AGENDA ITEM NO: 5.0. Primary Care Co-Commissioning Joint Committee - 14 Meeting Title/Date: February 2019 Report Title: Alfred Barrow Premises Relocation Report Sarah Bloy/ Date of Paper Prepared By: Steven Harris 24 January 2019 Paper: NHS England Responsible Executive Sponsor: Kevin Parkinson Sarah Bloy Manager: Committees where Paper Previously Presented: Background Paper(s):

Summary of Report: This report is to present the proposed relocation of community and GP services (A82010 Abbey Road Surgery, A82062 Atkinson Health Centre and A82072 - Risedale Surgery) into a new, purpose built healthcare facility on the former Alfred Barrow School site in Barrow- in-Furness. Recommendation(s): Approve the proposed relocation of services.

Please Select Y/N Identified Risks:

Impact Assessment: (Including Health, Equality, Diversity and Human Rights) Strategic Objective(s) Please Supported by this Paper: Select (X) Better Health - improve population health and wellbeing and reduce X health inequalities Better Care - improve individual outcomes, quality and experience of care X

Delivered Sustainably - create an environment for motivated, happy staff X and achieve our control total Please Contact: Sarah Bloy Senior Primary Care Manager NHS England

A82010 Abbey Road Surgery, A82062 Atkinson Health Centre and A82072 – Risedale Surgery

Premises Relocation

Moor Lane Mills

14th February 2019

Introduction

The purpose of this report is to present the case for the proposed relocation of three existing GP surgeries, together with a range of community services, into a new, purpose-built healthcare facility on the former Alfred Barrow School site in the centre of Barrow-in-Furness and to seek approval for the GP Surgeries to relocate.

Background and Summary

Primary, community and mental health services currently operate out of several sites across Barrow-in-Furness. The largest site is Furness General (FGH), which provides mainly inpatient services. The other sites are dispersed throughout the town and provide outpatient services in a range of buildings which are old and unsuitable to deliver modern NHS services. They are owned either by NHS Property Services or Partnership NHS Foundation Trust (CPFT) and some are leased. Issues have been identified with their suitability, backlog maintenance issues and ability to deliver modern integrated health care. The location and size constraints present operational difficulties resulting in inefficiencies.

Public feedback has indicated that there is a high level of unnecessary attendances and admissions at Furness General Hospital. The reasons for this have been identified as being due to poor access and capacity within primary care in Barrow-in- Furness and .

Work has already commenced between the GP practices to transform service delivery and improve integration and alignment across the practices.

The Strategic Case for Change

The strategic case for change is summarised below (taken from the Full Business Case published in April 2017):

 The need for this project and NHS commitment to make this happen was first identified in 2011.  Public health data highlights high levels of deprivation and reduced life expectancy in the area: Barrow is one of the most deprived shire district local authority areas in England.

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 Recent public inquiries regarding the quality of some service provision (such as maternity) has resulted in loss of confidence in services.  Evidence that the poor quality of the estate is having a negative impact on recruitment and retention of professionals to work in the area, which is having an adverse effect on the quality of service.  Recent CQC inspections and reports have indicated that unless the buildings are improved imminently future inspections are likely to fail services, see Appendix 7.  Evidence of a growing local economy and the need to cater for the health needs of increasing volumes of workers and their families.  This investment is critical to delivering the strategic objectives of Morecambe Bay CCG, NHS England, NHS Property Services and the Better Care Together Programme.

The BCT Strategy is a whole systems strategy but within this a key element is the out of hospital model, which has as its foundation the development of integrated core teams, within natural communities. At present, GP practices and community services are provided in Barrow from a multiplicity of buildings throughout the town, with little or no joint provision, poor building conditions and no opportunity to integrate services. The Alfred Barrow Health Centre development was one of the main estates developments highlighted in the Better Care Together Strategy as it has the potential to provide buildings so that services, especially general practice, can be provided in a safe and appropriate environment and to act as a catalyst to transformation of integrated services between primary and community care.

The Full Business Case was approved by Cumbria CCG, prior to the boundary change, on 15 March 2017 subject to the project remaining within the affordability gap. On 13 March 2017 the Chief Finance Officer/Director of Governance of Lancashire North CCG provided a letter of comfort to confirm support and commitment to the scheme from the CCG and to welcome approval of the FBC by Cumbria CCG. The revenue consequences and forecast revenue savings have transferred from North Cumbria to Morecambe Bay CCG and been factored into the financial plans.

Primary Care Proposal

There are three practices proposed to relocate from their existing premises into the new Alfred Barrow Health Centre:

 A82010 Abbey Road Surgery, 243 Abbey Road, Barrow-in-Furness, LA14 5JY

The practice currently has three GP partners; Dr M G Wyatt, Dr A Thimmiah and Dr E Mitsis. The practice list size is 6,726 (as at 15 October 2018).

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September 2017 December 2017 March 2018 June 2018

6,706 6,703 6,715 6,724

The practice is 1.3 miles (6 minutes) by car, 1.2 miles (25 minutes) on foot, and 1.3 miles (17 minutes) by public transport from the proposed new site on Duke Street.

 A82062 Atkinson Health Centre, Market Street, Barrow-in-Furness, LA14 2LR

The practice currently has four GP partners; Dr A Khshetrapal, Dr S S Choudhury, Dr A P Weijak and Dr J E Corrin. The practice list size is 4,705 (as at 15 October 2018).

September 2017 December 2017 March 2018 June 2018

4,718 4,727 4,731 4,723

The practice is 0.2 miles (1 minute) by car and 0.2 miles (4 minutes) on foot from the proposed site on Duke Street.

 A82072 Risedale Surgery, 2-4 Gloucester Street, Barrow-in-Furness, LA13 9RX

The practice currently has four GP partners; Dr G C Jolliffe, Dr I A M O’Donovan, Dr A Gupta and Dr R H Wyatt. The practice list size is 6,739 (as at 15 October 2018).

September 2017 December 2017 March 2018 June 2018

6,881 6,858 6,837 6,799

The practice is 1 mile (3 minutes) by car, 1 mile (17 minutes) on foot, and 1 mile (8 minutes) by public transport from the proposed site on Duke Street.

The locations of the three surgeries including their existing practice boundaries, and the location of the former Alfred Barrow School site are all detailed at Appendix D. Please note that Abbey Road Surgery, if it relocates to the Alfred Barrow Health Centre will actually sit outside of the existing practice boundary. There is actually no stipulation within the regulations that a practice premises has to be within the boundary it covers and the practice have indicated that they do not wish to apply to change their boundary. When the initial Outline Business Case and Full Business Cases were prepared a change in boundary was not discussed as a necessity. 3 | P a g e

Patient Consultation

There has been a comprehensive engagement programme undertaken in relation to the practice moves to the new Alfred Barrow site. The details of which are contained within the attached patient engagement report which is attached as Appendix 1.

Effects on groups protected by the Equality Act 2010

An full equality impact assessment has been completed in relation to the Alfred Barrow site, a copy of which is attached as Appendix 2.

Strategic plans for the area

The move of the three GP Practices into the Alfred Barrow site will support the national and local strategic aims of increased integration of primary and community services. The physical co-location of services will assist with the implementation of, and enable changes to, operational working practice which is felt could improve the care pathways for local patients.

Financial Impact

The Full Business Case sets out the detailed financial information to illustrate that the scheme is affordable and delivers a return on investment within the CCGs’ five-year plans. The scheme will deliver savings that will arise following the new integrated working which the building will support including reduced non-elective admissions as integrated core teams of GPs, community and specialist nurses and others ensure through more effective care planning that unnecessary admissions are avoided and reductions in outpatient appointments and follow ups.

The net cost of the project to the commissioners is a total of £767,620 broken down as below: • NHS E £360,502 • CCG £407,118

Both commissioners have confirmed that these costs are included in the financial plans. However, they have also made clear that, given the financial challenges facing the NHS locally and nationally, these figures represent affordability caps for the project.

Risks

If approved, the proposed relocation could result in patients having to travel an increased distance to access services. The distance in some circumstances could be significant enough that patients have to access public transport with associated inconvenience and costs. This is considered minimal as the distance to the new Alfred Barrow Health Centre is between 0.2 miles and 1.3 miles and has not been sighted as a major concern during the patient engagement exercise. 4 | P a g e

If the proposal is refused, patients will continue to access services within an aging estate in need of significant investment. Scope for innovation will be limited and space will increasingly become limited. Patients will continue to access services from a range of different sites and the benefits linked to increased patient access will not be achieved.

Policies

Policy context in relation to premises are attached at Appendix C.

Recommendation

Members of the Morecambe Bay Joint Committee are recommended to approve the proposal to ensure that services are relocated into a new, purpose-built healthcare facility on the former Alfred Barrow School site in Barrow-in-Furness.

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Appendix 1 – Patient engagement Summary Report

Alfred Barrow GP Practice Relocation- Patient Engagement reportv2.docx

Appendix 2 – Alfred Barrow Equality Impact Assessment

26 APPENDIX TWENTY SIX - FULL EIA 16th June 2016.pdf

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Appendix B – Practice Demographic Breakdown

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Appendix C – Policy and Guidance Manual

7.15 Premises 7.15.1 A contractor may wish to make changes to its contracted practice premises (including branch surgeries – for further information, see paragraphs 7.15.7 to 7.15.25 below) from which services are provided.

7.15.2 This would likely be a significant change to services for the registered population and as such the Commissioner and the contractor must engage in open dialogue in the first instance to consider the consequences and implications of the proposed change and discuss any possible alternatives that may be agreed between them.

7.15.3 The Commissioner and contractor, through their dialogue, may establish that there is a need to retain medical service provision in the locality and must seek to find a solution, which could include tendering for a new provider within that locality, though not necessarily within the same premises.

7.15.4 Once, and if, the final date for closure is confirmed, the Commissioner will issue a variation agreement notice to remove the registered address from the contract, and as in other variations under this policy, include the wording of the variation and the date on which it will take effect.

7.15.5 The contractor will be fully responsible for cessation or assignment of the lease for any rented premises and any disposal of owner occupied premises.

7.15.6 While it is likely that a PMS/APMS contract would reflect the terms as laid out in the GMS contract example above, it is essential that the Commissioner reviews the individual contract for relevant provisions that relates to removing the closing premises and any rights associated with that premises.

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Appendix D - existing practice locations and practices areas

A82010 Abbey Road Surgery, 243 Abbey Road, Barrow-in-Furness, LA14 5JY

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A82062 Atkinson Health Centre, Market Street, Barrow-in-Furness, LA14 2LR

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A82072 Risedale Surgery, 2-4 Gloucester Street, Barrow-in-Furness, LA13 9RX

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