GP practices in 2025 

GP practices in England often lease their premises, and these leases outline key aspects such as rent, rights, and obligations.  

The NHS Premises Costs Directions 2024 introduced changes that impact financial assistance and lease terms. Notably, GP practices can now apply for improvement grants covering up to 100% of project costs, including building extensions and environmental upgrades. Additionally, commissioners have more flexibility in funding GP premises, aiming to ease financial burdens. 

How do different NHS GP leases compare? 

The British Medical Association (BMA) guide on NHS GP leases provides a structured overview of lease agreements for GP practices. Whilst such leases vary based on factors such as lease length, rent terms, rights, and obligations. Here are some key differences: 

• Lease format: there is no standard format, although many law firms have created their own industry and sector preferred form of agreements which align with HMLR and property law regulations. 

• Rent and reviews: rent is typically reviewed against market rates or indices like the Retail Price Index, often leading to increases. 

• Rights and restrictions: tenants may have rights to communal areas, service connections, and maintenance access, while landlords retain rights over certain aspects. 

• Premises Cost Directions: the 2024 Directions introduced more flexibility, allowing commissioners to fund up to 100% of improvement projects, compared to the previous 33%-66%. 

Therefore, GPs should take several key actions to ensure compliance with NHS GP lease guidelines: 

• Review lease terms: ensure the lease aligns with NHS England’s and where necessary HMLR requirements.  

• Seek NHS approval: before signing a lease, GPs should apply for financial assistance under the NHS Premises Costs Directions. 

• Understand rent reviews: rent adjustments are often linked to market rates or indices, which can lead to increased costs over time. Seek specialist advice. 

• Clarify maintenance responsibilities: ensure the lease specifies who is responsible for repairs and service charges to avoid unexpected costs. 

• Engage professional advisors: work with specialist surveyors and solicitors to negotiate lease terms and protect financial interests. 

These steps help GP practices secure sustainable premises while minimising financial risks.  

The long-term effects of the NHS GP lease guidelines will shape financial stability, premises management, and service delivery for practices. We predict it will also aid operational planning so that practices can plan long-term estate needs in collaboration with NHS networks, ensuring premises remain fit for purpose. 

Strategic support: NHS bodies may be more inclined to share, use or also take over leased premises in cases where premises are deemed strategically important, reducing risks for GP partners. 

GPs sharing occupation with other NHS providers often operate under shared care agreements, rather than underleases. However, these mechanisms should be written agreements which define responsibilities between different healthcare professionals. Here are some key aspects: 

• Shared care arrangements: these agreements outline how GPs and specialists collaborate on patient care, including prescribing responsibilities and monitoring. 

• NHS vs. private providers: GPs may decline shared care arrangements with private providers if they do not meet NHS standards. 

• Prescribing and monitoring: if a GP agrees to shared care, they must ensure they are competent to manage the prescribed medications and monitor the patient appropriately. 

• General Medical Council (GMC) guidance: GPs must stay informed about medications, recognise adverse effects, and ensure proper clinical monitoring. 

• Workload considerations: NHS waiting lists have led to increased private healthcare use, adding extra workload for GPs handling referrals and prescriptions. 

These agreements help streamline patient care while ensuring GPs maintain safe prescribing practices. 

We hope you have found this general note of use. Please do engage professional advisors to work through any specific issues arising from your practices.