Q81 Mr Bacon: 20% instead of 6%.
Dr Kohli: Yes. 6% would be the base rate you would give and you would give 10% for hard FMs and you would get 6.6% under normal cost rent rules. That is the concern: it is stifling other opportunities because more money is being diverted to pay for these new developments.
Q82 Mr Bacon: You are saying that there might have been other money available to pay GPs to do cost rent schemes had it not been diverted in this direction. What about Mr Stewart's point that in certain areas like where we were in Newham, it is not necessarily obvious that GPs will pile in or put their own property or their own house at risk because it is not a pension in the way that it is in leafy Surrey. Would you have gone into a cost rent programme in somewhere like Newham?
Dr Kohli: When I was part of the scheme with five doctors in 1990 the property market was in dire straits and it was a big financial risk and we were all in negative equity for many years; infinitely more so than today. It was a very different climate. Today, with the property market in East London, which is all I know, having risen so much the affordability is there. It is where the property has no value that there is no point and you cannot afford to build new. Today you can in East London and local practices would. What they cannot do, what LIFT does give, is the next stage on, which is just beyond the GP's surgery: co-location, the different providers working together. That is the new thing which LIFT bought and that is what I got excited about, as I have written in my statement, and that is why I was so attracted to it. Like a lot of other GPs I am also equally struck by the costs and whether we can afford the other 10 buildings we need in Newham to do what we set out to do. If you read the original LIFT documentation in the strategic development plans, we were supposed to transform 30% or 40% of our entire premises stock within three to five years. It could be done but the affordability is not there.
Q83 Mr Bacon: Mr Coates, on the subject of an excellent LIFTCo building like the Newham one, I understand that LIFTCo has basic responsibility for how this building is built, developed, operated and managed. That is basically right, is it not?
Mr Coates: Yes.
Q84 Mr Bacon: Is that "except for IT"?
Mr Coates: As I understand the original agreement as struck, IT was left for the PCTs to settle with the GPs.
Q85 Mr Bacon: So if Dr Kohli wants to send an email on one local area network to the psychologist next door or to the dentist next door but one, as we saw will be possible physically, he cannot, he has to write to them because there is no local IT solution which would work for one building. It would not require a particularly complicated IT system because you are talking about how many professionals in the building altogether?
Dr Kohli: Eighty staff.
Q86 Mr Bacon: So we are talking about a relatively small- to medium-sized business, a very easy thing to do in terms of off-the-shelf IT and of course with the expertise that GPs have of developing user-friendly IT for themselves over the last 20 years it would not have been that difficult, yet you do not have that at all, do you?
Mr Coates: May I ask Dr Kohli why it has not been resolved?
Dr Kohli: To be fair we do have internal e-mail, which is rather different from having a shared IT system. The point I made earlier was that if we want to refer to one of the visiting consultants downstairs we do not just make an internal e-mail referral, you actually have to write back up to the hospital where the outpatient department happens to be and to be fair that is not really within LIFT. That has been nationally procured through an IT system and I suspect that is another debate altogether.
Q87 Mr Bacon: Are the consultants you have downstairs just occasional visitors or are they quasi resident inasmuch as it is the same ones each week?
Dr Kohli: No, the same people come every week for a clinic a week and not just them but also GPs with special interests who are community specialists.
Q88 Mr Bacon: So the referrals could be handled locally.
Dr Kohli: Follow-ups can be made locally and are made locally. It is the new appointments, because the system is all run through central operations. Even that is not the problem. The problem is that you cannot view it and you still have to write a paper record to the hospital. It is more like an outreach of the hospital as opposed to being joined up with community services and that is an evolution which is going to take some time.
Q89 Mr Bacon: I noticed, like Mr Trickett, the reference on page 36 to the IADP, the Issue Analysis/Dinner Party statement, what you call a high level conclusion, "The local LIFT models appear to be an effective mechanism clearly demonstrating value for money". Then, in paragraph 2.32, the sentence "Given the newness of the initiative and the importance of strategic factors that are not easily quantifiable, conclusions about the likely longer term value for money of LIFT are likely to be judgemental". I simply do not know, like my colleagues, whether this really is value for money or not. My question to you is: is this value for money, is it not value for money, or is it too early to say?
Mr Johns: I believe the simple answer to that question is that it is value for money and every LIFT deal that is signed has to be agreed by the Valuation Office and the Valuation Office of course have access to data on all developments for primary care, GP third party developments and LIFT and public sector schemes as well. Before they sign up the value for money of any LIFT scheme they do a comparison with a third party development. As Dr Kohli has intimated, that is not a straightforward comparison because LIFT tends to deliver a much broader, more complex range of services than a simple GP third party development. Against that background the Valuation Office do undertake a review and no LIFT business case can be approved without that Valuation Office approval of value for money. That is the first step. Because LIFT is innovative we cannot just look at what the costs of the schemes are: we also have to look at the value of the services provided and the benefits to patients. That does take longer to get a full long-term assessment.
Q90 Mr Bacon: Is it not therefore fair to say-I am not trying to be difficult-and therefore you cannot yet say whether it is value for money.
Mr Johns: What I can say is that in comparison with third party developments, the comparison the Valuation Office have undertaken not that we have undertaken, they determine that it is value for money. What I am saying is that we will get a much broader measure of value for money over the longer term and indeed we are undertaking work now with LIFTCos to investigate not only the cost of providing the facilities, but the benefits to patients and the benefits to health outcomes which ultimately is what drives value for money, not the premises but the health outcomes that we derive.