10 LIFT will bring improvements in GPs' premises, support co-location of healthcare professionals and help forge links between primary and social care. Indirectly, it may help resolve GP recruitment and retention problems, help shift services away from secondary care3, assist in achieving good chronic disease management4 and enhance "Patient Choice" - giving patients more choice over how, when and where they receive treatment.
11 It may not be the best procurement method for all areas, but overall does offer advantages over the alternatives. Procurement in primary care prior to LIFT included central funding, third party developments (where a private contractor develops premises on behalf of GPs or Primary Care Trusts) and PFI. The LIFT areas we visited had often experienced problems in developing new premises through these routes. Primary Care Trusts particularly welcomed a long term approach under local strategic direction together with national support and standardised documentation.
12 The processes for selecting LIFT areas, facilitating the set-up of LIFTCos and allocating start up funding were all basically well managed. Inevitably when establishing a new initiative and aiming for quick results there were some management problems. The local use of enabling funds was not monitored routinely by the Department, and some schemes did not utilise this funding in a timely manner. Although LIFT is still a quicker route than PFI, the timetable of 12 months for establishing the LIFTCo and completing negotiations for initial developments was too ambitious. Ashton, Leigh and Wigan were the quickest to complete in 13 months. Partnerships for Health thought it unproductive to monitor advisory fee expenditure strictly by LIFT areas given LIFT was new with no established comparators. Local project teams were responsible for monitoring, but the spend for each LIFT area was not reviewed centrally until December 2003, when Partnerships for Health identified that some schemes were not taking advantage of reduced rates because of a lack of local oversight of the total time billed by advisors.
13 Second and third wave LIFT schemes were rolled out before the first wave schemes had completed negotiations. Although common problems were generally resolved centrally, some project teams had to spend time resolving issues as they arose, because they did not have the chance fully to learn the lessons from the first schemes. Nevertheless, Partnerships for Health and the Department did disseminate emerging lessons to schemes through several channels, for example conferences. There are plans to develop the dissemination of lessons further at a national level to allow LIFT schemes, non-LIFT areas and those using similar procurement models to benefit. The Department recognises that LIFT is not the only means of securing improvements in primary care. No formal framework to evaluate LIFT exists, however, including the important issue of how it compares in practice to experience using alternative procurement routes.
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3 Health care provided by specialists or facilities on referral from a primary care professional, requiring more specialist knowledge or skills than can be provided through primary care.
4 Chronic diseases are those that at present can only be controlled and not cured. They include diabetes, asthma, arthritis, heart failure, obstructive pulmonary disease, dementia and a range of neurological conditions.