Conclusions and recommendations |
1. Primary Care Trusts have limited sources
of public funds for developing new premises other than through
LIFT. Very few new primary
care premises are funded through conventional public finance.
The Department has, therefore, encouraged new premises to be developed
through LIFT, in particular by providing funds to get the programme
started. The main alternative is for Primary Care Trusts and GPs
to commission a private contractor to develop premises which they
can then lease, which is not always feasible in deprived areas.
2. Providing new, purpose built primary care
premises is more expensive than continuing with the existing estate.
The higher cost of LIFT mainly reflects
the capital cost of new, high quality buildings compared to the
cost of existing premises which are often much cheaper but not
always suited to the delivery of modern primary care services.
3. The higher cost of new provision, whether
through LIFT or commissioning from contractors, could displace
other primary care spending. In preparing
business cases for LIFT projects Primary Care Trusts should compare
the cost of LIFT to the cost of the alternative procurement routes
available, and make the implications for spending on other primary
care facilities and services explicit.
4. Primary Care Trusts in some areas subsidise
other tenants to take space in buildings to encourage them to
participate in LIFT. Where Primary Care
Trusts are paying sizeable subsidies to make LIFT affordable for
other organisations, there should be a business case to support
the value of the subsidy and the expected benefits should be made
transparent. Subsidies should be used as a short term measure
to encourage tenants into the buildings unless there are exceptional
reasons that justify continued subsidy.
5. The Department and Partnerships for Health
have not yet developed a mechanism for evaluating LIFT although
they have started to do so. They should
complete this work quickly and publicise the underlying mechanism
and methodologies so that meaningful quantitative evaluation of
the value for money of the LIFT programme and its schemes can
6. There is no explicit provision to target
cost reductions over time. Earlier LIFT
schemes are expected to cost more than later ones, with costs
reducing once the model is rolled out more widely. Strategic Partnering
Boards, in consultation with the LIFTCo, should set cost reduction
targets for new projects in the light of experience in the local
LIFT area. There should be an annual review of progress against
the targets, once buildings are operational.
7. Under the Lease Plus Agreement, the LIFTCo
is responsible for all repairs and maintenance.
There is no threshold level in the standard LIFT contract for
minor alterations within a building. Some tenants within
LIFT buildings are frustrated that they cannot procure minor alterations
without prior consent from the LIFTCo and without going through
a time consuming and bureaucratic process. Partnerships for Health
should consult with the private sector partners and agree threshold
levels of expenditure below which any reasonable minor alterations
could be carried out promptly and without recourse to the LIFTCo.
8. New methods of care leading to centralisation
of services can result in access problems for patients. New
arrangements sometimes lead to less convenient locations for patients,
which can be a particular problem for those with mobility or transport
problems. Primary Care Trusts should liaise with other relevant
parties on location and access issues and give these priority
in Strategic Service Development Plans and the business case for
9. The effectiveness of Strategic Partnering
Boards is crucial to the performance of LIFT. Chairs
of Strategic Partnering Boards are appointed and remunerated by
Primary Care Trusts. Members come from local stakeholder bodies.
There is a risk that the Board can become a forum for discussion
rather than a decisive and results focussed body. Partnerships
for Health should help Primary Care Trusts and local authorities,
where relevant, develop a framework for appraising the effectiveness
of the Boards.