to surgery building
Dr Bhupinder Kohli's surgery was the first completed LIFT building in the
country here he describes the experience and gives advice to other GPs who wish to embark on a LIFT project
Our premises are called The Centre Manor Park and were the first in the country to be built under the public-private LIFT scheme. Our premises are a one-stop shop, home to three practices with a total list size of 16,000.
Staff and facilities include district nurses, health visitors, primary care psychology and a diagnostic/outpatient corridor, all under the same roof.
Altogether there are more than 100 people working from the building, which also has three retail units for use as a pharmacy, optician and dentist. We have a large amount of communal space with shared waiting areas, rest rooms, meeting rooms and a roof terrace.
Of the three practices here, ours has the largest list at 8,800 patients. We are in a typical inner-city part of London with a population that is probably 85 per cent minority ethnic (30 per cent do not speak English) with high levels of unemployment and social depravation. We manage with bilingual staff and a stream of advocates.
Before the new premises were built we worked from two rundown converted Victorian terraced houses. One of these became less than popular after staff found mouse droppings on the computers.
In our new premises we have 20 per cent of the new building and have to negotiate with the other teams at monthly meetings on the running of the premises. The structure of this process is still in development.
Stream of visitors
The building is erected on an old clinic site that was run down and in constant need of repair. It has attracted a lot of interest and we are constantly having visitors from various Government departments.
Two years before moving in, we were called to a series of meetings to discuss the type and style of the building that was needed. These meeting were held by the PCT LIFT office and were multidisciplinary with all the potential tenants being invited.
Sometimes these were useful but in hindsight they made excessive demands on our time.
The improvement in our working environment is very significant and this has helped recruitment in an area where it is hard to get good staff.
LIFT buildings are the fastest NHS building projects to get planning permission and to achieve completion that I know of. Some projects have been developed with input from local authorities. I wish we had been able to have had social services on site.
LIFT worked for us
I love working in our new centre and staff seem to love it too indeed many community staff apply to be transferred to our site. The patients obviously enjoy the place
once they get used to the size, and expect us to be open all the time like a walk-in centre.
LIFT has on occasions been criticised for being too expensive, overly bureaucratic and prone to delivering substandard premises, with GPs and their staff having too little input on design matters.
But overall we found it quite good. We were consulted about what our needs were and, as I have indicated, these have largely been met. The whole project was on time and the builders did a good job.
Best of all we did not have to worry about the finances or face any form of risk. This allowed us to continue to focus on what we are good at delivering primary care.
Of course there have been a few glitches. The telephone system is shared in the building and this initially caused a few difficulties, with some patient calls being lost. But this problem is now resolved.
Again the sharing of the building has been a steep learning curve which has been difficult at times. But there are definitely benefits too. For instance, it is easy to have a primary care team meeting or give referrals to the community nurses.
The worst experience is the parking. This is a constant aggravation as there are only 20 spaces! Gone are the days of protected parking for the doctors and this is one area where we are worse off than before.
What advice would I give other GPs who wish to use LIFT?
If you currently work from poor premises and you do not want the hassle of having to find a site and organise a building project, then a LIFT building is the answer. A lot of the stress is taken off your shoulders and you can concentrate on being a GP.
One or two warnings, however. Make sure you are consulted about your requirements, and make sure your voice is heard. Do not take on the burden of the head lease: the PCT is best at handling this.
Find out how flexible the situation is regarding what you can do by way of alteration and repairs in the future: your surgery building is a long-term commitment and service requirements can change. And find out the service charges and other costs you may have to pay.
Are the criticisms that have been voiced about LIFT fair or unfair?
LIFT is a PFI project for primary care with the addition of maintenance of the buildings. The LIFT company has a monopoly to provide premises in the PCT area for 20 years and such a long-term relationship is helpful to the private sector and NHS.
Starting LIFT schemes has been expensive for the Government and the private sector to initiate. LIFT is more expensive than cost-rent to the PCT due to the higher interest charges.
But because of LIFT, GPs and primary care have the benefit of excellent quality accommodation delivered to their requirements on time with no financial risk or management responsibility.
I consider myself to be lucky to be
working in a LIFT building and would highly recommend it if you are willing to give
up some control of the building you work from.
Bhupinder Kohli is a GP in Newham, east London
Our experience of LIFT
· No financial risk in moving into new buildings
· No delays in the building project
· Excellent build quality
· You work on site with other community services
· The financial risk is with the PCT
· No maintenance worries as the building is fully serviced and the service charge appears to be reasonable
· No long-term investment in the buildings
· Cost of alterations is higher than usual routes
· Notional rent to the PCT is significantly higher than traditional routes
· Learning to share a building with other teams can
be a trial