2.12 A shortage of suitable sites and appropriately skilled public sector staff led to delays in some cases. Schemes found it difficult to identify and purchase appropriate sites for construction of LIFT buildings. Land outside the primary care estate was found to be scarce (especially in London) and expensive. Suitably skilled public sector workers to implement LIFT were scarce. We found several examples where project directors were solely responsible for their local LIFT and operated on a day to day basis without a support team. Some of these individuals had additional non-LIFT work responsibilities. Where Primary Care Trust Chief Executives have shown a high degree of buy-in to the process and have been closely involved in local decision making, the process of completing negotiations has run generally more smoothly.
2.13 In our survey of project directors, 56 per cent of respondents indicated that they did not have sufficient resources to complete the drive towards financial close efficiently. Our case studies showed that where Primary Care Trusts allowed for closer involvement of senior management and key finance staff around the critical period just before financial close, negotiations were completed more quickly and non-LIFT Primary Care Trust activities remained adequately resourced. Where Primary Care Trust Chief Executives have shown a high degree of buy-in to the process and have been closely involved in local decision making, the process of completing negotiations has run generally more smoothly.
2.14 Negotiations with local clinicians, for example GPs, pharmacists, dentists and opticians, have tended to take longer than expected. Buy-in was sometimes patchy and in some cases attracting established GPs whose premises were not up to standard into the LIFT buildings proved more difficult than expected. Many GPs are very independent with established working patterns and did not find LIFT with its emphasis on co-location appealing. Representatives from the National Pharmaceutical Association, the British Dental Association and Local Authorities told us they had concerns over rental costs. There is a common perception from these groups of prospective tenants that the higher cost of LIFT, compared to current rent payments, outweighs the benefits of new, purpose built premises. The Department worked hard to address this through creation of GP champions for local areas and by hosting forums for GPs to understand the issues. Take up rates from other healthcare professionals have been variable and, occasionally, the Primary Care Trust has agreed to subsidise the rents to meet their wider health agenda. Generally pharmacists were interested in LIFT, while dentists and opticians were not.
2.15 In the absence of any experience of the demands presented by LIFT, Primary Care Trusts were often too optimistic about the number of projects that could be undertaken in the first tranche. East London LIFT, the first scheme to reach financial close, originally aimed to close on seven sites but scaled back to three sites, closing on just one site in May 2003. Partnerships for Health quickly grasped that closing on a manageable number of schemes was a key lesson for other areas to learn if they were to deliver to timetable and in October 2003 advised project teams that they should aim to complete their first tranche on a bundle of around three schemes. This practice had already been adopted by our other case study areas.
2.16 None of our case study LIFTCos negotiated the period from selection of Preferred Bidder to financial close in the three month timetable set by Partnerships for Health. It took Barnsley 11 and Sandwell eight months to complete this phase of procurement (Figure 7).
2.17 A key contributor to delays in some cases was difficult and time consuming negotiations with preferred bidders. In most cases delays were caused by the public sector changing project requirements. We are also aware that some private sector partners did not manage their involvement adequately. For example, one private sector partner was involved in several of the 42 local areas and found its resources too stretched to drive forward all its LIFT schemes. Project teams also experienced difficulties in managing the multiplicity of stakeholders in the lead up to financial close. They are required to consult with the preferred bidder, the Department and Partnerships for Health; they must also negotiate with other public sector organisations and prospective tenants.
2.18 Clear guidance about the role and level of involvement of stakeholders in the LIFT process is also important. The role of Strategic Health Authorities was only clearly defined in June 2003. The initial lack of guidance meant approval to the business case from some Strategic Health Authorities within our case study areas was delayed.