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

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Presentation on theme: "DELIVERING PRIMARY CARE PREMISES IN A NON LIFT AREA Stockport Approach Alison Tonge NatPact Workshop, Manchester 13-14 February 2003."— Presentation transcript:

1 DELIVERING PRIMARY CARE PREMISES IN A NON LIFT AREA Stockport Approach Alison Tonge NatPact Workshop, Manchester February 2003


3 Stockport and the PCT n Within Greater Manchester a population of around 293,000 - mixed economy deprived wards, affluent areas n one PCT, one DGH 3, one Council n £6m above resource target to 9% growth, financial deficit around £5m on £240m n narrowing health inequalities –

4 We have a strong vision

5 We cant deliver this vision because the estate is so poor... n Buildings are not fit for purpose n we have too many - over 70 primary care delivery points of which 20 are PCT owned for a population of 293,000 residents. n 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 n Over 50% of GP practices are operating in poor accommodation which must be replaced and rationalised n List size closures are as a result of insufficient and poor accommodation n poor utilisation of space -57% underused

6 Current pattern of PCT properties

7 Typical health centre...

8 Our estates strategy n To develop 2 levels of provision - Resource Centres and One- Stop practice sites n To rationalise our delivery points - particularly clinics and single handed GPs n To work with partners in making best use of estate opportunities n To support our service strategy - Tier 2 and integrated teams

9 Resource Centre - Town Centre Site DIAGNOSTIC FACILITIES - ultra sound -ecgs -xray OUTPATIENT CLINICS tier 2 (specialist GP/nurse services THERAPY CLINICS -podiatry -physiotherapy -dietetics -orthoptics GP CONTRACTOR SERVICES -GP, practice nurses, healthcare assistants, counsellors Pharmacy EXTENDED ACCESS MINOR INJURY SERVICES - nurse practitioner - minor illness - nurse triage TREATMENT ROOM - nurse practitioner - dns – minor surgery - hcas SPECIALIST NURSE BASE - continence - diabetic - hiv Health Promotion / Public Information Services CHILD HEALTH HV /school nurses social services teams SEXUAL HEALTH SERVICES - family planning - high intervention - education / training Breast Screening Unit Drug And Alcohol Team Stop Smoking Services

10 PROPOSED SERVICES – ONE STOP SITES GP Contractor Services Pharmacy Treatment RoomsConsultation Rooms THERAPY ROOMS Physiotherapy Speech Therapy Dietetics Nursing Suites PN/DN/HV/SN/ND/HCA GP Social Services Outpatient - Information / Advice

11 Future pattern of provision

12 Project Structures Wide Stakeholder involvement Events/LMC/LPC Board has multi agency stakeholders

13 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

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

15 Approvals systems need review n Strategic Service Delivery Plan n Estates development plan n Procurement plan and phases n Affordability n StHA approval to ? n Distinction between GP led and PCT led n Partner led schemes

16 IMT What is required to be approved? SSDP Estates plan Procurement and affordability PCT led Capital Investment Manual OBC/FBC - StHA approved GP led Partner led GMS/DV PCT approved Individual schemes and phases Stakeholders

17 Procurement n Aimed for a flexible solution n long term partnership BUT with an selected group of contractors - akin procure 21 n parallel procurement for PCT and GP led aswell as partner led schemes

18 Investment and Financing Resource Centre/ Diagnostic and Treatment Centre Joint Venture PPP / PFI PCT Lead GP lease Other Partners Lease One - Stop Centres across Stockport Brinnington Centre Dialstone Centre Joint Venture PPP/PFI (mini) GP Lead PCT Lease West East Locality Team Base North Joint Venture S.M.B.C Lead. PCTGP/lease

19 Procurement St Thomas Diagnostic and Treatment Centre One - Stop Centres across Stockport Brinnington Centre Dialstone Centre Estates Gazette OJEC OJEC - SMBC PQQ shortlist 8 Brief on Developments April 03 May 03 Proposal shortlist 8 40 ITN Site allocated 4 July 03 Sept / oct Timetable to be agreed

20 Managed project approach 1 Years 10 Project 1 Project 2 Project 3 Project 4 a Project 5 bc Is there a legal structure? How do you award projects to each ? New entrants?

21 Key issues we are working through n Surplus sites - and long term income n Joint venture - PCT land on GP led schemes - equity stake n do we offer GP equity or not n lease structure and underwriting n management structure of the centres n form of agreement for contractor group… n Lead PCT procurement, shared costs

22 Phasing and Cost n Phase 1 to 2006/7: £6.5m Capital, £118k unified revenue impact, £250k GMS impact n Phase 2 to 2009: £11.1m Capital, £101k unified revenue impact, £335k GMS impact n Phase 3 to 2012: £3.6m Capital, £-62k unified revenue impact, £143k GMS impact

23 Benefits of this approach n Flexible approach in time scale, phasing, partners and routes. n appeals to GPs as structure is built around each site - not a global company vehicle n it is a joint venture - still offers potential for equity and land n keeps competition through the short list approach over the life of the partnership n but -- needs PCT to manage the process

24 Funding issues n GMS contract - new rules versus old - unified budget - StHA role ?? n Land n project costs - up front monies to make it work n Implementation period - double running

25 What would help.. n Support in driving this new procurement framework forward - un picking any loopholes n clarity with StHAs on approvals processes n further guidance on new contract n access to some funds for legal fees, SSDP development, equity issues. n There is an alternative to LIFT and it could be better….

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