Select Committee on Health Minutes of Evidence

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 fora.

  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.

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2002
Prepared 15 May 2002