Oxfordshire Primary Care Commissioning Committee

Transcription

1 Oxfordshire Clinical Commissioning Group Oxfordshire Primary Care Commissioning Committee Date of Meeting: 1 May 2018 Paper No: 5 Title of Paper: A Primary Care Estates framework an discussion document Paper is for: (please delete tick as appropriate) Discussion Decision Information Purpose and Executive Summary: This discussion document describes how primary care estates should relate to the wider estates work, describes how capital will be accessed in the future and proposes some prioritisation criteria for primary care estates. An earlier version of this paper has been discussed at CCG executive. Key points raised included - Developing neighbourhoods - Phasing of funding vs approval of funding - Improving access - Ensure estate is modernised for new models of delivery Financial Implications of Paper: Primary Care Delegated Co-commissioning budget for GP Premises 17/18= 11,049k Action Required: OPCCC are asked to Note the link with STP strategic estates workbook and One Public Estate Provide feedback on the aims of the Primary Care Estates working group Note the primary care estates principles Provide feedback on the criteria scoring proposal OCCG Priorities Supported (please delete tick as appropriate) Operational Delivery Transforming Health and Care Devolution and Integration Empowering Patients Engaging Communities

2 System Leadership Equality Analysis Outcome: The risk management process enables equality and diversity related risks to be identified, evaluated analysed and reported across the CCG. Link to Risk: 789 Primary Care Estate Author: Julie Dandridge, Deputy Director, Head of Primary Care & Localities Clinical / Executive Lead: Diane Hedges, Chief Operating Officer Date of Paper: April 2018

3 Oxfordshire Clinical Commissioning Group A Primary Care Estates framework a discussion document 1. Background The locality place based plans all identified estates requirements to achieve a sustainable primary care and to support the system wide strategy to move care out of hospital. It is clearly identified that there is a need for a more co-ordinated to approach to primary care estates due to key drivers such as: Unprecedented levels of housing development and population growth across many areas of Oxfordshire over the next years (and longer), much of which is either underway or in detailed planning and commitment stages The intrinsic need to determine and provide health care infrastructure (and services) to support the existing and expanded local communities as sustainable developments To reflect and accommodate commissioning intentions as part of the Oxfordshire Transformation, including to develop and implement new models of care aligning with the Primary Care Framework and Locality Place based plans, involving a prioritised shift of care activity (as appropriate) from acute (hospital) settings to Community Care and Primary Care settings Maintaining and improving access to primary and community clinical & medical services and extended (locally commissioned) care services to the patient populations of Oxfordshire including the suitability and sufficiency of the Primary Care estate (buildings and facilities) Maintaining and strengthening links with District and County Councils. Estates and technology transformation funding (ETTF) was awarded for 7 practices (only one was for a new build) initially with a further practice being funded from national ETTF slippage money. However bids of 50M were requested and only 2M allocated leaving a large short fall in necessary funds to improve the estates. The locality place based plans identified 23 key estates projects that need investment in order to deliver sustainable estate and enable sites to be fit for purpose and enabled to deliver new models of care. The Oakleaf Six facet survey also identified substandard premises although some of this has been rectified with the 2017/18 minor improvement grants. This discussion document describes how primary care estates should relate to the wider estates work, describes how capital will be accessed in the future and proposes some prioritisation criteria for primary care estates. 2. Financial Implications Initial modelling based on the forecast for 85,000 additional homes by 2031 has estimated that around 200 additional clinical rooms will be required in community settings across the localities to support this growth, of which about 170 will be needed for GMS / Primary care with the remainder for additional community services. Some work was also done to estimate, using the same growth forecast

4 and timescale that the annual revenue consequences for primary care premises (NHSE reimbursable costs only) will increase by approximately 3.45m. Assuming this is largely GMS space and eligible for rent reimbursement, this will impact on CCG delegated commissioning budget. Current revenue budget for GP Premises is 11m. The Director of Finance is aware of the need to forward plan. Investment in primary care estate may either be through capital investment (from NHSE) or revenue. Revenue increases must be value for money and affordable and the CCG shall ensure this by agreeing revenue in line with - NHS (General Medical Services Premises Costs) Directions 2013 currently being updated - District Valuer recommendations New estate must also accommodate the delivery of new models of primary care including being able to accommodate multidisciplinary practice teams and make optimum use of technology. 3. STP Strategic Estates workbook There is renewed focus on the STP Strategic Estates workbook as this will be needed in order to support any capital bids. It is likely that this will be the only way that CCGs/practices will be able to bid for capital grants for funding new estates projects going forward. James Page, NHS Property Services Property Strategy Manager is co-ordinating its development and an Oxfordshire lead is currently being identified to represent the system. The projects identified in the locality plans will be key to input into the workbook. It is not yet clear how the workbook will prioritise projects across the STP. 4. One Public Estate (OPE) The One Public Estate programme is an established national programme delivered in partnership by the Local Government Association and the Cabinet Office Government Property Unit (GPU). It provides practical and technical support and funding to councils to deliver ambitious property-focused programmes in collaboration with central government and other public sector partners. OPE partnerships across the country have shown the value of working together across the public sector and taking a strategic approach to asset management. At its heart, the programme is about getting more from our collective assets - whether that s catalysing major service transformation such as health and social care integration and benefits reform; unlocking land for new homes and commercial space; or creating new opportunities to save on running costs or generate income. In December 2017/January 2018 Oxfordshire County Council OCC as the accountable body for the Oxfordshire OPE programme was awarded funding from the government s One Public Estate programme for four partnership projects in Oxfordshire which were Witney Welch Way Bicester Queens Avenue Joint Depot Provision Abingdon Guildhall A Partnership Group has been set up and the CCG is represented by the Director of Finance. The CCG has also identified representatives to attend 3 out of the 4 project groups (with the exception of Joint Depot Provision). Project groups will be exploring opportunities for greater alignment of services and potential co-location

5 It is likely that the OPE Partnership will also hold a series of place based asset review workshops around priority settlements in the county in order to explore opportunities for joint working and develop a pipeline of future projects for funding bids. The CCG representatives on the project groups will ensure that primary care estates need and the locality place based plans helps inform the discussion. 5. Primary care estates governance A CCG primary care estate working group has been set up to provide oversight of all primary care estates issues. Its aims will be to Ensure primary care premises are developed to provide the capacity and quality of premises required to meet needs associated with population growth and new housing Ensure primary care premises are developed in Oxfordshire to support the implementation of CCG commissioning plans and in particular the Primary Care Framework, locality place based plans and are STP and aligned to One Public Estate Ensure that the premises directions are applied when taking into account premises decisions including the rent review outcomes Provide recommendations to the Primary Care Commissioning Committee in line with scheme of delegation requirements Provide regular progress and update reports to the Primary Care Commissioning and Finance Committees (and any other committee or board as required). Ensure value for money using the views and expertise of the District Valuer Membership shall include Director of Finance, Chief Operating Officer, Director of Governance, GP deputy lead for quality and Head of Primary Care and the working group will meet monthly. 6. Primary Care estates principles These were previously agreed by OPCCC as part of the prioritisation of the locality place based plans in September They form the basis on which we will prioritise development of our primary care estates. Fits with OCCG strategy for sustainable primary care Ensures best use of existing NHS estate Supports whole system estate development where relevant eg: One Public estate Aligns with existing and planned neighbouring developments Supports practices working together, sharing space and facilities and conducive to practice mergers now or in the future Provides required capacity in areas of population growth and where current space is less than needed for the practice list size

6 Addresses where current premises unsuitable for delivery of primary care Delivers value for money in capital investment or revenue implications maximises use both in and out of hours Makes optimum use of available infrastructure funds Low risk to sustainability of practice over time Affordable within limits of GMS Premises Reimbursement Budget 7. Primary care estates prioritisation Prioritisation for primary care estates development was previously agreed at OPCCC in September Further work has now been done to quantify scoring on the criteria and feedback is welcome. It is clear that there may be other priority areas to consider and as such the scoring criteria will be updated to reflect this where possible.

7 DRAFT Primary Care estates scoring criteria v3 April 2018 CRITERIA AGREED Measurement SCORE 0 SCORE 1 SCORE 2 SCORE 3 1 Part of Locality Place based plans Locality plans NO YES 2 Fits with OCCG strategy for sustainable primary care Projected list size Not a key site but practice >15000 Key site Practice in an area of high deprivation practice IMD score (2015) Not a key site and for practice < list size < >20 Key site and practice list size > Ensures best use of existing NHS estate m2/list size There is capacity within existing estate to do things differently Existing GMS space is well used Space has been used optimumally including reuse of non GMS space where possible. Ensures optimum use of both GMS space and non GMS space and any space in local health buildings 4 Supports whole system estate development where relevant eg: One Public estate NO - isolated project Supports 2+ organisations working together Supports whole system estates development 5 Aligns with existing and planned neighbouring developments 6 Supports practices working together, sharing space and facilities and conducive to practice mergers now or in the future Locality plans m2/list size conflicts with other plans in neighbourhood ie both offer an MIU etc Delivers solution for only one practice takes into account other neighbourhood existing and planned developments Practices happy to consider working a t scale or delivers solution for a strategic site takes into account other locality existing and planned developments Practices agree to share facilities in new build Aligns with other estates plans for locality Practices agree to merge into new build or reconfiguration

8 7 Current space is less than needed for the practice list size m2/list size Current space is adequate for existing list growth Space is currently less than needed in practice (at least 10% more is needed) Space is currently less than needed in practice (at least 11% more is needed) Space is currently less than needed in neighbourhood (>10%) 7a Provides required capacity in areas of population growth and where current space is less than needed for the practice list size Population growth to 2031 as % of current population No population growth Practice population likely to grow by 10-25% Practice population likely to grow by >25% Neighbourhood population grows by greater than 10% 8 Addresses where current premises unsuitable for delivery of primary care 9 Makes optimum use of available infrastructure funds 10 Low risk re.sustainability of practice over time Oakleaf 6 Facet survey Developers contributions or NHS funding Succession plan for practice No C in any facet 1-2 or more C 2-3 or more C 3 or more C + over crowded No funding available to build Practice less than < time critical New build/reconfiguration required in 5-10years No site identified but funds available to purchase and build ( even if has an effect on revenue) Practice has a succession plan and is 8,000-14,999 list size New build/reconfiguration required in < 10years Land available (but needs to be purchased) and funds available for building Practice has a succession plan and is 15,000-19,999 list size Land available (gifted) and funds available for building Practice has a succession plan and is >20,000 list size ( or will be) New build/reconfiguration required in < 5years or urgent decision is need

9 8. OPCCC are asked to Note the link with STP strategic estates workbook and One Public Estate Provide feedback on the aims of the Primary Care Estates working group Note the primary care estates principles Provide feedback on the criteria scoring proposal Julie Dandridge V3 24 April 2018