It鈥檚 a customised cure for the ills of new-build health projects. And trials show it works. But too few NHS trusts are taking the medicine.

ProCure 21. It shortens waiting times. You get more for your money. And everybody feels a lot better having used it.

One year on from its national roll-out, this wonder drug is taking effect at NHS Trusts around the country. But there鈥檚 now a fear that the prescription might be withdrawn before it can have its full effect. The government announced in August that it was abolishing the NHS Estates, although no timetable has been set. The official line is that all its activities will be redistributed, but the whole organisation is now undergoing a three-month review.

NHS Estates first announced ProCure 21, to be used on projects over 拢1m, in April 2000. It selected five framework contractors or Principle Supply Chain Partners (PSCPs) for a pilot in the North West and the Midlands in April 2002. Led by main contractors, the PSCPs had to come to the table with their key suppliers 鈥 designers, architects, and in some cases specialist contractors 鈥 attached. The pilot was to run for four years with an estimated 拢300m-worth of projects.

The estimate fell well short. In the first year 拢600m-worth of work came out of the two regions. The pilot was cut short, due to its success said NHS Estates, and in September 2003 the NHS announced the 12 successful PSCPs which had won the five-year framework deals.

Since the pilot started in 2002, 拢1.87bn-worth of projects have been registered under ProCure 21, according to its website. 166 schemes are active with 30 on site. Five projects have now been completed.

It鈥檚 early days to talk about trends, says Peter Woolliscroft, who heads up the P21 team at NHS Estates, but ProCure 21 is already showing some positive results. The most obvious success is the reduction in procurement time. Because Trusts don鈥檛 have to go through the lengthy process of advertising the project in OJEC and selecting a partner through competitive tendering, a year is slashed from the programme (see 鈥楪etting selected the P21 way鈥, below).

The second positive result for NHS Estates is satisfied clients, says Woolliscroft. What do they like about it? John Loughlin, project director for a 拢10m mental health scheme for Cheshire and Wirral Partnership Trust, who has been involved in traditional build projects, finds the open way of working much better. He knows what鈥檚 going on and can contribute to decision-making.

Early involvement is generally a benefit for the contractors, says Chris Goss, framework manager for IHP. 鈥淚t can make the predictability side a hell of a lot better and help the trust manage some of the risks out.鈥 And it鈥檚 a boon for specialist contractors when it comes to resource planning, says Barry Hyam, ProCure 21 framework director for Haden Young. The M&E contractor is part of the supply chain for no less than six PSCPs and working on 11 ProCure 21 jobs.

Loughlin says ProCure 21 helps team members trust each other. He鈥檚 now on his second. 鈥淲hen we were talking about the brickwork, I knew that they had gone to the ends of the earth to investigate which one was best, so we would be using them on the next job. It was the same thing with the roofing.鈥

Repeat business is what really makes P21 an attractive proposition for contractors and their supply chains. PSCPs sign up with a Trust for the first project and will work with the trust on subsequent ones. This is where the PSCPs and their supply chain may start to see decent returns on the investment made to get into the P21 process. This is starting to happen, but pay-back could be a few years down the line yet.

Despite the positive messages, there is one problem with ProCure 21 to date: not enough trusts are using it. The PSCPs were promised between 拢1.4bn and 拢1.8bn in the first year of the national roll-out. Although there鈥檚 拢1.8bn schemes registered with NHS Estates, only 拢1.4bn has been let to the PSCPs and 拢600m of that comes from the pilot. In other words, 拢800m worth of new projects has come on stream.

All the PSCPs, even those at the top of the heap, have capacity to do more work. Ian Lawson, chairman of Kier Health, which is working on 11 projects, the most of any non-pilot PSCP says: 鈥淲e would like to see more work coming through the P21 route. There is still work coming through the traditional route. We hope that the government might be able to ensure Trusts use P21 for more schemes, to somehow make it mandatory.鈥 Lawson points out that ProCure 21 was made mandatory for Trusts in the pilot phase.

Passing the medical

There is a second challenge for some of the PSCPs: getting selected. PSCPs who were on the pilot have the advantage of a P21 track-record. You need that track record, with the right team of people and in particular the right project manager with the right experience and personality and a certain je ne sais quoi, because the final selection hangs on a one-hour interview.

鈥淚t鈥檚 not about your ability to lay bricks.

We are working in a confidence business,鈥 says Woolliscroft.

He holds 鈥榤eet the PSCP鈥 days for virgin Trusts who have yet to procure buildings to try and instill confidence in framework contractors without a track record in P21. 鈥淧otential clients can mix with the contractors and make sure that they haven鈥檛 got cloven hooves and horns,鈥 he quips.

But contractors have to learn lessons about charm, Woolliscroft says: 鈥淚f you cannot train charismatic, good-looking, well-spoken people to be construction people, get out of the business. It may sound trite but that鈥檚 exactly what it needs.鈥

So does Ray O鈥橰ourke employ particularly charming people? Laing O鈥橰ourke has won over one-third by value of projects to date. What鈥檚 the company鈥檚 secret? Laing O鈥橰ourke, as is often the case, wouldn鈥檛 comment. But others agree that the secret is preparation.

IHP鈥檚 Chris Goss says 鈥淩ay O鈥橰ourke does not do anything lightly. If you have got enough money in the kitty, you can put some time into developing your guys, getting those who are not natural presenters polished up. They are going for it.鈥

So what鈥檚 the prognosis for ProCure 21? Will it survive the dissolution of NHS Estates? Everyone talks it up because they have invested so much into getting it off the ground. Goss says: 鈥淭here is some evidence that things are happening, and happening quicker which is exactly what the government wants. I would be surprised if they said 鈥榟alt鈥.

鈥淚t鈥檚 getting more accepted by the trusts. I can鈥檛 believe we are going back to the bad old days.鈥

Getting selected the P21 way

1. If an NHS Trust is looking to procure a construction project worth over 拢1m and is interested in using ProCure 21, it contacts Peter Woolliscroft鈥檚 ProCure 21 team within NHS Estates.

2. One of seven regional members of Woolliscroft鈥檚 team meet with the Trust, trains them in ProCure 21 as necessary and helps them compile the selection criteria for the shortlist.

3. The Trust sends a pack and selection criteria to the 12 framework contractors or Principle Supply Chain Partners (PSCPs), appointed by NHS Estates 12 months ago after a rigorous selection procedure.

4. Interested PSCPs have one week to submit an expression of interest explaining how they meet the selection criteria.

5. The Trust shortlists between two and four PSCPs and invites them to an open day.

6. The PSCPs are invited to a one-hour interview, after which the Trusts decide who they want to appoint. From stage 3 to now can take as little as three days, but the recommended period is three weeks.

7. The Trust with the PSCP and its designers start working together towards a Guaranteed Maximum Price.
www.nhs-procure21.gov.uk

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