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									                                                                               ITT Bidder Clarification Question Template
                                                                          Western Cheshire Primary Care Trust - Blacon Scheme

                                                                                                ALL BIDDERS


   ITT Reference
                    Date Query                                                                                                                                                                           Date Answer
   (e.g. Volume 2                                             Clarification Question                                                              Clarification Answer
                       Sent                                                                                                                                                                                  Sent
    Section 3.2)


1. GENERAL
                                 Do copies of national documents need to be provided as Annexes (i.e. policy,   A weblink or reference to national documents is sufficient
                                 guideance etc) or do we just need to provide a weblink/reference. We are aware
                                 that copies of locally developed policies and processes will be required


                                 Can you offer any advice in relation to compiling the Invitation to Tender         The specific areas to concentrate on will be local integration with key partners
                                 document?                                                                          as a key component and a clear understanding of the Health needs in Blacon,
                                                                                                                    together with performance management of staff and clinical supervision.


                                 How many patients will form a registered list?                                     Approximately 200
                                 Will home visits be required?                                                      Home visits are only required for registered patients

                                 Is there an access issue?                                                          We are looking to improve access in accordance with patient demand.
                                                                                                                    Currently statistics demonstrate that there is an overall 86% satisfaction with
                                                                                                                    access to primary care. This will be monitored in relation to the GP Led Health
                                                                                                                    centre, in accordance with performance standards.
                                 We will be writing formally to request an extension for the Submission to the ITT. Western Cheshire Primary Care Trust have now agreed that a new date of 6th
                                                                                                                    October 2008 will be the revised deadline for submitting the Invitation to Tender.




2. PCT SCHEME OVERVIEW
                                 Is there a GP led health centre with registrable patients                          We are expecting the GP-led health centre to register only specified hard-to
                                                                                                                    reach patients i.e. new migrants to the UK (who are not currently registered with
                                                                                                                    a GP practice), Those living in hostels, YMCA and Bail facilities; Ex-offenders
                                                                                                                    within the specified boundary
                                 Does Contractor PDP support mean supporting with GP appraisals?                    This refers to personal development planning for all clinical and non-clinical
                                                                                                                    staff. All GPs will be expected to be part of the PCT GP appraisal process

                                 Does there need to be GP cover available 8 am to 8 pm                              Yes
                                 Can the walk in centre be Nurse led ?                                              No - it has to be GP-led.
                                 This section states that the projected number of walk-in patients are not
                                 guarantees of volume. It also states that the Provider will be renumerated
                                 during the term of the contract on the basis of actual average number of
                                 patients for each contract year.
                                 1. Does this mean that the actual number of patients attending the walk-in           Yes
                                 centre will be used to calculate the payment (i.e. the number of patient visits), or

                                 2. Does it mean if 7,200 patients have visited the walk-in centre over 12 months,
                                 but that as the start point was 0 the average is 3,600 patients and the payment No
                                 will be for 3,600 patients.
                                 3. Does it refer to registered and non-registered patients
                                                                                                                    Yes
                                 4. Does it refer to the number of non-registered patients who become registered The payment is based on usage of the walk-in centre, whether patients are
                                 at the walk-in centre                                                           registered or nonregistered.

3. CLINICAL
ITT Reference
                 Date Query                                                                                                                                                                                Date Answer
(e.g. Volume 2                                              Clarification Question                                                                Clarification Answer
                    Sent                                                                                                                                                                                       Sent
 Section 3.2)

                              Please clarify which patients the Quality and Outcomes Framework is to be            The Primary Care Trust expects to work with the successful bidder to develop
                              applied to and when these indicators have to be developed by . If this is to         and agree which of the Quality and Outcome Framework indicators are relevant
                              registered patients only there may be very small numbers of these patients (in       to the populations being served by this contract, with a particular focus on the
                              view of the narrow registering criteria). In addition Generating 50 or more          organisational domains acting as minimum standards. As noted due to the small
                              quality indicators and their evidence base in a short period of time is felt to be   number of registered patients, many of the clinical indicators will not be
                              not achievable under current national processes - at a national level 3-4            relevant.
                              indicators take around 12 months to develop.
                                                                                                                   Within the tender, bidders are expected to indicate their willingness to work with
                                                                                                                   the PCT to this end.

                              There is a requirement not to exceed the budget for prescribing - how will a The prescribing budget will be developed with the successful tenderer prior to
                              prescribing budget be allocated accurately to take account of there being little or commencement of the contract with scope for adjustment following the first
                              no registered list and minimal repeat prescribing.                                  year. It will largely be based on the demands from the walk-in centre

                              Scriptswitch is currently provided and funded by the PCT to all practices Yes
                              (prescribing support software which reduces costs/increases safety/quality). Will
                              this also be provided and funded for the clinic

                              Section 3a requires us to submit number of bookable, non bookable and       We are expecting the Bidder to provide what they feel is an appropriate
                              emergency appointments per 1000 patients per week offered. Does the Primary breakdown.
                              Care Trust have a baseline or target for this?

                              Section 3c - The requirement is for bidders to describe how they will supply non- Yes the Primary Care Trust will be able to support the provider on this.
                              speaking patients with professional translation services during all clinical
                              consultation and translated materials describing procedures and clinical
                              prognosis. Is the Primary Care Trust able to support the provider on this?


                              What would be the minimum requirements for offering translation services e.g.        Language line will be available
                              language line:
                              QOF Indicators. Will Bidders be expected to provide an evidence base for each The focus of QOF will be on the organisational indicators which we expect the
                              indicator listed?                                                             Provider to use as minimum standards, along with those clinical indicators that
                                                                                                            are relevant to the service specification.
                              Please clarify QOF indicators                                                        Please refer to above



                              When will the additional indicators included in QOF be made available to the         The Provider is ot expected to report on QMAS. The focus for quality
                              Bidder/Provider? What will be the reporting requirements and will these be           performance monitoring is on the quality schedule which will be reported on a
                              annually based with QOF or more frequent?                                            quarterly basis. The will be reviewed on an annual basis.
                              We note the requirement for the service to be provided by competent and              No this is the Providers responsibility
                              experienced advisors/counsellors etc. Will the Primary Care Trust offer training
                              to accredit and approve the Providers staff?

                              Will the Primary Care Trust provide stop smoking advisors?                           No this would be the responsibility of the successful bidder.



                              How will Western Cheshire Primary Care Trust set the budget?                         The budget will be developed and based on prescribing largely within the Walk
                                                                                                                   in Centre in the first year. Performance will be monitored as the prescribing
                                                                                                                   evolves. In the first instance it is anticipated that prescribing will be reviewed in
                                                                                                                   the context of effectiveness and in accordance with the prescribing guidelines.
   ITT Reference
                    Date Query                                                                                                                                                                               Date Answer
   (e.g. Volume 2                                              Clarification Question                                                                Clarification Answer
                       Sent                                                                                                                                                                                      Sent
    Section 3.2)

                                                                                                                   The PCT expects the Service Provider to aspire to achieve the exemplary
                                 1. Evidence that GPs are working to “exemplary standard” in 1 area as defined standard at all times. However we recognise that this might not always be
                                 in the document Good Medical Practice For General Practitioners; The Royal        possible so we require evidence for each employed GP that they have attained
                                 College of GPs 2008. Timescale: Within contract year. Does this mean that         "exemplary standard" in one of the 21 subsections of the guide.
                                 we will show evidence, for each employed GP, that they have attained
                                 “exemplary standard” in the whole of one of the seven sections of the guide, or
                                 in one of the 21 subsections. Alternatively, does it mean that we will provide
                                 evidence that the entire body of GP’s working in the Health Centre have
                                 collectively attained “exemplary standard” in one of the sections or subsections?

                                 2. Evidence/assurance of working to level 1 of NHS Litigation Authority               in terms of working to the levels of NHSLA standards, the PCT included this
                                 Standards. Timescale: Within contract year. Standards only appear to apply to         indicator as it provided some clear guidance around policies which would
                                 Acute Trusts and PCTs (and some other authorities) but none are specifically          demonstrate that the Provider had good risk management processess. The
                                 geared for General Practices, Walk-in Centres and Health Centres. How are we          NHSLA standards are indicators for the Standards for Better Health and would
                                 to apply these standards?                                                             therefore assist in demonstrating compliance. There is a specific link for GPs
                                                                                                                       within the the NHSLA standards around communication of Family Services
                                                                                                                       Forum of the NHSLA. This was not about achieving the accreditation it was
                                                                                                                       around demonstrating that the Provider is working to the levels - having the
                                                                                                                       policies which set the standard, implementing the policies etc., and monitoring
                                                                                                                       effectiveness of systems and processes.




4. WORKFORCE
                                 Occupational Health. Does Western Cheshire Primary Care Trust offer an                This would not be provided by the Primary Care Trust. If the Provider secures
                                 occupational health service that the Provider could utilise? If the Provider is to    their own service they would be able to offer this to other services.
                                 ensure it has its own internal service, will there be an opportunity for this to be
                                 commissioned to others?

                                 We note the requirements for the Provider to provide a CPD for independent            These will be developed following contract signature.
                                 contractors. The service standards and number of sessions to be provided are
                                 to be negotiated with the Provider. When will all these standards be made
                                 available with regard to the sessions provided? Will the bidder need to take into
                                 consideration reimbursement/payment to attendees and provide practice cover
                                 whilst these events are taking place?

                                 Can you please clarify the educational element of the service?                        There are two levels of education. One being a purely administration role for
                                                                                                                       the currently provided quarterly half days. The second being to provide a range
                                                                                                                       of training options for additional clinical training for independent contractors as
                                                                                                                       deemed appropriate and necessary. This additional training will require
                                                                                                                       administration, including locating venues and speakers; the costs need to
                                                                                                                       incorporate everything.



5. IM&T
                                 If a different building specification is agreed would there be increased funding for Funding will be geared to the final specification for the building, including IM&T
                                 additional IT (??and other areas) eg if more consulting rooms/ greater admin         provision. The Provider will have an opportunity to contribute to the building
                                 office facilities are provided, then more terminals will be required..               specification and hence agree with the PCT the final requirements for the
                                                                                                                      accommodation, infrastructure and equipment.
                                 Within the Invitation to Tender, we note that the Provider is identified as           No, the Primary Care Trust will provide all necessary approved IT equipment
                                 providing PC's, printers, scanners, telephony equipment. Please can we have           for service delivery.
                                 clarification of this? Are we right to assume that the purchase of this equipment
                                 is the responsibility of the Provider?
                                 Can you provide us with a list of IT Licences, software and IT hardware that will     Yes, a list of software with version numbers, hardware another IT equipment will
                                 be provided by the Primary Care Trust?                                                be provided to the bidders by Western Cheshire Primary Care Trust next week.
ITT Reference
                 Date Query                                                                                                                                                                                      Date Answer
(e.g. Volume 2                                             Clarification Question                                                           Clarification Answer
                    Sent                                                                                                                                                                                             Sent
 Section 3.2)

                              Will Cheshire ICT test the systems and software and how ill the testing be      Cheshire ICT will test the systems and software. We will work in partnership
                              carried out?                                                                    with the provider for this. The PCT will organise this with the successful bidder.


                              How will disaster recovery be managed?                                          There is a system back-up process via the GP soc agreement. This will be the
                                                                                                              responsibility of the Primary Care Trust. However bidders will need to
                                                                                                              demonstrate within the Invitation to Tender what contingencies they will have in
                                                                                                              place, i.e. paper work etc.
                              Please clarify how clinical systems will link to other systems?                 Front end clinical systems will need to interface with other third party health
                                                                                                              care systems.



                              The following question was asked at the bidder clarification meeting - Q: Can
                              you provide a list of the IT equipment and software that WCPCT will be
                              providing?

                              The response from the panel was A: Yes a list of software with version numbers, Attached is the specification the PCT adhears to under GPSoC. This is broken
                              hardware and other IT equipment will be provided to the bidders by WCPCT down to core and additional components. E.g of core components are PC's,
                              early next week. Please could you advise when this will be available?           printers, network, N3 connection,scanner, AV, Clinical system & licences. The
                                                                                                              following software will be provided:

                                                                                                              Windows
                                                                                                              MS Windows (Including outlook)
                                                                                                              Clinical System
                                                                                                              Document Management
                                                                                                              Anti Virus
                                                                                                              Basic




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  ITT Reference
                   Date Query                                                                                                                                                                          Date Answer
  (e.g. Volume 2                                             Clarification Question                                                              Clarification Answer
                      Sent                                                                                                                                                                                 Sent
   Section 3.2)

6. PREMISES
                                This section states "Western Cheshire Primary Care Trust will identify interim Statement confirmed.
                                premises to be made available to the Provider from the Commencement Date
                                until relocation to the Final PCT Identified Premises."


                                1. As no premises have currently been identified is it acceptable to include a Bidders should provide evidence of their approach to premises standards and
                                separately identified contingency amount to be used to bring premises up to the specifications. Financial data is not applicable to this question.
                                required standards?

                                2. As no premises have been identified by Western Cheshire Primary Care Trust Bidders should confirm that they will undertake works/provide details if this is
                                as yet it is not possible to say whether or not work to the Premises will be required.
                                required prior to occupation - please clarify whether this is an acceptable
                                response and if not, what an acceptable response is.

                                3. Similarly if interim Premised have not yet been identified and it is therefore Bidders should provide evidence of their approach/capabilities/capacity in these
                                not possible to say whether work will be undertaked prior to occupation, and areas should any works be required.
                                therefore not pot possible to provide a desciption,rationale, capability and fixed
                                costs, what is an acceptable response to this question.


                                4. As no premises have currently been identified, and if for some reason it is not The warrant statement will apply to any works the Bidder may undertake.
                                possible for Western Cheshire Primary Care Trust to identify interim premises by
                                the Commencement Date or before, how does this affect this warrant?


                                1. Will the lease be co-terminous with the contract and 2. Will any liability 1. Yes - see the Contract Schedule 6 Annex 1 - Heads of Terms 'Lease Term'.
                                associated with the sub underlease reamin after contract termination?         2. Liabilities may remain in accordance with the lease covenants.

                                This section states "At the final PCT Identified Premises, it is anticipated that Th GP Practice partners for whom part of the new integrated resource centre
                                GPs will hold a 21 year head lease of the whole health centre with the head will be the practice premises approved for reimbursement under the NHS
                                landlord, the Western Cheshire Primary Care Trust will take a 21 year under (General Medical Services - Premises Costs)(England) Directions 2004.
                                lease of part of the health centre from the GPs and the Provider will be required
                                to enter into a 5 year sub underlease for part of the PCT leased premises with
                                Western Cheshire Primary Care Trust." Which GPs is the preceeding sentence
                                referring to?
                                With reference to the costs of heating, lighting water, cleaning, repairs and Described in Volume 2 Section 6.2 and Contract Schedule 6 Annex 1 - Heads
                                decoration, including lift and boiler servicing, etc etc. can you provide information of Terms.
                                on what the likely interim and final solutions will look like in sufficient detail for
                                these to be quantified?
                                As the 'New Build' is scheduled to be available for end 2010 and the Primary The Primary Care Trust will provide an interim solution, all relocation costs etc
                                Care Trust will identify interim premises to be made available from will be regarded as pass through costs, this will be funded by the Primary Care
                                commencement date until relocation. What provision will be made by the Primary Trust.
                                Care Trust to facilitate this transfer and support the provider with the same?
                                Does the Provider need to factor costs in for the removal of service provision
                                from one site to another, disruption to services, contingencies etc?


                                Western Cheshire Primary Care Trust have declared that there are a number of Western Cheshire Primary Care Trust have declared that there are a number of
                                options under consideration in the context of a temporary solution. What sort of options under consideration. For the temporary building solution, these include
                                building will this be and will this interim solution take account of the services to modular build etc. The accommodation will take into account consideration
                                be provided?                                                                         suitability for the services to be provided and accessibility. The successful
                                                                                                                     bidder will be involved in both the temporary and permanent solution during the
                                                                                                                     refining stage. They will also be invited to attend project meetings.

                                Is there a Primary Care Trust run GP Practice in the area?                         There isn't a Primary Care Trust run Practice in the area. There are other GP
                                                                                                                   Practices with competing interests within the locality.
  ITT Reference
                   Date Query                                                                                                                                                                                Date Answer
  (e.g. Volume 2                                             Clarification Question                                                                 Clarification Answer
                      Sent                                                                                                                                                                                       Sent
   Section 3.2)

                                Is this best location for a GP Led Health Centre?                                     There is currently a surgery at Western Avenue and a branch surgery operating
                                                                                                                      from Blacon Clinic: The Elms Medical Centre. However many Blacon residents
                                                                                                                      are registered with practices with Practices across Chester. There is a
                                                                                                                      requirement to address inappropriate usage of acute care and it is anticipated
                                                                                                                      that there will be a market shift from the Accident Unit, based a short distance
                                                                                                                      away to the GP Led Health Centre for this.

                                The pass through costs listed in the financial model are computer maintenance         The PCT will pay for all utility costs and licenses but there is an expectation that
                                and central hardware infrastructure, rent/rates, bidder supplied premises.            the provider will observe any reasonable energy efficient measure, e.g. ensure
                                Please clarify whether or not this includes heat, light, power, water, and business   lights are switched off when rooms are unoccupied and heating use is
                                rates. Is it correct to assume that the rent referred to equates to the lease cost?   effectively managed.
                                If the PCT holds any licences for software to be used on the IT harware at the
                                Premises, who will pay for these licenses and if it is the bidder, please provide a
                                cost

                                If samples are taken laboratory tests how will these be charged and paid for?         These will be paid for through the existing contracts the PCT has with other
                                                                                                                      providers
                                Is there a transport run from the Health Centre to the COCH and can this be Transport arrangements will need to be established with the acute Trust but the
                                used to transport samples - if so what with this be recharged to the bidder costs for this will be picked up by the PCT


                                There is some ambiguity in Vol. 2 of the tender document. The table in 5.3 The bidder should assume that the table included in Cl. 5.4 is correct, i.e. the
                                disagrees with the table in 5.4 on 2 main points. One states that the hardware PCT will provideall IT hardware and GP Clinical System of Training and related
                                will by purchased by the PCT and the other states it will be purchased by the support.
                                provider. The other ambiguity is GP Clinical system training which follows the
                                same pattern as above. Please could you clarify the correct position


                                A 5 year sub underlease for the Final PCT Identified Premises, is not At the final PCT Identified Premises, it is anticipated that GPs will hold a 21 year
                                appropriate for a 5 year Contract                                     head lease of the whole health centre with the head landlord, the Western
                                                                                                                      Cheshire Primary Care Trust will take a 21 year under lease of part of the health
                                                                                                                      centre from the GPs and the Provider will be required to enter into a sub
                                                                                                                      underlease for part of the PCT leased premises with Western Cheshire Primary
                                                                                                                      Care Trust.

                                The Provider must provide a list of Equipment to be included in Schedule 6 All Equipment will be provided by the PCT therfore Annex 3 does not apply.
                                Annex 3 - Annex 3 has not been provided with the ITT documents             However, Annex 2 (List of Equipment to be Provided by the PCT), should be
                                                                                                           completed by the Provider and will be used as the basis to agree the final
                                                                                                           schedule of Equipment required by the Provider but supplied by the PCT for the
                                                                                                           purpose of completing the Financial Model Template. Annex 2 is attached to
                                                                                                           this Clarification Question Response for this purpose.




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8. EQUIPMENT




9. COMMERCIAL AND FINANCIAL
ITT Reference
                 Date Query                                                                                                                                                                           Date Answer
(e.g. Volume 2                                               Clarification Question                                                            Clarification Answer
                    Sent                                                                                                                                                                                  Sent
 Section 3.2)

                              Is there a minimum income guarantee?                                               No - not at this stage (Note:the PCT have confirmed that a Minimimum
                                                                                                                 Income Guarantee is acceptable but the details will have to be agreed and
                                                                                                                 will be subject to negotiation around how the bidder intends to attract
                                                                                                                 patients).

                              Will they consider a proposal which stipulates a minimum income guarantee?         The PCT have indicated that they are prepared to negotiate in the context of
                                                                                                                 how the bidder intends to attract patients, i.e. marketing strategy, etc. It is
                                                                                                                 suggested that at this stage the bidder submits an alternative proposal for
                                                                                                                 consideration IN ADDITION to a fully compliant bid.
                              Payment Caps. We note that if the number of patients in any month reached the This is included as part of the payment mechanism and both parties would need
                              projected month end number , the provider will not accept any new patients until to review the situation if the maximum was achieved.
                              they have received written approval to do so from Western Cheshire Primary
                              Care Trust. Can Western Cheshire Primary Care Trust advise on the process
                              that will be required and the time allocated for this? We can foresee issues with
                              being unable to accept/treat patients if any delays. Would there be an indicator
                              when the Provider could give the Primary Care Trust advance warning and get
                              approval prior to reaching the projected month quota?



                              In relation to the minimum guarantee - are the numbers/volumes based on a          In relation to the minimum guarantee, the numbers/volumes are based on a
                              comparable catchment area and what is the evidence for these figures?              comparable Walk in Centre and the ramp up process will be over 3 years. We
                                                                                                                 have taken into account new service and temporary accommodation. It was
                                                                                                                 agreed that Western Cheshire Primary Care Trust will share their evidence for
                                                                                                                 volumes next week.

                              Will the Primary Care Trust consider a minimum guarantee return to the             The Primary Care Trust have indicated that they are prepared to negotiate in
                              Provider?                                                                          the context of how bidders will attract patients through their Marketing Strategy
                                                                                                                 and local integration.
                              How will payments for registered patients work?                                    These payments will be incorporated within other payments. There will be a
                                                                                                                 separate payment.

                              Can the Primary Care Trust advise on how the projection of the Walk - in Centre The projection of Walk-in patients has been determined based on local and
                              has been determined?                                                            National Centres and comparability with other Primary Care Trusts and
                                                                                                              consideration of how these figures have been ramped up.

                              Could you please clarify the KPI set for complaints                                The KPI for complaints will be rectified and performance targets will be
                                                                                                                 reviewed.
                              Is there flexibility for the Provider to build their own KPI's?                    KPI's will be negotiated and it is expected that they will continually evolve
                                                                                                                 throughout the contract lifecycle.

                              How confident are Western Cheshire Primary Care Trust regarding the KPI on         This is a strategic driven commissioning intention. Western Cheshire Primary
                              1000 brief interventions on alcohol? There is a concern regarding widget driven    Care Trust does wish to reach out and pull people in. KPI's are subject to
                              care rather than nurturing care.                                                   negotiation.

                              Could Western Cheshire Primary Care Trust elaborate on their financial ceiling     Nationally not all procurements are setting a financial ceiling and are not
                              for the purposes of evaluating their bids?                                         indicating to bidders if there is a ceiling. Western Cheshire Primary Care Trust
                                                                                                                 are deciding on best value. They will assess bids on value for money and
                                                                                                                 against their own ceiling. If a bid is well above the Western Cheshire Primary
                                                                                                                 Care Trust financial threshold, it will not be considered further.


                              Can Western Cheshire Primary Care Trust confirm that this contract is viable, if   Yes the contract is viable. We see this as a servicing contract and it is not paid
                              offering services to migrants/hard to reach patients?                              on the basis of how many patients are registered.

                              Can you please clarify the 5 year lease arrangement?                               There will be an end date and termination clauses will be linked to the end date
                                                                                                                 of the contract.

                              Please clarify the arrangement for a 21 year lease by GP's who are the             Western Avenue Medical Centre is the expected GP practice for this lease.
                              anticipated GP's?
  ITT Reference
                   Date Query                                                                                                                                                                                     Date Answer
  (e.g. Volume 2                                                Clarification Question                                                            Clarification Answer
                      Sent                                                                                                                                                                                            Sent
   Section 3.2)

                                Can you please clarify why there is a mismatch between Schedule 2 and the          Annex 3 was taken out of this section , as it is a list to be completed by the
                                contract in the context of missing annex 3?                                        bidder of Provider supplied equipment and it is our responsibility now for
                                                                                                                   supplying all equipment. In response to question 8a of volume 2, it will be more
                                                                                                                   appropriate for the bidders to provide a list of equipment (necessary to carry out
                                                                                                                   the services). Any changes to the contract will be approved by solicitors and re-
                                                                                                                   issued in due course.
                                How will the acceptance of contracts be managed in view of any conflicts?          The successful bidder will be expected to accept the contract in principal,
                                                                                                                   subject to negotiation.
                                If the bidder has a subcontractor. If the contract is not final and has not been   It will be acceptable to have a signed off contract with detailed SLA's for
                                signed off at the Invitation to Tender stage. Is this acceptable?                  services to be agreed at a later stage, once details of the main contract are
                                                                                                                   defined and reasonable and end dates are established between bidder and
                                                                                                                   subcontractor.
                                What is the quarterly tariff?                                                      The bidder will need to provide a tariff.



10. CONTRACT MANAGEMENT
                                Will there be buy-in from other Service Providers, has Western Cheshire Primary Western Cheshire Primary Care Trust is reliant on the bidder integrating with
                                Care Trust got buy-in from the Countess of Chester Hospital, Accident and       the local health economy. This will be taken into account within the Primary
                                Emergency Department                                                            Care Trust Strategy.

                                KPI Performance Summary                                                            The PCT have revised Schedule 7, Annex 1 of ITT Vol. 3 (KPI Performance
                                                                                                                   Summary). The revised KPI Performance Summary is attached to this
                                                                                                                   Clarification Question Response and should be used t by the Bidder in the
                                                                                                                   response to the ITT



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