One consequence of the NHS reorganisation has been the issue of the National Health Service (General Medical Services – Premises Costs) Directions 2013 to replace the 2004 Directions. Most of the changes are to reflect the fact that the NHS Commissioning Board (now known as NSH England) has responsibility for administering the Directions.

There has been some speculation that the new Directions have been issued on an interim basis but had this been the case, simply updating to refer to the NHS Commissioning Board with some transitional provisions would have been sufficient. Instead there are a number of small but important changes. Most of these recognise known issues with the 2004 Directions.

For example the new Directions 7 and 31 make it explicit that the Board will not approve any applications for assistance made after contracts have been entered into or works commences. There is now provision for penalty payments on re-mortgaging to be potentially reimbursed so as to remove an impediment to taking advantage of lower interest rates that may be available.

One significant change that has perhaps attracted the most attention is the requirement for rent reviews to be concluded before NHS England will agree a new level of rent reimbursement. Whilst this may simplify the role of the District Valuer in approving a rent review (rather than becoming involved in it) it does place practices at risk in agreeing a rental increase which may not then be supported by full rent reimbursement. This may force practices to attempt to drive a harder bargain and create a saving, but the more certain outcome is that there will be a cost to practices for valuation advice which may in the past have been avoided under the old scheme by simply agreeing to any rent increase that the PCT, advised by the District Valuer, was prepared to accept.