areas), NHS England can waive the requirement that each space be accessible without the need to move other vehicles. A corresponding amendment has been made to paragraph 2(d) of Part 1 of Schedule 2.
• Direction 8(1)(k) clarifies that NHS England may make a premises improvement grant in respect of the cost of a tenant’s fit-out, where this relates to new build premises.

Direction 9

• The changes to Direction 9(b) (and corresponding changes to Direction 7 and Directions 8(1)(a) and 8(1)(k)) are to clarify that premises improvement grants may be made to fund fit-out works on land being acquired and developed as a practice premises and for acquiring land as part of an extension to an existing practice premises. The provisions of Directions 8 and 9 relate to premises improvement grants only and not grants for new premises developments (that is, where the grant also relates to acquisition of land and/or development of the shell and core).
• Direction 9(g) has been amended, to allow NHS England to make a premises improvement grant for improvements designed solely to reduce the environmental impact of premises in circumstances in which there is a net financial benefit to the NHS as a whole, and not merely to the contractor (as had been the assumption of the 2013 Directions).
• In relation to Direction 9(i) please refer to the explanation at Direction 8 above.

Direction 10

• Direction 10(1)(a) has been amended to clarify the role of the Local Medical Committee (LMC), to ensure that they have an opportunity to represent their members in a way which is proportionate to the premises development or improvement proposal under consideration.
• In relation to Direction 10(1)(c) please refer to the explanation at Direction 2 above.
• Direction 10(1)(d) has been amended:
  • to reflect the amended definition of ‘guaranteed period of use’ as set out at Direction 2 above
  • to allow NHS England to consider an application where there is not yet a lease in place but there will be a lease in place at a later, agreed point in time. Direction 10(1)(d) and Direction 10(1)(e) have been amended to take account of the fact that the development or improvements may take place at a future time
  • to allow NHS England to approve a premises development or improvement proposal where the remaining period of the lease is shorter than the applicable guaranteed period of use, but the contractor is entitled to renew (either on a contractual or statutory basis), and NHS England is satisfied that there are sufficient safeguards are in place to ensure the guaranteed period of use)
• Direction 10(3) further clarifies Direction 10(1)(d) and specifies that the provision of collateral warranties in favour the contractor (and assignable to NHS England or its nominee) will be required where a premises improvement grant is made to fit-out a new development.

Direction 11

• Direction 11(d) has been amended to remove reference to applications for premises development or improvement grants where the premises are held on a licence. It is considered unlikely that a premises held on a licence would provide enough security for NHS England to make a grant.

Direction 12

• Direction 12(2) of the 2013 Directions has been deleted, to allow NHS England to provide financial assistance up to 100% of the total cost of the premises development or improvement, where appropriate.
• Direction 12(3)(d) now refers to the new definition of ‘guaranteed period of use’, as noted above under Direction 2.
• Direction 12(3)(e) has been amended, so that guaranteed periods of use now apply to all applications for financial assistance in relation to premises development or improvements.
• Direction 12(3)(f) has been added to ensure that public funds are properly protected if the premises development or improvement is not completed.
• Direction 12(3)(g) has been added to ensure that premises development or improvement works which are the subject of financial assistance from NHS England are disregarded on rent review. This is necessary to align the position with prevailing commercial practice.
• Direction 12(3)(h) provides clarity on the terms to apply as part of a sale and leaseback arrangement following premises development or improvement works which are the subject of financial assistance from NHS England. This reflects the increased use of this type of arrangement since 2013 and existing NHS England guidance and practice and is to ensure the notional rent abatement and period of guaranteed use is preserved within the rent and rent review provisions (and the term) of the new lease.

Direction 13

• Direction 13 has been added to provide reassurance to contractors applying for premises grants; several changes have been agreed to support those contractors in receipt of a grant who may wish to retire before the expiry of the ‘guaranteed period of use’ but cannot find a successor partner from within the practice.
• Where the contractor does not provide ‘the guaranteed period of use’ specified under the grant agreement:
  • Direction 13(3) suspends repayment for up to 2 years where the contractor is the owner-occupier of the premises, is actively pursuing the sale of the premises and will use the proceeds of sale to repay NHS England. This reflects the fact that releasing capital from the premises may be the most straightforward way for the contractor to repay NHS England.
  • Direction 13(4) confirms that a contractor (who is an owner-occupier) is not required to repay NHS England where (although it has terminated its GMS contract) it has leased the premises to another person, D, where:
    • D is itself a provider of primary medical services; and
    • D has agreed to comply with the original conditions of the grant.

This reflects the fact that the proposed new arrangement is consistent with the purposes of the financial assistance, without the need for any amount to be repaid.

• Likewise, Direction 13(7) confirms that a contractor is not required to repay NHS England where although it has terminated its GMS contract) it has assigned its leasehold premises to another person, D, where:
  • D is itself a provider of primary medical services; and
  • D has agreed to comply with the original conditions of the grant.

This reflects the fact that the proposed new arrangement is consistent with the purposes of the financial assistance, without the need for any amount to be repaid.

• Direction 13(5) and Direction 13(6) ensure that the owner-occupier contractor cannot be required to repay more than the actual sale price for the practice premises (or if higher the best sale price that could reasonably be expected if the practice premises was sold on the open market). This is to prevent the obligation to repay in the grant agreement giving rise to the contractor having negative equity in the practice premises.
• Direction 13(8) ensures that the same principles for leasehold premises, set out above in regard to Directions 13(4) and 13(7), apply on any subsequent arrangements as they do on the first such arrangement (e.g. if there is a further lease assignment to another practice).
• Direction 13(9) allows NHS England to waive the requirement for the contractor to repay where the practice premises are leasehold in the circumstances contemplated in Direction 13(10) and Direction 13(11). These include:
  • where the contractor has taken all reasonable endeavours to its lease of the premises to another provider, or surrender it to a landlord (on terms reasonably acceptable to NHS England), but has failed to do so; and
  • where NHS England has been able to commission the provision of services at the premises by another provider to whom the contractors lease can be assigned.

When considering whether to waive repayment, NHS England must take account of the factors listed in Direction 13(12).

• In accordance with Direction 13(13), NHS England must waive repayment where the ‘guaranteed period of use’ is not achieved because the contractor relocates to another practice premises at the request, or agreement, of NHS England.

Part 3 – Professional fees and related costs incurred in occupying new or significantly refurbished premises

Direction 14

• Direction 14(3) allows NHS England to reimburse legal and other professional costs which a contractor incurs in relation to a sharing agreement which allows part of the practice premises to be used for the provision of other services, where agreed with the Commissioner. These costs are dealt with further at Direction 15(4). This is to facilitate multi-functional use of the practice premises.

Direction 15

• Direction 15(2)(b) has been amended to allow NHS England to reimburse surveyors’, architects’ and engineers’ fees in excess of 12% of the total contract sum, in appropriate cases.

Part 4 – Grants relating to relocation of or re-mortgaging by a contractor

Directions 18 and 22

• Directions 18 and 22 have been amended to clarify that NHS England is not required to provide financial assistance in relation to a mortgage deficit that has arisen by virtue of a mortgage holiday, period of forbearance, or a statutory scheme of similar effect.

Directions 19 and 23

• Directions 19 and 23 have been amended to clarify the relevant basis of valuation.

Direction 25

• Direction 25(3) has been added to ensure that where a contractor receives deferred consideration or overage on the sale of a practice premises (for which NHS England provided a guaranteed minimum sale price payment) that payment (or part of it) may become due to NHS England to the extent that the aggregate sale proceeds do not exceed the guaranteed minimum sale price payment.
• This Direction 25(3) replaces Direction 25(1)(g), which required NHS England (in appropriate circumstances) to impose overage or clawback provisions in the sale contract where NHS England had made a guaranteed minimum sale price payment, with a condition that any monies received could be used to reimburse NHS England. Although NHS England may still make this a requirement of agreeing to make this type of payment (where appropriate), the Directions do not require it.

Direction 29

• Direction 29(1)(a) has been amended to ensure that a contractor is no longer incentivised to prioritise seeking a surrender in comparison to an assignment and should instead take the approach which is most appropriate in the circumstances.

Direction 30

• Direction 30 has been amended to ensure that NHS England is no longer prohibited from granting financial assistance in respect of costs incurred in surrendering or assigning leases of premises let by former partners of the contractor, as long as any arrangement is on an arms’ length basis. This reflects the growing number of contractors for whom letting from their former partners is the best way to ensure financial viability and continuity of service provision. Direction 30 continues to apply to current partners.
• Direction 30 has been amended to ensure that NHS England is no longer prohibited from granting financial assistance in respect of costs incurred in surrendering or assigning leases of premises let to the contractor by certain NHS bodies, as this prohibition no longer serves a clear purpose.
• The wording previously contained in Direction 29(d) of the 2013 Directions has been deleted, reflecting the change at Direction 29(1)(a) above.

Direction 31

• Direction 31 now expressly covers SDLT incurred in relation to the acquisition of land (where purchased to facilitate an extension or new development).

Part 5 – Recurring Premises Costs

Direction 32

• Direction 32 clarifies that NHS England may provide financial assistance in respect of a lease premium, where that premium has the effect of reducing the amount of rent otherwise payable.
• Direction 32(3) has been added to clarify that a contractual rent review is relevant only to the amount of leasehold premises rental costs payable in accordance with Direction 33 and does not require the lease to be re-approved for reimbursement on each occasion.

Direction 33

• Direction 33(3) has been added, confirming that NHS England will continue to reimburse at least the rent initially payable under a lease, where the landlord is NHS Property Services Limited or Community Health Partnerships Limited. This is to assist NHS England in the administration of the NHS Estate as a whole.
• Direction 33(4) now provides that NHS England can agree to reimburse a reasonable sum in respect of PFI premises or LIFT premises, allowing NHS England to reimburse the fixed element of the unitary charge, which often includes hard FM services and lifecycle provision in addition to rent, to comply with DHSC-directed charging policy.
• Directions 33(5) to (9) allow NHS England to reimburse the VAT element of rent. Contractors are expected to use reasonable endeavours to secure agreement with the landlord that the terms of the lease include a provision that no VAT will be chargeable during the term of the lease, but where this is not possible, VAT will be reimbursed. When considering any application for financial support for rent reimbursement on a new lease (following the sale and leaseback of a practice premises) NHS may take account of the impact of VAT on the overall reimbursement costs when deciding whether to approve that application.
• Directions 33(10) and (11) have been added to address an increasing number of cases where, because of all the premises owning members of a partnership retiring, contractors have continued to receive a notional rent rather than rent reimbursement (even though the contractor is no longer the owner-occupier of those premises). In these cases, contractors will be entitled (and expected) to apply for rent reimbursement instead of notional rent. However, NHS England may (at its discretion) continue to reimburse notional rent on an interim basis, for example, to allow time for a new lease to be put in place.

Direction 34

• Direction 34 and Part 2 of Schedule 2 have been amended to provide greater clarity on the process for determining the amount of rent reimbursement. In particular:
  • Both the contractor and the landlord will now have an express opportunity to make representations as to the current market rent prior to determination. The Directions confirm that neither NHS England nor the appointed or district valuer may consider any representations made after their determination, other than by way of dispute.
  • Part 2 of Schedule 2 confirms that NHS England cannot determine a rent review unless a proposed revised market rent has already been agreed between the contractor and the landlord. This proposed revised market rent need not yet be binding as between the parties (it can for example be ‘subject to NHS England approval’) but it must be agreed. This is to avoid the current situation where the rent review process under the lease needs to have concluded and a rent review memorandum agreed, before the amount of rent reimbursement can be obtained.
  • Schedule 2 also confirms NHS England cannot negotiate on behalf of contractors with landlords, or vice versa.
• Direction 34(3) now provides that NHS England may not pay a revised current market rent unless the contractor has accepted NHS England’s determination of the current market rent. Alternatively, a contractor may within the required period choose to dispute NHS England’s determination of the current market rent and follow the applicable dispute resolution process. The required period is 12 weeks unless NHS England agrees to a longer period. These changes have been made to ensure that payments to contractors are not subject to significant ongoing uncertainty for indefinite extended periods.
• Direction 34(4) – Has been amended to clarify that NHS England may provide rent supplements (often referred to as ‘top-ups’) where appropriate and not just where the practice premises is in ‘an area of deprivation’.
• The new Direction 34(6) expressly discounts from consideration any part of the current market rent attributable to the fit-out works to the premises during or immediately after their construction financed by a premises improvement grant. In accordance with the changes to Part 2, NHS England expects the terms of the contractor’s lease to disregard (on rent review) any works financed by an improvement grant. These changes are to ensure the rent is not inflated by works which the NHS has paid for.
• Direction 34(7) ensures that the current market rent reflects any lease premium which was paid by NHS England or other public funds. This is to ensure that NHS England is not reimbursing the same costs twice. Correspondingly, Direction 35 continues to allow a contractor to receive reimbursement in excess of the current market rent where this is the result of the contractor having paid a lease premium without the use of public funds.

Direction 38

• Directions 38 to 41 have been amended to reflect recent experience and up to date lending practices and to ensure that borrowing costs are a valuable alternative to notional rent in a wider range of scenarios.
• Under Direction 38(2)(a)(i) a contractor must now tender for a loan from at least three regulated financial lenders to ensure best value for money.
• Direction 38(2)(b) clarifies that NHS England will reimburse the interest component of borrowing costs at the lower of the applicable published prescribed percentage and the actual interest costs incurred.
• Direction 59 confirms that the provisions of the 2013 Directions will continue to apply to contractors who are already in receipt of borrowing cost reimbursement when determining their entitlement.

Direction 40

• Direction 40 no longer directly refers to the 20-year gilt rate plus 1.5%, for fixed-rate lending. Direction 40 also no longer directly refers to the Bank of England Base Rate plus 1%. Instead, NHS England will now publish a prescribed percentage(s) to be applied and recalculate payments where applicable. This rate will reflect market conditions and the budget of NHS England.
• Direction 40(2) allows NHS England to reimburse borrowing costs under a fixed rate loan in full, even if market conditions change unless Direction 41 applies (i.e. the actual loan circumstances change). This reflects the fact that NHS England has previously approved the borrowing costs (including the extent of any fixed period) in accordance with Direction 38.

Direction 40(3) ensures that the extent of the contractor’s entitlement to borrowing costs under a variable rate loan is re-assessed if the prescribed percentage changes.

Directions 40(4) and Direction 40(5) ensure that the extent of the contractor’s entitlement to borrowing costs is re-assessed (or cease) if the amount of those borrowing costs changes. The Directions also require the contractor to notify NHS England of any significant changes to the loan terms.

Direction 42

• It is no longer a requirement for notional rent reimbursement that a contractor would otherwise be entitled to borrowing cost reimbursement. This requirement reflected historic practice that no longer reflects the current position. A contractor (who is an owner occupier) will be entitled to choose to receive either borrowing costs or notional rent, but not both.
• Direction 42(4) has been included to make clear, that the notional rent must be abated in accordance with Direction 44 where a grant has been received or public capital has been used towards the cost of developing or improving the premises.

Direction 43

• Direction 43(3) now provides that NHS England may not pay a notional rent unless the contractor has accepted NHS England’s determination of the level of notional rent to be paid. Alternatively, a contractor may within the required period choose to dispute NHS England’s determination of the notional rent to be paid and follow the applicable dispute resolution process. The required period is 12 weeks unless NHS England agrees to a longer period. These changes have been made to ensure that payments to contractors are not subject to significant ongoing uncertainty for indefinite extended periods.
• Direction 43(4) confirms that NHS England may pay notional rent at the reviewed level pending determination of the dispute, if less than the current notional rent.

Direction 44

• The amounts (of grant) and abatement periods referred to in Direction 44 have been updated (in line with the ‘guaranteed periods of use’). The abatement periods now more clearly align with the triennial review of notional rents, to ensure that (where possible) any change to the level of abatement can be taken account of as part of the triennial review, instead of separately.

Direction 47

• Direction 47 now reflects updated commercial practice regarding service charges, to simplify the process and make it more intuitive.
• Direction 47(4) allows NHS England to reimburse charges in accordance with a service charge estimate (for example, one provided at the start of the service charge year) as well as any end of year reconciliation. This reflects industry standard practice and replaces more complex drafting which often led to payments only being made in arrears.
• Direction 47(3) now makes clear that where a contractor has paid over any amount (that is, to the landlord is respect of the service charge), has been reimbursed for that amount, but subsequently is refunded by the person to whom it was originally paid, the contractor must pay such refund over to NHS England.
• NHS England has also agreed to reimburse BID levies in respect of Business Improvement Districts, on the same basis as business rates (non-domestic rates).

Direction 48

• The wording of Direction 48 has been clarified. Direction 48(1) is now more clearly a list of items that NHS England may not reimburse and must discount from any service charge. This reflects existing practice.
• Direction 48(3) provides NHS England with greater flexibility where a lease has been in existence of less than 12 months to determine which costs it may not reimburse based on an estimate. This avoids the need for NHS England to rely on the fixed figure of 40% which appears in Direction 48(3) and which may not accurately reflect the position.

Direction 49

• As noted at Direction 5 above, NHS England both recognises and anticipates a greater extent of sharing of premises between service providers. Direction 49 has therefore been updated to:
  • ensure, as set out in Direction 49(2) and Direction 49(3), space which is either shared with, or used exclusively by, a person who is not eligible for financial assistance under the Directions is discounted
  • ensure, as set out in Direction 49(4), that where space ceases to be used by a third party not eligible for financial assistance and is again occupied for the provision of services under a GMS contract, it continues to be considered when determining the appropriate level of financial assistance, as long as it is properly notified to NHS England
• NHS England has a relevant discretion to allow space which is either shared with, or used exclusively by, a person who is not eligible for financial assistance under the Directions to be included, if (for example) this use is in connection with the provision of services linked to services provided by the contractor or otherwise facilitates alignment with local commissioning plans.

Part 6 – Miscellaneous provisions

Direction 51

• Direction 51(2) allows NHS England to arrange a visit to premises on reasonable notice, for the purpose of satisfying itself that minimum standards are being met. This supplements NHS England’s rights under the GMS contract.

Direction 52

• Direction 52 has been clarified so that the obligation to make available reasonable information relating to the proposed financial assistance are now applicable to all applications for financial assistance under the Directions.

Direction 53

• Direction 53 now expressly requires a contractor to provide confirmation of their VAT status before NHS England is able to provide financial assistance, and to notify NHS England of any changes to that VAT status.

Direction 54

• Direction 54 allows NHS England (where a contractor wishes to retire) to recommend that a lease of a practice premises be assigned to a person nominated by NHS England, subject to an appropriate protocol being put in place to facilitate this and the necessary capital investment funds being available to the NHS. This provides a further option, if neither a surrender nor assignment to another contractor is possible in the circumstances. NHS England will develop further guidance as to what circumstances it may recommend to its nominee that it accepts the assignment of the lease.

Direction 56

• Direction 56 ensures that a contractor is always responsible for repaying any overpayments made to it under the Directions. Overpayments include payments purportedly made under the Directions but in fact made in error, payments made to a contractor in circumstances where the contractor was not eligible for part or all of that payment, or where a contractor receives financial assistance in respect of a payment but is later refunded that payment by the person to whom it was made.

Part 7 – Transitional, revocation and savings provisions

Directions 58 and 59

• The 2013 Directions are revoked. As noted above, Directions 37 and 38 of the 2013 Directions will continue to apply where a contractor is currently in receipt of borrowing costs under the 2013 Directions.
• All applications and payments will now be made under the new Directions.
• To ensure continuity, when determining the extent of financial assistance to be made, NHS England will apply the terms of the 2013 Directions to applications which have already been made for financial assistance in respect of costs (or the relevant part thereof) which were incurred before the entry into force of the new Directions. Any payment made because of such application will, nevertheless, legally be made under the new Directions.

Publication reference: PRN01404