delivering primary care premises in a non lift area stockport approach alison tonge natpact...
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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….