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Since the mid
1990s, there has been no large-scale, sustained, government programme of
premises development in the primary care sector. The NHS Plan set
targets to modernise the primary care estate by investing £1.19bn and by
2004 envisaged that up to 3,000 GP premises would be replaced or
refurbished and 500 one-stop primary care centres would be developed.
The number of one-stop primary care centres would be further increased
to 625 in 2006 and 750 by 2008.
To date, around 3,000 GP premises had been modernised and
around 565 primary care centres had been created by June 2006, of which
78 were completed under the Local Improvement Finance Trust (LIFT). A
further 60 LIFT premises are due to open in 2006.
In August 2004,
the Department of Health
announced the allocation a further £108 million to help refurbish and
develop GP surgeries, in addition to the £1.19 billion
above. In addition, over the period 2002-2006, the Department of Health
is investing around £215 million of public funds in NHS LIFT, with
around £1 billion of inward investment from private sector partners to
upgrade the primary care estate.
The Government’s
commitment to sustained rises in NHS funding and additional increase in
resource spending allocated in the 2004 Spending Review are now set to
lift overall NHS expenditure to £93.4 billion in 2007-08, of which 76%
or £71billion will be allocated to the primary care sector. NHS Capital
Expenditure is set to reach £6.1 billion by 2008 – 7% of total NHS
Spending - and £8.1 billion in 2010, around 8% of total NHS spending.
Furthermore, the
Government’s treatment centre programme has resulted in 44 NHS-run
centres already open and a further 19 are in development. There will be
around 80 centres treating NHS patients by the end of 2008 at a total
cost of around £2bn over 5 years.
The Government has also
recently pledged £750m over 5 years to stimulate a new wave of around 50
community hospitals and health centres, which will provide inpatient
services and diagnostic tests. Private companies are expected to provide
clinical services as part of the deal. This announcement sees a
general shift away from large acute PFI hospitals towards more local
facilities with around £12bn being cut from the PFI hospital programme
to between £7 and £9 billion.
These announcements come at a
time when the NHS is experiencing financial crisis. Despite NHS funding
currently standing at around £76.5 billion, nearly a quarter of NHS
trusts are failing to balance their accounts, and the NHS is facing an
estimated deficit well in excess of £250m.
In recent years,
the NHS has been undergoing a period of structural change and has
forged a much closer working relationship with the private healthcare
sector, including the direct purchase or leasing of health care from
the private sector.
Choose and Book,
the creation of new ‘localities’ to support GP commissioning and the
Government White Paper on Out of Hospital care, are a just a few of the
other major reforms currently taking place within the NHS.
Partnerships with
independent hospitals, the rise of independent treatment
centres and the plan to give all NHS hospitals independent foundation
status by 2008, signal the arrival of a new era for the NHS, with the
emphasis very much on care at primary level and the
continuation of outsourcing facilities and services to the
private sector.
Whilst much of the
investment proposed for improvements to the health service is being
funded from the public sector, a significant proportion of the
investment for new healthcare buildings is expected to come from the
private sector. The Private Finance Initiative (PFI) has traditionally
been the main vehicle for delivering large-scale capital schemes and PFI
contracts are expected to raise around £8 billion of private capital by
2010, primarily for major schemes. However,
PFI has not traditionally been used for primary care
facilities and tends to focus on larger schemes and is used on a
widespread basis for acute hospital projects.
As a result of
recent focus on initiatives to improve the performance of NHS trusts as
best practice clients, a new procurement method in the form of
Procure21 (P21) has been introduced to provide a prime-contracting
route for the delivery of medium-scale hospital projects over £1m
outside of PFI arrangements. Procure21 aims to establish main suppliers
in framework agreements with the NHS Estate and is expected to reduce
programme time and improve build standards.
The total planned
spend for the P21 programme is in the region of £1.4 billion per annum
(£7 billion in total), with an anticipated future capital expenditure
estimated to be between £900m and £1 billion per year over the next 3
years. The Framework has already exceeded its 5-year target by procuring
over £1bn of capital schemes in its first year.
Just
3 years since its inception, there are over 230 P21 schemes in
various stages of procurement representing an estimated value of £2.3
billion. Around 100 schemes have already been completed, with a
further 59 schemes on site and a further 177 in the earlier stages of
procurement.
P21 has played a
major part in fostering partnering between the public sector and the
construction industry, which has made a significant contribution to
establishing relationships built on trust, mutual respect and a real
desire for teamwork.
A large proportion
of the improvement programme for GP premises and primary care health
centres is being provided through the NHS LIFT, which packages
local surgery and primary care facility contracts through the formation
of Public Private Partnership (PPP) companies.
LIFT provides
community facilities, which are smaller in scale and cost, ranging from
£1million to £30million.
In England, LIFT schemes
involving a joint venture between private sector finance and the public
sector have been concentrated in areas of high deprivation or urban
regeneration. Outside these areas it has been almost impossible for
general practitioners to secure the necessary funding streams to build
new premises. Where LIFT schemes are operating, many GPs have found that
funding for other types of premises development (e.g. schemes involving
third party developers) is limited or non existent due to investment in
the LIFT scheme.
Over the period
2002-2006, the DH is investing around £215 million of public funds in
NHS LIFT, with just over £1.8 billion of inward investment from the
private sector partners in the first 4 waves of LIFT. To date, a total
of 42 schemes have now been announced as part of the first 3 waves of
LIFT involving over 150 Primary Care Trusts (PCTs) and, of these, 78
buildings under LIFT are operational and open to patients, with a
further 60 new LIFT-funded primary care schemes due to open in 2006.
The LIFT model’s
scope is adapting and expanding, with the DH now considering the
inclusion of “soft facilities management” services, such as cleaning and
catering and how these could be brought into the LIFT framework. The 4th
wave of LIFT schemes will see the LIFT model move into new clinical
areas, such as diagnostics and out-of-hours services, bringing the
concept more in line with the Government’s policy to focus away from
acute services and increase investment in primary care and deliver a
patient-led NHS. |
