primary care commissioning committee (pccc) meeting held

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.

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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


The tracker would show any outstanding and completed actions of the PCCC.


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

mailto:[email protected]


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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

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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


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

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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.

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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)

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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.

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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

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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

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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.

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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


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.


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);

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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)



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.


6th May 2021.

This paper outlines contract extensions for extended access providers across BLMK as agreed at the

last PCCC meeting.


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




COVID Vaccination in Primary Care.

How?

The slides show data on the vaccination numbers carried out across BLMK up to 6th May 2021.


For information only.


None


N/A


6th May 2021

Appendices

N/A


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%


49.32%

170,410

Dose 1 - Cohorts 1-12 - Up to 6/5498,975

58.39%


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]



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.


For Information only.


None. The Local Incentive Scheme will be funded from current CCG/ PCN allocations.


N/A


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.


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


Inclusion of Greensand Surgery Potton as a core PCN practice

Yes

Ivel Valley South


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


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


Lead Executive: Nicky Poulain, Director of Primary Care, BLMK CCG


PCN IT Equipment Funding.

How?

An update report on the current situation (additional funding and initial plans to deploy this resource).


To note the additional allocation and associated plans.


This report details plans to spend an allocation, received in the last year, across the BLMK PCN’s. No adverse implications.


None.


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.


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




Primary Care Contracting & Commissioning.

How?

Informing the committee on potential or realised contractual issues.


For information and assurance that primary care services have been commissioned for patients of Arlesey.


Temporary provider Caretaking costs.


• 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.


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.


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




Commissioning & Primary Care Contracting.

How?

Rapid procurement of a new Special Allocation Scheme provider.


Assurance that the SAS service has been procured for BLMK SAS patients and is operational.


Finances were compliant with the tender process and agreed framework price, this is a replacement service.


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.


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.


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]



Risk Registers for Primary Care Directorate and digital transformation programmes

How?

N/A


To receive assurance


N/A


Risks detailed in documents.


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.


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.




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


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.




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


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.




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


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


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


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


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


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.


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


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


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


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




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.


For information and quality assurance.


The size of QOF has increased from 567 to 635 points, value of a QOF point in 2021/22 will be £201.16.


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.


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:


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


Lead Executive: Nicky Poulain, Director of Primary Care / Geraint Davies, Director of

Performance & Governance


Primary Care Development.

How?

Supports improvement to primary care premises and capacity, which impacts on primary care resilience and quality of care.


• 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.


• 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).


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.


Item 12. Title: Report from Estates Working Group

Information


2


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


- 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


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.


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


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


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


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.


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


Section 106 / Community Infrastructure Levy contributions

One Public Estate

GP IT (capital and revenue) CCG Capital Allocation


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



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.


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".


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)


• 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.


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


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.

e-mail

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.

e-mail

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.

e-mail

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)


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


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


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.


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


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.


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


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.


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


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


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:-


• 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


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.


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’


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

primary care commissioning committee (pccc) meeting held

Documents