LIFT has the potential to support improvements in primary and social care

1.1 The Department's vision for the development of primary care services is set out in the 2000 NHS Plan. LIFT was established to address directly some of the objectives highlighted in the Plan, including premises improvement, increased co-location of healthcare professionals and recruitment and retention of GPs. As the Department's priorities have evolved to cover, for example, improvements in chronic disease management, so have the expectations of LIFT.

1.2 As a result of years of under investment in primary care services, the condition, functionality and age of many GPs' surgeries is unsuitable for delivery of modern primary care (Figure 2). Premises are often not purpose built; data collected in 1996 shows that almost half were based in either adapted residential buildings or converted shops. Access to these buildings for patients is often inadequate and buildings frequently fail to comply with Disability Discrimination Act (1995) requirements.6 Many premises were built over 30 years ago before standards on size were set, and lack of space inhibits development of services. LIFT will re-house GPs in new, purpose built and more spacious surgeries and where appropriate, redevelop existing premises to meet modern standards.

1.3 There is a national shortage of GPs. The NHS Plan 2000 set a target to recruit an extra 2000 GPs by the end of 2004. Some GPs have been put off practicing because of the poor quality of the premises available and restrictive and long term leases. Under LIFT, GPs can be bought out of existing premises and offered flexible leases within a LIFT building. In addition GPs can take shares in the LIFTCo equivalent to the value of the freehold on their existing premises, effectively swapping an interest in one property for an investment in a portfolio of properties and services, which may be traded if a secondary market develops. These new developments may encourage existing GPs to stay in the profession and will provide more choices for newly qualified GPs.

1.4 LIFT encourages the co-location of health and social care professionals in one building together with a more integrated approach to Primary Care. This would typically involve GPs working alongside nurses, pharmacists, dentists, therapists, opticians, midwives and social care staff. Co-location aids referral between primary care professionals and strengthens links between primary and social care services. Integration of services will benefit patients who need to draw on wider community services, particularly in deprived areas where the overlap between users of primary and social care services is greatest. Mental health teams, children's and elder person's welfare teams, advisory services and other community based initiatives can become involved in local LIFTs.

1.5 LIFT will also help meet changing priorities, such as making a wide range of services which currently are performed largely in a secondary care setting, for example minor surgery and scanning, available through primary care. LIFT is also well placed to assist in meeting the Government's chronic disease management agenda. Chronic disease accounts for 80 per cent of GP consultations and if well managed will minimise the need for admissions to secondary care, freeing up resources. The establishment of specialist chronic disease clinics within many LIFT buildings will offer patients co-ordinated care through multidisciplinary teams. Furthermore, the range of care provided through LIFT can help address "Patient Choice" issues. Giving patients a choice about how, when and where they receive treatment is currently a secondary care priority area. Patient choice in primary care is expected also to become a priority.

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6 The Disability Discrimination Act 1995 aims to end the discrimination faced by disabled people. The final rights of access came into force in October 2004, with service providers, including GPs, having to making permanent physical adjustments to their premises where non-compliant with the law.