Key findings:

•  other than through LIFT, Primary Care Trusts have limited sources of public funds for developing new premises. The alternative is for Primary Care Trusts and general practitioners to commission a private contractor to develop premises they can then lease, which is not always feasible in deprived areas;

•  it is more expensive to provide new, purpose-built premises than to continue with the existing buildings;

•  the higher cost of new premises, whether through LIFT or by commissioning contractors, could displace other primary care spending;

•  Primary Care Trusts in some areas subsidise other tenants to take space to encourage them to participate in LIFT;

•  the department and Partnerships for Health have not yet developed a mechanism for evaluating LIFT even though the deal has commenced;

•  there is no explicit provision to target cost reductions over time;

•  under the Lease Plus Agreement, the LIFTCo is responsible for all repairs and maintenance;

•  new methods of care leading to centralisation of services can result in access problems for patients; and

•  the effectiveness of strategic partnering boards is crucial to the performance of LIFT.