DELIVERING PRIMARY CARE PREMISES IN A NON LIFT AREA Stockport Approach Alison Tonge NatPact Workshop, Manchester 13-14 February 2003.

DELIVERING PRIMARY CARE PREMISES IN A NON LIFT AREA

Stockport Approach

Alison Tonge

NatPact Workshop, Manchester

13-14 February 2003

PARALLEL PROCUREMENT

AND DELIVERING A MANAGED PROGRAMME OF SCHEMES

ALISON TONGE

STOCKPORT PCT

Stockport and the PCT

Within Greater Manchester a population of around 293,000 - mixed economy deprived wards, affluent areas

one PCT, one DGH 3, one Council £6m above resource target - 8.5 to 9% growth,

financial deficit around £5m on £240m narrowing health inequalities

–

We have a strong visionPrimary Care in Stockport will offer …..

Greater Clinical team integration across primary and community services,skill sharing and multi-disciplinary assessment and delivery systems.

More Choice and Accessibility with emphasis on alternatives to admission,quicker diagnostics and treatments in primary care services, longer openinghours and more flexible delivery.

Emphasis on client focused pathway and process re design working acrossprimary and secondary sectors to manage the delivery of care in more effectiveand joined up manner.

Locality services orientated and targeted to need and profile of localpopulation

Inter agency working to optimise the opportunities for the mostdisadvantaged and vulnerable to access appropriate care packages.Through joint teams, pooled budgets, inter – agency centres.

We cant deliver this vision because the estate is so poor...

Buildings are not fit for purpose we have too many - over 70 primary care delivery points of

which 20 are PCT owned for a population of 293,000 residents.

the buildings are old and in poor condition -60% of the PCT Owned stock is over 30 years old and there is a £3m backlog maintenance cost

Over 50% of GP practices are operating in poor accommodation which must be replaced and rationalised

List size closures are as a result of insufficient and poor accommodation

poor utilisation of space -57% underused

Current pattern of PCT properties

Typical health centre ...

Our estates strategy

To develop 2 levels of provision - Resource Centres and One- Stop practice sites

To rationalise our delivery points - particularly clinics and single handed GP’s

To work with partners in making best use of estate opportunities

To support our service strategy - Tier 2 and integrated teams

Resource Centre - Town Centre Site

DIAGNOSTIC FACILITIES- ultra sound-ecgs-xray

OUTPATIENT CLINICStier 2 (specialist GP/nurse

services

THERAPY CLINICS-podiatry-physiotherapy-dietetics-orthoptics

GP CONTRACTOR SERVICES-GP, practice nurses, healthcare

assistants, counsellorsPharmacy

EXTENDED ACCESSMINOR INJURY SERVICES

- nurse practitioner- minor illness- nurse triage

TREATMENT ROOM- nurse practitioner- dn’s – minor surgery- hca’s

SPECIALIST NURSE BASE

- continence- diabetic- hiv

Health Promotion / Public Information

Services

CHILD HEALTHHV /school nurses

social services teamsSEXUAL HEALTH

SERVICES- family planning- high intervention- education / trainingBreast Screening Unit

Drug And Alcohol Team Stop Smoking Services

PROPOSED SERVICES – ONE STOP SITES

GP Contractor Services Pharmacy

Treatment Rooms Consultation Rooms

THERAPY ROOMSPhysiotherapySpeech TherapyDietetics

Nursing SuitesPN/DN/HV/SN/ND/HCA

GP

Social Services

Outpatient

-

Information / Advice

Future pattern of provision

Project Structures

Service PlanningService Planning

EstatesTechnicalEstates

Technical

Project Structures

Project BoardProject Board

Project TeamProject Team

•Workforce Plan•configuration•client pathways •locality

•Workforce Plan•configuration•client pathways •locality

•Capital cost•DCP•Functional Brief•Design Brief•Engineering

•Capital cost•DCP•Functional Brief•Design Brief•Engineering

FinanceLegal

FinanceLegal

•Revenue model•Affordability•Procurement•PFI/PPP testing

•Revenue model•Affordability•Procurement•PFI/PPP testing

BusinessCase

BusinessCase

Project ManagerProject

ManagerProject

AccountantProject

Accountant

Project Roles

Project SponsorProject Sponsor

Project DirectorProject Director

•Project planning•task scheduling•project reporting•advisors management

•Project planning•task scheduling•project reporting•advisors management

•Revenue model•affordability•PPP/PFI testing•VFM

•Revenue model•affordability•PPP/PFI testing•VFM

AdvisorsAdvisors

•Meetings•communications•project library•document control

•Meetings•communications•project library•document control

ProjectAdministrator

ProjectAdministrator

Modernisation leadModernisation lead

•Estates advisor•QS ,Architect/Engineer•Finance•Legal•Project

•Estates advisor•QS ,Architect/Engineer•Finance•Legal•Project

ServicePlanner(s)

ServicePlanner(s)

•Modelling of:•Primary care•Tier 2•Community•Intermediate

•Modelling of:•Primary care•Tier 2•Community•Intermediate

Wide StakeholderinvolvementEvents/LMC/LPC

Board has multi agencystakeholders

Key Relationships and Process

• Separate and Structured Project Management• Establishment of an Executive Project Board • Developing key relationships with MBC, Planning, the

Highways authorities, transport planners, CHC, patient groups, DVO.

• Explaining the process continually• MBC Executive• Scrutiny Committee• Area Boards• Area Networking events• Community briefings

Executive Project Board membership Chair, Stockport PCT Chief Executive, Stockport PCT Non-Executive Director, Stockport PCT Chair Professional Executive Committee, Stockport PCT Director of Finance and Estates, Stockport PCT Director of Primary Care and Information, Stockport PCT Head of Estates and Facilities Project Manager, Stockport PCT Project Administrator, Stockport PCT Director of Modernisation and Health Development Director of Clinical Services Chair, Local Opticians Committee Chair, Local Dental Committee Chair, Local Pharmaceutical Committee Chair, Local Medical Committee Director, Stockport Voluntary Services Director of Social Services Head of Policy and Planning, Stockport MBC Chief Officer, Community Health Council Executive Director, Greater Manchester Strategic Health Authority Assistant Director of Finance and Property Services SMBC Assistant Director, Social Services Finance, SMBC Director of Public Health, Stockport PCT Chief Officer / Board Member Lay Member/Member of the Public/Patient representative x 2 District Valuer Director of Voluntary Services Chief Officer, Stockport NHS Trust Chief Officer, GMAS

Approvals systems need review

Strategic Service Delivery Plan Estates development plan Procurement plan and phases Affordability StHA approval to ? Distinction between GP led and PCT led Partner led schemes

IMT

What is required to be approved?

SSDP

Estates planProcurement

and affordability

PCT led

Capital Investment ManualOBC/FBC - StHA approved

GP led Partner ledGMS/DV PCT approved

Individualschemes and phases

Stakeholders

Procurement

Aimed for a flexible solution long term partnership BUT with an selected

group of contractors - akin procure 21 parallel procurement for PCT and GP led

aswell as partner led schemes

Investment and Financing

Resource Centre/Diagnostic and Treatment

Centre

Joint Venture

PPP / PFI

PCT Lead

GP lease

Other Partners Lease

8 - 10 One - Stop

Centresacross Stockport

Brinnington Centre

Dialstone CentreJoint VenturePPP/PFI

(mini)

GP Lead

PCT Lease

West

East

Locality Team Base North

Joint Venture

S.M.B.C Lead.

PCTGP/lease

Procurement

St Thomas Diagnostic and

Treatment Centre

8 - 10 One - Stop

Centresacross Stockport

Brinnington Centre

Dialstone Centre

Estates Gazette

OJEC

OJEC - SMBC

PQQ shortlist8

Brief onDevelopments

Ap

ril 0

3M

ay 0

3

Proposal shortlist

8

40

ITNSite allocated

4

July

03

Sep

t / o

ct

Tim

etab

le t

o be

agr

eed

Managed project approach

1 Years 10

Project1

Project2

Project3

Project4

a

Project5

b c

Is therea legal structure?

How do youaward projectsto each ?

New entrants?

Key issues we are working through Surplus sites - and long term income Joint venture - PCT land on GP led schemes -

equity stake do we offer GP equity or not lease structure and underwriting management structure of the centres form of agreement for contractor group… Lead PCT procurement, shared costs

Phasing and Cost

Phase 1 to 2006/7: £6.5m Capital, £118k unified revenue impact, £250k GMS impact

Phase 2 to 2009: £11.1m Capital, £101k unified revenue impact, £335k GMS impact

Phase 3 to 2012: £3.6m Capital, £-62k unified revenue impact, £143k GMS impact

Benefits of this approach

Flexible approach in time scale, phasing, partners and routes.

appeals to GP’s as structure is built around each site - not a global company vehicle

it is a joint venture - still offers potential for equity and land

keeps competition through the short list approach over the life of the partnership

but -- needs PCT to manage the process

Funding issues

GMS contract - new rules versus old - unified budget - StHA role ??

Land project costs - up front monies to make it

work Implementation period - double running

What would help..

Support in driving this new procurement framework forward - un picking any loopholes

clarity with StHA’s on approvals processes further guidance on new contract access to some funds for legal fees, SSDP

development, equity issues. There is an alternative to LIFT and it could be

better….