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Supersizing our surgery

The largest supersurgery in the UK will be well worth the six-year wait, writes Dr Stewart Higgins.

This summer my practice plus the other five practices in Macclesfield will move into new, purpose-built premises. Waters Green Medical Centre will house 70 GPs- 30 partners and 40 other doctors - and is reputedly the largest 'supersurgery' in the UK.

We have travelled a long road from concept to concrete reality, but have learned some valuable lessons on the way.

It all started in February 1999. Looking at our existing premises, it was obvious that none of the practices could afford to stand still. We were working out of a variety of converted period buildings, with facilities ranging from reasonable to poor.

Problem buildings

The properties were difficult and expensive to maintain, car parking virtually non-existent and fire certification and the demands of the Disability Discrimination Act almost unattainable.

After some crystal ball gazing, which in the light of last month's primary care White Paper proved prescient, it seemed to make perfect sense to join forces on one site. This would also enable us to address important issues such as quality and clinical governance and provide more facilities and better services for patients.

I discussed the idea with Dr David Young, another GP in the town, and the two of us decided to try out the idea on all the practices. Amazingly we found ourselves pushing at an open door. The practices' mutual trust in each other had been built up largely as a result of our highly successful integrated out-of-hours service. But, six years ago, we had no idea how protracted a process obtaining our supersurgery would be.

Macclesfield is relatively prosperous and was perceived by the then health authority (HA) as being over-resourced. The LIFT scheme was not on the agenda. We were not top of the list for NHS investment and the HA (now PCT) became involved at a relatively late stage.

This meant we had to pull together all the main key players - funder, developer, architect, surveyor, solicitor and so on. The practices also consulted with local MPs, the town council (councillors, planning and transport departments) and patient groups.

After finding a location and appointing the key professionals, there were several interlinked issues to resolve.

Lease agreements

Pivotal was the 25-year lease agreement between each practice and the developer.

The leases had to be signed to enable the developer to access £12 million of loan finance for site acquisition and development.

Each practice had to agree a lease document of 70 pages covering masses of detail. The leases kick in on building completion and the PCT will reimburse the rent. But all that Macclesfield's GPs were signing up to at this time was a concept.

Complicated negotiations, including partnership commitment and how to dispose of the old properties, had to precede this stage.

I was shocked by just how hard-nosed and confrontational the commercial world was. There were interminable meetings about things we did not understand and it became obvious that we needed our own independent adviser.

We appointed solicitor Robert Street from north-west firm Brabners Chaffe Street. He protected our interests and was invaluable in building the confidence of all the GP principals involved.

Sterling teamwork

The energy needed to get the project off the ground was massive. But, once it was moving forward, I realised it was important to let go a bit as more people became involved.

We set up a steering committee which included a GP representative from each practice as well as practice managers and PCT project staff. Local GP Dr Gill Plant chaired the committee and really moved the project along.

While I know that the final result will not be exactly as I envisaged at the start, I think it will be a phenomenal facility for Macclesfield.

Together we will be able to provide a whole host of services that would not be possible as stand-alone practices, and to deliver care that patients would otherwise go to hospital for. Our new building will provide a real one-stop healthcare shop.

- Dr Stewart Higgins is a GP in Macclesfield

NEW PREMISES POINTERS

- Developers, financiers, the primary care organisation, builders and so on will be looking after their own best interests which might not coincide with yours. Conflicts must be resolved for the project to go ahead.

- Appoint an experienced professional adviser to act in your interests.

- Don't be afraid of confrontation and negotiation but let your adviser take the lead.

- Delegate decision-making: it is not practicable to be involved in every aspect.

- Before signing the lease agreement, make sure you have a detailed building contract with full specifications.

Source: Solicitor Robert Street, from north-west firm Brabners Chaffe Street, which specialises in GP premises developments

SUPERSURGERY COMES TO MACCLESFIELD
June 2006 30 partners and 40 GPs from six
practices (total 60,000 patients)
to move to purpose-built premises.
Supersurgery Four-storey leasehold premises
with 130 free parking spaces.
Site Former bus station, town centre.
Developer Primary Care Initiatives
(Macclesfield) Ltd - formed for
this project.
PCT East Cheshire.
Finance £12million for site acquisition
and development. Specialist medical
premises funder GPFC.
Lead professional adviser Robert Street, of north-west
solicitors Brabners Chaffe Street.
Builders Bowmer & Kirkland Ltd, Belper.
Architect Bower Mattin, Macclesfield.
Ground floor Health-related retail premises let
by developer (pharmacy and other
healthcare professionals).
First floor Second floor Six GP practices. Integration is a
future possibility.
Third floor Clinical administration area above
each practice.
Fourth floor Education and administration.
6,000 sq ft joint clinical area for shared care and diagnostic services
run by the practices, community services, PCT, and secondary care,
including visiting specialists in diabetes, dermatology, ophthalmology,
rheumatology, gynaecology and ENT. Plus social and voluntary sector
services.

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