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November 10, 2014

Filed under: Private Eye — Dr. Phil @ 4:18 pm


Subject: Chester situation email sent to local GP’s and CE of Chester Council by Dr O’Mahony

Date: 10 November 2014 12:54:15 GMT


Dear General Practice Colleagues


I have just seen this latest Public Health Update which has been issued to all practitioners and partners and feel I need to make some comment.


All of us in Sexual Health and HIV, running integrated services in the city of Chester and my colleagues in Leighton Hospital, Crewe, were totally shocked when the council initially awarded the contract to East Cheshire Trust in July 2014.


The joint bid between The Countess of Chester, Mid-Cheshire Trust (Leighton Hospital) and Body Positive had been put together by a very experienced team of 5 consultants in Sexual Health and HIV, along with procurement teams from both Trusts. This extensive clinical experience on the ground in Cheshire was used to create a comprehensive bid which would have given equity across Cheshire and improved the services in Mid-Cheshire to the current high standards of both Chester and Leighton.


In Chester, extensive consultation with local GPs had established that it would be best to move a significant portion, ie; all level 1, level 2 and a lot of level 3, into the specially designed Fountains complex which would have seen seamless working between General Practice and Sexual Health. This would have provided a perfect hub right in the city centre for Chester, leaving HIV at The Countess with some STD there and keeping the HIV and Sexual Health team intact.  The current innovations already at The Countess, ie; Telephonetics (web based results system which patient access 24 hours a day) and web based booking (already purchased) would have been introduced into the Mid-Cheshire clinics where they do not currently have such facilities. The council had indicated that £2.4M was the amount of money available.  It was therefore extraordinary that the council awarded the tender to East Cheshire Trust whose bid had been £2.8M, ie; £400,000 above the allocated sum.   It was also a surprise that there was no medical person whatsoever on the initial assessment panel.  Unlike every other tender submission we were involved in, there was no interview process.  This interview process is critical in differentiating bids prepared by a slick professional tender company from those prepared by real doctors working in the specialty.  A properly constructed panel at interview can easily establish from the shortlisted bidders whether the bid is fantasy or reality.  Not doing this is the equivalent of appointing a candidate to a post based totally on an uncorroborated CV with no interview and no references.  Indeed, the only full-time consultant they have in sexual health in East Cheshire Trust had no input into the bid.


Naturally, The Countess of Cheshire and Mid-Cheshire objected and the council were forced to re-run the tender process but the writing was on the wall.  If they were prepared to award the tender to East Cheshire at well above the amount of money available, it was inevitable that they would simply re-award it when East Cheshire re-submitted a sum equivalent to The Countess.  None of our exhortations and advice to the council to have a properly constructed panel was taken on board. The ‘new panel’ now had a GP with a  ‘special interest in sexual health’ (whatever that means) from outside the borough.  Can you imagine the council assessing a vascular tender and not having a consultant vascular surgeon on the panel and simply using a GP ‘with a specialist interest’?   This tender included level 3 services which involves managing complex STDs, genital skin problems and complex contraception – all level 3.


This inexplicable and illogical decision became even more bizarre when it was realised that the core of the East Cheshire Trust bid was to establish flexible units in Chester and Winsford. The technical term being used is ‘pods’ but the word ‘portakabin’ does spring to mind.  We had pleaded to the council to include the Fountains in the specification but they refused to do that. So here we have a magnificent, carefully designed floor at the Fountains which was at the heart of the Countess bid being left idle and instead, at vast expense, a pod is going to be put in, an as yet undetermined, location somewhere in Chester with water, sewage, electric, IT and fully equipped by the end of January 2015.


If this goes ahead, it will see the disintegration of the integrated service which local GPs and patients treasure. See attached spontaneous comment cards.  (Note: any comment with a ‘y’ beside it is where the patient gave mobile number and happy to be contacted to discuss their comment).


The total separation of sexual health from HIV will split the team which has worked together for 20 years and inevitably lead to reduced ability for partner notification, particularly in HIV and indeed an increase in late diagnosis2.


The Public Health Update also mentions that East Cheshire Trust “….has extensive experience of operating this type of service in the East Cheshire and in the Vale Royal area, and is excited to transfer some of this practice to West Cheshire….”  All of us working in sexual health in Cheshire and Merseyside are not aware of any novel, innovative or new practice in the Macclesfield area which we would wish to emulate.  Some more detail about what the current East Cheshire Trust service is doing which is so exciting would be of interest.


In summary, I am concerned at what has happened and fear a return to the portakabin culture which we struggled to shake off 20 years ago.  The main points which need addressing are:

East Cheshire bid prepared without any consultant input. CoCH and Mid-Cheshire had 5 experienced sexual health consultants with in-depth knowledge of the specialities and the localities

CoCH and Mid-Cheshire had at its core using the specially developed Fountains as the Chester hub. East Cheshire are proposing a pod (portakabin)

Initial assessment panel had no medical input whatsoever. Second panel had a GP with a special interest but remarkably no sexual health consultant

Initial East Cheshire bid was £400,000 above the stated price yet was still awarded the contractHaving been taken to task over the first bid, Chester council took the unusual step of refusing to have a standstill period after the second bid where legitimate complaint could have been madeI hope this clears up some of the background for this tender issue.

I had contacted Steve Robinson, Chief Executive of Chester City Council at  and if any of you have any views on this issue, I presume you can send them to him.


Dr Colm O’Mahony MD. FRCP. BSc. DIPVen. Consultant in Genitourinary & HIV  Appointments: 01244 363091

Integrated Contraception and Sexual Health Service Countess of Chester Foundation Trust Hospital, Liverpool Road, Chester.  CH2 1UL e-mail: Phone  01244 363097 Fax      01244 363095


Summary of comment cards from Sexual Health Dec 2013 to June 2014