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How our PBC group won bid for GP-led health centre

As a recognised local provider, Harness PBC consortium saw no reason not to bid to run the local Darzi centre. Dr Ethie Kong and Carlone Kerby explain how external orgnaisations helped them put a successful bid together.

As a recognised local provider, Harness PBC consortium saw no reason not to bid to run the local Darzi centre. Dr Ethie Kong and Carlone Kerby explain how external orgnaisations helped them put a successful bid together.

When we heard Brent PCT was looking to establish a GP- led health centre, we were keen it should be driven by local clinicians.

So Harness PBC consortium decided to grasp this opportunity and put in a bid to deliver the service. Demonstrating we were good at providing primary care services was only a part of the process. To win the bid, we knew we'd have to excel in procurement. We were aware the process tends to be lengthy, costly and complicated so decided to enlist the help of private companies that were experts in this field to guide and support us.

41232583The decision paid off when we were awarded a five-year £7.4m APMS contract for the GP-led centre in Wembley,which opened on 1 July. We have demonstrated a PBC consortium can compete alongside major private healthcare companies in a bid to deliver a large-scale service and win.

The GP-led centre is designed to improve access to primary care services and to give patients more choice. Brent PCT found patients were finding it difficult to register with a doctor and that it was hard for some to attend services during conventional opening hours. Harness's walk-in centre and new practice at the Wembley site will give both registered and non-registered patients access to care 8am to 8pm, 365 days a year. If there is any financial surplus from the scheme, it will be reinvested back to improve the local health economy.

At the end of five years, the new practice at the centre will be expected to have built up a list of 12,000 registered patients.

About Harness

Harness consortium was established as a GP co-operative in 2006 and now has

15 practices covering 80,000 patients. There are four other locality clusters in the area but Harness is the only one to have members from across Brent who have shared interests, though the 15 practices vary in size from singlehanded GPs to large partnerships.

Harness is run as a social enterprise, so any money we make is reinvested into improving healthcare for the local community. In order to make a clear distinction between commissioning and service provision and avoid conflicts of interest, Harness is comprised of two sister organisations, both of which are run on

a non-profit making basis. Harness GP cooperative concentrates on practice-based commissioning and service redesign, while Harness Care Co-operative focuses on service provision.

Service redesigns we have worked on include diabetes, ophthalmology and gynaecology.

Deciding to bid

When we saw the advert on the PCT's website inviting providers to bid for the

GP- led centre contract last October member practices wanted Harness to go for it.

A GP-led service commissioned by a PCT might not seem to fit with PBC. But for us, we saw that running a GP-led centre would involve input into commissioning the provision of clinical services as guided by patients needs – which is very much what Harness already does through PBC.

We also felt the bid was in line with our aims of local clinicians delivering local services that boost access and bring patient care closer to home. Winning the contract would help us to realise this vision.

When we approached the consortium's governance board with the idea of going for the bid, we anticipated there would be concerns. After all, it would mean setting up a new practice that could be seen as being in competition with Brent practices and with Harness member practices, including our own. However, we believed that given the Department of Health mandate that every PCT must have a GP-led centre, it would be better for Harness to seize the chance to create a truly GP-led service. Rather than seeing a new practice as a threat, why not view it as a way to boost access for patients and improve care?

Having convinced the consortium that we should ‘go for it', we met with various practices in Brent to try to reassure them.

We have also made sure our patient forum – as we value patients as partners – is up to speed with developments. Again we reassured them that the new service would not threaten practices, but instead provide better access for those who find it difficult to attend normal surgery hours.

Calling in the experts

We knew we had the skills and expertise to deliver good primary care services – that's our forte. We were also confident about completing the pre- qualification questionnaire (PQQ), which is the initial part of the bidding process and requires the bidder to show how they would meet certain operational and clinical requirements and put health and safety systems in place.

We foresaw our weakness would be the next stage of the procurement process, which would be to complete the intention to tender (ITT) document – a large questionnaire made up of 11 sections. This document asks the bidder to demonstrate their ability to deliver high-quality services, with innovation and efficiencies to the PCT. Completing the document is not only time- consuming but also expensive: it can cost as much as £40,000 in terms of the time and research required. We both had full-time positions and simply didn't have the manpower or the resources to complete the document alone without support.

Our approach to running the consortium has always been to work in partnership with others – whether private or not-for-profit organisations – that can complement our skills. We were used to buying in expertise and felt confident we could outsource what we needed and comfortably negotiate to work with people using short- term contracts that would prevent us spending beyond our means.

What they did

Having got through the PQQ stage, we had less than a month to complete the five-inch-thick ITT document. Circle Health, which has successfully bid for a GP-led health centre in Kent, guided us through the best way to do this.

We were already aware of Circle Health, which is a provider organisation that is founded, owned and run by clinicians and is the largest clinician partnership in Europe.

Circle did not charge us for its advice but there was a proviso that we would consider opportunities to work with Circle Health on mutually suitable projects in the future.

For example, if we chose to redesign a major pathway, such as musculoskeletal services, we could tender to do that together with Circle Health.

Unlike partnerships offered by some healthcare organisations, Circle has not required us to change our name or to work exclusively with them, nor do we require their consent to get involved in a scheme.

Another area where we lacked expertise was the financial modelling aspect of the ITT process, such as how to cost a venture like a GP-led health centre. Again, prior to beginning the bidding process we enlisted the financial modelling services of healthcare planning consultants Acton Shapiro. We came across the consultancy at a national conference, and it was clear they had a lot of experience in writing bids for healthcare organisations.

Having enlisted Acton Shapiro's services, which we paid for using funds that we built up by pooling the PBC local incentive scheme payments and certain LES payments we secured over two years, their staff set to work on costing the project. This involved such factors as how many doctors we would need to employ, and what equipment we would need to buy – in fact, every financial aspect of setting up a GP-led health centre. Their input was crucial because if you don't get your costings right and you pitch it too high, you could price yourself out of the bid. Too low and you could end up bankrupt.

Outsourcing this expertise helped us to reach the interview stage, which involved giving a presentation to the PCT interview panel on the key features of our service proposal and benefits, and answering such questions as how we would assure clinical quality and governance. Having a representative from Acton Shapiro beside us to answer financial queries was invaluable.

A ballpark figure for the total cost of putting the bid together was £30,000.

Getting centre up and running

From signing the contract on the 31 March 2009, we then had just three months to bring our plans to fruition. With such a tight deadline and given our existing commitments, we needed further assistance to get the centre up and running. Using the set-aside funding outlined above and setting up a loan facility with the bank, we were able to recruit both a full-time business manager and a co-ordinator to help run the scheme.

The GP-led scheme, called Brent GP Access Centre, will be sited at the Wembley Centre for Health and Care, with its head lease held by the PCT, which already houses a few existing GP practices and some community facilities. We applied for, and were awarded, a bank loan to pay for operational costs including salaries, drugs, dressings, furniture, equipment and other items needed to get the service up and running.

More human resources were required to launch the centre, so again we turned to Acton Shapiro, who supplied a project manager to ensure everything from equipment to health and safety was in place for the 1 July opening.

The performance of the scheme will be measured and rewarded based on its achievements on the key performance indicators as stated in the contract.

For a PBC group to take on such a large- scale scheme requires commitment, creativity and a belief that you have the skills to make it work. You also have to take an honest look at the skills you lack and buy in expertise to help you. By partnering up with the right people, and using their expertise wisely, even the most difficult PBC challenges can be overcome.

Dr Ethie Kong is GP clinical lead of Harness Consortium and a senior partner, Church End Medical Centre, Brent

Dr Caroline Kerby is management lead of Harness Consortium and managing partner of Brentfield Medical Centre, Brent

" Our approach has always been to work with whatever organisations complement our skills" Dr Ethie Kong and Caroline Kerby 60 second summary brent Related Seminar: PBC Masterclass

PBC Masterclass: Regional events

What: These regional PBC events are designed to equip you with the sophisticated skills needed to overcome barriers and push on towards PBC success.

When: 10 individual events running from October 2009 to January 2010

Where: 10 different regions throughout England. Each event has been tailored to address the learning priorities highlighted by practice-based commissioners in that area.

Next steps: Find out more and book

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