With NHS Trusts now operating in a more consumer driven healthcare market, the importance of attractive, patient focused facilities has never been more important. NHS Trusts should expect their new facilities to be delivered on time, within budget and offer value for money throughout their life. They should expect them to be fit for purpose and represent the opinions of those using them. ProCure21 offers the Trust a better chance to achieve these expectations than they would get from a traditional procurement relationship.

These pages will give you an introduction of the principles and tools of ProCure21. More detail is provided in the ProCure21 guide also downloadable from this site.

Time

ProCure21 is a very fast procurement route. It is ideal for NHS Trusts who have a tight deadline and trusts who are keen to open their facilities as soon as possible so they can start to receive patients and income.

Using ProCure21 NHS Trusts do not have to OJEU tender their schemes. They can select a Principal Supply Chain Partner (PSCP) from the ProCure21 framework in a way that is most appropriate to them. ProCure21 has a recommended selection process that satisfies all audit requirements and only takes 3-4 weeks, but it has been done in a much shorter time. There is potential to bring delivery of the project forward by at least 6 months using this selection process alone.

There can be further time savings during construction periods, typically 7 weeks on schemes between £1-5m and 17 weeks on schemes between £5-15m. These savings are generated from better and more robust planning before the construction period begins.

Cost

ProCure21 encourages the trusts to bring the PSCPs and their supply-chains in to the design process as early as possible. Getting the expertise in this early gives the supply-chain the maximum chance to understand the scheme, the trust and engage key stakeholders. It offers a chance to include expertise from the supply chain members on design options, materials, cost, construction planning and gives them a better knowledge of the scheme reducing risk all round. As a result of this work a higher percentage of the overall cost is incurred in the early stages of the scheme, but there is shorter smoother construction period bringing overall cost in-line with traditional methods.

The detailed design will be agreed and market tested before it’s submitted for approval in the Full Business Case. The Trust and the PSCP must agree a Guaranteed Maximum Price (GMP) before construction. Should there be any increase in out-turn cost above the GMP that is not down to client changes (Compensation Events), the PSCP will burden the increase. If final out-turn cost is below GMP then any savings will be shared 50:50.

The PSCPs submitted cost models to the Department of Health upon their appointment to the framework, to which all subsequent costs must adhere. ProCure21 requires a system of open-book accounting and all costs must fall within Departmental Cost Allowance Guides (DCAGs) and are constantly monitored by the Department of Health.

ProCure21 supports whole-life-costing and seeks to ensure that buildings represent value for money throughout their life. Capital cost often represents a very small percentage of the total cost of the building and activities that are carried out within it.

ProCure21 operates a centralised approach to VAT recovery. The Department of Health employ specialist VAT experts to carry out all VAT calculations free of charge to the NHS. The consistent methodology agreed with HM Customs and Excise offers an excellent rate of return and can be done in a very short time period. We have seen that money recovered is generally re-invested into the scheme.

Quality

ProCure21 schemes are setting world-class standards in building design, materials, finishes, clinical planning and equipment. There is a solid commitment to innovation, best practice and sustainable construction. ProCure21 schemes achieve on average 8.5/10 for product and service satisfaction and also have a very good defect rating.

ProCure21 ensures that good quality design is high on the agenda from scheme outset. Supply chains include clinical planners and healthcare architects with extensive experience of working within the NHS. Use of Achieving Excellence in Design Evaluation Toolkit (AEDET Evolution) is mandatory on every scheme.

Early involvement of the supply-chain and other key stakeholders in the design process helps a scheme by;

• Advising of feasibility and affordability issues at the most appropriate time.
• Increasing the knowledge of the trust decision makers and other non-project team staff of ProCure21 and the expectations of them.
• Adding detail and stakeholder input for a more robust business case.
• Increasing the supply-chains knowledge of the scheme, the trust and their key drivers.
• Educating the supply-chain on the nature of the patients, the effect the new facility and the building process will have on them. Particularly important on mental health or other primary care schemes.
• Improving construction planning toward better health and safety on site, leaner construction methods, better integration of the works within a live hospital environment.
• Encouraging an open working relationship and positive problem solving attitude.

Contract

ProCure21 schemes use the NEC2 EEC Contract Option C with Activity Schedule.

The contracting parties are the NHS Trust and the PSCP. The two upon PSCP appointment will enter into contract with each other to develop the scheme further until agreement of the GMP. After agreement the two parties must sign a stage 4 contract for construction and delivery.

The NEC contract is a partnering contract and used by over 500 clients of all types and sizes. It is written in plain english and encourages an open, honest working environment. It requires both parties to take a pro-active approach to scheme management and contractually requires them to alert one other as soon as there is an issue that could affect time and cost. It encourages all parties concerned to have a positive problem solving attitude and operate in a no blame culture.

ProCure21 provides support for use of the contract, through in-house experts, Implementation Advisors and scheme guidance including worked examples and pro-forma packs. The Department of Health is currently developing an online contract administration tool.

See: www.neccontract.com

Training

ProCure21 requires a very pro-active client and an experienced project director. Demands on the NHS Client are high and it has been difficult for some trusts who have little of no construction experience. A ProCure21 scheme must be resourced properly, and as a rule is not a job that can be done in addition to the day job or by someone with little or no construction experience.

Often the early stages of the scheme are the most difficult to manage. There is a lot of requirement on the Trust to arrange funding, submit Strategic Outline Cases or Outline Business Cases, select a PSCP, organise clinical requirements and develop the design. With the addition of new techniques perhaps not used before, and the swift nature of the ProCure21 process, it can be a real challenge.

(In 2007 – 71% of NHS Project Directors MOT’d were on their first ProCure21 scheme)

ProCure21 aims to provide as much assistance and possible. We have provided free training for the NHS on the principles, processes, tools and the requirements of the NHS Trust. We are continuing to provide these courses as long as there is demand for them. However in 2008 we aim to provide a suite of more in-depth courses that cover areas like NEC contract PSCP Selection Roles of the Project Director, Project Manager and the Cost Advisor Risk Management Partnering

We would like them to be provided locally on a small basis to 1-2 project teams at any one time.

Other training can be provided through the Implementation Advisors as required.

Performance review

ProCure21 is based upon performance review, lessons learned and continuous improvement. We have a range of Key Performance Indicators that the PSCPs are required to their report performance against.

They measure key areas of delivery such as; GMP and out-turn cost Fee levels Time Design quality Defects Client satisfaction Client performance PSCP performance

This performance information is collected by the Department of Health and used to measure the performance of the PSCPs and the framework overall.

Performance is reviewed with each PSCP on a regular basis as part of an ‘MOT’ process. Areas of improvement are identified and actions are issued for further review.