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Why I am no longer thinking of quitting

Three individuals in the primary care sector discuss the issues surrounding procurement of new premises, the benefits and pitfalls of public private partnership, and the dramatic benefits a new primary care centre can bring to a population

The Investor

Barry Panton, chair, Prime

Since the publication of the NHS Plan in July 2000 primary care has been redefined. Community hospitals, mental health institutions, elderly nursing care, resource centres, public health, one-stop shops and GP surgeries are now all part of the integrated primary care service.

As the primary care sector develops, so too must its facilities, but with central funding stretched and young GPs increasingly reluctant to invest in their own premises, options are limited. With the NHS Plan alone committed to the replacement or improvement of more than 3,000 outdated facilities, public private partnership (PPP) provides a viable solution. But for many young GPs the first and often one-off experience of procuring premises is all too daunting.

Working with a private investor requires a huge amount of trust but it also brings tremendous benefits in transferring the significant risks of development. Private, specialist companies are able to provide the necessary expertise in planning, accountancy, design and management to steer a project through any difficulties or hurdles.

But for anyone who decides to choose PPP, it is essential to select a private partner with NHS experience or background. Primary care is about people ­ people who provide services and people who use them.

An investor that understands this will be an invaluable partner, who brings a true understanding of the specific needs of the primary care community to a project and who is sympathetic to your priorities and requirements.

The degree to which you involve yourself with the project is entirely your own choice, but the more you put in, the more you will take away.

While red tape and planning pitfalls will be taken out of your hands, there is a real opportunity to work with your investor on design and layout, down to very last details of reception areas and colour schemes.

This is essential in creating a truly bespoke facility and ensuring a real sense of ownership when it is finally handed over.

Not only can a new facility aid GP recruitment ­ particularly in rundown or rural areas ­ it can also play an essential part in improving services to patients, aiding urban regeneration, reducing health inequalities and removing pressure from the acute sector ­ a key target outlined in the Government health agenda.

The Practice Manager

Pat Davies, practice manager,

Pontardawe, Wales

Whatever the reason health care professionals are looking to procure new premises, it is a process with which none of us is at all familiar. For us, the decision to move premises was taken out of our hands when in October 1998 our existing trust building was flooded. For the next five years we operated out of portable buildings.

The funding process for new premises is by no means simple and we struggled to move things forward. Ironically enough, we read about PPP in a magazine and that was how our process of procuring premises began.

Investing in our own premises was not really an option as we were reluctant to be financially tied to property, and while initially the target of having neutral cost to the GPs seemed unrealistic, PPP gave us the opportunity to make it happen.

There are a lot of misconceptions about PPP, but our experience has been extremely positive. We invited a number of private investors to present to us and from this we were able to select the most suitable. It's essential to procure your premises through an investor that has a sound knowledge of primary care and understands the mentality of general practice and trust staff.

Another good tip is to look for someone who is willing to appoint an independent agent who will act on behalf of all parties involved.

For us, the real advantage of PPP is that it took the red tape and bureaucracy out of our hands and put it in the hands of experts. Let's face it ­ none of us is a professional in the procurement of premises.

Some worry that this means losing a sense of ownership but this has not been our experience.

We were heavily involved at every stage, from design, colour schemes and layout, meaning that we have ended up with a truly bespoke facility that is fully functional.

It is a fabulous building that is just as we wanted and that we cannot help but take a pride in. By integrating the trust services with those of general practice we are able to accommodate the needs of the population in a way that we never could before.

The GP

Dr David Grainger, GP, Throckley

Before our primary care centre was completed we were operating out of a tiny and inadequate building that did not even have enough individual rooms for all the doctors. Facilities were extremely cramped and there was no car-parking space available.

We had been trying for nearly 10 years to lead the procurement of our own premises but we had come across numerous funding barriers, and were refused planning permission for a number of schemes.

It was our decision as GPs to approach a private investor. We went on the recommendation of another doctor and when we met with the investor concerned we were impressed.

They had been involved in other projects in the North-East so we went to see their past work and talk with the doctors they had worked with. This is a really essential stage for anyone considering PPP.

It's important to work with an investor that is specialised in health care and fully understands your needs. Ours was particularly skilled in bringing all the different teams together, such as the PCT, pharmacy and the council. We felt the fact so many of their staff had NHS backgrounds made a tremendous difference, giving them an understanding of our needs and aspirations.

You can be as involved in the project as you want to be, and for us we never lost a sense of ownership of the building because we were so involved in every aspect of its development. What we have now is a bigger and much better designed facility that is enabling us to improve services to patients and is aiding GP recruitment.

In fact, we have at present got three GP registrars (and four medical students who attend weekly sessions), something that never would have been possible before due to lack of space and facilities.

There is of course an element of risk with PPP, as there is with anything. For example, the long lease at first seemed a little daunting. But the alternatives of either staying where we were, or investing our own money, were both far more risky.

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