Government Urged to Abolish NHS Property Services and Write Off GP Debt Amid Growing Premises Crisis

The NHS Confederation has issued a bold call for the abolition of NHS Property Services (NHSPS) and a national write-off of historical GP debt, in a new report exposing the deep flaws in the current capital and property regime within the NHS. With general practices facing crippling charges and inadequate infrastructure, the report outlines a roadmap for urgent reform, advocating for local empowerment, financial clarity, and a rethinking of how the NHS estate is managed.

A Broken System in Urgent Need of Reform

The NHS Confederation’s report, released in February 2025, lays bare the failings of the current system that governs NHS properties. It states unequivocally that the capital regime is “broken,” and that the existing structure—particularly the role played by NHS Property Services—has created widespread dysfunction in managing NHS-owned buildings, particularly in primary care.

Owned entirely by the Secretary of State for Health and Social Care, NHSPS controls a large portion of the NHS estate, including a 15% share jointly with Community Health Partnerships. Much of this portfolio includes GP premises, which have been at the centre of increasing tensions over rent, maintenance, and service charges.

Legal Disputes and Financial Strain on GP Practices

Disputes between GP practices and NHSPS have intensified since 2016, when the latter introduced its “consolidated charging policy.” This initiative aimed to recover costs for rent and facilities management by charging GP practices directly—often without signed leases or clear cost breakdowns.

The British Medical Association (BMA) has received hundreds of complaints from GP partners who say they are being charged unjustly. In some cases, practices reported that charges were so high they became financially unviable.

In 2023, legal action supported by the BMA led to dramatic reductions in service charges for five GP practices, with savings ranging from £25,000 to over £400,000. Despite this success, NHSPS has remained embroiled in ongoing litigation to recover what it describes as “historical debt.”

NHS Confederation’s Vision: Empower ICBs, Scrap NHSPS

To resolve the escalating crisis, the NHS Confederation proposes transferring the ownership and management of NHSPS properties to Integrated Care Boards (ICBs). These local bodies would take over responsibility for property management, rent negotiations, and capital investment decisions.

The report argues that removing NHSPS as a landlord would allow GPs to “re-enter NHS-owned buildings with confidence” and remove the toxic landlord-tenant dynamic that has soured trust between clinicians and central estate managers.

Importantly, the report recommends a one-off national settlement to clear historical debt across all NHSPS-managed sites. This would offer a fresh start for GP practices and eliminate the lingering threat of retrospective charges and legal action.

NHSPS Responds: Reform, Not Abolition

NHS Property Services has acknowledged the need for major reforms, but pushed back against the call for abolition. A spokesperson stated that dismantling NHSPS could “fragment” a valuable body of expertise built up over 12 years and “lose the benefits” of a centralised approach to NHS asset management.

Instead, NHSPS proposed forming a new enabling organisation, composed of experts from NHSPS and other NHS property bodies, to support Integrated Care Systems (ICSs) in managing local estates. This would, in their view, preserve institutional knowledge while aligning more closely with the NHS Confederation’s decentralisation goals.

On the matter of GP debt, NHSPS conceded that the issue needs urgent attention, echoing the call for debt relief. However, it warned that writing off historical debt without a new funding mechanism would simply result in new debt accumulation. The removal of a subsidy in 2016, which they claim was not initiated by NHSPS, left many practices unable to meet the rising costs of premises.

“Debt write-off without a change in funding will simply rebuild debt,” the spokesperson said. “The critical point not drawn out in NHS Confederation report is one of affordability at individual practice level.”

Capital Investment Shortfalls and Crumbling Infrastructure

The report also draws attention to the deteriorating condition of the NHS estate, particularly in primary care. It references the Darzi report, which highlighted a staggering £37 billion capital shortfall across the NHS estate. Years of underinvestment have led to buildings that are unsafe, outdated, or unsuitable for modern care delivery.

Matthew Taylor, Chief Executive of the NHS Confederation, commented:

“Staff are having to treat patients in crumbling buildings while capital investment is too often held back by red tape. Cutting the bureaucratic burden on NHS organisations is essential to avoid costly delays.”

To address this, the Confederation recommends:

• Streamlining the capital approval process, reducing steps and red tape;
   
• Delivering five-year capital budgets for ICBs, starting from the next Spring Review;
   
• Allowing private investment, which is currently prohibited, to support capital development;
   
• Reinvesting in local, neighbourhood-based health centres to bring care closer to communities.
   

Politically and Economically Timed?

The recommendations arrive at a politically sensitive moment. In the Autumn Budget of 2024, the Chancellor pledged £3.1 billion in additional capital investment over two years, including £100 million earmarked for 200 GP estate upgrades. However, many in the health sector fear this sum falls far short of what is needed to reverse decades of neglect.

The Confederation’s call to overhaul NHSPS also comes as the Government prepares a 10-year plan for health, presenting a critical opportunity to implement structural reforms that can reshape the NHS estate for a generation.

Implications for GPs and Patients

For general practitioners, these proposed changes could be transformative. The removal of NHSPS, coupled with the debt write-off, could free practices from years of financial and legal uncertainty, allowing them to focus on delivering patient care. More flexible and localised control over property decisions could also lead to more responsive infrastructure investment and innovative community health models.

For patients, the ultimate impact could be improved access to care in safer, more modern facilities. The push for localised asset control could also align with the NHS’s long-standing goal of integrated, place-based care—where services are coordinated and delivered closer to home.

Conclusion: Will the Government Act?

The NHS Confederation’s recommendations set the stage for a pivotal debate about the future of NHS infrastructure. The question now is whether the Government will act boldly and embrace a decentralised, more transparent, and locally driven model—or continue with a centralised system that many argue is no longer fit for purpose.

While NHS Property Services defends its record and role, the growing chorus of criticism—from frontline GPs to national bodies—suggests that the current model is no longer sustainable. Whether abolition, reform, or transformation lies ahead, the message is clear: the status quo must change, and the needs of primary care must be prioritised in any future capital strategy.

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