Legal work for GP practices and dental practices

Most of my healthcare work is for GP practices in England, which means the partners who hold a GMS or PMS contract and have to run a business around it. I also help dental practice owners, pharmacists, PCNs and other providers regulated by the CQC. They usually get in touch when something is changing, such as a partner retiring, two practices wanting to merge, a suggestion that the practice should move into a limited company, or a contract arriving which needs to be reviewed before it’s signed.

A practice is a business like any other, but its main contract is with the NHS, and that contract controls who can hold it, what can be sub-contracted and what can be sold. In particular, the goodwill of an NHS medical practice can’t be sold (section 259 of the National Health Service Act 2006), which changes how every merger, buy-in and retirement has to be put together.

What I do myself

The pages below cover the main pieces of work in more detail. I draft and update GP partnership agreements, advise on incorporation (novating the GMS contract to a company, sub-contracting to one, or both), and act on mergers and takeovers of practices. Where partners have fallen out, I can advise at an early stage on what the deed says and negotiate an exit.

I also pick up the employment law side for practices, which covers contracts and staff handbooks and advice to the partners as employers on disciplinaries, performance and dismissals, although day-to-day HR is really a job for an HR consultant. I review the contracts which practices are given as well, and these days those are mostly from software suppliers and digital health providers.

Procurement and challenges to commissioning decisions

Since 1 January 2024, NHS health care services in England have been procured under the Provider Selection Regime, set out in the Health Care Services (Provider Selection Regime) Regulations 2023, and not under the general public procurement rules. An ICB awarding a contract has to use one of the processes in those regulations (three kinds of direct award, the most suitable provider process, or a competitive process), and for most of them there’s a standstill period before the contract can be signed. A provider who thinks the rules haven’t been followed has eight working days from the start of that period to make written representations (regulation 12), so you need to act quickly. I’ve written about how to challenge an award under the regime.

I advise practices on procurement, both when they’re bidding and when a decision looks wrong. I’ve also worked on judicial reviews of commissioning decisions, with my colleague Amit Kapoor and with counsel. If your matter is heading that way I’d look at it first and oversee it initially, but the court work itself would most likely be passed to a Nexa colleague who does litigation every day.

What goes to colleagues

I’m a consultant solicitor and all my legal work is carried out through Nexa Law Limited, which is authorised and regulated by the Solicitors Regulation Authority. That means the things I don’t do myself are covered by Nexa colleagues I already work with.

The main area is disputes, so if partners can’t settle their differences by negotiation, or a claim has to be brought or defended, I work out who at Nexa is the right person (taking into account what the matter needs, their capacity and their pricing) and introduce you. They then run the matter and quote their own fee. Property work goes to property colleagues, which includes buying or leasing surgery premises, sale and leasebacks, and the notional rent and premises costs questions that come with NHS buildings. Dental practice sales and purchases usually go to Jonathan Jacobs, who leads Nexa’s dental work.

I also act on the purchase and sale of care homes, which is closer to my ordinary business sale and purchase work than to anything NHS-specific.

Fees and next steps

I work on fixed fees, with a written scope agreed before I start, and the pages below give a guide for each type of work. If you get in touch and send me the details, I’ll tell you whether it’s something I do myself and what it would cost.