Luton tPCT Primary Care Development Framework

Luton Teaching PCTTonia Parsons & George Murdoch

Manchester, 14 February 2003

Luton tPCT Primary Care Development Framework

Background to the initiativeHistory within local health economyCase for centralising the processFacilitating & supporting Practice planningJoint vision for service developmentPrimary care provides platform for other

project work & meeting NHS Plan targets

Background

PCG, now PCT, coterminous with Council195k population, HAZ area, deprivationDiverse racial & cultural mixingSpecific health issues include lifestyleDensely populated, few available sitesExisting primary care estate too smallMost premises older & unsuitable

Framework History

PCT keen to expedite new project deliveryRecognised GP support would be crucialWanted co-ordinated whole-town approachRecognised benefits of individual projectsPCT not in position for new commitmentsAffordability geared to surgery rentalsInitial projects/sites already identified

Existing primary care estate

35 Luton Practices + various clinics47 sites in totalAll but 5 have surgery space for GPsInclude 6 old & tired health centres36 surgeries owned or rented by GPsOnly 1 building too big for current useDDA, Health & Safety = major cost issues

Converted House

Typical Surgery

A hive of activity during the day……

Surgery premises

always exceptions to prove the rule….…

Branch Surgery well out of town ………..

Our only building with spare space……

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.

More modern building.

What was to be done?

Recognised case for centralisationAt same time, promote individual schemesEngage Practice GPs from the outsetUnderstand surgery needs first, then othersPCG, as was then, facilitated the structureFramework process initiated with NexusHelped by having first sites identifed.

Supporting Practice Planning

All Practices were visited to discuss plansFirst wave of schemes identifiedGeneric Framework structure formulatedPractices undertake own business plansFeasibility Study for premises proposalsPCT support for overall processParticipating Practices close engagement

Joint vision for service development

Foster GP relationships with PCT servicesPrimary / Secondary Care interfaceTeaching, training, education functionsJoint working with Social ServicesWorking boundaries with secondary careDGH links, domiciliary/intermediate careAlso acute, specialist & outreach links

Primary Care Framework

GP-led schemes need GP ‘champions’Need to foster realisable Practice ambitions Generic Framework from national advertSelection process follows PFI routinesPreparing first wave of project proposalsHelps if sites can be found firstProtocols recognised on direct contact etc

Framework Process

Four developers selected from competitionOffered first sites with extensive briefingBids centred on layout & design solutions Clinical output specs / operational policiesCommon issues neutralised in processDisposal of redundant surgeries includedFor each scheme, GPs select FW partner

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.

Delamere Centre, Stretford, Manchester

Framework provides a platform

Inter-linkages with other PCT projects.PCT currently developing WIC & DTCPCT also flexing commissioning musclesNew regime for outpatient services / acuteCascade effect for location prioritiesPyramid approach may be appropriateAffordability still has the last word.

Meeting those NHS targets…….

Luton tPCT faces challenging targetsCurrently working with CHICapacity constraints are inhibitingPremises shortages only part of problem New premises will aid recruitment New facilities help service integration.PCT more control over future resources?

What next for Framework?

Had thought it might stop at first phaseHowever, many more schemes neededContinue process as sites become availableOther projects can now join the processNational interest in process & leasesPCT commissioning & Practices working

at Levels 4/5 of new GP Contract may foster new approach to GP-led schemes.

So what about NHS Lift?

Learn from Lift formats & proceduresUseful for Lease arrangements with GPsFostering development partneringAffordability issues remain the sameFlexibility & competition maintainedLower up front costs, DV rental precedentSo, anything Lift can do, can we do better?