Build Your Own Surgery

Build Your Own Surgery are a collaborative independent team of professionals who have harnessed their multidisciplinary experience to help GPs develop and own their new build primary care facility.

The team at Build Your Own Surgery have all worked with GPs across the UK on self builds, refurbishments and surgery extension projects. We understand the complexities of building your own surgery and also appreciate the project management pressures required to realise your vision. This means that you benefit from the team’s knowledge and expertise to successfully deliver your own new facility.

What are your options?

There are currently four options available to you:

Option 1 Build your own surgery Option 2 Enter a Joint Venture ownership route with a 3rd party developer/investor Option 3 3rd party developer designs and builds and owns your surgery with you as long term tenant Option 4 Employ a 3rd party developer to complete the whole process of the build with you purchasing at the end

Option 1: The Build Your Own Surgery option offers you:

Option 2: Joint Venture ownership offers you:

• A GP owned building

• A constantly evolving option requiring you to enter into a joint arrangement with a 3rd party developer or investor

• Support in ensuring viability and affordability of the project from the outset • A clear understanding of the roles and scope of duties for the team members that you will engage with • A project that is owned by you from the outset. The project is yours as we are not developers - you are - and we are there to facilitate the process

Option 3: A 3rd party developer designs and builds your surgery with you as long term tenant. This offers you: • A new building to operate from without the risk of carrying out the development yourselves • The requirement that your GP practice will be expected to commit to a long term lease as a tenant with the developer/landlord, typically 25 years

• A cash injection from a 3rd party to assist the viability of the project » The need to consider what the longer term implications are and what control and hold will a 3rd party have on your surgery » The Build Your Own Surgery team may be able to provide support to assist this option

» Your developer/ landlord intends to retain ownership of the property for the long term and is a specialist healthcare recognised developer. You need to be comfortable that your new landlord does not intend to sell to the highest bidder on, or soon after completion.

» The landlord/owner ideally needs to operate in the healthcare sector and understand the future demands of expansion or refurbishment needs and be able to carry • An element of care should also be taken with out that work and negotiate any future rent this option as you need to ensure that: reimbursements with the NHS

Option 4: Employ a 3rd party developer to complete the whole process of the build with you purchasing at the end:

» This route often proves unaffordable and un-fundable by lenders from the GMS and pharmacy rent re-imbursement

• This option needs to be approached with care as:

» Lenders will require you to demonstrate that the debt is serviceable and you may be required to introduce a considerable cash input to reduce the debt to make it affordable

» A developer’s profit % will be added to project costs which will increase the price to be paid » Stamp Duty and VAT on the total project cost most likely not recoverable by you and will be added to the purchase price

There are two key upfront considerations for a new build project: • Available and appropriate site to purchase • CCG support to approve the rent reimbursement that covers the loan repayments required to cover the total project costs

Initial Steps To address these two considerations we would assist you with the following initial steps at no cost to you: • Meet with the BYOS key team players • Prepare a schedule of accommodation to identify requirements • Feasibility / site analysis on any identified sites • Cost the scheme • Discuss with the CCG to determine whether they will support the scheme in principle

Next steps Once the CCG’s support has been determined in principle, these are the next steps: • Commission any required site surveys and reports • Complete a business case for the NHS to approve • Obtain lender support to the funding required during and following completion of the build • Submit and obtain planning approval • Prepare tender packs for main contractors to submit fixed pricing terms to complete the build project • Prepare agreements for lease documentation for the building tenants ready for signature prior to build commencement • Select main contractor and agree a start date • Finalise land purchase process and building contract requirements to the satisfaction of the lender • Start on site

Key Team Players

Primary Care Consultancy Negotiate Land Purchases Rent Reimbursements NHS approvals

Solicitor Leases Site acquisition Partnership Structure

Quantity Surveyors

Chartered Architects

Sector Experts Construction Cost Advice Contract Management

Specialists Quality Designs Efficient and Flexible

Finance Consultancy Feasability Affordability Guidance

Primary Care Consultant

Chartered Architects

Alistair Black, FRICS is a Chartered Surveyor with extensive experience of NHS Business Case requirements, preparing and presenting them and further developing the case with the CCG. Alistair works with the District Valuer to negotiate the rent reimbursement and will assist with the site negotiations and lease terms.

Corstorphine & Wright is an AJ Top 25 RIBA chartered architects practice specialising in the Primary Care sector. C&W have worked on more than 200 primary care projects over the last 25 years.

New health centre developments are usually bigger than the surgery buildings that they will be replacing, which means that proportionately more GMS rent will be required. To address this Alistair will produce a robust NHS Business Case to qualify the GP Practice for the requisite additional rent which in turn would finance the interest repayments on the borrowed capital.

Finance Consultancy Business Finance Plus will assist you to assess and decide on your options to end own and whether it is viable or indeed feasible before too much expenditure or commitment is incurred.

This approach ensures you have a complete outline and awareness of what is required to get a scheme successfully built with the NHS, or appropriate body support, and the right level of lender support demonstrating value for money and debt serviceability from day one, identifying any additional capital should it be required.

Quantity Surveyor CDA Limited are Chartered Quantity Surveyors and Employers Agents who offer construction cost advice and contract management services to both the Design Team and Main Contractor. CDA are experts in the Primary Care Sector and can draw on an experienced, professional team to assist you from inception to completion to deliver your medical centre development.

This experience brings an individual design approach to projects, resulting in high quality design coupled with functional, flexible and sustainable buildings. C&W pride themselves on understanding your requirements to help realise the vision, and our passion for architecture and the spaces created are reflected in their successfully completed projects.

Solicitor Andrew Miscampbell is a partner at Blake Morgan LLP and been involved in surgery development projects across the UK. With over 10 years with the team, Andrew and his specialist construction and corporate team will ensures we are able to deal with complicated issues finding the right solution for you. Experience of acting for banks lending on these projects, further supports Blake Morgan’s legal contribution. Andrew has experience of working with NHSE on grants, in particular negotiating on VAT and Capital Allowance issues.

Wider Team • VAT Consultant • Pharmacy Consultant

Selected BYOS Projects

Shawbirch Medical Centre, Telford Due for completion in May 2022, the new facility will provide significantly improved services and built in expansion spaces.

The Wilson Health Centre, Cheltenham Due for completeion June 2022, the new Cheltenham Medical Centre, houses 3 GP Practices, a Phamarcy Dentist and expansion spaces.

The Memorial Health Centre, Birmingham, West Midlands Completed in July 2019, the new medical centre has dramatically improved patient access and the quantum of services delivered. The building was delivered to BREEAM Excellent standards.

The Cotgrave Hub, Nottingham Delivered by key members of the BYOS team, the new building brings together a GP Primary Care Centre, Library, a Police Station for Nottinghamshire Police and Town Council Offices all under one roof.

The BYOS team have worked with our Practice for a number of years covering our new build surgery and a number of refurbishments to our properties.

They have provided intuitive and imaginative solutions to our requirements and continue to support us with our estate challenges.

A great team that is responsive and commercial.

Jon Herman, Business Manager, Belvoir Health Group

Cleevelands Medical Centre, Bishops Cleeve Completed in 2019, the new medical centre has been a great success and replaces outdated and cramped facilities.

Delighted that patients are now enjoying first-rate GP services at the new Cleevelands Medical Centre in Bishop’s Cleeve, officially opened on 7 Feb 2019 by the Lord-Lieutenant of Gloucestershire.

Gloucestershire CCG

Get in touch Corstorphine & Wright (Chartered Architects) 5 Aldergate Tamworth B79 7DJ Telephone: 01827 67123

www.buildyourownsurgery.com