agenda - sutton ccg · 2018. 1. 8. · brearley 02 4. matters arising to review any matters arising...

SUTTON CLINICAL COMMISSIONING GROUP

PRIMARY CARE COMMISSIONING COMMITTEE

Wednesday 10 January 2018, 11:00am-1:00pm

Meeting Room 1, Priory Crescent, Cheam, Sutton SM3 8LR

AGENDA Chair: Sally Brearley

Report Author Presented by ENC

WELCOME & INTRODUCTIONS

1. Welcome & Apologies for Absence

Sally

Brearley

2. Register of Declared Interests

Primary Care Committee members are asked to

declare if their entry upon the Register of Declared

Interests (attached) is not a full, accurate and current

statement of any interests held

Jane Walker Sally

Brearley 01

3. Minutes of previous meeting

To approve the minutes of the Sutton Clinical

Commissioning Group Primary Care Commissioning

Committee meeting held on 1 November 2017

Jane Walker Sally

Brearley 02

4. Matters Arising

To review any matters arising and the action log

following the meeting held on 1 November 2017

Jane Walker Sally

Brearley 03

FOR APPROVAL

5. Primary Care Strategy Sian Hopkinson 04

6. Old Court House Development Business Case Lou Naidu 05

7. Well Court and James O’Riordan Practice Merger Business Case

Sian Hopkinson 06

FOR DISCUSSION

8. Community Education Providers Network Annual Review 2017/18

India Peach /

Carolyn Reynolds 07

9. General Practice Nursing 10 Action Points Plan Karol Selvey 08

10. Primary Care Finance Report Geoff Price 09

11. Primary Care Risk Register Chux

Ebenezer

(NELCSU)

Carolyn

Reynolds

10

FOR RATIFICATION

12. Contract Variation – Bishopsford Road Surgery Carolyn

Reynolds William

Cunningham

-Davis

11

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FOR NOTE

13. PMS Contract update William Cunningham-Davis Verbal

14. Primary Care Operational Management Group

Report

Carolyn Reynolds 13

15. Primary Care Transformation update Lou Naidu 14

16. Forward Plan Sian Hopkinson 15

FOR INFORMATION

17. Questions from the Public Members of the public can submit questions relating to the

agenda if raised with the Chair 48 hours prior to the

meeting. The Chair will make every effort to ensure

questions are responded to at the meeting however there

may be occasions where time constraints preclude this. If

a question cannot be answered at the meeting, or a fuller

response is required, a written reply will be sent as soon

as possible.

Sally Brearley

ANY OTHER BUSINESS & CLOSE

18. Any Other Business

19. Meeting Close

20. Date of Next Meeting

The next meeting of the Primary Care Commissioning

Committee in public will take place on Wednesday 7

March 2018, 11:00am-1:30pm, at Priory Crescent,

Cheam, Sutton SM3 8LR

Closure of Part I To resolve that the public now be excluded from the meeting, on the basis that publicity would be prejudicial to the

public interest by reason of the confidential nature of the business to be conducted in the second part of the agenda.

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Register of Interests

NHS Sutton CCG’s Register of Interests are made publicly available at the Governing Body meetings of the CCG and can be found at

http://www.suttonccg.nhs.uk/News-Publications/publications/Key%20publications/DECLARATIONS%20OF%20INTEREST%20-%20January%202016.pdf

The Register is maintained by the Head of Corporate Governance. The Register is constructed in line with the CCG’s Constitution and Conflicts of Interest

Policy which can be found at

http://www.suttonccg.nhs.uk/News-Publications/publications/Key%20publications/GB%20Approved%20SCCG%20Conflicts%20Of%20Interest%20Policy.pdf

The Register contains details of all members of the CCG’s formal committees and the Governing Body itself. The interests of those individuals that are in

attendance only will be captured in the minutes of the meeting concerned.

Name Position Held Declaration of Interest Membership Date

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Pippa Barber Governing Body – Independent Nurse

• Director THF Health Limited

• Non-Executive Director at Kent Community NHS Foundation Trust (as from 01/12/16).

✓ ✓ ✓ ✓ (23.11.16)

Gillian Bennett Patient Reference Group (Participating Observer)

• Representative for the Grove Road GP Surgery on the Patients’ Representative Group

• Shareholdings in AstraZeneca.

✓ Membership to be confirmed - Non-Voting Member

Sally Brearley Lay Member – Patient & Public Engagement and Chair of the Quality Committee

• National Nursing Research Unit, Kings College. London - Visiting fellow

• Member, NHS England Clinical Priorities Advisory Group

• Chair, NHS England London Region Health in the Justice System Patient and Public Voice

✓ ✓ ✓ ✓ (07.12.16)

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Reviewed: 05 January 2018 Jane Walker, Head of Corporate Governance


Reviewed

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Group

• Fellow in Patient and Public Involvement, Faculty of Health, Education and Social Care, Kingston University and St George's University of London.

• Member of the South London Health Innovation Network Musculoskeletal Advisory Board

• Patient representative, NHS 11 Futures/Digital Urgent Care Board.

Annette Brown Healthwatch representative

• No interests to declare. ✓

Dr Robert Calverley

Wallington Locality Lead

• GP partner at Manor Practice (1.11.16)

• Member of Sutton GP Services Ltd

• GP Trainer.

✓ Commenced 01.09.16 (26.04.17)

Dr Jonathan Cockbain

GP Board Member Carshalton Locality Lead

• GP Partner – Chesser GP Practice


• Wife employed by Sutton College working as ESOL tutor.

✓ ✓ ✓ Updated 12.01.17 (Commenced on Exec 01.11.16)

Dr Jeffrey Croucher

Clinical Chair • GP Partner at Benhill and Belmont GP Centre

• Benhill and Belmont GP Centre is a Member of the Sutton GP Federation

• Wife is a Consultant Gynaecologist/Infertility services at Epsom and St Helier’s NHS Trust and is Clinical Director for Women’s Health

• Received a research grant from the Health Innovation Network in 2015/2016 for

✓ ✓ ✓ Updated 06.11.17 Commenced Role as Chair 10.7.17

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Musculoskeletal clinical services in Sutton

• Project Lead for the Belmont surgery, in developing the new Belmont GP Centre

• GP Trainer and occasionally supervise OOH shifts in SELDOC for GP Trainees.

Dr Chris Elliott Chief Clinical Officer

• Sutton Healthcare Services - Director

• Member of SWL STP Executive Committee

• Locum GP.

✓ ✓ ✓ ✓ (21.09.16) Updated 12.04.17

Dr Simon Elliott Independent GP Advisor

• No interests to declare. ✓

Susan Gibbin Lay Member - Performance

• Director – Susan Gibbin Consultancy Ltd

• Corporate consultancy support to Carnall Farrar, Strategic Health and Care Consultancy

• Trustee and Board member of the Bourne Education Trust

• Chair of Governors – Downs Way School, Oxted.

✓ ✓ Commenced 01.05.17

Mary Hopper Director of Quality • No interests to declare. ✓ ✓ (21.09.16)

Dr Senthooran Kathirgama Kanthan

Sutton and Cheam Locality Lead

• GP Partner Well Court Surgery


• GP Tutor St George's University of London.

✓ (26.09.16)

Sean Morgan Director of Performance & Delivery

• No interests to declare. ✓ Commenced 03.07.17

Dr Dino GP Board Member • GP Partner - Mulgrave Road. ✓ ✓ ✓

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Pardhanani

Geoff Price Chief Finance Officer

• Daughter working in a nursing post with Epsom and St Helier NHS Trust at Epsom hospital.

✓ ✓ ✓ ✓ ✓ (17.03.17)

Dr Les Ross Lay Member – Secondary Care Consultant

• No interests to declare. ✓ ✓ ✓ ✓ ✓ ✓ (21.09.16)

Paul Sarfaty Lay Member – Governance and Audit, Vice Chair and Chair of the Audit Committee

• Feughside Limited – Director and Shareholder

• Consultancy through Feughside Limited.

• Trustee of St George's Hospital Charity

✓ ✓ ✓ ✓ ✓ ✓ ✓ (01.09.17)

Dr Roshni Scott GP Executive Member


• GP Partner - Dr Scott & Partners

• Husband- clinical director planned care Merton CCG (includes MOT).

• Husband to join partnership - Dr Scott & Partners (01.04.17)

• Member Triage Panel Richmond GP Alliance

✓ ✓ (22.11.17)

Karol Selvey Primary Care Nurse Board Member

• Partner at The Old Court House - Dr Grice & Partners

• Member of Sutton GP Services Ltd.

✓ ✓ ✓ (01.10.16)

Lucie Waters Managing Director • No interests to declare. ✓ ✓ ✓ ✓ ✓ Commenced 01.04.17

David Williams Chair - Healthwatch (Participating

• Member of Old Court House Surgery Patient Participation Group

• Chair, Patient Reference Group

✓ Non-Voting Member

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Observer) • Healthwatch Sutton Chair

• Appearances on Radio St Helier on behalf of Healthwatch Sutton

• Son is a Planning Officer with the London Borough of Sutton.

Clare Wilson Deputy Chief Operating Officer (Interim)

• Director/Owner Chamberlain Partners Ltd. ✓ Commenced 03.10.16 (10.01.17)

No longer a member of a formal committee and/or the Governing Body and removed from the Register:


Reviewed

Dr Brendan Hudson

Clinical Chair • Principal of The Grove Practice, 83 Grove Road, Sutton, SM1 2DB

• Practice is a member of Sutton GP Services Limited (GP Federation)

• From time to time raised money for Royal Marsden Hospital Cancer Charity and St Raphael’s Hospice

• Past Councillor and Mayor (2008/9) of London Borough of Sutton

• SWL Commissioning Collaborative - As Chair of the CCG member of the clinical board and governance committee. Joint clinical lead

✓ ✓ ✓ Updated 26.09.16 (new DoI form completed) Stepped down 10.7.17

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Reviewed

for the children and young person workstream.

Helen Bailey Director of Delivery (interim)

• Director/Owner Wayside Health & Care Ltd. ✓ Commenced 03.10.16 (09.01.17) No longer Director 3.7.17

Dr Nicola Lang Board Member - Director of Public Health

• Director of Public Health – London Borough of Sutton

• Offender health work with NHS England on offender-related issues

• Director of Public Health Lead for Offender Health, London ADPH

• Director of Public Health Lead for Drugs and Alcohol.

✓ ✓ Left Sutton CCG 1 July 2017

Sian Hopkinson Director of Performance & Primary Care

• No interests to declare. ✓ No longer a member of the Exec

Jonathan Bates Chief Operating Officer

• No interests to declare. ✓ ✓ ✓ ✓ ✓ Left Sutton CCG 31.03.17

Dr Chris Keers GP Executive Member

• GP - Wrythe Green Surgery

• Member - SELDOC

• Practice is a Member of SW London Primary Care Research Network


• GP Trainer.

✓ Resigned as an Exec member - last meeting 28.09.16

Dr Ashraful Mirza

Carshalton Locality Lead

• GP Partner Faccini House Surgery

• Sutton GP Services Ltd

• Member of Sutton GP Services Ltd.

✓ Resigned as an Exec member 01.11.16

Dr Farhan Rabbani

Wallington Locality Lead

• GP Partner Wallington Medical Centre

• Board Director of SELDOC


• Director of Sutton GP Services Ltd.

✓ No longer a member of the Exec 01.09.16

Dr Lindsey Local Medical • Salaried GP Wallington Family Practice ✓ No longer a member of

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Reviewed

Roberts Committee (Participating Observer)

• Lead with in practice for anticoagulation service and IUCD/implant service.

• My husband is a consultant cardiac surgeon working for UCLH

• Director of Roberts Medical Limited.

GB (confirmed 01.02.17)

Sue Roostan Director of Commissioning

• No interests to declare. ✓ Left Sutton CCG 30.09.16

Hilary Smith Patient Reference Group Rep

• No interests to declare. ✓ No longer a member of the QC

Dr Mark Wells GP Executive Member

• Practice is a Member of SW London Primary Care Research Network

• GP - Wrythe Green Surgery

• Member of Sutton GP Services.

✓ On sabbatical for 3 months from 01.01.17

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MINUTES OF THE SUTTON CLINICAL COMMISSIONING GROUP

PRIMARY CARE COMMISSIONING COMMITTEE

Wednesday 1 November 2017, 11:00am – 1:00pm Meeting Room 1, Priory Crescent

Present

Voting Members:

Sally Brearley SB Chair Primary Care Commissioning Committee, Lay Member - Patient & Public Involvement

Dr Simon Elliott SE Independent GP Advisor

Susan Gibbin SG Vice Chair Primary Care Commissioning Committee, Lay Member - Performance

Dr Clare O’Sullivan COS General Practitioner, Mulgrave Road Surgery

Geoffrey Price GPr Chief Finance Officer

Mr Les Ross LR Governing Body member - Secondary Care Consultant

Paul Sarfaty PaS Lay Member - Governance & Audit

Lucie Waters LW Managing Director

Non-voting Members:

William Cunningham Davis WCD Head of Primary Care, NHS England

Dr Rebekah Dowdy RD Sutton Local Medical Committee (LMC)

David Williams DW Healthwatch representative

In Attendance

Lou Naidu LN Primary Care Transformation Programme Manager

Siân Hopkinson SH Associate Director of Primary Care

Carolyn Reynolds CR Head of Primary Care Commissioning

Jane Walker JW Head of Corporate Governance

Apologies

Pippa Barber PB Governing Body Member - Independent Nurse

Clare Ridsdill-Smith CRS Head of Public Health Integration, London Borough of Sutton

Dr Prashanth Sathiagnanam

PrS GP, Sutton

Nóra Simon NS Assistant Head of Primary Care Commissioning, NHS England

Clare Wilson CW Deputy Managing Director

Welcome & Introduction

1. Welcome and Apologies SB welcomed members, both voting and non-voting, to the meeting in public of the Primary Care Commissioning Committee (PCCC). Apologies were noted as detailed above.

2. Register of Declared Interest The Register of Interest was agreed as a correct and accurate record.

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3. Minutes of previous meeting The minutes of the Sutton CCG PCCC meeting held on 6 September 2017 were agreed as an accurate record.

4. Matters Arising Action Log It was noted that the action log would be updated and submitted to the next meeting of the PCCC.

For Approval

5. Primary Care Operational Management Group - Terms of Reference SH presented the Primary Care Operational Management Group Terms of Reference, previously known as the Primary Care Programme Board, for approval by the PCCC. SH confirmed that previous discussions had taken place at both the September meeting of the Primary Care Commissioning Committee and the October meeting of the Primary Care Operational Management Group, where suggested changes had been recommended and subsequently incorporated. Following discussion by the PCCC it was agreed to amend the quoracy of the meeting to state ‘the meeting is quorate when 50% of members, including at least one clinical member, are present’. SH also confirmed that other members of the CCG would be invited to the group to present their work on an on-going basis. Recommendation The PCCC APPROVED the amendments to the Terms of Reference for the Primary Care Operational Management Group, to include the recommendation detailed above.

6. Primary Care Clinical Quality Review Group - Terms of Reference SH introduced the Terms of Reference for the Primary Care Clinical Quality Review Group which had previously been discussed in detail at the October seminar of the PCCC. It was proposed to establish a Primary Care Clinical Quality Review Group to improve oversight of quality of primary care. As this was a newly established group, it was agreed to review the Terms of Reference after a period of six months. Following discussion the following key points were noted:

• It was agreed that initially the LMC would not be invited to attend the meeting but should receive the agenda in advance to have the opportunity to feed in comments.

• Within the Terms of Reference, Significant incidents should be changed to read significant events.

• The Transformation Programme should be referenced.

• The National GP survey results should be included. The date of the first meeting would be arranged for early December 2017, and would include a review of formal written complaints made by

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patients to NHSE regarding Sutton practices and how to take the reporting process forward. Recommendation The PCCC APPROVED the Terms of Reference for the Primary Care Clinical Quality Review Group, noting the comments made above and to be reviewed in six months.

7. Primary Care Commissioning Strategy SH presented the strategy for primary care commissioning in Sutton which was framed by national policy, particularly the GP Forward View, regional policy and 17 primary care specifications for London. The presentation covered the following areas:

• National guidance on the development of primary care and general practice

• Sutton approach to date

• Timescales and process for finalising the Sutton CCG Primary Care Strategy

It was noted that following engagement with stakeholders, GP practices and patients, Sutton’s priorities included:

• Sustainability

• Healthy Communities

• New Ways of Working

• Improved Access and Experience SH also stated that there were a large number of transformation projects underway, and significant engagement with general practice and the public would be required to ensure that the improvements in workload, workforce, proactive care and management of complex patients could be realised. LW stated that although significant engagement had taken place to date, she would welcome further comments and engagement to help develop the strategy. Further comments made by the PCCC included:

• The need to use all the skills across South West London

• To agree the model for care navigators for Sutton

• To ensure synergy with the primary care estates strategy

• The need to look at each individual practice separately to understand what they are able to do with the capacity they have.

• The need for further engagement with patients to ensure they help shape how the strategy is implemented

It was agreed to bring back the Primary Care Commissioning Strategy to the January meeting of the PCCC and for formal sign off at the Governing Body meeting in March 2018. Recommendation The PCCC NOTED the work to date on the Primary Care Commissioning Strategy.

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8. PMS Review – Minor Surgery Provision CR presented a paper, for approval by the PCCC, following previous discussion at the September Primary Care Commissioning Committee regarding minor surgery provision. CR stated that the next steps detailed within the paper regarding the provision of minor surgery within the community and primary care were discussed and agreed by the Executive Committee on 25 October 2017. Recommendation The PCCC APPROVED the next steps as detailed within the paper.

For Discussion

9. Premises Development Updates

LN updated the PCCC on the following premises developments:

Central Sutton

Following a successful bid to the Estates and Technology

Transformation Fund (ETTF), Sutton CCG’s primary care team have

been working with local practices to explore the opportunity to develop

and extend Robin Hood Health Centre to provide modern purpose built

premises to up to 5 Sutton town centre practices.

As part of the programme of engagement, a patient survey was

undertaken to consider patient views on the proposal. The GP Practices

were asked to decide by 13th October, given all of the information

available, if they wished to take advantage of the opportunity. All

practices (with the exception of those already within Robin Hood Health

Centre) have decided to remain within their existing premises.

Sutton CCG will now consider alternative options to accommodate the

growing population within Sutton town centre. The options appraisal

scheduled for 20/10/17 was postponed, pending further discussion.

Old Court House

Drs Grice and Partners have submitted a business case to the CCG to

refurbish and expand the Old Court House surgery on Throwley Way. In

light of the decisions made with regard to Central Sutton, and to allow

sufficient time for options to be fully explored, it is proposed that this

business case is brought to the Primary Care Commissioning

Committee for decision in January 2018.

South Sutton

A decision on the planning application is due in November 2017, with

site works expected to commence in March 2018, subject to permission

being granted.

Hackbridge

Commissioners are currently negotiating Head of Terms with the

landlords, Barratt London, with a view to contracting a specialist primary

care developer to work with them.

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Recommendation The PCCC noted the update.

10. National GP Patient Survey July 2017 CR presented the analysis report for Sutton following the IpsosMori July 2017 patient survey publication. CR highlighted the overall findings including:

• Sutton CCG is performing above or in line with national averages

for all areas

• The range of results across Sutton CCG practices is always

wider than those ranges seen across local CCGs

• Patients were most dissatisfied with being involved in decision

making regarding their care when seeing their GP or nurse

• Performance for ease of getting through to a practice and overall

experience of making an appointment are very much higher than

found nationally.


11. GP Forward View Transformation Progress LN presented a summary report which tracked progress against the numerous primary care transformation workstreams. This was the first draft which required further detail to be added, however it was felt that it gave an overview of the programme of transformation which was underway in primary care. Recommendation The PCCC noted the dashboard.

12. Quality Review

SH presented a draft dashboard showing practice ratings and/or target

achievements for:

• GP Patient Survey

• Friends and Family Test

• CQC Rating

• Childhood Immunisation Coverage

• Patient online Coverage

The PCCC noted the report and agreed that this would in future go to

the Primary Care Clinical Quality Review Group to consider in more

detail.


SH

13. Primary Care Finance Report GPr presented the financial position for the six months to 30 September and full year forecast which is in line with budget. It was noted that there were some relatively small overspends offset by savings in the list size growth provision and benefits from prior year provisions.

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GP stated that work was in progress to put together a report for all primary care related budgets. This would be completed in stages and in full by the end of the financial year The PCCC would receive an update for the next meeting of the PCCC in January 2018. Recommendation The PCCC noted the update.

GP

14. Primary Care Risk Register The PCCC received the Primary Care Risk Register which highlighted the current risks to the CCG around Primary Care Commissioning. It was noted that there had been no changes since the last report at the October meeting. Recommendation The PCCC noted the register.

For Ratification

15. Contractual Changes SH confirmed that there had been no contractual changes for Sutton practices for April to September 2017. SH informed the PCCC that The Grove Road Practice proposed a

reduction to their inner boundary for new registrations for a period of 18

months. Reasons for the request were cited as a steadily rising practice

list and clinical staffing recruitment issues. This had previously been

discussed by the Primary Care Operational Management Group

(PCOMG) at the September and October 2017 meetings. Following

further information provided at the October 2017 meeting, the PCOMG

recommends that the request is not granted.

LW stated that there was a need to discuss with the practice how the

CCG could help them do things differently.

Recommendation The PCCC ratified the decision of the PCOMG to decline the request by The Grove Road Practice for a reduction to their boundary.

For Note

16. Extended Access Performance LN presented an update on performance relating to the primary care extended access service. LN highlighted the following key points:

• To date, service utilisation has been very good with capacity

being actively managed by the provider over the quieter summer

period. Plans are in place to increase capacity over the winter

months to provide additional primary care resilience whilst also

providing appointments to accept redirections and direct booking

from both St Helier’s Emergency Department and NHS111.

• Numbers of patients failing to attend their booked appointments

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(“did not attend” or DNA rate) have been higher than the average

reported across South West London and work is being

undertaken to actively reduce this.

• Patient feedback about the service has been very positive to

date and all except one practice have referred into the service.

• In January 2018 the service will become directly accessible to

patients over the weekend, whereas it is currently only bookable

via a patient’s own practice.

It was agreed to look at text and telephone reminders to reduce the number of DNAs. It was also agreed to review practice data to ensure equity with access to the service across practices. Recommendation The PCCC noted the update.

LN

LN

17. Primary Care Programme Board Report – 12 October 2017 The PCCC received a report from the Primary Care Programme Board held on 12 October 2017, which was noted as helpful and it was agreed that the PCCC would receive regular reports going forward.

SH

18. Forward Plan It was agreed to add the Primary Care Operational Management Group Report to the forward plan for each public meeting of the PCCC.

SH

For Information

19. Questions from the public There were no questions from the public.

Any Other Business

20. Any Other Business There was no other business raised.

21. Meeting Close

22. Date of Next Meeting The next meeting of the Primary Care Commissioning Committee in public will take place on Wednesday 10 January 2018, 11:00am-1:30pm, at Priory Crescent.

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Updated: 05 January 2018 Jane Walker, Head of Corporate Governance

Sutton CCG Primary Care Commissioning Committee (PCCC) - Matters Arising /Action Points from previous meetings.

Date Item Title and Action Required Lead Comments Status

5 July 2017 6 Equality of service offer in primary care

CR Paper to reflect the fact that the GMS practice was not contractually required to agree to the arrangement and did have a choice.

Updated: 01.11.17 Service offers had not yet been received by practices with negotiations about to commence

5 July 2017 9 Quality Primary Care indicators NS/CR Quality to be a standard item on all future meetings of the PCCC.

Updated: 01.11.17 NHSE in the process of developing a primary care quality dashboard. A quality dashboard was being developed across SWL.

1 Nov 2017 12 Quality Review SH Report to go to the Primary Care Clinical

Quality Review Group to consider in more

detail.

To be included on the agenda for the PCCQRG.

1 Nov 2017 13 Primary Care Finance Report GP PCCC to receive a report for all primary care related budgets.

To provide an update at the January meeting of the PCCC.

1 Nov 2017 16 Extended Access Performance LN To look at text and tel reminders to reduce the number of DNAs. To review practice data to ensure equity with

access to the service.

To provide an update at the January meeting of the PCCC.

1 Nov 2017 17 Primary Care Programme Board Report

SH PCCC to receive regular reports going forward. On agenda.

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Updated: 05 January 2018 Jane Walker, Head of Corporate Governance

1 Nov 2017 18 Forward Plan SH Forward Plan to include the Primary Care Operational Management Group going forward.

On agenda.

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Report to the Sutton Clinical Commissioning Group

Primary Care Commissioning Committee

Date of Meeting: 10th January 2018

Agenda No: 5 ENCLOSURE: 04

Title of Document: Primary Care Strategy

Purpose of Report:

For Approval

Report Authors:

Sian Hopkinson

Associate Director - Primary Care

Lead Director:

Clare Wilson

Deputy Managing Director

Executive Summary:

The attached strategy for primary care commissioning in Sutton is framed by national

policy, particularly the GP Forward View, and regional policy including the 17 primary

care specifications for London as described in the Strategic Commissioning

Framework. Strengthening and transforming general practice will play a crucial role

in the delivery of the ambitions of the South West London Sustainability and

Transformation Partnership (STP).

Following engagement with stakeholders, GP practices and patients, Sutton’s

priorities have been identified as:

• Sustainability



• Improved Access and Experience

There is a programme of transformation underway, requiring significant engagement

with general practice and the public, to ensure that the improvements in workload,

workforce, proactive care and management of complex patients can be realised.

Key sections for particular note (paragraph/page), areas of concern etc:

Slide 14 summarises the improved outcomes for primary care anticipated

Slide 16 lists the workstreams currently underway to deliver the strategy, with further

detail in Appendix 3

Slide 19 outlines the engagement activities undertaken or planned up to Governing

Body sign off of the strategy in March 2018.

Recommendation(s):

The Primary Care Commissioning Committee is asked to:

APPROVE the Primary Care Commissioning Strategy and recommend it for final sign

off by the CCG Governing Body in March 2018

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Committees which have previously discussed/agreed the report:

Earlier drafts have been discussed by the Primary Care Commissioning Committee.

The strategy has been discussed at all three Locality Meetings in October 2017 and

with the London Borough of Sutton Scrutiny Committee (18/10/17).

Financial Implications:

Delivery of the strategy will require investment, much of which is identified (see the

Primary Care Transformation Dashboard). Delivery of the Sutton Health and Care

Locality model for proactive care is still being developed and will require additional

investment.

Equality Impact Assessment:

The CCG is committed to monitoring the compliance with the Equality duty of the

providers from whom we commission services. This is done through the quality and

contracting process.

Information Privacy Issues:

This report is to be published in the public domain.

Communication Plan:


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DRAFT PRIMARY CARE

COMMISSIONING STRATEGY


10th January 2018

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Introduction

This Strategy supports the vision for safe, sustainable and high quality primary care services, provided in

modern premises that are fit for purpose. Our ambition is to support patients to stay well for longer, connect

people to sources of community support and ensure people receive joined-up out of hospital care.

This requires a resilient primary care service at the core of local communities, playing a leading role not only

in the provision and co-ordination of high quality medical care and treatment, but also in supporting improved

health and well-being.

There are a number of national and local challenges for health services, including:

• increased demand and expectations

• a growing population with more complex needs

• workforce pressures

• constrained funding growth

Despite the very real pressures that exist, there continues to be overall high levels of patient satisfaction with

the quality of primary care in Sutton, and we must build on this strength.

This strategy seeks to explore new ways of working to protect and enhance the primary care service for

current and future generations of patients, carers and healthcare professionals.

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Background

• General Practice is the foundation of the NHS and sees more

patients than any other NHS service.

• The General Practice Forward View, published in April 2016,

developed by NHS England, Health

3

Education England and the Royal College of General Practice commits to

strengthen general practice in the short term and support sustainable

transformation of general practice in the future.

• The GP Forward View identified four key priorities for transformation: Care

Redesign, Workload, Workforce and Practice Infrastructure.

• Strengthening and transforming general practice will play a crucial role in the

delivery of Sustainability and Transformation Plans (STPs).

• Creating a resilient, diverse primary care workforce, by addressing workload

pressures and delivering the 10 point action plan for General Practice Nursing, is

the foundation for sustainable primary care, which in turn is the cornerstone of

integrated, proactive care.

• This strategy has been developed locally to deliver the vision of the GP Forward

View and London Strategic Commissioning Framework. of 114

Sutton: Demography

• The population registered with Sutton GPs is approximately 195,0001, with

the resident population predicted to rise from 202,000 in 2016 to 223,000 by

20242.

• The population of children and young people aged 0 to 19 years is expected

to increase by 16.6%, higher compared to 14.8% for London and 7.8% for

England.

• The Sutton working age population (20-64 years) was around 116,000 at

the 2011 census, i.e. 61% of the population, and the proportion of working

age people in Sutton is projected to rise over the next decade.

• Sutton’s population is also aging, with the number of over 65s predicted to

increase from 30,000 in 2014 to 36,000 by 2024.

• Significant growth in population will put a further strain on primary care

services and this strategy seeks to ensure that transformation and

integration of services delivers the capacity required.

4

1 NHS Digital, October 2017; 2 Sutton JSNA 2017

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Leadership & Governance

Sutton CCG Governing Body

Primary Care Commissioning

Committee

Primary Care Operational

Management Group

Primary Care Clinical Quality Review Group

Executive Committee

Quality Committee

5

South West London Sustainability and Transformation

Partnership

Healthy London Partnership

• The Primary Care Commissioning Committee (PCCC) is a decision-making sub-committee of

the CCG Governing Body.

• The PCCC is supported to carry out its functions by the Operational Management Group and

Clinical Quality Review Group.

• Where appropriate, primary care issues are raised with the CCG Executive and Quality

Committees.

• Sutton’s Primary Care commissioning is informed by and collaborates with the South West

London Sustainability and Transformation Partnership and the Healthy London Partnership.

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Patient Experience

6

• It is good to see that in the most recently published national GP Patient Survey

results (July 2017), practices in Sutton continue to perform better than, or in line

with, the national CCG average. There is, nevertheless, practice variability hidden

within that overall level achievement.

• The overall results are well summarised by the following questions:

• Patient experience measures are an important indicator of the quality of primary

care being provided. The CCG will continue to encourage practices to discuss

their individual results with their Patient Participation Group (PPG) to identify

areas for local improvement and action.

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Primary care now

– surviving?

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Primary care future

– thriving

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Sutton’s Draft

Primary Care Strategy

Stakeholder engagement with Sutton’s practice teams, patients and partner organisations identified 4 priorities for primary care to deliver the ambitions of the GP Forward View and the London Strategic Commissioning Framework for Proactive, Accessible and Coordinated primary care:

• Sustainability



• Improved Access and Experience

This strategy for primary care links with the CCG Estates Strategy: high quality primary care is best delivered from premises meeting modern standards for accessibility and safety, and commissioners will continue to seek out opportunities to improve and develop premises.

Bo

rou

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ide

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ice

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Sustainability

• Drive continuous improvement across all

practices to ensure safe and high

quality general medical services

• Deliver the 10 High Impact Actions for

releasing time in general practice

(Appendix 1)

• Policy drivers and long term trends point

towards ‘primary care at scale’

• At borough or locality level this could

mean shared triage, referrals, home

visiting, telephone and online

consultations, etc.

• Larger primary care health centres as

focal point for locality based services

• Development of more proactive support

for complex patients (Sutton Health

and Care)

H E A L T H C E N T R E

GP GP GP

Enabling this:

• Collaboration between practices,

GP federation & health centres

• Sharing of patient records

• Shared employment models

• Consolidation and collaboration of

administrative functions

Locality Collaboration

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rou

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Other Community Services

Healthy Communities

• Approximately 20% of demand in primary

care driven by social rather than health

needs (local & national evidence)

• Significant untapped potential of

community assets for generating health

• Development of comprehensive “Social

Prescribing” service to address non-

medical influences on health and

wellbeing

• Better use of community pharmacies to

optimise support available and health

champions to signpost to services

Enabling this:

• New approach to commissioning

third sector organisations

• Training for staff in influencing

health behaviours

• Better data to understand local

variation in wider determinants of

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New Ways of Working

Enabling this:

• Increase training via multi-

professional training hubs

• Recruitment drive reinforcing the

benefits to living and working in

Sutton

• Integrated cross-organisational

records

GP

Practice Nurse

Healthcare Assistant

Core Team

Extended Team

Integrated MDT

• Diversify the primary care team to

utilise a higher proportion of skilled

nurses, healthcare assistants,

pharmacists, etc to free up GPs for more

complex care

• Collaborate across a locality footprint of

approximately 50,000 population

• Integrated multi-disciplinary team-

working to improve cross-organisational

coordinated patient-centred care

• Embed multidisciplinary training &

development (e.g. trainers groups) and

move to a model where trainees deliver

capacity

• Deliver the 10 point action plan for

general practice nursing (Appendix 2)12

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Improved Access &

Experience

• Reinforce continuity of care via core

practice teams

• Offer ‘one stop’ type clinics

• Help navigate complex health

management via care navigators

• Move towards a single point of access

for primary care for booking

appointments, viewing records, and

telephone/online consultations

• Expand opening hours for general

practice to meet local needs

• Continue to promote digital access

• Support self-care and self-

management

Enabling this:

• Implement care navigator role

• Accelerate digital access routes

• Engage patients in design of

improvements to services

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What will be different?

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Integrated Teams

Collaborative working and proactive case management of

the most complex patients

Primary Care Team

GP as expert generalist within a multi-disciplinary team and

working at scale

Access

Shorter waiting times

Easier to see GP when needed

Experience

Patients feel better supported to manage their health and

know how to access help when they need it

Sustainability

Stable workforce, increased staff satisfaction, digital

innovations

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High Level

Implementation Plan

• This section describes the High Level Implementation Plan and

timelines for delivery of priorities in the Primary Care Strategy.

• Whilst many of the workstreams commenced in 2017/18, full

implementation is planned for completion in 2018/19.

• In order to deliver this strategy and realise the benefits for

individuals, their family and carers, a more detailed implementation

plan has been developed by the Sutton Primary Care Operational

Management Group and is shown at Appendix 3.

• The plan will ensure best use of the existing resources, building on

what has been done to date and where necessary develop specific

project mandate(s) to take collaborative improvement work forward.

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High Level

Implementation Plan 2017/18

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17

High Level


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18

High Level


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Engagement

• Stakeholder workshop Summer 2016

• Engage with stakeholders:

– Carshalton Locality October 2017

– Sutton and Cheam Locality November 2017

– Wallington Locality November 2017

– LBS Scrutiny Committee October 2017

– Patient Reference Group January 2018

• Finalise strategy:

– Primary Care Commissioning Committee January 2018

– Governing Body approval March 2018

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Appendix 1:

10 High impact actions

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Appendix 2: 10 point action plan

for General Practice Nursing

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Appendix 3:

Implementation Plan (1/5)

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Appendix 3:


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Appendix 3:


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Appendix 3:


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Appendix 3:


Workstream Name Workstream OverviewBudget 17/18

(£000s)

Progress in DeliveryRAG: GREEN= on track/no delays; AMBER minor delays/minor issues; RED significant delays/major issues

Current Key Milestone

Timescalefor delivery

RAG

Premises Development: South SuttonRelocation of Belmont branch of Benhill and Belmont GP Centre to a new

health centre

Capital

privately funded

With council planning department for approval

- decision expected 16/01/18Sep-19 GREEN

Premises Development: Hackbridge Relocation of Hackbridge Medical Centre a new health centre

s106

HoT's almost agreed

Foundations laidSep-19 GREEN

Community Education Provider Network

(CEPN)

Clinical and non-clinical training and education programme to support

general practice workforce initiatives, new ways of working and quality

improvement

HESL & CEPN

Wide range of training courses and protected

learning time delivered throughout the year.

Dec 17; Interviews undertaken for CEPN

Lead for 18/19

Ongoing GREEN

General Practice Nurse 10 Point Action

Plan

Action Plan to raise the profile of practice nursing, extend leadership,

increase the number of student nurses, preceptorship, return to nursing,

access to educational programmes, advanced clinical practice,

apprenticeships and improve retention

HESL & CEPN

Detailed training programme against each

criteria has been developed, some of which

has been completed, is on going and planned

for 2018

Ongoing GREEN

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Title of Document: Old Court House Development Business Case

Purpose of Report:

For Decision

Report Authors:

Lou Naidu

Primary Care Transformation Programme Manager

Lead Director:

Clare Wilson


Executive Summary:

Drs Grice and Partners submitted a business case for modernising their main site of

the Old Court House Surgery and an option to expand into the void space within the

building. This was discussed at the Primary Care Commissioning Committee (PCCC)

Seminar on 6th December 2017.

The Practice’s preferred option is to reconfigure the current surgery and expand into

the void space to improve patient flow within the building and create 5 additional

clinical rooms. This would create sufficient capacity on the site to accommodate all

patients plus expansion space for significant numbers of new patient registrations,

allowing them to close their branch surgery at Robin Hood Health Centre.

By operating on one site only, the practice would be more efficient and this would

support long term resilience for the practice.

By vacating Robin Hood Health Centre, this would create the opportunity to

reconfigure the space to bring more of the ground floor into clinical use, and hence

provide additional clinical capacity for new registrations on that site for Dr Seyan’s

practice.

The solutions presented provide increased primary care capacity in Central Sutton

which will meet the needs of the growing population

The practice has now updated their business case to make clear this preferred option

and provide additional information as requested at the PCCC seminar in December to

enable a decision by the Primary Care Commissioning Committee in January 2018.


None

EN

C 0

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2

Recommendation(s):

The Primary Care Commissioning Committee is asked to APPROVE the business

case subject to:

• Value For Money recommendation and Valuation by the District Valuer

• Agreement of Heads of Terms between the landlord and the tenant

Committees which have previously discussed the report:

Primary Care Commissioning Committee – 6th December 2017


• Recurrent CCG revenue costs for additional rent and rates as detailed in the

business case

• Non recurrent IT costs for additional hardware as detailed in the business case

• Some short term/interim financial support may be required for Dr Seyan’s

Practice to cover increased service charges incurred by taking on additional

space at Robin Hood Health Centre whilst the patient list grows.







Communication Plan:


EN

C 0

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Final Version 5th January 2018

Publications Gateway Reference 00368

NHS England

£1m - £3m Business Case Proforma

SPONSORING

NHS

ORGANISATION

The Old Court House Surgery, Throwley Way, Sutton, Surrey, SM1 4AF

SOURCE OF

CAPITAL

Landlord-funded by – Primary Medical Property Investments Limited, managed by Octopus Healthcare.

TITLE OF

SCHEME The Old Court House Surgery (H85030)11107

CAPITAL REQUIREMENT (£’000 incl VAT)

All figures

include VAT

2017-2018

£’000

2018-19

£’000

2019-20

£’000

Total

£’000

0 0 0 0

REVENUE REQUIREMENT (£’000 excl VAT)

All figures

include VAT

2018-2019

£’000

2019-2020

£’000

2020-2021

£’000

Total 2018-

2021

£’000

Recurrent 32.9* 65.8** 65.8** 165

Non-Recurrent 69*** 0 0 69

Total 101.9 65.8 65.8 234

CONTACT

DETAILS

* Maximum of 6 months increased revenue 2018/19 after development completes. All figures include VAT **Note proposed rent review due in March 2017 remains outstanding ***2018-19 non-recurrent cost would be incurred in 2017-18

GP Project Lead Dr David Coldrey

[email protected] 07712 336 014

Dr Grice & Ptnrs Business Manager

Jackie Manville [email protected] 020 8652 1919

NHS Sutton CCG Contact

Lou Naidu [email protected] 07920 722201

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SCHEME

SUMMARY

This PID has been developed as a supplemental paper to the original proposal which was

approved in February 2016. The report provides additional information about the proposed

use of the Old Court House premises and a review of the original options appraisal.

The original content has been included to demonstrate consistency especially in relation to

the strategic case for change. It has however been updated to reflect the changes since

original submission.

Background

This paper has been produced to supplement the business case dated February 2016. This

case was developed in conjunction with NHS England and was approved by the CCG. The

practice’s patient participation group has had regular involvement by attending meetings;

commenting and amending the designs of both the property and service opportunities; and

completing satisfaction surveys. The proposed solution represents the outcome of this

patient engagement and partnership working approach.

Following the approval, the development was delayed as the CCG wished to determine

whether the project would be suitable for PCIF funding (later amended to ETTF). This project

does not require capital investment due to the commitment of the Landlord to invest the

appropriate funding and to recover this funding in rent as valued by the District Valuer

Service (“DVS”) through a new 20-year lease. The scheme did not therefore satisfy the ETTF

scheme.

In June 2016, the partners of OCH were asked by the CCG to consider moving the service into

the Robin Hood Lane development. For the reasons outlined within the economic case of this

paper the partners have decided that this move would not be in the interests of the patients

or practice.

In June 2017, the practice was selected, after a competitive application process with four

other practices, as the preferred site for the delivery of the Extended Access Service as the

Hub for Sutton as run by Sutton GP Services. This commenced in July 2017 and the practice in

discussion with Sutton GP Services (the Federation) are exploring additional opportunities to

further improve the utilisation of the site in its current and projected condition.

The CCG has now confirmed that they are supportive of the delivery of care from the OCH

property and have requested the development of this supplementary paper to consider the

lease extension, development options and to clarify the intentions of the practice in relation

to its role as a primary care provider and the Hub for Sutton.

Property details

The property is a former courthouse originally constructed c. 1950 and subsequently

converted c.1996 for the provision of primary care services. The site comprises a single

building with two main sections. The front elevation being a single storey, facing Throwley

Way, and the rear elevation consists of a two-storey construction. There is an additional

basement area and 24 accessible car parking spaces and 3 restricted car spaces. Please note

the sizes have been subject to further assessment and differ slightly from the original figures.

Area Existing (m²) New space (m²) Total (m²)

Basement Area 46.06 33.44 79.5

Ground Floor 581 581

First Floor 140.5 140.5

First Floor 130 130

Total 767.56 931

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Figure 1. Existing premises viewed from Throwley Way

The subject property is owned by a third-party investment fund, Primary Medical Property

Investments Limited, which forms part of Octopus Healthcare, a specialist investor and

developer in primary care. The site is held on a lease by Dr D Coldrey, Dr S Grice, Dr J Vernon

for a 25-year term commencing 28th March 1997 on Full Repairing and Insuring terms.

Currently there are less than 5 years left unexpired on this lease.

The existing building is a well-located facility providing and currently offers a wide range of

enhanced primary care services including Phlebotomy, NHS Health Checks, Minor Surgery,

Low Risk Skin Cancer Surgery, ECG and Novacor testing and Enhanced Diabetes services.

However, the partnership is limited in delivering future primary care services / additional

services and is under increasing pressures from premises constraints. Parts of the existing

building fail to comply with the Disability Discrimination Act and the Equality Act.

Throughout late 2016 and early 2017 the practice explored the possibility of transferring to

the Robin Hood Lane premises as part of the redevelopment of that property. For the reasons

outlined within the refreshed options appraisal detailed in the Economic Case section of this

report the practice’s partners have decided not to pursue this option.

No other suitable or affordable premises or land have been identified in the local area for

relocation and the existing building remains in prime position for patient access. The existing

building when constructed included expansion space on the first floor. The project therefore

is to refurbish, reconfigure and upgrade the existing premises and to fit-out existing vacant

space on the first floor (130 m² NIA) and basement (33.44 m² NIA) so that the building can be

fully utilised.

The project will achieve an additional 5 Clinical Rooms, a Multi-Purpose Suite, a Dirty Utility

Room, Lift installation and a new medical records filing room with overall enhanced access

and specification to meet CQC/NHS compliance. This is illustrated in Appendix 1.

The development work is proposed to be fully funded and carried out by the Landlord and the

GP Partnership will enter a lease for 20 years.

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STRATEGIC

CASE

1. Strategic Drivers

These proposals are entirely consistent with the following strategies and plans:

• NHS Plan (DoH 2000)

• Building on the Best: Choice, Responsiveness and equity (DoH 2003)

• Standards for Better Health (DoH 2004)

• Our Health, Our Care, Our Say (DoH 2006)

• High Quality Care for All: NHS Next Stage review Final report (DoH 2008)

• Delivering Care Closer to Home: Meeting the Challenge (DoH 2008)

• Health Inequalities: Progress and Next Steps ( DoH 2008)

• A Call to Action (NHSE 2013)

• A Call to Action – Transforming Primary Care in London (NHSE 2013)

• GP Five Year Forward View (NHSE 2014)

• Better Health for London (London Health Commission 2014)

• Strategic Commissioning Framework for Primary Care Transformation in London (NHS 2014)

• South West London Collaborative 5 Year Strategic Plan (2014)

• Putting Patients First (NHSE Business Plan 2014/2015 – 2016/2017)

• General Practice Forward View (NHSE 2016)

• Sutton CCG GPFV Operating Plan (SCCG 2016)

• PCCC Primary Care Transformation Report (2017)

• NHSE GPN Ten Point Action Plan for General Practice Nursing (2017)

• South West London Collaborative Commissioning Sustainability and Transformation Plan (STP 2017-2019)

Additionally, the following legislation is also of relevance:

• The Equality Act 2010

• Health and safety at Work Act 2005

• Disability Discrimination Act 2005

• Regulatory Reform (Fire Safety) Order 2005

The emphasis on providing patients with access to high quality services closer to home and

to shift the balance of services from secondary to primary care settings is consistent with

The NHS Plan (DoH; 2000), “Our Health, Our Care, Our Say” (DoH; 2000), Building on the

Best: Choice, Responsiveness and Equity (DoH; 2003), Delivering Care Closer to Home:

Meeting the Challenge (DoH; 2008) and High-Quality care for All (DoH 2008).

The additional space would provide an environment that promotes effective care,

optimises health outcomes (Standards for Better Health; DoH 2004) and assists with

promoting the reduction in health inequalities (DoH 2008) while meeting the NHS England

“Transforming Primary Care in London: General Practice A Call to Action” (Nov 2013)

agenda by providing access to appropriate care within a local community environment and

support continuity of care for patients with long term conditions (LTC). It will also support

the provision of primary care at greater scale, which it is suggested will enhance

sustainability of the primary care model.

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The NHS Five Year Forward View recognises the central importance of the registered list,

and everyone having access to a family doctor alongside a greater integration of services

provided in the community. The practice partnership is eager to respond to these

proposals, but, without the suggested investment in primary care infrastructure, would be

limited in its capacity to deliver additional services and scope from the existing premises.

The Forward View further states that properties need to offer the following:

‘…increase the flexibility of facilities to accommodate multi-disciplinary teams and their

training, innovations in care for patients and the increasing use of technology. And new

premises may be needed to cater for significant population growth, and to facilitate

primary care at scale or enable patient access to a wide range of services.’

The premises do not currently provide this but the proposed development will satisfy each

of these requirements. It will future proof the property for the life of the new lease as a

minimum.

The latest draft Strategic Commissioning Framework for Primary Care Transformation in

London specifies the three aspects of care that matter most to patients; the enhanced

premises will enable the partnership to provide proactive, accessible and coordinated care

through fit-for-purpose fully compliant, extended premises, located in the right place for c.

13,000 patients.

The additional space will enable a significantly greater provision of services thus

empowering clinicians and facilitating better working with the CCG, locality GPs, secondary

care, mental health and community care providers. At the same time quality and safety will

be at the heart of delivery of services through fit-for-purpose and compliant premises.

• Royal College of General Practice Strategy

The RCGP “Vision for General Practice in the future NHS” 2013 Strategy demonstrating the

college’s view of what general practice will look like in 2022.

The key themes are highlighted in Figure 3 below:

Figure 2: RCGP view of the patient experience in 2022

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This proposal for additional space and refurbishment enables this primary-care driven

project to deliver the above items and deliver the RCGP Strategy.

• Sutton CCG Strategy

As part of its primary care strategy programme, NHS Sutton Clinical Commissioning Group

has invested in primary care in Sutton. The aim of this programme is to transform primary

care services to ensure that Sutton residents and patients have access to consistent high

quality, accessible and responsive health services.

This strategy revolves around:

• improving access

• improving patient experience

• improving health outcomes

• Education and training and workforce development

• GP Practice IT system upgrade

The recent PCCC report has further operationalised these principles and the future

development of the practice will be delivered with the express purpose of delivering these

outcomes.

The proposed project responds to this strategy through

• Better management of LTCs through early diagnosis, increased patient education and an upskilled workforce leading to improvements in health outcomes

• Adequate space to enable training and development at the site and increased space to enable more GP / medical student and nurse training placements

• Improved access to secondary care, mental health and community services through out-of-hospital, community based care

1. Socio-demographic need

The Sutton Health and Wellbeing Strategy 2016 - 2021 estimates that in 2014 Sutton had a

population of 199,000 residents with, at that time, 27 Practices in the NHS Sutton

catchment area. There are estimated to be around 13,900 children (7%) under the age of 5

which is higher than the England average which is 6.3%

There are 4,300 people aged over 85 which accounts for 2.2% of the Sutton population, this

is higher than London (1.6%).

The population of Sutton is increasing. It is predicted that by 2022 it will have increased by

14% since 2012. However, the age profile is rising as well as the actual numbers – it is

predicted that by 2022 there will be a 21% increase in over 65’s.

Applied to the immediate demand upon the practice it should be noted that much of this

development is within 0.5 miles of the practice. The practice is located immediately behind

the high street which makes it a very central location for the entire community and very

convenient for access.

CCG Query: Provision of increased Primary Care Capacity

It has been noted by the CCG that the existing list size has not differed significantly for the

past five years. This is in the context of the majority of practices in the locality seeing similar

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consistency.

The existing patient to GP ratio of c.2,250 patients per WTE does not currently offer a safe

basis on which to grow the list further.

The extended and renovated site will change this situation. The new space will allow the

practice to increase the number of clinicians and health professionals, including trainees by

providing dedicated clinical space in accordance with the deanery’s requirements. This will

improve the ratio and will allow the practice to actively promote its services.

This approach will also allow the utilisation of AHPs who can help provide services such

assessment and support of the needs of frail elderly individuals and those with complex

needs or multiple co-morbidities.

The development of increased clinical space will enable us to significantly expand the

number of patients on our registered list and we are currently exploring a number of

methods/ways to do this. These include:

• changing the signage on the building to NHS dementia friendly signage that will

clearly identify the site as providing NHS primary care services

• highlighting the redevelopment and modernisation through the local press, local

community pharmacies and community centres

• providing leaflet information to the new developments within the town centre

• improving our use of technology integrated healthcare to assist with the provision

of convenient service delivery

• requesting a change of name to the bus stop outside the surgery on Throwley

Way from “Manor Place” to “Old Court House Surgery”

Once the specialist clinics, multi-specialist team services and third sector support

arrangements are in place the partners anticipate a rapid increase in patient list size. When

the practice provided dedicated diabetes hub clinics c.2010 they were unable to register all

the requests received and a similar demand is anticipated moving forward.

2. Local Health Needs

The Local Joint Strategic Needs Assessment (JSNA) Health data in Figure 3 below highlights

the following key areas that need to be addressed in the Sutton Central ward:

• High percentage of pensioners living alone

• High levels of multi co-morbidity patients

• Significant pockets of high deprivation

• Increasing levels of frail / elderly patients

• Sutton has become more ethnically diverse in recent years

• Significant health inequalities with an 8-year variance in life expectancy

• High levels of mental health population

• Increasing birth rate

• Increase in poverty due to welfare reform

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Figure 3 – Public Health England

The practice’s specific details represent similar patterns and the improved premises will

help to target these on behalf of the wider locality needs.1

1 http://fingertipsreports.phe.org.uk/gpp/index.php?CCG=E38000179&PracCode=H85030

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3. Premises issues

The key premises issues include the following:

• The practice currently occupies and provides services within a converted courthouse that is in part non-compliant.

• There are no facilities for running additional clinics at times of high demand, for example on Mondays or Fridays. The consulting rooms are all used to maximum capacity, meaning that it is not possible to increase the capacity necessary for the rising population.

• Larger scale clinics such as health education sessions cannot be organised.

• There is no dedicated room for Practice meetings and training sessions.

• When the clinic rooms are full, GPs use the computer stations in the reception areas, which is noisy, crowded and presents difficulties for confidentiality.

• There is no dedicated secure patient record space; records are currently stored in the reception areas as well as in the small offices.

• The premises do not comply with best practice for infection control (sink installations and floor coverings) and are not Equality Act compliant. Special arrangements are required to allow for patients with specific access requirements.

• The site did pass CQC inspection in 2016 achieving a ‘Good’ rating. This was only achieved by providing evidence that the site was due to be refurbished and confirmation that the CCG had approved it in February 2016.

• There are no premises or land of sufficient size in the local area to relocate to and there is vacant space within the existing building that is not currently in use.

In addition, it is anticipated that the local plans for significant numbers of new homes will

consequently impact the number of registered patients by in the Central Sutton ward by an

estimated 8,000 new individuals. In addition, the JSNA report estimates Sutton population

will increase to an estimated 222,000 individuals by 2022.

With over 12,800 patients, the existing building is currently used to its fullest capacity and

there are significant issues with the current layout, design and specification which results in

CQC / NHS non-compliance.

The project proposal will be able to provide additional space for the provision of PMS and

secondary care services, which will be able to service the existing patient list size and the

expected population growth.

There is therefore an urgent need to develop and enhance the existing premises for the Old

Courthouse Surgery to continue providing primary care medical services.

4. Key priorities to be addressed

This proposition delivers a strategic need which:

• Responds to NHS England, RCGP and CCG Strategies for primary care

• Identifies the local need for additional services in Sutton and addresses key local

health issues

• Responds to the requirements of the local population

• Addresses the existing premises issues

• Presents value for money to the NHS

• Provides the partnership with security of tenure and future business stability

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Benefits of achieving this will include:

• Compliance with all CQC regulations and NHS design and specification. It is

important to note that the existing ‘Good’ rating was predicated on providing

evidence of the refurbishment plans and CCG’s original approval for the works to

be completed. Failing to now complete this work is likely to trigger a re-inspection.

• Ability to provide additional clinical services to a growing and aging local

population and a high prevalence of long term conditions and multiple co-

morbidity (there is on-going development in Sutton which is expected to generate

significant numbers of new dwellings within 0.5 miles of the surgery).

• Ability to provide additional clinical / primary care services to meet the Out of

Hospital NHS agenda.

• Ability to deliver services that would support the Out of Hospital agenda and

reduce pressures on secondary care/ emergency services.

• Ability to comply with the Equality Act by improving access for disabled patients

and parents with small children, and includes the installation of a lift. This will also

improve patient satisfaction and attract new patients.

• Provision of a multipurpose Education and Development Room that can be used

for patient education and staff training and improve collaboration opportunities

through fit-for-purpose meeting facilities.

• Ability to employ / train additional Healthcare professionals and provide primary

care services with GP / Nurse / patient training and education facilities

• Support the development of telehealth and other technology based systems such

as virtual consultations via platforms such as Skype

• Ability to improve the quality of care through increasing skill mix of primary care

clinicians, additional clinical hours, extended hours and additional on-site services

which will improve the overall Patient experience.

• Re-modernisation will attract new healthcare professionals into the partnership.

• Extended lease terms will provide existing partnership with security of tenure and

attract new partners to the practice in the future.

• Ability to provide a better working experience for staff and be able to offer

education sessions for patients (requested by PPG) and also improve the overall

patient experience.

The proposal will meet NHS England and CCG Strategies to provide:

• proactive, accessible and coordinated care through a joined-up approach

between primary care, secondary care, community care, local authority and

mental health providers

• improving access

• improving patient experience

• Improving quality and safety

• improving health outcomes

• education and training and workforce development

• improved primary care services

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Provision of community services and activities as part of a health and community hub to

meet key local needs:

• Mental health

• Learning Disabilities

• Elderly frail individuals

• Carers

• Mother and baby services

Confirm the extent to which the scheme delivers on high priority NHS

capital investment requirements, e.g. improving patient safety and the patient

environment, reducing backlog maintenance (% of total); enabling QIPP

delivery, etc.

This question was raised within the original business case as it represented one of the

requirements for the PCIF scheme. The current proposal does not have NHS capital

investment requirements. The following information does however; provide evidence that

the development contributes to the NHS property priorities.

The scheme will enable us to comply with Infection Control guidelines ensuring that we

provide a clinically safe environment for patients. An NHSE Infection Prevention and

Control Audit undertaken in 2016 has clearly identified a deterioration in the fabric of the

Surgery. It also fails to meet a significant number of Infection Control standards which will

be highlighted in our next CQC Inspection.

The additional Clinical Rooms will allow us to accommodate a more diverse range of

Clinicians, more appointments and subsequently increase Patient Access to meet the

increasing demand.

We already contribute to the Out of Hospital Care Agenda by housing the community based

ECG service. Although there is evidence that there is more demand for this, however we

are unable to extend the days we offer the service due to lack of space.

The level of increase in dwellings that Sutton has been asked to provide on an annual basis

(new build and brownfield developments) is resulting in an increased density of the Sutton

Central population. A significant majority of these individuals are either

• elderly (in care homes, residential homes or housed in the growing number of

retirement apartments being developed)

• immigrant (where English is not their first language)

• young families

This has already led to a significantly increased demand across all Clinicians in Primary Care.

In addition, this increased demand, coupled with the on-going difficulty in recruiting

clinicians locally in Primary Care, has led to a local Practice closing their list to new

registrations.

Our recognition of the often-complex health needs of our Practice population has required

us to diversify our clinical skill mix. However, to remain an employer of choice our

employment policies reflect the national requirement to offer family friendly, flexible

working arrangements for our staff. This has led to an increased number of part time staff

who require confidential workspace to provide clinical services.

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Due to the confidential nature of clinical interactions, each individual requires a room to

work in, and this has resulted in considerable movement of staff between rooms on a daily

basis.

Whilst staff are happy to be flexible, we still require an area for each Clinician to undertake

consultations. Without the increase in clinical rooms we are unable to increase the number

of employed Clinicians and therefore unable to increase the number of patient contacts.

In line with recent findings (JSNA 2016) regarding the more common causes of morbidity

and mortality of Sutton residents we have expanded our Clinicians’ knowledge base to

ensure they are able to meet the needs of patients with long term conditions, specifically

diabetes, respiratory disease and those with multiple co-morbidities. However, the

increasing elderly population will require additional clinical time in order to obtain support

in managing these LTC – again resulting in the need for extra Clinicians.

The current window furniture means that noise disruption has an adverse effect on clinical

sessions. There are delivery lorries at the back of the building and frequent buses to the

front. This compromises both the quality of the patient interaction and patient

confidentiality. Double glazed windows (as opposed to the existing windows) will help

manage heating costs and provide noise management for the Consulting Rooms that are

affected by traffic and passers-by.

It is anticipated that the proposed plans for the replacement of the heating system will

reduce boiler maintenance costs and improve energy efficiency.

Confirm the support of key clinicians and the way in which the scheme

supports delivery of local commissioning priorities.

The practice already partners with a number of community and voluntary services that use

the building such as Age UK and the Carers organisation. It is recognised that given the

location and size of the building, the partnership is ideally placed to allow other

organisations to deliver services from this site.

The practice would like to grow and collaborate; however, this is simply not possible due to

premises constraints:

• There is no opportunity to increase the medical / nursing training offered by the practice, as there are no rooms available to provide further GP registrars, F2s or nursing pre/post registration students with dedicated space.

• There is simply no prospect of developing or extending further enhanced services at the practice (despite the demands of the patients) because there is no room to do so.

• There is limited scope for future partnership working with other practices, which would enable possible improvements to out of hours and extended access, due to the restrictions of the current building. Redevelopment of the currently unutilised space will facilitate such development.

• The lack of a dedicated meeting room means that integrated care working opportunities cannot be realised, as the practice cannot accommodate external staff to work along the practice team.

• Patient Participation Group (PPG) - a recent survey indicated an overarching concern with regards to access for patients and the ability to comply with the Equality Act.

• Approximately 20% of the current patient list (c. 2,500) is aged 65 and over which

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is set to increase with an aging and growing population.

• Sutton CCG – regular discussions have taken place and the project is fully supported to provide future Primary Care services from this building. This proposal to increase and develop a wide range of community based services would assist in supporting NHS Sutton CCG with its Strategic Five-Year Plan and enable the proposals of the GPFV to be realised.

• NHS England – discussions have been on-going for a number of years and it had been indicated that this scheme would be supported.

• LMC – no formal discussions have been held however we have no reason to anticipate any objections.

The additional space and enhanced facilities will benefit users, such as:

• Local populace / registered patients, especially older patients (65+ years)

• Medical / Nursing students from St George’s Hospital and Kingston University

• Post Graduate nursing students and GP Registrars from St George’s Hospital

• The PPG

• Baby and Infant Support Services

• Parkinson’s Group

• Educational groups within the CCG

• The Voluntary Sector

• Secondary Care Providers

• Enhanced services with Sutton GP Federation

• Clinical Forums

ECONOMIC

CASE

Options Appraisal

Within the original business case an appraisal of the non-financial benefits of the three

identified options was undertaken. Since that time the partners have had the opportunity

to review the options further and to test the basis of their original decisions.

This process has not changed the original decision and has helped the partners form

stronger arguments in favour of option 2. The following provides a brief summary of the

latest position on each option starting with options 1 and 3 to explain the decision to

exclude these.

Option 1 – Do nothing

The case against doing nothing remains largely unchanged. This includes the following:

• The lease is due to expire in 5 years at which point the practice will be occupying

at risk

• The property continues to age and without a commitment to a new lease the

necessary refurbishment cannot be funded

• The boilers require replacing whilst the environmental compliance of the property

is very low due to the poor insulation and windows. This will affect future

environmental audits

• The service is not fully Equality Act compliant

• If the commissioners are no longer committed to improving the condition of the

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property, the CQC will no longer be able to give a ‘Good’ rating as this was

predicated on the commitment letters provided by the commissioners

• The minor operations and treatment suite are subject to an infection control

audit. It is likely that the service will no longer be able to provide minor surgery in

accordance with the new DES. As one of only two Level 3 minor surgery providers2

this will result in the following:

o Increased referrals to acute services (for example c.45 basal cell

carcinomas in 2016/17 saving approximately £17,000 when compared

with elective day cases3 other minor surgery will have similar cost

efficiencies which will be lost)

o The practice may consequently see a reduction in income of

approximately £15,000 to £20,000 which in turn may compromise

employment of clinicians or support services

o Patients will not be able to access treatments at their preferred choice of

surgery

• The service is unable to provide a full range of training to its staff and patients as

it lacks appropriate facilities. The practice employs experienced GP trainers and

50% of the localities nurse mentors including the only sign-off mentor

• The service has been successful in recruiting, unlike neighbouring practices, this is

due to the reputation of the services and vision for the future. To continue with

this the partners, need to deliver the improvements in the service. This will assist

in the next generation of partners committing to the future of the practice and

will secure the provision of health care in the heart of Sutton

• List growth is currently limited due to the limits on the property, this increases the

risk that the practice will not be able to register a significant proportion of the

8,000 to 10,000 new individuals and families due to move into the town

• The selection of the site as the preferred Hub for extended hours and federation

services has resulted in new opportunities to help the community, these will need

to be hosted in appropriate services and require long term planning which the site

is not able to commit to given the current position

• Medical records storage has reached capacity and the current storage

arrangements were raised as a concern by the CQC. The provision of the

alternative storage plans gave them sufficient assurance about the future of

medical record management but it is essential that this is delivered

The site is close to becoming unfit for purpose. The imminent end of the lease is the

necessary catalyst for bringing about improvements whilst the strategic demands upon

primary care mean that substantial benefits can be provided through the renovation of the

property.

Option 3 – Find new premises

When the CCG proposed redeveloping the Robin Hood Lane (“RHL”) site the partners

participated in reviewing this as an alternative. The practice runs branch services from the

2 http://www.suttonccg.nhs.uk/Aboutus/primary-care-commissioning/docsPCCC/FINAL%20PCCC%2006.09.17.pdf#search=old%20court 3 https://www.nice.org.uk/guidance/ph32/resources/costing-statement-pdf-67559149

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site and it was deemed appropriate to consider this option. During this review period, it

became evident to the partners that the option was not suitable for the following reasons:

1. The location is less favourable for patients. OCH currently has 14 bus routes and

over 60 buses an hour stop at the front door. It offers immediate access to the

high street. RHL, while reasonably close to some bus routes, does have, by

comparison, reduced public transport access. Although it is close to the high

street it is at the top end of the hill which has been commented upon by patients

and staff. Furthermore, the route of access has been identified as difficult by a

significant proportion of patients who took part in the practice questionnaire.

2. OCH has dedicated parking including disability bays. It is close to several of the

larger public car parks. RHL has no dedicated parking and only one busy public car

park which is often full.

3. A patient survey run by the PPG on behalf of the practice returned over 1,200

responses which preferred the redevelopment and continued use of the OCH

property and only approximately 39 in favour of the move.

4. The capital cost and time required to develop the RHL property is far greater than

the cost and time required to improve the OCH premises. OCH can be developed

within 9 months of approval, it does not require NHS capital funding and the

increase in revenue funding will be within the limits defined by the DVS providing

greater certainty and affordability for the practice, patients, CCG and NHS

England. Furthermore, the development will not incur disruption of nor relocation

of services.

The OCH partners have concluded that this option is no longer viable and scores

significantly lower than the original scoring in 2016.

Option 2 – Modernise/extend existing premises

For the reasons outlined above the partners believe that this is the only viable option. It is

apparent that there are four sub-options to this option:

A. Modernise only

B. Modernise and reconfigure existing demise

C. Utilise existing vacant expansion space

D. Remodelling and extension of existing premises (including effective utilisation of

current vacant space) and harmonisation of Primary Care services onto one site

(Old Court House Surgery site only) removing the need for branch premises at RHL

All four sub-options would require an extended lease at a reviewed Current Market Rent

figure to give the service stability and to provide the landlord with sufficient security to

invest in undertaking the appropriate work.

A. Modernise only

This sub-option would result in significant modernisation of the property but relatively few

significant changes to the layout of the existing demise. It would not extend the property

into occupying the current vacant spaces.

There is little benefit to the practice, the patients or the NHS in taking this approach. The

site would ensure CQC, Equality Act and infection control compliance and the general

working environment would be improved but the most significant issues will not be

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resolved. For example, this approach would not cover the following:

• There would be insufficient clinical space to grow and expand services for the

practice, for the integrated locality model of primary care or extended services as

a Hub

• The practice will not be able to provide training for GPs and nurses due to the

insufficient number of clinical rooms

• Medical record storage is at capacity and may not satisfy data security

requirements

• The premises are not future-proofed and the decision to redevelop and expand

will need to be regularly reviewed by the commissioners as local demand on

services increases

It should be noted that due to the landlord using the revenue funding model to fund the

modernisation works this approach would not affect the cost to the NHS when compared

to sub-option B.

The practice would not support this approach and believes the service should maximise

the return from the revenue funding but undertaking the full scope of redevelopment an

expansion works.

B. Modernise and reconfigure existing demise

This approach would result in the following additional benefits to the practice:

• Three additional clinical rooms

• Overflow waiting facilities with the ability to isolate infectious patients

• Improved patient access including the installation of a lift to utilise the existing

upstairs demise for clinical purposes

• Installation of improved and appropriate minor operations and treatment suite

including dirty utility facilities

This sub-option would not resolve the medical records storage problems and would create

greater difficulties as existing space would be reduced further to optimise clinical usage.

This would lose the current staff room and kitchen areas.

The approach would provide limited ability to redesign service delivery to incorporate

greater integration with social and third sector services. The increased clinical facilities

would not provide the non-clinical facilities required to deliver the objectives of the GP

Five Year Forward View.

The partners are of the view that this sub-option would improve the utilisation of the site

but would not offer the potential benefits to the future of the service.

C. Utilise existing vacant expansion space

The principle difference from the other sub-options is the development of the vacant first

floor space and the basement. The remainder of the practice will be redeveloped and

modernised.

This additional space will increase the demise funded by rent reimbursement by 163.44 sq.

metres accounting for the proposed revenue increase.

The additional space will allow the practice to provide the following:

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• Five additional clinical rooms (uprated from 3)

• Secure storage facilities utilising the Court’s former cells for security

• The development of a multi-purpose training suite will allow delivery of the

following:

o Dedicated training space available to staff, patient groups, the CCG and

other providers, with no additional cost to access the training

o Meeting facilities, with no additional costs to the CCG

o Multi-disciplinary team services including out of hospital and integrated

primary care services

o Health education for patients

D. Remodelling and extension of existing premises (including effective utilisation of

current vacant space) and harmonisation of Primary Care services onto one site ( Old

Court House Surgery site).

This is the preferred option for the partners.

As previously outlined, utilisation of the additional space would provide, alongside other

benefits:

• Five additional clinical rooms

• Secure storage facilities for patient notes

• Development of a multi-purpose education and training suite

The Partners propose that harmonisation of primary care services onto one site, the Old

Court House Surgery which would enhance the management and continuity of patient

care. Currently all clinicians provide one day of service at the Robin Hood Lane branch site

meaning that patients may have to travel across sites on occasion to see their preferred

clinician or undergo specific investigations (for example, spirometry ). Such localisation of

clinicians and services would also enhance relationship continuity, identified as an

important factor in patient-clinician relationships by our recent patient survey.

As has previously been stated, the Central Sutton location of the Old Court House provides

significant access to local transport links with an adjacent bus stop that receives 58 buses

an hour from 14 different routes. Furthermore the proximity to the High Street enables

rapid access to community pharmacies and local shops which has been identified as a

significant situational benefit by our patients.

This is the partners’ preferred option. It has significant benefits to the wider health and

social care sector and ensures that the premises are future proofed for projected

demographic changes in the locality for the next 20 years

Value for Money

Assessing Value

This report has identified three areas in which benefits can be delivered by the extension

and modernisation of the existing OCH site whilst delivering value for money. Some of

these benefits can be delivered without delay upon completion of the work whilst others

will need to tie into the longer-term process of service redesign, working at scale and

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integration.

Consequently, there are limited guarantees beyond the immediate benefits, which are

anticipated to cover the increase revenue value, but it is important to focus upon the

opportunity value which is substantial for the site.

It is important to note that the property refurbishment can be completed within 9 months

whilst the staged approach to implementing the works will ensure that various parts of the

refurbished property will be available earlier than this. OCH will deliver service changes

and developments within this financial year if approval is granted without delay.

Financial Value

The existing landlord is offering an investment of approximately £1.47 million to undertake

the necessary works. This investment will be recovered through the standard rent

reimbursement process and does not represent a capital cost to the NHS.

The rent will be subject to DVS valuation although it is anticipated to equate to an

additional revenue cost of £54,824 plus VAT. This sum represents the entire financial

commitment from the commissioners.

This revenue figure is comparable to the cost of relocating and the savings from not using

NHS capital funding should ensure an immediate benefit for the NHS.

The partners are confident that the utilisation of the facilities and delivery of a wider range

of integrated services will represent a significant saving far exceeding this figure on a

recurring basis.

The following is a summary of indicative savings to the wider health economy that the

extended and redeveloped property will contribute to.

1. Extended access to primary care

In July 2017, the Primary Care Committee identified the Old court House surgery

as its preferred site for the Central Sutton hub to deliver extended primary care

services. This service will underpin the delivery of 8-8 seven-day week access on

behalf of neighbouring practices. The financial value of this will be significant as it

will allow for better co-ordination of care between the practices balancing patient

command. This is the first of several ways in which the practice can and will assist

Sutton GP Services to deliver primary care at scale whilst improving integration.

The commitment to avoid ‘double pay’ by ensuring property costs such as rent or

licence fees are not charged provides an immediate financial benefit. An exact

figure is difficult to quantify but this has reduced the overhead charge by around

£3,000 per annum which will offer greater benefit the more the federation and

other providers utilise the additional space.

2. Secure minor surgery clinics

The current risk to minor surgery provision at the site will no longer exist which

reduces the risk of referrals to more expensive outpatient and day-case services

provided by acute services. The improved facility will allow the service to train

new GPs in minor surgery. This will increase the number of appropriately skilled

clinicians within the locality.

The savings represented by securing the future of this service are substantial.

Expanding the basal cell carcinoma surgery within the practice could deliver

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savings of £388 per patient for the health economy requiring less than 2 a week

to deliver sufficient savings to cover the investment.4

3. Musculoskeletal services

The premises may be able to host some of the community MSK services. No rental

fees would be charged providing an immediate financial benefit. This will provide

patients with easy access to this service within the Sutton town centre. Working

with the CCG, Sutton GP Services and local practices the partners could explore

similar service developments being piloted in Croydon.5

4. Falls clinic

The service could host some of the Sutton Falls Prevention Service exercise class

within a Sutton town centre location. For each fall that results in a hip fracture it

can cost the NHS on average £5,744 plus ambulance costs6. Half of those who

suffer from this lose independence and 20% enter care homes. This is a significant

cost which is reflected within the patients of the practice. The JSNA identified the

need to greater integrate primary prevention with access to health care.7 The

developed premises could help to facilitate this and would work with the Sutton

Community Healthcare Services to develop the pathways for Sutton residents.

5. Diabetes education clinics

The prevalence of diabetes, particularly Type II has continued to grow. This

increases the strain on all local health and social care services. The practice has

several clinicians capable of providing an enhanced diabetes service including

accredited education. NICE guidance has indicated that relatively low-cost

intervention and support will have the biggest impact on NHS budgets.8 It is

proposed that the new space within the premises will be available to host lifestyle

training sessions, DESMOND training, dedicated DNS clinics and space could be

available for the Intermediate Community Diabetes Service to provide clinics. This

will assist the existing community diabetes service in delivering additional out of

hospital services and provide further savings.

This is a small sample of the additional services that the practice will look to host and / or

deliver. The partners are fully aware of the importance of moving services out of hospital

and offering alternative routes for patients to access care.

The small increase in revenue funding would be offset by significant savings within the

wider health economy. The decision to appoint OCH as the extended GP Services Hub

supports the further development of the property to host other services designed for

greater working at scale. The close relationships with the federation, community and acute

services will help to identify and mobilise these opportunities ensuring a return on the

investment is achieved within a reasonable time frame.

Practice Value

It is important to note that these changes will have a significant benefit to the practice,

patients and primary care services within the locality.

This project will ensure that the premises satisfy current regulatory standards and improve

the environment for both staff and patients. It will however also provide the following

4 https://www.nice.org.uk/guidance/ph32/resources/costing-statement-pdf-67559149 5 https://www.croydongpcollaborative.co.uk/services/primary-care-msk-pilot/ 6 https://www.nice.org.uk/guidance/cg161/resources/costing-statement-pdf-190029853 7 https://data.sutton.gov.uk/wp-content/uploads/2017/08/FALLS-PREVENTION-Fact-Sheet.pdf 8 https://www.nice.org.uk/guidance/ph35/resources/costing-statement-pdf-68871997

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quantifiable benefits:

1. Improved recruitment

Locally recruitment has been difficult for some practices. OCH has not had this

problem and has successfully recruited over the past 12 months. The reputation

of the practice and future plans have helped with this process. However, essential

to this is the development of the site moving forward. Without this recruitment

could become a concern in the future.

The cohesive, committed and long standing primary care team at Dr Grice and

Partners have created significant stability for the patients and the commissioners

especially in the context of local practices seeking to close their lists. This will

impact on the ability to provide services locally and on the number of GPs and

nurses available within the local community.

2. Development of training

The practice currently employs medical and nurse trainers and importantly, this

includes 50% of the nurse mentors for the whole of Sutton. It is a requirement

established by the Deanery that trainees require dedicated working space.

Currently there is insufficient capacity to provide this and consequently the

practice is unable to offer medical training opportunities. The practice continues

to support pre and post registration nursing and Non-Medical prescribing training

opportunities but the lack of additional clinical rooms restricts the number of

these placements.

The new clinical consulting rooms will allow the practice to provide rotations for

students and placements for trainee GPs and nurses. This is an essential resource

to continue to develop clinicians within the locality and to ensure the CCG does

not miss opportunities to access the increased numbers of GPs and nurses being

trained in accordance with the GPFV. The practice currently works with the CEPN

but is unable to fully assist with deliverability of the GPN 10-point plan due to the

current space restrictions.

3. Diversified workforce

The partners have always supported a multidisciplinary workforce but the list size

and the facilities make this increasingly difficult to deliver. The increased space

and the position as a service Hub means that the practice will now be able to host

a range of additional clinicians and will work with local practices to establish how

a diverse workforce can be delivered at scale.

The practice currently has three receptionists undertaking training to provide an

enhanced care navigator role. A further example of this will be to work with the

federation to utilise the services of a Clinical Pharmacist in accordance with their

successful bid for funding. The practice is interested in diversifying further its

workforce to include paramedics and PAs to assist with the assessment of the frail

elderly and those with complex needs, alongside the delivery of home visit

assessments.

4. Increased expertise within existing team

The practice has always invested in the training of its team members. All nurses

undertake advanced training in management of long term conditions to enable

management of the increasing number of patients with multiple co-morbidities

and complex conditions. This approach to staff development ensures that staff

continually upskill to meet the identified health needs of the practice population.

Multidisciplinary educational sessions, which already utilise local clinical expertise

form secondary and community services experts could be expanded to other

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practices in the locality with the aim of increasing the core skills and expertise

across the local primary care infrastructure.

5. Succession planning

The registered patient list size for Dr Grice and Partners has remained static over

the past few years due to the lack of available clinical space to support additional

team members. We currently have a multidisciplinary team that includes

healthcare support workers but have been unable to develop this further due to

the lack of available clinical rooms on the Old Court House site.

Remodelling of the, already established, Old Court House site will provide

continuity of service for a Practice that has already existed in Sutton town centre

for three generations. The fundamental principles embedded in our mission

statement are embraced by the current Partnership and supported by our staff.

Attracting new GP’s into the practice and ensuring that the underpinning ethos

regarding patient care continues into the future will be a core feature of our

service harmonisation. To date we have been fortunate to have easily attracted

new staff, both clinical and administrative, to work at our practice.

We consider that the proposed modernised and enhanced environment,

alongside a commitment to improve our use of technology, will continue to

attract new clinicians who will continue to strengthen our focus on reducing

health inequalities and providing primary healthcare services for the 21st century

and beyond.

As previously stated this will represent a significant return for the investment required.

Social Value

The partners are conscious of the increased importance of demonstrating social value

when assessing opportunities. This section considers the impact the preferred option will

have on the social, economic and environmental wellbeing of the Sutton locality.

Social

The premises will be utilised to develop a wide range of integrated services in partnership

with both social and third sector organisations. This will include the development of care

navigation and the practice will work with the Sutton Centre for Voluntary Sector9 to

identify partners and methods of utilising the site to optimise the benefit to the patients

and community.

It is acknowledged that a significant proportion of GP and nurse appointments are not

related to clinical matters. By supporting the development of administrative staff into the

role of care navigators OCH can become a central hub where individuals can access social

support alongside health needs. This will enable patients to access the additional support

they may require and subsequently facilitate a reduced demand on health services.

OCH will embed the principles and benefits of social prescribing through a variety of

pathways such as the formal commissioning of social prescribing services or by virtue of

the expanded relationships with the third sector.

The premises will look for opportunities to maximise use of the space in a multi-

disciplinary manner. This would include providing access to patient support groups such as

Breathe Easy, Asthma UK, Diabetes UK, the Alzheimer’s Society and Age UK to provide

9 http://www.suttoncvs.org.uk/

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dedicated support and self-management training to patients.

Where possible programs will be developed to support patients in attending OCH as a

“one- stop shop”. For example, a multi-disciplinary foot clinic could be run in conjunction

with diabetes or heart failure clinics to treat and educate patients within one dedicate

space. Such services result in managed patterns of demand and reduced variance within

on-day demand requests.

It should be noted that this approach has been highly successful within the Bromley by

Bow Centre and recent research by the Social Prescribing Network has shown the following

benefits to the wider health economy which could be delivered in Sutton:

• Average 24% reduction in A&E attendances

• Average 28% reduction in GP referrals

• Average SROI of £2.30 per £1 invested10

The partners understand that this field of work is relatively new and continues to develop

however the current research suggests it will provide significant returns to the

commissioners. From a practical perspective, the partners have strong relationships with

local charities and understand the needs of their registered population. They understand

that providing this integration will ensure that the practice offers real value to patients. It

will shift the model of primary care delivery from the sickness model towards the

enhanced self-care model which provides far greater benefits for the health economy and

the wider community.

Economic

The development of improved navigation across all sectors will directly impact upon the

wellbeing of patients. Referrals to housing teams, job seeking services and charities

dedicated to assisting people back to work will help develop a complete holistic model of

support around the individual.

This will be provided in conjunction with existing plans to develop local services and the

premises will be able to assist with holding appropriate meetings and clinics to help access.

The location in the town centre will help accessibility for a wide range of individuals who

may otherwise struggle to find these resources.

Environmental

The current property is not environmentally friendly. The property is poorly insulated,

requires new windows and has inefficient heating system. Improving these aspects will

improve the environmental rating of the property.

The property will improve compliance with the carbon reduction policies.

In addition, it will significantly improve the working environment of the employed staff and

overall patient experience.

Strategic Value

Careful consideration has been had in relation to how the future of the practice will be

shaped by the changing needs of the community and the demands upon general practice.

The partners acknowledge and the above points should evidence that the traditional

model of care has questionable sustainability and needs to evolve to provide enhanced

10 https://www.westminster.ac.uk/patient-outcomes-in-health-research-group/projects/social-prescribing-network

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health and wellbeing benefits for all.

Since the submission of the original business case the strategic priorities have been

clarified with the development of the South West London STP Commissioning Intentions11,

Sutton CCG GP Forward View Operating Plan12 and the CCG’s Primary Care Commissioning

Committee has published the Primary Care Transformation Report13 which has allowed the

practice to align plans with delivering the PCCC’s priorities.

Each of the projects detailed above can be matched to corresponding strategic and

operational objectives outlined within the documents referenced. The redevelopment will

ensure that the practice can comply with the 17 Transforming Primary Care in London

standards the PCCC have referenced:

It should be noted that delivery against these can be commenced without delay and the

current delivery of Hub based GP access services demonstrates that the practice is already

delivering against these standards.

Upon receiving confirmation from the CCG to proceed the landlord can commit to

commencing delivery of the renovation within 9 months. This is significantly less time than

the development of RHL and will provide an immediate test bed the CCG can use to

develop concepts they may wish to implement elsewhere.

The practice is also committed to working with the CCG and partner organisations to

reform and evolve the delivery of services without delay.

Conclusion

The partners believe the case for the second option provides significant value for money to

the commissioners. They would gladly discuss this further and the specifics of any services

can be developed once the new lease has been approved.

FINANCIAL

CASE

There are no capital funding requirements for this project from NHSE / PCIF. The estimated capital costs to be incurred by the landlord of The Old Court House Surgery are summarised below:

11 http://www.healthwatchcroydon.co.uk/sites/default/files/wel20161019_05_03_ccg_appendix_1_10.pdf 12 http://www.suttonccg.nhs.uk/Aboutus/primary-care-commissioning/docsPCCC/ENC%2004bSutton%20GPFV%20Operating%20Plan%20Dec%202016.pdf 13 http://www.suttonccg.nhs.uk/Aboutus/primary-care-commissioning/docsPCCC/FINAL%20PCCC%2006.09.17.pdf#search=old%20court

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Estimated Capital Costs 2017: In 2016 and 2017 the landlord has completed procurement exercises to improve the accuracy of the estimated costs. This accounts for the significant increase since the original business case. The landlord remains committed to making this investment despite the increase and reiterates that it does not seek a capital contribution from the NHS in order to undertake the works.

Capital Works Total cost Rate psm Comments

Fit-out works £173,250 £718 For former vacant space

Refurbishment works £1,005,749 £890 Covers all areas

Fees £282,204 n/a Incl. SDLT & legal fees

Finance costs £9,741 n/a 4.5% for 50 weeks

TOTAL £1,470,944

The Landlord will consider any proposals put forward by NHSE for capital deployment, if it

were to contribute a capital sum towards these costs.

Confirm the recurrent revenue costs of the scheme. If a lease is proposed,

confirm the whole life cost of the lease

The property will be leased to the partnership on a full repairing lease for 20 years. The

tenant will therefore take responsibility for all operating costs, such as cleaning and other

‘soft’ facilities management, repair, maintenance, replacement / renewal of hard facility

management systems, energy and utility consumption, security and property management

over the life of the built asset.

The building is already leased to the partnership with only 5 years remaining. The building

was fully fitted out 20 years ago, with the costs of repair and maintenance having

increased since initial occupation. The Landlord is proposing to upgrade and modernise

the facilities, including new boilers and air flows, and the resulting maintenance and repair

costs should fall, even though additional occupational space will be created.

The costs below are the current annual costs of the existing building plus an estimated 17%

uplift for the additional space being brought into use. The estimated 17% represents the

proportionate size of the void expansion space to the rest of the existing building.

Rent and rates reimbursement costs – NHS funded

Cost £ per annum VAT @20%

Whole Life Cost (x20 years)**

Existing rent £177,300 £35,460 £4,255,200

Proposed additional rent* £54,824 £10,964.8 £1,315,776

Rates £88,982 n/a £1,779,640

Total £310,201 £46,424.8 £7,350,616 *Current proposed maximum Landlord additional rent (to be confirmed by DVS). **Excludes any rent reviews/indexation/adjustment

Surgery Operational Costs – OCHS Practice funded

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Current annual running costs Total cost

Cleaning £14,625

Inspections (i.e. H&S) £3,500

Maintenance / Repair £32,000

Energy / Utilities £17,550

Consumable items £10,000

Management £4,000

Approximate Total per annum £81,675

Practice Whole Life Costs – 20 years * £1,633,500

*no allowance for inflation

Confirm any non-recurrent (e.g. transitional costs) of the scheme.

Confirm sources of income and expenditure.

Cost Category Sum (exc VAT) Comment Funder

Monitor Surveyor £8,800 1% of build cost Practice

Legal £4,400 0.5% of build cost Practice

Furniture and Fixtures £5,000 Practice

IT Costs £5,000 Price to be confirmed CCG

SDLT £34,000* Landlord

TOTAL £57,200

TOTAL INC VAT £68,640 *Not subject to VAT

The IT cost would include additional hardware equipment which would need to be

supplied in accordance with the standard primary care IT provision arrangements. This is

one cost which will need to be incurred by the commissioners. The details of which can be

confirmed as part of the project implementation stage.

The landlord has agreed to fund all of the new data cabling required up to the wall socket.

Connection to the server itself will need to be provided by the relevant NHS IT contractor.

The non-recurrent charges will be incurred between approval of this business case and

completion of the works in November 2018. This sum would therefore cover two financial

years.

Provide supporting income and expenditure analysis that sets out clearly

the recurrent and non-recurrent costs of the scheme, the sources of funds to

meet these costs, and which demonstrates clearly that the scheme is

affordable.

All figures include

VAT

2018-2019

£’000

2019-2020

£’000

2020-2021

£’000

Total 2018-

2021

£’000

Recurrent 32.9* 65.8** 65.8** 165

Non-Recurrent 69*** 0 0 69

Total 101.9 65.8 65.8 234

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* Maximum of 6 months increased revenue 2018/19 after development completes. All figures include VAT **Note proposed rent review due in March 2017 remains outstanding ***2018-19 non-recurrent cost would be incurred in 2017-18

As detailed above these funds have been identified and are affordable. The landlord and

practice will contribute to all but the IT costs which will need to be managed in accordance

with the local IT infrastructure procedures. The recurrent sum represents an uplift which is

discussed above and considered within the economic case to represent good value for

money.

COMMERCIAL

CASE

Confirm the commercial arrangements for delivery of the proposed capital

investment, e.g. procurement approach and proposed contract type (If not

using NHS Procure21+ for new build or refurbishment projects explain why

not)

The subject property is owned by a third-party investment fund, Primary Medical Property

Investments Limited, which forms part of Octopus Healthcare, a specialist investor and

developer in primary care. The site is held by Dr D Coldrey, Dr S Grice, Dr J Vernon on a 25-

year lease commencing 28th March 1997 on Full Repairing and Insuring terms. Currently

there are only 5 years left unexpired.

The existing building when constructed included expansion space on the first floor, which

is already included within the lease. The project therefore is to refurbish, reconfigure and

upgrade the existing premises and to fit out the existing vacant space on the first floor

(130 m² NIA) and basement areas (33.44 m² NIA) so that the building can be fully utilised.

The development work is proposed to be fully funded and carried out by the Landlord and

the GP Partnership will enter a new lease for 20 years effectively extending occupation for

a further 16 years.

Our Landlord will effectively act as third-party developer and invest the funds required to

develop the premises and bring it up to NHS design and specification standards. It is the

Landlords single focus on the delivery of primary care premises, since it is a specialist,

which means it can offer a dedicated service to the practice, Area Team and CCG to deliver

this scheme.

The partnership and patient participation group has been involved with the layout and

design of the property. The Landlord is best placed to take on this work. The partnership

believes that this will represent value for money to NHSE who will not need to make any

capital contribution but will need to increase rent reimbursement for the additional PMS

space created.

Confirm when any necessary full planning consent will be achieved.

Following the original business case planning permission was submitted to the local council

in relation to two external enhancements. The first was the installation of entrance

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canopies to protect the main and fire exits. The second was for the extensions of a section

of the roof to allow the installation of a passenger lift. These were approved in April14 and

June15 2016 respectively.

Consent for making these improvements expires in 2019 and the landlord is confident that

they will be installed in early 2018 upon receiving approval from the CCG.

All other works refer to internal fit out and do not require planning permission.

The landlord reserves the right to undertake additional work in relation to the installation

of a ramp to improve access and compliance with Equality Act although this is likely to

occur at a later stage and falls outside the remit of this business case. Should it be installed

it will be a landlord investment and would not be subject to further NHS approval.

There are no known factors preventing these developments.

Confirm status of legal documentation and what (if anything) remains to be

agreed

The development work is proposed to be fully funded and carried out by the Landlord and

the GP Partnership will propose a new lease for 20 years. There is currently 5 years

remaining on the existing lease, which includes the expansion space. The landlord will

fund the SDLT costs.

Heads of Terms have been drafted but yet to be agreed, and the latest version is attached

in Appendix 3. These will be finalised following discussions with the DVS and confirmation

to proceed from the CCG.

Fee proposals have been obtained from lawyers and draft documents will be worked up

should the application be successful.

For new build and refurbishment projects confirm: i) compliant with DH

guidance (HBN & HTM); ii) compliant with eliminating mixed sex

accommodation; iii) compliant with an approved infection control strategy; iv)

in alignment with an approved estate strategy, or equivalent; v) intention to

undertake BREEAM assessment and target outcome.

The project team confirm the following:

I. Compliant with new provisions of DH guidance (HBN & HTM) II. n/a

III. Proposals meet HBN & HTM guidance, which includes design in accordance to approved infection control strategy

IV. CCG Strategy supports the proposed works

14 https://fastweb.sutton.gov.uk/fastweb/detail.asp?AltRef=B2016/74237&ApplicationNumber=&AddressPrefix=the+old&Postcode=sm1+4af&CaseOfficer=&ParishName=&AreaTeam=&WardMember=&DateReceivedStart=&DateReceivedEnd=&DateDecidedStart=&DateDecidedEnd=&Locality=&AgentName=&ApplicantName=&ShowDecided=&DecisionLevel=&Sort1=FullAddressPrefix&Sort2=DateReceived+DESC 15 https://fastweb.sutton.gov.uk/fastweb/detail.asp?AltRef=B2016/73733&ApplicationNumber=&AddressPrefix=the+old&Postcode=sm1+4af&CaseOfficer=&ParishName=&AreaTeam=&WardMember=&DateReceivedStart=&DateReceivedEnd=&DateDecidedStart=&DateDecidedEnd=&Locality=&AgentName=&ApplicantName=&ShowDecided=&DecisionLevel=&Sort1=FullAddressPrefix&Sort2=DateReceived+DESC

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V. BREEAM standard are to be maximised to the extent permissible by the property

Confirm any contribution to carbon reduction plan (if applicable).

The project includes the replacement of boilers with modern specification and the

installation of double gazed windows.

Where appropriate, attach site plans and design drawings for the preferred

option.

Please find these attached In Appendix 1

MANAGEMENT

CASE

Confirm the arrangements for management and delivery of the capital

investment scheme

The project is to refurbish, reconfigure and upgrade the existing premises and to fit out the

existing vacant space on the first floor (130 m² NIA) and basement areas (33.44 m² NIA) so

that the building can be fully utilised.

The development work is proposed to be fully funded and carried out by the Landlord who

will act as third-party developer and invest the funds required to develop the premises and

bring it up to NHS design and specification standards.

The scheme will be delivered as outlined in the project delivery proposal attached.

Confirm the key risks to delivery and measures to mitigate and manage

these risks.

Octopus healthcare is highly experienced at managing and delivering the development of healthcare facilities. An experienced project manager will be appointed and their project team will oversee all details of the project. This experience has helped them to develop schemes and methodologies that reduce the impact upon the clinical services during the development. This includes agreeing a plan which will phase each stage of the project. This will be tailored to the practice’s needs and will ensure that clinical services are not impacted. A significant proportion of the work is scheduled to be completed within the basement and first floor which have limited current use (with the exception of the administration offices). By timing the completion of this work, it will allow the patient flow to be designed in conjunction with the practice so they are not inconvenienced by the work. A detailed risk register will be produced and regularly reviewed as part of the project with the partners. The CCG will have an open invitation to attend project meetings to discuss progress. Some common risks will include the following:

• Delays caused by contracting During 2016 and 2017 much of the project was put out to tender. This means that the contracting process will be accelerated and this should avoid some of the traditional delays in the early stages of projects of this nature.

• Lease and revenue costs not approved

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This will prevent the landlord from being able to commit the funding that has been earmarked for this development. This is being managed currently through this business case process and outline terms and conditions have been produced (see below) which should accelerate development

• Poor weather The work includes replacing windows, repairing and replacing sections of roofing. This requires appropriate weather conditions. It is anticipated that this project would commence over the winter which increases the risk of poor weather. However, the contractors are highly experienced and have appropriate plans and actions to manage this risk including flexible prioritisation in delivering each element of the project.

• Unknown property flaws There is always a risk that there could be inherent flaws within the property. The risk of this is low as they would have been identified during the original development in the 1990s. Furthermore, throughout this development stage the project has been under regular review of architects and experienced property professionals. If any issue Octopus has access to highly specialised property experts and they will develop appropriate mitigation plans to manage the issue.

For the avoidance of any doubt there are no anticipated or identified risks to the delivery of this project outside those anticipated of any other refurbishment. These will be managed by applying the best practice principles of property project management.

Provide a simple timeline with key milestones for the procurement and

delivery of the scheme.

Business Case Approval January 2018

DV VfM assessment & approval February2018

Out to tender February2018

Tender Returns February2018

Receipt of NHS App to Proceed March 2017

Legal Documents Completed May 2018

Planned start of works May 2018

Estimated completion date November 2018

CCG QUERIES

During the development of this paper representatives of the CCG have raised a number of

important questions. These have been answered throughout this paper but this section

has been produced to directly respond to them.

1. Why has patient list size remained constant in recent years and what is the basis for

the assumed growth in future years?

The list size has remained consistent across the majority of practices in the Central Sutton

locality. The existing patient to GP ratio of c.2,200 per WTE does not offer a safe basis on

which to grow the list without sufficient clinical room capacity.

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The extended and renovated site will change this situation. The new space will allow the

practice to increase the number of clinicians and health professionals, including trainees by

providing dedicated clinical space in accordance with the Deanery’s requirements. This will

improve the ratio and will allow the practice to actively promote its services.

This approach will also allow the utilisation of increased numbers of AHPs who can assist

with the provision of services such as management of the frail elderly and multiple co-

morbid, complex individuals who are often housebound.

Once the specialist clinics, multi-specialist team services and third sector support

arrangements are in place the partners anticipate a rapid increase in patient list size. When

the practice provided dedicated diabetes Hub clinics c.2010 they were unable to register

all the requests for registration received and a similar demand is anticipated moving

forward.

Local population growth is anticipated to be in the region of 8,000 to 10,000 patients, .

This will increase the level of demand upon all practices who have open lists. The partners

would certainly prefer to remain open for all and these plans should secure this.

2. Is the current operational PMS space sufficient to support the current list size?

This is not accurate. The current PMS space does not consider the design of the original

property which means the actual usable space is less than the GIA indicates. By way of

example the reception foyer, stairways, corridors and waiting areas are based upon the

design of the original magistrate’s Court and its structural requirements. This accounts for

a disproportionate amount of the space available.

As a consequence, the clinical rooms are a smaller proportion than one may otherwise be

led to believe.

This data should then be compared to best practice and guidance on what is deemed

appropriate space for clinical services. This was detailed in the original business case at

page 8 which shows the site is currently 10% undersized and with anticipated five-year

growth will soon be 13% undersized.

3. If the practice is to be the Hub, what assurances are there that the CCG will not have

to ‘double pay’?

The partners are committed to ensure that this does not occur. The current Hub based

access service is being provided within the existing demise of the PMS service. The practice

is not charging a lease for this service and costs are limited to the actual costs to the

practice such as consumables and staff time as agreed with the contract holder (Sutton GP

Services).

This precedent was set by the practice not charging the CCG for rent costs associated with

providing the Sutton ECG service at Old Court House and the Jubilee Health Centre in

Wallington. In addition to not making additional rental charges for CCG commissioned

services the practice would manage an open diary process for the use of the multi-purpose

suite. The CCG, other providers and third sector organisations would be able to book the

room suite with no rental fees.

This will assist in ensuring that the premises are embedded within the local health

community and are providing a high level of utilisation for the revenue funding. The PMS

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services will benefit directly from this by developing improved care pathways and

navigation to appropriate support services reducing the demand upon the practice by

ensuring patients access the right support at the right time.

4. How will the landlord manage the risk of ‘hidden costs’ e.g. the installation of

standard sink units?

These costs will fit within two categories. Firstly, landlord costs of redevelopment and

secondly practice costs for fit-out.

The landlord will undertake a competitive tender process with detailed specifications to

ensure appropriate equipment is utilised and the costs are manageable. They are highly

experienced in developing GP surgeries and have very strict tight processes to manage

this. It is however, important to note that the CCG will not be contributing towards any of

these costs so the landlord’s decision to install higher end equipment would be done at

their own cost risk.

It is more appropriate to ensure the minimum standards are appropriate and these will be

agreed with the parties during the tender process.

The practice has agreed to fund the fit-out costs of items such as furniture. This will be

directly funded by the partners and again will not impact upon the CCG’s funding.

The one exception to this may be the increased IT equipment which will be developed in

conjunction with the CCG and the provider of IT services to practices to ensure they are

appropriately funded.

5. How will SDLT be funded?

The original business case proposed that the existing lease would be extended to reduce

legal and SDLT costs. Upon reviewing this with lawyers it has been determined that this

approach would not be appropriate as the funding of the additional space, albeit space

formally within the demise of the existing lease, is likely to trigger SDLT liability.

The landlord has reviewed this and confirmed that they will cover these costs within the

investment cost of the project. This will not be a ‘hidden cost’ for the NHS or the practice.

6. Does the rent reimbursement meet the value for money requirements?

This question has been responded to in substantial detail within the strategic case and the

case has been submitted that the changes will provide financial, social and strategic value.

The additional revenue cost is comparable with other options which will require a similar

footprint whilst saving the NHS from needing to make a capital investment. The benefit to

patients and community would represent an excellent return on the investment. Final

approval will be subject to the District Valuer’s ‘Value for money (VFM)’ report and

agreement of Heads of Terms.

7. How does the Practice intend to engage with Patients about the proposed

development of its premises

The Practice propose an assortment of strategies in co-ordination with their Patient

Participation Group to update registered patients and inform people new to Sutton of the

proposed changes. These include, but are not limited to:

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• Display of the redevelopment plans at Old court House and Robin Hood Lane

surgeries

• Letters to all registered patients who live on the west of St Nicholas Way

• Information on our practice website

• “Special Edition” of our newsletter to be distributed to local community

pharmacies

• Open events for Q and A at the Salvation Army Community centre

• Information in local newspapers

• Meeting with the Central Sutton Local Authority Councillors and local MP

LOCAL

APPROVAL

PROCESS

This paper is being re-submitted, for decision, to the PCCC on 10 January 2018 taking into

account the recommendations from the PCCC seminar on 6th December 2017.

If the committee is happy to proceed the practice will require confirmation of its decision.

The landlord will immediately complete discussions with the DVS and finalise the Heads of

Terms.

This will trigger the formal legal procedures and commence the modernisation works.

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REVISED BUSINESS CASE SUBMITTED BY

SUBMITTING

ORGANISATION

PARTNERS

Organisation

Dr Grice and Partners

Name

Dr David Coldrey

Title

GP Principal

Signature

David Coldrey

Date

5th January 2018

LETTERS OF APPROVAL / SUPPORT

These refer to the original letters of support from February 2016.

Organisation Enclosed Letter dated Note

SPONSORING

ORGANISATION

Y N 29th February

2016

LEAD COMMISSIONER

Y N 26th February

2016

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Appendix 1 – Development Proposals Existing and Proposed

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Appendix 2 – The Sutton GP Surgery Landscape

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Appendix 3 – Current Draft Heads of Terms

HEADS OF TERMS The Old Court House Surgery,

Throwley Way, Sutton, Surrey, SM1 4AF

SUBJECT TO CONTRACT

1 Premises

GP Surgery demise at The Old Court House Surgery, Throwley Way, Sutton, Surrey, SM1 4AF, as shown on the attached plans. The existing building, when constructed included expansion space on the first floor. The proposed project is to refurbish, reconfigure and upgrade the existing premises and fit out the first floor vacant space (130 m² NIA) and new basement area (33.44 m² NIA) so that the building can be fully utilised. The proposed project will achieve an additional 5 Consulting Rooms, a Multi-Purpose Suite, a Dirty Utility Room, Lift installation and a new medical records filing room with overall enhanced access and specification to meet CQC/ NHS compliance. The works will be completed in line with the attached plans, agreed room data sheets, and design and specification.

2 Landlord Primary Medical Property Investments Limited whose registered office is at 5 Godalming Business Centre, Woolsack Way, Godalming, Surrey GU7 1XW

Telephone : 0203 142 4865

Contact name: James Young

Email: [email protected]

3 Landlord’s Solicitors TBC

Telephone:

Contact name:

Email:

Contact address:

4 Tenant Dr A Coldrey, Dr S Grice, Dr J Vernon

The Old Court House Surgery,

Throwley Way, Sutton, Surrey, SM1 4AF

Contact Name: Dr David Coldrey

Telephone: 07712 336 014 / 020 8652 1919

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Email: [email protected]

5 Tenant’s Solicitors TBC

Telephone:

Mobile:

Email:

6 Rent Fitted Out Expansion Space - £48,000 per annum exclusive of VAT payable quarterly in advance. Plus, new Basement Storage area - £8,897 per annum exclusive of VAT payable quarterly in advance. Existing PMS area unchanged - £177,300 per annum exclusive of VAT payable quarterly in advance.

7 Rent Free Period The rent commencement date on the expansion will be from practical completion and occupation by the GPs.

8 Rent Review Every 5 years, upwards only to market rent – no change from existing lease terms.

9 Term 25 years from lease completion date. Existing lease to terminate early and be replaced by new lease.

10 Break Option None

11 Underletting Permitted, in line with existing underletting clause.

12 1954 Act Protection The Lease to be subject to the security of tenure provisions contained within Part II of the Landlord and Tenant Act 1954.

13 Repair The Lease will mirror existing lease terms on Full Repairing and Insuring Basis. The tenant will not be liable to rectify latent defects.

13 Alienation Permitted, existing clause to be amended to reflect no deed of covenant or consent required for an assignment of lease to new GP partners, save that no less than 3 to be held on the lease at any one time.

14 Alterations and Signage The Tenant will be allowed to undertake internal non-structural alterations, to make associated alterations to services/media and to install alter and remove internal demountable partitions without Landlord’s consent. The Tenant will not be allowed to undertake any structural alterations at the premises or to alter the external appearance of the premises. The Tenant will be permitted to display prominent external and internal directional signage subject to first obtaining Landlord’s consent as to type size and location (consent not to be unreasonably withheld or delayed).

15 Service Charge None

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16 User The Tenant will be able to use the premises solely for a D1 medical use in accordance with their GMS NHS contract and in compliance with any planning conditions.

17 Agreement for Lease Prior to completion of the Lease the Landlord and the Tenant will exchange an Agreement for Lease which will oblige the Landlord to undertake the Landlord’s Works at the Landlord’s expense. Completion of the Lease will take place following completion of the Works. The Agreement for Lease will be conditional on NHS England / CCG approval for the extension of the lease and proposed works.

18 Insurance The Landlord will insure the premises at a reasonable rate and reclaim the cost from the Tenant.

19 The Tenant’s Works None required

20 The Landlord’s Works The Landlord will undertake the Works as per the particulars attached (specification to follow). The Landlord will provide the tenant with warranties (architect/ SE / main contractor, QS) on completion.

21 22

VAT SDLT

VAT will be payable on the rent (on receipt of a VAT invoice) The Stamp Duty Land Tax liability for the transaction is to be paid by the Landlord.

23 Costs Each party to bear their own costs.

24 Others The Agreement is subject to Board approvals from the Board of MedicX Fund.

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Report to the Sutton Clinical Commissioning Group Primary Care Commissioning Committee

Date of Meeting: 10 January 2018 Agenda No: 8 ENCLOSURE: 07

Title of Document: Community Education Providers Network Annual Review 2017/18

Purpose of Report: For Discussion

Report Authors: India Peach – Project Manager Carolyn Reynolds Head of Primary Care Commissioning

Lead Director: Clare Wilson Deputy Managing Director

Executive Summary: Sutton CEPN, which is a part of the CCG, is responsible for the organisation and co-ordination of primary care workforce development and transformation activities. Funded by Health Education England, the CEPN has nationally defined objectives relating to 6 Core CEPN objectives: increasing community placements, supporting workforce development, workforce transformation, building the CEPN network, workforce planning/ future workforce & multi-professional training. This paper provides an update to the Primary Care Commissioning Committee on the development and progress of the Sutton Community Education Provider Network (CEPN) summarising key activities and progress to date.


Recommendation(s): The Primary Care Commissioning Committee is asked to: Discuss and comment on the activities and progress to date.

Committees which have previously discussed/agreed the report: Education and Training Steering Group monthly.

Financial Implications: Main CEPN funding streams; HEE (Health Education England), NHSE, discrete project funding and CCG discretionary allocation.

Other Implications:

EN

C 0

7

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Equality Impact Assessment: The CCG is committed to monitoring the compliance with the Equality duty of the providers from whom we commission services. This is done through the quality and contracting process.

Information Privacy Issues: N/A

Communication Plan: N/A

EN

C 0

7

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Sutton CCG Primary Care Commissioning

CEPN Update

Background This paper provides an update to the Primary Care Commissioning Committee on the development and progress of the Sutton Community Education Provider Network (CEPN) summarising key activities and progress to date. Sutton CEPN, which is a part of the CCG, is responsible for the organisation and co-ordination of primary care workforce development and transformation activities. Funded by Health Education England, the CEPN has nationally defined objectives relating to 6 Core CEPN objectives: increasing community placements, supporting workforce development, workforce transformation, building the CEPN network, workforce planning/ future workforce & multi-professional training. Main CEPN funding streams; HEE, NHSE, discrete project funding and CCG discretionary allocation. Activity to date Additional resource has recently been sourced to further develop the CEPN model and ensure Sutton practices have every opportunity to participate in workforce development opportunities currently taking place.

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of 3

Phase one (July- Sept)

• Re-establish the Sutton Education & Training steering group

• Review and strengthen CEPN governance arrangements

• Develop an Education Commissioning Framework (decision making framework)

• Agree and establish financial management procedures

• Clarify funding allocations, SLA obligations and review budget lines

• Define and communicate practice funding application procedure

• Embed HEE procedural reporting requirements (KPI's and CEPN progress reporting)

• Identify opportunities for collaborative working (workforce related) across the STP

• Ensure Sutton CEPN is represented when GPFV and GP resilience funding is discussed

• Ensure Sutton CEPN has access to funding opportunities (eg GPN project funding & bids)

• Develop a Sutton CEPN education newsletter for practices, to advertise training opportunities

• Promote the 2018 GPN Programme and student nurse placements

Phase two (Oct- Dec)

• Develop outline project proposals in line with specific funding streams (eg. GPFV & HEE funding)

• Review possibility of local student nurse tariff uplift

• Develop outline for multi-professional protected learning time (PLT) events

• Plan a one-day mentor ‘refresher’ course for nurses with ENB998 qualifications

• Development of pre-cert nursing placements

• Deliver HCA development session

• Recruitment for the HEEsL funded GPN programme

• CEPN newsletter, communication & engagement

• Project manage the delivery of the Sutton-wide "managing clinical correspondence" training (currently 11 practices booked)

• Recruit to substantive 'CEPN Lead' post

Phase three (Jan- March)

• Training needs data collection: survey monkey/ practice interviews

• Establishment of the Nursing Preceptorship programme

• Finalise and disseminate multi-professional PLT dates and programme content/workshop options

• Develop the 2018/19 CEPN Operating Plan

• Attend local school career fairs to promote careers in primary care and care homes

• Review federation development status & consider longer-term CEPN model

• Review university (indirect) funding commissions to ensure maximum uptake

• Review current resourcing arrangements to ensure continuity

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of 3

Carolyn Reynolds

Head of Primary Care Commissioning

Sutton CCG

[email protected]

India Peach & Melanie Ashdown

Sutton CEPN Project Managers

[email protected]

[email protected]

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Report to the Sutton Clinical Commissioning Group Primary Care Commissioning Committee

Date of Meeting: 10th January 2018 Agenda No: 9 ENCLOSURE: 08

Title of Document: General Practice Nursing 10 Point Action Plan

Purpose of Report: For Discussion

Report Authors: Karol Selvey Lead Nurse Primary Care Clinical Lead Long Term Conditions and Community Services India Peach, Project Manager

Lead Director: Clare Wilson Deputy Managing Director

Executive Summary: This paper provides an update to the Primary Care Commissioning Committee of activities occurring against the GPN 10 point Plan. Work is being delivered through the Sutton Community Education Provider Network


Recommendation(s): The Primary Care Commissioning Committee is asked to:

• Discuss and comment on the activities and progress to date.

Committees which have previously discussed/agreed the report: Education and Training Steering Group monthly


Other Implications:

Equality Impact Assessment: The CCG is committed to monitoring the compliance with the Equality duty of the providers from whom we commission services. This is done through the quality and contracting process

Information Privacy Issues: N/A

Communication Plan: N/A

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Sutton CCG Primary Care Commissioning

GPN 10 Point Plan Update

Background This paper provides an update to the Primary Care Commissioning Committee of activities occurring against the GPN 10 point Plan. Work is being delivered through the Sutton CEPN with Karol Selvey.

Objective Activity Comments

1 Celebrate and

raise the profile

of general

practice nursing

and promote

general practice

as a first

destination

career for nurses

• Publicise the film ‘A day in the life of a GPN’ (via GP TeamNet, Sutton Newsletter and websites)

• Attend local school career fairs

• Work with HEIs to ensure primary care nursing is promoted

• Increase the profile (amongst student nurses) of the newly developed primary care preceptorship programme.

• Increase the profile (amongst practices) of the newly developed primary care preceptorship programme as a way to support GPN recruitment, particularly of NQN’s.

• Promoting the “GPN Programme” for nurses new to primary care (delivered by SGUL, funded by HEE). Two nurses signed up for Jan 2018 start. Each practice also gets £5k grant.

Completed

Booked for

2018

In progress

In progress

In progress

In progress

2 Extend leadership

and educator

roles

• Review the JD of the Sutton locality lead nurse roles to allow for increased leadership and extended educator roles to support the CEPN or develop an additional role to support the CEPN network locally

• Sutton has bid for and received £7.5k to put towards extending GPN education & support functions

• Sutton is in the process of bidding for a further £15k to establish a preceptorship system, which will support this point.

• Ongoing work to increase nurse mentors and review lapsed mentorship

• Currently bidding for £50k to put towards SWL CEPN Primary Care Development Programme to support aspiring leaders (multi-prof)

In progress

Completed

In progress

In progress

Completed

3 Increase the

number of pre-

registration

(student nurse)

placements in

general practice

• We are providing info, resources and tools to practices unsure about taking on a student nurse.

• Ongoing work promoting the idea of student nurse placements (newsletter, GP TeamNet)

• Karol Selvey available to talk to practices wanting to ask questions

• Ongoing work to increase nurse mentors and review lapsed mentorship

• Currently exploring a top-up of the student nurse placement tariff to incentivise practices

In progress

In progress

In progress

In progress

In progress

4 Establish

inductions and

preceptorships

• Sutton is in the process of bidding for £15k to establish a preceptorship programme. This would have a local element, as well as a jointly delivered SWL element.

• Local induction pack to be developed for NQN’s (as part of bid)

• Develop understanding of the number of newly qualified nurses

entering Sutton.

In progress

In progress

In progress

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5 Improve access to

‘return to

practice’

programmes

No activity at present

6 Embed and

deliver a radical

upgrade in

prevention

• The Sutton CEPN are planning a series of multi-professional primary care development afternoons (PLT’s), with the support of Sutton CCG. Using GPFV funding and HEE funding we are proposing key themes/ topics to develop the workforce in areas: prevention, mental health for elderly and mental health for young, simulation training, online consultations, care navigation & medical assistants.

• Ongoing training courses on long term condition prevention and management planned as a rolli9ng programme in 2018/2019

In progress

In progress

7 Support access to

educational

programmes

• As above; the Sutton CEPN are planning a series of multi-professional primary care development afternoons (PLT’s), with the support of Sutton CCG.

• The Sutton Education and Training Steering Group has been reconvened with refreshed membership

• Review and strengthen CEPN governance arrangements

• Develop an Education Commissioning Framework (decision making

framework)

• Agree and establish financial management procedures

• Clarify funding allocations, SLA obligations and review budget lines

• Define and communicate practice funding application procedure

• Sutton CEPN is working with other SWL CEPNs to ensure spaces on

courses in other areas are shared widely to increase access to

programmes. Increasing choice & availability.

• Introduction of new CEPN Co-ordinator has enabled better communication with practices to support communication & access to workforce development & transformation opportunities in Sutton.

• Currently exploring use of providing an interim nurse to practices enabling the GPN to be released to attend particular education and training without disrupting service provision, as a way to support access to education programmes.

In progress

Completed

Completed

In progress

Completed

Completed

Completed

Completed

In progress

8 Increase access to

clinical academic

careers and

advanced clinical

practice

programmes, incl

nurses working in

advanced

practice roles

• Workshops have been delivered – aimed at ANPs and senior nurses,

which included: headache & MSK and minor illness

• Programme of advanced training modules specifically for advanced

nurses to be delivered as part of a rolling programme

• ANPs are encouraged to apply for training, specific to their clinical role,

through the Sutton CEPN Education & Training.

Completed

Completed

9 Develop

healthcare

support worker

(HCSW)

apprenticeship

• Hold HCA development workshop to undertake training needs assessment, review present roles, care certificate and developmental opportunities

• Hold regular HCA Forums

• Review HCA developmental opportunities at HCA forum and then

Completed

In progress

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and nursing

associate career

pathways

discuss this at PN and PM forums

• The CEPN will support the HCA development agenda

• HCAs have the opportunity to apply for training, specific to their clinical role, through the CEPN.

In progress

In progress

10 Improve

retention

• Preceptorship Programme is aimed at supporting NQN’s and those new

to primary care to support retention

• Currently exploring a GPN recommendation of T&Cs- similar to the

Lambeth example

• Increase the provision of clinical supervision through the Nurse Forum

by the locality lead nurse and the GPN forum

• Ensuring GPNs have access to and are aware of the wide variety of

support available

In progress

In progress

In progress

In progress

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1



Date of Meeting: 10 January 2018


Title of Document:

Primary Care Finance Report Month 08 2017/18.

Purpose of Report:

For Note

Report Author:

Geoff Price, Chief Finance Officer

Lead Director:

Geoff Price

Chief Finance Officer

Executive Summary:

Financial position - 8 Months to 30 November 2017 and full year forecast

1. Overview:

The financial position for the eight months to 30 November and full year forecast is in

line with budget.

There are some relatively small overspends offset by savings in the list size growth

provision.

2. Core 2017/18 Practice budgets:

The expenditure budget was based on contractual commitments and to meet all

known and anticipated costs.. The budget includes an allowance for both

demographic growth (based on historic government forecasts for 2017-18 population

growth) and a 2% increase for premises cost.

Whilst there is no specific QIPP target included in budgets, the CCG is expected to

benefit from the continued renegotiation of local authority rateable values being

undertaken nationally.

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A summary of the results is as follows :

Service

Annual Budget

YTD Budget YTD Actual

Exp YTD

Variance Forecast

Forecast Variance

Forecast Variance

£000's £000's £000's £000's £000's £000's %

PMS 24,639 16,246 16,287 41 24,670 31 0.10%

GMS 631 413 410 -3 630 -1 -0.20%

APMS 0 0 0 0 0 0 0.00%

Other Medical Services 308 205 44 -161 130 -178 -57.80%

Prior Year Accruals 0 0 147 147 147 147

QIPP 0 0 0 0 0 0 0.00%

Total Primary Care Medical Services

25,578 16,865 16,889 24 25,578 0 0.00%

A more detailed breakdown is given in appendix 1. Eight months results to 30th November are reported as £24k above budget, with a forecast in line with budget. The forecast is currently shown as a breakeven on budget including a £22k overspend, due to QOF costs where actual achievement in 2016-17 was a little higher than anticipated at the time of budget setting, resulting in higher aspiration payments and the reflective achievement accrual. This QOF overspend is offset by small emergent savings in the list size growth provision. The year to date and forecast for DES costs now reflect the latest position in sign-up, and record a saving of £38k on budget in the year to date. There has been a considerable number of claims for Locum cover for sickness, which is now subject to less stringent rules regarding a practices’ entitlement to claim (as part of the 2017/18 GMS contract uplift negotiations). This has resulted in a £55k over-spend on budget in the year to date and is forecast to rise modestly to £75k by year-end. The impact of payments made in 2017/18 for 2016/17 enhanced services and QOF have now been finalised, the net impact is a charge to this year’s accounts of £147k, this is included in the year to date and forecast figures 3. Other primary care budgets

Appendix 2 gives the financial position on a range of other primary care budgets. These show expenditure in line with budget for the 8 months to end November 17 and full year forecast. These budgets cover a range of areas including primary care developments, locally commissioned services and the out of hours service.

The Committee is asked to note this report

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Title of Document:


Risk Register

Purpose of Report: For Review

Report Authors: Chux Ebenezer,

Corporate Assurance and Risk Manager,

NEL CSU

Lead Director:

Clare Wilson

Deputy Chief Operating Officer

Executive Summary:

This document highlights current risks to the CCG around Primary Care

Commissioning. The Risk Register shows any gaps in services and sets out the

mitigations and actions to minimise these risks.

The PCCC Risk Register continues to be reviewed in line with the Strategic

Objectives of the CCG.

Highest Scoring Risks:

Code Description Current

Score

Target

Score

Change

Since

Review

BAF Page

Number

1017 Primary Care estates

not fit for purpose

16 9 Yes 1

1023 Issues with quality of

provision of service in

relation to patient

records

16 4 Yes 1

1033 Vulnerable Practices

in the Carshalton

Locality

16 2 Yes 2

Key issues to note are:

The Corporate Assurance and Risk Manager recommends a deep dive of the 3

highest scoring risks itemised above to ensure that all internal controls, management

assurance and action plans are commensurate with the risk score.

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Please note that the risks scores of 16 itemised above have remained constant over

a short period.

A Risk Matrix is attached for critical analysis of individual risks scores to ensure a

consensus on the appropriateness of current and target risk scores.

De-escalation of risks from the Board Assurance Framework to the Quality Committee Risk Register No risks have been de-escalated from the Corporate Risk Register. Escalation of risks from the Quality Committee Risk Register to the Board Assurance Framework No risks have been escalated from the Corporate Risk Register.

Recommendation:

The PCC Committee is asked to:

• NOTE the PCCC Risk Register

• AGREE any updates that are to be included in the register going forward

• AGREE they are satisfied that the mitigating actions provide sufficient

assurance that the risks are being well managed


The Risk Register is reviewed at each PCC Committee.

Financial Implications: As per Strategic Objective 3




contracting process


As per Freedom of Information Act 2000

Communication Plan:

As per Freedom of Information Act 2000

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SCCG Primary Care Commissioning Risk Register

Generated on: 03 January 2018

Risk Category Description Commissioning Code Title Description Impa

ct Likelihood

Current Risk Score

Date Reviewed

Internal Controls

Gaps in Control Management Assurance

Actions Due Date

Impact

Likelihood

Target Risk Score

Target Risk Target Date

Risk Owner Ownership Assigned To

Risk Assurance Framework Description

Categories Description

Risk Business Units Icon

Risk Business Units Description

1017 Primary Care estates not fit for purpose

Cause: Significant period of lack of investment in primary care premises Effect: Financial implications of getting estates to standard where fit for purpose Keywords Primary Care Estates Investment Premises Financial Implications

4 4 16 07-Nov-2017

Condition surveys carried out on all Sutton Practices during April/May and June 2016

Lack of in house expertise - capacity and capability

CCG Estates Strategy Prioritised as number seven in SWL schemes

Sutton estates strategy being implemented

31-Mar-2018

3 3 9 31-

Mar-

2018

Clare Wilson Sian

Hopkin

son

Yes OBJ.

03 -

15/16

SUTTO

N CCG

SCCG

CCG estates strategy agreed and in place

ETTF preliminary approval for Sutton Town Centre – Engagement with practices and patients required

31-Mar-2018

Premises developments have been bid for against the ETTF money in line with the Estates Strategy

1023 Issues with quality of provision of service in

Significant issues around provision of service from Capita, with

4 4 16 07-Nov-2017

Regular NHSE contract performance monitoring

SCCG is not in control of the contract, so cannot take

Issues raised with NHSE as identified -

31-Mar-2018

4 1 4 31-

Mar-

Clare Wilson Caroly

n

Yes OBJ.

02 -

SCCG

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2

Code Title Description Impact

Likelihood

Current Risk Score

Date Reviewed

Internal Controls


Actions Due Date

Impact

Likelihood

Target Risk Score







relation to patient records

records missing or sent to incorrect practices. Results in problems for continuity of care. Keywords Quality Service Patient Records Capita Continuity of Care

direct action to address the issues with the provider Complaints at practice level from patients, which cannot be remedied by practices or SCCG Complaints made to PCSE with no responses

ongoing 2018 Reynol

ds

15/16

SUTTO

N CCG

SCCG reported concerns to NHSE

Update reports to SCCG programme board

1024 Gaps in primary care workforce - both GPs and nurses

Significant number of GPs and nurses are at or approaching retirement age, which may result in primary care staff shortages, impacting the ability to provide services of sufficient capacity Keywords Primary Care Workforce GP's Nurses Retirement Staff shortages Services Capacity

4 3 12 07-Nov-2017

Member of SWL wide workforce initiative

Recruitment and training vacancies Significant increase in nurse indemnity costs

Use info from SWL collaborative to mitigate gaps

31-Mar-2018

4 2 8 31-

Mar-

2018

Clare Wilson Caroly

n

Reynol

ds

Yes OBJ.

02 -

15/16

SUTTO

N CCG

SCCG

Monitored and reviewed at Primary Care Programme Board

Primary care strategy includes workforce as a priority

1033 Vulnerable practices in Sutton CCG

Vulnerable practices in Sutton CCG Effect: Risk of losing some GPs and the business closing

4 4 16 07-Nov-2017

Involvement of the Chief Medical Officer at NHSE AND Chief Clinical Officer at the

They are independent Contractors and contract could become repudiated with 6months

Escalated to Board \Assurance Framework because of high Risk Score.

Further Develop and embed the CCG’s Quality Concerns Trigger

30-Sep-2018

1 2 2 30-

Sep-

2018

Clare Wilson Yes OBJ.

02 -

15/16

SUTTO

SCCG

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3


Likelihood

Current Risk Score

Date Reviewed

Internal Controls


Actions Due Date

Impact

Likelihood

Target Risk Score







Keywords Vulnerable Practices GP's

CCG notice. Oversight by NHSE and the Chief Clinical Officer at the CCG.

Tool. N CCG

Ongoing Assessments by the GMC.

Ongoing oversight function by the Governing Body because of the nature of the risk

30-Sep-2018

Regular visits to the Practices by NHSE and the CCG.

Risk Category Description Financial Code Title Description Impa

ct Likelihood

Current Risk Score

Date Reviewed

Internal Controls


Actions Due Date

Impact

Likelihood

Target Risk Score







1022 Potential for overspending on Primary Care Commissioning

There is a risk that expenditure will exceed allocation, resulting in the CCG failing to meet financial targets for the year. Keywords Overspend Primary Care Commissioning Risk Expenditure

3 3 9 04-Jul-2017

Plan is in balance - no 2016/17 overspend

CCG does not yet have control over primary care budget setting

Assurance reports from NHSE re financial position

OD plan in development to move NHSE staff to SWLSTP

30-Jun-2018

3 2 6 Clare Wilson No OBJ.

03 -

15/16

SUTTO

N CCG

SCCG

Regular ongoing liaison with NHSE re financial position

Raised issues with NHSE - ongoing

31-Mar-2017

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Likelihood

Current Risk Score

Date Reviewed

Internal Controls


Actions Due Date

Impact

Likelihood

Target Risk Score







Allocation Financial targets

Reserves held in mitigation

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Title of Document: Contract Variation

Purpose of Report:

For ratification

Report Authors:

Carolyn Reynolds

Head of Primary Care Commissioning

Lead Director:

Clare Wilson


Executive Summary:

Bishopsford Road Practice has requested the following contract change:

• GP partner, Dr Gupta, to leave the partnership

• Dr Anita Somalanka to join the partnership

NHS England has made the required checks on Dr Somalanka.

Due to the timing of meetings, the Primary Care Commissioning Committee approved

this request at the Seminar meeting in December, to be formally ratified by the

Committee in public at the January meeting.


Recommendation(s):


• RATIFY the decision made to approve this contract variation


The Primary Care Commissioning Committee approved this contract variation at the

Seminar on 6th December 2017.


None





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Communication Plan:


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Title of Document: Report from the Primary Care Operational

Management Group on 9th November 2017

Purpose of Report:

For Note

Report Authors:

Sian Hopkinson

Associate Director - Primary Care

Lead Director:

Clare Wilson


Executive Summary:

The following items were discussed at the Primary Care Operational Management

Group on 9th November 2017:

QIPP Programme

• The Director of Performance and Delivery presented progress against the

2017/18 QIPP programme and outline plans for 2018/19. Members were

reminded of the £4/head KPI within the newly negotiated PMS contract to

support joint locality working and progress the integration agenda.

Well Court / James O’Riordan Practice Merger Business Case

• The proposed merger of a Sutton CCG practice with a Merton CCG practice

was discussed and the draft business case reviewed.

• Business case to be revised and then presented to the Primary Care

Commissioning Committee in December, and then for formal approval in

January 2018.

Bishopsford Road Practice Partnership Change

• Practice had requested removal of partner from the contract.

• Senior partner was advised that a replacement partner would need to be found

before the removal could be approved, to avoid becoming single-handed

• Support discussed and team to follow up with practice

Engagement Scheme Planning 2018/19

• Planning event was discussed and teams for presentations identified

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Electronic Referral System (eRS)

• Sutton is aiming for all referrals to be made electronically to secondary care by

April 2018.

• The issues and challenges were discussed along with training plan for clinical

and non-clinical practice staff

Central Sutton Next Steps

• Discussion about alternative plans for primary care provision to accommodate

the expected town centre population growth, following practice decisions about

the Central Sutton opportunity.

• Primary care team to meet with practices to discuss their business plans.

Winter Assurance

• Primary care capacity over the winter period had been requested from NHS

England for both core general practice and extended access.

PCSE (Capita)

• Ongoing issues with service provided to practices have been escalated and a

senior level meeting is scheduled between NHS England and Capita.

CQC Inspections

• CQC are inspecting some practices in Sutton over the coming weeks in the

next cycle of routine inspections (Sutton’s first wave of inspections was in

January 2015).


Recommendation(s):


NOTE the work that is being undertaken by the Primary Care Operational

Management Group.


N/A


N/A



This report will be in the public domain.

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Date of Meeting: 10th December 2017


Title of Document: Primary Care Transformation Update

Purpose of Report:

For information

Report Authors:

Lou Naidu

Primary Care Transformation Programme Manager

Lead Director:

Clare Wilson


Executive Summary:

Attached is a summary tracking progress against the numerous primary care

transformation workstreams.


Note the progress to date across a large number of workstreams.

Recommendation(s):


NOTE progress to date and key milestones


None


Where applicable, funding for each scheme is identified on the dashboard.




contracting process



Communication Plan:


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v4 updated 22.12.17

GPFV

10 HIAs

Primary Care

Specifications

Provider

Development

Workforce

Development

Technology

& EstatesAccess GPN 10 PAP

Current Key

Milestone

Timescale

for deliveryRAG

Releasing Time for Care

Programme LN ✓ ✓ ✓ ✓

Centrally

funded

Dec 17:Funding for full programme no

longer available. SWL team working to

develop alternative support programme -

further detail awaitied Jan 18

Jan-18 AMBER

Social Prescribing

Social Prescribing projects support and facilitate primary care teams to

link their patients to the wider support services available by using a

simple electronic referral form, embedded within the clinical system.

These services could include:

• Health, wellbeing and healthy lifestyles – such as Health Trainers for

support with healthy eating and exercise

• Community based mental health projects and exercise programmes;

weight management and more

• Befriending services, volunteering and time bank programmes

• Social Welfare, Legal Advice and Money Management groups

• Adult learning and skills development programmes

• Employability & employment programmes

SM ✓ ✓ ✓ ✓ 40

• Reviewing all documentation

• Relationship building with key providers

• Working with GP practice to embed

referral form into EMIS

• Pilot commenced - to run until 31/03/18

Sep-17 GREEN

Patient Education

Build on the work in 2016/17 delivering twelve Patient Education

sessions in community settings which brought together multiple

stakeholders to provide patients with information to support self-care

as well as short educational talks

CLK ✓ ✓ ✓ 14.4 Programme being developed Nov-17 AMBER

Help Yourself to Health

Six week programme for migrant, black and minority ethnic

communities/patients, specifically the Tamil, Urdu and Polish

communities within the Sutton Borough.

It aims to support learning about NHS Services and how to access

them appropriately, to raise the awareness of key health prevention

messages, encourages self-management and self-care of minor

ailments to support participants to take greater control of their general

health and wellbeing.

CLK ✓ ✓ ✓ ✓ 36.5Programme repeated for 2017/18 following

its successMar-18 GREEN

National Diabetes

Prevention Programme (NDPP)

Working with Practices to proactively identify ‘pre-diabetic’ patients,

provide lifestyle advice and referral into the national education

programme

LJ ✓ ✓ ✓ 65On-going support and monitoring via GP

engagement scheme Mar-18 GREEN

MDT Locality Model

At scale (locality) development of a proactive MDT model of enhanced

care for improved management and outcomes for an identified cohort

of complex patients. This model is being developed as a proactive

model of admission prevention.

Aspirational timeline;

• Primary care team leading the work with localities and wider

stakeholders in the development of the model

• Significant engagewith all stakeholders

• Test against models elsewhere in SW London, London and nationally

• Aim to present a business case for investment in the autumn – needs

to be cost effective

• Model to be commissioned from April 2018

✓ ✓ ✓ ✓Not yet

costed

December 17: Establish delivery plan,

task and finish group, cohort identification,

governance structure January

18: Model co-design, Engagement

workshop, activity and impact assessment

for OBC February 18: refine

model, engagement March 18: Finalise

model, finalise OBC April 18: Test

proactive care model, sign off OBC

June/July 18: Review and refine model,

update busines case,

August 18: Roll out across all localities

Apr-18 AMBER

Pharmacists in

General Practice

• Sutton GP Federation has bid for and been successful in securing

funding from NHSE as part of a national programme of work securing

pharmacist input into GP Practices.

• Sutton CCG’s Medicines Optomisation team are currently running a

pilot to April 18 in conjunction with Robin Hood Lane Health Centre to

demonstrate and evaluate the value of practice employed pharmacists

in a wider role within GP practices.

CR RS ✓ ✓ ✓ ✓ 26 GREEN

Health Champions

Sutton CCG and Sutton Centre for Voluntary Services have developed

a Health Champions project. The project will train and develop 30 local

people to sign post patients and enable access to health services.

The pilot started in June.

CLK ✓ ✓ ✓Traning to commence/Health Champions

active from Jan 18Jan-18 AMBER

Development of Care

Navigators

and Medical Assistants

SWL piloting care navigator and medical assistant roles as part of bid

from HEE.

Care navigators: Provides patients with a first point of contact which

directs them to the most appropriate source of help. Reception staff

are given training and access to a directory of information about

services.

Medical Assistants: A member of clerical staff in the practice is given

additional training and relevant protocols in order to support the GP in

clinical administration tasks.

CR RS ✓ ✓ ✓ ✓ 33.6

Medical Assistant and Care Navigator

training courses underway.

New Sutton integrated MDT locality model -

possible care navigation element currently

being explored.

Oct-17 GREEN

Extended Access

(April 2017-March 2019)

Sutton launched its extended access GP service (6:30pm-8:30pm

Mon-Fri and 8am-8pm at weekends) in April 17

The service is provided by Sutton GP Services, a federation of 24 GP

practices in Sutton.

The first hub site is at Wrythe Green Surgery in Carshalton.

The second hub was selected following an agreed selection process

and opened in July 2017 at Old Court House Surgery .

LN ✓ ✓ ✓ 615

Commissioners are working with Sutton

GP services to ensure maximum utilisation

and work is currently underway to enable

referrals to be received from NHS111.

St Helier ED piloting direct booking of

diverted patients into hub services at

weekends.

Oct-17 GREEN

Sutton CCG - Primary Care Workstream Dashboard

Workstream Overview

Overarching Primary Care Programme

Workstream NameCCG

Lead

Clinical

Lead

Progress in DeliveryBudget 17/18

(£000s)

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GPFV

10 HIAs

Primary Care

Specifications

Provider

Development

Workforce

Development

Technology

& EstatesAccess GPN 10 PAP

Current Key

Milestone

Timescale

for deliveryRAG

Workstream Overview

Overarching Primary Care Programme

Workstream NameCCG

Lead

Clinical

Lead

Progress in DeliveryBudget 17/18

(£000s)

iPlato

Sutton CCG offered a fully funded messaging service to all its member

GP practices, which includes the myGP app for patients and two-way

SMS. This is funded for 3 years from a successful joint South West

London ETTF bid.

LJ ✓ ✓ ✓ ✓ ETTF Offered to all practices Jul-17 GREEN

GP TeamNet

Through the 2017/18 Engagement scheme a web based portal has

been procured on behalf of practices (for two years) to facilitate

engagement and effective communication networks, particularly across

clinical groups who may feel distant from existing networks e.g.

salaried GPs

LJ ✓ ✓ ✓ 22.3 Complete Apr-17 GREEN

Skype for Business LJ ✓ ✓ ✓ ETTF Awaiting ETTF approval 18/19 NOT STARTED

Mobile Working

High specification, EMIS enabled and smartcard ready mobile laptop,

to support mobile working in general Practice i.e.home visits, visits to

care homes, working off site.

The three pilot practices Aug 17

• Wrythe Green

• Robin Hood Lane

• Park Road

The plan is to have one device per 4000 patients

Roll out expected – during Q4 2017/18

LJ ✓ ✓ ✓ ETTFCurrently troubleshooting issus raised

through pilotMar-18 NOT STARTED

Wifi for GP Practices

Free Wi-Fi for patients will allow them access to health and social care

resources, online tools and services; empowering self-care and

helping them to make informed decisions about their healthcareLJ ✓ ✓ ✓ 91.7

Sutton has joined Merton and Wandsworth

CCGs to jointly procure a Wi-Fi solution for

all practices. Supplier has been selected

and roll out will be completed by March

2018.

Mar-18 AMBER

E-consultationsOnline consultation software for practices to enable electronic

consulations. Funded by GPFV.LJ ✓ ✓ ✓ 50.5

SWL PMO leading to agree a single

solution across SWL CCGs. Alignment of

solution with NHS111 online software has

been agreed as preferred option.

Mar-18 NOT STARTED

Sutton Integrated

Digital Care Record (IDCR)

Sutton IDCR is now sharing information from residents' GP and social

care records with local Urgent Care, Accident and Emergency, GP out-

of-hours and community health services.

CW ✓ ✓ ✓ Tech Fund 2 GREEN

KinesisElectronic secondary care advice for primary care clinicians to better

manage patients without the need for referral to hospitalLJ/SR ✓ ✓ ✓ 65

All Sutton GP Practices have access to

Kinesis Apr-17 GREEN

Docman Upgrade

As a result of a successful ETTF across SW London, we received

funding to migrate practices to Docman Vault which would enable

external use to practice users (extended access hubs, remote users

etc.) to access scanned documents with the clinical system.

LJ ✓ ✓ ✓

Initially

procured

across SWL

through ETTF

bud and

supported

with one off

non-recurrent

funding of

£20K from

Sutton CCG

Further development of Docman 10 moves

the storage of document to the cloud. The

CCG agreed to support the additional

costs required for Docman 10 and this will

be rolled out in 18/19

Apr-18 NOT STARTED

Patient Online

GP practices are required to promote and offer online services to

patients – booking appointments, order repeat prescriptions and

access coded information and BMA and NHS England target of 20 per

cent of all practice patients’ active users by 31 March 2018.

LJ ✓ ✓ ✓ ✓Centrally

Funded

Practices issued with patient tablets and

Wi-Fi access to enable patients to use

apps to access Patient Online services

Mar-18 GREEN

Premises Development:

Central Sutton

Development of Robin Hood Health Centre and adjacent council-

owned land for large scale multi-occupancy health centreLN ✓ ETTF Practices have decided not to relocate Oct-17

SCHEME

TERMINATED

Premises Development: South

Sutton

Relocation of Belmont branch of Benhill and Belmont GP Centre to a

new health centreLN ✓

Capital

privately

funded

With council planning department for

approval - decision expected 16/01/18Sep-19 GREEN

Premises Development:

HackbridgeRelocation of Hackbridge Medical Centre a new health centre LN ✓ s106

HoT's almost agreed

Foundations laidSep-19 GREEN

Community Education Provider

Network (CEPN)

Clinical and non-clinical training and education programme to support

general practice workforce initiatives, new ways of working and quality

improvement

CR ✓ ✓HESL &

CEPN

Wide range of training courses and

protected learning time delivered

throughout the year.

Dec 17; Interviews undertaken for CEPN

Lead for 18/19

Ongoing GREEN

General Practice Nurse 10

Point Action Plan

Action Plan to raise the profile of practice nursing, extend leadership,

increase the number of student nurses, preceptorship, return to

nursing, access to educational programmes, advanced clinical

practice, apprenticeships and improve retention

CR ✓ ✓HESL &

CEPN

Detailed training programme against each

criteria has been developed, some of

which has been completed, is on going

and planned for 2018

Ongoing GREEN

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Primary Care Commissioning Committee Forward Plan – January 2018

Updated 27/12/17

Standing agenda items

• Minutes plus actions • Finance report • Risk register

• Declaration of interest • Quality Report • PCCC Forward Plan

• Contractual changes • PCOMG Report

November 2017 December 2017 January 2018 February 2018 March 2018 April 2018

Standing agenda items For Approval:

• ToRs – PCOMG & PCCQRG

For Discussion:

• Minor Surgery Provision

• Premises Dev. Updates

• National GP Pat. Survey

• GPFV Transformation progress

• Extended access performance

Seminar Old Court House Dev Business Case Practice Merger Business Case Strategy Contract change


• Old Court House Dev Business Case

• PC Strategy

• Practice Merger Business Case

• Contractual changes For Discussion

• CEPN Report (Community Education Providers Network)

• GPN 10 Action Points For Note:

• PMS Contract update

Seminar 2018-19 Draft Operating Plan


• Operating Plan sign off

• Engagement Scheme For Note:

• LCS Plan


Part 2 Part 2 Part 2

May 2018 June 2018 July 2018 August 2018 September 2018 October 2018





Standing agenda items Results of the GP Survey

Standing agenda items Review the Terms of Reference

Part 2 Part 2 Part 2

EN

C 1

5 P

CC

C -

For

war

d P

lan

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17

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