By James Goulden BSc MRICS, Chartered Surveyor – RICS Registered Valuer, Director at Wignalls
I’ve sat across the table from a lot of healthcare tenants over the years — GP partners, dental principals, pharmacy owners — negotiating rent reviews they had no real ability to walk away from. That’s the part of this story I want to start with, because I think it explains why the ban on upwards-only rent reviews matters more in healthcare than in almost any other sector, and why I think the next two years matter more than the ban itself.
The ban is now law. The English Devolution and Community Empowerment Act 2026 received Royal Assent on 29 April 2026, and it prohibits upwards-only rent review clauses — the standard mechanism under which rent can rise or stay flat at review but can never fall, whatever’s happened to the local market in the meantime — in business tenancies across England and Wales.
It is not yet in force. The government still has to consult on the detail, including whether “caps and collars” (a floor and ceiling on how far rent can move at each review) will be permitted, and commencement is expected sometime in 2027 or 2028. There’s also one specific retrospective element worth knowing regardless of your view on the rest of it: any “tenancy renewal arrangement” — including a contractual right to renew or a put-and-call option — entered into on or after 17 March 2026 will be caught by the ban once the renewal lease is actually granted, even if the arrangement itself was signed before the ban commences. That date has already passed. If you’ve signed anything with a renewal mechanism since mid-March this year, it’s worth having checked now, not when the renewal comes round.
Most commercial tenants have a card to play at rent review that healthcare occupiers simply don’t: the ability to leave. A retailer whose rent gets pushed above market can, in principle, relocate to the unit two doors down. A GP practice, a dental surgery, or a pharmacy can’t do that without enormous cost and genuine risk to the business itself — patients are registered to an address, referral patterns and reputation are anchored to a specific building, and in the case of NHS dental contracts specifically, your Units of Dental Activity are tied to a registered premises that NHS England has to approve you moving. Pharmacy contracts carry a similar premises link. A GP practice needs commissioner support to relocate at all.
What that means in practice is that healthcare tenants have had the weakest negotiating position of almost any commercial occupier, while frequently being locked into leases specifically designed to remove even the theoretical benefit of a falling market. I don’t think that’s ever been a fair trade, and I’ve watched it play out badly enough times — a practice stuck paying a rent set at the top of a market that’s since softened, with genuinely nowhere to go — that I’m entirely comfortable calling this reform overdue rather than merely welcome.
Here’s my central opinion on this, and it’s the one I think is getting the least attention: the riskiest period for healthcare tenants isn’t after the ban commences. It’s right now, in the run-up to it.
Every landlord and every landlord’s agent negotiating a new healthcare lease over the next year or two knows exactly what’s coming. That creates an obvious incentive to get upwards-only terms signed and locked in while it’s still legally possible — on a lease that might run 15, 20, even 25 years, which is entirely standard for purpose-built health centre premises. A GP partnership signing a new 20-year lease today, without pushing hard for two-way review terms, could be the last cohort of tenants trapped in the old regime for the entire span of their working career in that building, while every competitor and neighbour who signs after commencement gets the benefit of a fair, two-way review as a matter of course. I think that’s a genuinely bad outcome to sleepwalk into, and I don’t think “the ban is coming eventually” is good enough advice for anyone signing now. My advice is blunt: don’t accept upwards-only terms in any new healthcare lease from this point forward, full stop, regardless of what a landlord tells you about “standard market practice.” The market is actively in the process of not being that anymore.
There’s a second issue I think deserves far more attention than it’s getting, particularly for dental principals and GP partners who sublet consulting rooms to associates or salaried colleagues, which is extremely common. Many healthcare leases require any sublease to mirror the head lease’s rent review mechanism, upwards-only element included. Once the ban commences, that mirroring requirement in the head lease has no effect on subleases granted after commencement — which means you can end up with a head lease rent that can only ever rise, sitting above a sublease rent that’s now free to fall with the market. You’d be paying your landlord more than you’re collecting from your own subtenant, on the same rooms, at the same time. I think this is the single most concrete, quantifiable risk in the whole reform for anyone running a multi-surgery or multi-associate practice, and it’s exactly the kind of thing that needs fixing in your paperwork before commencement, not discovered at your next review.
I want to be balanced about this, because I think there’s a real cost to this reform that isn’t being discussed enough in the healthcare press, and it’s on the investment side rather than the occupier side. A lot of new health centre and surgery development in this country gets built because an investor is willing to fund it against the security of a long lease with a rent that’s contractually guaranteed never to fall — sometimes underpinned further by NHS rent reimbursement assessed by the District Valuer. Take that guaranteed floor away, and some of that investment appetite goes with it, or at minimum gets repriced through higher headline rents, shorter leases, or tighter break clauses to compensate. I genuinely don’t think government has fully answered what happens to the pipeline of new surgery developments in areas with growing populations and genuine capacity pressure — parts of Lancashire and Merseyside very much included — if the standard financing model for building them changes underneath the sector without anything filling that gap. Fairer reviews for existing tenants and continued investment in new NHS premises are both things I want. I’m not convinced the Act, as it stands, has actually reconciled them.
On the specific question of caps and collars, which government is still consulting on: I’d rather see a genuine open-market, two-way review than a landlord-favoured “collar” that quietly reintroduces a floor under a different name. If a collar ends up functioning as upwards-only-with-extra-steps, it isn’t reform, it’s rebranding.
If you’re negotiating, renewing, or thinking about assigning a healthcare lease in Lancashire or Merseyside today, here’s where I’d focus, in order:
This is exactly the kind of lease and rent review advice we provide to GP surgeries, dental practices, pharmacies and other healthcare occupiers and landlords across the region, and it’s a genuinely live issue right now, not a future one — the transitional window I’ve described above is open today and will likely stay open for another year or two. If you’re facing a rent review, a lease renewal, or a new letting on healthcare premises anywhere in Lancashire or Merseyside, get independent advice before you sign anything, not after.
James Goulden BSc MRICS is a Director at Wignalls Chartered Surveyors and an RICS Registered Valuer, advising healthcare occupiers and landlords across Preston, Lancashire and Merseyside on leases, rent reviews and valuations.
Sources: English Devolution and Community Empowerment Act 2026 (Royal Assent 29 April 2026); legal sector commentary on commencement timing and the retrospective renewal-arrangement provision (Addleshaw Goddard, Bevan Brittan, Dentons, Blake Morgan); HCR Law analysis of healthcare-sector exposure and sub-letting mirror-clause risk (May 2026).
© Wignalls Chartered Surveyors 2026
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