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Luton tPCT Primary Care Development Framework. Luton Teaching PCT Tonia Parsons & George Murdoch Manchester, 14 February 2003. Luton tPCT Primary Care Development Framework. Background to the initiative History within local health economy Case for centralising the process
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Luton tPCT Primary Care Development Framework Luton Teaching PCT Tonia Parsons & George Murdoch Manchester, 14 February 2003
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
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
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
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
Surgery premises • always exceptions to prove the rule….…
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.
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.
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
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
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
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
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.
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.
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?
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.
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?