1. Luton tPCT Primary Care Development Framework Luton Teaching PCT Tonia Parsons & George Murdoch Manchester, 14 February 2003

2. Luton tPCT Primary Care Development Framework Background to the initiative History within local health economy Case for centralising the process Facilitating & supporting Practice planning Joint vision for service development Primary care provides platform for other project work & meeting NHS Plan targets

3. Background PCG, now PCT, coterminous with Council 195k population, HAZ area, deprivation Diverse racial & cultural mixing Specific health issues include lifestyle Densely populated, few available sites Existing primary care estate too small Most premises older & unsuitable

4. Framework History PCT keen to expedite new project delivery Recognised GP support would be crucial Wanted co-ordinated whole-town approach Recognised benefits of individual projects PCT not in position for new commitments Affordability geared to surgery rentals Initial projects/sites already identified

5. Existing primary care estate 35 Luton Practices + various clinics 47 sites in total All but 5 have surgery space for GPs Include 6 old & tired health centres 36 surgeries owned or rented by GPs Only 1 building too big for current use DDA, Health & Safety = major cost issues

6. Converted House

7. Typical Surgery

8. A hive of activity during the day……

9. Surgery premises always exceptions to prove the rule….…

10. Branch Surgery well out of town ………..

11. Our only building with spare space……

12. Even newer ones are too small Newer surgeries may still look good, but they are more than 10 years old and much too small for current activity, before taking growth & development into account.

13. More modern building.

14. What was to be done? Recognised case for centralisation At same time, promote individual schemes Engage Practice GPs from the outset Understand surgery needs first, then others PCG, as was then, facilitated the structure Framework process initiated with Nexus Helped by having first sites identifed.

15. Supporting Practice Planning All Practices were visited to discuss plans First wave of schemes identified Generic Framework structure formulated Practices undertake own business plans Feasibility Study for premises proposals PCT support for overall process Participating Practices close engagement

16. Joint vision for service development Foster GP relationships with PCT services Primary / Secondary Care interface Teaching, training, education functions Joint working with Social Services Working boundaries with secondary care DGH links, domiciliary/intermediate care Also acute, specialist & outreach links

17. Primary Care Framework GP-led schemes need GP champions Need to foster realisable Practice ambitions Generic Framework from national advert Selection process follows PFI routines Preparing first wave of project proposals Helps if sites can be found first Protocols recognised on direct contact etc

18. Framework Process Four developers selected from competition Offered first sites with extensive briefing Bids centred on layout & design solutions Clinical output specs / operational policies Common issues neutralised in process Disposal of redundant surgeries included For each scheme, GPs select FW partner

19. Can still have shared space This one is in Manchester, not Luton, and typifies the ambition of the Framework process in delivering GP led schemes for buildings of less than about 2,000 sq.m.

20. Delamere Centre, Stretford, Manchester

21. Framework provides a platform Inter-linkages with other PCT projects. PCT currently developing WIC & DTC PCT also flexing commissioning muscles New regime for outpatient services / acute Cascade effect for location priorities Pyramid approach may be appropriate Affordability still has the last word.

22. Meeting those NHS targets……. Luton tPCT faces challenging targets Currently working with CHI Capacity constraints are inhibiting Premises shortages only part of problem New premises will aid recruitment New facilities help service integration. PCT more control over future resources?

23. What next for Framework? Had thought it might stop at first phase However, many more schemes needed Continue process as sites become available Other projects can now join the process National interest in process & leases PCT commissioning & Practices working at Levels 4/5 of new GP Contract may foster new approach to GP-led schemes.

24. So what about NHS Lift? Learn from Lift formats & procedures Useful for Lease arrangements with GPs Fostering development partnering Affordability issues remain the same Flexibility & competition maintained Lower up front costs, DV rental precedent So, anything Lift can do, can we do better?