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