Microsoft word - ssdp sept 2011 v3.doc

Halton & St Helens
Knowsley and Warrington LIFT
Halton and St Helens, Knowsley & Warrington
Strategic Service Development Plan (SSDP)
2011/2012 update
CONTENTS
SECTION NO
Key Targets & National Policy – National Drivers for Change Patient & Public Involvement – Community Involvement Key Partnerships & Links to Other Strategic Developments Commissioning Strategic Plan – all 3 PCT Section 1
Executive Summary
This document sets out the Strategic Service Development Plan (SSDP) for primary and community based services across Halton & St Helens, Knowsley and Warrington which provides the basis of the investment strategy for the local LIFT Project. It describes the vision of the local health economy for a radically improved modern, patient centred service and ambitious plans to develop premises and facilities to help deliver the vision. The Halton & St Helens, Knowsley, and Warrington LIFT Company, Renova Developments Ltd (formerly Partners 4 Lift) was formed on 20th October, 2004 at which time the PCTs in Halton & St Helens, Knowsley and Warrington signed the Strategic Partnering Agreement (SPA). Summary of operational and future LIFT schemes (including all third party development schemes in which involve Renova are as below, those marked with * are being developed via other finance arrangements and do not include Renova: Operational
Construction
approval
Halton & St
Operational
Construction
approval
Knowsley
Warrington
Section 2
Introduction and Strategic Context

2.1 What is an SSDP?
The SSDP should set out an integrated service strategy for the LIFT area that will deliver modernised integrated patient centred services, responsive to national objectives, the SHA and PCT strategic vision and the local community, health and social care needs assessment. It should lay out the benefit objectives and outline the short, medium and long term facility requirement needed to deliver the strategy. Should the PCT take a project forward to Stage1 of the LIFT approval process, an assessment of revenue implications together with an affordability analysis and assessment of deliverability of the project will be undertaken.
2.2 Key Targets and National Policy - National drivers for change

The fol owing table summarises the key national policy drivers that influence decision about LIFT projects: Publication
Strategy and relevance to LIFT developments
The NHS Plan, July 2000  Unprecedented growth in NHS resources,  Improved access, reduced waiting times  Infrastructure developments – staff, buildings and  Improvements in public health required to ensure well-being of the population and financially viable  Need to focus on day-to-day lifestyles  Focus on building community capacity and  Access to primary and secondary care services Publication
Strategy and relevance to LIFT developments
 Key principles for supporting the public to make healthier and more informed choices in regards to  Integration of health and social care  Improved  Primary Care Trusts and Local Authorities to lead  putting patients and service users first through  a focus on the whole of health and well-being, not  Move focus off hospital care and develop more  Self care and individual responsibility  The family of Primary Care providers and social services working together as part of a joined-up  Improved access to General Practice  Choice including new types of provider and alternatives to the traditional model of General Practice  Services better tailored to local need  Better information for the public about access and  Workforce development that supports radical shifts  Increased detection and identification of high risk  Integrated care across primary, secondary, tertiary,  The provision of skills, service and facilities to Publication
Strategy and relevance to LIFT developments
 Children  Renal  Respiratory (in  Report on a future model for London Health Services, which responds to anticipated demographic changes and acknowledged problems with existing service configuration.  Model calls for localising services where possible - More care at home - Development of ‘polyclinics’ offering extended range of primary care services, with possible inclusion of extended days, diagnostics, out-patient clinics, minor injury care, etc. - Identification/rationalisation of hospitals as  Department of Health advice is that this model may not be replicated across England. Interim report for rest of England due October 2007 and final report due June 2008. Framework for Health and Well-Being (March  Putting people at the centre of commissioning - greater choice and control over services and  Understanding the needs of populations and individuals - Joint strategic needs assessment by councils, and practice based commissioners will help them to better understand the needs of individuals  Sharing and using information more effectively to  Assuring high quality providers for all services - develop effective, strong partnerships with providers and engage them in needs Publication
Strategy and relevance to LIFT developments
assessments. Procurement should be transparent and fair.  Recognising the interdependence between work,  Developing incentives for commissioning for health and well-being. Bringing together local partners using Local Area Agreements.  The Next Stage Review sets out the agenda for the future development of the NHS, with a renewed emphasis upon placing quality of service and patient experience at the centre of what we do Equitable Access  The focus of this programme will be on achieving primary medical care the vision of a fair and personalised NHS (whilst services (October upholding the values of safe and effective primary 2007)  The Government has provided new investment of £250m to support PCT’s in establishing “at least 100 new general practices in the 25% of areas with the poorest provision; and new GP led health centre/s in each PCT in easily accessible locations.  The PCT has procured three new practices within the borough of Knowsley located in North Huyton, Whiston and Halewood  Improving cleanliness and reducing HCAIs;  Improving access through achievement of the 18- week referral to treatment pledge, and improving access (including at evenings and weekends) to GP services;  Keeping adults and children well, improving their health and reducing health inequalities;  Improving patient experience, staff satisfaction and  Preparing to respond in a state of emergency, such  Provides the regional vision for delivering 21st Century healthcare and in particular the challenges of delivering the vision of the clinical care pathway groups and the measurement of success Publication
Strategy and relevance to LIFT developments
 White paper describing the new government’s strategy for the NHS. Includes the following key aims - Liberating the NHS - Putting patients and the public first - Autonomy, accountability and democratic - Cutting bureaucracy and improving efficiency  The revision to the NHS Operating Framework for 2010/11 sets out which changes need to happen in- year and those areas where change can be expected in the NHS Operating Framework for 2011/12. It centres on five areas: - future direction and next steps on transforming - finance and efficiencies; and - accelerating development of the payment  The ‘new’ Operating Framework Guidance sets out the priorities and direction for the NHS through 2011/12, set within the context of ‘Equity and Other drivers for change include:

2.2.1 Transforming Community Services (2009)
The Next Stage Review Primary and Community Care Strategy set out the vision for modern, responsive, high quality community services that give patients greater choice and personalisation and improve access to an integrated range of services. The Transforming Community Services (TCS) Programme has been set up to help deliver this vision by supporting clinicians and staff to increase their skills and knowledge to innovate, deliver high quality care and lead transformational change. More effective commissioning wil also be crucial to transforming community services - World Class Commissioning is the vehicle for delivering this. The Transforming Community Services Programme is designed to improve service provision and drive up quality and overall performance in the services delivered to local communities Local y there are two strands to implementing the TCS programme; these are being Transformational – commissioning leads for the TCS pathways have developed high level
outcome based ‘Commissioners Requirements’. These will form the basis for the transformation of services over the next 2-3 years. A key component of these requirements is that services should be delivered in the most appropriate setting. In most cases this means ‘closer to home’ in a range of community settings. It is therefore of vital importance that we have sufficient high quality capacity in the primary and community estate for the delivery of these services.
Transfer of Staff – the recent NHS white paper requires PCTs to divest themselves of
provider services by 31st March 2011. Regardless of the future organisational form the services will still be provided from primary and community based venues in line with the Commissioners Requirements. Within the original national programme there was a requirement for PCTs to produce a Commissioners Investment and Asset Management Strategy (CIAMS). Stage 1 of this work has been completed and further guidance is expected detailing how this work will continue in the context of ‘Liberating the NHS’ as PCTs will cease to exist from April 2013. What is clear however is that there will be a need for the whole of the Public Sector estate to be reviewed and an assessment made of what will be required for the delivery of community based health and social care
2.2.2 Darzi – Context for the PCTs
Lord Darzi's interim report 'Our NHS, Our Future' makes a number of commitments to ensure more equitable access to primary medical care, including investment of new resources, through a £250 million access fund, to deliver at least 100 new GP practices i n the 25% of PCTs with worst provision, and at least one new GP-led Health Centre in each PCT. Both Knowsley and Halton & St.Helens PCTs are required to increase the number of new GP practices in their area and in addition to set up a GP Access Centre. Details of the plans proposed by each PCT are included in the relevant section. NHS Knowsley has established 3 new practices across the borough, located in North Huton, Halewood and Whiston, al of these are operational as at November 2009. NHS Halton & St Helens has procured two new practices within the borough of Halton, the GP Led Health Centre in Widnes and a new practice in Windmill Hill, Runcorn as well as the new practice located at Marshalls Cross, St Helens’ Hospital. NHS Warrington has procured one new practice located in Golden Sqaure in the town centre. 2.2.3 Estates
Much of our current primary care accommodation was not designed for 21st century healthcare use or to meet the current needs of the local population.  Limited scope for future development  Ageing infrastructure  Location of services  Disability access  Working environment  Inflexibility in estate restricting service development NHS Halton & St.Helens is currently updating its Estates Strategies in conjunction with
Renova Developments Limited and details of the Strategy can be found in Appendix xx.
NHS Knowsley is nearing the end of its review of their Estates Strategy and have identified
that they have 2 main priorities for accommodation eg Kirkby Town Centre and Pilch Lane.
There are only 5 GPs in unfit or unsuitable buildings.
Dr Thong, 10 Dulas Road, Southdene,Kirkby - moving into Kirkby Scheme.
Dr Tewari & Partners, 37 Trentham Road, Westvale,Kirkby - moving into Kirkby Scheme.
Dr Messing, Princess Drive Medical Centre, Liverpool
Aston – Camberley, 11b Camberley Drive, Halewood
Dr Singh -
Warrington Info
Dental Decontamination.
Al PCTs have to review the DoH guidance on dental decontamination, all NHS and general
dental practitioners premises have to be brought up to date with local decontamination units.
The PCTs plan to review all the effected premises over 2009/early 2010. There is a potential
impact on all NHS estate requiring additional funding to put these facilities into a state
compatible with this guidance.
Carbon Reduction.
The NHS recognises and is committed to reducing its carbon footprint and becoming more
sustainable. These carbon reduction targets are expected to have little impact on the newer
developments and those currently under construction, however the impact is expected to be
much greater on the older NHS premises. Innovative thinking is required by all NHS bodies to
reduce their carbon footprints in line with the national targets.

Practice Based Commissioning
Practice-based commissioning enables GPs to commission care and other services that are directly tailored to the needs of their patients. Practices can keep up to 100 percent of any savings made by agreement with local primary care trust (PCT). Plans for new LIFT developments need to take into account plans for the commissioning of services and in this way are linked to local need and the Quality and Outcomes Framework information.
2.3 Patient and Public Involvement – Community Involvement
Patient and public involvement is about a two-way communication process that means more than consultation. It is about working towards enabling local people to become part of the decision-making and service delivery processes. It is not just about responding to other peoples’ agendas. It should reflect the need to develop active communities that define their own needs and develop their own solutions to those needs. Involvement will mean employing a range of methods and activities ie, surveys, focus groups, open days, displays that will be undertaken at different times and situations to involve individuals and communities in addressing their own health care needs and involve the public in addressing the health care needs of their area. The LIFT approvals process provides a framework for patients to contribute to service development and to the design of the new buildings and location. Consultation and engagement mechanisms have been established with local people as part of the plans to develop new health care facilities. Focus groups and user groups have been set up around each project, which bring local stakeholders together on a regular basis to consider the needs of clinicians, patients and local residents. This ensures that the views of the community are included from the beginning and throughout the planning and development stage of new facilities. For example, local knowledge has been invaluable when discussing such issues as security, access, design and the provision of services in the new buildings.
2.4 Benefits
Realisation

2.4.1 A benefits realisation programme for all LIFT schemes was piloted for the tranche 1 schemes
(Tower Hill & Widnes Health Care Resource Centre) in 2007/8. This benefits realisation programme will be undertaken approximately 18 months after handover of the buildings and will comprise of: Review of services offered in new build against those listed in the Business case Room utilisation study – initially against utilisation matrix in Business case viii) Amended opening times and times of clinical sessions. In addition, the PCTs have agreed with Renova that the fol owing evaluation of LIFT schemes  GP / Practice Manager Forums / Involvement AEDET Evaluation - Formal D of H Staff Evaluation Process 6 & 12 Months post Community Involvement Forum – 3 Monthly Reviews Internal Operational Reviews Monthly – RDL / GTC / PCT / FM Public Health Teams in each of the localities will review public health data to assess the changes to health across the localities to ensure the specific health needs are met. Al LIFT buildings from tranche 3b onwards will be fitted with occupancy monitoring facilities that will provide much needed data showing how and what services use the facilities.
2.5 Key Partnerships and Links to Other Strategic Developments
(Hospital
Redevelopment)
The essence of NHS LIFT is based on the local Health Community incorporating its local
primary care service needs and relationships with other organisations. The aim is to enable
partners to join together in order to design and deliver services around the need of users
rather than worrying about organisational boundaries. These arrangements should help
eliminate unnecessary gaps and duplications between services. The key partnerships are
listed below:

2.5.1 Local Authorities

The PCTs are committed to using the opportunities presented under LIFT to facilitate and further support joint working and service integration with their Local Authority partners. This commitment extends from vehicles of single service provision and delivery, through to the wider social and economic benefits to a community of regeneration and employment. The significant capital and revenue investments outlined in the SSDP provide an opportunity for wider strategic change and benefits realisation, beyond the commissioning of merely a new physical NHS resource. Each borough now has a sustainable community plan which acts as a joint plan to meet the needs of the local population and a way of being explicit about the aspirations and objectives 2.5.2 Secondary Care
The development of this SSDP and the associated capacity plans has been taken forward in the context of the whole health economy. The involvement of secondary care has been critical in the assessment of need, capacity planning and service redesign. This approach has concentrated not only on the short term, but has looked ahead to the parallel significant capital projects across secondary care. The PCT estate strategies therefore have been developed to support whole health economy solutions to future needs and capacity requirements. Particular emphasis has been paid to ensuring maximum flexibility within scheme designs to not only meet expectations of a shift of outpatient activity but also clinical change. Section 3
LIFT Processes & Procedures
Once a PCT decides to bring forward a scheme from the SSDP for development, the PCT and other users of the building will work up an accommodation schedule and produce a Project Initiation Document for Renova, detailing the PCTs basic requirements in terms of size, location and occupants of the proposed facility. The PCT will work closely with the users and Renova and its supply chain in producing Stage 1 documentation. The aim of Stage 1 approval is to ensure that that the PCT is clear about the strategic requirements and specification of the health facility proposed, why it is required, that it is affordable and to put in place appropriate procedures to ensure that the final scheme proposals represents value for money. As per the Strategic Partnering Agreement, all new LIFT project proposals must contain, as a minimum, the fol owing information in sufficient detail to enable the Strategic Partnering Board and PCT Board to make an informed decision: The identity of the participants who will become tenants and an indication of any other parties that will become tenants in the facilities to be provided under the new project; An explanation of how the new project fits into the service delivery strategy as set out in the SSDP and evidence of how the new project meets the participants' requirements; Indicative funding proposals from the participants setting out the maximum available revenue they are each able to commit to that new project (the "Affordability Cap"); The effect (if any) on any employees of the participants, including any potential transfer of any such employees to any LiftCo Party or Lease Plus Service Provider; and What land (including participant land) is required to be used in the new project and an The Stage 1 approval document also includes the requirements detailed in the draft LIFTCo New Project Business Case NHS Approval guidance produced by the Department of Health. The new guidance requires a strengthening of the Stage 1 approval process. The additional information should therefore allow the PCT Board, LIFT Strategic Partnering Board and NHS North West to make an informed decision. Fol owing approval of the Stage 1 approval document, the project will move into Stage 2 and the scheme designed and developed in detail. From the point at which the project moves from Stage 1 to Stage 2, the PCT wil become liable for all development costs, should the project then be aborted by the PCT. These abortive costs will be in excess of £500,000. Stage 2 of the LIFT Process involves working on the design to enable a planning application to be made to the relevant authority. The PCT will produce Tenants Requirements documentation to inform the design team how the building is to work and what it is to include, from these a detailed design can be produced and the costs can be fully determined. Renova will work towards Financial Close and throughout the whole of the project the PCT need to ensure that they are getting good value for money (VFM). The process for assessment of VFM of any proposed scheme is very important to ensure that the PCT gets the best value deal available within its resources. The process to establish value for money is laid down by the DoH and covers all facets of the development and operating costs for the project that are included in the financial model put forward by Renova and from which is calculated the annual lease cost of the building. The financial model includes all of the cost incurred by Renova during development phase of the project plus the funding costs and key costs incurred during the operational phase, these can be summarised as fol ows:  Construction (including: Architect, M&E designer, Structural Designer, CDM Co-  Project costs (including project management costs, legal fees, financial advisor fees,  Costs of borrowing (including bank due diligence fees, interest etc)  Maintenance (including facilities management costs and lifecycle costs)  Operational phase costs (including insurance, administration and financial  Costs of land purchase  Residual Value (how much the land/building will be worth at end of lease period)  Third party income (pharmacy premium and annual rental figure) NHS Advisor Roles.
The NHS employs advisors to ensure that the model inputs put forward by Renova are correct and that they represent value for money:  Ernst & Young are the NHS financial advisors who will ensure that the funding terms represent good value for money that the model is optimised to provide the best deal for the NHS and that project costs are comparable with other LIFT Schemes across the country. A funding competition will be run for each Tranche and Ernst & Young will work with Renovas’ Financial Team to agree suitable parties to go out to tender too and then appraise the results.  Auburn Ainsley & Partners are employed by the NHS to act as Quantity Surveying and cost consultants and will check and benchmark construction, Facilities management and Lifecycle maintenance costs to ensure they represent value for Money. They will benchmark costs against other LIFT, Primary Care and PFI schemes as well as Community Health Partnerships national LIFT benchmarking data. They will also ensure that appropriate Value Engineering has been undertaken.  The District Valuer (part of HM Revenue and Customs) will act for the NHS to ensure that the model outputs in terms of the annual Lease Plus figure and the lease costs per M2 represent value for money and are comparable with other LIFT and Primary Care third part schemes (the District Valuer office have access to a national database of lease costs).  The District Valuer will also ensure that the purchase and sale prices of any land included in the transaction represent value for money. The NHS North West also works with the local NHS to ensure that the proposed costs represent value for money and interrogate both the Stage 1 and Stage 2 Business Cases to ensure that they are in line with other LIFT projects which have recently been presented to them. Fol owing changes to the capital regime in December 2010, PCT’s no longer have delegated powers to approve major capital schemes; this authority now rests solely with NHS North West. The contents of this Stage 1 Approval document will be updated with additional detail at the end of the Stage 2 to form the new project final submission (Business Case) which will be presented to the PCT Board, the Cluster Board, LIFT SPB and NHS North West. Once the PCT advisors have confirmed that the proposals offer VFM, Financial Close can be achieved with the formation of a new FundCo responsible for the delivery of the facility. Generally fol owing Financial Close, the construction will commence with 4 – 6 weeks. Section 4
Halton & St Helens PCT

4.1 Halton & St Helens Strategic Overview

4.1.1 Development of the Commissioners Investment & Asset Management Strategy
(CIAMS)

NHS Halton & St Helens are currently in the process of developing the CIAMS. The completed document was submitted to NHS North West on 1 April 2010. The strategy will determine the optimum solution for dealing with the remainder of the PCT and non PCT estate within their affordability limits. The work will look at new build, refurbishment and extending existing buildings to create capacity as wel as an estate that is fit for purpose. The six facet survey of the PCT estate has been completed and the draft findings were issued to the PCT Board in May 2009, and the surveys will form the basis of the Phase 1 of the CIAMS document “Understanding Your Estate”. Commissioning and Service Delivery were consulted in April 08 and Questionnaires for Staff and Patients were undertaken in March and April 2008. The PCT Commissioning Master Control Plan includes an Estates Strategy column for monitoring purposes. See Appendix XXX for CIAMS & Estate Strategy
4.2 Halton & St Helens Schemes

Detailed information on LIFT/Non-LIFT schemes:

Development Target
Capex £m
Operational
Developments
Limited or 3rd
Party

4.3 SCHEMES AT STAGE 1
Eccleston

In 2004, the PCT required new accommodation for the new GP practice in Eccleston and a
temporary portakabin solution was provided in January 2005. The PCT is planning to develop a
permanent solution as soon as possible. It is estimated that a permanent facility will be around
400-500m2. The temporary solution is located adjacent to the Church Hall at the Christ Church
site in Eccleston. The Church have been developing plans for a new Church Hall, discussion
with the planners have indicated that they would prefer a scheme for the whole site. This
proposal has been reviewed by Renova and due to the small size of the health facility, the
scheme does not offer value for money. Planning permission has subsequently been granted
on the site of a former factory, Triplex located within ½ mile of the existing surgery. In order to
be granted planning permission to develop housing, there is a provision under a s106
agreement to provide a health centre. Jones Homes are developers and they have approached
the practice with the view to develop a new facility. As at June 2011 no details of layouts or
costs have been received by the PCT to comment on.

4.4 SCHEMES AT STAGE 2
Haydock
The Current Health Centre is very constrained with regard to space and parking spaces are severely limited. The building is owned by the two GP practices based there. The original building was constructed in 1974, with extensions in 1990 and 2001. The GPs are planning to under take a third party development to develop a new health centre for both GP practices plus PCT services, a pharmacy, a dental practice and an optician. The new facility would accommodate 9 GPs and the capital cost is likely to be c £3.5m. A site has been identified within Haydock that was formerly the Kwiksave supermarket and planning has been granted for the project, the purchase is still under negotiation and the practice have been ranted Board approval for community space by Bridgewater Community Trust and Halton & St Helens PCT have agreed to fund an increase in rental levels and fund some capital works for training facilities. 4.5 SCHEMES UNDER CONSTRUCTION
4.5.1 Castlefields, Runcorn.

Health Issues

The population is amongst the most deprived in the country, with high premature mortality from all causes but circulatory disease and cancer especially, high smoking rates, poor diet and participation in exercise, low birth weight babies, high teenage pregnancy, high levels of drug and alcohol abuse, poor mental health and lots of domestic violence and crime. Suitability of Existing facilities

This is a 1970’s purpose built health centre which has had some refurbishment, the
requirement of the scheme encompasses the need to replace accommodation that is in need of modernisation and to offer improved and additional services for the local community. This scheme is part of the whole project to regenerate infrastructure, retail and residential facilities in the Castlefields area of Runcorn. Services to be Provided at Castlefields
Childrens’ Medicine & Medicine Management Dementia Asthma Cancer & Pal iative Care
4.5.2 Belvedere Road, Newton
Dr Pitalia has purchased the site with the view to develop a GP surgery replacement for Bridge St
surgery. The additional cost rent has been agreed by the District Valuer and Director of Finance at
approximately £44k per annum plus a capital contribution of £68,000. The replacement of the
existing surgery is a priority of the PCTs as the existing premises is not DDA compliant and not fit for
surgery purposes. Construction commenced March 2011.
4.6 FUTURE SCHEMES
4.6.1 Thatto Heath

Renova Developments Limited has agreed a purchase price for the Rainbow Medical Centre
premises. The purchase of the premises has been delayed pending agreement by the PCT to
support an increased rent. Following completion of the purchase the premises wil be
refurbished and extended to provide additional consult rooms, treatment room and staff
meeting and rest areas.
The development will also introduce a pharmacy and a dentist to the site.

This scheme has been put on hold.

4.6.2 Rainhill

There are plans for a development in Rainhill this will accommodate two GP practices and
additional PCT services. The development is listed a subsequent scheme with a proposed
construction date of 2013/14. Both proposed surgeries are lacking the facilities and the room
required to practice medicine in the 21 century and have been condemned in the recent Moody
& Stanley survey.
Patients & staff at both surgeries are being disadvantaged in comparison with other practices
within the PCT area. Better provision of premises would enable the practices to extend the
services on offer to patients. The new facility would include re-provision of the existing Rainhill
Clinic, the aim is for a single building to provide all the relevant and necessary space and
rooms required to deliver a modern health agenda. Tenants and a suitable site are to be
confirmed.
4.6.3.
Billinge Surgery, Orrell Branch

Fol owing discussion between NHS Halton and St Helens and NHS Ashton, Leigh and Wigan
both Boards agreed in 2009 that the branch surgery and community clinic would be improved
by the building of a new surgery (approximately 5000 ALW residents are registered at the
Bil inge surgery and therefore the responsibility for the delivery of general medical services lies
with H&StH) The additional cost rent of approximately £70k was agreed.
4.6.4 GP Out of Hours.
NHS Halton & St Helens has to ensure the provision of general medical services to the
population of St Helens out of hours. Currently this service is provided by local GPs from
premises in Hall Street. The landlord has requested an alternative venue to be provided and
ROTA are in the process of purchasing Albion Street Clinic from the PCT to refurbish.
4.6.5 Appleton Village Surgery
The GPs are currently operating out of a converted and extended domestic property that has
limited scope to improve and expand services due to the limitations of current
accommodation. The Practice intends that the new building will enable them to continue to expand, to further develop as a GP Training Practice, and to increase their list size. It will enable the practice to increase and improve the current services they provide. Renova and the GPs plan to form a joint venture partnership to procure a new facility in which
A preferred site has been identified and negotiations are underway to procure it. The
proposed accommodation requirements extend to circa 1800m2, this includes space for the GPs, practice nurses, 3 trainees and adequate space for visiting clinical staff eg health visitors, counsellors etc. as wel as adequate space for administration and to allow some expansion space and future proofing. It is planned that a Business Case will obtain final approval for the proposed development for the PCT will be submitted during September 2010, as soon as approval of this has been received the design wil be finalised and submitted for planning. It is envisaged that work will commence on site in November 2010 and be completed
4.6.6 Upton Rocks Medical Centre

The surgery is based in a modular building which is approximately 8 years old. The contract
for the service was awarded to SSP in 2007 and at the tie it was agreed that the company would pursue a 3rd party development to secure a permanent site. A number of possibilities were explored however the economic recession has severely restricted the availability of funds to secure a solution. It is however still a priority for the PCT to resolve.
4.6.7 Windmill Hill Surgery
A temporary solution is in place with effect from January 2010, a modular building has been
erected. As the service establishes itself the PCT will need to plan a permanent location. Initial investigations have taken place to locate a site although availability is limited. Section 5
Knowsley PCT

5.1 Strategic Overview

The development of LIFT projects in Knowsley has taken advantage of the opportunity to adopt an innovative approach to healthcare provision, with the creation of an integrated model ‘Health and Social Care Centres’, which are jointly commissioned by the PCT and the Council. Examples of this approach can be seen at Towerhil and Halewood. Town centre locations for the Health and Social Care Centres has provided a solid foundation for the Council and the PCT to make new linkages for promoting public health, increased uptake of library and other services, thereby promoting an increase in overal well-being. They also provide the physical infrastructure for a significantly increased range of primary health services under one roof. Accessibility to services is further facilitated through the co-location of Council services. Earlier in 2009 we saw the integration of the Health & Wellbeing Estate Management function. NHS Knowsley gained the responsibility for the management of all the Local Authority estate and for finalising the plans to review the functionality, suitability and usage of these facilities. This exercise is to be completed by mid 2010. The PCT Commissioners are presently conducting a review of the long term provision of Facilities Management across their entire estate of LIFT, 3rd party development and any residual NHS estate. The review will be looking at building maintenance, cleaning, reception provision, security and room utilisation. The findings of this report are due back to the Commissioners in March 2010 and an action plan will be formulated at this point. The third quarter of 2009 saw the PCT commence a review of the room utilisation across all of its estate, the final report is due Spring 2010 and the expected outcome is to show increased productivity and increased room utilisation and hence a reduction in the usage of 3rd party meeting accommodation. The PCT are working with Renova on a number of initiatives to assist with Estate Management. The PCT plan to transfer the residual NHS stock to Renova and for Renova to then take on the responsibility for building maintenance instead of this being done by the Estates function at Whiston Hospital. A fixed term contract is to be agreed for this function. NHS Knowsley is looking at the Improving Working Lives initiative and are committed to the further expansion of the IT infrastructure to allow new work styles. They have a planned programme of remodelling office provision to support flexible working and reduce the future need for fixed office accommodation. This new way of working will require the use of new technology eg wireless portable workstations and more flexible office layouts and associated furniture requirements. Over 2010/2011 NHS Knowsley will seek to dispose on the open market several of their residual properties that are surplus to requirement.
5.2 Knowsley
DEVELOPMENT
BUILD START
COMPLETION
DEVELOPER CAPEX
5.3 SCHEMES AT STAGE 1

Kirkby Town Centre

Kirkby town centre has been the subject of a huge change as the masterplan put together was to include a new supermarket, additional retail, Everton football stadium and new accommodation foe the PCT and local authority. November 2009 saw this masterplan refused by the Secretary of State and planning permission was refused. The PCT are now awaiting the outcome of negotiations between the local authority and Tesco and until such a time that the outcomes are known and a revised masterplan is put together, the PCT are not in a position to move forward with this development. It is anticipated that by March 2010 the PCT will be able to explore options. The scheme will replace the current Kirkby Health Suite and nearby St Chad’s Clinic onto a single site. The new development will include PCT clinical services, out patient clinics for secondary care and office accommodation for PCT staff. St Chads Clinic is listed as below acceptable standard for Functional Suitability and overcrowded in the Estates Report September 2002. Kirkby Health Suite is ful to capacity and neither clinic would be able to accommodate new or secondary care outposted services. Therefore a new development in the town centre is needed to amalgamate those existing services and build room for future capacity. An overview of the services that may be included in the development are as fol ows: Out Patient Services / Adult Paediatrics Progress of the Kirkby Town Centre development was dependent on the outcome of the Public Enquiry on the proposed new Everton Football Club Stadium which is planned for Kirkby. The results of the public enquiry in November 2009 refused consent for the masterplan development and the PCT and Renova are now in the position of having to work with the Council to find an alternative suitable site. It is expected that the new Town Centre PCRC wil provide a hub for the development of secondary
care adult and paediatric services for the Kirkby population. The inclusion of one, possibly two small
single handed GP practices within development is under consideration. A local GDP has also
expressed interest in the scheme
5.4 SCHEMES AT STAGE 2
None at the moment

5.5 SCHEMES UNDER CONSTRUCTION
None at the moment.
5.6 FUTURE

5.6.1 Pilch
There are three GP practices located in converted residential accommodation in the Pilch lane area of South Huyton. The PCT asked Renova Developments Limited to undertake a land search to identify a suitable site to locate a health centre large enough to include three GP practices and a pharmacy. In December 2009 the Board of NHS Knowsley granted approval for the PCT to purchase the identified land of the former Boundary Public House, this will then allow the PCT to review the timing for this development and will protect their development opportunity, The development of this scheme will relocate the three practices with a total list size of 12,232 to a one new site. In the Knowsley Estates Strategy (September 2002) only one of the GP practices was regarded as DDA compliant, however as it was built in 1900 it is not considered suitable to provide future "modern" primary care services. The proposed tenants are as fol ows:  Aston Health Care Ltd It is intended that the new building would include a community pharmacy. As the Pilch Lane area is a built up residential area, suitable sites for the new facility is limited. The local community will continue to be engaged during the planning and design phases of the development. Section 6
Warrington PCT

The Warrington economy and population has developed rapidly, partly as a result of its
communications hub. Warrington has attracted and developed a broad mixture of out of town retail
development, heavy industry, big business, service industries and small businesses. The PCT has
a mixture of old and new, and rural and urban housing.
6.1 Strategic Overview
Warrington PCT’s overall intention is that access to services is improved and that patients and users are seen in the most appropriate place. New services and centres will be developed so that they:  Increase the range of local y based services  Can be accessed in a more flexible and timely manner. The new centres can support the provision of services in one location so that individuals have the option see all the professionals involved with their care at one visit. New and augmented services will help to meet the local capacity plan and flexibility within the design and capacity within the new buildings will ensure that developments around practice based commissioning, payment by results and patient choice can be delivered within the plans for the new centres. The PCT Board adopted the Strategic Commissioning plan (subject to formal consultation) at its formal meeting held on the 1st October 2008. The PCT’s vision is to achieve a Healthier Warrington for Al and is underpinned by four strategic goals. 1. Improve healthy life expectancy as well as life expectancy of all, and reduce inequalities 2. Prioritise earlier interventions in care pathways to keep people well and maximise health 3. Improve the quality and safety of all commissioned services and patient experience. 4. Optimise resource use and health outcomes whilst achieving sustained financial balance In order to meet these four strategic goals, the PCT, together with its Partners and the Public has identified seven key priorities. 1. Increase resources into prevention “ staying healthy” and reducing inequalities 2. Improve access to planned care and reduce inappropriate acute hospital admissions and 3. Support Long Term Condition prevention and management 4. Improve the health outcomes of older people 5. Improve the health outcomes of children 6. Develop local integrated services that provide care in the most appropriate settings and 7. Achieve higher level of efficiency and effectiveness within care pathways by bringing investment, needs and outcomes into line. The development of the strategic plan has established an emerging consensus about the shape of the health care system of the future. The key element is a shared priority for more col aborative working between health and other bodies at a community level. This is consistent with the development of neighbourhood management areas by the Borough Council. The public has prioritised investment in activities that support health and prevent ill health, and this is supported by GP’s. All parties acknowledge that the NHS cannot influence health and wellbeing alone and there is a shared understanding in the town that we need to work in partnership with other agencies, employers and communities. Detailed information on LIFT/Non-LIFT schemes:
Development
Target Build
Developer Capex
Start Date
Operational

6.3 Schemes under Construction
6.3.1 Orford Park
The Orford Park scheme is being built together with new sports facilities beside the college on Winwick Road. Completion is expected in winter 2011/12 and it will provide rooms for three GP practices as well as District Nurses, Community Matrons and Healthy Lifestyles Team. Other Community Health Services will relocate from the Orford Clinic, a building erected almost 60 years ago. The scheme contributes to the regeneration of Orford which is one of the seven most deprived areas in England, and is in partnership with Warrington Borough Council, Warrington Collegiate, William Beamont School, The Orford Neighbourhood Project, Warrington Wolves Rugby League Club, Warrington Disability Partnership, Network Warrington and NHS Warrington. 6.3.1 Town
The Town Centre scheme replaces the current Garven Place Clinic built about 50 years ago. Completion is expected to be January 2013 and will bring together two GP practices and a number of community services including dental, district nursing, stoma nursing, mental health, physiotherapy, sexual health, smoking cessation, enuresis, genitor urinary medicine, immunisations, weight management and citizens advice bureau. The new building will be on the site of the Warrington swimming baths and car parking will extend on to the existing Garven Place site until such time as Warrington Borough Council take an option to buy that area as part of their town centre plans. At that time the council will reprovide the same number of parking places for the Town Centre Primary Care Resource Centre. 6.4 Future
There are no further schemes planned at this time. However, two private groupings are planning developments. Plans for a new health facility at Chapelford Vil age are being taken forward by Culceth Healthcare (Part of Sequel Healthcare Ltd) and the Eric Moore Partnership plan to develop new facilities on their existing site. Bothe are using private funding sources. 6.4.1 Chapelford
Description of the new project
Originally planned as a LIFT development it is now being taken forward as a 3PD project by Culceth Healthcare who now provide GP services at Chapelford under a contract with NHS Warrington. Culceth Healthcare is owned by Sequel Healthcare Ltd The healthcare centre is to be located in the village square but development of that part of the village has been delayed as a result of the slow down in the housing market. 6.4.2 Eric Moore
The Eric Moore Partnership have purchased their premises in Tanners Lane and have a development plan to improve the premises and expend the services available on the site.

Source: http://www.sthelens.gov.uk/media/269735/lps38.pdf