Private practice setup · step 4 of 7
Premises and commercial lease negotiation
A clinic lease is a fifteen-year decision made in a fortnight, usually against an agent acting for the landlord who negotiates leases full time. The headline rent is rarely where the money is.
What this involves
- Negotiate heads of terms on the points that carry real value: rent-free or half-rent periods, the basis of future uplifts, break rights, service charge caps, repairing obligations and reinstatement at the end of term.
- Push back on review mechanics. A fixed compounding annual uplift and an open market review are very different fifteen-year commitments, and the difference is rarely explained at heads of terms stage.
- Handle landlord works approval, consents and the fees attached to them, which are frequently introduced late and priced as though they are standard.
- Check the VAT position, because a landlord who has opted to tax changes what your entity needs to do at incorporation.
- Run the negotiation directly with the agent so that you are not doing it between clinics.
The mistake that costs the most
Negotiating the rent and conceding everything else. Agents concede on headline rent readily because it is the number the client is watching, then recover it through the uplift basis, the service charge, the repairing obligation and the reinstatement clause. A rent-free period is worth less than a capped service charge over a fifteen-year term, and dilapidations at the end can cost more than a year's rent if the repairing obligation was accepted without amendment.
Why this workstream matters
For most clinics the lease is the single largest financial commitment in the venture and the least reversible. It also gates everything else: funding, fit-out programme, CQC registration and opening date all depend on the premises being settled.
Common questions
What should I negotiate in a clinic lease besides rent?
The uplift basis, the service charge and whether it is capped, the repairing obligation and whether it is full repairing or limited by a schedule of condition, break rights and their conditions, reinstatement at end of term, and landlord works approval and its fees. Over a fifteen-year term these are collectively worth far more than the headline rent, and they are where an agent recovers what was conceded on rent.
Is a rent-free period the best concession to push for?
It is the most visible but rarely the most valuable. Three months rent free is a one-off benefit. A capped service charge, a schedule of condition limiting the repairing obligation, or an open market review instead of a fixed compounding uplift each recur for the whole term. Ask for the rent free and then trade it if a structural point is available.
Do I need the lease settled before applying for funding?
Not settled, but the terms need to be firm enough to model, because the rent, the rent-free period and the works obligations all feed the forecasts a lender is underwriting. In practice the two run in parallel and each informs the other, which is why having one adviser handling both avoids the numbers drifting apart.
Reviewed 22 August 2026. Nothing on this page is legal, tax or financial advice, and regulatory requirements change. We work alongside your solicitor and accountant rather than in place of them.
The rest of the programme
These overlap heavily. Running them in sequence rather than in parallel is what adds months to an opening date.
See the full practice setup overview, or our CQC and Ofsted registration support and Provider Selection Regime guide.
Where are you up to?
A director replies, and the first conversation is about sequencing rather than fees.
Premises and commercial lease negotiation
What is your specialty, do you have premises or partners in mind, and what stage are you at?