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Primary Care Commissioning Committee (PCCC) Meeting held in Public Date: 18th May 2021 Time: 1045-1245 Venue: Microsoft Teams
No Time Slot
Agenda Item Lead Purpose Attachment
1. 1045 Welcome & Apologies
Chair -
2. Declarations of Interest
Chair/All Requirement -
3 PCCC in Public Minutes 17.11.20.
Chair Information Item 3
4. 1050 Clarify role of the PCCC in BLMK CCG
- Terms of Reference
Chair Information Item 4
5. 1055 Reset & Restoration
5.1 Extended Access to Primary Care – contract update
Richard Noble Information Item 5.1
5.2 Covid Vaccination in Primary Care
Alexia Stenning
Information Item 5.2
6.
1115 Primary Care Networks (PCNs) update - PCN changes for 2021-22 - Local Incentive Scheme (LIS)
David Picking Information Item 6
7. 1125 Primary Care Network PCN IT Funding 2021-22 - funding for Additional Roles
Reimbursement Scheme (ARRs)
Mark Peedle Note / Information
Item 7
8. 1135 Arlesley Medical Centre - temporary provider update
Tony Medwell / David Picking
Information / Assurance
Item 8
9. 1145 Special Allocation Scheme (SAS) Tony Medwell Assurance Item 9
10. 1155 BLMK Primary Care Risk Register
Richard Noble Assurance Item 10
11. 1210 Quality & Outcome Framework (QOF) Changes – supporting Primary Care 2020 & 2021
Tony Medwell Information / Quality Assurance
Item 11
12. 1215 BLMK Estates Working Group report including:
Nikki Barnes
- Primary Care Estates Strategy 2020-24
Note/Endorse Item 12&12.1
- Dunstable Hub: Project Initiation Approval Item 12&12.1.1
Document (PID)
- Kingsway/Conway Project update Note/ Information
Item 12
13. 1230 Finance Report (Month 12)
Stephen Makin Assurance Item 13
14. 1240 Any other business
Chair/All -
15. Date of Next Meetings 20.07.21. 0900-1030 Private 1045-1245 Public Please note timings may change due to agenda requirements
Chair Information
Voting Members
Alison Borrett Lay Member for Patient and Public Engagement (Chair)
Sally England Lay Member for Finance and Performance (Deputy Chair)
Felicity Cox Accountable Officer/ Integrated Care System Executive Lead
Stephen Makin Director of System Finance/Deputy CFO (for Chief Finance Officer)
Dr Ed Sivills Medical Director
Anne Murray Director of Nursing and Quality (Chief Nurse)
Nicky Poulain Director of Primary Care
Dr Shankari Mahathmakanthi Governing Body Member Representative
Dr Linus Onah Governing Body Member Representative
Dr Sureena Goutam Governing Body Member Representative
Non-Voting Members
Rachel Webb
Director of Primary Care and Public Health NHS England and NHS Improvement – East of England
Joanne Pope
Head of Nursing, Leadership and Quality (Direct Commissioning), NHS England & NHS Improvement – East of England
Lauren Sibbons
Senior Contract Manager – General Practice (BLMK System) NHS England and NHS Improvement – East of England
Lucy Nicolson Chief Operating Officer, Healthwatch Luton
Phil Turner Chair, Healthwatch Luton
John Wright Chair, Healthwatch Bedford Borough
Helen Terry Chief Executive, Healthwatch Bedford Borough
Diana Blackmun Chief Executive Officer, Healthwatch Central Bedfordshire
Tracy Keech Interim Chief Executive Officer, Healthwatch Milton Keynes
Paul Lindars Associate Director Primary Care Development
Amanda Flower Associate Director Primary Care Commissioning & Transformation (BCA)
Alexia Stenning Associate Director Primary Care Commissioning & Transformation (MKICP)
Tony Medwell Head of Primary Care Contracting
Lucy Hubber Director of Public Health, Luton Council
Vicky Head Director of Public Health, Bedford Borough, Central Bedfordshire & Milton Keynes Councils
Mike Harrison Co-Chief Executive, Bedfordshire & Hertfordshire LMC Ltd
Dr Nicky Williams Co-Chief Executive, Bedfordshire & Hertfordshire LMC Ltd
Dr Matt Mayer Chief Executive Officer – Berkshire, Buckinghamshire & Oxfordshire LMCs
Dr Richard Wood Chief Executive Officer – Berkshire, Buckinghamshire & Oxfordshire LMCs
Future meeting dates:
Date Time Venue Paper Circulation
20.07.21. Public 1045-1245 Via MST 13.07.21.
21.09.21. Public 1045-1245 Via MST 14.09.21.
16.11.21. Public 1045-1245 Via MST 09.11.21.
18.01.22. Public 1045-1245 Via MST 11.01.22.
15.03.22 Public 1045-1245 Via MST 08.03.22.
1
Minutes Author: Secretariat Contact Information: [email protected] Lead: PCCC Chair Alison Borrett
Action Log Author: Secretariat Contact Information: [email protected] Lead: PCCC Chair Alison Borrett
Minutes: Public
Which activity does this paper relate to?
Draft minutes from the PCCC meeting held in public on 17.11.20. For information only as the minutes were approved at the PCCC meeting held in private on 19.01.21. as no meeting in public was held that month. Approved by the Chair (Alison Borrett) and the Director of Primary Care (Nicky Poulain).
What is the Committee being asked to do?
The minutes are provided to the Committee for information only.
Action Log: Public
Which activity does this paper relate to?
The tracker would show any outstanding and completed actions of the PCCC.
What is the Committee being asked to do?
There are currently no outstanding actions.
Appendices 3.1 Public minutes 17.11.20.
Primary Care Commissioning Committee Meeting held in Public 18th May 2021 09:00-1030
Item 3: PCCC draft Minutes 17.11.20. – For information
Information
Page 1 of 9
Minutes of the Primary Care Commissioning Committees in Common Meeting Held in Public on 17th November 2020 at 1045-1245
Held over Microsoft teams
Members Present:
Alison Borrett Lay Member PCCiC Chair (BCCG Chair PCCC) Bedfordshire AB
Darren Smith Lay Member (MKCCG Chair PCCC) Milton Keynes DS
Lloyd Denny Lay Member (LCCG Chair PCCC) Luton LD
Dr Amit Goyal GP Board Member Milton Keynes AG
Dr Christopher Longstaff GP Board Member Bedfordshire CL
Dr Linus Onah GP Board Member Bedfordshire LO
Mahmood Aziz Lay Board Member Luton MA
Maria Laffan* Deputy Chief Nurse (Left at 1200 Item 7) BLMK ML
Mike Rowlands Lay Board Member Milton Keynes MR
Dr Nessan Carson GP Board Member Milton Keynes NC
Nicky Poulain Director of Primary Care BLMK NP
Paul Lindars Associate Director Primary Care Development BLMK PL
Dr Roshan Jayalath GP Board Member Bedfordshire RJ
Sally England Lay Board Member Bedfordshire SE
Dr Sanjay Sharma GP Board Member Bedfordshire SS
Dr Sarah Whiteman Medical Director BLMK SW
Stephen Makin** Deputy CFO/Director of System Finance BLMK SM
Apologies from Members:
Anne Murray Chief Nurse * Deputy ML BLMK AM
Chris Ford CFO/Deputy AO ** Deputy SM BLMK CF
David Kempson Lay Member Luton DK
Dr Ed Sivills GP Member Milton Keynes ES
Dr Helen Turner Secondary Care Doctor Luton HT
Dr Krishna Patel GP Member Milton Keynes KP
Patricia Davies Accountable Officer BLMK PD
Richard Alsop Director of Commissioning & Contracting BLMK RA
Others in attendance:
Alexia Stenning Associate Director Primary Care Commissioning & Transformation
BLMK AS
Amanda Flower Associate Director Primary Care Commissioning & Transformation
BLMK AF
Carla Barbato Programme Manager Primary Care Milton Keynes CB
Edna Muraya Senior Finance Manager Milton Keynes EM
Dr Hetal Talati GP Board Member/PCN Clinical Director (Eden) Luton HT
Janine Welham Primary Care Manager Milton Keynes JW
John Wright Chair of Healthwatch Bedford Borough Bedford Borough JW
Kayley O’Sullivan Primary Care Support Officer Milton Keynes KO
Lauren Sibbons Senior Contract Manager – General Practice (Joined NHSE/I (BLMK LS
Page 2 of 9
1130 for Item 6.3) System)
Lisann Blower EA Primary Care – Minute Taker LCCG LB
Lucy Nicholson Chief Executive Healthwatch (Left 1218 Item 10) Luton LN
Lynda Linbourne Deputy Head – Primary Care Commissioning and
Contracting
Bedfordshire LL
Mark Peedle Head of Digital (Joined at 1045 for Item 4) BLMK MP
Mike Harrison Co-Chief Executive, Beds and Herts LMCs Bedfordshire & Luton
MH
Nikki Barnes Associate Director Transformation & Integration& ICS Estates Programme Lead
Bedfordshire BLMK ICS
NB
Nina Hannagan Contract Support Manager NHSE/I (BLMK System)
NH
Patricia Coker Head of Service Lead for Integration Central Bedfordshire Council (Joined 1120 Item 6.1)
Central Bedfordshire
PC
Phil Turner Chair Healthwatch Luton PT
Dr Raj Grewal Service Co-ordinator Healthwatch Milton Keynes RG
Raj Hira Public Health Principal for Primary Care, Milton Keynes Council
Milton Keynes RHi
Richard Noble GPFV Transformation Manager (Joined at 1118 Item 6.1)
Bedfordshire RN
Roger Hammond Associate Director Finance – Primary Care & OOH BLMK RH
Sarah Watts Senior Quality Manager for Primary Care & Out of Hospital
BLMK SWa
Simon White Chief Officer Health Integration Bedford Borough Council
Bedford Borough SWh
Susi Clarke Primary Care Workforce Programme Lead BLMK ICS SC
Tony Medwell Head of Primary Care Contracts and Commissioning Bedfordshire TM
Dr Una Duffy GP from a Member Practice Luton UD
Apologies from Attendees
Andrew Harrington CEO MKGP Federation (MKGP Ltd and MKGP Plus Ltd) Milton Keynes AH
David Barter Head of Commissioning NHSE/I DB
Diane Blackmun Chief Executive Officer of Healthwatch Central
Bedfordshire
Central Bedfordshire
DB
Jennie Russell Deputy Director of Quality and Clinical Governance Luton JR
Liz Cox Associate Director of Finance – Luton / Strategy,
Planning & Performance
BLMK LC
Lucy Hubber Interim Director of Public Health, Luton Council Luton LH
Dr Matt Mayer CEO BBO LMC Milton Keynes MM
Nicky Wadely Associate Director of Population Health BLMK NW
Dr Nicky Williams Co-Chief Executive, Beds and Herts, LMCs Bedfordshire & Luton
NWi
Oliver Mytton Deputy Director of Public Health, Milton Keynes Council
Milton Keynes OM
Pam Lewin Primary Care Contract Manager – GP BLMK NHSE/I PLe
Rachel Webb Director of Primary Care and Public Health NHSE/I RW
Dr Richard Wood CEO BBO LMC Milton Keynes RWo
Tracy Keech Interim Chief Executive Officer Healthwatch Milton Keynes TK
Page 3 of 9
1. Welcome and Apologies for absence
The Chair for Bedfordshire and for Committees in Common (Alison Borrett): - welcomed all members, attendees, the Public to the first PCCiC meeting held in Public - apologies were received and noted as above - advised that the meeting was quorate - informed the Committee that the meeting would be recorded for the purpose of the minutes
and published on line and therefore members of the public were advised to keep their cameras turned off and for microphones to be muted
- for future meetings the public can request questions related to agenda items prior to the meeting but for the purpose of today’s meeting they should use the chat feature.
Action
2. Declarations of interest (DoI) (Chair)
(i) No members declared any additional/new interests to their current DoI on the CCG Interests Register.
(ii) No declarations of interests were made by members or attendees in relation to items on the agenda.
3. Clarify purpose of the Primary Care Commissioning Committees in Common (Chair)
The Primary Care Commissioning Committee (PCCC) is a committee between NHS England and Bedfordshire, Luton and Milton Keynes CCGs, with the primary purpose of jointly commissioning primary medical services for the local populations. As the CCGs are currently three statutory bodies, each area retains its own Committee terms of reference. It was established to enable the members to make collective decisions on the review, planning and procurement of primary care services under delegated authority from NHS England. The Committee has representatives from NHSE, GP members, Primary Care Networks (PCNs), Local Authorities, Local Medical Committees, Healthwatch, Public Health and the CCGs.
4. BLMK Primary Care Digital Strategy update (Mark Peedle)
The impact of Covid 19 has seen a rapid acceleration in the take up of digital technology with constructive developments within primary care including online consultation tools now widely used in 90% of Practices and being embedded in Care Homes.
- 111 first & same day primary care: working with BLMK partners on a digital waiting room for easy access for urgent and emergency department access (non-emergency); exploring / piloting a Hub model for PCNs to use for online video consultations;
- Integrated Urgent Care: video consultations in Out of Hours Services (OOHS) and Clinical Assessment Services (CAS) and access to diagnostics by OOHS clinicians on behalf of GP
- Primary Care - Secondary care interface, working across care systems : tools to improve advice and guidance prior to referrals; focusing on a multi-disciplinary team approach
- Mental Health link with primary care: looking at effective access to multi-disciplinary team meetings and rehabilitation services
- Next steps: BLMK Digital Assembly established and attended by all Primary Care Networks (PCNs) and Clinical Directors; continued engagement with BLMK Integrated Care System (ICS) Digital leads and fully engaged with the East Region Digital Transformation group. Realistic roadmap for the next two to three years to be developed (clinically led and agreed).
The Caldicott Guardian is kept fully appraised of the work of the Digital Team to ensure it was clinically safe. RG requested that the Digital team consider the difficulty within triage pathways for carers or family to access NHS services where the patient is unable to provide clinical consent. MP assured the Committee that BLMK CCGs recognised that digital technology was not a single solution and they will continue to ensure that it is considered part of the system approach but not ‘the’ system and that solutions and access were available to digitally excluded patients.
Page 4 of 9
The Committee received assurance from the update on the BLMK Primary Care Digital Strategy.
ACTION 001: MP to share the BLMK Primary Care Digital Strategy with the BLMK Patient & Public Engagement Committee for support/endorsement.
MP
5. BLMK Estates Working Group Report (Nikki Barnes)
The Estates Working Group (01.11.20.) made the following recommendations in relation to primary care estates schemes. Members of the Primary Care Commissioning Committees are asked to approve the final costings to relocate Conway Medical Centre and to note both the application to utilise Section 106 funding for an options appraisal for Cobbs Garden Surgery and the bid submitted as part of the Bedfordshire One Public Estate programme.
5.1 Relocation of Conway Medical Centre
The Committee discussed the Business case proposal to relocate to nearby Kingsway Health Centre. The scheme was previously approved by LCCG PCCC and scrutinised by the BLMK Estates Working Group. The main driver for the scheme is the relocation of one of the most constrained practices in BLMK into new premises with ample capacity to serve patients well. The relocation with another practice in their PCN bolsters long term resilience in the area. The updated version of the Project Initiation Document will be shared with the Committee. Proposal received from the Landlord and formal report from the District Valuer confirming an increase in cost against the primary care delegated budget, but rated as value for money. Due diligence to finalise leasing arrangements will be completed.
LCCG PCCC approved the final costings for the scheme to relocate Conway Medical Centre.
5.2 Cobbs Garden Surgery: application to utilise Section 106 funding for an options appraisal
BLMK Director of Primary Care (NP) has approved support for the Practice to apply to Milton Keynes Council to access Section 106 funding for professionals advisors to carry out an options appraisal. They are a constrained Practice in an area of significant housing growth and have Section 106 funding already secured to support improvements in capacity. The outputs of the study will be shared with the Committee. The Practice are aware that this will be an early exploratory stage, and does not commit MKCCG to funding any recommendations from the options appraisal.
The Committee noted the approval granted by the BLMK Director of Primary Care for an application to utilise Section106 to commission an options approval and business case development for improving the surgery.
5.3 Bid submitted as part of the Bedfordshire One Public Estate Programme
BCCG PCCC previously signed off the strategic outline case document for a range of Hubs across Bedfordshire. It approved progression to outline business cases, subject to availability of funding and supported the concept of trying to secure funding externally as opportunities arose. Bid submitted on behalf of the Bedford Borough and Central Bedfordshire Hub Programmes with BLMK Executive Team approval to start the detailed planning for proposed Hubs in West Mid Bedfordshire, Houghton Regis, Kempston and Leighton Buzzard. Planning would include healthcare plan, working up detailed service model and schedule of accommodation to understand size required and test against initial assumption. Confirmation of the outcome of the bid will be received early in 2021.
The Committee noted the bids submitted on behalf of the Bedford Borough and Central Bedfordshire Hub Programmes.
6. Primary Care Workforce (Susi Clarke)
Page 5 of 9
6.1 Primary Care Workforce/Training Hub highlight report
Report provided a high level summary of key workstream areas. SC highlighted pieces of work and initiatives for information and to note: - additional funding received to increase GP numbers across BLMK; in addition to schemes
already running SC is working with GP Leads to refresh GP recruitment and retention strategy based on meeting local needs
- support packages for assistance with new roles being recruited into primary care - PCN workforce plans enable active targeting to make sure wrap around support provided - Practice Nurse Leads and Clinical Pharmacist Leads increasing student placement capacity
and training existing and more experienced staff to supervise students - running a national pilot looking at how to support students virtually - funding training to develop a multi-disciplinary coaching and mentoring faculty for new roles
and student placements, but also providing career / portfolio option for experienced staff - programme of funded continual development for the training and education of staff (over
418 staff based on PCNs requirements). SC confirmed to RG that a focus of the Training Hub was around a cultural shift for both patients and practice workforce with support through different ways and levels of approach.
The Committees noted the work outlined in the Highlight Report.
6.2 Workforce plans and Additional Roles Reimbursement Scheme (ARRS)
Primary Care Networks were given an additional opportunity to amend Workforce Plans for 2020-21 enabling them to include numbers to recruit to the Nursing Associate and Training Nurse Associate roles. The planned number of whole time equivalent posts to be recruited within this financial year is 240. The Training Hub to support staff to be embedded in the networks and to support the networks to understand how those roles would work.
Training Hub and CCG to provide process whereby each PCN has the opportunity to bid against the indicative underspend. There is a strict criteria and PCNs can only bid against the underspend in their CCG area. Those PCNs further advanced in the process to work with CCGs to support the rest of the system to progress. If required Workforce Plans would be amended and resubmitted to NHSE at an aggregate level.
SC assured NC of the career pathway in place across BLMK for the role of Practice Nurse and confirmed that there was a Team of Nurse Leads supporting those in post and provided examples of career progression across BLMK. PL explained to SE the multiple factors contributing to the Bedfordshire underspend including recruitment to lower banded roles, variations of infrastructure in place and ability to recruit.
The Chair requested that the Committee were kept updated on Items 6.1 and 6.2.
The Committee noted the current position in terms of planned recruitment 2020-21, the indicative underspend and the next steps for PCNs to bid against the underspend.
6.3 BCCG Primary Care PCN Development Funding 19/20 (Paul Lindars and Richard Noble)
PCNs were asked to confirm their development funding submissions made earlier in year or resubmit with new priorities or ideas. Update confirmed the PCNS that have engaged either in situ or been approved and provided assurance to the Committee that the place teams continued to work closely with PCNs to ensure that funding was utilised within the current financial year. PL and RN confirmed to SE that PCNs who were adopting a different online consultation model were operating within NHSE approved options, and that this enabled the system to test and understand different solutions through digital workstreams. AG explained how his practice/PCN had chosen the system they use and how every surgery had different ways of working so should not be limited to current providers and should be considered as part of the funding NHSE/CCCG provide for these systems.
Page 6 of 9
Continuation of the PCN Development Contract agreed in 2019/20 with the Bedfordshire,
Luton and Milton Keynes (BLMK) ICS (Paul Lindars)
National Association of Primary Care (NAPC) contract was paused due to Covid 19 and to make best use of the remaining legacy contract it was agreed by the Primary Care Cell to repurpose the approach to establish a tailored online project based and evaluated learning approach of the General Practice Nursing CARE programme. This will be consolidated through four exemplar PCN sites and shared across BLMK. It has received positive feedback and the plan is to echo that model to provide PCN support using legacy funding.
The Committee noted the update on BCCG PCN Development Funds (2019-20) and on the BLMK NAPC Legacy Agreement (2019-20).
6.4 Funding for Primary Care Workforce Development, beyond Additional Roles Reimbursement
Scheme (ARRS) (Paul Lindars)
PL outlined the BLMK CCG / ICS primary care funding allocations to be received from NHSE/I, noting the different allocations for different projects in the programme and an overview of the governance structure in place to manage the funding. There is an expectation that these funds are invested this year. The Committee noted the funding allocations to be received from NHSE/I and the proposed governance framework to oversee the programme of work.
The NHSE/I Memorandum of Understanding states ICSs are empowered to shift funds between designated workstreams. The Committee discussed the recommendation to use ‘spare’ funding allocated for online consultations to support the GP resilience programme.
The Committee approved the recommendation to divert spare online consultation funds to
support the GP resilience programme.
2020/21 PCN Development Funding Proposal
The Committee reviewed the recommendation that utilisation of the BLMK PCN Development Funding for 2020/21 is based on the recommended principles outlined in the paper. The CCG to share these principles with PCN Clinical Directors allowing further feedback and possible refinement in relation to the menu of proposed PCN initiatives. Once the menu has been finalised in agreement with PCN Clinical Directors, the CCG will release the PCN allocations.
The Committee agreed the recommended approach, including the principles set out to deploy the PCN development funds.
7. BLMK Primary Care Strategy (Summary) April 2021-2021 (Amanda Flower, Alexia Stenning & Paul Lindars)
The Associate Directors for Primary Care presented a summary of the strategy produced as part of the BLMK CCGs merger application for NHSE England which outlined the definition and vision for primary care from now to delivery in 2023-24:
- primary care covers wider scope than general practices and the strategy covers the services that support and work around practices and PCNs to provide care to the population
- inspiration drawn from the Primary Care Home Model on how to integrate services around PCNs (community health, mental health and social care services), with services co-designed with GPs and communities
- aim to deliver improvements in the health and wellbeing of the population and create a strong, safe and sustainable health and care system through six key areas develop Primary Care Networks to boost out of hospital care reduce pressure on emergency hospital services give people more control and personalised services digitally-enabled primary
Page 7 of 9
care focus on population health (how to reduce inequalities and improve health outcomes for the population)
- outlined impact of Covid and the challenges for the population and healthcare professionals to move from traditional ways of working to new digital solutions; 0800-2000 opening across the system; weekend access and multi-disciplinary team working
- Phase 3 recovery includes: major response around expanded flu vaccination programme; mass vaccination planning; focus on early diagnosis of cancer for people with a learning disability, maintenance of disease registers, new patient reviews, routine medication reviews, frailty reviews, screening programmes, childhood immunisations
- demonstrated the benefits of working together as one clinically led BLMK CCG with aligned clinical and management leadership.
NP assured MH that the strategy did not disregard individual practices not in PCNs (three) and
that the CCGs recognised and worked with all 98 practices
ACTION 002: NP invited RG and other Healthwatch members to advise how they would like to
work with BLMK CCGs and partners to receive assurance on patient confidence and feedback
on the strategic approach.
RG, JW, LN, PT, DB
The Committee received assurance on the BLMK Primary Care Strategy.
8. Quality and Outcome Framework (QoF) Changes – supporting Primary Care 2020-2021 (Tony Medwell)
QoF is a system of quality management and payment to general practice with built in quality incentives around screening, monitoring, ill health prevention and addressing inequalities. It is a national scheme but with a local approach based on local population needs.
Recent interim guidance aims to support practices to reprioritise and focus on care not related to Covid 19 and to do that GPs require guaranteed income support. The changes are intended to release capacity within general practice to focus efforts upon the identification and prioritisation of people at risk of poor health, and those who experience health inequalities for proactive review. All practices across BLMK are currently working on three local Population Stratification Plans.
The Committee noted the QoF changes and were assured that BLMK Practices have commenced working on QoF Population Stratification plans which will be agreed with the BLMK PCCiC. The Committee will be updated on progress on 19.01.21.
9. Pilot to adequately resource Practices to produce Child Protection Safeguarding Reports (Tony Medwell)
The Committee discussed the request to ratify an operational decision made by the BLMK Executive to commence a six month pilot Safeguarding Report process. All CCGs tasked by NHS England to establish a process to fund GPs and improve the quality of reports undertaken within primary care to ensure children and vulnerable adults were effectively safeguarded. The pilot will establish a baseline of activity, time taken for each report, quality of reports and that the reports requested are appropriate. TM confirmed to NC and CL that their requests to consider digital (integration rights) and how to streamline the process particularly around duplicate requests would be included within the pilot.
The Committee will be informed of the outcome and recommendations of the pilot.
The Committee ratified the decision made by the BLMK Executive to commence a pilot Safeguarding Report process which includes remuneration and quality support to GPs.
10. BLMK Finance Report (Roger Hammond)
RH reported financial expenditure to Month 6 and forecast against NHSE advised 2020-21 budget (Months 1-6). He explained the temporary financial regime put in place in response to Covid for April-September 2020 where CCGs received budgets from NHSE, which for primary care was based on 2019/20 expenditure. This did not reflect additional investments that had been
Page 8 of 9
notified into primary care.
CCGs report monthly expenditure which NHSE review and a retrospective non-recurrent adjustment is reimbursed for reasonable variances. CCG has received Months 1-5 adjustments resulting in break even position. The overspend in Month 6 reflects the net position. From Month 7 CCGs received an allocation for the rest of the year enabling the setting of more realistic budgets. Outside of normal delegated approach, practices have been financially supported through their response to Covid. BLMK have received ring-fenced allocation to support primary care covid related costs for the remainder of the year and completing process for practice claims. Covid expenditure and non delegated areas of spend shared, with confirmation that variants seen were primarily driven by the Month 6 position in terms of actual budget versus spend.
The Committee received assurance on the BLMK financial report as at Month 6.
11. Bedfordshire PMS Reinvestment Funds 2020-2021 (Tony Medwell)
PMS Reinvestment Schemes specifications for Bedfordshire were paused due to Covid 19 response and changes to the GP contract under the pandemic regulations. National guidance supported practices with interim income protection and it is proposed that the current payments arrangements for Q1 and Q2 continue for Q3 and Q4, except where notice had already been given on service provision. Practices have started to reinstate services provided by PMS reinvestment funds in line with national and local priorities including Multi-Disciplinary Team working to support patients with more complex conditions. Work has commenced to agree the reinvestment criteria for released funding of PMS premium monies for the 2021-22 Scheme.
The Committee discussed the proposed scheme from December 2020 recommended by Dr Roshan Jayalath (Mental Health Commissioning Clinical Lead BCCG & BLMK ICS), for Health Checks for patients with a serious mental illness (SMI) with includes additional support and clinical reviews. To fund this scheme, it is proposed to cease current dementia payments to practices from October 2020. The Committee were assured that practices and wider mental health partners had systems and processes in place to identify dementia patients; payments had continued to practices during 2020-21 although the one year scheme had ceased.
BCCG PCCC approved the proposal for PMS reinvestment reinstatement of scheme for Health Checks for patients with a serious mental illness.
12. Current impact of Covid on Primary Care Services (Nicky Poulain)
NP concentrated on recognising the challenges for primary care services, the 98 practices, PCNs and staff and commending how adaptive they have proved to be to support patients and ensure both patient and staff safety. She described the impact for practices of working differently with community providers to ensure personalised services to patients in care homes and housebound patients; new ways of working (including digital) for both staff and patient experience; the ongoing process to ensure a sufficient supply of PPE; regular testing for practice staff and the challenges of covid vaccinations.
The Committee noted the update and endorsed the credit due to GPs and primary care staff.
13. Memorandum of Understanding & Delegated Functions of Responsibilities Agreement (LS)
NHSEI have developed a core offer of support for CCGs. The Memorandum of Understanding sets out their role as a regulator for the CCGs and provides the CCGs and the public with assurance on the ways in which both NHSEI and the CCGs are working collaboratively to deliver benefits for patients. The appendices circulated outline the level of support available and the level of co-production and integrated work that is taking place. LS confirmed that the arrangement was working effectively, particularly with the Heads of Primary Care and three CCGs and thanked the CCGs for working collaboratively with NHSEI.
The Committee noted the integrated support offer available to CCGs from NHSEI.
Page 9 of 9
14. Any other business
No other business was raised.
15. Date of Next Meeting: 19.01.21. at 1030-1230.
16. Meeting Closed 12:32
Author: Nicky Poulain, Director of Primary Care
Contact Information: [email protected]
Lead Executive: Nicky Poulain, Director of Primary Care
Which activity does this paper relate to?
Terms of Reference for a single CCG Primary Care Commissioning Committee were finalised in April 2021 upon NHS England’s confirmation of the delegated commissioning arrangements it would enter into with the single CCG (BLMK). Terms of Reference for CCG Committees form part of the CCG’s Constitution and these are shared with the Committee held in Public to outline the purpose of the Primary Care Commissioning Committee. The Committee functions as a corporate decision-making body for the management of NHS England delegated primary care functions and the exercise of the delegated powers. Terms of Reference are reviewed annually but cannot be amended without BLMK CCG Governing Body and NHS England approval.
What is the Committee being asked to do?
Terms of Reference shared for information.
Date to which the information this paper is based on was accurate
01.04.21.
Appendices
BLMK CCG PCCC Terms of Reference
Primary Care Commissioning Committee Meeting held in Public 18th May 2021 1045-1245
Item 4. Title: Primary Care Commissioning Committee (PCCC) Terms
of Reference
Information
1
Constitution (V1 01.04.21. NHS England Final Approval)
2c Primary Care Commissioning Committee – Terms of Reference
Introduction
1.0 Simon Stevens, the Chief Executive of NHS England, announced on 1 May 2014 that NHS England was inviting CCGs to expand their role in primary care commissioning and to submit expressions of interest setting out the CCG’s preference for how it would like to exercise expanded primary medical care commissioning functions. One option available was that NHS England would delegate the exercise of certain specified primary care commissioning functions to a CCG.
2.0 In accordance with its statutory powers under section 13Z of the National Health
Service Act 2006 (as amended), NHS England has delegated the exercise of the functions specified in Schedule 2 to these Terms of Reference to Bedfordshire, Luton and Milton Keynes CCG. The delegation is set out in Schedule 1.
3.0 The CCG has established the Bedfordshire, Luton and Milton Keynes CCG Primary
Care Commissioning Committee (“Committee”). The Committee will function as a corporate decision- making body for the management of the delegated functions and the exercise of the delegated powers.
4.0 It is a Committee comprising representatives of the following organisation: Bedfordshire, Luton and Milton Keynes CCG.
Statutory Framework
5.0 NHS England has delegated to the CCG authority to exercise the primary care commissioning functions set out in Schedule 1 in accordance with section 13Z of the NHS Act. Arrangements made under section 13Z may be on such terms and conditions (including terms as to payment) as may be agreed between the Board and the CCG.
6.0 Arrangements made under section 13Z do not affect the liability of NHS England for
the exercise of any of its functions. However, the CCG acknowledges that in exercising its functions (including those delegated to it), it must comply with the statutory duties set out in Chapter A2 of the NHS Act and including:
a) Management of conflicts of interest (section 14O);
2
b) Duty to promote the NHS Constitution (section 14P);
c) Duty to exercise its functions effectively, efficiently and economically (section
14Q);
d) Duty as to improvement in quality of services (section 14R);
e) Duty in relation to quality of primary medical services (section 14S);
f) Duties as to reducing inequalities (section 14T);
g) Duty to promote the involvement of each patient (section 14U);
h) Duty as to patient choice (section 14V);
i) Duty as to promoting integration (section 14Z1);
j) Public involvement and consultation (section 14Z2).
7.0 The CCG will also need to, specifically in respect of the delegated functions from NHS England, exercise those in accordance with the relevant provisions of section 13 of the NHS Act.
8.0 The Committee is established as a Committee of the Governing Body of Bedfordshire,
Luton and Milton Keynes CCG in accordance with Schedule 1A of the “NHS Act”. 9.0 The members acknowledge that the Committee is subject to any directions made by
NHS England or by the Secretary of State.
Role of the Committee
10.0 The Committee has been established in accordance with the above statutory provisions to enable the members to, for example, make collective decisions on the review, planning and procurement of primary care services in Bedfordshire, Luton and Milton Keynes under delegated authority from NHS England.
11.0 In performing its role the Committee will exercise its management of the functions in accordance with the agreement entered into between NHS England and Bedfordshire, Luton and Milton Keynes CCG which will sit alongside the delegation and Terms of Reference.
12.0 The functions of the Committee are undertaken in the context of a desire to promote increased quality, efficiency, productivity and value for money and to remove administrative barriers.
13.0 The role of the Committee shall be to carry out the functions relating to the
commissioning of primary medical services under section 83 of the NHS Act. 14.0 This includes the following:
a) GMS and APMS contracts (including the design of APMS contracts,
monitoring of contracts, taking contractual action such as issuing
branch/remedial notices, and removing a contract);
3
b) Newly designed enhanced services (“Local Enhanced Services” and “Directed
Enhanced Services”);
c) Design of local incentive schemes as an alternative to the Quality Outcomes
Framework (QOF);
d) Decision making on whether to establish new GP practices in an area;
e) Approving practice mergers;
f) Making decisions on discretionary payment.
14.1 The CCG’s key objectives under Delegated Commissioning are to:
a) To plan, including needs assessment, primary medical care services in
Bedfordshire, Luton and Milton Keynes;
b) To undertake reviews of primary medical care services in Bedfordshire, Luton
and Milton Keynes;
c) To co-ordinate a common approach to the commissioning of primary care
services generally;
d) To manage the budget for commissioning of primary medical care services in
Bedfordshire, Luton and Milton Keynes.
14.2 The key responsibilities of the Committee are to work together to:
a) Utilise local knowledge from CCG GP members to influence the development
of and investment in general practice to improve access to services and
patient outcomes;
b) Develop and commission end to end care and increased autonomy to shape
future Primary Care services;
c) Take an active role in driving forward the Five Year Forward View Agenda;
d) To manage the budget for commissioning of primary (medical) care services in
Bedfordshire, Luton and Milton Keynes;
e) Plan, including needs assessment, primary medical care services in the CCG
area;
f) Undertake reviews of primary medical care services in the CCG area;
g) Co-ordinate a common approach to the commissioning of primary care
services generally;
h) Ensure collaborative working on monitoring and addressing issues of quality in
primary care;
i) Support the development and implementation of a joint strategy for the
enablers; primary care estates and premises, workforce development and
IM&T infrastructure, which meets current and future needs.
4
Geographical Coverage
15.0 The Committee will cover the Bedfordshire, Luton and Milton Keynes CCG geographical area.
Membership
16.0 The Committee membership shall be as follows and a lay and executive majority will be maintained.
16.1 Members with voting rights:
a) Chair – Lay Member (Patient and Public Engagement);
b) Deputy Chair – the Lay Member (Finance and Performance) who has
knowledge about the CCG area enabling them to express an informed view
about discharge of the CCG functions;
c) Accountable Officer;
d) Chief Finance Officer;
e) Medical Director;
f) Director of Primary Care;
g) Chief Nurse;
h) At least two Member Representatives on the CCG’s Governing Body.
17.0 Executive members unable to attend a Primary Care Commissioning Committee meeting may appoint a Deputy to attend on their behalf. No other deputies are permissible.
17.1 Other attendees – Non-voting
17.2 The following non-voting attendees will be invited to attend the meetings of the
Primary Care Commissioning Committee:
a) NHS England Locality Director;
b) NHS England Delegated Deputy Director of Nursing;
c) NHS England GP Contract Manager or Deputy;
d) One or more Health Watch representatives;
e) Health and Wellbeing Board Representatives;
f) Associate Director of Primary Care;
g) Head of Primary Care contracts and Commissioning;
h) Public Health Representative.
5
Meetings and Voting
18.0 The Committee will operate in accordance with the CCG’s Standing Orders. The Secretary to the Committee will be responsible for giving notice of meetings. This will be accompanied by an Agenda and supporting papers and sent to each Member Representative no later than seven calendar days before the date of the meeting. When the Chair of the Committee deems it necessary in light of the urgent circumstances to call a meeting at short notice, the notice period shall be such as they shall specify.
19.0 Each voting member of the Committee shall have one vote. The Committee shall
reach decisions by a simple majority of members present, but with the Chair having a second and deciding note, if necessary. However, the aim of the Committee will be to achieve consensus decision-making wherever possible.
20.0 In exceptional circumstances, where urgent action is required, the Chair is authorised
to take urgent action with prior discussion with one other Committee member. A report should be made to the full Committee for ratification, and to the Audit Committee, for scrutiny, at the earliest next opportunity.
Quorum
21.0 The Quorum for the Committee shall be 3 members:
a) The Chair / Deputy Chair;
b) Medical Director or Director of Primary Care;
c) Any Executive Governing Body Member.
21.1 In exceptional circumstances, and with the agreement of the Committee Chair, individuals will be deemed to be present if they are able to engage with the discussion of the meeting using telephone or video technology. The Chair will take into account the degree to which and such meeting can comply with the requirement for it to be held in public.
Frequency and Notice of the Committee meetings
22.0 The Primary Care Commissioning Committee shall adopt the Standing Orders of Bedfordshire, Luton and Milton Keynes CCG in so far as they relate to the:
a) Notice of meetings;
b) Handling of meetings;
c) Agendas;
d) Circulation of papers, and
e) Conflicts of Interest.
23.0 The Primary Care Commissioning Committee will meet at least six times a year and in public, except as otherwise agreed by members.
6
24.0 Meetings of the Committee shall:
a) Be held in public, subject to the application of 23 (b);
b) The Committee may resolve to exclude the public from a meeting that is open
to the public (whether during the whole or part of the proceedings) whenever
publicity would be prejudicial to the public interest by reason of the confidential
nature of the business to be transacted or for the other special reasons stated
in the resolution and arising from the nature of that business or of the
proceedings or for any other reason permitted by the Public Bodies
(Admission to Meetings) Act 1960 as amended or succeeded from time to
time.
25.0 Members of the Committee have a collective responsibility for the operation of the
Committee. They will participate in discussion, review evidence and provide objective expert input to the best of their knowledge and ability and endeavour to reach a collective view.
26.0 The Committee may delegate tasks to such individuals, sub-Committees or individuals, sub-Committees or individual members as it shall see fit, provided that any such delegations are consistent with the parties’ relevant governance arrangements, are recorded in a scheme of delegation, are governed by Terms of Reference as appropriate and reflect appropriate arrangements for the management of conflicts of interest.
27.0 The Committee may call additional experts to attend meetings on an ad hoc basis to
inform discussions. 28.0 The Committee will apply best practice in the decision-making process and have full
authority to commission any reports or surveys it deems necessary to help fulfil its obligations.
29.0 Members of the Committee shall respect confidentiality requirements as set out in the
CCG’s Constitution or Standing Orders. 30.0 The Committee will present its Minutes to the Regional Team of NHS England and the
Governing Body of Bedfordshire, Luton and Milton Keynes CCG following each meeting for information, including the Minutes of any sub-Committees to which responsibilities are delegated under paragraph 26 above.
31.0 The Committee will also comply with any reporting requirements set out in the Standing Orders.
32.0 The Primary Care Commissioning Committee’s Annual Business Cycle will be agreed
by Committee members and reviewed on an annual basis.
7
Decision Making Authority and Exercise of Functions
33.0 Under the approved Scheme of Reservation and Delegation and the Standing Orders,
the Committee is allowed or authorised to do the following;
a) The Primary Care Commissioning Committee will make decisions within the
bounds of its remit;
b) The decisions of the Primary Care Commissioning Committee shall be binding on NHS England and Bedfordshire, Luton and Milton Keynes CCG.
34.0 A Register of Decisions will be published by Bedfordshire, Luton and Milton Keynes
CCG. This register will appear on the same page of the CCG’s website as the Register
of Interests.
35.0 The Terms of Reference and conduct of the Primary Care Commissioning Committee’s business is in accordance with any relevant national guidance, relevant codes of conduct and good governance, for example, the Seven Principles of Public Life (the Nolan Principles).
Accountability of the Committee
36.0 The Primary Care Commissioning Committee is accountable to the CCG’s Governing Body and to NHS England.
37.0 The Primary Care Commissioning Committee shall report key decisions and areas of
discussion to the CCG Governing Body at the subsequent Governing Body meeting. 38.0 The Primary Care Commissioning Committee shall report key decisions and areas of
discussion to the appropriate Regional Team of NHS England 39.0 For the avoidance of doubt, in the event of any conflict between the terms of the
Delegation and Terms of Reference and the Standing Orders of Standing Financial Instructions of any of the members, the Delegation will prevail.
Procurement of Agreed Services
40.0 Procurement of agreed services will take place in line with the arrangements set out in the delegation agreement and other associated guidance.
Review
41.0 These Terms of Reference were approved on 1st April 2021. 42.0 These Terms of Reference will be formally reviewed by the Committee on an annual
basis, but may be amended at any time. 43.0 Any proposed amendments to the Terms of Reference will be submitted to the
Governing Body for approval. Changes will not be implemented until after an application to NHS England to vary the Constitution has been agreed.
44.0 A record of the date and outcome of reviews will be kept by the CCG and included in the CCG’s Governance Handbook.
8
Delegation by NHS England
1 April 2021
Delegation by NHS England to NHS Bedfordshire, Luton and
Milton Keynes CCG
Delegation
1. In accordance with its statutory powers under section 13Z of the National Health Service
Act 2006 (as amended) (“NHS Act”), NHS England has delegated the exercise of the functions
specified in this Delegation to NHS Bedfordshire, Luton and Milton Keynes CCG to empower
NHS Bedfordshire, Luton and Milton Keynes CCG to commission primary medical services
for the people of Bedfordshire, Luton and Milton Keynes.
2. NHS England and the CCG have entered into the Delegation Agreement that sets out the
detailed arrangements for how the CCG will exercise its delegated authority.
3. Even though the exercise of the functions passes to the CCG the liability for the exercise of any
of its functions remains with NHS England.
4. In exercising its functions (including those delegated to it) the CCG must comply with the
statutory duties set out in the NHS Act and/or any directions made by NHS England or by the
Secretary of State and must enable and assist NHS England to meet its corresponding duties.
Commencement
5. This Delegation, and any terms and conditions associated with the Delegation, take effect from
1 April 2021.
6. NHS England may by notice in writing delegate additional functions in respect of primary
medical services to the CCG. At midnight on such date as the notice will specify, such functions
will be Delegated Functions and will no longer be Reserved Functions.
9
Role of the CCG
7. The CCG will exercise the primary medical care commissioning functions of NHS England as
set out in Schedule 1 to this Delegation and on which further detail is contained in the
Delegation Agreement.
8. NHS England will exercise its functions relating to primary medical services other than the
Delegated Functions set out in Schedule 1 including but not limited to those set out in Schedule
2 to this Delegation and as set out in the Delegation Agreement.
Exercise of delegated authority
9. The CCG must establish a committee to exercise its delegated functions in accordance with the
CCG’s constitution and the committee’s terms of reference. The structure and operation of the
committee must take into account guidance issued by NHS England. This committee will make
the decisions on the exercise of the delegated functions.
10. The CCG may otherwise determine the arrangements for the exercise of its delegated functions,
provided that they are in accordance with the statutory framework (including
Schedule 1A of the NHS Act) and with the CCG’s Constitution.
11. The decisions of the CCG Committee shall be binding on NHS England and NHS Bedfordshire,
Luton and Milton Keynes CCG.
Accountability
12. The CCG must comply with the financial provisions in the Delegation Agreement and must
comply with its statutory financial duties, including those under sections 223H and 223I of the
NHS Act. It must also enable and assist NHS England to meet its duties under sections 223C,
223D and 223E of the NHS Act.
13. The CCG will comply with the reporting and audit requirements set out in the Delegation
Agreement and the NHS Act.
14. NHS England may, at its discretion, waive non-compliance with the terms of the Delegation
and/or the Delegation Agreement.
10
15. NHS England may, at its discretion, ratify any decision made by the CCG Committee that is
outside the scope of this delegation and which it is not authorised to make. Such ratification will
take the form of NHS England considering the issue and decision made by the CCG and then
making its own decision. This ratification process will then make the said decision one which
NHS England has made. In any event ratification shall not extend to those actions or decisions
that are of themselves not capable of being delegated by NHS England to the CCG.
Variation, Revocation and Termination
16. NHS England may vary this Delegation at any time, including by revoking the existing
Delegation and re-issuing by way of an amended Delegation.
17. This Delegation may be revoked at any time by NHS England. The details about revocation are
set out in the Delegation Agreement.
18. The parties may terminate the Delegation in accordance with the process set out in the
Delegation Agreement.
Signed by
Ann Radmore
NHS England Regional Director
for and on behalf of NHS England
11
Schedule 1 –Delegated Functions
a) decisions in relation to the commissioning, procurement and management of Primary
Medical Services Contracts, including but not limited to the following activities:
i) decisions in relation to Enhanced Services;
ii) decisions in relation to Local Incentive Schemes (including the design of such schemes);
iii) decisions in relation to the establishment of new GP practices (including branch
surgeries) and closure of GP practices;
iv) decisions about ‘discretionary’ payments;
v) decisions about commissioning urgent care (including home visits as required) for out of
area registered patients;
b) the approval of practice mergers;
c) planning primary medical care services in the Area, including carrying out needs
assessments;
d) undertaking reviews of primary medical care services in the Area;
e) decisions in relation to the management of poorly performing GP practices and including,
without limitation, decisions and liaison with the CQC where the CQC has reported non-
compliance with standards (but excluding any decisions in relation to the performers list);
f) management of the Delegated Funds in the Area;
g) Premises Costs Directions functions;
h) co-ordinating a common approach to the commissioning of primary care services with other
commissioners in the Area where appropriate; and
i) such other ancillary activities as are necessary in order to exercise the Delegated Functions.
Schedule 2- Reserved Functions
a) management of the national performers list;
b) management of the revalidation and appraisal process;
c) administration of payments in circumstances where a performer is suspended
and related performers list management activities;
d) Capital Expenditure functions;
e) section 7A functions under the NHS Act;
f) functions in relation to complaints management;
g) decisions in relation to the GP Access Fund; and
h) such other ancillary activities that are necessary in order to exercise the Reserved Functions;
12
Author(s): Richard Noble, Senior Primary Care Development & Transformation Manager Paul Lindars, Associate Director Primary Care Development Yasmin Farooqi, Primary Care Commissioning & Transformation Project Manager Steve Gutteridge, Senior Primary Care Commissioning & Transformation Programme Manager (Integrated Urgent Care)
Contact Information: [email protected]
Lead Executive: Nicky Poulain, Director of Primary Care
Which activity does this paper relate to? This paper relates to extended access to primary care
across BLMK.
How? The paper relates to contracts with current providers.
What is the Committee being asked to do? For information.
What are the financial implications?
An extended access allocation has been confirmed by
NHSE for Q1 & Q2 (2021/22), with an indicative figure
for Q3 and Q4.
Total funding expected is: c.£4.5m.
Set out the key risks and risk ratings
There is a low risk of NHSE not allocating funds for
extension of contracts though this is low.
Date to which the information this paper is based on was accurate
6th May 2021.
This paper outlines contract extensions for extended access providers across BLMK as agreed at the
last PCCC meeting.
Primary Care Commissioning Committee Meeting held in Public 18th May 2021 1045-1245
Item 5.1 Title: Extended Access to Primary Care – contract update
Information
Executive Summary
2
At the previous PCCC meeting approval was given to extend contracts with current providers as
summarised below.
Provider Primary Care Networks (PCNs) served
Bedoc Caritas, East Bedford, North Bedford, Unity, Ivel Valley North, Ivel Valley South, Leighton Buzzard, Hillton, H is for Health
Chiltern Vale Health Community Interest Company
Chiltern Hills, Titan
Eden Eden
Evexia Hatters, Phoenix, Oasis and Medics
MKGP Plus (GP Federation) Milton Keynes PCNs
MKUCS Milton Keynes PCNs
The PCCC also approved the following in relation to the Bedfordshire (Bedoc) service:
• Transfer of finances and provision associated with Asplands practice to the relevant Milton
Keynes provider when agreed with all parties
• Transfer of finances and provision associated with Leighton Buzzard PCN from the current
contract to a new contract to be held by the PCN.
An update on progress regarding the extensions was requested for the May meeting.
Bedfordshire
• Both providers (Bedoc and Chiltern Hills Health Community Interest Company have agreed to
a contract extension and are continuing to provide the service
• Following further discussion Leighton Buzzard PCN have decided that they would prefer to hold
off from delivering the service until extended access becomes part of the PCN DES in April
2022.
Luton
• Eden PCN and Evexia Ltd, Luton Extended Access providers have agreed to a contract
extension and will be continuing to deliver the service under previous terms and conditions
• Evexia will continue to deliver the service on behalf of the four PCNs in Luton (Oasis, Pheonix,
Medics and Hatters). There was a discussion with Hatters PCN who wanted to provide the
service for their own population, however have decided to hold off until April 2022 in line with
national PCN DES arrangement
Milton Keynes
• Both providers have agreed to a one-year contract extension and to include provision for the
Asplands population. A plan to move across from the current providers is being agreed with the
practice.
Introduction
Current Position
Author: Alexia Stenning, Associate Director Primary Care Commissioning and Transformation
Contact Information: [email protected]
Lead Executive: Nicky Poulain, Director of Primary Care
Which activity does this paper relate to?
COVID Vaccination in Primary Care.
How?
The slides show data on the vaccination numbers carried out across BLMK up to 6th May 2021.
What is the Committee being asked to do?
For information only.
What are the financial implications?
None
Set out the key risks and risk ratings
N/A
Date to which the information this paper is based on was accurate
6th May 2021
Appendices
N/A
Primary Care Commissioning Committee Meeting held in Public 18th May 2021 1045-1245
Item 5.2. Title: Covid Vaccinations in Primary Care
Information
COVID Vaccinations in
Primary Care
Alexia Stenning
Associate Director
Primary Care Commissioning and Transformation
Dose 1 - Vaccine Delivered Dose 2 - Vaccine Delivered (% of 1st Dose Done)
Dose 1 - Cohorts 1-9 - Up to 6/5
345,530
88.18%
Dose 2 - Cohorts 1-9 - Up to 6/5
49.32%
170,410
Dose 1 - Cohorts 1-12 - Up to 6/5498,975
58.39%
Dose 2 - Cohorts 1-12 - Up to 6/5
208,853
41.86%
Total 1st and 2nd doses across BLMK as at 6th May 2021
2
Dose 1 Remain
excluding
Declined Declines
Dose 1
Done
% Done
excludes
declines
Dose 2
Done
Dose 2
Remainin
g based
on Dose 1
Done
Cohort 1 Elderly Care Home Residents 215 0 3,672 94.5% 3157 515
Cohort 2a - 80+ Years 994 909 37,302 95.1% 35434 1,868
Cohort 2b - Health and Social Care Staff 7,573 0 30,075 79.9% 11331 18,744
Cohort 3 - 75-79 Years 733 555 28,133 95.6% 26567 1,566
Cohort 4 - 70-74 Years 1578 821 39,732 94.3% 35866 3,866
Cohort 5 - 65-69 Years 3256 844 40,484 90.8% 22124 18,360
Cohort 6a - 16-17 Years - At Risk 682 58 819 52.5% 123 696
Cohort 6b - LD/Other Care Homes Residents 34 0 632 94.9% 443 189
Cohort 7 - 60-64 Years 5246 905 48,671 88.8% 11768 36,903
Cohort 8 - 55-59 Years 8393 1043 57,164 85.8% 12353 44,811
Cohort 9 - 50-54 Years 11271 1205 58,846 82.5% 11244 47,602
Total Cohorts 1-9 39,975 6,340 345,530 88.18% 170,410 175,120
29,421
42,131
44,584
666
54,822
66,600
3,887
37,648
GP Registered
Population
39,205
71,322
391,845
1,559
Cohorts 1 - 12
3
Dose 1 Remain
excluding Declined Declines
Dose 1
Done
% Done
excludes
declines
Dose 2
Done
Dose 2
Remaining
based on
Dose 1
Done
Cohort 10a - 45-49 Years 20030 484 50,774 71.2% 9348 41,426
Cohort 10b - 40-44 Years - Gradual release from 26/4/21 37925 511 39,954 51.0% 7993 31,961
Cohort 11 - 30-39 Years - Not yet released 124822 1001 38,192 23.3% 12514 25,678
Cohort 12 - 18-29 Years - Not yet released 123747 737 24,525 16.5% 8588 15,937
Total 346,499 9,073 498,975 58.39% 208,853 290,122
GP Registered Population
854,547
71,288
78,390
164,015
149,009
Dose 1 Remain
excluding Declined Declines
Dose 1
Done
% Done
excludes
declines
Dose 2
Done
Dose 2
Remaining
based on
Dose 1
Done
Cohort 4b - All Ages Years Clinically Extremely Vulnerable 3370 0 36,821 91.6% 30138 6,683
Cohort 6a - 16-64 Years in at risk group 8192 2202 70,555 87.2% 18450 52,105
Cohort 6ai - 18+ (all ages) - Qcovid 4025 0 18,092 81.8% 8306 9,786
Cohort 6c - Carers (SystmOne) - All Ages 152 147 6,314 95.5% 3237 3,077
Cohort 6d Travellers 921 0 278 23.2% 87 191
Cohort 6e Homeless 1913 9 92 4.6% 18 74
Cohort 6f People on an LD Register 160 162 3,498 91.6% 1378 2,120
Cohort 6g People on an SMI Register 2152 0 5,423 71.6% 1918 3,505
Cohort 10a - 45-49 Years - At Risk 1110 382 12,345 89.2% 4114 8,231
Cohort 10b 40-44 Years - At Risk 1233 414 10,473 86.4% 3202 1,420
Cohort 11 30-39 Years - At Risk 4123 923 15,540 75.5% 4381 11,159
Cohort 12 18-29 Years - At Risk 3331 680 9,111 69.4% 2368 6,743
40,191
80,949
Below shows At Risk Groups by cohort - these are a subset of the age cohorts 1-12 above.
GP Registered Population
7,575
22,117
6,613
13,837
12,120
1199
2,014
3820
20,586
13,122
4
Data from 1st Pilot in Luton : 26th to 28th March 2021
5
Numbers of vaccination by location
Location Number of residents vaccinated
Friday Saturday Sunday
Bus 402 245 347
Town Hall Not open 117 82
Mosque Not open 215 316
Redgrave vaccination site 247 141 118
Inspire vaccination site 126 237 + 283 local data 278 + 279 local data
Total 775 1238 1420
Total of service users
vaccinated over three day
pilot
3433
1%
0%
0%
1%
1%
1%
1%
1%
2%
2%
2%
2%
8%
11%
15%
16%
35%
0% 10% 20% 30% 40%
Not stated
Mixed - White and Black…
Mixed - Other mixed groups
Chinese
Black or Black British - Other…
Mixed - White and Black…
Mixed - White and Asian
Black or Black British -…
White - Irish
Any other ethnic group
Black or Black British - African
Asian or Asian British - Other…
Asian or Asian British - Indian
White - Other
Asian or Asian British -…
Asian or Asian British -…
White - British
Vaccinations by ethnicity
count %
White - British 601 35%
Asian or Asian British - Pakistani 273 16%
Asian or Asian British - Bangladeshi 263 15%
White - Other 181 11%
Asian or Asian British - Indian 130 8%
Asian or Asian British - Other Asian 42 2%
Black or Black British - African 42 2%
Any other ethnic group 35 2%
White - Irish 33 2%
Black or Black British - Caribbean 22 1%
Mixed - White and Asian 14 1%
Mixed - White and Black Caribbean 12 1%
Black or Black British - Other Black 11 1%
Chinese 10 1%
Mixed - Other mixed groups 8 0%
Mixed - White and Black African 7 0%
Not stated 16 1%
Total 1700
Data from 2nd Luton Pilot 23rd to 25th April 2021
6
100% 50% 0% 50% 100%
<30
30-39
40-49
50-59
60-69
70-79
80+
Vaccinations by age and gender
Males Females
Males Females Total
count % count % count %
80+ 2 0% 2 0% 4 0%
70-79 4 0% 2 0% 6 0%
60-69 13 1% 8 1% 21 1%
50-59 50 5% 41 6% 91 5%
40-49 504 53% 345 46% 849 50%
30-39 380 40% 344 46% 724 43%
<30 3 0% 2 0% 5 0%
Total 956 744 1700
• 30 – 49 year olds: 93% of
vaccinations
7
Author: David Picking, Head of Primary Care Relationship Development & Transformation
Paul Lindars, Associate Director Primary Care Development
Contact Information: [email protected] / [email protected]
Lead Executive: Nicky Poulain, Director of Primary Care
Which activity does this paper relate to?
BLMK Primary Care Networks (PCNs).
How?
To provide an update on:
• PCN changes for 2021/22
• Local Incentive Scheme (LIS) arrangements that are in place to ensure the continued delivery of network services for patients of opted out practices.
What is the Committee being asked to do?
For Information only.
What are the financial implications?
None. The Local Incentive Scheme will be funded from current CCG/ PCN allocations.
Set out the key risks and risk ratings
N/A
Date to which the information this paper is based on was accurate
07/05/2021
Appendices N/A
This paper summarises the BLMK PCN changes and likely changes for 2021/22, and Local Incentive
Scheme (LIS) arrangements that are in place to ensure the continued delivery of network services for
patients of opted out practices, or practices not yet a member of a PCN, for the Network Contract
Directed Enhanced Service (DES) 2021/22.
Primary Care Commissioning Committee Meeting held in Public 18th May 2021 1045-1245
Item 6. Title: Primary Care Networks (PCNs) update
Information
Executive Summary
2
The table below provides a summary of the PCN changes that have occured, or we are expecting to
happen, for 2021/22:
PCN Place * Change Documentation completed and submitted to NHSE
North Bedford
Bedford Borough
Actual change of Clinical Director from Dr Lane to Dr Vrinda Patil
Yes
Ivel Valley North
Central Bedfordshire
Inclusion of Greensand Surgery Potton as a core PCN practice
Yes
Ivel Valley South
Central Bedfordshire
Inclusion of Lower Stondon Surgery as a core PCN practice Removal of Arlesey Practice – who are now a non-core member of the PCN with a LIS in place to ensure population continue to receive services.
Yes
Chiltern Hills
Central Bedfordshire
Inclusion of Kirby Road Surgery Yes
Titan Central Bedfordshire
Possible change of Clinical Director No – to be completed once confirmed by PCN
Phoenix Luton Possible change of Clinical Director No – to be completed once confirmed by PCN
Oasis Luton Actual change of Clinical Director from Dr Zaidi to Dr Esene.
Yes
* There are no current or anticipated changes for the PCNs within Milton Keynes.
BLMK have moved from the 2020/21 position of four non-core PCN member practices, to just two as
listed in the table below for 2021/22:
BLMK practice not a core member of a PCN in 2021/22
BLMK PCN delivering services on behalf of non- core member practice
Type of agreement Comments
The Village Medical Centre
North Bedford PCN Local incentive agreement with a single Core Network Practice (as a signatory on behalf of a PCN in a lead provider arrangement)
Currently North Bedford PCN have agreed to continue with the current agreement LIS in place and working relationship with The Village Medical Centre. They will review the position 30.09.21
Arlesey Ivel Valley South PCN Local incentive agreement with a single Core Network Practice (as a signatory on behalf of a PCN in a lead provider arrangement)
Ivel Valley South have agreed to work with the Arlesey provider under a LIS agreement following selection of an emergency caretaker.
Update on PCN changes for 2021/22
PCN Local Incentive Scheme (LIS) - to ensure the continued delivery of
network services for patients of Arlesey and the Village Medical Centre
3
To ensure the continued delivery of network services for patients of Arlesey and the Village Medical Centre who are not core members of a PCN for the Network Contract Directed Enhanced Service (DES) 2021/22; the CCG is required to, and has, put in place a Local Incentive Scheme (LIS) arrangement. Adhering to guidance in the Network Contract Directed Enhanced Service released in March 2021, the following (included in the BLMK LIS) sets out the responsibilities for the PCNs (Ivel Valley South & North Bedford) which continue to deliver network services for patients of practices that are not a core member of a PCN, and the responsibilities of the Commissioners:
1. BLMK CCG is required to work with PCNs to agree how any patients from a non-DES practice can be covered by a PCN.
2. These local agreements will be managed locally and the patient population of a non-DES
practice, for whom a PCN is providing network services, will not be accounted for within the PCN ODS reference data.
3. Having agreed which PCN or provider will provide the cover, BLMK CCG will need to ensure
the following services/activities are provided to patients of the non-DES practice in accordance with the timescales for these services/activities:
a. a social prescribing service; b. the extended hours access requirements as listed at section 8.1 of the Network Contract
DES specification; c. the Structured Medication Review requirements as listed at section 8.2 of the Network
Contract DES Specification; d. the Enhanced Health in Care Homes requirements as listed at section 8.3 of the Network
Contract DES Specification; and e. the Early Cancer Diagnosis requirements as listed at section 8.4 of the Network Contract
DES Specification.
4. Other provisions that would be expected to be included in a local agreement are:
a. A provision requiring the PCN to provide to BLMK CCG any details of non-co-operation by a non-DES practice with the PCN who is providing network services via the local agreement to the non-DES practice’s patients. This information will be used by the commissioner to consider whether to take any action under the non-DES practice’s primary medical services contract;
b. Breach – how breaches by the PCN providing cover are dealt with BLMK CCG; and c. Boilerplate provisions – the usual contractual provisions about commencement, duration,
extension, break-clause, termination, variation, dispute resolution, entire agreement, surviving provisions, governing law, etc.
The committee is asked to note that the current BLMK LIS arrangement in place with Ivel Valley
South and North Bedford PCN covers all of the requirements as set out above.
Author: Mark Peedle, Head of Digital, BLMK CCG
Contact Information: [email protected]
Lead Executive: Nicky Poulain, Director of Primary Care, BLMK CCG
Which activity does this paper relate to?
PCN IT Equipment Funding.
How?
An update report on the current situation (additional funding and initial plans to deploy this resource).
What is the Committee being asked to do?
To note the additional allocation and associated plans.
What are the financial implications?
This report details plans to spend an allocation, received in the last year, across the BLMK PCN’s. No adverse implications.
Set out the key risks and risk ratings
None.
Date to which the information this paper is based on was accurate
06/05/2021.
Appendices
None.
Historically there has been underinvestment in General Practice resource and infrastructure making it
difficult to meet the increasing demands placed on Primary Medical Care Services. This has impacted
on the national and local aspirations to deliver the transformation required, as set out in the NHS Long
Term Plan and the new GP contract (investment and evolution), resulting in an inability to recruit and
retain GPs and their team.
Primary Care Commissioning Committee Meeting held in Public 18th May 2021 1045-1245
Item 7. Title: Primary Care Network (PCN) IT Funding 2021-22.
Funding for Additional Roles Reimbursement Scheme
(ARRs)
Information
Executive Summary
2
Implementation of the NHS Long Term Plan requires the development of effective Primary Care
Networks (PCNs). Under the PCN Directed Enhance Service (DES) funds are available to recruit to
new additional roles, and develop the PCN workforce. Since 2019/20 PCNs have been recruiting to
new roles; in year one the numbers of additional staff recruited to support practices and PCNs were
minimal. Recruitment has subsequently picked up at pace with an additional 103 PCN staff being in
situ at the end of 2020/21, and a further 109 staff anticipated for 2021/22. Funding for the recruitment
of these additional PCN roles (unlike GP practice staff) does not currently include additional funds to
support the operational infrastructure required to support these roles, such as laptops and estates.
Mature PCNs with access to the right resource (workforce and infrastructure) is essential to ensure
locally we fulfil the health and care needs for our population, by providing long-term sustainable access
to high quality primary care services. By embedding new clinical roles within the primary care team and
enabling these staff through IT solutions, we will meet the national ambition to free up GP time allowing
highly skilled staff to focus on addressing the needs of our most complex patients. This is especially
important to meet the growing demands placed on providers throughout the pandemic, and as part of
reset and recovery process.
In February 2021, on behalf of the then three CCG’s, BCCG CCG bid for £2000 per person (new PCN
additional role) to allow the purchase of a laptop and supporting infrastructure for each individual, this
was working on the assumption we will have approximately 212 new staff in situ as at the end of March
2022 – these figures informed by PCN workforce plans:
The system was successful first in receiving an initial allocation of £173,971 and this has been set
aside to fund equipment purchased over 2020/21 (from the GP IT budget) for PCN staff already in situ.
An indicative allocation to PCN’s based on laptops already deployed is as follows* :
Row Labels Q1 Q2 2019/20 Grand Total IT Allocation
NHS Bedfordshire CCG 5.13 7.2 17.68 30.01 £ 60,020
CARITAS MEDICAL PCN 2.49 2.49 £ 4,980
CHILTERN HILLS PCN 1 1 £ 2,000
EAST BEDFORD PCN 1 1 2 £ 4,000
H IS FOR HEALTH PCN 1 1 2 £ 4,000
HILLTON PCN 2.67 2.67 £ 5,340
IVEL VALLEY NORTH PCN 2.73 2.73 £ 5,460
IVEL VALLEY SOUTH PCN 2 2 4 £ 8,000
LEIGHTON BUZZARD PCN 1 1.7 2.7 £ 5,400
NORTH BEDFORD PCN 1 0.2 2 3.2 £ 6,400
TITAN PCN 2 2 4 £ 8,000
UNITY (BEDFORD) PCN 0.4 2.82 3.22 £ 6,440
NHS Luton CCG 9 10.75 5.66 25.41 £ 50,820
EDEN (LUTON) PCN 1 3 2 6 £ 12,000
HATTERS HEALTH PCN 2.66 2.66 £ 5,320
MEDICS PCN 1 4.75 5.75 £ 11,500
OASIS PCN 2 1 3 £ 6,000
3
PHOENIX SUNRISERS PCN 7 1 8 £ 16,000
NHS Milton Keynes CCG 5 19.48 7 31.4755 £ 62,951
ASCENT PCN 4 4 £ 8,000
CROWN PCN 3 2 1 6 £ 12,000
EAST MK PCN 2 1 3 £ 6,000
NEXUS MK PCN 1 3 1 5 £ 10,000
SOUTH WEST PCN 1 2 3 £ 6,000
THE BRIDGE MK PCN 1 1 1 3 £ 6,000
WATLING STREET NETWORK PCN 6.476 1 7.4755 £ 14,951
* note that supporting infrastructure is also being funded which is reflected in centralised spend rather than a monetary
transfer to PCN’s
We were then subsequently issued an additional allocation (£424,000) meeting the request of our entire
bid (£2,000 x 212 new roles) - giving a total allocation of £597,971. This means we are in a position to
provide laptops and infrastructure for all the new PCN staff (based on anticipated numbers) between
now and March 2022, along with some of the required infrastructure to support this increase.
The CCG team working with HBL ICT (who are holding funds on our behalf) and our Primary Care
Team are in the process of finalising the mobilisation plan to ensure PCNs are able to furnish their new
recruits with a laptop at the point of, or soon after, recruitment.
This plan includes the development of the infrastructure to support PCNs with the growing workforce
ensuring digital solutions are in place to maintain the needs of the expanding workforce and new ways
of working, for example the ability to log on at any site in a PCN, sharing documents collaboratively.
An update will be provided for the next PCCC regarding progress on these points, but immediately was
can be assured that the system has funding for the IT implications and any new posts that come on
stream this year.
Author: Lynda Linbourne, Senior Primary Care Contracts and Development Manager
Contact Information: [email protected]
Lead Executive: Nicky Poulain, Director of Primary Care
Which activity does this paper relate to?
Primary Care Contracting & Commissioning.
How?
Informing the committee on potential or realised contractual issues.
What is the Committee being asked to do?
For information and assurance that primary care services have been commissioned for patients of Arlesey.
What are the financial implications?
Temporary provider Caretaking costs.
Set out the key risks and risk ratings
• Concern with remedying outstanding CQC actions – medium- mitigated by working with quality and caretaker
• Risk realised with resignation of Sunnyhill Board
• Reputational – mitigated by communication with patients and stakeholders.
Date to which the information this paper is based on was accurate
7.5.21
Appendices None.
The committee are being notified of the decision to appoint MKGP Plus Ltd as an emergency provider
for no longer than twelve months at the Arlesey Medical Centre following the Sunnyhill CIC board
decision to hand back their APMS contract on the 4th May.
The Committee are assured that the new provider has mobilised and primary care services are being
delivered. In addition, turnaround plans are being developed to address the outstanding CQC issues.
Background
The Arlesey Medical Centre current list size is 4,700 with the practice sited within an area of housing
development and therefore potential list growth which cements the importance of the premises
remaining in use as a GP surgery. The lease is currently held with Central Bedfordshire Council.
Primary Care Commissioning Committee Meeting held in Public 18th May 2021 1045-1245
Item 8. Title: Arlesey Medical Centre - temporary provider update.
Information
Executive Summary
2
Despite support the practice has had difficulty in resolving the ongoing CQC issues which has been
made more challenging due to the lead GP leaving suddenly, as well as an awareness that the current
contract was due to finish in eleven months making recruitment and retainment of staff problematic.
Recommendation for ratification at the extraordinary PCCC meeting held on 20th April 2021
To ensure stability to the practice population the recommendation to the committee was to commence
with an emergency caretaker for an initial period of 6 months with the possibility of extension for a
further 6 months. The committee agreed to the recommendation and due to the emerging emergency
situation, the decision was made to speak with local federations/practices/Primary Care Networks
(PCNs).
A non-competitive expression of interest (EOI) pack was formulated as a tool to support an emergency
situation (as it is not a competitive procurement), with Paul Lindars (Associate Director – Primary Care
Development), Tony Medwell (Head of Primary Care Contracting & Commissioning) and Attain which
was sent to the four providers, who expressed a verbal interest, on the 20th of April 2021.
Three EOI were submitted by interested providers by the stipulated deadline of 5pm Friday 23rd April
2021.
Process
Due to the very urgent need to install a caretaker arrangement for Arlesey a formal procurement was
not possible, and the CCG relied on Regulation 32(c) of the Public Contracts Regulations 2015 (as
amended The Public Procurement (Amendment etc.) (EU Exit) Regulations 2020) in order to begin a
rapid process to identify a caretaker provider through a non-competitive Expression of Interest (EOI)
exercise.
The EOI was made up of a number of capability and capacity centric questions that, although not a
competitive procurement, still adhered to the principles of transparency and equal treatment of
providers. The EOI also asked providers to confirm their CQC rating and QoF performance.
The EOI was sent out to identified providers who had verbally stated their interest in the caretaking
role.
Submitted EOI were sent to assessment panel members to enable them to individually assess
capability and capacity through the EOI questions set using a confidence scale score rating.
The panel met virtually on 26th April 2021 to agree on a consensus basis.
An output of this consensus meeting was agreement to send to, ensuring equal treatment, a finance
clarification to all three providers. Three responses were received by the stipulated deadline of 10am
on 27th April 2021 which provided the CCG with the further assurance in order to proceed to
recommend a caretaker provider.
Recommended Provider
Through a non-competitive expression of interest exercise in which capability, capacity and affordability
were assessed across three interested providers, MKGP Plus Ltd were identified by the assessment
panel as being the preferred caretaker provider for an initial period of six months with the option to
extend for a further six months.
MKGP Plus Ltd were able to demonstrate to the assessment panel a good clinically led approach with
clear leadership roles identified and accountability. The panel noted an emphasis on local requirements
with good knowledge of local clinical pathways and systems as well as comprehensive description of
how they make use of existing relationships to support the care of patients.
3
This provider cited recent expertise regarding caretaking and described well their bank of staff and
relationship with agency and how that could be called upon quickly.
In the context of the emergency requirements financial modelling was undertaken by the Associate
Direction of Finance.
MKGP Plus Ltd
MKGP Plus Ltd are part of MKGP Federation and a local provider of primary care services, operating
in Milton Keynes, Bedfordshire, Cambridge and Royston, and has a record of mobilising quickly and
successfully to deliver services at short notice.
Communications
Patient letters, frequently asked questions and stakeholder letters were sent on the 30th April with
assistance from the enquiries team to manage any patient phone calls following the letters being
received.
Mobilisation
First mobilisation meeting held with primary care contracts and quality manager on the 6th May 2021,
with follow up meetings arranged fortnightly. Full mobilisation plan, due diligence plan and highlight
report shared with the CCG. No significant key risks identified at this early stage, however, additional
meetings to be held with PCN, patient participation group and aligned care home week commencing
10th May. Full offer of support by the CCG and transparent, collaborative working to ensure stability of
the patient population.
To date the provider has mobilised and is;
• Working with the CCG Quality and Primary Care Team prioritised the handover and care of
vulnerable patients
• had positive discussions with all staff regarding TUPE arrangements with the offer of 1:1’s
• completed rota of clinical staff up to 30th June with MKGP Federation interim Medical Director
overview and onsite support three days per week
• Review of all governance and subsequent transformation plan in development
• Linked in with CCG Medicine Optimisation team to gain assurance that CQC actions have been
followed up.
• Buddy system in place to support the current practice manager
• Commenced engaging with Chase House (local Care Home).
Recommendation
The Primary Care Commissioning Committee are requested to note the appointment of MKGP Plus
Ltd as the Caretaker of the Arlesey Practice from the 4 May 21 and that the provider has worked rapidly
with a proper clinical governance and due diligence to mobilise primary care services for the Patients
of Arlesey.
Author: Tony Medwell, Head of Primary Care Contracting & Commissioning BLMK
Contact Information: [email protected]
Lead Executive: Nicky Poulain, Director of Primary Care
Which activity does this paper relate to?
Commissioning & Primary Care Contracting.
How?
Rapid procurement of a new Special Allocation Scheme provider.
What is the Committee being asked to do?
Assurance that the SAS service has been procured for BLMK SAS patients and is operational.
What are the financial implications?
Finances were compliant with the tender process and agreed framework price, this is a replacement service.
Set out the key risks and risk ratings
Key risks were related to appointment of a provider & mobilisation at short notice – Service has mobilised and will continue to be supported to mitigate any ongoing risks. Such a service requires robust risk assessments to ensure the safety of staff and patients. This was part of the service specification and was assessed by the procurement panel.
Date to which the information this paper is based on was accurate
7th May 21
Appendices
None.
Following a rapid procurement process The Medicus Health Partners have been awarded a four year
contract to provide primary care services to patients who are placed on the Special Allocation Scheme.
The service mobilised on the 4th May 21 and a formal clinical handover has occurred and patient
reviews are currently underway. The service is already offering appointments and care to their
registered patients. The Committee are requested to note the appointment of a new provider and the
commencement of the new contract.
Primary Care Commissioning Committee Meeting held in Public 18th May 2021 1045-1245
Item 9. Title: Special Allocation Scheme (SAS)
Information
Executive Summary
2
Special Allocation Scheme
It is important that practices can maintain a safe environment for their patients and all staff working in the practice. Special Allocation Schemes were created to ensure that patients who have been removed from a practice patient list can continue to access healthcare services at an alternative, specific GP practice. NHS England has a responsibility to ensure that all patients can access good quality GP services and that patients are not refused healthcare following incidents that are reported to the police.
Background
Following the current provider of the Special Allocation Scheme handing in three months’ notice with
the approval of the PCCC, BLMK CCGs invited all providers on the multi-Supplier NHS Special
Allocation Scheme (SAS) Service Framework Agreement under to take part in a Further/Mini-
Competition process for the provision of Primary Care Medical Services in Bedford, Luton and Milton
Keynes (BLMK).
Procurement process
NEL Support Services were contracted to lead and advise the commissioners on the procurement
process. The procurement process was initiated in March 2021.
Suppliers were required to agree to provide the service in line with the service specification and the
agreed Framework price for the service at an agreed price. The service was required to commence on
1st May 2021 for an initial period of 4 years.
Appointment of a new SAS provider for BLMK
In accordance with the evaluation process outlined in the invitation to tender documents, the tender
submitted by the following organisation was selected and approved by the Director of Primary care.
Medicus Health Partners 28,Tenniswood Road Enfield EN1 3LL
Mobilisation
Rapid mobilisation and transfer commenced immediately on appointment and a clinical handover from
current provider at Basset Road Surgery to Medicus has taken place with an initial focus on any
housebound or vulnerable patients.
Notes have transferred. However, the new providers Health Information System is EMIS which
requires additional IT input & support.
Prior to the handover prescriptions were reviewed.
All Patients contacted by the new provider and are currently undergoing health assessment.
The mobilisation of the service took place with the oversight of the Quality Team and there were daily
joint meetings between the Primary Care Commissioners and Medicus Health Partners to ensure the
tasks were completed so that the service commenced on the 4 May 21.
Patients have already been offered health assessments and routine appointments and we are grateful
for the support of the Basset Road Practice team who continue to work with the new provider.
3
Next Steps
Further mobilisation tasks will continue over the next three months with regular contract meetings and
Medicus are in the process of securing access to more permanent premises solutions as outlined in
their tender and which offers additional sites across BLMK.
Recommendation
The Committee are requested to note the appointment of a new provider and the commencement of
the new contract.
Author: Richard Noble, Senior Primary Care Development & Transformation Manager
Contact Information: Phone: [email protected]
Lead Executive: Nicky Poulain, Director of Primary Care
Which activity does this paper relate to?
Risk Registers for Primary Care Directorate and digital transformation programmes
How?
N/A
What is the Committee being asked to do?
To receive assurance
What are the financial implications?
N/A
Set out the key risks and risk ratings
Risks detailed in documents.
Date to which the information this paper is based on was accurate
11/5/21
Appendices
None
Two separate documents are presented this month. This is because BLMK CCG is in the process of transitioning
all risks over to the 4Risk system.
The main Primary Care Directorate risks have been transferred but the primary care digital risks, usually on a
separate tab of the same document, are in the process of transferring over. Future reports should once again
consist of a single document.
The risk matrix used in 4Risk has also been included with the papers.
Primary Care Commissioning Committee Meeting held in Public 18th May 2021 1045-1245
Item 10. Title: BLMK Primary Care Risk Register
Information
Executive Summary
Risk Ref Risk Title Risk Description Initial
Score
Risk Control Current
Score
Action Required Person
Responsib
le
Target
Score
I = 4 L = 4
16
I = 3 L = 3
9
I = 2 L = 2
4
I = 3 L = 4
12
I = 2 L = 2
4
I = 2 L = 1
2
I = 3 L = 4
12
I = 2 L = 2
4
I = 2 L = 1
2
Amanda
Flower
262 Co Com 13
Risk Owner: Nicky
Poulain
Risk Lead:
Last Updated: 11
May 2021
Latest Review Date:
07 May 2021
Latest Review By:
Richard Noble
Last Review
Comments:
Reviewed with
Senior PC Team
7/5/21
As a result of the current resilience issues
facing multiple BLMK practices, there is a
risk that some practices will not have the
resource and capacity to maintain or
expand their training / mentorship
provision, which may result in a reduction
in the number of students training in
general practice and impact on the
development of the future workforce and
the capacity of general practice to
innovate and transform in line with ICS
strategy.
BLMK Training Hub schemes and leads
Continued assessment of
capacity/support needed
Use of technology (e.g. training/support
via Teams)
Continued assessment of situation and use of
controls as listed.
Nicky
Poulain
258 BLMKPC3
Risk Owner: Nicky
Poulain
Risk Lead:
Last Updated: 07
May 2021
Latest Review Date:
07 May 2021
Latest Review By:
Richard Noble
Last Review
Comments:
Reviewed with
Senior PC Team
7/5/21
As a result of the central role that primary
care has in the BLMK COVID 19
vaccination programme and the extensive
resouces needed to mobilise and manage
this, there is a risk that some 'business as
usual' and other ongoing transformation
work may not be prioritised resulting in it
being delayed or not taking place
Support from CCG primary care team
Communication and clear decisions
regarding what is 'safe to pause'
Discussion with NHS England
Continued engagement with practices, NHS
England and other partners as per controls.
Support to practices regarding any future
guidance to primary care regarding
workload/'safe to pause'.
Alexia
Stenning
256 BLMKPC1
Risk Owner: Nicky
Poulain
Risk Lead:
Last Updated: 11
May 2021
Latest Review Date:
07 May 2021
Latest Review By:
Richard Noble
Last Review
Comments:
Reviewed with
Senior PC Team
7/5/21
As a result of the multiple factors
impacting on BLMK general practices
(including the increased needs of patients
and other demands), there is a risk that
practices will become increasingly more
vulnerable and less resilient, which may
result in access issues, referral variation,
reduced morale, reduced workforce,
restriction of services delivered, impacted
CQC ratings, an increase in acute care
access with its resulting financial impact
to the CCG, as well as an inability to
transform in line with ICS priorities.
Workforce Development Programme
ARRS recruitment
Releasing Time for Care Programme
Estates and Technology Development
Phone system offer to practices/PCNs
Primary Care Network development
GP resilience Programme
Place-based team
RCGP support
Digital development
Merger support
Pre/post-CQC support
Ongoing use of controls to support general
practice across BLMK.
Individual/localised practice issues will be
managed via the PC Quality Dashboard.
I = 3 L = 3
9
I = 2 L = 2
4
I = 1 L = 1
1
I = 3 L = 4
12
I = 3 L = 3
9
I = 2 L = 2
4
I = 4 L = 3
12
I = 3 L = 3
9
I = 2 L = 2
4
Paul
Lindars
401 BLMK PC4
Risk Owner: Nicky
Poulain
Risk Lead: Nicky
Poulain
Last Updated: 11
May 2021
Latest Review Date:
Latest Review By:
Last Review
Comments:
As a result of the increasing asks of
general practice across BLMK and post-
lockdown backlogs to be addressed there
is a risk that there will be an increasing
level of staff 'burnout' resulting in
increasing resilience issues with
practices, low moral and a rising level of
vacancies
BLMK Primary Care Team support and
representation at system level
Primary care involvement in system
transformation
Training Hub engagement and support
Continued implementation of controls
Support from Place based teams and senior
team to address avoidable asks of primary
care on an ongoing basis
Nicky
Poulain
266 PC COM 84
Risk Owner: Nicky
Poulain
Risk Lead:
Last Updated: 07
May 2021
Latest Review Date:
07 May 2021
Latest Review By:
Richard Noble
Last Review
Comments:
Reviewed with
Senior PC Team
7/5/21
As a result of system-wide workforce
challenges and complications around
employment there is a risk that PCNs may
struggle to recruit to PCN DES
reimbursable roles such as Social
Prescribing Link Workers and Clinical
Pharmacists resulting in patients not
benefitting from the additional capacity
and PCNs have less capacity to deliver
the PCN DES specifications.
• Support and relationship management
from PC team including resources
(materials/ skills/ expertise) available from
training hub
• Continued work with wider provider
partners to offer scaled and resilient
solutions
• Support from CCGs to work up PCN
workforce plans
- PCNs eligible to utilise the regionally
available recruitment resource provided
by South Essex
- Encourage PCNs to diversify..
Continued support provided as per controls
Support to be commissioned from MK
Federation and EPPC
265 PC COM 81
Risk Owner: Nicky
Poulain
Risk Lead:
Last Updated: 11
May 2021
Latest Review Date:
07 May 2021
Latest Review By:
Richard Noble
Last Review
Comments:
Reviewed with
Senior PC Team
7/5/21
As a result of the varying ambitions
beyond services and characteristics
explicit in the PCN DES, there is a risk
that services, access and patient
experience may vary between PCNs
across BLMK resulting in inequitable
services for patients, inequalities in
patient population, variations in outcomes
and variations in work backlogs.
Place based team support
Maturity Matrix/BLMK dashboard
assessment
Clinical Director support
Population Health Management/Business
Intelligence outputs
Primary Care Strategy
ICP, ICS, Partnership Board
Continue to provide consistent offers of
support across BLMK:
- Continued work with Quality Team
- BLMK Access Group
- Maturity Matrix reviews
- DES assurance reporting
Paul
Lindars
Information Sharing Phase 1 Risk RegisterRare Unlikely Possible Likely Almost Certain
Catastrophic 5 10 15 20 25
Major 4 8 12 16 20
Moderate 3 6 9 12 15
Risk ID Date RaisedDescription of Risk
As a result of x, there is a risk of y, which may result in z
Proximity
Date or date range
when the risk
might occur
Inherent
Likelihood
Click in box and
choose from drop-
down list
Inherent Impact
Click in box and choose from drop-
down list
Overall Risk Rating
Automatic scoring
Response Option
Click in box and choose from drop-
down list
Controls
What are the key controls in place to prevent the risk from
occurring?
Actions
What further actions to control the risk are planned. When should they be completed?
Progress on Actions
What is the progress since the last report?
Date Actions
Updated
Residual
Likelihood
Click in box and
choose from drop-
down list
Residual Impact
Click in box and
choose from drop-
down list
Residual Risk
(Automatic Scoring)
Lik
elih
oo
d2 Trend
Movement of scoring
3 = Up,
2 = unchanged,
1 = down
Responsible Governance Group
Risk Owner
Individual responsible for
the management and
control
Risk Actionee
Person who the risk
owner delegates specific
actions to
Risk Status
Click in box and choose from
drop-down list
ISP1-5 22/07/2018
Due to the number of schemes delivering
within the DTPC programme concurrently
there is a danger that provider resource
may not be able to stretch resulting in the
delay or non-delivery of agreed schemes. 2019/20
2020/21Possible Major Moderate Reduce
Programme planning and prioritisation Updated milestone plans drafted 23/4/19: extension until end of June 2019 agreed.
24/09/19: All work now commissioned within separate
work packages with defined milestones
21/01/21 Key work packages i.e. PCN interoperability,
coming to an end. WP process has proved successful and
replicated in other programmes. 21/01/2021 Unlikely Moderate Low DTPC Board Nicky Poulain Mark Peedle Active
ISP1-11 24/09/2019
As a result of resistance to change from
clinical teams, there is a risk that new
systems deployed through the ISP1
programme don't achieve the expected
benefits to patients and clinicians, which
could result in poor VfM for the programme
2019/20/21 Possible Major Moderate Reduce
Monitoring of uptake/benefits Workstream handovers to BAU/commissioning leads to ensure ongoing monitoring of
uptake/benefits
Development of delivery dashboard
24/09/19: dashboard for discussion at September ISP1
Board
21/11/19: dashboard to be developed by new Programme
Manager
01/08/20 Benefits being tracked in programme plan;
benefits review in 21/22
01/08/2020 Possible Major Moderate DTPC Board Nicky Poulain Mark Peedle Active
ISP1-12 12/03/2020
As a result of COVID 19, there is a risk that
the programme team and providers
delivering on work packages will be
impacted in the event of a significant
outbreak, which could result in delays on
delivering outcomes and benefits.
2019/20
2020/21Likely Moderate Moderate Reduce
1. Keep up to date with Public Health England management of
national situation and guidance (updated daily)
2.Ensure Programme Team are able to work at home to allow
for business continuity.
3. Reassess priorities and situation regularly; set expectations.
1. Fast track funding where available, to commission relevant work packages to help
primary care cope given a significant outbreak.
2. Key team members should take their laptops home every evening as part of the
team's disaster recovery plan.
1. WP 10 agreed to supply video consultation kit and
enhance VPN capabilities.
2. DR plan is in action for Programme Team.
01/08/20 Remote working is now embedded across the
programme and work is continuing on track.
21/01/21 The vaccination programe is having some
impact on CCG staff capacity under risk ISP1-15, but HBL
ICT are still operational.
11/03/21 Staff have been vaccinated which has reduced
possible impact of further outbreaks.
11/03/2021 Unlikely Moderate Low DTPC Board Nicky Poulain Mark Peedle Active
ISP1-14 23/06/2020
The programme is delivering new systems
to practices (i.e. GP TeamNet, S1 Hubs,
Mjog, Ardens…) and there is a risk that the
commitment to these will not continue
long-term once they are no longer funded,
which could result in inconsistency in the
systems in use locally.
2020/21 Possible Moderate Moderate Reduce
Before projects are initiated, establish if there is a long term
funding stream past the end of the programme's funding.
Ensure clear communication of the funded period to primary care teams in receipt of
systems.
21/01/21 Commitment for the next financial year to
renew Ardens and Mjog at the CCG has been agreed.
8/2/21 Renewals for a further 3 years with TeamNet is
being organised.
26/04/21 There is an increasing overlap on functionality
between these systems, and a review is being discussed as
part of the DF PID 21/22 and procurement of OC/VC next
year.
26/04/2021 Unlikely Moderate Low DTPC Board Nicky Poulain Mark Peedle Active
ISP1-15 15/12/2020
As a result of the Covid19 vaccination
programme, there is a risk that programme
resource and key stakeholders will be
diverted to focus on this delivery, which
may result in delays in delivery, decision
making and programme management
activities.
2020/21 Likely Minor Moderate Reduce
Impact is anticipated to be most significant during the launch of
each wave, which will be controlled by programme planning
and prioritisation;
Delegation where appropriate;
Use of HBL ICT as a delivery partner thereby spreading the risk
out from the CCG.
Monitor progress on activities/milestones. 21/01/21 The CCG digital team are supporting the
vaccination programme as are primary care teams. This
may have some impact on the 20/21 programme but the
HBL ICT team is still operational, mitigating the risk.
11/03/21 Vaccinations are having an impact on
engagement with practices. Scope has been adjusted
where necessary, but progress still being made.
11/03/2021 Likely Moderate Moderate DTPC Board Nicky Poulain Mark Peedle Active
Digital Transformation in Primary Care
Digital First - Risk RegisterRare Rare Unlikely Possible Likely
Catastrophic 5 5 10 15 20
Major 4 4 8 12 16
Moderate 3 3 6 9 12
Risk ID Raised by Date Raised
Description of Risk
As a result of x, there is a risk of y, which may result in
z
Proximity
Date or date
range when
the risk might
occur
Inherent
Likelihood
Click in box and
choose from drop-
down list
Inherent
Impact
Click in box and
choose from drop-
down list
Overall Risk
Rating
Automatic
scoring
Response
Option
Click in box and
choose from drop-
down list
Controls
What are the key controls in
place to prevent the risk from
occurring?
Actions
What further actions to control
the risk are planned. When
should they be completed?
Progress on Actions
What is the progress since the last report?
Date
Actions
Updated
Residual
Likelihood
Click in box and
choose from drop-
down list
Residual
Impact
Click in box and
choose from drop-
down list
Residual Risk
(Automatic
Scoring)
Trend
Movement of
scoring
3 = Up,
2 = unchanged,
1 = down
Responsible
Governance
Group
Risk Owner
Individual
responsible
for the
management
and control
Risk Actionee
Person who the risk
owner delegates
specific actions to
Risk Status
Click in box and
choose from drop-
down list
DF-1 20/21 PID 05/10/2020 There is a risk that there will be an Inability to
obtain resource with the right skill set to complete
the work within the allocated time frames, which
may delay benefits being realised by the
programme.
2020/21 Almost Certain Moderate
High
Share The risk is shared with our IT
partner, HBL ICT and the LAs as
resource will be based across
several organisations.
Make use of existing resources
and structures where possible.
Prioritise work appropriately
according to resource availability.
Set delivery expectations to all
stakeholders.
If HBL ICT are unable to recruit
certain skill set, we will work with
them and other providers to find
approriate resource.
15/12/20 HBL ICT have not recruited but are
managing the work in the existing team. LA
recruitment is in progress. The CCG should be able
to recruit in the NY.
21/01/21 HBL Recruiting; LA recruitment in
progress, 1 in post;
08/02/21 3 LA posts recruited. Excellent progress is
still being made.
11/03/21 All LA leads now in posts; JDs for CCG
roles complete and funding will be carried over to
21/22.
10/05/21 CCG roles approved and recruitment
process started.
10/05/2021 Possible Minor
Low
Digital First
Programme
Board
Nicky Poulain Mark Peedle
Active
DF-2 20/21 PID 05/10/2020 BLMK CCGs are planning to merge by April 2021.
The One Team programme is underway and a
significant restructure of the CCGs is in process.
There is a risk that this may impact staff's
availability and the CCG's recruitment of the 3
CCG based roles, which may delay the programme
realising benefits.
2020/21 Almost Certain Moderate
High
Reduce The majority of the project work
will be managed by our IT Partner,
HBL ICT.
Programme management and
oversight duties at the CCG to be
included in the review of new
roles in the restructure.
Work will be postponed until after
the consultation is over where
possible.
Prioritise work appropriately
according to resource availability.
Set delivery expectations to all
stakeholders.
21/01/21 One Team consultation over but Covid
vaccination taken over staff's time and is unlikely
recruitment will happen this financial year.
08/02/21 The CCG will start recruiting for 2 of the
posts - PCN Systems Lead and Programme
Administrator. Progress has been made despite the
posts still being vacant.
11/03/21 JDs written and CCG roles funding should
be carried over.
10/05/21 Exec approval given for recruitment to
the roles. Process to commence this month.
10/05/2021 Possible Minor
Low
Digital First
Programme
Board
Nicky Poulain Mark Peedle
Active
DF-3 20/21 PID 05/10/2020 Primary Care budgets for 2020/21 are expected to
be tight for BLMK CCGs, there is a risk that this
may impact on what the programme is able to
achieve in year resulting in poor VfM.
2020/21 Likely Moderate
Moderate
Reduce Funding for some systems will be
available i.e. OC systems. Apply
for alternative funding to help
support practices where
appropriate.
Prioritise work appropriately
according to resource availability.
Set delivery expectations to all
stakeholders.
21/01/21 funding for OC still not clear. Alternate
funding has been sought for some other digital
projects. Covid19 vaccination taking priority across
the ICS.
11/03/21 OC & VC funding still being finalised
10/05/21 New OC/VC framework live.
10/05/2021 Likely Moderate
Moderate
Digital First
Programme
Board
Nicky Poulain Mark Peedle
Active
DF-4 20/21 PID 05/10/2020 As a result on the ongoing Covid-19 work and the
start of winter, there is a risk that there will be a
lack of engagement from key stakeholders which
may result in poor outcomes for the programme.
2020/21 Likely Moderate
Moderate
Reduce Engage the Digital Clinical Lead to
help with comms.
Make sure that key stakeholders
are identified and are informed
and involved.
Prioritise work appropriately
according to resource availability.
Set delivery expectations to all
stakeholders.
15/12/20 HBL will set up a single point of contact
for practices to help manage engagement.
21/01/21 Vaccination programme is taking priority
across primary care & the ICS.
08/02/21 Progress is being made with projects that
require little engagement.
11/03/21 EOI process developed for engagment
with practices.
11/03/2021 Likely Moderate
Moderate
Digital First
Programme
Board
Nicky Poulain Mark Peedle
Active
DF-5 20/21 PID 05/10/2020 As a result of a failure to ensure strong
governance and programme management of
delivery across the footprint, there is a risk that
this may impact on the speed and effectiveness of
implementation
2020/21 Possible Moderate
Moderate
Reduce Using proven programme
governance from the existing
BLMK DTPC programme linked in
to the ICS.
The DTPC Programme Board and
programme controls are in place
to manage the DF programme.
21/01/21 The programme governance is being
maintained.
10/05/21 Programme is being managed with
existing team, still in post after the CCG restructure.
10/05/2021 Unlikely Moderate
Low
Digital First
Programme
Board
Nicky Poulain Mark Peedle
Active
DF-6 20/21 PID 05/10/2020 If the communication channels are not effective
there is a risk that comms will not reach everyone
involved which may result in the work not being
based on a shared vision and understanding.
2020/21 Possible Moderate
Moderate
Reduce To be delivered in line with CCG
primary care strategies and place-
based transformation plans to
ensure consistent direction and
message.
Specific communications resource
included in the CCG team.
Using proven programme
management from the existing
BLMK DTPC programme.
Make sure key stakeholders are
identified up front.
Comms planning should be part of
the programme overall
management.
21/01/21 Comms have been reduced due to
Covid19 but those that are essential are going out
via the correct channels.
21/01/2021 Possible Moderate
Moderate
Digital First
Programme
Board
Nicky Poulain Mark Peedle
Active
DF-7 20/21 PID 05/10/2020 As a result of underestimating the level of change
these proposals will require and the amount of
support general practice will need to embed the
changes, there is a risk that the programme will
not realise quality benefits.
2020/21 Likely Major
High
Reduce The use of skilled business change
management resource in the
project team.
Specific communications resource
included in the CCG team.
Make sure key stakeholders are
identified up front and engaged
with.
Utilise PCN lead role to work with
practices.
15/12/20 The programme has been discussed with
key stakeholders at the Digital Strategy PC forum.
21/01/21 Primary care is focused on the Covid19
vaccination programme.
10/05/21 HBL ICT are carrying out scoping sessions
with practices to manage change and expectations.
10/05/2021 Possible Major
Moderate
Digital First
Programme
Board
Nicky Poulain Mark Peedle
Active
DF-8 Board 15/12/2020 As a result of the Covid19 vaccination programme,
there is a risk that programme resource and key
stakeholders will be diverted to focus on this
delivery, which may result in delays in delivery,
decision making and programme management
activities.
2020/21 Likely Moderate Moderate Reduce Impact is anticipated to be most
significant during the launch of
each wave, which will be
controlled by programme
planning and prioritisation;
HBL ICT and the LA are delivery
partners thereby spreading the
risk out from the CCG.
Monitor progress on
activities/milestones.
21/01/21 The CCG digital team are supporting the
vaccination programme as are primary care teams.
This will have some impact on the 20/21
programme but the HBL ICT and LA teams are still
operating at present which mitigates the risk.
11/03/21 Vaccinations are having an impact on
engagement with practices. Scope has been
adjusted where necessary, but progress still being
made.
11/03/2021 Likely Moderate Moderate Digital First
Programme
Board
Nicky Poulain Mark Peedle
Active
Risk Matrix
Impact
5. Catastrophic 5 10 15 20 25
4. Major 4 8 12 16 20
3. Moderate 3 6 9 12 15
2. Minor 2 4 6 8 10
1. Insignificant 1 2 3 4 5
1. Rare <20% 2. Unlikely 21%-40% 3. Moderate 41%-60% 4. Likely 61%-80% 5. Imminent >80%
Likelihood
Impact Details
Name Description
1. Insignificant
A Business:
Breach of confidentiality (no adverse outcome)
Health records/ documentation incident (no adverse outcome).
B Clinical:
Potential risk for loss of specialist skill
C Commissioning:
Insignificant impact to the quality/ cost effectiveness of commissioning.
Manageable within project/team/work stream.
D Communication:
Rumours, potential media coverage
E Financial:
Small loss risk of claim remote
F HR Skills:
Short term low staffing level, where there is temporary reduces service quality (>1 day)
G Operational:
Insignificant schedule slippage
Regular loss/interruption of access to data >1 hour
Interruption does not impact on delivery of patient care or the ability to provide service
Business continuity issues may cause minimal negative impact
Unplanned loss of IT facilities (< half day)
H Partnership:
Transformation timescale, small slippage.
I Quality/Compliance:
Minimal impact on quality, unnoticeable
Informal complaint/inquiry verbal complaint
Unsatisfactory patient experience not directly related to patient care
Small number of recommendations which focus on minor quality improvement issues.
J Strategy:
Insignificant cost increase/schedule slippage
2. Minor
A Business:
Minor breach of confidentiality (resolvable).
Unplanned loss of IT facilities (<1 day)
Small percentage of inaccuracies in data or incorrect coding.
B Clinical:
Low risk of loss of specialist skill
C Commissioning:
Minor impact on the quality/ cost effectiveness of commissioning activities.
Less than 2 week delay to milestones/plans
D Communication:
Local media coverage – short term reduction in public confidence
Elements if public expectations are not being met
E Financial:
Budget is short by 0.1-.99%
Budget shortfall results in <4 months delay in benefits delivery
Claims less than £10k
F HR Skills:
Ongoing low staffing level reduces service quality
Minor error due to ineffective training / implementation of training
G Operational:
Schedule slippage causing minor project delays
Regular loss/ interruption of access to data >8 hours
Short term disruption to service with minor impact on patient care
Business continuity issues may only have a minor impact
Health records/ documentation incident (readily resolvable)
H Partnership:
Transformation timescale, small slippage.
I Quality/Compliance:
Quality affected but has minor impact
Minor recommendations/ impact which is recoverable by a low level of
communication/management action.
Unsatisfactory patient experience / clinical outcome – readily resolvable
Formal complaint with local resolution
Single failure to meet internal standards
Minor implications for patient safety if unresolved reduced performance rating if unresolved
Increase in hospital LoS by 1-3 days
J Strategy:
<5 % project budget Schedule slippage
3. Moderate
A Business:
Moderate breach of confidentiality – complaint initiated.
Some incorrect coding or incorrect data
B Clinical:
Small time of specialist time to invest in transformational work
Moderate risk of loss of specialist skill
C Commissioning:
Short term impacts to quality/ cost effectiveness of commissioning.
Resources used from other parts of the organisation
D Communication:
Local media coverage – long-term reduction in public confidence
Significant effect on staff morale and public perception of the organisation
E Financial:
Budget is short by 1-5% Budget shortfall results in >4 months delay in benefits delivery
Claims between £10k-£100k
F HR Skills:
Late delivery of key objective/service due to lack of staff
Unsafe staffing level or competence (>1 day)
Low staff morale
Poor staff attendance for mandatory/key training
G Operational:
Schedule slippage requiring 5-10 % more time
Regular loss/interruption of access to data >1 day
Disruption causes unacceptable impact on patient care
Temporary loss of ability to provide service
Health records/ documentation incidents – patient care affected with short term consequence.
H Partnership:
Transformation timescale small slippage or incomplete
I Quality/Compliance:
Moderate impact on quality of service or product
Challenging recommendations which can be addressed with appropriate action plans
Mismanagement of patient care, short term effects (>1 week)
Formal complaint with local resolution (with potential to go to independent review)
Repeated failure to meet internal standards with major patient safety implications if findings are
not acted on
Increase in hospital LoS by 4-15 days
J Strategy:
<5-10 % project budget Schedule slippage.
4. Major
A Business:
Serious breach of confidentiality (more than 1 person)
Health records/ documentation incidents – patient care affected with major consequence.
Significant incorrect coding or incorrect data also impacting performance stats
B Clinical:
Limited time of specialist time to invest in transformational work
Medium risk of loss of specialist skill
C Commissioning:
Significant delays/reduction in provision commissioning across multiple work streams (<1 month
delay to work stream)
D Communication:
National media / adverse publicity, < 3 days service well below reasonable public expectation
Public confidence in the organisation undermined
E Financial:
Budget is short by 5- 10%
Failure to deliver >25% of savings target
Claims between £100k- 1m
F HR Skills:
Uncertain delivery of key objective/service due to lack of staff
Unsafe staffing level or competence (>5 days)
Loss of key staff Very low staff morale
No staff attending mandatory key training.
G Operational:
May be completed within the agreed time frame with additional resources
Major injuries / long term incapacity or disability (e.g. loss of limb)
Long term sickness>4 weeks
Unplanned loss of IT facilities (>1 day but < 1 week)
H Partnership:
Transformation timescale slippage or incomplete
Difficult working relationship
Contractual leavers
I Quality/Compliance:
Major impact on quality of service or product
Serious mismanagement of patient care, long term effects (more than a week), non-compliant
service
Major adverse effect on delivery of key objective - Critical report
Multiple complaints/ independent review
Low performance rating Critical report
The reputation of the organisation/service is significantly damaged and will require major
investment of resources to recover it
Increase in hospital LoS by >15 days
J Strategy:
Noncompliance with national 5-10 % over project budget
Schedule slippage Key objectives not met
5.
Catastrophic
A Business:
Serious breach of confidentiality (Large numbers)
Health records/ documentation incidents – catastrophic consequence.
No or inaccurate service data available also impacting performance stats
B Clinical:
Lack of specialist skill to invest in transformational work
High/impendent risk of loss of specialist skill
C Commissioning:
Realisation of risk preventing delivery of significant services through its contracts with providers
to the public
D Communication:
National / international media / adverse publicity, more than 3 days
MP Concern (questions in parliament)
Total loss of public confidence
E Financial:
>10% over budget
Failure to deliver major elements of financial savings targets
Loss of contract / payment by results
Claims >£1m
F HR Skills:
Non-delivery of key objective/service due to lack of staff
Ongoing unsafe staffing levels or competence
Loss of several key staff
No staff attending mandatory training/key training on an ongoing basis
G Operational:
Well behind schedule and highly unlikely to deliver project therefore associated benefits
Estimations were completely out sync with reality leading to huge cost overruns and project
failure
Death or major permanent incapacity
Significant number of people affected (screening errors)
Unplanned loss of IT facilities (> 1 week)
H Partnership:
Unable to make transformation happen
Difficult working relationship with potential reputational damage
Contractual leavers
I Quality/Compliance:
Quality cannot be achieved
Complete systems change required, zero performance rating
Totally unsatisfactory patient outcome or experience continued ongoing long term effects
Totally unacceptable level or quality of treatment/service or level of compliance
Gross failure of patient safety if findings not acted on Inquest/ombudsman inquiry
Confidence in the organisation/service is irrecoverable
Litigation certain
Event impacts a large number of patients
J Strategy:
Noncompliance with national >25 % over project budget.
Schedule slippage Key objectives not met.
Likelihood Details
Name Description
1. Rare <20% The event is not expected to occur.
2. Unlikely 21%-40% The event might occur at some time.
3. Moderate 41%-60% The event will occur at some time.
4. Likely 61%-80% The event will occur in most circumstances.
5. Imminent >80% The event is certain to occur
Author: Tony Medwell, Head of Primary Care Contracting and Commissioning
Contact Information: [email protected]
Lead Executive: Nicky Poulain, Director of Primary Care
Which activity does this paper relate to?
Primary Care Commissioning Quality and Outcomes framework (QOF).
How?
Improving the quality of Primary care – Quality and Outcomes framework changes - supporting quality improvement in primary care.
What is the Committee being asked to do?
For information and quality assurance.
What are the financial implications?
The size of QOF has increased from 567 to 635 points, value of a QOF point in 2021/22 will be £201.16.
Set out the key risks and risk ratings
Key moderate risk is variation. Mitigations are supporting practices and monitoring QOF, working with PCN’s on supporting population health. There are specific leads that support practices for example with immunisation, Cancer or Learning Disabilities.
Date to which the information this paper is based on was accurate
7th May 2021
Appendices
None.
QoF Implementation in 2021
As a response to the pandemic and the need to clinically support the most vulnerable patients QOF
was adjusted with some protected indicators to focus clinical care in the following areas:
Primary Care Commissioning Committee Meeting held in Public 18th May 2021 1045-1245
Item 11. Title: Quality and Outcome Framework (QOF) Changes – Supporting
Primary Care 2020 & 2021
Information
Executive Summary
2
• Immunisation and screening e.g. Flu vaccination and cervical screening as part of the recovery
plans.
• Quality improvement in the areas of learning disability and early cancer diagnosis with PCN
level plans.
• Maintaining Disease registers as well as Prescribing.
• Each practice developed submitted plans to support patients who were the most vulnerable for
example Homeless, those in Deprived areas and those who may have been missing important
reviews such as patients with a serious mental health diagnosis.
• There was also a focus on ethnicity recording as this was a relevant clinical factor in assessing
patients who were more at risk of severe illness from Covid 19.
All BLMK Practices and PCN’s developed and implemented QoF and in particular focused efforts upon
the identification and prioritisation of people at risk of poor health and those who experience health
inequalities for proactive review including:
• BAME groups
• the 20% most deprived
• those with a history of missing annual reviews.
Qof Changes for 2021/22
Going forward for the coming year 2021/22 QOF is moving back to normal arrangements with the
following adjustments:
• A new vaccination and immunisation domain, this replaces the childhood immunisation DES
• There is a focus on flu vaccination for target groups (CHD, COPD, stroke/TIA and diabetes) • Focus on SMI physical health check. • New indicator focused on cancer care has been introduced with amendments to time-frame
and requirement for cancer care review framework. • Quality Improvement modules are to be repeated in their intended format for Learning
Disability and supporting early cancer diagnosis (working with PCN’s). • For 2021/22, practices may deliver patient reviews remotely where clinically appropriate to
do so, unless otherwise specified. • Face-to-face reviews have been recommended for patients with dementia.
The size of QOF has increased from 567 to 635 points, value of a QOF point in 2021/22 will be £201.16.
The national average practice population figure will be 9,085
QoF Quality Improvement
BLMK leads will continue to support practices and monitor QOF to benchmark and improve outcomes.
This work links in with PCN’s on supporting population health. There are also specific clinical and
transformation leads that support practices for example with immunisation, Cancer or Learning
Disabilities.
Author: Nikki Barnes, Head of Infrastructure & Integration / BLMK ICS Estates Programme Lead
Contact Information: [email protected]
Lead Executive: Nicky Poulain, Director of Primary Care / Geraint Davies, Director of
Performance & Governance
Which activity does this paper relate to?
Primary Care Development.
How?
Supports improvement to primary care premises and capacity, which impacts on primary care resilience and quality of care.
What is the Committee being asked to do?
• Note and endorse the CCG’s Primary Care Estates Strategy
• Approve the business case (Project Initiation Document) relating to the primary care space within Dunstable Hub, and approve the recommended approach to the Primary Care Network (PCN) space
• Note the progress update in relation to the Kingsway/Conway Medical Centre project, and the updated position on capital costs to support the decant of Medina Surgery from the Kingsway building to Malzeard Road.
What are the financial implications?
• Commitment to increase in rent reimbursement of £92,996 p/a for Priory Gardens Surgery from 2023/24, as a result of relocation to Dunstable Integrated Health & Care Hub (within the value previously approved in principle by PCCC)
• Commitment in principle to cover rent and potentially service charges for Chiltern Hills PCN space within Dunstable Hub from 2023/24 – total of £70,401 p/a. Detail of lease arrangements to be worked through once legislative powers of ICSs to control estate are established.
• Circa £20k capital funding to support the Medina Surgery decant to Malzeard Road (previously approved in principle by PCCC).
Set out the key risks and risk ratings
Risk of affordability of delivering Primary Care Estates Strategy. Further prioritisation of schemes across BLMK may be necessary as costs and deliverability of schemes are further developed.
Primary Care Commissioning Committee Meeting held in Public 18th May 2021 1045-1245
Item 12. Title: Report from Estates Working Group
Information
2
Date to which the information this paper is based on was accurate
7th May 2021
Appendices
12.1. Primary Care Estates Strategy 12.1.1. Dunstable Hub Project Initiation Document (PID)
1.0 Introduction
The purpose of this report is to provide an update to members of the Primary Care Commissioning Committee
in relation to premises issues and development work across BLMK.
Members of the Committee are asked to:
• Note and endorse the CCG’s Primary Care Estates Strategy
• Approve the business case (Project Initiation Document) relating to the primary care space within Dunstable
Hub, and approve the recommended approach to the Primary Care Network (PCN) space
• Note the progress update in relation to the Kingsway/Conway Medical Centre project, and the updated
position on capital costs to support the decant of Medina Surgery from the Kingsway building to Malzeard
Road.
2.0 Primary Care Estates Strategy
The enclosed Strategy sets out the CCG’s approach to enabling delivery of the Primary Care Strategy through
the primary care estate, with a particular focus on supporting the continued development and evolution of
Primary Care Networks, integrated care delivery, and a wider Population Health Management approach.
It draws and builds on work carried out within each “Place” to identify the key estates issues and opportunities,
and sets out the existing and emerging priority projects across BLMK.
It should be noted that this is a live strategy and will continue to develop, and that delivery timescales may be
subject to change. For example, many of the projects set out have experienced delays due to Covid over the
last year. However, it provides an important framework to support decision-making in relation to
premises/estates, and to steer the focus of the CCG’s Estates and Primary Care teams.
The work programme is necessarily ambitious, and further work may be required later this year to more explicitly
prioritise projects across BLMK and at “Place” level, in line with available resources.
3.0 Dunstable Hub
The Project Initiation Document for the Dunstable Hub is enclosed and approval is sought from PCCC members
for the additional revenue costs associated with Priory Gardens Surgery relocating to the Hub, and for the
recommended approach for dealing with the rent reimbursement and service charges for the Primary Care
Network (PCN) space.
Bedfordshire Hospitals NHS Foundation Trust (BHNHSFT) have agreed to take on the Head Lease for the entire
building and are working towards signing a Memorandum of Understanding (MOU) to that effect with Central
Bedfordshire Council on 13th May. Other tenants will then enter into a sub-lease with BHNHSFT, including Priory
Gardens Surgery.
Executive Summary
3
The Trust may expect an MOU from BLMK CCG with regards to the Primary Care space in the building, ahead
of starting the formal lease negotiations with Priory Gardens Surgery, to provide them with adequate assurance.
Whilst there are some details still to be finalised in the scheme PID, a mandate is sought from PCCC to enable
the CCG to progress with negotiations to reach an MOU with the Trust (should it be required) which commits
the CCG to covering the additional rent reimbursement charges for the Priory Gardens Surgery space within the
building:
Current Rent Reimbursement Priory Gardens £61,000 p/a
Rent reimbursement in Dunstable Hub for Priory Gardens dedicated demise & portion of shared/bookable/circulation space
£153,996 p/a
Net revenue impact for Priory Gardens Rent £92,996 p/a
The Dunstable Hub will provide a base for the Chiltern Hill’s Primary Care Network, and accommodation is
included for the Additional Roles Reimbursement Scheme as further posts are created in the coming years.
Currently there is no clear policy on covering the costs of space shared across a PCN. Following discussions
with the national and regional teams, we understand that it is expected that in the transition of the ICS to a
statutory body, legislative changes will enable ICSs to control clinical estate (i.e. own properties and hold leases).
It is expected this will provide an opportunity for more dynamic occupation arrangements with tenants, which will
better help to enable new transformative models of care. It is anticipated that this will be the case from 2022/23
(and certainly by the time the Hub is complete in 2023), and would therefore provide an additional option for the
ICS to take on the sub-lease for the PCN space in due course. An alternative option would be to include the
PCN space in the Priory Gardens lease, and to consider options for the most appropriate arrangements for
covering the service charge costs. Advice from national colleagues is that it would be reasonable to provide
commissioner assurance to the landlord around this space (subject to local affordability) in the short-term, and
progress the formal legal arrangements as the available options become clearer and can be worked through in
detail.
Until this change passes through legislation, we are recommending to the PCCC that the CCG agree to sign an
MOU with BHNHSFT committing to covering the rent and service charges for the PCN space within the Hub
(should this be required by the Trust):
Rent for PCN demise (& portion of shared/bookable/circulation space)
£54,257 p/a
PCN accommodation service charges £16,144 p/a
Total revenue impact of PCN space £70,401
Following PCCC endorsement of the PID and the recommendations above, the PID will be submitted to the
Regional Capital Investment Oversight Group, who, it has been established, need to approve investments in
primary care rent reimbursement.
4.0 Kingsway/Conway Medical Centre Project
Previous reports have been provided to PCCC around the project to relocate Conway Medical Centre into the
void area of Kingsway Health Centre. The project is progressing well, and the key estates milestones are set
out below:
• May 2021 – Patient engagement with Medina Surgery patients to advise of relocation of surgery to
Malzeard Road
• 1st June 2021 – Completion of building works at Malzeard Road
• End of June 2021 – Relocation of Medina Surgery
• 9th July 2021 – Commencement of building works at Kingsway
4
• Autumn 2021 – Patient engagement with Conway Medical Centre patients in relation to relocation of
surgery into Kingsway building
• April 2022 – Anticipated completion of building works.
It should be noted that there are a series of interdependencies with contracting decisions relating to the Kingsway
APMS contract and the Medina caretaking arrangements. The estates programme has been developed in close
alignment with the contracting milestones, though the delays to the estates scheme as a result of Covid will
impact some of the contracting timescales. Further information around this will be provided to PCCC as
recommendations are finalised.
PCCC has previously agreed in principle to cover the costs of the capital works required at Malzeard Road, to
support the decant of Medina Surgery and enable the wider scheme to move forward. These costs are being
finalised by the practice, and are expected to be in the region of £20,000. Further costs are expected to support
off-site storage of patient records for the three practices; these costs have been budgeted for.
Primary Care Estates Strategy 2020-2024October 2020
Item 12.1
This Strategy sets out the overarching principles and aims for the Primary
Care Estate across Bedfordshire, Luton and Milton Keynes (BLMK).
Partnership working at a local level is critical for maximising integration
opportunities through estates projects, and is important for maximising joint
opportunities in the context of One Public Estate and strategic planning in
relation to housing growth.
Therefore this Strategy sets out the established and emerging Place-based
Strategic Estates Plans for Central Bedfordshire, Bedford Borough,
Milton Keynes and Luton.
These plans take into account existing variations in capacity within
practices/PCNs across BLMK, and also recognises planned housing growth
and opportunities to enable delivery.
A central principle of this Strategy is maximising existing capacity in the first
instance, bearing in mind geography and reasonable access for patients/
service users.
Introduction
2
In line with national and local strategies, there is a significant transformation programme underway across primary care in
Bedfordshire, Luton and Milton Keynes (BLMK). Central to that programme is the ongoing development of the 23 Primary Care
Networks (PCNs) that have been established, as the platforms for primary care at scale, improved access to services and
workforce expansion, effective skill-mix and integrated multi-disciplinary working, and personalised and proactive care.
This is against a backdrop of significant population growth, largely driven
as a result of housing development, which is impacting on the capacity of the
primary care estate in some parts of BLMK. There are significant premises
issues which are hindering the delivery and future development of primary
care services in some areas.
Development of the primary care estate can play a key enabling role in
supporting the consolidation of PCNs, and enabling an integrated approach
to health and care delivery across services, whilst providing much-needed
additional and flexible space to accommodate the expanding primary care
workforce.
• A number of small GP practices working independently across a geographical area with minimal interaction
• Mainly staff with traditional clinical roles including GPs, Practices Nurses, Healthcare Assistants
• Standalone IT systems
• Core opening hours, most contact via face to face appointments
• Limited MDT working and limited integration with wider health and care services
• 98 practices operating from 128 sites and organised in to 23 Primary Care Networks (3 practices not signed up to PCN DES)
• Multidisciplinary teams established and developing across health providers and social care
• New workforce roles emerging: e.g. Clinical Pharmacists, Social Prescribing Link Workers, Pharmacy Technicians,
Physicians Associates
• Increasing digital utilisation including access via video and online consultations and apps for self care
• Information sharing across health economy is increasing, population health approach developing
• Routine services available 8am-8pm weekdays and at weekends
• Developing system working for improved access to same day urgent care
• Consistent high quality access to primary care services via on the day services and 24/7 single point of access
• Mature Primary Care Networks working in partnership with Integrated Care Providers to improve population health
• New workforce embedded into primary care, 400+ across 23 Primary Care Networks enabling more sustainable, resilient services
• Population health approach addressing health needs and inequalities across populations, in partnership with local communities
• Greater focus on proactive, anticipatory care, and personalisation in place with those who will benefit
• Integrated Urgent Care and rapid community response services
• Optimised digital access in place for patients, and shared health and care record in place, supporting integrated delivery of care
• Estates solutions (such as integrated health and social care hubs) in place where needed
• High confidence in primary care services from the local population
Traditional Primary Care
Where We Are Now
Where We Want to Be 2023/24
Primary Care Strategy –
Achieving the Vision
3
The BLMK Primary Care Strategy sets out the local vision for Primary Care across the Bedfordshire, Luton and Milton
Keynes Integrated Care System (BLMK ICS).
Estates Strategy
Where We Are
• Primary care services delivered from 128 GP practice premises – largely from standalone GP practices
• Limited co-location and genuine integration of primary, community, mental health and social care services
• Significant variation in capacity levels between primary care premises, with many GP practices considered
constrained or severely constrained whilst others have a surplus of space
• Significant variation in the condition and suitability of premises
Where We Want To Be
• Estates solutions will support the development of integrated teams of GPs and other Network professionals,
expanded community health and social care staff – and with other community-based services that can
positively impact on health and wellbeing (e.g. via social prescribing and voluntary sector)
• PCNs will be enabled through a range of virtual and physical Hub arrangements, depending on local
circumstances
• Services to be delivered in each Hub (over and above minimum service offer) will be based on local population
health need
• Cost effective estates/Hub solutions that maximise existing premises, and that optimise opportunities to work
with other public sector partners under the principles of One Public Estate
How We Will Get There
• Potential delivery of up to 13 physical Hub facilities across BLMK. These schemes will enable the co-location of GP
practice premises into one building to support PCN arrangements, and where possible these will be larger facilities
which co-locate community, mental health, social care and other wellbeing services
• Improvements to/relocations of a range of GP premises, to sustain key “spoke” sites where geographically required
• A range of small-scale quick-win projects to help create extra space for the expanding PCN workforce
• Estates and digital developments progressed in tandem
4
Significant scoping work has taken place across each of the ‘Places’ in BLMK in partnership with local stakeholders, and this
Strategy brings together all of the local issues and approaches into one consolidated Primary Care Estates Strategy for
BLMK. In summary, our Estates Strategy can be described as:
The BLMK Primary Care Estates Strategy is a core element, central to the Estates Strategy for the wider BLMK Integrated
Care System:
5
Alignment with ICS Estates Strategy
Integrated
Health and
Care HubsDevelopment of up to
13 Hubs across
BLMK, enabling
Enhanced Primary
Care at scale,
integrated multi-
disciplinary teams
across primary,
community, mental
health & social care,
centres for health and
well-being (incl. Local
Authority & voluntary
sector services as
appropriate to each
community)
Primary Care
Community
and Mental
Health
Sustainable
Secondary
Care
Key “spoke”
premises
sustained, with
clear pathways to
Network/Hub
services
Consolidation
of services
and improved
facilities for
inpatient care
in the
community
System
Recovery &
Transformation
Response to
Covid-19
6
The CCG/s have developed the following principles to underpin estates planning, to support delivery of the
Primary Care Strategy in each of the four Places:
• Primary Care Networks will be enabled through a range of virtual and physical Hub arrangements, depending on local
circumstances.
• Will work towards establishing a minimum core service offer across all Primary Care Networks, which will align with the
proposed Hub service model.
• Services to be delivered within each Hub (over and above minimum service offer) will be based on local population health
need.
• Estates/Hub solutions need to be cost effective, will need to maximise existing premises, and maximise opportunities to
work with other public sector partners under the principles of “One Public Estate”
• Estates and digital developments will be progressed in tandem, in particular Primary Care Networks will be supported to
develop online digital consultations.
• Estates solutions will support the development of integrated teams of GPs/community health and social care staff, and the
development of expanded community health teams to provide fast support to people in their own homes as an alternative to
hospitalisation.
• Opportunities will be maximised to integrate health and social care services with other community-based services that can
positively impact on health and well-being of patients, e.g. via social prescribing, and voluntary sector.
Estates Principles
Implementing a Place based approach to estates planning, underpinned by these principals, ensures an approach that is
sensitive to the significant differences in demographics, ethnic diversity and deprivation within the BLMK footprint.
7
Each of the Place-based estates plans set out in this Strategy are based on
detailed scoping work that has taken place with local providers and/or Local
Authority partners, underpinned by the BLMK Estates Principles. There are a
range of estates projects set out, which include the following:
• Primary Care Hubs – with the aim of co-locating two or more GP
practices into larger facilities, with the ability to operate as Hubs for
services delivered across Primary Care Networks
• Large multidisciplinary integrated Hub schemes – with the aim of co-
locating general practice services alongside a range of community, mental
health, social care and wider wellbeing services, depending on local need
• GP practice relocations/improvements – in communities where it is
necessary to retain ‘spoke’ GP practices, but where the current premises
are not fit for purpose and/or cannot meet future needs
• Quick win schemes to increase capacity to support GP practice/PCN
delivery, e.g. to accommodate additional workforce, to accommodate
significant local housing growth and/or to centralise services between
practices such as same-day access. These schemes include conversion
of administrative rooms into additional clinical rooms, establishment of
dedicated remote consultation spaces, extensions, acquisition of
additional clinical rooms from adjoining health centres/ in nearby health
facilities.
Successful ‘Hub’ proposals should be transformational projects based on
local need, arising from Primary Care Networks, making the best use of
existing resources and infrastructure. The CCG/s work continually with
providers to jointly agree service and infrastructure developments or address
issues as they arise. We also liaise with local planning authorities to consider
the impact of local development plans on the demand for health and social
care. As a consequence a number of schemes are already operational, under
construction or approved that will or could meet the integrated Hub concept.
Range of Estates Solutions
As the challenges of a growing and ageing population
intensify, and the face of health and care across BLMK
changes in response, the primary care estate (including
community care) will come under increasing pressure. It
is vital that the estate adapts to support the delivery of
new models of integrated services.
Both nationally and locally, it is recognised there can be
value in bringing a range of services together into “Hub”
facilities as geographically appropriate, enabling close
integration between a range of teams and professionals,
including the wider community, where this is
geographically and demographically appropriate, and
where this can be achieved cost-effectively.
Each of the three CCGs in BLMK are working closely
with providers and Local Authority partners to develop
detailed Primary Care Estates plans under an umbrella
BLMK framework. Where this planning is further
progressed, priority estates schemes are being brought
forward, including a number of integrated Hub schemes
where national capital or Local Authority funding has
been secured.
The service model for any Hubs (virtual or physical) will
necessarily vary according to the needs of the
communities they serve, but to ensure a consistency
and equity of approach, the CCGs have developed a
Hub service model framework which sets out the CCGs’
expectations for Hub developments.
Integrated Hubs and Spokes
8
As PCN workforces expand, and professionals work increasingly closely together
across primary, community, mental health and social care within Networks, a range of
Hub arrangements will develop – some in new physical Hub buildings, others
utilising surplus space in existing buildings, and via virtual information and
space sharing arrangements.
A population health approach may have a significant impact on current and future
infrastructure requirements. It is a bottom up, needs-based methodology that will
target services and investment to areas of highest need and more effective models of
care. This may lead to significant variations in the type of services offered by
Hubs across the BLMK area.
Dependent on local circumstances, a range of additional and wider professionals will
sometimes need to provide outreach support to individual practices (e.g. where
practices are geographically distant from their associated Hubs), and practices/PCNs
are expected to develop increasingly close links with their wider communities as the
proactive Population Health Management approach is embedded across BLMK.
Therefore the future use of primary care buildings (both Hubs and their associated
GP practice “spokes”) is likely to change over time to incorporate the satellite
presence of additional roles such as Social Prescribing Link Workers, health
coaches, care navigators, and potentially wider voluntary/community
interaction.
With the growing emphasis on proactive, preventative care and new professionals
supporting Primary Care Networks in a social prescribing and health coaching
context, this will need to be incorporated into the facilities used by primary care
providers going forward (e.g. access to an increasing number of smaller counselling
rooms for wider professionals to use, facilities for group education sessions, etc), and
it is feasible that there may be opportunities to consider co-locating some of
these new services with wider wellbeing and community services in the future.
Opportunities will be explored with partner organisations around these alternative
‘spoke’ arrangements as this aspect of primary care provision continues to develop.
9
Integrated Hubs and Spokes
As the Strategic Commissioner within the BLMK Integrated Care System, our central approach to delivering this Primary
Care Estates Strategy is around enabling and supporting our local providers, including via their Primary Care
Networks (PCNs), to deliver their estates ambitions, to help enable achievement of service transformation and
sustainability goals – and ultimately improve outcomes for patients.
This support to providers can range from technical advice to individual GP practices through to project management of
some of the larger multi-agency Hub schemes. There are 98 primary care providers across BLMK, operating from 128
premises, many of whom have ambitions around improving their facilities or expanding their capacity. It is therefore essential
for the CCG/s to prioritise and target support, alongside a standard offer of advice and guidance accessible to all
providers.
There is significant variation in the condition and capacity of the BLMK primary care estate. Capacity at practice level across
BLMK ranges from 5 to 59 patients per m². The gold standard capacity for “traditional primary care” has been 16-18 patients
per m² (prior to the significant digital transformation that has taken place during 2020 as part of the Covid-19 response).
Support therefore needs to be focused on the practices and PCNs with the most significant capacity constraints and/or
operational pressures associated with their premises, whilst taking a pragmatic approach to partnership delivery
opportunities and forward planning in line with housing growth.
At PCN level the variation in capacity is less extreme (10 to 27 patients per m²) which suggests that there may be
opportunities to improve utilisation of some buildings to support other practices within Networks, where this makes
sense for patients and practices. This is reflected in the Place-based Estates Plans.
The support that providers can expect from the CCG includes:
• Strategic estates planning and prioritisation
• Facilitate access to S106/CIL funding and other external funding to support business case development
• Access information around housing growth to review current and future capacity need
• Advice and navigation through process and governance, signposting to professional advisors/technical guidance
• Support negotiations with developers/Local Authority Planners/landlords/District Valuer
• Support discussions with NHS Property Services and community/mental health providers
• Project management for some schemes, particularly multi-agency Hub projects.
The CCG role in supporting delivery of
the Primary Care Estates Strategy
10
Top twenty most constrained practices in BLMK
11
Premises Capacity at Practice Level
Surgery Name
List Size
(this
site)
Site type NIA m2
Total NIA
of all
sites
Total practice list
size
Total
patients
per m²
PCN
STOPSLEY VILLAGE PRACTICE 10,265Standalone 173.00 173.00 10,265 59.34Oasis Network
ASHCROFT ROAD SURGERY 5,035Standalone 101.30 101.30 5,035 49.70Eden Network
MEDINA MEDICAL CENTRE 6,041Standalone 132.00 132.00 6,041 45.77Phoenix Sunriser
GOLDINGTON AVENUE SURGERY 10750Standalone 249.00 249.00 10,750 43.17Unity
CONWAY MEDICAL PRACTICE 7,992Standalone 200.00 200.00 7,992 39.96Phoenix Sunriser
STONEDEAN PRACTICE 7,305Main 198.51 198.51 7,531 37.94Nexus
GREENSAND SURGERY 9,516Main 253.43 253.43 9,516 37.55Hillton
ST JOHNS SURGERY 5,920Standalone 164.00 164.00 5,920 36.10Caritas
FISHERMEAD MEDICAL CENTRE 7,192Standalone 199.40 199.40 7,192 36.07Ascent
GREAT BARFORD SURGERY 5,045Standalone 142.00 142.00 5,045 35.53Unity
KINGSBURY COURT SURGERY 9,096Standalone 270.00 270.00 9,096 33.69Chiltern Hills
PUTNOE MEDICAL & WALK-IN CENTRE 16,155Standalone 500.00 500.00 16,155 32.31East Bedford
PRIORY GARDENS HEALTH CENTRE 15,060Standalone 466.63 466.63 15,060 32.27Chiltern Hills
WATLING VALE MEDICAL CENTRE 13,132Standalone 415.00 415.00 13,132 31.64Watling Street Network
HOUGHTON REGIS MEDICAL CENTRE 11,878Standalone 378.20 378.20 11,878 31.41Titan
COBBS GARDEN SURGERY 8,450Standalone 271.05 271.05 8,450 31.18Crown
WEST STREET SURGERY 11,915Standalone 397.00 397.00 11,915 30.01Chiltern Hills
WOODLAND AVENUE SURGERY 12,039Standalone 402.00 402.00 12,039 29.95Medics Network
OAKLEY SURGERY 4,483Standalone 150.00 150.00 4,483 29.89Hatters Health Network
BELL HOUSE MEDICAL CENTRE 9,726Standalone 333.00 333.00 9,726 29.21Medics Network
PCNTotal NIA for all PCN
sitesTotal PCN list size Total patients per m²
per PCN
Chiltern Hills 1903.63 53259 27.98
East Bedford 2072.1 51014 24.62
Hillton 1387.6 32582 23.48
Crown 1826.12 42665 23.36
H is for Health 1385.55 31959 23.07
Watling Street Network 1836.65 41569 22.63
South West Network 2151.32 47371 22.02
Titan 1512.2 32791 21.68
Ascent 1402.07 30268 21.59
North Bedford 2195.7 47060 21.43
Unity 1980 41804 21.11
Nexus 2835.75 57721 20.35
Eden Network 1690.71 34263 20.27
Medics Network 2554.7 51599 20.20
Caritas 2430.85 48157 19.81
Hatters Health Network 2193.32 43401 19.79
Ivel Valley North 2803.78 55079 19.64
Ivel Valley South 2389.6 42146 17.64
Leighton Buzzard 2960.7 49222 16.63
East MK 3210.14 52662 16.40
The Bridge 2738.53 42194 15.41
Phoenix Sunriser 3672 53631 14.61
Oasis Network 2456 24852 10.12
Premises Capacity at PCN Level
12
Some of the practices with the greatest constraints are within the PCNs with the most amount of physical space, which suggests possible
opportunities for improving utilisation of existing premises, where this works well for providers and their patients.
Impact of Digital First
Approach on Primary Care Estate
Worked example for Dunstable Hub
2020 has seen significant digital transformation take
place in primary care, which will have an impact on how
we assess and plan primary care premises capacity
going forwards.
At the peak of Covid-19 lockdown, contacts in primary
care shifted from 90% activity taking place face-to-face
(F2F) to 85% happening remotely (nationally). It is
challenging to predict future F2F activity levels, but it’s
very likely that digital transformation will continue to have
a positive impact on estates pressures. This will
change the requirement from buildings going forward,
including the need for dedicated areas for clinicians to
carry out remote consultations, to prevent inefficient
use of large consultation rooms. Opportunities to digitise
patient notes (Lloyd George records) and the likelihood of
some staff continuing to work off-site/from home will also
help.
This will partially be offset though by the significant
investment in PCN Additional Roles (ARRS) – an
average of an extra 22 professionals working in each
of the 23 BLMK PCNs by 2024, which could increase
pressure on space-constrained Networks and
practices.
It is essential that the planning for all primary care estates
schemes is closely aligned to local digital transformation
and workforce planning.
13
14
PLACE-BASED ESTATES PLANS
CENTRAL BEDFORDSHIRE
As a desirable place to live and work, the population of Central Bedfordshire is growing almost 5% faster than the population of
England. Overall, the capacity currently available is 35% below the estimated capacity required to deliver primary care services in
Central Bedfordshire (based on traditional, predominantly face-to-face service delivery). This gap will grow to 50% by 2035.
In addition, capacity is not equitably distributed. The capacity gap (the difference between that available and projected need) will
grow at a different rate in each of the localities across Central Bedfordshire.
An ambitious joint programme is underway across Central Bedfordshire to develop of a number of Integrated Health and Care
Hubs (IHCHs), to enable a new model of care which will support the integration of a range of health and care services virtually and
physically, in shared centres. This will mean developing premises in key localities. IHCHs present an opportunity for additional
capacity and a new focus. Slides 14-18 provide an outline of the programme, which is expected to address the following challenges
and issues:
• Projected population growth, due to new housing - both the location of new homes and the likely impact on the age profile
• The impact of an ageing population and a growing acuity of needs
• The need to accommodate multi-professional/organisational working and the space needed to deliver Primary Care Home
model via Primary Care Networks
• Flexibility to ensure that future changes, as yet to be fully developed, can be accommodated, including digital and technological
transformation.
Growth in new housing is accommodating and encouraging population expansion. Existing practices will not have the capacity to
manage additional patients without additional resources, both workforce and space. Organic growth within the existing population is
also high. Life expectancy is increasing and the population over the age of 65 is growing at a faster pace than the population under the age
of 65.
Although the birth rate in Central Bedfordshire is reducing, net migration is positive. This will add to demands on health and social
care services and must be factored into capacity requirements. These demands will be for a different mix of services, to meet the needs of
the aging population. Overall, the capacity currently available is 35% below the estimated capacity required to deliver primary care services
in Central Bedfordshire. This gap will grow to 50% by 2035. In addition, capacity is not equitably distributed..
IHCHs will address the capacity gap in locality based care. In some localities, the Hubs will add to the existing estate rather than replacing it,
depending on need and the preferred service model in each Primary Care Network. In terms of geographical spread, the current population
of Central Bedfordshire is distributed across c23 areas. The highest concentrations are in Dunstable, Leighton Buzzard and Biggleswade,
which account for 32% of the population. Population distribution creates a challenge in terms of where services are best located.
As well as the growing demand on health and care services due to an expanding population, people are requiring more intensive support
and for a longer period. By 2025, 9.1m in the UK will be living with multiple, serious long-term conditions. Patients with long-term
conditions account for 55% of all GP appointments (Royal College of Physicians). Providing more intensive support for chronic needs
requires a different model of community based support to that historically provided.
15
Central Bedfordshire
- 50,000.00 100,000.00 150,000.00 200,000.00 250,000.00 300,000.00 350,000.00 400,000.00 450,000.00 500,000.00
00-19
20-64
65-119
Growth in Bedfordshire Population 2017-2023
2022/23 2021/22 2020/21 2019/20 2018/19 2017/18
In common with most other
systems, Central Bedfordshire is
contending with these pressures
whilst also experiencing a
declining workforce. The position
of the primary care workforce
creates a further imperative for a
new model of care that will be
enabled through Integrated
Health and Care Hubs. They will
make better use of the limited skills
and expertise available, enable the
implementation of new technology
and promote self care.
16
Housing
Growth in
Central
Bedfordshire
This map highlights the major
housing growth sites planned
within the Local Plan to 2035.
Alongside the IHCH
programme, a number of
individual GP practices will
need support to improve and
expand their premises – in some
instances through relocation to
new buildings. This recognises
the significant geographical
spread between communities
across Central Bedfordshire, and
potential distance to some of the
planned Hubs.
A number of these projects
are already in train (e.g.
major reconfiguration of
Marston Surgery to provide
much-needed capacity prior
to a potential new facility in
the Marston Vale
development in the long-
term).
Partnership opportunities
between health and the Local
Authority, and with housing
developers, will continue to
be maximised, including
exploring co-location of key
primary care “spokes”
alongside a range of
wellbeing services where
appropriate and feasible.
Integrated Health and Care Hubs (IHCHs),
enabling effective and joined up primary
and community care, are considered the
best option for providing the space and the
opportunity for care providers to co-work
cases and overcome the barriers that have
previously hindered seamless care.
By making out of hospital care more effective,
significant benefits are expected for patients
and the financial health and sustainability of
the system.
In persisting with the current model, which is
reliant on the secondary care providers, the
‘do nothing’ cost risks an additional £10m
per annum in acute care costs (BCCG,
2019).
In Central Bedfordshire, practices are now
operating within seven Primary Care
Networks (PCNs). Their development will
form the focal point for the provision of out
of hospital care services in each locality.
IHCHs will support the workforce to deliver
health and social care through a hub and
spoke approach across the CCG area,
aligned to PCN development. This should
strengthen the consistency and quality of
care, and improve the resilience and
sustainability of services and the system
going forward.
Scoping has been completed for all five
Hubs, and delivery is in train for Dunstable
and Ivel Valley IHCHs.17
Proposed Hubs in Central Bedfordshire
Scheme Description Indicative
Timescale for
Delivery
Dunstable Integrated
Health & Care Hub
(IHCH)
Relocation of 2-3 GP Practices into Integrated Health & Social Care Hub along with community, mental health
and social care. Central Beds Council leading delivery of building. Final designs and service model now
complete with construction expected to commence Spring 2021.
2023
Ivel Valley IHCH Relocation of up to 2 GP practices into Integrated Health & Social Care Hub. Central Beds Council leading
delivery of building on the Biggleswade Hospital site.
2022/2023
West Mid Bedfordshire
IHCH
Interim development in Flitwick – pursuing space within the new Flitwick Extra Care facility.
Planned consolidation of 2/3 GP practices into an Integrated Health & Care Hub along with community, mental
health & social care, whilst retaining the rural practice "spokes". Scoping work complete & Steppingley Hospital
identified as preferred location.
2022
2023/2024
Houghton Regis IHCH Interim development in Houghton Regis.
Proposal to relocate main Primary Care services to Integrated Health & Social Care Hub along with
community, mental health and social care at preferred site on Kingsland campus. Practice to retain some
presence in Houghton Regis town centre.
2022
2024
Leighton Buzzard IHCH Interim development to utilise surplus premises capacity in the town to provide a focal point for PCN services.
Proposal to develop an Integrated Health and Care Hub. Scoping work complete, with two potential preferred
site options identified.
2024/2025
Cranfield & Marston
Surgery
Reconfiguration of existing premises to provide additional clinical and administrative capacity.
Long-term plan to re-locate Marston premises into the Marston Vale development.
Potential to develop new surgery premises in Cranfield, working in partnership with Central Bedfordshire
Council and housing developers.
2020 Delivered
TBC
TBC
Ivel Valley South PCN Exploratory work with Ivel Valley PCN to review how the evolving PCN services can best be provided, and
housing growth accommodated, across the existing premises, and in line with the proposed Ivel Valley Hub in
Biggleswade. Likely to result in proposals to expand capacity in Shefford and/or Arlesey.
TBC
Barton Pursuing option to extend space-constrained surgery. 2021/22
Caddington Relocation of Caddington Surgery from their dated, constrained premises to a new purpose-built building on a
nearby Council-owned site, as part of a larger community and residential development
2022
Lower Stondon Surgery Reconfiguration of the existing building to increase the capacity to meet demands of housing growth in the
area.
2021/22
18
Central Bedfordshire–
Estates Schemes
19
PLACE-BASED ESTATES PLANS
BEDFORD BOROUGH
Primary care services in Bedford Borough have experienced a number of resilience challenges in recent years, and an important
programme of work is underway to ensure that local services continue to deliver good quality care and remain sustainable. In line with
national policy and the approach across the Bedfordshire, Luton and Milton Keynes system, GP practices are working more closely
together in Primary Care Networks, and are working towards delivering more proactive, preventative care and in a more joined-up way
with other health and social care colleagues.
Slides 19-23 set out the ambitions and aspirations for the transformation of the future primary care estate across Bedford Borough, to
help facilitate new ways of working and to ensure sustainable primary care services for the residents of Bedford Borough. It is proposed
that up to ten primary care estates projects may be required over the next ten years, including a number of Hub facilities to support
integrated care provision.
There is a strong foundation of primary care services across Bedford Borough, but many GP practices are experiencing pressures,
including in relation to the premises that they operate from. This section sets out the current position in relation to the primary care
estate and a summary of some of the challenges.
There are 20 GP practices currently operating out of 28 buildings across Bedford Borough with a combined patient list of some
182,000 people (c.10,000 more than the population of the Borough itself). Taking into account the Department of Health and Social
Care’s space standards* the current primary care estate in the Borough is estimated to be around 48% undersized. This gap in
capacity is expected to widen with population growth.
A large proportion of the estate comprises former residential properties which are increasingly becoming unfit for purpose. 14
converted houses are used as GP surgeries, and there are two temporary surgery buildings. The current status of the estate has
repercussions for the delivery of primary care services, not least the ability of many practices to retain and recruit new staff, or the
ability to introduce new services.
Bedford Borough has a diverse population, especially between the urban south and the rural north, each of which brings separate
challenges and requirements for health and care. Parts of the urban south include a number of deprived communities, where issues
such as smoking, alcohol and drug abuse, obesity and lifestyles create a range of challenges. To the rural north, there is large older
population with a range of separate issues related to age and isolation. There is significant variation in for example the rates of people
living with long term conditions, rates of emergency admissions into hospital and life expectancy. Therefore different parts of the
Borough require a different range of health and care services to help maximise the wellbeing of local people.
The wards with some of the more deprived areas (with the highest incidence of hospital admissions and long term health conditions)
have the highest numbers of households without access to a car. They are, therefore, more dependent upon public transport, walking
and cycling. However, residents within these wards have the best access to current healthcare facilities. This is principally because
the majority of the health care estate is concentrated within the urban areas – where the issues are most severe.
*Health Building Notes 11-01: Facilities for Primary and Community Care Services (Department of Health and Social Care, 2013)
20
Bedford Borough
Expected Housing Growth across Bedford Borough to 2030
21
Housing Growth in Bedford Borough
22
Notes:
This map shows indicative resident zones for each of
the proposed Primary Care Home Hubs. The
indicative zones cover the whole population based
on projections in 2030.
The zones are illustrative only and do not include GP
practice catchment boundaries.
It should be noted that actual usage of a PCHH will
reflect:• Patient choice
• Overlapping GP catchments
• Residents travelling to other local authority areas for services
• Travel considerations (please note that
modelling has confirmed that the majority of
residents will be able to access a Hub within a 20 minute drive time)
The GP practices in Bedford Borough are organised into
four Primary Care Networks. There is significant
geographical overlap between all four. In recognition of
this, local estates planning has taken the Network
catchments into consideration, but has also factored in
the natural communities across the Borough, and travel
times. These estates plans have therefore been
developed around approximate resident zones, to help
work towards all areas of the Borough having appropriate
levels of estates capacity.
Given the overlap in catchment areas, many communities
will be served by more than one Network. Therefore
some of the proposed estates solutions will support
practices from more than one Network. These practices
will be encouraged to work collaboratively to maximise
the opportunities around economies of scale from shared
facilities.
Scheme Description Indicative
Timescale
for Delivery
Gilbert Hitchcock
House Hub (MSCCC)
Proposed relocation of De Parys, Pemberley and Goldington Medical surgeries into the Gilbert Hitchcock House
(GHH) building on Bedford Health Village site on Kimbolton Road. Integrated working with mental health and
community teams already based on the site that serve a larger catchment.
Interim initiative to co-locate all of the practice’s same-day access services into the GHH building.
2022/23
April 2020
Delivered
Kempston Hub
(MSCCC)
Proposed relocation of King Street, Cater Street and St Johns Street Surgeries into one Hub facility in
Kempston, with potential to provide a range of other health and community services from the same building
2022/23
Biddenham Primary
Care Home Hub
Proposed relocation of the two Bromham branch surgeries into a new facility between Bromham and
Biddenham.
2021/22
London Road Primary
Care Home Hub
Potential relocation of one or more of the London Road, Ampthill Road and Cauldwell Medical surgeries into a
new facility longer term. Potential to operate as a Primary Care Home Hub.
2024/25
Wootton Healthy Living
Centre – new premises
Proposed relocation of the surgery in Wootton into new permanent premises. Planning for this new facility is
being carried out in conjunction with the planning for the proposed Kempston facility, to maximise opportunities
to improve access for Wootton residents to a wider range of services.
2021/22
Shortstown Surgery –
new premises
Relocation of Shortstown Surgery into new facility. Autumn 2020
Delivered
Goldington Surgeries –
new premises/ Primary
Care Home Hub
Additional capacity to be provided for these practices within the Unity Network. Potential relocation of one or
more of Goldington Avenue, 12 Goldington Road and Rothesay Garden Surgeries into a new facility. Potential to
operate as a Primary Care Home Hub. Interim initiative to achieve additional capacity in a nearby health facility
for Goldington Avenue Surgery
2022/23
Great Barford Surgery –
new premises
Potential relocation of the surgery into new premises. Working to secure new space for exceptionally
constrained practice & absorb current/new housing growth; options available on former school site in the village
2022/23
Queen’s Park – new
premises
Potential relocation of one or more of Queen’s Park and Ashburnham Road surgeries into new premises longer
term.
2027/28
Wixams – new surgery Potential development of new surgery premises in Wixams. Would seek to work with Primary Care Networks in
the area to expand capacity, rather than procure new GP provider for this area. Expected to be an additional
location for an existing practice (2 have expressed an interest in running services from the facility.
2023/24
23
Bedford Borough – Estates Schemes
LUTON
24
PLACE-BASED ESTATES PLANS
In Luton there are a significant number of primary care facilities which struggle to meet modern standards for health care buildings.
The Borough is densely populated and developed, and is therefore not experiencing quite the same levels of housing growth as the
other Places in BLMK. Whilst this results in some less pressure on primary care premises arising from growth, it also means there are
less opportunities to dovetail estates plans with housing developments and external funding opportunities. This has impacted on the
deliverability and affordability of some estates proposals in Luton in the past.
There is a robust transformation programme underway supporting closer integration between primary, community, mental health,
secondary care and social care in Luton, and there is keen interest from partners in further enabling joint working through the co-
location of services, particularly into a town centre Hub to serve the whole Borough for some services. This is a key ambition within
this Strategy.
In addition to a town centre integrated Hub, a number of other key estates schemes are proposed to replace poor quality premises with
a smaller number of hub locations. The CCG will work with PCNs to identify those current premises which are unsuitable for future
investment and facilitate a managed migration to other facilities, potentially including through improving the utilisation of a number of
existing larger facilities across the Borough. Slides 24-28 set out these intentions.
In Luton, the CCG holds contracts with 27 independent GP contractors who operate from 33 locations across Luton and one branch in
neighbouring Central Bedfordshire. They operate within 5 Primary Care Networks
Between them the practices have around 236,500 registered patients, an average weighted list size of 6,392 patients per site. These
range from under 1,500 at one branch to over 15,600 (Lea Vale – Liverpool Road site).
Just over half of these premises were purpose-built with 56% of the registered population accessing services through purpose-built
premises.
Converted premises lead to some compromises in service delivery and more recent purpose-built accommodation is usually more
compliant.
Ten of the practices (14 sites) are Teaching Practices helping to train GP clinical staff.
The majority of Luton’s practices have been rated ‘Good’ by the CQC however two ‘Require Improvement’ and two were ‘inadequate’ at
the latest review.
There are significant structural issues at the Town Centre practice which was an older office block converted in 2002. It is an NHS
Property Services leasehold facility whose next break point is 2022. Backlog maintenance is estimated at around £250,000; these
issues may require relocation of the facility. The Luton Urgent Care Service and Out of Hours medical care is also delivered from the
building.
The CCG intends to support our providers to address a number of infrastructure issues, the solutions to which might assist in promoting
the integrated Hub model:
• The replacement of the Town Centre Practice.
• Improved utilisation of Kingsway
• Improved utilisation of the Churchfield Medical Centre.
• Improved utilisation of Bramingham Health Centre
• Improved utilisation of Marsh Farm Health Centre
• Exploring developer contributions to assist meeting demand in north Luton
25
Luton
26
The map shows the potential registration capacity
(blue) and constraint (white) of each of the premises in
Luton to the average levels of utilisation of 21.29
patients per m2 (across the Borough and MK). The
circles are sized proportionally to give a visual
indication of capacity and constraint. This is
overlaid against predicted population growth
(approximate registration demand to be generated)
arising from housing development in the Local Plan to
2031. This information suggests a number of
premises in key locations have underutilised space
that might assist in the achievement of PCN strategies.
Current premises capacity at the Town Centre and
Medici practices should be sufficient to more than meet
the demand expected in the town centre, although
significant structural issues at the Town Centre
practice may require relocation of the facility.
Demand from the proposed eastern expansion
should easily be accommodated by the two practices in
Churchfield Medical Centre. Closer working between
the practices could enable further expansion and the
inclusion of a wider range of clinical interventions.
To the north, current capacity in the Phoenix practice at Bramingham Park Medical Centre should be able to meet much of the demand
in the earliest phases of development. However, new registrations arising from housing developments to the north may choose to
register at closer practices which are more constrained. Planning for the appropriate infrastructure to meet these needs will dovetail
with the planning for Central Bedfordshire. Whilst the Gardina practice only occupies a small part of the building, the existing Marsh
Farm Medical Centre is significantly underutilised (less than 40%). This facility also offers the potential to provide capacity for the
developments proposed to the north of Luton, subject to further scoping.
Housing Growth in Luton
Emerging Proposals for Hubs in Luton
27
The Hub proposals for Luton are at an
earlier stage of planning than those in
Bedfordshire, and further scoping is
required in partnership with the PCNs
and other providers.
There are emerging proposals for how
capacity challenges can be
addressed, and a more integrated
service model can be enabled, through
the existing estate, and proposals to
bring forward a number of new Hub
facilities:
• In the centre, a replacement for the
Town Centre practice provides an
opportunity to create a new Hub to
serve the whole town (potentially
alongside proposed outpatient
clinics and community, mental
health and social care).
• Churchfield Medical Centre might be
upgraded to provide an eastern
Hub.
• A further Hub in the north might be
developed using one of the existing
sites but further feasibility and
options work is required.
• In the longer term, a Hub in the
Bury Park area may help to
address current service and
infrastructure problems, and target
significant deprivation related health
issues.Churchfield Medical Centre
Scheme Description Indicative
Timescale for
Delivery
Luton Town Centre
Hub
Proposal to relocate the Town Centre Practice (potentially along with one or more other town
practices) into a central Hub facility. Depending on availability of a suitably sized site, potential to
co-locate a wide range of community, mental health, outpatient and social care services into the
facility.
TBC
Eastern Hub Potential to develop the existing Marshfield Health Centre premises into a Hub for Luton east. A
hub here could assist in easing pressure at Stopsley and cross border demand from North East
Hertfordshire. Further scoping required to test feasibility, acceptability and to establish likely
timescales for delivery.
TBC
Luton North Potential to co-locate a number of premises in north Luton into a Hub facility. There are a number
of underutilised sites and buildings that could be candidates. A Hub in this area might also help to
address deprivation related health issues in Marsh Farm and Sundon Park. Further scoping
required to test feasibility, acceptability and to establish likely timescales for delivery.
TBC
Bury Park Given the close proximity of a number of older noncompliant facilities and resilience issues around
Bury Park, a Hub in this location could help to transform services in an area of high deprivation.
Further scoping required to test feasibility and establish likely timescales for delivery.
TBC
Kingsway Relocation of Conway Medical Centre into Kingsway Health Centre, alongside Kingsway Surgery
and Medina Surgery.
2021/22
Farley Hill Relocation of Lea Vale branch surgery to a more appropriate Council-owned site. TBC
Neville Road Relocation of practice to a more appropriate site. TBC
28
Luton– Estates Schemes
The four proposed Hub schemes for Luton are at an early stage of scoping, and therefore timescales (and feasibility) for delivery are yet
to be established/confirmed.
MILTON KEYNES
29
PLACE-BASED ESTATES PLANS
The primary care providers across Milton Keynes are organised into seven Primary Care Networks (PCNs), each with their own
evolving plans for developing their service offer to patients, and ambitions for working increasingly closer with community, mental
health and social care colleagues.
This is against the backdrop of Milton Keynes being an area of significant housing-led population growth - the largest challenge in
relation to primary care estates is the rate at which the town continues to expand. Commissioners have worked closely with Milton
Keynes Council to plan the health infrastructure needed to serve these growing communities, and large new facilities have already
been developed in the eastern and western flanks of development (Brooklands and Whitehouse).
Including these two new facilities, a number of the Milton Keynes PCNs have larger health centres or infrastructure within their
catchment which have the potential to facilitate delivery of their transformation plans over time.
There remain capacity issues for specific practices and PCNs in Milton Keynes though, with pressure expected to increase in line
with further housing growth. This estates plan for Milton Keynes set out in slides 29-33 is as much focused on working with PCNs
to help them maximise their existing estate to enable delivery of their service and integration ambitions, as it is about scoping the
feasibility for developing new estates solutions for the areas/PCNs with under-provision of capacity, now and further down the line.
In Milton Keynes there are 27 Practices operating from 31 locations. They operate within seven Primary Care Networks (including
one GP practice situated in Central Bedfordshire).
The combined registered list of all the practices exceeds 297,000. With an average weighted patient list per site of 9,288. Ranging
from just under 3,000 to over 16,000 (Central MK and Newport Pagnell).
Just 2 sites (6%) are conversions (from domestic premises) One of these is expected to close shortly and the second are
preparing a business case to improve the premises.
Milton Keynes have eleven GP Training practices.
All of the Milton Keynes practices are currently rated ‘Good’ by the CQC and two are recognised as ‘Outstanding’.
Currently there are two hubs within Milton Keynes:
• Brooklands providing a service hub for the Eastern Expansion of Milton Keynes. This facility replaced a temporary building
and is now operational.
• Whitehouse serving the Western Expansion area, due to become operational in December 2020.
Some of the key factors that have influenced the development of the estates plan for Milton Keynes are:
• Whilst significant capacity currently exists at Brooklands this is likely to be fully utilised over the next decade.
• The proposed Whitehouse Medical Centre offers the potential for later expansion if growth in the west exceeds current plans.
• In the longer-term demand is likely to exceed capacity east of the M1 and in the Bletchley area.
• Providers report constraints where the data suggests there should be capacity. The CCG will work with these practices and
PCNs to better understand space utilisation, to consider strategies for easing operational constraints.
30
Milton Keynes
The map shows the potential registration
capacity (blue) and constraint (white) of each
of the premises in Milton Keynes to the average
levels of utilisation of 21.29 patients per m2
(average across Luton and MK). This is overlaid
against predicted population growth
(approximate registration demand to be
generated) arising from housing development in
the Local Plan to 2035.
When considered against the average utilisation
most Milton Keynes practices show
underutilised space that may help to offset the
rapid growth of the town and achieve some of
the Primary Care Network service ambitions.
The CCG has been working with local authority
colleagues to ensure the town’s expansion
plans are accompanied by the provision of
health infrastructure. The most recent of these
Brooklands is now operational and has
significant registration capacity.
The CCG have commissioned a new health
facility (Whitehouse) to support the western
expansion of the town. Work is underway and it
should come into service during 2020.
A number of practices have significant
constraint issues, those serving Stony
Stratford and Olney are not able to be eased by
capacity in neighbouring practices. In the south
the Redhouse practice is the most constrained
in the Milton Keynes area.
31
Housing Growth in Milton Keynes
Brooklands Medical Centre
Emerging Proposals for Hubs in
Milton Keynes
32
In Milton Keynes a number of current and
proposed facilities can potentially enable
delivery of a Hub within each PCN’s locality.
In the east (Bridge PCN) the operational Hub
at Brooklands
In the west (Watling St PCN) the Whitehouse
Hub currently under construction
In the north (Nexus PCN) Wolverton Health
Centre
In central Milton Keynes (East PCN)
investments at Central Milton Keynes surgery
In the longer-term additional Hubs may be
required and initial feasibility will be
considered for:
In the south (South West and Crown PCN’s)
around Bletchley
East of the M1, linking to planning work in
Bedfordshire
This analysis suggests that there is significant infrastructure in place to support the PCNs in delivering their transformation ambitions,
although further capacity is likely to be needed in the South and East of the M1 over time. The CCG focus will be on supporting the
PCNs to maximise these facilities, whilst supporting a number of individual “spoke” practices with specific capacity/operational
constraints.
Scheme Description Indicative
Timescale
for Delivery
Brooklands (Bridge
PCN)
New build scheme to provide premises for a new GP practice to deliver services to the eastern
housing development area. It provides a service hub, hosting multiple services with the potential for
more to be added. Its APMS provider has extended opening (12 hours per day 365 days per annum)
and a catchment that covers the whole of the Milton Keynes area.
2019
Delivered
Whitehouse (Watling
Street PCN)
New build scheme to provide premises for a new GP practice to deliver services to the western
housing development area. Other health tenants expected to deliver services from the facility,
including secondary care.
2020
Delivered
East of M1 Joint planning required with providers in East MK and Central Bedfordshire to develop infrastructure
and service proposal to provide for the housing growth expected in this area.
TBC
Bletchley Potential to relocate one or more providers into a Hub facility for the southern area of Milton Keynes.
Further scoping required to test feasibility, acceptability and to establish likely timescales for
delivery.
TBC
Central MK Surgery Recent investment at the Central Milton Keynes Medical centre will see this modern facility expand
further and may over time move to the full hub model envisaged by the CCG and ICS.
2020
Delivered
Redhouse Proposal to expand current premises by purchasing adjacent property to the current surgery utilising
s106 monies and a 3rd party developer
2022/23
Cobbs Garden Potential relocation of surgery into new build premises, part-funded by S106 contributions. At early
stage of scoping.
2022/23
Stony Stratford Potential expansion/relocation of Stony Stratford Surgery to address capacity challenges. TBC
33
Milton Keynes– Estates Schemes
The delivery of these schemes is expected to take place alongside work with PCNs to support them in maximising the utilisation
of their existing premises to support delivery of their service and integration ambitions.
• As stated earlier, the CCG’s central approach to delivering this Primary Care Estates Strategy is around enabling and
supporting our local providers, including via their Primary Care Networks (PCNs), to deliver their estates ambitions.
The estates plans set out in this Strategy must be progressed in tandem with, and as an enabler to, service development plans.
• The NHS Long Term Plan commits considerable recurrent resources for the development of local services including
infrastructure. Successful proposals are likely to be transformational projects based on local need, arising from Primary
Care Networks that make the best use of existing resources and infrastructure.
• Delivery of this Strategy will be overseen by the CCG’s Primary Care Commissioning Committee (and its sub-Group, the
Estates Working Group). Approval to progress individual schemes will be subject to sign-off of business cases by the
appropriate CCG Committee (Primary Care Commissioning Committee / Governing Body depending on the scale of investment).
• Delivery of the Strategy may require changes to the way the CCG commissions services, including:
– Hub locations may need to be mandated in contracts to ensure full utilisation and longevity. Most providers are currently
consolidating to a smaller number of bases. Multidisciplinary Team Working is often the first casualty where space or
resource constraints affect a service.
– To achieve the BLMK primary care clinical model objectives, new types of spaces, procurement and ownership may
be required. For example versatile and flexible spaces not in the ownership of one provider and bookable by a wide
variety of stakeholders. The national Cavell Centre Programme supports and will help to enable this approach.
– PCNs are unlikely to be in a position to take out commercial leases for some years and under current rules neither are
CCGs. There are national proposals to address this problem with the statutory powers expected for ICS to control estate,
but in the interim PCNs may need to work with NHS Property Services, Community Health Partnerships or Local
Authorities to achieve the flexible spaces required.
– If future voids are to be prevented, integration needs to be enforced by commissioning strategies.
– A number of infrequently used infrastructure requirements might be more efficiently delivered through partnerships with
the third sector for example: Group rooms for talking therapies, meetings and staff development, physical or
occupational therapy, hydrotherapy, exercise and Social Referral.
34
Delivery
All projects are expected to be progressed in line with the CCG’s framework for estates development schemes, and in line with
relevant national regulations, e.g. Premises Cost Directions. A suite of documents will be prepared to support practices and PCNs
across BLMK with taking forward their premises developments effectively.
35
Project Stages Key Activities
1. Project
Inception
Stakeholder engagement; assessment of need; initial site options appraisal; review estate exit implications
➢ Project Initiation Document (PID) /Strategic Outline Case (SOC) depending on likely value of scheme
➢ Secure mandate from impacted organisations to progress scheme
➢ Secure funding to commission Outline Business Case (OBC) if necessary
1. Delivery
Planning
Establish formal project and governance arrangements; communications and engagement plan;
development of Service Model and Schedule of Accommodation; detailed site options appraisal; public
engagement/consultation; site surveys; designs 1:200 / 1:100; confirm compliance with all health design
standards; negotiate Heads of Terms; Value for Money assessment by District Valuer; financial appraisal;
plan exit and disposal arrangements; planning application
➢ Outline Business Case (OBC)
➢ Secure funding for Full Business Case (FBC) if necessary
1. Finalising Plans Site formally secured, detailed designs and room data sheets, schedule of works, procurement of
construction contractor, Agreement for Lease secured
➢ Full Business Case (FBC)
➢ Secure final sign-off from commissioner/s
1. Construction Practical completion
1. Mobilisation Relocation plans; installation of equipment; operational policies; community involvement; communications
and launch activities
Stages of Delivery
There are a range of funding sources available to help bring forward the schemes set out in this Strategy, but the majority of
developments will have cost implications for the CCG/s. The table below indicates the potential types of funding required for each
scheme, and possible funding sources. The CCG will need to continue to take a flexible and adaptive approach to securing
external funding where possible, and the CCG will continue to work closely with planning authorities to ensure developer
contributions are sought for strategic sites..
Given that many of the schemes are at an early stage of scoping, and because of the range of funding sources potentially
available, it has not been possible to quantify the financial implications for the CCG associated with delivery of this Strategy. All
schemes will be closely tracked by the Estates Working Group (reporting to the Primary Care Commissioning Committee),
including the finances, and a more thorough understanding of the financial implications will be built up over the next twelve
months. Once the full quantum of costs are understood, it may be necessary for the CCG to introduce a prioritisation process, to
ensure that investment is directed to the schemes where need is highest.
36
Finance
Type of Funding Potential Funding Sources
Capital Provider capital investment
NHS capital (accessed via ICS capital bidding processes)
ETTF (or similar future programmes)
Section 106 / Community Infrastructure Levy contributions
Third party developers (including Local Authority partners)
CCG Capital Allocation – potential funding for minor improvement grants
Revenue
Rent / notional rent and rates reimbursement to providers
CCG Primary Care Budget
Abated in line with any NHS capital / S106 contributions
Value for Money ensured via District Valuer
Non-recurrent revenue
Reimbursements in line with Premises Cost Directions, e.g.
provider legal costs, Stamp Duty Land Tax, monitoring
surveyor fees
Professional fees, e.g. architects, healthcare planners,
surveyors
CCG Primary Care Budget
ETTF (or similar future programmes)
Section 106 / Community Infrastructure Levy contributions
One Public Estate
GP IT (capital and revenue) CCG Capital Allocation
ETTF (or similar future programmes)
Scheme NameStage 0 - Project
InceptionStage 1 - Delivery
PlanningStage 2 - Finalising
PlansStage 3 - Construction Stage 4 - Mobilisation
Dunstable Integrated Health & Care Hub (IHCH) Complete Complete Feb-21
CommenceMay-21 Jan-23
Ivel Valley IHCH Complete OBC Sep-21 FBC Aug-22Commence Autumn
2022 Winter 2023
West Mid Beds IHCH Complete OBC Sep-21 FBC Oct-22Commence Autumn
2022 Winter 2023
Houghton Regis IHCH Complete OBC Dec-21 FBC Dec-22Commence Autumn
2022 2024
Leighton Buzzard IHCH Complete OBC Spring 2023 FBC Autumn 2023Commence Winter
2023 2025
Gilbert Hitchcock House Primary Care Hub Complete OBC Mar-21
TBC - revising programme plan
TBC - revising programme plan
TBC - revising programme plan
Kempston Multi-Speciality Community Care Centre Complete
TBC - applying for external funding TBC TBC TBC
Brooklands Complete Complete Complete Complete Complete
Whitehouse Complete Complete Complete Complete Complete
Bletchley Hub In Progress TBC TBC TBC TBC
North of M1 In Progress TBC TBC TBC TBC
Luton Town Centre Hub In Progress TBC TBC TBC TBC
North of Luton In Progress TBC TBC TBC TBC
East Luton In Progress TBC TBC TBC TBC
Bury Park In Progress TBC TBC TBC TBC
BLMK Hub Programme Roadmap
Please note some of these dates have been impacted by Covid and may subject to further change
37
Primary Care Estates Schemes
Scheme Name Local Authority Description Stage 0 - Project Inception Stage 1 - Delivery Planning Stage 2 - Finalising Plans Stage 3 - Construction Stage 4 - Mobilisation
Asplands MK
S106 funded minor extension and alterations works at Asplands Medical Centre and Woburn Surgery. Purpose of project is to enhancepracticality of the buildings by creating additional useable space for currently under facilitated functions.
In Progress
Barton Surgery CBCEarly exploration of a 3 Consulting room extension to help with practice & PCN constraints
In Progress
Biddenham BBC
Relocation of two branch surgeries in nearby village to a new build facility within an area of housing development.
Complete Complete
Biggleswade Hub CBCRelocation of up to 2 GP practices into Integrated Health & Social Care Hub. Central Beds Council leading delivery of building.
Complete In Progress
Brooklands MKNew primary care facility providing for housing developments in the area. APMS contract.
Complete Complete In Progress Complete Complete
Cobbs Garden (Olney) MKPotential relocation of surgery into larger premises to accommodate increased list size.
In Progress
Cranfield Surgery CBCCCG/CBC/Developer working jointly to provide new GP surgery on cost neutral basis.
Complete In Progress
Dunstable Hub CBC
Relocation of 2-3 GP Practices into Integrated Health & Social Care Hub along with community, mental health and social care. Central Beds Council leading delivery of building.
Complete In Progress - Spring 2021 In Progress - Spring 2021 Spring 2021-Spring 2023 2023
Farley Hill, Luton LBC New build facility
Gilbert Hitchcock House Hub BBCRefurbishment of Gilbert Hitchcock House into a primary care Hub, to enable the relocation of 3 GP surgeries into the building.
Complete Behind Schedule Sep-21 Jan-22 Spring 2023
Goldington Avenue - Enhanced Services Centre BBC
Practice keen to occupy 1st floor of Enhanced Services Centre on Bedford Health Village site, PCN services could be offered from 2nd floor.
In Progress
Gooseberry Hill, (Barton branch surgery) CBC
Early exploration of taking over occupation of 3 additional roles within the Health Centre they share with community services
In Progress
Great Barford CBC
Aiming to secure new space for this exceptionally constrained practice & absorb current/new housing growth
In Progress In Progress
Houghton Regis Hub CBC
Relocation of main Primary Care services to Integrated Health & Social Care Hub along with community, mental health and social care. Practice to retain some presence in Houghton Regis town centre.
Complete
Kempston Hub BBCRelocation of 3 premises (2 GP Practices) into a primary care Hub in Kempston
Complete
Kingsway LBC
Refurbishment of existing health centre premises to provide better utilisation of space. Complete Complete In Progress
Leighton Buzzard Hub CBC
Possible relocation of 1 GP Practice plus space for PCN services into Integrated Health & Social Care Hub along with community, mental health and social care
Complete
Leighton Road Surgery CBC
Plan is to move all staff to Grovebury Site freeing space for Leighton Road reconfiguration to increase clinical capacity
In Progress
Lower Stondon Surgery CBC
Redesign the existing building to increase the capacity to meet demands of housing growth in the area.
In Progress
Luton Town Centre Hub LBC Relocation of 3 practices into new build Hub facility In Progress
Marston Refurbishments CBC
S106 funded refurbishment project to provide new admin area & reconfigured space giving additional clinical rooms.
Complete Complete Complete In Progress
Neville Road Surgery LBC
Relocation of Neville Road Surgery to alternative premises which allows list growth & integration with other service providers to provide primary care at scale.
In Progress
Redhouse MK
Shortstown Surgery BBCNew surgery to replace existing premises which is not fit for purpose.
Complete Complete Complete Complete Complete
West Mid Beds Hub CBC
Consolidation of 2/3 GP practices into an Integrated Health & Care Hub along with community, mental health & social care, whilst retaining the rural practice"spokes".
Complete In Progress
Whitehouse MK
New primary care facility providing for the Western expansion development of MK. APMS contract will start with zero list size but premises will act as a service hub for PCN services in the area.
Complete Complete In Progress Complete Dec-20
Wixams CBC
New surgery premises in Wixams centre; expected to be an additional location for an existing practice (2 have expressed an interest in running services from the facility)
Complete In Progress
• 30 Primary Care
Estates projects
underway in 2020
across the 98
practices in BLMK
(128 sites)
• Reflective of
capacity
constraints, rate of
housing growth and
availability of S106
funding in some
parts of the ICS
• Number of quick
win schemes to
support PCNs with
accommodating
Additional Roles is
likely to increase.
38
This Strategy identifies a range of challenges related to the primary care estate across BLMK, and sets out an
ambitious programme of works to address these, with a particular focus on transformative, strategic projects.
Whilst a variety of potential funding sources have been identified to support delivery of this programme, ultimately
delivery will be limited to the resources available. It may therefore be necessary to further prioritise this
programme as details around costs and deliverability are worked through.
Delivery of this programme is likely to take in excess of 10-15 years to be achieved. It will therefore be essential to
retain a balance between resourcing the delivery of our larger strategic projects, whilst supporting practices and
PCNs with their shorter-term operational constraints. These constraints are becoming increasingly acute for PCNs
as they continue to recruit extra professionals through the Additional Role Reimbursement Scheme. In the shorter
tem, the CCG may need to consider approaches to pump prime new ways of working to address premises
constraints – e.g. consideration of Minor Improvements Grants to enable establishment of dedicated remote
consultation areas within practices/other venues, to free up clinical space.
Ultimately, this estates strategy is a key enabler to supporting the achievement of our wider primary care development
objectives. This Strategy aims to support the sustainability and resilience of primary care, including through the
continued development and evolution of Primary Care Networks within BLMK, our ambitions around achieving more
integrated care delivery, and embedding a wider Population Health Management approach.
Whilst some of the projects and timescales set out in this document are indicative at this stage, they provide a
framework to support decision-making in relation to primary care premises/estates, and to steer the focus of the
CCG’s Estates and Primary Care teams.
39
Conclusion/Summary
NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 1 of 17
Project Appraisal Unit
Capital Investment, Property, Equipment & Digital Technology proposals
NHS England Project Appraisal Unit
Project Initiation Document - Type 1
Clinical Premises Not to be used for NHS England administrative premises - see PID Type 2
Sponsors and authors of documents seeking appropriate authority to fund or proceed with a
scheme or project must consider whether the content or strategy to which the document applies at this stage is sensitive or may have commercial implications. If it is considered necessary, the
document should be headed and watermarked appropriately.
Unless building and premises based PIDs are informed by sufficient detail and forward planning this can hinder a prompt and informed decision on PID approval. A PID is the first stage in the process, but there are fundamental
issues to be considered before progressing to business case stage. This particular PID type for clinical premises is therefore designed to support authors in considering some of those important issues that need to be covered in the
PID to inform local decision making. It is also acknowledged that at PID stage not all of the information asked for may be available. However, all PIDs for
this type of proposal must be as complete as possible and, where information is not known, a brief explanation should be provided.
Document version control (for use by PID sponsors)
Add rows as required.
Last entry should read: ‘Final for signatures’
Version No. Status Issue date Notes
1.0
1. TITLE OF SCHEME
Scheme reference number and source of number (organisation).
Please ensure the relevant unique reference (for all Schemes) is used in all correspondence and reporting using an appropriate format: e.g. XXX – YY - XXX (Org Code – 17 – 001)
Reference No.
Confirm the Organisation issuing the reference number.
NHS England Midlands and East (East)
2. DATE OF FORMAL PID SUBMISSION
Date
3. IS THIS A RESUBMISSION OF AN EARLIER PID?
If so, provide details and reference no.
Reference No. N/A
IF YES: Will this resubmission result OR potentially result in a duplicate funding application
Please provide
details N/A
Item 12.1.1.
NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 2 of 17
already covered by another PID, etc.?
Is any element of this PID actually, or potentially funded through any other previous (already approved), parallel (current) or planned (future) application for funds?
4. NHS ENGLAND CAPITAL FUNDING STREAM (from any source)
Please confirm the NHS England capital funding stream relevant to this investment e.g. BAU, etc.
Financial tables should clearly show the NHS England commitment.
Where capital funding is from a special initiative e.g. ETTF, please use the first two rows opposite to denote initiative name and scheme reference number
Please use standard NHS finance codes when completing this section
If applicable, funding initiative name
N/A
Scheme reference No.
Funding stream
Revenue funded
Cost Centre BLMK CCG Delegated Primary Care budget
Subjective Code
Total value of NHS England funding. £
N/A
5. DETAILS OF ANY ADDITIONAL CAPITAL FUNDING SOURCE (where applicable)
Please confirm and briefly explain ANY additional capital funding stream relevant to this investment e.g. NHSPS Customer Capital.
The additional/alternative funding should be clearly shown in Table 3 below with relevant totals.
The implications of the additional funding must be clearly shown in the Economic and Financial sections of this PID.
Funding source name
Central Bedfordshire Council
Brief explanation of funding
Capital funding c. £24m
Is this funding to be used for a specific purpose?
Yes; for Dunstable Integrated Health and Care Hub capital construction
Is any element of this funding liable for repayment?
No
If yes, please give details including reason, amounts and dates.
Total value of additional funding. £
6. NHS ENGLAND REGION/LOCAL DIRECTOR OF COMMISSIONING OPERATIONS (DCO) OFFICE
Region
DCO
7a. SPONSORING ORGANISATION No. 1 AND LEAD CONTACT
Please include a named lead contact for this application who can
Organisation Bedfordshire, Luton & Milton Keynes CCG
Title/position Estates Programme Manager
Name Carrie Walker
Office tel. 07825 280950
NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 3 of 17
answer any queries relating to this PID
Mobile tel. 07825 280950
e-mail [email protected]
7b. SPONSORING ORGANISATION No. 2 (where applicable)
Please include a named lead contact for this application who can answer any queries relating to this PID
Organisation
Title/position
Name
Office tel.
Mobile tel.
7c. SPONSORING ORGANISATION No. 3 (where applicable)
Please include a named lead contact for this application who can answer any queries relating to this PID
Organisation
Title/position
Name
Office tel.
Mobile tel.
8. NHS PROPERTY SERVICES OR COMMUNITY HEALTH PARTNERSHIPS CONTACT (where applicable)
Please include a named contact as appropriate
Organisation N/A
Title/position
Name
Office tel.
Mobile tel.
9. OTHER LOCAL STAKEHOLDERS OR TENANTS
Please add further lines where required
CCG BLMK CCG
Local Authority Central Bedfordshire Council
Other (1) East London Foundation Trust
Other (2) Cambridgeshire Community Services
Bedfordshire Hospitals Trust
Herts Urgent Care
Priory Gardens Surgery, and Chiltern Hills Primary Care Network (PCN)
NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 4 of 17
10. SCHEME DESCRIPTION
Include a brief description of the scheme, which should include, but need not be limited to:
• scope and content
• the scheme type - new build, refurbishment or a lease
• objectives and benefits – these may be financial and/or non-financial
• location – address and name of the facility
• NHSPS/CHP premises code where known and available
• wider stakeholders and their interest e.g. potential occupants
• indicative scheme value for approval purposes
• confirm other stakeholders are signed up to the general terms, costs and implications of the proposal.
• confirm that where details are known, any proposed leases, are appropriate and acceptable to all participants.
• if the scheme requires temporary accommodation
• if costs for enabling works are required and, if so, included in the overview costs.
Scope and Content This scheme will provide accommodation in Dunstable for Primary Care and a base for associated Primary Care Network (PCN) services within an Integrated Health and Care Hub to be built by Central Bedfordshire Council, then leased and managed by Bedfordshire Hospitals NHS Foundation Trust (and sub-let to various health and care tenants). Whilst this PID provides context around the total development, including the wide range of services to be delivered from the Hub, approval is only being sought from PCCC/CIOG in relation to the rent reimbursement for the primary care space in the Hub. The Dunstable Integrated Health and Care Hub will provide a focal point for integrated out of hospital care and wellbeing services for the residents of Dunstable and surrounding villages (currently 53,000 patients registered within the Chiltern Hills PCN). The Hub will provide co-location of adult and children’s community, mental health and social care services, alongside new improved premises for Priory Gardens Surgery (currently 15,500 list size) and a base for the expanding PCN staff and services, all in a building designed to facilitate joined-up working and to promote community involvement and wider wellbeing. The Chiltern Hills Primary Care Network (made up of five Dunstable practices and nearby Caddington) is the most premises-constrained PCN in Bedfordshire, Luton and Milton Keynes (BLMK), and this new build will provide modern, compliant space for Priory Gardens Surgery, who will relocate to the facility, and also provide a base for wider PCN services. The building is being designed to be future proofed and will have sufficient flexible space to ensure access to sustainable general practice for the growing population in the area. The current PCN practice population is 53,823 (Jan ’21). The population in Dunstable is expected to rise by around 22% in the years to 2031 1due to housing growth in the area. Significant stakeholder engagement has taken place to develop the Service Model for the Hub. The services anticipated to relocate into/deliver services from the Hub include: • Priory Gardens Surgery in Dunstable, and for the Hub to act as the main base for services delivered across the Primary Care Network, including Additional Roles. There is an anticipation of shared delivery of long-term condition management, services for frail elderly from the building and shared training facilities. • Base for extended access and Out of Hours services • Adult and children’s community health services (nursing, therapy and phlebotomy) • Adult and children’s social care services • A wide range of children’s, adults and older people’s mental health services, including addiction services • Learning disability services • Café and group rooms for community/provider use • Capacity for delivery of minor surgery and community-based specialist services • A private dental surgery • Sexual health services The Hub will create an opportunity for far greater integration of services and is expected to help improve health and wellbeing outcomes for patients. For Priory Gardens Surgery, the Hub will provide 9 Consult/Exam Rooms, 3 Treatment Rooms and 4 Quiet Workspaces suitable for clinicians to carry out digital consultations. Combined with modern administrative space and a library facility there is a total of 424 m2 of dedicated space for the surgery. The Hub will also offer space to accommodate staff employed through the PCN Additional Role Reimbursement Scheme. Three Consult/Exam Rooms, 2
1 Figures from Public Health, CBC, BBC & MKC Jan 2020
NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 5 of 17
Treatment Rooms and 1 Quiet Workspace will be dedicated to PCN use, as well as some administrative space. There is a total of 149 m2 dedicated to the PCN. The Hub will enable the practice to continue to grow their provision of Primary Care training for themselves and the PCN. In addition, Primary Care will have access to a wide range of bookable rooms
within the building, including shared clinical space. This space is designed to
enable specific MDT clinics, such as frailty clinics to take place in the Hub,
bringing together practitioners in combined sessions to work in a more integrated
way around the individual patient in a familiar setting rather than necessitating a
trip to a hospital.
The administrative space in the building is also designed to enhance team
collaboration. When practitioners undertake administrative tasks, they will be
seated alongside each other. The offices include staff from all providers
including separate NHS service provider organisations and Central Bedfordshire
Council. Everyone using shared staff facilities, including the staff rest room, will
enhance this collaboration.
The objectives & benefits of the scheme are as follows:
Investment Objective Benefit
Objective 1: To provide improved access to sustainable Primary care in Chiltern Vale
-Reduced resilience and access challenges associated with physical capacity constraints. Covid-19 has exacerbated these constraints. -Provides much-needed additional space to enable development of primary care multi-disciplinary team, to support the whole PCN -Increased focus on preventative care and early intervention for high risk individuals -Supports integrated health and social care teams including GPs community matrons, district nurses, social workers, mental health practitioners, pharmacists, and third sector representatives -Promotes self-management and self-care
Objective 2: To develop the resilience and sustainability of general practice including development of the future workforce
-Supports cross practice working and cover which will improve capacity of practices -Enables development of primary care training hub, maximising existing strong training credentials and links to training and research establishments, and maximising development opportunities via proximity of Central Beds College in respect of admin/nursing and HCA roles -Enables primary care at scale to deliver services to all patients through ease of access to clinicians and common IT systems -Reduces professional isolation and offers different opportunities to develop, therefore improving workforce recruitment & retention
NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 6 of 17
Objective 3: To provide pro-active care for both frail elderly people and those living with LTCs
-A focus on preventative care and early intervention for high risk individuals -Supports integrated health and social care teams including GPs community matrons, district nurses, social workers, mental health practitioners, pharmacists, and third sector representatives -Promotes self-management and self-care
Objective 4: To provide efficient planned care close to patients’ home.
-Enables greater understanding of specialist planned services to ensure appropriate referrals -Allows local access to mobile imaging e.g. MRI and breast screening -Provides opportunity to increase specialist outpatient and diagnostic access in a local setting
Objective 5: To support the regeneration of Dunstable Town centre
-Increased investment in Dunstable provides increased prosperity helping to address health inequalities & improve wellbeing -Supports the housing development needs for older people in the area -Offers opportunity for local employment and training -Continues regeneration in Grove Theatre area -Rejuvenates the retail offer in Dunstable via increased footfall
Objective 6: To deliver a focal point for delivering integrated health and social care services
-Facilitates integrated health and social care team working -Enables face to face 24/7 access across organisational boundaries to provide optimised care in patient's own home enabling early supported discharges and rehabilitation support -Provides integrated IT systems allowing information sharing across organisational boundaries -Supports the promotion of joined-up care pathways
Objective 7: To provide a care 'hub' as part of a hub and spoke model as a focus for the delivery of the Primary Care Home model
-PCN services delivered from the Hub will enable patients to access services requiring scale -Larger catchment of populations means that more 'niche' services can be offered to patients improving access -Cost efficiency through increased staff utilisation over longer opening hours and greater potential to ensure integrated team working -Patients are less likely to fall 'between the cracks' with services coordinated jointly between co-located multi-disciplinary teams.
The facility will be built on Central Bedfordshire Council land off Court Drive, Dunstable LU5 4JD, along with a development of residential accommodation for older people on the same site.
NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 7 of 17
East London Foundation Trust (ELFT), Cambridgeshire Community Services (CCS), Circle MSK & Herts Urgent Care will all occupy space in the Hub and have been closely involved in the creation of the building designs. They have been informed of the rental and service charges for their required space and are committed to moving ahead with plans to relocate a wide range of services in to the Hub. The head lease for the facility will be held by Bedfordshire Hospitals NHS FT, with sub-lets to other tenants, which will help to facilitate more integrated working across all health and care providers in the locality. Capital construction of the facility is expected to commence in May 2021, and is due for completion spring/summer 2023. The capital costs for the scheme are being met by the Council and are circa £24m. The demise in the facility for Priory Gardens Surgery will be secured via a sub-lease between the Trust and the practice. Prior to the conclusions of lease negotiations, BLMK CCG will be expected to enter into a Memorandum of Understanding (MoU) with the Trust committing to ensure these costs are covered. In addition, the CCG is expected to commit to covering the costs of the PCN space which has been designed into the facility. Discussions with Jon Murphy, the national Primary Care Estates Lead, has indicated that reforms to primary care estate ownership are expected to have been implemented before 2023, when the Hub facility will become available. It has been advised that the details of the sub-lease for the PCN space would be best negotiated during 2021/22, and it would be reasonable for the CCG to commit to the costs via an MoU/Letter of Comfort at this early stage. The CCG has confirmed the costs are affordable to the local system via the Primary Care Commissioning Committee. There will be no requirement for temporary accommodation or enabling works.
11. STRATEGIC NEED
• Provide the strategic drivers and justification for the scheme.
• Confirm and outline alignment with other strategies as appropriate
The development of Integrated Health and Care Hubs in BLMK is a longstanding ambition and is central to the BLMK Primary Care Strategy, which formed the foundations of the Estate’s Strategy:
Currently, health, social care and third sector services are delivered from a
number of different locations in the Dunstable area. This scattering of services
NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 8 of 17
presents difficulties for local people to navigate their care pathways and begin to
take care of their own health and wellbeing.
People also have the issue of travelling to different places to access different
types of care and this disjointed silo approach does little to encourage them to
stay away from A&E unless absolutely necessary. In addition, services are often
delivered from outdated, inappropriate buildings meaning the safety of staff and
patients could be in question in the long term.
BLMK CCG and Central Bedfordshire Council have considered the needs of the
local population both now and that expected in the future i.e. people living longer
and growing demand for more complex health pathways and this in conjunction
with rationalisation of estate and land have proposed a new hub facility to bring
services together.
The case for change for the Chiltern Vale project was originally set out in the
Strategic Outline Case in December 2017. At that time there was a substantial
shift in the requirement in the way that health and care services were expected
to be delivered across the UK generally. Since then this requirement has
become further defined and the need to provide people with a better range of
services delivered from appropriate infrastructure is now greater than ever. An
absolute priority is to move traditional visits to acute hospitals into appropriate
health and care settings in the community. This will alleviate pressures on acute
settings and allow better control by patients over their own health and care
through smoother pathways, better access to a bigger range of services in a
timelier fashion and shift the focus onto prevention rather than cure.
Regionally providers are expected to respond to these challenges by applying
local knowledge and statistics to maximise the opportunity to provide these new
ways of working and Central Bedfordshire have done this through joined up
working with a variety of provider bodies. The result has been the out of hospital
hub programme, the Chiltern Vale hub project forming part of this programme.
There have been several drivers for a change in the way of delivering Health and
Care in the Central Bedfordshire area, namely;
• An ongoing expected growth in population
• An increased life expectancy
• Large demographic changes with increasing numbers of people living
with 3 or more long term conditions
• Isolated communities
• The ability to deliver new developments within health including
optimising the opportunities presented by new technologies.
The need for flexible, safe and convenient estate in a well thought out location,
central to the area it will serve and accessible by all is paramount.
The purpose of the Dunstable Integrated Health and Care Hub is to deliver a
range of Primary, secondary and 3rd sector services within defined communities
in one place rather than the current arrangements requiring users to travel to
services in a number of separate locations. The shift in focus for health services
now looks to deliver local based ‘closer to home’ care, enabling people to
manage their own healthcare and looking towards more preventative rather than
reactionary treatments.
NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 9 of 17
The service model for the Dunstable Hub has been developed with a view to
delivering against a key set of objectives set out for the Hub Programme:
• A wider range of primary health services;
• Increased primary care capacity, and flexibility to enable
accommodation for groups of practices who wish to co-locate under one
roof;
• Improved access to GPs through extended hours, out of hours and walk-
in services;
• A focus for management of more complex long-term conditions including
dementia care;
• Access to mental health care services; and
• Access to all out of hospital care services.
Specifically in relation to the primary care space within the facility, one of the key
drivers for relocation of Priory Gardens Surgery into the Hub is the acute
premises constraints that they as a practice, and within the wider PCN are
experiencing. At an average of 28 patients per m², the Chiltern Hills PCN is the
most constrained PCN within BLMK. Priory Gardens Surgery currently have 33
patients per m², with a list size that has consistently increased over the last five
years. There is significant housing growth taking place around Dunstable which
is expected to increase demand for primary care registration for a number of
years. Given the constraints within the other local practices, it is expected that a
significant proportion of this growth will need to be accommodated within the
Hub.
12. CONSISTENCY WITH SUSTAINABILITY AND TRANSFORMATION PLANS (STP), COMMISSIONING AND ESTATES PLANS
• Confirm alignment with the NHS England Five Year Forward View and related implementation plans.
• Confirm that the proposed scheme is consistent with the relevant STP, commissioning, clinical and (where appropriate) estates and or technology strategies.
• Confirm whether formal public consultation is required.
• Confirm whether any planning permission (including change of use) is required and its current status.
• Confirm that any proposed property development brief to designers will require and ensure
The BLMK Hub Programme an essential component of the ICS Strategy and is entirely consistent with the NHS Long term plan and national strategies relating to primary and integrated care. There are clear synergies with the recently announced large national programme to deliver “Cavell Centres”. The programme will deliver new and refurbished buildings, owned and managed by the system, to provide additional capacity for primary and community health care to deliver out-of-hospital service at PCN level. The table below sets out how the scheme aligns with the NHS England Five Year Forward View:
Five Year forward view approach
Hub alignment
Patient needs are changing, and new treatment options are emerging
Flexible facilities to accommodate new methods and ways of working Facilities designed with patient journey at the forefront
Challenges in mental health, cancer and support for frail elderly patients
New service model used as foundation for design of new healthcare facilities
NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 10 of 17
compliance with appropriate and relevant NHS guidance, such as BREEAM, Health Building Notes, common minimum standards for the procurement of built environments in the public sector, etc.
New partnerships are envisaged with local communities, local authorities and employers
Integrated health and care hub absolutely delivers this vision by its very nature
The need for rapid upgrade in prevention and public health
Facilities designed with patient education and access to support available including 3rd sector providers
Patients will need to gain more control of their care
Facilities designed with patient education and access to support available including 3rd sector providers
Barriers removed to care provided by family doctors, hospitals, physical and mental health and health and social care
By having a variety of services ‘under one roof’ patient pathways are going to be radically improved, easy access to other services and quicker referrals are expected.
In the future, more services delivered locally but others in specialist centres
Designing the facility with adequate support systems such as ‘spokes’ to the main hub and clever design around emerging technologies such as remote consultation.
More support for patients with multiple health conditions
With a range of services and improved technologies in one place patients with multiple health conditions can be seen and referred more quickly
Future radically different care delivery options including integrated hospital and primary care providers
New service models with supporting infrastructure
Formal patient consultation has taken place regarding the relocation of Priory Gardens surgery to the Hub. A wide range of engagement events took place in local supermarkets and community groups. Over 70% of respondents strongly agreed or agreed with the aims of the hub. There is a comprehensive communications and engagement plan to ensure ongoing involvement with the community as the Hub is developed and becomes operational. Planning permission was granted in November 2020. Compliance: - This project is in line with the standards for BIM Level 2, both BS1192/PAS1192-2 and the ISO19650-1/-2 suite of documentation. The design targets an achievement of BREEAM ‘Excellent’. It is expected that the design team will employ a specialist consultant to advise on BREEAM and will keep account of the progress towards BREEAM via a tracker or log, this will be continuously reviewed to ensure that credits exceed the 70% threshold to achieve “Excellent”, the design stage evidence is being complied and the BREEAM submission will be undertaken as soon as practicably possible. A pre-assessment has been carried out, this indicated that there is a potential to score 76% (70% is required for BREEAM Excellent). Clinic Rooms have been sized generically as laid out in HBN11-01 to allow considerable flexibility of clinical use.
All rooms are HBN compliant.
The CCG has appointed a monitoring surveyor to ensure compliance and to provide professional advice on derogations & Value Engineering recommendations.
NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 11 of 17
As part of good practice and assurances a Valuation Office checklist has been completed for the scheme; this will be revisited as the detailed architectural, mechanical and electrical design for the building are fully worked up. DVS (part of the Valuation Office Agency) has been engaged as part of the primary care development process. As the scheme moves forward the DV will continue to ensure that best value for money is achieved from the project, whilst helping to ensure that the Developer’s design proposals comply with Department of Health, NHS England, Health Authority, Health and Safety Executive, HM Government and other applicable guidance and requirements, room sizes and efficiency of layout.
13. ESTIMATED PROJECT DEVELOPMENT COSTS Cost per Stage of Development
Funded by Project Sponsor £
Total incl. VAT £
Incurred Pre PID
PID to Option Appraisal
Option Appraisal to OBC 880,581
OBC to FBC 587,055
Total 1,467,636 Revenue only
14. CAPITAL COST ESTIMATES
(Inc. VAT)
This section is anticipated to be very high level (but based on evidence), prior to any formal options appraisal. Benchmarked construction costs can be accessed through the NHS England PAU team.
Please use table 2 (and, if and where available, append any more detailed ready prepared tables that are considered appropriate), to detail the capital requirements to deliver this scheme in years 1, 2 and year 3 where applicable.
Please use Table 4 to confirm capital funding sources that should sum to the total in Table 2.
Two-site scheme Two-site schemes may potentially occur where, say, there is a move from one site to another and to achieve this there may be some level of expenditure on two sites. The total scheme costs for both
Capital Total Financial tables must clearly show the total NHS England commitment only. Central Bedfordshire Council are providing the capital funding for this scheme.
Table 2. Total Capital requirement inc. VAT for current and future years Description £
Current year
(year 1) 2017
£ Current
year (year 2) 20[../..]
£ PID total
Years 1+2
£ Third year
only 20[../..]
£ Total
across three years
Land (generally only apply to year 1)
Development costs from Table 1 above. (generally only apply to year 1)
IT cost/ Project Management
Enabling works, where applicable
Construction
Fixed equipment
Totals
Two-site schemes - see notes on left). If this is part of a 2-site scheme, please provide details by year, by site in the following tables to show the total estimated value of the overall project, and these should collectively sum to the total capital requirement in Table 2, above.
Explanation and description of any two-site scheme covered by this PID
NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 12 of 17
related sites are to be provided in the tables. This does not mean that 2 unrelated sites or schemes can be approved under a single PID.
Please ensure that all proposed costs set out in these tables are for capitalisable expenditure.
Please insert the relevant dates in the [square brackets]
N/A
CAPITAL FUNDING SOURCES The table below will therefore show the full capital cost of the scheme PLEASE NOTE THESE FIGURES RELATE TO THE TOTAL SCHEME WHICH INCLUDES PRIMARY CARE, COMMUNITY AND MENTAL HEALTH, SECONDARY CARE AND SOCIAL CARE.
Table 3. Total Capital requirement inc. VAT for current and future years Capital funding
source £
Current year
(year 1) 2021
£ Current
year (year 2) 20[../..]
£ Scheme
total Years 1+2
£ Third year.
only 20[../..]
£ Total
across three years
NHS England - IT cost/ Project Management
L.A Capital 429,482 16,889,989 17,319,471 12,736,206 30,055,677
Totals 429,482 16,889,989 17,319,471 12,736,206 30,055,677
15. REVENUE AFFORDABILITY / IMPACT • Net Recurrent Revenue Impact:
£’x’k over the following years.
• Outline any additional revenue costs of capital investment beyond current costs, and other additional costs if applicable e.g. additional rates, energy, FM costs and any planned offsetting savings
• Specify funding source for any adverse net revenue impact
• £’x’k Estimated lifecycle costs:
• £’x’k Gross Recurrent Revenue Impact
AS STATED ABOVE THIS SECTION ONLY RELATES TO THE REVENUE IMPACT FOR THE PRIMARY CARE SPACE IN THE FACILITY. OTHER GOVERNANCE ROUTES HAVE BEEN FOLLOWED IN RELATION TO THE OTHER AREAS OF THE BUILDING AS APPROPRIATE.
Rent: Rent in the Hub has been calculated using the DV recommended rate for the area of £205 per m2. Net internal area
The Hub will provide an increase in the NIA available for Primary Care as illustrated below. In addition to the dedicated demise for the practice and PCN, there are a shared spaces to allow functions such as staff support, reception, storage, WC’s etc. Bookable meeting rooms and clinical spaces are also available for the practice & PCN to make use of & maximise the opportunities for multi-disciplinary working. The NIA used to calculate the Priory Gardens and PCN rental charges is shown below:
Priory Gardens Surgery NIA
Demise in Health Centre 429 m2
In Dunstable Hub NIA
Priory Gardens dedicated demise 424 m2
PCN dedicated demise 149 m2
Bookable space available 294 m2
Shared space 974 m2
NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 13 of 17
Total available space: 1841 m2
Rent Reimbursement
Current Rent Reimbursement Priory Gardens
£61,000 p/a
Rent reimbursement in Dunstable Hub for Priory Gardens dedicated demise & portion of shared/bookable/circulation space
£153,996 p/a
Net revenue impact for Priory Gardens Rent
£92,996 p/a
New rent for PCN demise (& portion of shared/bookable/circulation space)
£54,257 p/a
Net revenue impact arising from Rental charges
£147,253 p/a
Service Charges: Service charges in the Hub cover:
• Cleaning
• Security/Caretaking
• Repairs & Maintenance
• Utilities
• Rates
• Clinical Waste
Net Revenue impact
Current Service/FM Charges in Priory Gardens
£77,005 p/a £0
Service Charges in Dunstable Hub
£45,823 p/a
PCN accommodation service charges
£16,144 p/a £16,144 p/a
Net revenue impact arising from S/Cs
£16,144 p/a
Total Net Recurrent Revenue Impact:
£163,397 p/a
BLMK CCG will fund adverse revenue impact. Priory Gardens Health Centre would be available for disposal and has a market
value of approximately £925k, based on the assumption that planning permission
would be granted to build out the site for flats. It is expected that national policy
changes will have been implemented by 2023 that will enable the ICS to receive
all/a significant proportion of the capital receipt.
Amounts to be determined but non-recurrent revenue costs are expected to be incurred for the following:-
NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 14 of 17
• Practice legal costs
• GP IT
• Monitoring surveyor
• Further patient engagement
• Digitisation of records
• Stamp Duty Land Tax (approx.. £45,007)
16. PROPOSED PROCUREMENT STRATEGY
Please describe the procurement strategy, who will be leading, and when it is anticipated to complete and capital spend will be incurred. For new build solutions, please confirm if the proposal is likely to be within a LIFT geographical area.
Where available attach a key milestones plan. As a minimum, this should include, as appropriate:
• Option Appraisal
• Procurement Route Confirmed
• OBC/New Project Proposal
• OBC Approval/Stage 1 Approval
• FBC/Final Project Proposal
• FBC Approval/Stage 2 Approval
• Date of procurement
• Planned start of works
• Estimated completion date
Central Bedfordshire Council have led the procurement strategy for the Hub. A design and build route was chosen due to greater cost certainty, improvements to programme timeline over design then build, and the benefits of the designers and builders sharing a supply chain. Following a robust review of the procurement options it was decided to use the LHC framework. A procurement exercise led to Willmott Dixon being appointed as the lead contractor.
• Build Contract to be awarded – 23 April 2021
• Planned start of works – May 2021
• Estimated completion date – March 2023 As a multi-agency project this scheme has progressed through a variety of due diligence and governance processes across partner organisations. CBC as the lead developer of the scheme have approved their internal business case and agreed the award of the build contract in April ’21. Similarly, Bedfordshire Hospitals NHS Foundation Trust has secured the necessary approvals to enable them to finalise the MOU with CBC and head lease negotiations are underway.
17. CONSIDERATION OF OTHER OPTIONS
Describe other options under consideration, including the ‘Do Nothing’ Option.
Briefly consider the advantages and disadvantages of each option under consideration and identify the one used for benchmarking to indicate the scheme value in this PID
As part of the scheme development the Project Board considered a range of service model options and a range of location options.
The service model options included an option of business as usual; continuation of current service delivery. All other options (named Bronze, Silver, Gold in the Options Appraisal) included the relocation of Priory Gardens Surgery to the Hub & space to allow for population growth, given the significant premises constraints they are experiencing. Adult and children’s social care, adult community health services, mental health services, phlebotomy & out of hours services were also included in all other options. Moving from Bronze – Gold an increasing number of mental and community health services, specialist nursing and additional services were included in the service model, as well as team bases for an increasing number of services.
The panel concluded that the „Silver“ option offered the opportunity to relocate those services which would most benefit from physical integration and operating in a multi-disciplinary building and offer the greatest improvements for patient outcomes. Following a post Covid review of the schedule of accomodation, it was agreed that the relocation of the iCash service (from the „Gold“ option) from the Dunstable Health Centre would be advantageous and would enable a disposal opportunity. The chosen option brings the benefits of a mixed economy of NHS, social care, voluntary, Local Authority, private and commercial provision within the Hub.
The chosen service model meant that the location options were limited due to the land which would be required to accomodate the building. The CBC owned land off Court Drive in Dunstable was identified as the prefered option. It offers good transport links and access from the town centre, good car parking, & is of the size required to accomodate the desired service model. Being in CBC’s ownership the site also offered ease of deliverability. The site had the added advantage of
NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 15 of 17
offering an opportunity to develop housing for older people within the site & further supporting the regeneration of the town.
18. SITE PLAN
Where available and for larger schemes (>£1m), please provide a simple site plan to demonstrate the proposal.
The site plan is shown above. The 1:200 designs for the Hub are embedded here:
CVH-PPA-V4-00-DR-
A-0010 - Ground Floor GA.pdf
CVH-PPA-V4-01-DR-
A-0011- First Floor GA.pdf
CVH-PPA-V4-02-DR-
A-0012 - Second floor GA.pdf
CVH-PPA-V4-03-DR-
A-0013 - Third Floor GA.pdf
19. OTHER ISSUES
Confirm and provide brief explanation about: a) Is the output from One Public
Estate planning known for the relevant locality?
b) Have NHS PS / CHP / or other named party provided input into the PID?
c) Is there spare service (or accommodation) capacity in neighbouring, cross boundary areas?
d) Are any service or accommodation closures
a
The Transforming Bedfordshire OPE initiative has been a catalyst for securing further investment from the Estates and Technology Transformation Fund (ETTF), to progress the plans for both the Dunstable and Biggleswade Integrated Health and Care Hubs to planning stages. OPE Phase 3 funded the Strategic Outline Case for the Dunstable Hub; the opportunities for greater integration and regeneration of a surplus council asset (Court Drive site) being very much in line with the aims and objectives of One Public Estate. The funding was also a catalyst for stimulating partnership working across primary care systems, enabling better use of public assets to deliver new models of care & the co-location of health and care teams in fit for purpose facilities. As a multi-agency health and housing project developed by CBC, with the involvement of a wide range of health & social care partners, it very much embodies the OPE vision, using public assets to create multi-functional places with service integration for communities.
NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 16 of 17
anticipated as a result of these proposals?
e) Will any land be released? f) Is the proposal dependent on
reinvestment from disposals? g) Where applicable, is the land
clearly identifiable and available.
h) Is the land in the ownership of the NHS?
i) Are there any known constraints that could influence the outcome of this scheme in construction or use? E.g. in a flood zone, listed building, etc.?
j) Where GP or other organisations will share the facility, are there plans to integrate the common areas, or are the organisations intent on remaining fully separate entities in practical terms? The latter may not be acceptable for this PID to be approved
k) Has any IT infrastructure been factored into the costs for this scheme in the tables 2, 3, 4 and 5? If yes, please quantify.
l) If not, please confirm source and certainty of funding for this item.
m) In schemes involving GP’s, what is the anticipated value of the GPIT requirement?
n) please confirm source and certainty of funding for GPIT.
b NHSPS are involved in the project in relation to the disposal of Priory Gardens Health Centre
c No, the Chiltern Hills PCN is the most premises constrained in BLMK.
d Yes – Priory Gardens Surgery & Community Services will re-locate from the Priory Gardens Health Centre. And will result in the closure & disposal of this NHSPS owned facility.
e Yes – see above.
f No – CBC are providing the full capital required.
g Yes – the land is in the ownership of CBC.
h No – see above.
i No – ground surveys have taken place and no issues found. Planning permission has been granted.
j
Yes, there are plans to share and integrate common areas. The whole building has bene designed with the ethos and commitment to integrated working between services, and shared areas and adjacencies have been carefully considered to help enable closer working.
k IT infrastructure costs have been factored into the capital build costs.
l N/A
m Non-recurrent GP IT costs still to be established.
n It is expected that GP IT costs will be funded via the CCG’s GP IT capital budget in due course.
20. KEY RISKS
Please provide adequate information to enable reviewers to understand the level and likelihood of risk and how it is to be mitigated.
Please list any risks to delivery, for example if the spend is dependent on a practice merger other estates investment, involvement of a 3rd party, etc.
Risk Mitigation
CBC – agreements for lease not yet signed
Practice has consistently provided evidence of commitment to the scheme at appropriate governance stages.
Practice cannot afford the increase in service charges in the Hub
CCG has agreed a time-limited, tapered transformation payment to support their transition to this new model of care.
PCN space – funding of service charges still to be determined
Likely to be influenced by national estates ownership reformation programme and change in statutory powers for ICS’
NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 17 of 17
21. SCHEME OR PROJECT ENDORSED BY:
CCG CHIEF FINANCIAL OFFICER
Statement
I hereby confirm that I am satisfied the investment of capital as set out in this PID is necessary expenditure and offers value for money. I also confirm that any commitments made in this PID to the covering of revenue will be honoured by the CCG and/or its relevant stakeholders. I am satisfied that the capital funding requirement set out in this PID is not replicated in any other NHS capital funding request, e.g. under other parallel capital investment initiatives
Organisation
Name
Signature
Date
NHS ENGLAND DCO DIRECTOR OF COMMISSIONING
Statement I hereby confirm that I am satisfied the investment of capital as set out in this PID is necessary expenditure, offers value for money and conforms with relevant policy.
DCO
Name
Signature
Date
NHS ENGLAND DCO DIRECTOR OF FINANCE
Statement
I hereby confirm that I am satisfied the investment of capital as set out in this PID is necessary expenditure and offers value for money. I also confirm that I am satisfied with the financial commitments made by the CCG in this PID.
DCO
Name
Signature
Date
NHS ENGLAND REGIONAL
DIRECTOR OF FINANCE
Statement
I hereby confirm that I am satisfied the expenditure of capital as set out in this PID is necessary expenditure and offers value for money. I also confirm that I am satisfied with the assurance provided by the relevant local DCO office Director of Finance in this PID in relation to the covering of revenue costs. I confirm that any NHS England capital expenditure assumed in this PID is funded within the Regional capital budget for the relevant year(s). I am assured that there is a credible plan in place to account for any assumed NHS England capital expenditure in the appropriate financial year in accordance with NHS England standard accounting practice.
Region
Name
Signature
Date
PRIORITISATION (For regional use only where applicable)
BLMK Primary Care Commissioning Committee Meeting held in Public 18th May 2021 1045-1245
Which activity does this paper
relate to?
To manage the delegated and other primary care related budgets for the
commissioning of Primary Medical Care Services.
How? Report financial expenditure to month 12 (Full Year 2020-21).
What is the Committee being
asked to do?
To receive assurance.
What are the financial
implications?
Overall each CCG achieved its own 2020-21 financial target. Contributing to
those, delegated primary care was within budget as was other primary care
areas. Prescribing contributed an overspend due to national pressures.
Set out the key risks and risk
ratings
1. A prudent approach has been taken towards risks and
uncertainties as part of the year-end closedown and in estimating
accruals which are reflected in the reported position.
2. Any further legacy financial risks from 2020-21 that may impact
upon the new year and single BLMK CCG are not considered
material.
Date to which the information this
paper is based on was accurate
27th April 2021
Author: CCG Finance Teams
Contact Information: Associate Director of Finance, BLMK CCG
Lead Executive: Stephen Makin, Acting Chief Finance Officer
Information
Which CCGs does this paper apply to?
Bedfordshire ✓ Luton ✓ Milton Keynes ✓
Item 13. Title: Summary Finance Report (Month 12)
1
Primary Care Commissioning Committee18th May 2021
Executive Summary
The NHS response to the COVID pandemic made for an interesting and uncertain year. Primary
Care had to rapidly adapt in how it maintained services to patients and supported national
COVID programmes. Financially, the rules and funding available to CCGs to support services
was forever changing.
The changes to the funding regime have been reported previously as the year unfolded. Primary
Care was supported through:-
(a)Guaranteeing baseline funding to practices so that activity dependent income was maintained
whilst practice staff concentrated on supporting the COVID response
(b)Ring-fenced COVID funding for additional costs of PPE, backfilling for increase levels of staff
absence, additional equipment and adapting premises and patient services to ensure they
were COVID safe.
In summary, combined 2020-21 outturn position across the three CCGs is
- Delegated is showing a net £229k underspend (0.2% of £143m budget).
- Other primary care services is underspent by £625k (3.3% of £18.7m budget); and
- Prescribing is £2.1m overspent (1.5% of £136m budget) due to national pressures.
2
Month 12 Finance Report - BLMK CCGs Primary Care Commissioning
Stephen Makin, Acting Chief Finance Officer
18th May 2021
3
Review of 2020-21
Summary 2020-21
• CCGs were issued with revised allocations for months 7-12 that replaced the previous monthly arrangements.
Months 1-6 were effectively ‘topped up’ to ensure CCGs broke even on their expenditure. For months 7-12,
CCGs were expected to manage expenditure within the given allocations for the remainder of the year.
• Some of the variations reflect individual positions and approaches by each CCG, for example how budgets
may have been loaded initially, how COVID spend is categorised, expected levels of spend during months 1-6
may have not been as expected or prior year positions coming through into the new year.
• As the year progressed, a more consistent approach across the CCGs was adopted towards budgeting and
forecasting.
• The COVID pandemic inevitably had an impact on service provision, previously planned investments and
service models had to adapt so that patients and staff operated in a COVIOD safe environment. The COVID
response also brought additional costs to practices. Overall, the additional costs were offset through
additional COVID funding and underspends. Of particular note, the increased investment available to PCNs to
expand their Additional Roles workforce was not fully utilised for a variety of reasons.
• Practices response to COVID continued to be directly supported financially. £2.4m was made available to
practices under the COVID Support Fund scheme and in January, NHSE promoted additional PPE support for
practices in addition to being able to access central PPE supplies.
• BLMK also received £1.6m to support GPFV which was distributed across CCGs to support PCNs and
primary care as previously reported to this Committee.
4
Forward 2021-22
Organisational resources have been focused on preparing for the merger on 1st April 2021 of the three
former CCGs into BLMK CCG. This required significant time and effort plus operational and system
changes, including
(a)New team structures being developed and appointments made
(b)Preparing back office functions (e.g. merging three ledgers and associated systems) and
commencing payments to providers and suppliers from new ledger
(c)Closing the final accounts for the three out-going CCGs and preparing for audit
(d)Amending BLMK planning and draft budgets for changing NHSE allocations and recently issued
planning guidance.
Consequently, budgets are still in draft and it is expected to bring these to the next Primary Care
Committee. However, core baseline contractual payments are still being made to practices and Primary
Care Networks.
The new CCG has also received a £1.975m allocation, ring-fenced for primary care, to support any
continuation of additional costs incurred due to any on-going COVID implications and to enable general
practice to gradually return to providing normal levels services to patients. This funding runs until
September 2021.
5
Financial Performance (Month 12)
Primary Care Delegated Reporting (2020-21 Outturn)
BEDFORDSHIRE LUTON MILTON KEYNES COMBINED
Plan Actual Variance Variance Plan Actual Variance Variance Plan Actual Variance Variance Plan Actual Variance Variance
£000 £000 £000 % £000 £000 £000 % £000 £000 £000 % £000 £000 £000 %
REVENUE RESOURCE LIMIT 67,621 35,541 40,012 143,174
228199.7
GMS Contracts 40,220 40,216 4 0.0% 17,609 17,533 76 0.4% 23,951 23,948 3 0.0% 81,780 81,698 83 0.1%
APMS/PMS Contracts 4,078 4,108 (30) (0.7%) 3,751 3,715 35 0.9% 2,514 2,472 41 1.6% 10,342 10,296 46 0.4%
Primary Care Networks 4,335 3,778 557 12.8% 2,084 2,203 (119) (5.7%) 2,559 2,487 72 2.8% 8,978 8,468 510 5.7%
Enhanced Services 601 574 27 4.5% 248 224 24 9.5% 370 377 (7) (1.9%) 1,219 1,175 44 3.6%
Premises 4,970 5,087 (117) (2.4%) 3,834 3,567 267 7.0% 4,118 4,136 (18) (0.4%) 12,923 12,790 132 1.0%
Primary Care Other 876 880 (4) (0.5%) 436 452 (16) (3.7%) 558 567 (9) (1.6%) 1,869 1,898 (29) (1.6%)
QoF 5,941 6,124 (183) (3.1%) 2,774 2,774 (0) (0.0%) 3,248 3,248 - 0.0% 11,963 12,146 (183) (1.5%)
Prescribing & Dispensing 1,618 1,694 (76) (4.7%) 161 198 (36) (22.5%) 199 199 0 0.0% 1,978 2,090 (112) (5.7%)
PMS Re-investment 2,652 2,598 54 2.0% 710 734 (24) (3.4%) 407 407 (0) (0.0%) 3,768 3,739 30 0.8%
Other 2,328 2,350 (22) (0.9%) 3,935 4,144 (209) (5.3%) 2,088 2,148 (60) (2.9%) 8,351 8,642 (291) (3.5%)
Contingency & Reserves - - - 0.0% 0 - 0 100.0% - - - 0.0% 0 - 0 100.0%
- - -
Primary Care Delegated 67,619 67,409 210 0.3% 35,541 35,544 (3) (0.0%) 40,012 39,990 22 0.1% 143,172 142,943 229 0.2%
Bedfordshire
Luton
Milton Keynes
The final outturn position is £3k adverse. An increase in Primary Care Network costs has been driven by Additional Roles to help out at vaccination sites. The Other costs are due to additional COVID costs and
digistisation and storage of patient records due to practice moves. These additional costs have been offset by a reduction in Premises vacant space charges and the GMS list size not increasing as much as
expected.
The overall position on Primary Care Delegated commissioning is an underspend of £22k. This can be attributed mainly to £59k underspend against the additional roles budget due to delayed recruitment
which has reduced from last month due to some roles that were recruited to in the last month. APMS contracts are underspent as a result of the delay in the opening of the Whitehouse practice. The
overspends are in premises where there is an anticipated increase in clinical waste and in other spend which relates to services e.g. the sterile services and Valuer fees.
CCG EXPENDITURE ANALYSIS
Forecast Net Expenditure Forecast Net Expenditure Forecast Net Expenditure Forecast Net Expenditure
Forecast underspend £210k (0.3%) primarily arising from ARRS recruitment by PCNs being slow due to prioritising COVID response. Elements of overspend include premises due to catch up on rent reviews
and providing for back dating of sums due, QoF overspend is a legacy from previous year where QoF outturn was higher than estimated, APMS due to final reconciliation for Caudwell upon transfer to new
provider.
6
Primary Care – Other Services
Primary Care (Other) - Outturn
BEDFORDSHIRE LUTON MILTON KEYNES COMBINED
Plan Actual Variance Variance Plan Actual Variance Variance Plan Actual Variance Variance Plan Actual Variance Variance
£000 £000 £000 % £000 £000 £000 % £000 £000 £000 % £000 £000 £000 %
Local Enhanced Services 978 795 183 18.7% 2,657 2,626 30 1.1% 1,175 1,176 (1) (0.1%) 4,809 4,597 212 4.4%
PCN Support 755 741 14 1.9% 359 359 0 0.1% 454 453 2 0.4% 1,568 1,552 16 1.0%
GP IT 2,589 2,700 (111) (4.3%) 1,680 1,655 25 1.5% 1,558 1,641 (83) (5.3%) 5,828 5,996 (168) (2.9%)
GP Forward View 2,470 2,430 40 1.6% 1,769 1,253 516 29.2% 1,456 1,456 (0) (0.0%) 5,695 5,139 556 9.8%
GP Forward View (BLMK) 837 827 10 1.1% 837 827 10 1.1%
Total Primary Care (Other) 6,792 6,666 126 1.9% 6,465 5,893 572 8.8% 5,480 5,552 (72) (1.3%) 18,737 18,111 625 3.3%
Doctors Drugs 64,752 65,741 (989) (1.5%) 28,992 29,499 (507) (1.7%) 37,066 37,611 (545) (1.5%) 130,810 132,851 (2,041) (1.6%)
Central Drugs 1,804 1,832 (28) (1.6%) 857 864 (7) (0.8%) 1,141 1,107 34 3.0% 3,802 3,803 (1) (0.0%)
Home Oxygen Service 724 698 26 3.6% 253 260 (6) (2.4%) 467 506 (39) (8.4%) 1,445 1,464 (19) (1.3%)
Total Prescribing 67,280 68,271 (991) (1.5%) 30,103 30,623 (520) (1.7%) 38,674 39,224 (550) (1.4%) 136,057 138,118 (2,061) (1.5%)
Bedfordshire
Luton
Milton Keynes
Local Enhanced Services is below budget due to recovery of VAT for the PCN Development & Leadership programme. The GPIT favourable variance is due to lower software licence charges than planned. The
underspend on GP Forward View is primarily under utilisation of Extended Access funds. Doctors drugs outturn is higher than budget due to increased GP Fees plus Prescribing costs including Category M and
NCSO cost pressures.
Primary care overspend due to GP IT of £83K and the increases in costs relating to licences and other non capital GP IT spends.
The prescribing spend relates to data received up to January 2021 requiring accrued estimates for the two month time lag. Pressures expected in prescribing costs due to general growth, CatM and NCSO drug
pressures towards the last two months at the end of the financial year. Home oxygen also increased in the last two months of the end of the year.
CCG EXPENDITURE ANALYSIS
Forecast Net Expenditure Forecast Net Expenditure Forecast Net Expenditure Forecast Net Expenditure
Increased cost of licences and higher spend on IT equipment lead to GPIT overspend. Local enhanced services partially through prior year benefits and budgets anticipating natural activity growth that didn't
materialise due to COVID. GPFV arises.
Prescribing year end reflects estimated accrual for two months time-lag in information and potential continued impact of Cat M and NCSO.
7
Additional Roles Reimbursement Scheme (ARRS)
ARRS funding is available to PCNs via CCGs’ baseline allocations and further support that can then bedrawn down from NHSE once CCGs’ baseline funds have been expended.
The table below summarises the spend for the year against the respective CCGs’ baseline allocation andalso the total resource available (including the NHSE held element). Only the net position against the CCGs’baseline allocation is reflected in the outturn position. Table also shows the increase in ARRS staffcompared to last March.
The funding is ring fenced for ARRS and an exercise was undertaken in September asking PCNs to outlinetheir recruitment plans to year end and hence forecast their spend. Where underspends were identified,these were then made available to PCNs to bid against so that the ARRS funds were utilised as fully aspossible. ARRS funds could also be used by PCNs for additional hours in supporting COVID programmes.
However, COVID has inevitably had an impact on the ability for PCNs to recruit to the extent that there was£556k underspend by PCNs across BLMK.
Financial Position
CCGBaseline
AllocationSpend
Underspend against
baseline
Additional Budget
Total Forecast Underspend
‘£000 ‘£000 ‘£000 ‘£000 ‘£000
Bedfordshire £1,961 £1,394 £567 £1,358 £1,925
Luton £996 £1,068 -£72 £671 £599
Milton Keynes £1,135 £1,076 £59 £764 £823Total £4,094 £3,538 £556 £2,793 £3,347
Staffing Data
Mar ‘20 Feb ‘21 Increaseper 10,000
popn
wte wte wte wte
15.8 48.0 32.2 1.00
7.7 31.8 24.1 1.33
7.0 44.4 37.4 1.41
30.5 123.7 93.2 1.20
8
Individual PCN positions for ARRS are shown below.
Allocations are individual PCN’s original budget. However, spend may include approval of a PCN’s bid for additional funds.
Additional Roles Reimbursement Scheme (ARRS)
Outturn by Individual PCN
Allocation Underspend against
CCG/PCN Baseline Additional Spend Baseline Additional Total
Luton £000 £000 £000 £000 £000 £000Eden £164 £111 £183 -£19 £111 £92Hatters £195 £132 £219 -£24 £132 £108Medics £252 £170 £231 £21 £170 £191Oasis £171 £115 £111 £60 £115 £175Phoenix £214 £144 £323 -£109 £144 £34
£996 £671 £1,068 -£72 £671 £599
Milton KeynesNexus £217 £146 £209 £8 £146 £155Watling Street £159 £107 £70 £89 £107 £196South West £173 £116 £150 £23 £116 £139East MK £197 £132 £163 £34 £132 £166The Crown £175 £118 £209 -£34 £118 £84The Bridge £152 £102 £169 -£16 £102 £86Ascent £62 £42 £107 -£45 £42 -£3
£1,135 £764 £1,076 £59 £764 £823
Allocation Underspend against
CCG/PCN Baseline Additional Spend Baseline Additional Total
Bedfordshire £000 £000 £000 £000 £000 £000
Caritas £184 £127 £185 -£1 £127 £126
Chiltern Hills £216 £149 £92 £124 £149 £273
North Bedford £188 £131 £191 -£3 £131 £128
East Bedford £193 £133 £115 £78 £133 £211
H is for Health £173 £120 £61 £112 £120 £231
Hillton £132 £91 £146 -£14 £91 £77
Ivel Valley North £224 £155 £84 £140 £155 £294
Ivel Valley South £165 £114 £164 £1 £114 £115
Leighton Buzzard £184 £127 £51 £133 £127 £260
Titan £130 £90 £152 -£22 £90 £68
Unity £174 £121 £153 £21 £121 £142
£1,961 £1,358 £1,394 £567 £1,358 £1,925
9