Clinical Commissioning Group. Primary Care Commissioning Committee. Paper Summary Sheet. For: Decision Discussion Noting

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1 Clinical Commissioning Group Primary Care Commissioning Committee Paper Summary Sheet Date of Extraordinary Meeting: 26 September 2017 For: Decision Discussion Noting Agenda Item: Author: PCCC/17/09/6e The Avenue Surgery, GMS Expansion Request Victoria Stanley, Primary Care Commissioning Manager Lead Director/GP from CCG: Executive summary: Jo Cullen, Director of Primary and Urgent Care This paper was presented to the Extraordinary PCCC Meeting held on 6 September The Avenue Surgery has been experiencing an increase in patient list size since Smallbrook Surgery reduced their opening hours. Westbury Group Practice (White Horse Health Centre) are merging with Smallbrook Surgery in September 2017 with a view to close the Smallbrook Surgery premises. Smallbrook patients are registering between the Avenue and White Horse. The practice has recently received notification from the Research Unit that the nurse currently occupying a room at the surgery will be vacating due to a reduction in research funding from the PCRN, thus making further research unviable. The surgery now has an opportunity to utilise the vacated capacity in order to accommodate the increased demand. The practice has also received notification from a tenant using the ground floor of the Station Road branch surgery. Given the increasing list size the practice also wishes to utilise this space to accommodate the increasing number of patients.

2 Evidence in support of arguments: Who has been involved/contributed: The Primary Care Commissioning Committee is asked to approve the expansion of the Avenue s GMS Services. As at 29 th August, The Avenue have registered an additional one thousand one hundred patients from Smallbrook. NHS England Wessex Local Medical Committees Cross Reference to Strategic Objectives: Engagement and Involvement: Communications Issues: Financial Implications: Review arrangements: Risk Management: National Policy/ Legislation: Public Health Implications: Equality & Diversity: Other External Assessment: What specific action re. the paper do you wish the Governing Body to take at the meeting? Practice resilience and GP Forward View implementation. Extensive engagement has been undertaken for the Smallbrook closure. Extensive engagement has been undertaken for the Smallbrook closure. The practice will lead on communications for the additional practice space. In total there will be an additional commitment of 13,500 per annum. The total funded GMS space will be and remains within their SFE allocation of 1083sqm. The practice will be subject to the three yearly rent reimbursement programme. Minimal risk as additional the space is fit for purpose. National Premises Costs Directions 2013 None identified No adverse impact identified. Services will be available to all registered patients of The Avenue Surgery. NHS England, Wessex Local Medical Committee, Healthwatch and Wiltshire Council are represented on the Primary Care Joint Commissioning Committee. The full membership of the Primary Care Commissioning Committee is asked to ratify the decision made by Voting Members at the PCCC Extraordinary Meeting held on 6 September 2017 concerning the expansion of the Avenue s GMS Services.

3 Wiltshire Clinical Commissioning Group Primary Care Commissioning Committee Report 6 September 2017 GMS Services Expansion Programme Avenue Surgery 14 The Avenue Warminster Wiltshire BA12 9AA Prepared by: Victoria Stanley, Primary Care Commissioning Manager Lead Director: Jo Cullen, Wiltshire Clinical Commissioning Group

4 GMS Services Expansion Programme within existing Avenue Surgery Purpose of Paper The purpose of this paper is to consider a request from Avenue Surgery, Warminster to expand their GMS Services within their existing Surgery. The Avenue Surgery has been experiencing an increase in patient list size since Smallbrook Surgery reduced their opening hours. Westbury Group Practice (White Horse Health Centre) are merging with Smallbrook Surgery in September 2017 with a view to close the Smallbrook Surgery premises. Smallbrook patients are registering between the Avenue and White Horse. The practice has recently received notification from the Research Unit that the nurse currently occupying a room at the surgery will be vacating due to a reduction in research funding from the PCRN, thus making further research unviable. The surgery now has an opportunity to utilise the vacated capacity in order to accommodate the increased demand. The practice has also received notification from a tenant using the ground floor of the Station Road branch surgery. Given the increasing list size the practice also wishes to utilise this space to accommodate the increasing number of patients. The Primary Care Commissioning Committee is asked to approve the expansion of the Avenue s GMS Services. Supporting Information Current Position Avenue Surgery is based in Warminster with a raw list size of registered patients as of 1 July Recent changes following the Smallbrook closure are: 1200 patients registered with The Avenue 600 patients registered with White Horse 2300 not as yet registered Normalised weighted list size is

5 Proposal The practice is requesting approval to utilise an approximate additional metres squared ( ) subject to District Valuer assessment. The smaller space is the now vacant research space, the room will be divided into two to provide additional GMS space and will be fit for purpose in a part of the practice that was previously used by the Research Nurse/s. The larger space will already has six clinical rooms sub-divided and will be able to be used with immediate effect. The extra room capacity will help towards accommodating the increasing population and improve access to existing services. The current allocation is The total revised allocation requested will be The approximate cost of the additional space (103.77m 2 ) per annum is (to be confirmed by the DV) taking the total rent reimbursement amount to approximately 122, The current reimbursement is 98, for The Avenue and 10, for the first floor of Station Road, a total of 108, In total there will be an additional commitment of per annum. The total funded GMS space will be and remains within their SFE allocation of 1083sqm. The current rates reimbursement is 13, The additional rent will be funded as a short-term cost pressure from Primary Care reserves. There will be short term savings made from the notice given on Smallbrook premises at Warminster Hospital to NHSPS. The current notional rent payable for Smallbrook is 29, Premises (M 2 ) The Avenue Actual GIA tbc GIA (District Valuer) Station Road Actual GIA GIA (District Valuer) Current SFE allowance 1,083 (based on 16,000 patients)

6 NHSPS are currently looking for alternative use for Smallbrook and will be tied to overall development of the integrated urgent care system and extended access to primary care. Six Facet Survey Current Space Available Space Current Rent The Avenue , Station Road , Utilisation The practice wish to expand their GMS Space allowance to accommodate any additional patients. Practice GP staffing Partners Sessions Dr Caroline Wingfield 8 Dr Rebecca Austin 8 Dr Oran Corey 8 Dr Lisa Hirst 8 Dr Nicola Jones 8 Dr Lukasz Ferchow 8 Dr Lindsay Kinlin 8 Total Sessions 56 WTE (9 sessions) 6.22 Regular Locum GPs Sessions Dr Charlotte Holliday Dr Ernst Scholte 6 increasing to 8 from 1st March 2018-replacing Dr L.K as a Partner 4 increasing to 8 from Sep will become a Partner on 1st March 2018 Dr Koren Stickland 2

7 Dr Ferdinand Morris 6 Dr Kevin McBride As required Total Sessions 12 increasing to 24 WTE (9 sessions) 1.3 increasing to 2.66 Other Clinical Staff Nurses WTE 6.9 includes on Nurse working 30 Hrs /wk from Sep WTE= 37 hrs per and one Nurse working 28 hrs/wk from Jan week HCAs WTE 4.9 QoF achievement: 99.75% /2017 Current Premises Position The building is a purpose built (1990) self-contained Surgery, built in 1990, with a front extension built in The property is owned by the GP partners. General Medical Provision in Warminster There is one other practice in the town Smallbrook Surgery, which will close September Current Size Available Practice Population GMS Allowance GMS Smallbrook Avenue , CQC Quality Report March The overall CQC summary is Good. Warminster Community Area Warminster is entering a period of growth. New housing is to be built on the west side of the town in line with the Wiltshire Core Strategy (WCS), which plans for sustainable development across the county. The WCS makes provision for 1920 new dwellings in Warminster over the period Approximately 504 of these houses have already been erected (as at 2014) leaving a balance still to be built. Nine hundred of these new houses will form a development on the west side of Warminster known as the West Urban

8 Extension. There are two other significant initiatives that may impact upon the future growth of Warminster. Wiltshire Council has undertaken a Strategic Housing Land Availability Assessment (SHLAA) to satisfy government requirements. The SHLAA identifies possible sites that might be developed to meet the need for additional new homes. It includes greenfield and previously developed land that lies both within and outside the existing settlement boundary. Inclusion of a site in the SHLAA merely highlights potential for the land to be developed. Any application would be governed by the existing planning regulations. Wiltshire Council is preparing a Housing Site Development Plan Document (DPD) which will review the settlement boundaries to ensure that they are up to date and reflect the emergency plans and other needs of the community. Land is also earmarked for new businesses that will provide added employment opportunities. Actions requested The Primary Care Commissioning Committee is requested to approve the application from Avenue Surgery for an increase in GMS space.

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11 Equality Impact Analysis the EIA form Title of the paper or Scheme: The Avenue Surgery, GMS Expansion Request For the record Name of person leading this EIA: Victoria Stanley Date completed: Names of people involved in consideration of impact Name of director signing EIA: Jo Cullen Date signed: What is the proposal? What outcomes/benefits are you hoping to achieve? The proposal is to increase the amount of GMS funded space within The Avenue Surgery, following the closure of Smallbrook Surgery. The main benefit will be increased access for all patients. Who s it for? All registered patients of The Avenue How will this proposal meet the equality duties? Increased access for all registered patients What are the barriers to meeting this potential? None identified. 2 Who s using it? Refer to equality groups What data/evidence do you have about who is or could be affected (e.g. equality monitoring, customer feedback, current service use, national/regional/local trends)? GP Patient Survey results showing how patients are responding to the ease of accessing appointments at the surgery. How can you involve your customers in developing the proposal? Extensive engagement has been undertaken for the Smallbrook closure. The practice will lead on communications for the additional practice space. Who is missing? Do you need to fill any gaps in your data? (pause EIA if necessary) None identified 3 Impact Refer to dimensions of equality and equality groups Show consideration of: age, disability, sex, transgender, marriage/civil partnership, maternity/pregnancy, race, religion/belief, sexual orientation and if appropriate: financial economic status, homelessness, political view Using the information in parts 1 & 2 does the proposal: a) Create an adverse impact which may affect some groups or individuals. Is it clear what this is? How can this be mitigated or justified? None identified What can be done to change this impact? b) Create benefit for a particular group. Is it clear what this is? Can you maximise the benefits for other groups? NHS Wiltshire CCG EIA form Page 1 of 2

12 Does further consultation need to be done? How will assumptions made in this Analysis be tested? No. 4 So what? Link to business planning process What changes have you made in the course of this EIA? None What will you do now and what will be included in future planning? The CCG will monitor the number of new patient registrations at The Avenue from Smallbrook as well as results of the GP Patient Survey. When will this be reviewed? As and when available How will success be measured? Results from the GP patient survey to show the level of patient access to GP s has either remained or increased. NHS Wiltshire CCG EIA form Page 2 of 2