Public-private partnerships and efficiency in public procurement of primary healthcare infrastructure: a qualitative research in the NHS UK

Aim There is growing interest in the contribution of public-private partnerships (PPPs) bridging the
shortage of financial resources and management expertise in developing public healthcare
infrastructure. However, few studies have evidenced PPPs’ ability in increasing efficiency in public
procurement of primary healthcare infrastructure. The aim of this study was to assess to what extent
PPPs would increase efficiency in public procurement of primary healthcare facilities.
Subject and Methods A qualitative analysis, adopting a realistic research evaluation method, used data
collected from a purposive sample of public (n=23) and private sector staff (n=2) directly involved in
the UK National Health Service Local Improvement Finance Trust (LIFT).
Results We find a positive association of LIFT helping to bridge public sector capital shortages for
developing primary care surgeries. LIFT is negatively associated with inefficient procurement because
it borrows finance from private banks, leaving public agencies paying high interest rates. The study
shows that some contextual factors and mechanisms in LIFT play a major part in obstructing public
staff from increasing procurement efficiency.
Conclusion PPP’s ability to increase efficiency may be determined by contextual factors and
mechanisms that restrict discretion over critical decisions by frontline public sector staff. Developing
their capacity in monitoring PPP activities may make partnerships more efficient.