Select Committee on Public Accounts Minutes of Evidence

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.


  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 PMS1,644,814 188,1288.7
Total GMS679,105 101,5736.7
Total PMS and GMS2,323,919 289,7018.0
Boleyn Medical Centre (est full cost £574k) 476,42011,774 40.5
Centre Manor Park (est 61% of full cost £1,084k) 661,24014,430 45.8
LIFT sites1,137,660 26,20443.4
Grand total rent for GP's premises 3,461,579315,905 11.0
Primary Care premises costs Population Costs
Total PMS and GMS2,323,919 289,70192% 67%
LIFT sites1,137,660 26,2048% 33%
Grand total rent for GP's premises3,461,579 315,905100% 100%


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)

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