Putting Darzi into Practice

Lord Darzi's vision of equitable access primary medical care for all is starting to be realised in bricks and mortar developments across the country.

By Christian Dingwall and Lynne Abbess, Partners at Hempsons  

Primary Care Trusts and GPs are working together to achieve the best patient care outcomes in terms of accessibility, range and quality of services for local people, in purpose-built health centres which combine medical services, GP practices, pharmacies and other health and social care providers under one roof.

Handling property issues and partnership agreements effectively are key to the success of those developments and we are advising on 25 equitable access schemes across the UK.

One of the most recently completed projects was for Syston Health Centre in Leicestershire. Opened by Her Royal Highness The Princess Royal last year, the £6 million purpose-built facility is a totally self-funded venture by a dedicated consortium of ten local GPs, from two separate practices.

Unlike conventional LIFT projects, where the PCT has to fund higher than current market rent reimbursement for the building and facilities management of the premises, this is effectively an unlimited property owning partnership formed by the GPs, who took on the risk of borrowing themselves, to finance the purchase and development of the site, based only on notional rent reimbursement estimates provided by the district valuer.

Having taken on the personal risk of building the centre to a larger specification than required by the practices, they had the scope to include two surgeries and accommodation for a wide range of high quality intermediate and secondary care services.  These include an MRI/CT scanner docking station, NHS audiology, ultrasound, echocardiography and private general and sports physiotherapy. There is also an on-site Boots pharmacy.

The consortium funding is serviced by the receipt of notional rent received via the leasebacks granted to the two GP practices, which the PCT reimburses through their contracts in the usual way. They receive further rental income streams via the leases issued to the other service providers, including the PCT & the Pharmacy. Others operate under licence and pay on a session-by-session basis.

NHS work can be done under a variety of options, from secondary care and PCT services using the space, to practice led services run either by current GP practice staff, or by sub-contracting to external companies through PBC schemes.  Syston now has a number of services up and running using a mixture of these options, delivering a variety of diagnostic tests as well as outpatient appointments and day-case surgery.  A successful Minor Hand Surgery Service has been running for over a year now and there are plans for an innovative LA Hernia repair service which is due to commence in September.  Possibilities for the future include areas such as dental and ophthalmic services, as well as private healthcare and running classes to encourage healthy living, depending on the time and resources available, as well as the future health needs of the local population.

It took great commitment from all those involved in Syston to overcome the complexities of such an innovative scheme and to deliver a modern health centre on such a large scale. PCTs and GP practices across the country are using flagship developments such as these to inform their own initiatives as the Darzi vision becomes a reality.

PCTs are already a long way through the procurement process of some 260 GP-led health centres being targeted.  The target set by Lord Darzi had been at least one for each of 152 PCTs and over 100 in areas regarded as being short of doctors. The Health Department records just over 200 contracts awarded: 42% to partnerships of GPs, 21% to private sector companies and 19% to consortia, usually a mix of GPs with independent sector partners.  Initial concerns that no GP providers would be interested, have not materialised.

There are still issues to be considered, but there is a realisation that the process is happening and that the new services will result in a significant investment into primary care, with patients benefiting from better access, at convenient locations and times. Our expectation is that there will be more high quality, innovative bids received from all sectors of the primary care provider market by the end of the year.