The government's £1bn investment plans for primary care premises are unworkable and cannot be achieved within the timescale set, according to a national survey of GPs and managers reported exclusively in HSJ.
'Lack of identifiable funding' and a regulatory framework that has failed to keep pace with changing demands on primary care were cited as major obstacles to NHS plan targets of refurbishing or replacing 3,000 GP premises and providing 500 'one-stop primary care centres' by 2004.
Of 27 GPs and primary care managers interviewed, not all had heard of the government's publicprivate partnership NHS LIFT (Local Improvement Finance Trust), which the researchers described as 'an unclear policy' and lacking 'enough realistic resources to achieve what it intends to throughout the NHS'.
But respondents saw private finance as the way forward, although they opposed the private sector taking on facilities management in hospital private finance initiative deals - promoted by the Department of Health as a potential benefit of NHS LIFT.
This 'raises serious doubts about its [NHS LIFT's] ability to resolve the needs in the areas it was established to resolve, ' the researchers comment.
'Furthermore, as a policy backbone it has neither been understood or heard of by the vast majority of those questioned and this must be seen as a major point of concern. '
The survey, by Dearden Consulting, consisted of indepth interviews with 27 GPs and primary care managers - including one regional primary care director, two primary care group chairs and four chief executives at PCG/trust and health authority level - in the four months up to March this year.
Some had recently been involved in premises development, others were known through their PCG/T development work.
Most agreed that developments would take a minimum of two years after locating a suitable site and that the prospect of funding additional space was limited in the current system.
'There was an overall feeling that the proposals in the NHS plan would not be achievable, ' says the report.
Managers also questioned the benefits of one-stop centres: where was the evidence that they were what the public or healthcare professionals wanted, or that they would provide better services, they asked.
There was even greater scepticism about the government's refurbishment plans, which respondents suspected were politically motivated rather than based on health need.
They could not see how such developments would be financed, 'with clearly no return for investment' for the private sector, and 'saw little incentive for struggling practices in deprived areas to take this on willingly in response to government policy'.
Maryan Pye, associate consultant with Dearden, said the research highlighted the 'huge constraints in the system' and the fact that 'policy-making is getting ahead of the regulatory framework needed to back it up'.
She was also concerned about the scale of the proposals given that that change has traditionally been practice-led.
Information from the survey indicated that the provision of 500 new one-stop centres would require relocating as many as a third of GPs in England.
'This is potentially a huge, huge disturbance given there is no one to lead it, ' she said.
New Agendas in Healthcare: premises for primary care.
Nick. owen@brackley-investments. co. uk 01869-244848.
See 'Delayed LIFT-off ': special report, pages 1-3.