How private finance is moving primary care into corporate ownership

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Abstract
A central aim in establishing the NHS was to integrate primary care and health and social services in health centres. But this aim was compromised by the absence of public capital and the reluctance of the Treasury to buy out practice premises owned by general practitioners. Although there was some grant funding for health and local authority owned health centres, by 1974 only 15% of general practitioners operated out of these.1 General practitioner owned practice premises remained the dominant model from 1966 until 1989, financed by government loans and funded from NHS revenue under the rental reimbursement schemes. The privatisation of the government loan body in 1989 saw a switch to private finance and the entry of commercial companies and for-profit corporations. The amount of capital that can be raised by the private sector for new investment in the NHS is unrestricted. However, these debts have to be repaid through NHS funds or user charges. The renewed impetus for integrated services in the 1997 white paper, The New NHS ,2 means that more sophisticated buildings are required to accommodate advanced clinical technology and information systems. The complex financing and funding arrangements, combined with demographic factors, makes it likely that as general practitioners opt for a salaried service, the trend to for-profit corporations owning and buying out practice premises will accelerate. #### Summary points Healthcare companies and property developers are rapidly expanding into the ownership and provision of primary care premises Under the private finance initiative, there are no restrictions on the amounts that can be borrowed or invested “Bundling” of diverse NHS and non-NHS facilities into one project allows the commercial sector to target new sources of revenue No data are collected centrally on the different types of public-private partnerships in primary care or on the various methods of financing and …