Memorandum submitted by Dr Bhupinder Kohli
I have been closely involved with the LIFT building
program in East London. When the program was first launched in
2003 I was the GP representative on the selection panel for the
private partner selection. At the time I was the Chair of the
executive committee of the Newham Primary Care Trust. I have been
closely associated with promoting LIFT buildings in our area and
as a result was appointed the clinical champion for LIFT in Newham.
I was inspired by the concept of super surgeries
and of the partnership between several public sector bodies and
the private sector. LIFT was like a breath of fresh air the development
of primary care buildings and area of neglect for many years in
East London.
I was very impressed with the early stages of
LIFT and the speed with which it promised to deliver the buildings.
I decided I wanted to work in one of the new LIFT buildings. As
a result I applied to take over a single handed retirement vacancy
in the area of the new LIFT building and resigned my post in an
established group practice and with the hope that this would mean
I could work in the new super surgery.
Soon after this we were successful in taking
over another two local single handed vaccines in Manor Park and
were selected to work in the Super Surgery.
Working in The Centre Manor Park the first super
surgery to be opened under LIFT is a joy as the building is by
far one of the best designed primary care premises in the area.
It has transformed the lives of local residents and the working
lives of health workers. Although the move has been hardwork the
end result has been a vast improving in the services we offer
and helped in the recruitment of Doctors in a deprived hard to
recruit area.
Many other practices in the area have wanted
to have the same opportunity of moving into buildings like the
one I work in. However the LIFT buildings are significantly higher
in revenue costs than previous methods to provide GP premises
like for instance third party developers.
I am not an expert in accounting but as a lay
observer I am concerned at the affordability of LIFT.
The building I work in cost £5 million
to build and has a service charge of over £1 million per
annum which includes repairs and maintenance for the building.
This is 20 year contract which is inflation linked and includes
hard facilities management cost.
The two LIFT buildings in Newham that have been
finished take up 33% of the budget for 8% of the population. See
tables below given to me by David Stout, Chief Executive of Newham
PCT.
CONCLUSION
Most of the local primary health care workers
would love to see more high standard buildings in the area to
replace the 35 odd premises that are significantly below standard
as they are converted Victorian terraced houses. However the significantly
higher revenue costs of LIFT buildings poses an affordability
question for the other practices and patients of Newham. The cost
of LIFT buildings is significantly higher that traditional 3rd
party development and has put a stop to other forms of delivery
of primary care premises.
My concern is that we will not be able to deliver
the patient led NHS agenda or Practice Based Commissioning which
are the corner stones of delivering the New NHS and of giving
choice to patients. A problem of inequity of buildings quality
to patients is a problem.
Furthermore for alterations that may be needed
from time to time to LIFT buildings we have lost the ability to
obtain to get a competitive quote. Traditionally in primary care
when minor alterations are required we were asked to get three
quotes and the best value and quality and supplier got the business.
Under LIFT we have to use the LIFT landlord who has a monopoly
in providing for any alterations. We have had some bills for minor
works which have been significantly higher than what we are used
to paying for in the community NHS. My concern is that due to
cost we will not make the necessary minor alterations that affect
patient care.
Analysis of General Practice premises
cost in Newham 2005-06
| Total rents paid—Newham PCT 2005-06
| $ | List size
| £ per patient |
| Total PMS | 1,644,814
| 188,128 | 8.7
|
| Total GMS | 679,105
| 101,573 | 6.7
|
| Total PMS and GMS | 2,323,919
| 289,701 | 8.0
|
| Boleyn Medical Centre (est full cost £574k)
| 476,420 | 11,774
| 40.5 |
| Centre Manor Park (est 61% of full cost £1,084k)
| 661,240 | 14,430
| 45.8 |
| LIFT sites | 1,137,660
| 26,204 | 43.4
|
| Grand total rent for GP's premises
| 3,461,579 | 315,905
| 11.0 |
| |
| |
| Primary Care premises costs |
| | Population
| Costs |
| Total PMS and GMS | 2,323,919
| 289,701 | 92%
| 67% |
| LIFT sites | 1,137,660
| 26,204 | 8%
| 33% |
| Grand total rent for GP's premises | 3,461,579
| 315,905 | 100%
| 100% |
| |
| | |
Notes
Lift rents include hard FM costs not covered in other practices.
Share of GP space in LIFT sites estimated.
List sizes based on 1 January 2005 (some estimated)
Wide variation in rent costs in GMS and PMS practices (from £2.1-£20.7)
| 
