Unlocking the vision for new primary care premises………

George Murdoch

Nexus Consulting

January 2003

The vision for quality…..

Quality of service delivery – and the human resources offering it.

Quality of patient experience – and the communications systems supporting it.

Quality of working environment – and the physical facilities providing it.

Quality of strategic planning – and the degree of futureproofing behind it.

Service delivery…….

Considering services provided by GPs & other Primary Care Practitioners….

ensuring services are accessible & local. reflecting national targets & local needs. ‘all under one roof’ integrated approach. seamless ‘patchwork quilt’ effect. but what is General Practice anyway? & how is quality being monitored??

Managing the Patient experience.

Retailers manage customer needs, not wants Economists seek to manage expectations. Politicians manage the decisions process -

(while mismanaging much else besides). GPs have to manage ‘gatekeeper’ responses

to what patients put in front of them. Needs careful balance of demand & supply. While maintaining perceived/actual quality.

More on Patient experience Expectations Close & accessible Clean & functional Convenient times Clear wayfinding Chain-links in service Choice of provider Comfortable setting Cost-effective service

Need to avoid…. Difficult locations Dirty appearance Deterring attendance Dearth of signage Disintegrated org. Disconcerting feel Duplicating resources

Quality of working environment

Technical specification for primary care – currently changing– eg HBN36.

Managing & maintaining the new asset – for which revenue funding is crucial.

‘Facilities Management’ process must maintain quality & controls (PFI lessons).

Key human role in good asset management. Inter-dependencies with service delivery.

Quality of Strategic Planning..

‘Fit for purpose’ & functional suitability – the straightforwad bits around logistics.

Flexibility & malleability in space use – giving architects a challenge to respond to.

Be big enough to meet future demand – the goal for PCTs & General Practice.

Needs whole systems approach & service integration – the real challenge for all…….

But how can we afford to be big?

Funding surgery space ‘non cash limited’ for local health economy level for now.

Allocating PCT funding support for additional space requirements.

PCT commissioning & Unified Budgets. Rooting out current cost inefficiences –

while maintaining quality. Forcing funding to follow the patient??

More on Affordability

Surgery space for GPs may still access Red Book rental funding for both GMS & PMS.

Additional space, in addition to surgery area, needs other rental commitment.

Other operational costs, in addition to Rent & Rates, met by Practices & PCT.

Balance between optimising surgery area for Practice & additional areas for PCT & other healthcare users, including retail.

Sharing space can save money…

Sharing surgery areas among primary care services increases efficiencies.

It also improves deliverability. Practice service delivery policies should

reflect flexible working & substitutability. Longer opening hours allows user spread. Building security with tiered access for

differential in areas available, out of hours.

Underpinning strategy

Individual scheme should be an output of SSDP or SOC, or at least comply with it.

Business Cases & Feasibility Studies for individual schemes should adopt an integrated whole health-economy approach.

Linkages with secondary care services, transfers from acute, intermediate care & community provision should be developed.

PCT commissioning should support plan.

Toolkits for making right choice

NatPact/NHS Estates Premises guidance. HBN31 Electronic. Workshop venues. Management support. One-to-one discussion Supporting PCT team Signposting.

Process/procurement Framework process

for GP-led schemes PFI/PPP for PCT-led

schemes (FRS5). Lift & non-Lift Batching & linking. StHA/PCT approvals Optimising Red Book

Decision Tree Pyramid GP-led primary care reimburseable areas forms

the first layer for surgery projects. Larger & mixed use schemes maintaining >50%

GP-led surgery space is next layer. PCT-led schemes with subletting to GPs more

complex next layer PFI projects following established hospital route is

top layer. Remember these can run concurrently,