PRIMARY CARE COMMISSIONING COMMITTEE MEETING Date of meeting 16 th October 2018 Agenda item number 8 Title of report Paper presented by: Paper prepared by: Poplar House (P81031) Premises Relocation Application Phillip Hargreaves, Head of Estates Phillip Hargreaves, Head of Estates CCG strategic objective supported by this paper: (please tick ) Develop and maintain an effective organisation Commission high quality, safe and cost effective services which reduce health inequalities and improve access to healthcare Effectively engage patients and the public in decision making Develop excellent partnerships which lead to improved health outcomes Make the best use of resources Purpose of report The report is for the Primary Care Commissioning Committee to consider the proposal to relocate premises and revenue consequences of Poplar House Surgery (P81031). In addition, the committee are also requested to review the affordability measures test represent Value for Money (VFM) and that the decision of this Committee be reported back to NHS England. Recommendation The recommendation is for the Primary Care Commissioning Committee to approve the application and revenue consequences to relocate Poplar House Surgery. The Primary Care Commissioning Committee are also requested to approve the affordability measures which represent Value for Money and that the decision of this Committee be reported back to NHS England. Please indicate which Group this has been discussed with (please tick ) Executive Management Team Quality Improvement and Governance Cttee Clinical Commissioning Committee Finance and Performance Committee Audit Committee Remuneration Committee Council of Members Primary Care Commissioning Committee Other/Not Applicable Patient and Public Engagement: Yes Equality Impact Assessment: Resource Implication(s): Yes Yes Are there any associated risks? If so, are the risks on the risk register? If yes, please include risk descriptor and current risk score For further information please contact: Philip Hargreaves or Barbara McKeowen
1.0 Background 1.1 The following paper presents a proposal to relocate the existing GP practice Poplar House Surgery from their existing premises into the St Annes Primary Care Centre. The practice has a GMS contract and their registered list size is shown below: Practice P Code Contract Type List Size Number of GP Partners Poplar House Practice P81031 GMS 7,371 (weighted 7,702 ) 2 partners + 1 salaried 1.2 The Primary Care Webtool has been developed by NHS England for use by its regional and area teams, clinical commissioning groups (CCG) and general practices. It mobilises a suite of comparative data and information to support assurance and quality improvement in general practice and this shows that the surgery is an achieving practice. 1.3 The practice has identified that the case for change is embedded in the Fylde and Wyre Clinical Commissioning Group Strategic Estates Plan and their proposal would assist supporting delivery of Primary Care Networks. 1.4 The proposed increase in housing and population growth in the surrounding locality. 1.5 There is a marked disparity in premises conditions at Poplar House Surgery when compared with the nearby Primary Care Centre. 1.6 The CCG agreed Estate Strategy clearly identified the relocation of Primary Care Provision in St Anne s into new premises. 2.0 Current Situation 2.1 The surgery is located on a corner plot at the junction of St Anne s Road East and St Patrick s Road South in a residential area lying just outside the main Town Centre of St Anne s. 2.2 The surgery comprises the end two units of a simple terrace of 8. At the basement level is a pharmacy (St Anne s Pharmacy Ltd.) 2.3 The site area is 0.086 hectares (0.21 acres) and the ground floor level is elevated from the surrounding pavement level. 2.4 The building is made up of 4 levels, there are 3 storey s above ground level under a slate covered pitched roof with a basement pharmacy.
2.5 There is a single storey extension at the rear of the building providing reception and waiting area space. This is a much later addition. The main building dates to circa 1890 and the extension 1991. 2.6 Generally the building is constructed of brickwork and is in a reasonable condition. 2.7 Window frames which consist of white PVCu are in good order. External paths are in a good state of repair. 2.8 There is parking on site for only 5 cars; there is no dedicated disabled parking. Road side parking is available but due to the close proximity of the busy road junction, parking restrictions (yellow lines), a bus stop and the numbers of staff that park along the street upon arrival at the surgery for work each day this displaces patient parking further away from the premises and therefore limits patient parking and visitor parking. The narrow rear access road also impedes parking. 2.9 The building fails to meet DDA compliance and infection control standards. 2.10 Limited expansion capability. 2.11 Restricted internal space and poor room adjacencies i.e. clean and dirty utilities. 2.12 Restricted internal access due to lack of lift. 3.0 Proposed Premises 3.1 The proposal is to relocate the surgery into the nearby Primary Care Centre. 3.2 The new Primary Care Centre was opened in 2009. 3.3 The Primary Care Centre is located within a half mile radius from Poplar House surgery and can be found between Durham Avenue and Stephen Street just off St. David s Road North. 3.4 The centre is self-contained occupying its own grounds and is a three storey detached contemporary medical building. 3.5 The site is within a predominantly residential area and in close proximity to the town centre. 3.6 The centre comprises of a large car park for 125 cars (Including 15 disabled spaces). A dedicated area for motorised powered vehicles (8) is provided along with cycle storage for 20 and a taxi drop off point and ambulance bay. 3.7 Access to Public transport is good with the St Anne s railway station being in very close proximity. Bus stops are available along St David s Road North within easy walking distance of the centre. 3.8 The proposed gross internal area for the surgery is 614 sq. m. however the GP Practice will benefit from other infrastructure services already on site e.g. lift,
stairs, reception, meeting room, corridors, and toilets etc. which keep to a minimum the necessary floor area to enable the relocation. 3.9 The proposed site is located along Durham Avenue and currently hosts a modern primary care centre used by a number of NHS tenants. The Primary Care Centre is currently occupied by two GP surgeries (Park & Clifton), a pharmacy and a range of community services provided by Blackpool Teaching Hospitals NHS Foundation Trust. 3.10 The surgery advises that the relocation would support them to improve patient access by providing a more effective and holistic approach to providing primary care services. 3.11 For some time the practice has struggled with an unfit for purpose building, failing to provide a modern clinical facility. The benefits to the patients such as a purpose built primary care building with dedicated parking, ground floor disabled access to all our patients and visitors. A one stop shop housing, not only the Gps, nurses but District Nurses, wound care, midwifery clinics, child health, dietetics to name a few. Future proofing the care of patients in St Annes to a excellent standard. Working and sharing services with Clifton/Park ensuring a high standard for all the patients in our community. 3.12 NHS Fylde and Wyre CCG s Strategic Plan 2014-2019 aims to focus hospital care to situations when specialist treatment cannot be provided in a community setting or at home. The aim is to move to a joined-up health and social care model, co-ordinated with neighbourhoods of GP Practices to deal with more complex and ongoing conditions. 3.13 Deed of Comfort - there are two existing surgeries in occupation at the primary Care centre. At the inception of the new build scheme around 10 or more years ago the ingoing practices were granted a Deed of Comfort by the then PCT (North Lancashire Teaching PCT). Such an approach was common on many of these forms of development. The practice (Poplar House) has requested that a similar deed be offered to them and agreed by the CCG. In essence the Deed recognises the concerns of the Doctors having to commit to the lease for the 18 years now remaining and the impact it would have on the doctor s abilities to retire from the partnership. The Deed of Comfort has been termed a Last Man Standing Clause. The Deed acknowledges that the CCG would either: take an assignment from the outgoing doctor of his or her interest under the lease procure that a third party shall take an assignment of the Outgoing doctors interest under the lease enter into a deed of Guarantee to Guarantee the payment of the rent and other liabilities under the lease from a relevant trigger event Given that both of the current GP Practices operating out of the centre enjoy such a Deed and in the interests of fairness and equality it is recommended that a similar deed be agreed with the ingoing Practice
4.0 Engagement 4.1 A survey signed by 1,196 Poplar House Surgery patients indicating their support for relocating to St Anne s Primary Care Centre was submitted to Fylde Council in early 2016. 4.2 More recently, a survey produced by the CCG and distributed to Poplar House Surgery patients using social media and text messaging has seen 75 per cent of respondents giving their support to the relocation. A Q&A has been shared with Poplar House Surgery and the two co-locating practices Park Medical Surgery and Clifton Medical Practice to publish on their websites in response to comments made by the 25 per cent saying they did not support the proposal. Reasons for this included: Impersonal feel of larger primary care centre Possible loss of chemist Expansion of building at St Anne s Primary Care Centre Added distance Insufficient parking Added difficulty accessing appointments 4.3 The CCG s head of estates has met several times with the patient participation groups (PPGs) at Poplar House Surgery and both practices within St Anne s Primary Care Centre throughout the development of this proposal. There was initial opposition from patients at Park and Clifton practices, but at the most recent meeting all concerns had been addressed. 4.4 The CCG s clinical chief officer has met twice with the local MP Mark Menzies. On the first occasion Mr Menzies expressed opposition to the move and asked for the CCG to look at alternatives. However in the most recent meeting, also attended by the CCG s chief finance officer, Mr Menzies expressed his support for the move following amendments to the planning proposal.
5.0 Financial Impact 5.1 Projected costs for new refurbished build scheme (figures are estimated at this stage) Projected Costs 1. New rent As advised by the landlord 2. Running Costs As advised by the landlord 249,246.00 46,383.95 Total 295,629.95 Existing Rent 3. Poplar House 34,700.04 Running Costs 4.Poplar House surgery Total existing running costs for site Net increase of approx. 51,127.00 85,826.81 209,803 per annum 6. Total increase 209,803 5.2 Whilst it is acknowledged that there is an increase in revenue costs for the GP Practice the space that the surgery would potentially move into is already being paid for by the NHS. As a result of this proposal Blackpool Teaching Hospitals NHS Foundation Trust will occupy a reduced footprint at the site thereby generating annual savings of 21,912 (excluding rates) to reflect a reduction in both rent and service charge. 6.0 Risks 6.1 The practice is forecast to grow its list size by 4,000 over the next five years following a large number of housing developments in St. Anne s and the surrounding area. Detailed discussions have been held with Fylde Borough Council to understand the locations of housing developments and the numbers proposed.
6.2 Several sites are now under development or approved: Queensway St Anne s Former Pontins site St Anne s Former Government buildings 1150 dwellings on site 1.3 miles away 348 dwellings on site 1.8 miles away 162 dwellings on site 1.5 miles away Former council depot 32 dwellings on site 0.5 miles away Kwik Save site 15 dwellings on site 0.3 miles away Total Using ONS data of 2.3 average household size = 3926 population. 1707 dwellings The newly proposed premises will support the increase in patient registrations. 6.3 The practice advises that the current premises do not allow for expansion to support increase in population growth. 6.4 The practice is currently located in the end two units of a converted terrace of houses with small rooms and poor layouts that do not allow for easy access or for the delivery of new models of care. 6.5 If approved, the associated revenue consequences may create a financial pressure. The proposed new location is approx. ½ mile from the practice. 6.6 The practice and the CCG will continue to support patients in ensuring the relocation will be beneficial and alleviate any concerns raised. However as previously noted the practice and CCG will continue to support patients who raise concerns. 6.7 If the application is not approved, the practice feels that their ability to expand services will be limited as they will be unable to extend their premises. The existing practice premises are not DDA compliant and the practice feels that they have insufficient car parking. 6.8 Proposals to alter the existing Primary Care Centre nearby have the benefit of Planning Permission and landlord approval for the works. Tenders have been invited and received for the project with the scheme ready to commence for occupancy in March 2019 or thereabouts. 6.9 The Primary Care Committee is asked to note that the development costs to undertake the works are being fully funded by the landlord. The PID for a new lease has been submitted to NHS England & South Cumbria who have indicated they are supportive of the scheme and benefits it provides. 6.10 However NHS England have requested that the CCG provide evidence of the Value for Money (VFM) affordability measures test have been satisfied and the internal governance process.
6.11 The PCCC are requested to consider and approve that the measures represent Value for Money and the assessment has been based on the following: The CCG and its predecessor organisations have been working on a practical and viable solution for Poplar House for many years. This opportunity that is before us offers a realistic, deliverable and sensible approach to relocate the surgery from its present outdated, weary and non-compliant premises into modern fit for purpose accommodation. When analysed as such this represents VFM. By placing the surgery alongside two other practices and Community services this is following the CCG s forward view and is a sensible contribution to delivering the objectives of the 5 year forward view. Supports integration of services Supports development of Primary Care Networks which is a national driver Supports PCN/Neighbourhood resilience via joint sharing of facilities Improves patient accessibility and experience Supports holistic approach to healthcare Improves staff working conditions and morale and recruitment Improved access to more effective and holistic approach to providing primary care services. To potentially provide extended opening hours to support the national agenda for 7/7 working. To provide the opportunity to bring out of hospital care into the community Increased training capacity for both undergraduates and postgraduate GP trainees Provides much needed additional capacity for primary care Reduces unsuitable Primary Care Estate (Condition and Compliance) Co-location of the primary care services are the general direction of travel for national policy To meet current and future local needs and the planned housing growth Improved utilisation of St. Anne s Primary care Centre which is currently at an average of just 41% utilisation. Focusing activity at a location where handback is unachievable. (Under the NHS PS handback policy this site is restricted and space cannot be handed back, thereby sweating the asset.) Generating savings at other locations to the health economy Other sites were examined and no other option existed at that value commensurate to the size of the estate/ facilities being gained for the Community and patients Consolidating services at a hub locality The rent at St Anne s PCC is based on the figures agreed with the DV in 2009 and is currently 296 psm for GP space and 322 psm for community space. The additional space being taken would be charged at the same rate if relocating the practice did not involve considerable additional work. The cost of these works is 920k and the landlord is proposing an additional rent to cover the cost of the works of 70psm which would produce additional rental of 47,670/year. Over the remaining 19 year term of the lease this would produce further income of 905,730. Together with the agreed fixed rate rises, this would reimburse the funds invested by the landlord. The basic rental would cover the current shortfall in the existing mortgage repayments. The whole costs are loaded onto one single occupant and not shared across the buildings tenants.
7.0 Recommendation 7.1 Members of the Primary Care Committee are recommended to approve the application to relocate and associated revenue consequences, in the best interest of the patients, to provide purpose designed, high quality health care facilities, supporting the CCG vision, new models of care and primary care at scale. 7.2 Members are also requested to approve that the affordability measures test represents VFM and that NHS England will be informed of the decision determined by the Primary Care Commissioning Committee.