Memorandum by NHS Alliance (PS 60)
LIFT and PFI in primary care are designed to
provide investment in areas, where traditional capital investment
by GPs themselves has been poor. The aim is to establish "Primary
Care Centres", which not only provide traditional GP services
but also a whole range of other services (eg direct access, health
information, pharmacy advice, voluntary services, benefits advice
or complementary medicine) and which provide a "one stop
shop". Traditional investment in general practice has been
private but the investors have been those who have been working
for and within the community (eg the GPs themselves). LIFT/PFI
in primary care present an untested hypothesis and NHS Alliance
would want to ensure that in practice they are able to:
Attract capital to areas which were
traditionally undesirable under previous systems.
Extend the quality and remit of services
available in deprived areas.
Provide services that were sensitive
to the needs of primary care practitioners working within the
premises and the patients served by them.
Met the priorities of the local PCT.
Ensured equity of access for any
services covered under LIFT/PFI schemes.
Did not incur the loal PCT in servicing
greater debt than traditional methods, which might reduce the
PCTs ability to carry out its function of improving local health,
secondary care services and primary care itself.
PFI in secondary care is relatively new. PFI/LIFT
in primary care very new. NHS Alliance believes that a pragmatic
approach should be taken to both, which means that there should
be adequate evaluation and research to produce a disinterested
assessment of the value of both. At this stage, NHS Alliance believes
that LIFT/PFI schemes should be concentrated in areas where investment
has been traditionally low. Where private investment by GPs has
been generally satisfactory (and therefore particularly attractive
to private investors through LIFT/PFI schemes), we feel that LIFT/PFI
schemes should be discouraged for the time being. This would enable
a comparison to be made between whole areas where there was traditional
GP investment in capital and where LIFT/PFI schemes predominated.
There are "a priori" reasons for maintaining
the status quo where investment is already satisfactory. Health
Centres, funded by public money, failed to meet the expectation
of those who advocated them during the 1970s/80s and are now virtually
extinct. If funding by public money failed to produce the level
of investment and sensitivity to local population/professional
needs (in comparison to premises owned by GPs themselves) then
the onus must be on the private sector to prove that they can
do better. A wholesale movement of private capital from GPs to
private investors might provide financial benefit for both but
cost the NHS more and reduce the ability of local people and professionals
to play their part in ensuring that the local health economy has
the services that it requires.
For these reasons, NHS Alliance feels that NHS
LIFT should be piloted in defined areas to begin with and rolled
out nationally only when there is clear evidence that it can provide
value for money, quality and equity.
NHS Alliance believes that public/private partnerships
in the provision of clinical care (eg elective surgery) do have
a part to play especially in meeting short term capacity problems
in the NHS. Such activity needs to meet four criteria:
Any contracts should be part of a
corporate agreement between local professionals and people through
the medium of the PCT. If there is complete freedom of individual
access to private services this may lead to inequity of access
and lack of corporate accountability for use of public money.
Any private contracts should take
full account of any impact upon current services provided. Where
the action of one PCT might affect the patients of another then
there needs to be agreement between all relevant PCTs with arbitration
by the Strategic Health Authority where agreement is not possible.
In the costing of many private services,
any hidden costs should be taken into account. For instance, comparative
costing of elective surgery with any spare capacity in the NHS
should take into account the cost and probability of any need
for support services such as ITU.
There need to be mechanisms for ensuring
that the quality of any private services are comparable with those
provided within the NHS. For instance, private services should
be open to CHI inspection and by local PCT patient/professional
A detailed summary of the NHS Alliance position
on private/public partnerships is outlined in our current joint
document with the King's Fund entitled Public/Private Partnerships
in Primary Care.