7.2

1

NHS DORSET CLINICAL COMMISSIONING GROUP

PRIMARY CARE COMMISSIONING COMMITTEE

PRIMARY AND COMMUNITY CARE UPDATE

Date of the meeting 06/02/2019

Author R Payne, Head of Primary and Community Care

Purpose of Report The report provides an update on areas of work being undertaken to support delivery of the Primary and Community Care Commissioning Strategy and areas of CCG responsibility as part of full delegation for Primary Care commissioning from NHS England.

Recommendation The Committee is asked to approve the additional investment plans and commissioning intentions for 2019-20.

Stakeholder Engagement NHS England / Local Medical Committee / Public Health / Clinical Leads / Primary Care Operational Group / Primary Care Reference Group / Member Practices

Previous GB / Committee/s, Dates

January 2019 Directors Performance meeting

Monitoring and Assurance Summary

This report links to the following Strategic Objectives

Prevention at Scale

Integrated Community and Primary Care Services

One Acute Network

Digitally Enabled Dorset

Leading and Working Differently

Yes [e.g. ]

Any action required?

Yes

Detail in report

No

All three Domains of Quality (Safety, Quality, Patient Experience)

Board Assurance Framework Risk Register

Budgetary Impact

Legal/Regulatory

People/Staff

Financial/Value for Money/Sustainability

Information Management &Technology

Equality Impact Assessment

Freedom of Information

I confirm that I have considered the implications of this report on each of the matters above, as indicated

Initials : RP

7.2

2

1. Introduction

1.1 This report provides an update on a number of areas of Primary and Community Care planning to support sustainability and transformation in line with our Integrated Care System plans, Primary and Community Care Commissioning Strategy and GP Forward View ambitions. This work aligns with strengthening our responsibilities under full delegation for Primary Care commissioning, responding to NHS England (NHSE) planning guidance and meeting the ambitions set out in the GP Forward View.

1.2 The report includes an initial overview of the NHS Long Term Plan in relation to Primary Care, the internal audit review of our delegated Primary Care commissioning and contracting responsibilities, plans for further investing in Primary and Community Care in 2019-20, an update on Primary Care contracts, quality and resilience planning, as well further details of progress towards General Practice Forward View delivery.

2. The NHS Long Term Plan for Primary and Community Care

2.1 The NHS Long Term Plan published by NHSE in January 2019 makes a commitment to move to a new service model in which patients get more options, better support, and properly joined-up care at the right time in the optimal care setting. Primary and Community Care is central to this plan which seeks to achieve:

Significant changes to hospital outpatients - and the role of Primary and Community Care in bringing more services out of hospital;

Primary Care Networks (PCN) serving populations of 30-50,000 based on neighbouring local Practices and community teams;

More personalised care to enable people to have greater control over their own health;

A new patient right to on-line consultations - as part of a drive to improve access to care and use of new technology;

A new guarantee to invest more in Primary medical and community services over the next 5 years with a focus on population health.

2.2 The NHS Long Term Plan for Primary and Community Care describes a vision for joined up services delivered in local communities, achieved by a new approach to the commissioning and provision of services in order to achieve:

7.2

3

‘primary care networks based on neighbouring GP practices that work together typically covering 30-50,000 people. As part of a set of multi-year contract changes individual practices in a local area will enter into a network contract, as an extension of their current contract, and have a designated single fund through which all network resources will flow. Most CCGs have local contracts for enhanced services and these will normally be added to the network contract. Expanded neighbourhood teams will comprise a range of staff such as GPs, pharmacists, district nurses, community geriatricians, dementia workers and AHPs such as physiotherapists and podiatrists/chiropodists, joined by social care and the voluntary sector. In many parts of the country, functions such as district nursing are already configured on network footprints and this will now become the required norm’

The NHS Long Term Plan, NHS England, January 2019, page 14

2.3 The Dorset Strategy for Primary and Community Care already aligns well with

this national vision. Over the next few months we will use the Long Term Plan ambitions to refresh our local priorities and plans as part of the Dorset Integrated Care System response to this.

2.4 In addition the GP Partnership Review made its final report to NHSE in January 2019 following a year long review. The review concludes that the partnership model still offers many strengths including providing a powerful independent advocate role for patients with accountability to local communities. There are a number of recommendations made which include:

A need to reduce the current personal liability and risk associated with GP partnerships;

Embedding more services and a great skill mix to support delivery of direct patient care;

The development of Primary Care Networks as a way to ensure General Practices are sustainable;

Increase resources to enable Practices to deliver innovative digital services;

Ensuring General Practice has a strong and representative voice at the Integrated Care System level.

3. Commissioning and Contracting

Additional Investment Plans and Commissioning Intentions for 2019-20 3.1 The Clinical Commissioning Local Improvement Plan (CCLIP): The

CCLIP for 2019 / 20 plans to focus on three key areas - Improving Quality; developing Primary Care Networks and Improving Primary Care workforce resilience. This will support delivery at right scale through a combined Practice and network level approach.

7.2

4

3.2 The proposal is to maintain investment levels in line with the 2018-19 allocation. We will continue to invest in the engagement of Member Practices in Strategy delivery and quality improvement but to realign this to a new set of priorities and plans, this is shown in Table 1 below:

CCLIP Component Total £s

CCG Membership and Locality Engagement

252,000

Quality Improvement 731,818

Primary Care Network Development

1,016,413

Workforce 84,000

Total 2,084,230

3.3 GP Forward View Transformation Investment: A recurrent investment will continue to be made to support the ongoing transformation of General Practice. The majority of this investment will continue to be funded at a locality level, however, with a more targeted approach of supporting each Primary Care Network. Workforce and estates planning will continue to operate at a pan Dorset level but with support tailored locally.

3.4 The proposed investment is detailed in Table 2 below:

3.5 Improving Access to General Practice: It is anticipated that the total population level funding for improving access will be released recurrently by NHSE for investment from 2019 / 20. The majority of this funding will continue to be invested as part of the Integrated Urgent Care Service. The proposal is that the remainder, once the national allocations are confirmed, will be invested in General Practice with a Network level agreement overseen by Clinical Chairs (circa £1.6m).

Dorset-wide Investment £s

Primary Care Network development 35,000

Workforce Planning 35,000

Locality Infrastructure Planning 50,000

Sub Total 120,000

Locality Devolved Allocation £s

Clinical and Business Leadership supporting PCNs

PCN Project Management

Continued stakeholder engagement

Protected Learning Time (programme agreed by Locality)

Sub Total 680,000

Total 800,000

7.2

5

3.6 Part of this work will be to improve access to services locally as part of new

care models, and will be considered at a PCN level, recognising Practice workload and supporting management of demand.

3.7 Each PCN will work within a set of agreed principles and aims in order to

ensure local plans improve access to General Practice services for their registered populations. Networks may also use this funding to support the delivery of their quality initiative, as agreed within the CCLIP.

3.8 Frailty: in order to continue the drive for enabling Primary Care to work at the right scale, the CCG has previously provided notice to General Practice that from 19 / 20 this service will be commissioned at Primary Care network level, e.g. through a lead provider. This is in line with the guidance published recently as part of the NHS Long Term Plan (NHS England, January 2019).

3.9 Phlebotomy out of the Acute and into the Community: As part of Clinical Services Review (CSR), work has been underway to move phlebotomy out of the acute hospitals in the East of Dorset by the summer of 2019 (the model is already community based in the West). This will lead to a significant improvement in local access to services for patients and address some of the inequalities in access across Dorset. Locality plans are currently being developed and it is hoped these will be agreed by March to enable the new service to become operational from April.

3.10 It is recognised that the phlebotomy activity and demand may change in the future as a result in changes in care pathways and the introduction of new treatment methods and near patient testing technology. For this reason the phlebotomy activity levels used to plan for this new service model will be reviewed annually to inform future commissioning and contracted activity levels.

Internal Audit 3.11 In July 2018, NHSE issued a Primary Medical Care Commissioning and

Contracting Internal Audit Framework for delegated Clinical Commissioning Groups. This laid out the requirements for an annual internal audit of the CCG’s Primary Medical Commissioning arrangements from 2018 - 19, with the programme to be delivered over 3 to 4 years.

3.12 Dorset CCG reports to two NHSE Regional teams as we are in a period of transition, these are NHSE Wessex for commissioning and contracting, and NHSE South West for GP Forward View, access and workforce.

3.13 The Internal Audit Framework is designed around the commissioning cycle:

Commissioning and procurement of services;

Contract Oversight and Management Functions;

Primary Care Finance; and

7.2

6

Governance (common to each of the above areas).

3.14 Dorset CCG received an overall assurance rating of 'Substantial' in respect of the areas reviewed in 2018-19. Whilst the controls in place adequately addressed the risks to the successful achievement of objectives in most areas, there were certain elements reviewed that could benefit from enhancements to controls.

3.15 Dorset CCG demonstrated good practice with regards to Commissioning and Procurement as well as Contract Oversight and Management functions. Frailty was used as an exemplar and the CCG demonstrated a robust approach to managing and co-ordinating mergers and closures of Practices.

3.16 The main area that would benefit from enhanced controls include the management of resilience funding. The management of resilience recently transferred to Dorset CCG from NHSE as part of plans to develop locality resilience approach under full delegation. The CCG recognises that systems and processes need to be better aligned and managed in order to improve governance of decision making and have put in place an action plan to address over the coming months.

3.17 The full Internal Report is on part 2 of the agenda. NHSE Primary Care Transactional work

3.18 NHSE has proposed that all transactional work relating to Primary Care could be moved to delegated CCGs. There is currently no resource planned to come with this.

3.19 NHSE Wessex team who currently manage all the Primary Care transactional work relating to Dorset’s CCGs Full Delegation have put forward a formal offer for delegated CCGs to take on the following transactional work relating to:

GP retainers;

GP Locum Reimbursement;

Statutory contract variations;

Local Contract variations - Partnership changes;

Local contract variations - GP 24 hour retirement;

Local contract variations – Practice mergers;

Local contract variations – boundary changes.

7.2

7

3.20 There are implications associated with taking on this work especially to the CCG Finance, Contracting and Primary Care teams who have not currently got the capacity or the resource to take this work on. There are, however, potential benefits in oversight of the process and a reduction in process delays.

3.21 The CCG has gone back to NHSE Wessex team and informed them that the CCG would not be in a position to take on any additional transactional work without additional resource.

3.22 It is likely that NHSE will expect this transactional work to be devolved to Dorset CCG at some point in the near future and the resource implications of this will need to be considered further. Quality and Resilience

3.23 We continue to work with NHSE to increase local resilience and sustainability.

Recently NHSE has agreed an additional circa £120K to invest in Dorset plans. This has reduced the cost pressure on the resilience budget which resulted from the planned closure of Abbotsbury Road. We are now working to a 2018-19 budget allocation of £346,000 which includes both NHSE and CCG allocations.

3.24 The GP Resilience Programme budgeting for 2018-19 is now in place to support all prioritised schemes and we are on target to achieve the NHSE requirement to spend 75% of this by January 2019 and the remainder by April 2019.

Improving RightCare and Demand Management

3.25 Primary Care continues to support a number of care pathways to try to ensure patients have good access to the right care, this includes work to help patients self-manage their condition with expert advice, access community services, as well as manage the variation in demand and access to secondary care services. Figure 1 below summarises the trend in GP referrals related to this work.

The MSK referral figures show a 30.7% reduction of referrals in 2018 / 19 compared to this period in 2017 / 2018. This is likely to be directly connected to the introduction of the MSK Triage Service in October 2017;

The Physiotherapy service in Dorset is currently under review and it is expected that the draft pathways will be released in early 2019. It is anticipated that the improvements to this service should complement the MSK Triage Service;

7.2

8

Cardiology: Work has taken place this year to standardise the Atrial Fibrillation and Palpitation Pathways so that there is a consistent approach across the county. GPs fed back on the draft versions of the pathway as part of the Cardiology Right Referral Right Care work and these were launched in November 2018;

Dermatology: The data shows that there has been a fairly large decrease in the numbers of Dermatology referrals in 2018 / 19 compared to 2017 / 18. However, it should be noted that this is likely to be because in January 2018, the Dermatology department at Royal Bournemouth and Christchurch NHS Foundation Trust (RBCH) stopped accepting non-two week wait referrals. This then had a knock-on effect on Poole Hospital (PHT) who stopped access to non-two week wait referrals in September 2018;

In September 2018, a Telederm app was launched to all GP Practices enabling them to take a picture of skin lesions and send the photos securely to secondary care for advice and guidance. Despite some IT related operational issues being highlighted by Practices, to-date 1457 images have been taken using the app, with 69 GP Practices actively using it. There are currently 181 app users in Dorset.

Figure 1: GP Referrals: Comparison of % change for rolling 12 months

Integrated Community and Primary Care Services investment - impact on Occupied Bed Days (OBD)

3.26 Investment in Integrated Community and Primary Care is at the heart of Dorset’s Integrated Care System planning and there are a number of key system metrics which this investment seeks to support. Two of these key indicators are Occupied bed days and length of stay.

7.2

9

3.27 The 12 month rolling position as at September 2018 shows good progress being made with:

Occupied bed day reductions;

Number of patients staying over 7 days.

3.28 The position has not changed or worsened for:

Readmissions;

Lengths of stay in super stranded over 21 day patients.

3.29 Substantial increase in minor and intermediate attendances (as seen in Figure 2 below) is of concern and may be related to:

Emergency Department streamed activity to Primary Care urgent care services and how this has been counted;

Improving access to General Practice reporting.

Figure 2: Minor and intermediate attendances -trend for all localities

7.2

10

3.30 Figure 3 below reflects the Quarter 2 (12 month ending September 2018) Occupied Bed Days (OBDs) between our localities.

Figure 3: Occupied Bed Days - Month ending September 2018 3.31 Bournemouth North: The locality has seen a reduction in admissions and

stranded patients but remains the locality with greatest OBDs in people over 65 yrs. The Integrated Community and Primary Care Services (ICPCS) investment focuses on admission avoidance.

3.32 Central Bournemouth: There are wide fluctuations each quarter in Length Of Stay (LOS) and long stay patients, although admissions and readmissions indicate no increase in line with population growth which is good. The ICPCS plans seek to put in place sustainable hub and frailty services.

3.33 East Bournemouth: LOS and admissions are back to close to the end of 2017 position and the priority should be to sustain this scale of decrease which we have seen before but was not maintained. The ICPCS plans have a strong focus on admission avoidance and frailty.

3.34 Christchurch: The recent rise in LOS has been reversed and it will be important to sustain this and the reduction in admissions. This locality bucks the trend in localities where RBCH is the main provider and is part of the group of localities with lower hospital utilisation.

3.35 East Dorset: This locality is part of the locality group with lower hospital utilisation but is above target and this is primarily due to the substantial increase in bed days associated patients who stay more than 7 and 21 days.

3.36 North Poole: This locality made large reductions last year and is part of the locality group with lower hospital utilisation which has been sustained. Admissions are slowly rising.

3.37 Poole Central: This locality started to make large reductions during the last year and these are continuing in LOS and admissions are not rising.

7.2

11

3.38 Poole Bay: This locality is in the group with lower hospital utilisation and previous OBD reductions have been maintained, and there is a degree of consistency across Practices.

3.39 Purbeck: Continues to have the lowest bed occupancy rate although we have seen an increase in the lengths of stay with a small number of patients. Admissions are on target to reduce.

3.40 Mid Dorset: The increase in admissions and OBD have reversed and this is one of the few localities where Ambulatory Care Sensitive (ACS) admissions 1+ days have reduced. Long stay patients have however increased.

3.41 North Dorset: Similar to Mid Dorset reductions in admission and OBD but patients in hospital over 21 days are rising. The focus on the ICPCS investment to support reducing LOS in patients out of county as well as in County providers remains a focus.

3.42 Dorset West: Patterns similar to Mid Dorset for admissions and OBD and patients over 21 days.

3.43 Weymouth and Portland: This locality has seen a substantial rise in a few patients with very long stays which are contributing to a significant increase in OBD. Admissions have continued to reduce.

3.44 The ICPCS investment across Dorset localities continue to have a strong focus on admission avoidance and enhancing frailty models of care.

Diabetes

3.45 National Diabetes Audit (NDA) data for 2017 / 18 is now available. Dorset achieved 100% participation in the NDA, compared with 84.8% the previous year.

3.46 There is considerable variation across Dorset in terms of how diabetes is managed and there is a need to support practices in a different way. Initiatives already under way include:

WISDOM – this programme is funded from NHSE Diabetes Transformation funding to develop locality Multi Disciplinary Teams (MDTs) which bring together Primary Care and specialist services to learn from each other in terms of how patients are managed and supported. The particular value of WISDOM is that supportive relationships are built across services which then enable the sharing of good practice and effective communication about patients’ needs and how to meet them. Additionally WISDOM has provided patient education to people with diabetes diagnosed for some time; recognising that patient education is not only helpful upon diagnosis, but needs to be followed up throughout the life course.

7.2

12

ICPCS funding – the localities in receipt of this are increasing their capacity by recruiting additional staff and supporting new ways of working in MDTs in line with the WISDOM work started in 2018/19;

The local contract is to be reviewed and made simpler so that it moves away from a complex ‘pay per intervention’ transactional process to something more transformational building on the service improvement work completed to-date. This aims to improve quality and reduce unwarranted variation. This work will be developed further during 2019/20.

4. Finance

4.1 As of month 9, the Primary Care finance delegated budgets are forecast to break even at year end.

4.2 The Local Enhanced Services and Community Schemes budgets are also on track to break even at year end with minor over and under performance against some of the local enhanced service activities offsetting each other.

4.3 There is pressure on the resilience budget but additional funding from NHSE

to support locality resilience planning and at risk Practices has negated most of the risk, with local Primary Care non-recurrent investment supporting the remaining funds required.

5. GP Forward View: Transformation and Engagement Update Developing Primary Care Networks across Dorset

5.1 We continue to develop our plans to support General Practice working in Primary Care Networks. In 2019 this will be aligned to a new incentive framework as part of the CCLIP.

5.2 The plan will ensure that each PCN completes a validated baseline position and progresses to level 3 maturity. The three steps to this are described in table 3 below: Table 3: Dorset Primary Care Network Development

Primary Care Network Maturity

Level

Key indicators

Step 1

The relationship and trust of key partners is established, understanding needs, resources and arrangements for team working.

Step 2

Network builds on plans to deliver care incorporating population health management and risk stratification; models put in place to manage routine, complex and urgent care.

Step 3

Fully developed Network with business and service delivery model in place delivered by an integrated team. Network has a defined role within the ICS.

7.2

13

Current Network Profile and anticipated Trajectory

5.3 During early 2019 we will be expecting all PCNs to validate their baseline position. Based on feedback from Clinical Chairs and key stakeholders we have begun to profile the current position in Figure 4 below: Figure 4: Primary Care Network current position

5.4 Our planned trajectory through to the summer of 2019 sees a gradual increase in maturity of all of our networks to achieve all Networks at Step 2 and at least three Networks at Step 3:

Figure 5: Primary Care Network Development Plan

7.2

14

Next Steps

5.5 The above forecast trajectory is based on:

Completion of a validated baseline for all Dorset PCNs (by March 2019);

Targeted support to all Networks based on agreed priorities (by April 2019);

An accelerated programme of support and development for at least three PCNs (to commence in early 2019).

Personalisation

5.6 Help and Care have been awarded the contract to provide the Primary Care

Non-Clinical Health Coaching and link to Social Prescription Service for people with Long Term Conditions and Carers. The service will mobilise early in 2019 with an operational start date of 1 April 2019.

5.7 A new governance structure has been proposed, with Task and Finish groups already underway. Figure 6 below provides an overview of this: Figure 6: Personalisation Proposed Governance Structure

7.2

15

5.8 We are seeking to align funds from the GP Forward View Care Navigation Programme with the Personalisation programme to enable a more seamless and consistent approach to active signposting training. What matters is how people (individuals, teams, services and systems) work together in a ‘joined up’ way, so that people know when and how they can get access the right help, at the right time, in the right place. The funds will support further improvements in the patient pathway and promote seamless working between commissioned services e.g. Live Well Dorset, Steps to Wellbeing and Help and Care to support Primary Care.

5.9 A training gap analysis is underway and will be completed in January, to support all Dorset Practices to complete active signposting training.

Improving Access

5.10 Dorset CCG has continued to commission services to maintain the national mandated target for Improving Access to General Practice Services (IAGPS).

5.11 As at October 2018 the achievement against this target was met through delivery across the three Cluster areas: Table 4: Improving Access to General Practice Services

5.12 An allocation of circa £3.15m has been made to delivery of the 100% target to be maintained through the new Integrated Urgent Care model from April 2019. The remaining £1.6m funding for IAGPS expected from April will be invested in routine care at a PCN level as part of the overall investment plans for Primary Care. This is expected to augment existing routine care provision as well as support local delivery of new care models, taking into account local demand and capacity. The additional investment is not intended to be used to replace the Extended Hours Directed Enhanced Service should this be discontinued from the GP Contract.

5.13 In response to a national expectation to provide additional capacity between 20 December 2018 and 7 January 2019, providers of IAGPS have been asked to increase service provision within their geographic footprint for this period of time. This additional capacity is still required to meet the seven Core National requirements of IAGPS and will be a clear step change in service provision over the weeks of Christmas and New Year for the people of Dorset. It will be funded from within the existing financial allocation for IAGPS.

7.2

16

5.14 From 7 January, service levels will return to current levels, continuing to meet the 100% target population coverage through to, and beyond, 1 April 2019 when the service will be a key component of the Integrated Urgent Care service.

5.15 Each of the eleven IAGPS (Urgent) sites, the respective hours of service provision and the specifics of where the patient should present upon arrival is detailed on its own page within the Directory of Services. This increased level of detail will not only prove to be more useful for the 111 Call Handlers, it will allow for a more dynamic update of opening hours. This will be used to improve service utilisation and directly support winter planning.

5.16 NHSE have confirmed reporting on service provision and utilisation will continue through into the next financial year. The NHSE-led Utilisation Tool has still not been made available so providers and commissioners will be expected to provide details through local data extraction. A future intention will be to report on individual Practice service usage and age profile of the service user.

6. Estates, Technology and Workforce Planning

Technology Enabling Care – GP Online Consultations

6.1 The first Dorset Practices went live with eConsult during November 2018.

6.2 First wave Practices attended ‘launch days’ in Weymouth (December 2018) and in Wimborne (January 2019). November 2018 saw the first four Practices remotely support 127 Unique Visitors - they had 21 eConsults submitted and an estimated 12.6 visits saved. For December 2018 these figures rose to 442 Unique Visits, 41 people choosing self-help, 98 eConsults submitted and an estimated 59 appointments saved. This represents good progress in the mobilisation of GP and patient use of on-line consultations and this trend in use is expected to increase as the roll out of the technology continues during 2019.

7.2

17

6.3 The figures below provide an overview of service use and the age distribution of patients during the early mobilisation phase for this service: Figure 7a: e-Consult User Profile

Figure 7b: Age Profile of Users

6.4 In December 2018, month three of service mobilisation, the milestone of a

1,000 e-Consult visits in a month was passed for the first time.

6.5 As at 11 January 2019:

10 practices live with e-Consult;

1243 e-Consult visits made;

973 Unique Visitors;

7.2

18

130 estimated appointments saved.

6.6 Plans are now underway for the e-Consult service to be made available to patients as part of the Integrated Urgent Care and the Improving Access to General Practice workstreams.

Workforce

6.7 Over the past three years, there has been a noticeable change over time in

our workforce. The shift from GP provider (partners) to salaried / other GPs reflects what we know from national surveys of GP trainees, with a reducing number wanting to become business owners and an increasing number wanting a portfolio career.

6.8 The skill mix of General Practice staff has significantly changed and diversified for those providing direct patient care. With huge pressures nationally in nursing, it is overall a very positive story. However, this data is pan-Dorset and therefore does not reflect those areas that are particularly struggling to recruit and retain staff.

6.9 Without also knowing the increased demand, it is also difficult to understand what the impact of the change has been, this emphasises the importance for PCNs to start to more fully understand their own workforce status and resilience for the future and to consider this with regards to new care models.

Figure 8: Workforce Planning - GP numbers

6.10 The GP target agreed with NHSE is 512 WTE by September 2020. Figure 8

confirms that to-date we are tracking slightly below the planned trajectory, however, the trajectory for 2020 is slightly higher than the STP target.

Strategic Primary Care Estates Planning 6.11 Primary Care Estates planning continues to develop in order to ensure the

following outcomes:

Ensure capital investment is appropriately targeted;

Put in place the appropriate skills and resources to achieve the agreed strategic priorities;

Provide the Primary Care estate intelligence required to inform the Dorset STP whole system strategic estate planning.

7.2

19

6.12 Estate projects continue to be prioritised based on an understanding of the current Primary Care estate profile including factors such as the physical condition of the estate, the quality of the patient experience, the planned housing development in the local area, and the ability of the estate to support Primary Care transformation including new workforce and care models.

6.13 Primary Care estate planning needs to ensure that the infrastructure is able to respond to the changing patterns of care so as to be fit for the future, this includes provision for:

Integrated local care teams;

At-scale working;

Resilience and sustainability.

6.14 In order to support this work Locality Strategic Estate Plans are being developed which will provide:

A baseline of property information;

Mapped housing development zones;

Options for future infrastructure developments;

Agreed local priorities and action plans.

6.15 Locality Plans have now been completed for Weymouth and Portland, Poole Central and Purbeck. Draft locality Plans are in place for both North and West Dorset.

Estates and Technology Transformation (ETTF) Schemes update 6.16 This NHSE funded Programme of Capital Investment in Primary Care

Premises ends on 31 March 2020. Three Dorset Projects continue to progress through the various stages of approval:

Carlisle House Surgery Reprovision: Capital £1.46M;

Wareham Surgery Reprovision: Capital £1.93M possibly increasing to £5.30M;

Parkstone Surgery Improvements to Premises: Capital £2.18M.

6.17 If all three schemes proceed this will result in a total capital investment of between £5.57M and £8.94M into Primary Care in Dorset.

Wareham Surgery 6.18 The Outline Business Case will be considered formally at an NHSE Panel in

Spring 2019.

7.2

20

Parkstone Health Centre 6.19 The Outline Business Case will be considered formally at an NHSE Panel in

Spring 2019.

Carlisle House Surgery 6.20 The Full Business Case was approved by NHSE on 12 December 2018. This

is the first ETTF project in South of England to reach this stage. Capital investment of £1.46M has been secured. Work is to start on site in early 2019 with plans being developed for the surgery to relocate in Summer 2019.

7. Recommendations

7.1 The Committee is asked to note progress across a number of Primary and

Community Care Commissioning Strategy and GP Forward View Programme delivery areas.

7.2 The Committee is asked to approve plans for the additional investment and commissioning intentions for 2019-20 set out in sections 3.1 - 3.7.

Author’s name and Title: Rob Payne, Head of Primary Care Date: 23 January 2019

Telephone Number: 07866 266848