Select Committee on Health Minutes of Evidence

Memorandum by the BMA (PS 59)


  The BMA is a voluntary professional association of doctors, and their trade union, which promotes the science of medicine and maintains the honour and interests of the medical profession. With over 122,000 members, it represents around 80 per cent of the medical profession in the UK.


  The Secretary of State for Health set out the scope of private involvement in the NHS in a speech to the NHS Confederation on 6 July 2001. He identified four areas namely:

    —  Using spare capacity in the private sector to perform operations on NHS patients.

    —  Private sector management to run some of the new stand alone surgery centres.

    —  Extending PFI beyond the hospital sector into the new PPPs in primary care, social services and provision of equipment.

    —  Using private sector management expertise such as the provision of IT services.

  The first of the areas identified by the Secretary of State finds its clearest expression in the concordat on partnership between the NHS and private and voluntary health providers agreed between the Department of Health and the Independent Healthcare Association which identifies the following options for elective care:

    (i)  Primary Care Group or Primary Care Trust commissioning or renting accommodation from the private and voluntary health care sector with the service delivered by NHS consultants and other NHS staff under their NHS contract.

    (ii)  An NHS Trust "sub-contracting" the provision of a service to the private and voluntary health care provider.

    (iii)  Primary Care Groups of Primary Care Trusts commissioning directly from a private and voluntary health care provider.

  The establishment of PCGs/PCTs has prepared the way for practitioner led commissioning of health and social services. Experience of fund-holding and personal medical pilots have shown that GPs are well suited to deliver improvements to services and to introduce innovative ways of working to the benefit of their patients.

  Interest is now beginning to be expressed in the extension of the "best value" approach to healthcare. The final report of the Commission on Public Private Partnerships suggests that as primary care groups/trusts become more established and care trusts emerge, consideration should be given to the application of the best value regime to primary health care and community services. The NHS Confederation, whilst not proposing that the commissioning process be opened out beyond NHS providers, suggests that the best value approach could provide a useful framework for commissioning NHS care. The issue of best value is a matter that the Committee may wish to pursue with the Minister.


  Public Private Partnerships will be extended into primary and community care, the third of the Secretary of State's bullet points (above), with the proposals set out in "Modernising Primary Care in the NHS—NHS Local Improvement Finance Trust (NHS LIFT)". The BMA understands that essentially NHS LIFT is a means of using public funding as pump priming to attract private sector finance into premises development. It assumes a PCT-wide strategic approach to premises development.

  Using powers under the Health and Social Care Act, its initial focus will be on areas such as inner cities where primary care services need most expansion. It currently operates in six areas of high deprivation (Barnsley, Camden and Islington, East London and City, Manchester, Salford and Trafford, Newcastle, Sandwell) but the plan is to roll it out to other areas of England.

  When PCGs/PCTs produce the local Health Improvement Plan (HimP), investment and estates plans will be developed as part of this process. A private sector partner will be found to establish a local LIFT company as a joint venture between local stakeholders, the private company and "the national joint venture" (ie "Partnerships UK"—the body established by the government to develop public private partnerships and the Department of Health). The private sector partner will work with local health bodies in a long term partnership for developing primary care and community facilities, providing investment and management and delivering services as required. It will also be involved in the planning of future local services, coming forward with ideas for investment opportunities where appropriate. The aim is for there to be long term partnership with the aim of providing integrated local services. In order to make involvement in a LIFT an attractive option financially, the private sector partner will be given exclusive rights over future developments within the scope of the partnership.

  As a consequence of the NHS plan, utilising LIFT, up to 3,000 GP premises would be improved by 2004, up to £1 billion invested in primary care facilities. The investment to replace the old NHS building stock and to catch up on the backlog of maintenance is sorely needed. The Government's intention to improve GP premises particularly in inner cities, is one the BMA would support.

November 2001

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