The Government will explore private investment in primary and community health infrastructure, a strategy paper has revealed.
The Public Private Partnership (PPP) model has not been used by central Government since 2018, but a new 10-year infrastructure strategy proposed reintroducing the model for taxpayer-funded projects ‘in very limited circumstances where they could represent value for money’.
The Government said it will ‘rapidly explore’ the potential to use PPP in ‘certain types’ of primary care infrastructure and will take a decision by the autumn.
The PPP model provides a mechanism ‘to bring in private finance to infrastructure projects’, through a long-term contract between a private party and the public sector where the private sector ‘designs, builds, finances and operates a public asset and related services’.
The private sector finances the construction of the asset and is recompensed for this, and ongoing maintenance, via annual payments either directly from taxpayers or through charges.
But GP leaders told Pulse the long-term consequences of private investment outweighed the short-term gains, and cited previous procurement strategies such as the as the Private Finance Initiative (PFI), contracting private firms to fund infrastructure projects which are then paid back over decades.
The strategy document said: ‘Government will rapidly explore the potential to use Public Private Partnerships to deliver certain types of primary and community health infrastructure, taking a decision by Autumn Budget 2025.’
It comes after chancellor Rachel Reeves announced £100m of capital funding ‘earmarked’ for 200 GP estate upgrades. However, the Department of Health and Social Care (DHSC) said in May this money would be stretched across more than 1,000 GP surgeries instead.
The move follows on from Lord Darzi’s 2024 report into the NHS in England which cited a capital investment shortfall and a ‘byzantine’ approvals process leading to ‘crumbling’ primary care infrastructure.
Around 130 NHS schemes were funded by PFI until 2018 and are expected to ultimately cost more than £80bn in repayments, and the private finance model was criticised for its inflexibility and perceived value for money.
The Darzi report said that significant lessons ‘have been learned from the past’ and any new PPP model ‘would reflect several improvements and be developed in consultation with industry’.
Doctors’ Association UK GP spokesperson Dr Steve Taylor told Pulse that fixing the premises crisis through private investment would be ‘short sighted’.
He said: ‘Many GP partners have invested in the long term for their patients, remaining invested in the community.
‘With less certainty around the partnership model, in part exacerbated by Wes Streeting’s previous statements, there is less incentive for investment.
‘So in part, the need for investment has increased as a result of NHS England and Government decisions over funding.
‘To fix this through private investment will be short sighted, cost more now and have consequences for the future of provision, with costs rising in the future for the benefit of private providers.
‘Selling out to large companies with no links to communities and focused on profits would be a mistake.’
Previously, the NHS Confederation said in evidence to the Public Accounts Committee that ‘private investment models used in appropriate circumstances can streamline the investment process by transferring risk, at a cost, to the private sector.’
Health secretary Wes Streeting previously said addressing problems with GP premises investment would ‘take time’ following the collapse of a roof at an Oxfordshire surgery.
And the NHS Confederation has recommended abolishing NHS Property Services to ‘de-toxify the current premises challenge’ for GP practices.
