​GP contractors are eligible for rental reimbursements. The type of reimbursement applicable depends on who owns the building. For instance:

• where the GP owns the building, this is known as ‘notional rent’
• where the GP is paying off a mortgage, this is known as ‘borrowing cost reimbursements’ (historically known as ‘cost rent’)
• where the GPs are tenants in a building owned by an NHS landlord or a private owner, they receive leasehold cost reimbursements. 

Please note that this guidance refers to the 2013 premises costs directions for England. Whilst many aspects will also be reflected in directions for Scotland, Wales and Northern Ireland not all parts of this guidance will be relevant.

Notional rent reimbursements

Contractors who own their premises may be eligible for notional rent reimbursement.

How much?

The amount of notional rent to be paid to the contractor is based upon the CMR (current market rental) value for the property, as determined by a surveyor. The CMR is assessed based on notional lease terms, which assume a 15-year term tenant internal repairing obligations with the landlord responsible for external and structural repairs and insurance.

Switching to notional rent

Contractors who currently receive borrowing cost reimbursement can switch to notional rent payments.

The area team must grant the application if the contractor chooses to switch from borrowing cost payments to notional rent. However, once the switch has been made, it is not possible to move back to borrowing costs.

Review

The level of CMR, and the amount of notional rent paid, must be reviewed every three years. The review will be brought forward:

• if there is a change to the purpose for which the premises are used
• if there is further capital investment in the premises which will be reflected in the payments the contractor is receiving under its contract.

Leasehold rent reimbursements

Contractors who rent their premises can receive reimbursement for their rental costs.

How much?

The level of leasehold rent that may be granted is determined by the CMR value of the premises, or the actual lease rent, whichever is lower.

The CMR value of the premises is as assessed by independent valuation conducted by the district valuer, who must determine what might be reasonably expected to be paid for the premises.

Review

​The level of leasehold rent reimbursement paid to the contractor must be reviewed when the landlord undertakes a rent review provided for in the respective lease. That is unless the review does not result in any change to the level of rent being charged.

Under the 2013 premises cost directions, when the CMR is to be reviewed, practices are required to provide the area team with a rent review memorandum. This is a signed agreement between the tenant and the landlord stating any changes made to the level of rent being charged.

Borrowing cost reimbursements

GPs who own their premises and have incurred costs, such as a mortgage or loan for repairs, may be eligible to have their borrowing costs reimbursed by the area team.  

The conditions attached to borrowing costs reimbursements are found in part 5 of the premises cost directions.

Changes to the loan

It is the responsibility of the contractor to notify the area team of any changes to the terms and conditions of the loan.

Failure to notify the area team may result in them clawing back any overpayments received by the practice.

For how long can I borrow?

• Borrowing cost reimbursements should only be in place for a finite period of time.
• Once the mortgage has been repaid, the practice is no longer eligible for borrowing cost reimbursements and should notify the area team and switch to notional rent.
• When servicing their loan, practices are expected to pay down the capital and interest of the loan.
• Practices found to only be making payments on the interest of the loan may face NHS England sanctions.