Building Starts On Chesham's New Health Centre
12:27pm 1st September 2010
(Updated 1:02pm 1st September 2010)
Work has finally started on Chesham's 6 million pound Healthzone.
How the site looks today
A spokesperson for Bucks Primary Care Trust told Mix96 "when complete, the state of the art facility on Berkhamstead Road will house two of the GP practices currently based in Chesham - The New Surgery in Lindo Close and The Surgery in Gladstone Road - together with additional healthcare services."
Richard Mills, Director of Strategy and Planning for NHS Buckinghamshire, said “We are very pleased that building work is beginning on Chesham Healthzone. The facility will be a positive development for the town of Chesham and will enable residents to access a wider range of services, such as those supporting the management of long term conditions, closer to home.”
13 year old patient of the New Surgery Madeline Finch and members of Bucks PCT
Questions raised at a public meeting on 21 January 2009
1. When will you start demolishing the existing buildings?
We will be serving the Health & Safety notices very shortly and doing preparation work. The demolition itself will start in early February.
2. Are you aware that there is asbestos in the buildings?
Yes, that is why there has to be thorough preparation.
3. We were originally told the project would be completed by the end of 2009. Why has it been delayed so long?
We always said the timings were subject to various possible delays. This is not unexpected. In this case, the rearrangement of the land holdings is beneficial for the overall layout of the facilities so it is worth the slight extra delay.
4. Are you aware that there may be underground springs on the site?
We have done a lot of investigation as we are fully aware of the geology of the area and we are as confident as we can be that there are no springs affecting the site.
5. What is the overall cost of the project and how much is the PCT paying?
The costs are the same as agreed in the tender, i.e. the capital cost is £6 million and the PCT will be paying £288,000 + VAT per year. The PCT held a competitive tender process and achieved a very good deal for the public purse.
6. What is the design life of the building?
The mainframe of the building has a 60 year design life. Some elements subject to normal wear will need replacing in 30 years. We would expect the sedum roof to last 40 years or even longer.
7. Is the power plant from the original Wright’s Mill still on the site?
8. I am concerned about the parking and the possibility of overspill of cars into the surrounding roads. Is there a chance we could have a residents’ parking scheme to prevent this?
This would be a matter for Chiltern District Council. The Outline Planning Permission requires 105 parking spaces and that is what we have included in the new application.
9. Does the figure of 105 spaces include use by staff?
10. How are you going to monitor the parking use?
We at Brackleys have installed various types of parking control in some of the previous schemes we have developed. In our experience the need is best assessed once the facility is in use.
11. Will patients need to go upstairs?
All the normal clinical space is on the ground floor. The first floor rooms are for use outside of normal surgery requirements but in any case there is a lift for access.
12. What about the second phase and when will it happen?
The building has been designed to be constructed in two phases: 1932 square metres in the first phase and 568 square metres in the second phase.
13. What is the point of constructing in two phases?
There will be ample room in the first phase building for all the planned services. As new services are created over the next few years, then Phase Two will be implemented.
14. Will there be problems in Berkhamstead Road during the building works?
Unfortunately we cannot avoid some disruption and inconvenience to residents and traffic, but we will do our best to minimise this. However, the project includes the provision of a right turn lane using some of the land from the site, which will reduce future congestion.
15. Can you specify the use of local bricks?
We noted this request at the last meeting and we will try to do so but this is ultimately up to the planning authority.
Questions on Services
16. Will there be an A & E department?
No, this is not possible. The complexity of modern trauma services and the level of staff experience required means that an A & E department is only feasible where there is a larger concentration of population than in Chesham.
17. Could we not have at least somewhere we one could be patched up before being sent on to A & E?
Some minor injuries will continue to be treated in the practices but if A & E treatment is necessary then it is best to go directly to A&E to avoid any possible delay.
18. Will you be able to find enough staff for the Healthzone?
We don’t foresee a problem with staff – we just need the space.
19. Are there any plans for services in partnership with voluntary organisations e.g. CAB?
Yes, there is space allocated for the CAB and we want to work with other voluntary organisations too.
20. Is there any chance of having an ambulance stationed in the Healthzone?
This is unlikely as there is an ambulance station in Amersham. In any case, the ambulance service nowadays has ways of calculating where to position vehicles so as to achieve faster response times.
21. Is there a budget for upgrading the equipment e.g. computers?
Yes. The GPs will fund any necessary replacement of clinical equipment and the PCT will fund the IT systems.
22. Will the Healthzone be open on Saturdays?
The opening hours will be longer than those at present but exactly what the extended opening times will be is still under discussion between the GPs and the PCT.
23. Will there be an NHS dentist on the site?
No. There are a number of dental practices in Chesham including one very close to the site in Berkhamstead Road.
24. Is it correct that there won’t be an X-ray facility?
That is correct. Modern X-ray services require a lot of high- tech equipment and there would not be enough use in Chesham to justify a full X-ray suite.
25. But it is usually the least mobile people who need an X-ray.
Patient transport is provided for patients who meet the criteria for medical need.
26. Will there be ultrasound?
Ultrasound would be available for any intermediate gynae services but this is nowadays provided by a small portable device.
27. Will there be a dietician?
28. Will there be a diabetic retinopathy service?
This is unlikely as this is provided in Amersham.
29. Will there be a community midwife service?
The existing community midwifery service serving Chesham will continue but this is actually based at the maternity unit in Wycombe.
30. Will we still be able to see our own GP?
There is no intention to change the way each practice works. The two practices will remain as individual practices.
31. Will there be an endocrinologist?
This is unlikely.
32. How many more patients could be taken on if the town population increases?
We can’t say exactly but there is clearly plenty of room for growth.
33. The original project included consultant outpatient appointments. Will these be available?
There are a number of services being developed at present involving consultants in a new way. Joint teams of consultants, staff grade hospital doctors and GPs with special training will provide services. Examples already in operation are a musculoskeletal service and an eye service and we envisage some of these new services will be provided at the Healthzone.
34. Will Water Meadow Surgery patients be able to use the new facilities?
Yes, any services additional to the normal GP services will be available to Water Meadow patients.
35. Will there be physiotherapy?
This will continue to be provided at the Leisure Centre.
Questions raised at our public meeting on 17 October 2007
1. Will there be an A & E Department at the Healthzone?
No. Accident and Emergency care to current standards can only be provided in large centres, where there is sufficient population. But Heathzone will be able to provide a number of types of treatment which are currently only done in hospitals. For example, there is a major review of provision for minor injuries going on and it is possible that a Minor Injuries Unit could be sited at Healthzone.
2. What about beds?
The community hospital beds which were at the old CheshamHospital were reprovided at Waterside Ward of Amersham Hospital. Nowadays the thrust is for more treatment in people’s own homes so there is less need for long periods in hospital beds.
3. Will the opening hours be longer than the present surgeries’ hours?
Will there be more GPs? Extending opening hours is currently the subject of national negotiations. This would not mean more GPs – GPs would probably work shifts and there would be a different skill mix of staff.
4. Will there be services such as taking blood tests?
Yes, that is what we would like to see.
5. Will there be any problems about planning permission?
There may well be issues, but they should not be insurmountable. We already have outline planning permission.
6. How soon will you be able to remove the present occupiers of the site?
The tenants have a rolling three month contract.
7. Will hospital consultants come to the Healthzone?
Our vision includes consultant-led services in a range of specialisms.
8. Can you be more specific?
Gynaecology, urology, musculo-skeletal, ear nose and throat, and dermatology are some of the ones we are considering.
9. What is the position regarding X-ray provision?
It will not be possible to provide an X-ray service in the old way, but with modern X-ray technology imaging results can be transmitted electronically so that doctors in Healthzone will be able to see results of X-rays taken elsewhere.
10. How will you consult with local residents?
We need to have continuous dialogue throughout the project. Will you consider having residents on your working party? We would be delighted to arrange that.
11. Is vehicular access still a problem?
We have an outline planning permission so unless we alter the final plan considerably, this should not be a problem.
12. Will there be a pharmacy on the site?
This will be negotiated with the developer so we can’t say for sure until the contract is signed but this is something we would definitely want to see included.
13. Would an on-site pharmacy jeopardise the other pharmacies in Chesham eg Boots?
If they went it would be a disaster for the town. There are strict rules to be followed when deciding if and how a new pharmacy is allowed, designed to prevent that happening.
14. In a recent league table of the quality of health services around Europe, the UK came 17th. What is the PCT’s benchmark for the quality of the services which will be provided at Healthzone?
The critical factor is the population’s needs. We’re actually blazing a trail here, so there isn’t really a benchmark in existence. Lord Darzi, who is leading the Government’s review of health services, is now talking about bringing in polyclinics. This is exactly what Healthzone is.
15. Chesham is to have two children’s Centres. How closely is the PCT going to work with the children’s services on this?
We will work closely with Bucks County Council. Health visiting will be reintegrated back into primary care.
16. What happened to the £3 million proceeds of the sale of CheshamHospital?
It’s an NHS rule that the proceeds return to the Secretary of State. In any case it would not have been enough by itself. We will be spending a lot more per year to run the services in Healthzone than was ever spent in Chesham Hospital, so Chesham will get more back than was ‘taken away’.
17. Will there be a dental surgery in Healthzone?
It is hard to find an NHS dentist in Chesham. No, there won’t be a dentist in Healthzone. There is currently one dental practice in Chesham taking new patients. The PALS service will be happy to give details.
18. How will Healthzone link with Watermeadow Surgery?
The Healthzone will provide services for Watermeadow patients as well as for patients from outside the town. The PCT will encourage all GPs in Chesham to work together, as they will then be able to justify a wider range services.
19. How wide an area beyond Chesham will patients come from?
This will vary according to the specialism but in general from Amersham, Great MIssenden and perhaps the Chalfonts.
20. Will the Healthzone be financed by PCT money or by a PFI (Public Finance Initiative)?
It won’t be a PFI. The selected developer will raise private finance to build the centre and the PCT will pay for the use of the facilities.
21. Will the building be owned by the developer?
This is not yet decided. There are various options but the most likely is for the premises to be owned by the developer.
22. In that case, is there not a risk that at some future date a similar situation will apply as at AmershamHospital, ie where some of the space is no longer needed but still has to be paid for?
We are convinced that this will not happen, as primary care services will be needed for the foreseeable future. In any case, the contract, unlike a PFI deal, will have a break clause.
23. Isn’t it over optimistic to assume that you will be able to fund the running of Healthzone through savings to be made from patients not using hospital services?
It’s clear that there are huge savings to be made from reconfiguring services, but the funding of Healthzone is not dependent on releasing funds from hospital services.
24. Won’t this jeopardise the viability of WycombeHospital?
No. We see Buckinghamshire NHS Hospitals Trust as essential to health service provision in this area. They have financial challenges but there is still a lot they can do to improve efficiency, and modernise.
25. Why did you close Chesham Hospital before building the new facility?
Health services are rapidly getting more specialised and the old hospital would never have coped with modern circumstances. We should look forward rather than to look to the past.
26. Your plans seem very nebulous.
That is because this is only the first meeting. We want to engage with you, the local people, about what services you want to see provided.
27. Why have you stated that the Healthzone will help recruit and retain staff?
Because the environment and facilities will be much better than at present. Also because the staff teams will be bigger which has a number of benefits including facilitating more flexible working patterns.
28. Do you need to get Strategic Health Authority approval?
No. By doing it in the way we are now proposing we will have much more control over it ourselves.
29. What will the Healthzone look like?
We want a high quality building which is sympathetic to the nature of the town. However, there won’t be a lot of spare cash to spend on the appearance.
30. Bucks Association for the Blind was consulted over the design of AmershamHospital but its comments were ignored. Can we assume this won’t happen again?
Yes, you can be assured we will listen and incorporate your comments to make the building as accessible as possible to the visually impaired.
31. What are the main benefits for the GPs?
We’ll be able to provide more services than at present – we have fallen slightly behind on developments in primary care provision because of our limited premises. For patients it will mean not only new services but also easier access and a much more modern and appropriate environment.
32. Why are you calling it Healthzone and not Health Centre?
Health Centre has a specific meaning in the NHS: a PCT-provided facility etc. This is a completely new concept and the term Healthzone is just a first attempt at conveying that newness.
33. Regarding disabled access, will wheelchair users be consulted during the design stage?
Yes we will make sure we do so.
34. The recent PCT paper says that your aim is to pool resources with the Local Authority. Will you work with Bucks County Council to ensure a truly whole system approach?
The paper you mention referred to revenue funding. The situation is more complex where capital funds are concerned. However, we will certainly work closely with all our local authority partners in the realisation of this project.
Questions raised at our public meeting on 26 June 2008
Questions raised at our public meeting on 17 October 2007
1. What is the difference between the Healthzone and a polyclinic?
We need to distinguish between the concept of polyclinics and GP led health centres. Healthzone will not be a polyclinic in the way the term is used in this country. Healthzone is a development in which two existing primary care practices come together on the same site with the addition of some PCT-led services. It will be run by the existing GPs, not by a private provider or anything like that. It will, however, have some of the benefits of a polyclinic – for example, it will bring a range of services together in one accessible place. Healthcare professionals will be better able to work together and there will be economies of scale. In Buckinghamshire we are calling this concept a “Primary Care Hub”. The GP led health centres are a separate initiative aimed at extending access to primary care.
2. Can you guarantee that Water Meadow Surgery won’t be affected by the Healthzone and that you won’t be pressurising the GPs there to move into the Healthzone?
Yes, I can guarantee that. We certainly won’t be forcing anyone- and indeed, even if we wanted to we don’t have the power to do so.
3. Why is it called the Healthzone?
It was a provisional working title thought up right at the start of the original project some time ago. It might not stick!
4. I run one of the five community pharmacies in this area. What is the idea of the on-site pharmacy in the illustration? Will there definitely be a pharmacy?
These are only illustrative drawings and it is not definite that there will be a pharmacy on-site. If the PCT received an application to open a pharmacy on the site, we would have to consider the application in the normal way.
5. I agree that there should be a pharmacy there, but not in addition to the other five in the town, which would be jeopardised. Is there is scope for the existing pharmacies to work together on this?
The PCT has no discretion on this. If the local pharmacies want to apply, the PCT would have to consider it in the proper way.
6. Who owns the site?
Currently the PCT does. Brackley Investments will buy the site and lease the building to the doctors.
7. Can we have the Out of Hours service in the Healthzone instead of at Amersham?
We can’t say for sure but this is one of the ideas for additional services we need to consider. The service will go out to tender next year.
8. Please can you use local brick as much as possible?
We will consider that.
9. Why are there only five disabled spaces – there are bound to be more than that number of disabled people in the Healthzone at times?
We have included the number required by the Planning Authority who have a formula for calculating the requirement. However, we can look at it again.
10. How is the overall parking space requirement arrived at? Do you know how many staff and patients will be on site at any one time?
The total parking requirement is also laid down by the Planning Authority and is five spaces per consulting room.
11. We hope that the staff won’t take up too many of the spaces – that’s what happens at Amersham Hospital.
We do understand your concerns and will keep an eye on this.
12. Will there be an X-ray facility?
No. Modern imaging is very hi-tech and to make it feasible requires the numbers which are only found in a large hospital. But results can be sent over much more quickly nowadays.
13. Originally on our wish-list of services we had consultant outpatient clinics. At the last meeting it was made clear that consultants would now not be coming to Healthzone, yet now you are mentioning this again. What has changed?
Buckinghamshire Hospitals Trust policy has changed. We are now actively working to repair the gulf which had developed between primary and secondary care. We are not trying to replicate a hospital service here, but to provide what is appropriate. I have no doubt it will work.
14. 102 parking spaces would be OK as long as only people using the Healthzone park there. How will you stop other people abusing the parking?
Car park management is always a challenge but we are experienced in this and there are a number of methods. We are actively working on this.
15. Why are you proposing to build this in two stages – surely it is more expensive that way?
We are applying for planning permission for the whole scheme. We want to get the main part of the development working well before moving on to build the extra space. We don’t need all the space in the first phase as we won’t be able to organise all the services to use it that quickly.
16. Have you taken green issues into account in the design?
It is not possible to have a zero-carbon building. Solar powered cells are not feasible due to the huge amount which would be needed. Rainwater use is not safe in a healthcare building. However, this is a very green building as it has excellent insulation – the main problem will be to keep it cool in summer. The energy use will be far less than in the buildings it is replacing.
17. Why is there no pedestrian footway at the entrances?
On the contrary, there is a pedestrian footway at the southern entrance, as shown on the artist’s impression.
18. Traffic congestion is bad on Berkhamstead Road at rush hours. Can you stagger the working hours?
We are keen to have extended opening hours, so we will see what can be done regarding staggered hours of work.
19. Drainage is a major problem on Berkhamstead Road – what will you do about this?
All schemes will be built to the Highways Authority’s standards to ensure that surface water drainage is no worse than at present. It will have to be stored in an attenuation tank and discharged gradually into existing drainage pipes.
20. Considering you already have different levels on-site, why are you not proposing a twostorey car park?
There is not enough space as we would need to include ramps and planning would be a problem. Cost is also an issue.
21. What sort of factors could delay the project?
Very few. We have the site, we have outline planning permission and we have a developer with a good track record. The main risk might be a delay in getting full planning permission but that is outside our control.
22. Some time ago during the original project you asked the young people of the town which services they would like and they came and did a presentation. Will those results be used?
We will dig out the report and try and re-engage with the current young people.
23. Will there be pedestrian crossing on Berkhamstead Road near where the bus stops?
We will look at that.
24. How much notice do you have to give to the current tenants of the site?
The tenants have already been given the appropriate notice and the site will be vacated by December.
25. When do you expect to get full planning permission?
As most of the matters have already been approved under the outline permission, we would hope to get the final permission within the target time of eight weeks from submission. However we expect it to be more like 13 weeks.
26. How many workers and vehicles will there be during construction?
A lot! Sadly the work cannot be done without some disruption to the local area but we don’t think you should worry unduly.
27. What is the cost?
The building costs are £6 million, to be borne by Brackley but there are charges to be paid by the NHS every year throughout the period of the contract. We believe it’s a very costeffective deal for taxpayers while providing a high quality facility.
28. How viable is it for the practices to pay the rent?
Totally viable as the PCT funds the rent.
29. What security will be provided – this could be a vulnerable building out of hours.
All our design are run through the “Secure By Design” system which includes a vetting by the police. For example, it will incorporate anti-climb guttering.
30. Can patients be kept separate from goods deliveries?
The loading bay is located alongside the pharmacy at the side of the site as the bulk of the deliveries would be to the pharmacy. In addition there will be plenty of room for vehicles to unload next to the surgery, so there will be no problem with safety.
31. What will happen to the land and buildings in the future, if they are going to be signed over to an investment company?
The contract is for 30 years but we firmly believe that the Healthzone has a long term future as there will always be a need for a primary care facility.
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