AGENDA FOR PRIMARY CARE COMMITTEE
Part 1
11th December 2019, 15:30 – 16:30
Hall 1, Community Centre, 32 Merchant Street, London, E3 4BX
Item Time Item name Enclosure/ Page Action Lead no. verbal Required 1.1 15:30 Declarations of Interest Julia Slay & Minutes of the previous Enc. A 2 - 4 For meeting: Part 1 approval 1.2 15:35 Wood Wharf project Enc. B1-5 5 – 69 For Dean Musk approval 1.3 15:45 Island Medical decant Enc. C 70 – 82 For Alison O’Grady approval 1.4 15:55 Wellington Way Enc. D 83 – 89 For Alison O’Grady communications plan approval 1.5 16:05 Finance Report Enc. E 90 - 100 To Note Steve Collins 1.6 16:15 Healthwatch research - Urgent Verbal - To Note Karen Bollan Treatment Centres and A&E 1.7 16:25 AOB All NEXT MEETING Primary Care Committee in Common on 14th or 21st January 2020 Venue to be confirmed
Please look over the agenda and reflect on whether any topics or papers might present an area of interest for you. This means an item where a decision or recommendation made may advantage you, your family and/or your workplace. These advantages might be financial or in another form such as the ability to exert unseen influence. If anything on the agenda has the potential to put you in such a position, or raised in the meeting along the way, you should inform the meeting attendees and Chair immediately. This means we can ensure that our decision, recommendations or actions can be guarded from the impact of any possible conflict you or others could have or be seen to have. If you are unsure, it is best to raise the possibility with the chair before the meeting or at any point during the meeting if a possible interest strikes you. This openness is important and ensures we can discuss how to manage decision making in a complex environment and learn together how to manage these issues effectively. Meeting attendees are agreed that we will challenge others on areas of interest or possible conflict as it is recognised that sometimes these issues can be overlooked.
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Enclosure A
Primary Care Committee Minutes Part 1 15:30 – 16:30 Date: 13th November 2019 Venue: Community Centre, Hall 1, 32 Merchant Street, E3 4BX Chair: Mariette Davis
In attendance: Karen Bollan Healthwatch Representative Healthwatch Non-Voting Steve Collins Executive Director of Finance THCCG Voting Mariette Davis Governance Body Member for Governance THCCG Voting (Chair) Alison Goodlad Deputy Director of Primary Care (North East London) NHSE Non-Voting Dr Nicola Hagdrup Representative GP THCCG Non-Voting Olya Klufas Senior Commissioning Manager THCCG Primary Care Jenny Mazarelo Director of Primary Care (Interim) THCCG Primary Care Gareth Perry Project Support Officer THCCG Primary Care Jo-Ann Sheldon Head of Primary Care THCCG Primary Care Apologies: Jackie Applebee Local Medical Council representative LMC Non-Voting Somen Banerjee Public Health representative LBTH Non-Voting Maggie Buckell Governing Body Registered Nurse Member THCCG Voting Selina Douglas Accountable Officer/Managing Director THCCG Voting Angela Ezimora-West Assistant Head of Primary Care (North East London) NHSE Non-Voting Pacifique Kimonyo Performance and Quality Manager THCCG Non-Voting Virginia Patania Governing Body Member for Primary & Urgent Care THCCG Non-Voting
Dr Rebecca Rosen Independent Clinical Advisor THCCG Voting Julia Slay Governing Body Lead for Patient & Public Involvement THCCG Voting
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ACTION LOG SUMMARY Agenda Action Due date RAG Lead item # rating Previous actions 3.3 Update Terms of Reference as per suggestions made November GP New actions 1.4 CCG to create a document containing all moves and mergers Early 2020 JS with timelines, to be brought to a future meeting.
Item Item name Lead # 1 Welcome, introduction and apologies Mariette Davis The Chair welcomed everyone to the Committee. Apologies noted and listed on page one of the minutes. 1.1 Declarations of Interest Mariette Davis None noted. 1.1 Minutes of the previous meeting Mariette Davis • Part 1 The minutes of Part 3 of the Primary Care Committee in Common held on the 1st October 2019 agreed as accurate. SC’s title noted as incorrect, has now been amended.
1.2 Finance Paper: Month 6 Olya Klufas Highlights • PC spending currently keeping in line with allocation and expenditure. • Currently over on spending of GMS and QOF due to recharging of patients under GP at Hand. Finance are chasing for an update on these numbers from NHSE. • Growth rate of new patients is increasing. • Noted that this will be the last year of local QOF, as next year practices will revert back to national QOF • PCN payments are ongoing. • Payments for social prescribing and pharmacists remain outstanding but NELCA have informed this should be arriving soon.
Comments The committee have been impressed by the quality and information in the finance reports. OK will continue to develop these.
3 1.3 PCN update Alison • There is currently a focus on a new OD package and training for PCNs. Goodlad • All PCN managers were requested to provide areas in their Networks they want to improve, leadership planning etc. • A small amount funding has been saved for activities at a London level. • There is also funding available in North East London for events, likely to be taking place in January. • The majority of funding allocated to the CCG is based on weighted capitation.
The NIS will likely have duplication of funding with items in the DES and will therefore need a review. Unfortunately, no draft specification of the DES is yet available to make the required comparison and amendments.
1.4 AOB • Stroudley Walk and Merchant Street Update There has been communications with MPs etc. over last 6 months. Unfortunately, due to construction delays etc. it has been difficult to confirm a move date. Letters could not go out to patients until a final move date could be agreed. Currently the likely move day will be January/February 2020 • Patients have been a bit anxious around this process. Practices have been asked to identify patients with vulnerabilities or mobility issues. Support can then be provided to these patients.
ACTION: CCG to create a document containing all moves and mergers with timelines, to be brought to a future meeting.
End of Part 1
4 Enclosure B
Primary Care Committee Enclosure
Date of meeting 11 December 2020 B 1.2 Agenda item Wood Wharf, an introduction and project update Title of report: Dean Musk, Head of Estates & Jack Dunmore, Estates Project Officer Author(s): Dean Musk, Head of Estates Presented by: Sponsor (if different): For further information
• A Project Initiation Document (PID) was put into London Borough of Tower Hamlets (LBTH) in July 2019 for s106/community investment levy (CIL) capital. In September 2019 Wood Wharf Health Centre gained approval. • To approve the grant funding of £5,780,000.00 to provide a modern health facility within the Wood Wharf development. This will provide sufficient capacity to meet projected population demand and support the introduction of new models of care to deliver a broader range of integrated primary care and community health services to the local community. (Ref, LBTH Grants Committee 11th September 2019). • WEL CCG Strategic Finance & Investment Committee (SFIC) approved the procurement and development of the project through NHS Property Services which has been developed Executive summary through local practice and network consultation through the design quality indicator (DQI) to RIBA 2 (due to complete 6th December 2019). • LBTH & Canary Wharf Group (CWG) Ltd. s106 agreement (planning) between the two parties requires LBTH to approve the s106 obligation on CWG to provide a health centre on Wood Wharf by 9th February 2020. • In order to do this, WEL CCG must have an approved business case for the project in January 2020. • CCG primary care strategy outlines proposed alignment of Wood Wharf estates project to local APMS procurement. This procurement will be subject to full PCC business case approval. Encl. Strategic Finance & Investment Committee (SFIC) – August 2019 Estate Paper, London Borough of Tower Hamlets Grants Approval
5 Minutes September 2019, AECOM RIBA 0 Cost Report, LBTH Project Initiation Document (PID)
Recommendation: Approval in principle of the Wood Wharf project to serve the current and future projected population on the Isle of Dogs, subject to WEL CCG Strategic Finance & Investment Committee (SFIC) approval in January 2020.
Information Approval To note Decision
Conflicts of Interest There are no identified conflicts of interest in this approval; conflicts will be managed through the APMS Procurement Business Case.
Key issues As outlined in the executive summary and relevant enclosures.
Report history None
Patient and Public Full Local Patient & Public Involvement to be undertaken as part of involvement APMS procurement.
Link to the Board The CCG priorities relating to this report are as follows: Assurance Framework CO (1) - To work in partnership to commission high quality hospital services that are accessible, provide the appropriate treatment in the right place, and achieve good patient outcomes for people of all ages living in the borough CO (3) - To contribute towards a financially sustainable and responsive health and care economy which delivers value for money and innovation and supports the appropriate use of services
Impact on Equality and There are no identified negative impacts on equality & diversity. Diversity Resource requirements There is no additional resource requirements as part of this sought approval.
Next steps SFIC Wood Wharf Business Case Approval in January 2020.
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Enclosure B1
Date 16th August 2019 Author(s) Dean Musk, Head of Estates To Strategic Finance & Investment Committee – 20th August 2019 – Agenda item 11
Report Title:
Update on Wood Wharf capital project and request for approval to appoint NHS Property Services to deliver the project
1.0 Executive Summary
1.1 Further to the approval by London Borough of Tower Hamlets (LBTH) of a THCCG project bid for funding of the Wood Wharf capital scheme to allow a new primary care health centre to be developed on the Isle of Dogs (to the East of Canary Wharf) THCCG has submitted a full project initiation document to LBTH. The application for the requested £5.78m is expected to be approved by the LBTH Cabinet in October 2019. 1.2 THCCG plans for the new health centre to accommodate a new APMS practice (potentially combined with the current Island Medical APMS practice). NHS Property Services will hold the head lease from the landlord. The head lease will run for 25 or 30 years while the under lease with the APMS operator will run for only 10 or 15 years, hence it is not possible for the GP practice to lease direct from Canary Wharf Group. 1.3 The new health centre will be a shell and core fit out within a new build mixed use development. This is as per current THCCG schemes such as Sutton’s Wharf and Goodman’s Fields. The developer and landlord in this case is the Canary Wharf Group. The Canary Wharf Group have an obligation under a Section 106 agreement to offer space for a new health centre to the NHS, however, this is on commercial terms. NHS Property Services are leading on the head lease negotiation with Canary Wharf Group in the same way as they successfully did for Sutton’s Wharf and Goodman’s Fields. 1.4 As per the NHS’s recent experience on the Goodman’s Fields project the negotiations with the developer are certainly commercial and hence it is essential for the NHS to be well placed for these and in good time for critical stages of the negotiation. The Canary Wharf Group (CWG) are claiming that as a result of a formal notice issued by them in May 2019 there is a deadline for the NHS Property Services to reach Agreement for Lease with CWG of 9th February 2020. The terms of the Section 106 agreement between LBTH and the CWG are open to interpretation, however, it is prudent to work to that deadline. If NHSPS are to enter into formal Agreement for Lease with the developer by that deadline then the NHS business case will need to be approved before then and that will require the internal fit out design to have been progressed and costed to at least concept stage (RIBA Stage 2) by the end of 2019. 1.5 THCCG now needs to confirm its procurement strategy for taking this project forward, and to commence the design phase of the project as soon as possible to complete concept design given only 4 months are available for what would normally take at least 6 months. 1.6 Identified options for progressing the project include NHSPS, East London FT (ELFT), LBTH or direct procurement of the professional team by THCCG. LBTH have been approached and while this may be an option in future setting up such an arrangement would not be possible in the timeframe for
7 this particular project. Direct procurement by THCCG is also an option for the future, however, at this time there is not capacity within THCCG to support this. 1.7 NHSPS and ELFT are both considered as viable options for delivery of the project as both are currently progressing THCCG capital schemes. NHSPS has progressed the St Paul’s Way health centre to completion for THCCG and is currently progressing Wellington Way, Sutton’s Wharf and Goodman’s Fields. ELFT is currently progressing Aberfeldy Village for THCCG. 1.8 This paper considers the existing involvement of NHS Property Services (NHSPS) with the project in terms of negotiating and holding the head lease from CWG, the increasing urgency to progress the design given the deadline of February 2020, the respective offers from NHSPS and ELFT to progress the project for THCCG, and the risks on this particular project. The recommendation to SFIC is that THCCG now progresses the project with NHSPS as to progress this particular project with an alternative such as ELFT would risk complications at a later stage (primarily in terms of property and legal issues) which would jeopardise achieving the deadline of February 2020.
2.0 Wood Wharf background
2.1 The GLA population projections for the Isle of Dogs suggest an increase of over 45,000 residents by 2033 and this is supported by the continuing level of residential development. For this reason THCCG is planning to increase primary care capacity on the Isle of Dogs. 2.2 To facilitate this expansion of primary care capacity THCCG is able to take advantage of Section 106 (S160) Town Planning agreements between commercial residential/mixed use developers and LBTH. These S106 agreements offer health centre accommodation (at D1 market rents) and/or contributions to the associated health centre fit-out costs. One such opportunity is space for a new health centre which is currently offered by the Canary Wharf Group (CWG). This is within Canary Wharf’s new mixed use district of Wood Wharf which includes 3,300 new homes. The space will need to be leased on commercial D1 usage terms and NHSPS is leading on the negotiations with the Canary Wharf Group. The space is leased as a shell and core unit, and the rental cost is therefore approximately half of what it would be for a fully fitted-out health centre. 2.3 The normal approach taken by THCCG is to for NHSPS to lease as shell and core, and then for THCCG to attract S106/CIL capital grant from LBTH to fit out the premises. Normally NHSPS has then been instructed by THCCG to fit out the health centre using the S106 funds accessed by THCCG. This is the approach that was taken at St Paul’s Way and that is being taken at Sutton’s Wharf and Goodman’s Fields. NHSPS then normally sub-lease the accommodation to the relevant GP practice operator and this provides a safeguard to THCCG in case of the GP practice surrendering the lease for any reason e.g. if the GP practice were to go out of business for any reason NHSPS could then re-let the space to the next primary care provider. 2.4 In the case of relatively short term APMS contracts such as Goodman’s Fields and Wood Wharf it will assist THCCG that NHSPS holds the head lease and can re-let the space on re-procurement of the APMS contract. THCCG has explored both with ELFT and LBTH if they might be interested in performing this role in the case of Wood Wharf, however, they have not been interested in doing so to date. 2.5 THCCG has made an application to LBTH to attract £5.78m for the development of the Wood Wharf Health Centre and LBTH approval of this is anticipated in October 2019. 2.6 In the case of St Paul’s Way, Wellington Way, Sutton’s Wharf and Goodman’s Fields THCCG has employed NHSPS to lead on the health centre fit out capital project i.e. to appoint and manage out-sourced architects and engineers to design the new facility, and to then procure a suitable building works contractor to undertake the works. In the case of Aberfeldy Village THCCG has employed ELFT in this role.
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3.0 Wood Wharf programme and urgency
3.1 In early 2019 the Canary Wharf Group advised that the completion of the Wood Wharf shell that had been anticipated for 2022 would be brought forward to February 2021. The reason for this is that the reduction in demand for commercial space has driven the earlier completion of the residential elements of the scheme and hence the trigger point (of dwellings developed) that commits CWG to offering the health centre to the NHS. 3.2 As a result of this THCCG needed to prioritise in 2019 the completion of the PID to LBTH requesting S106/CIL funds to progress the Wood Wharf fit out capital project. The bid was submitted March 2019 and was approved June 2019, and the PID was then promptly submitted to LBTH in June 2019. Approval of the PID is now anticipated in October 2019. 3.3 As a result of the protracted application and approval process for the S106/CIL funds THCCG had considered progressing with NHSPS in advance of LBTH approval e.g. either by asking NHSPS to commence its procurement of the design team in advance of THCCG formally instructing NHSPS on the project and/or a limited formal instruction to commence the design. This was, however, stood down in June 2019 when the STP team queried the appointment of NHSPS and suggested that THCCG should formally appraise its options in terms of the fit out. 3.4 Programme pressure built further in June 2019 when the CWG suggested that as a result of a notice issued in May 2019 it had set the “clock ticking” on a deadline of 9th Feb 2019 for NHSPS to reach Agreement for Lease for the shell and core with Canary Wharf Group. 3.5 This deadline is questionable given CWG did not in May 2019 issue a Heads of Terms including a proposal on the rental cost, however, as it may not be possible to immediately rebut the 9th Feb 2019 deadline it is prudent to accept it for the time being and work to it pending a challenge of its legitimacy. 3.6 The only way that THCCG can meet this deadline of 9th Feb 2019 would be progress the design urgently and target a business case approval on the basis of a costed concept stage design (RIBA stage). That would be approval on the same basis on which Goodman’s Fields was approved i.e. RIBA 2 concept stage rather than RIBA 4 technical stage as tendered. Normally NHSPS would not be prepared to take a head lease on behalf of a CCG without full business case (FBC) approval and normally FBC requires technical stage design and costs as tendered. 3.7 It is therefore urgent to clarify the procurement route of the design and to commence the fit out project. The project timescales suggested by NHSPS and ELFT as below are tight to achieve a costed RIBA stage 2, but achievable if we can avoid complication.
4.0 Programme risk and need for immediate start
4.1 The property aspects of the project are always complex i.e. NHSPS negotiating a head lease from the developer (in this case CWG) and the letting the under-lease to the GP practice. In the case of Wood Wharf the property aspects of the project are further complicated by the fact there will not be an identified primary care provider to hold the under-lease until the APMS contract is procured. This immediately complicates how the Licence for Alterations (LFA) would be agreed with NHSPS if they are not both holding the lease and undertaking the works. How it would be managed with ELFT is unclear and at best this would complicate and delay. An aspect of this is that that the head lease is on the basis of a shell and core and NHSPS would charge a shell and core rent to the GP practice, while, as a result of the S106/CIL funded fit out works, leasing to the GP tenant a fully fitted out premises.
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4.2 When the LBTH S106/CIL capital grant is confirmed by LBTH it will be necessary to promptly progress the project to concept stage design (RIBA Stage 2) as there will only be Oct 2019 – Dec 2019 for this and that is shorter than normally required. It is achievable, however, we would normally allow 6 months to get to that point. January 2020 will be required for the approval of the business case and for NHSPS to finalise the agreement for lease with CWG once the business case is approved. 4.3 Canary Wharf Group (CWG) are of the view that agreement for lease (AFL) will need to be reached with NHSPS by 9th February 2020 and in which case the outline/full business case for Wood Wharf will need to be approved in January 2020. That will require the health centre design to have been progressed to at least concept (RIBA Stage 2) stage by December 2019 to allow a cost review and demonstration that the £5.78m budget is sufficient. 3.2 As the S106 funding approval is not anticipated until Oct 2019 this would allow only 2 months for a design process which would normally take around 6 months. For that reason it is recommended that the RIBA stage 1 is progressed by THCCG ASAP (in advance of the S106 funding approval by LBTH) in Aug/Sept 2019. That would allow Oct – Dec 2019 for RIBA stage 2 with commencement of RIBA stage 2 as soon as the S106 is approved. As will be appreciated it will be important that procurement issues do not delay THCCG progressing the Wood Wharf project e.g. as they did in the case of ELFT managing the Aberfeldy Village project.
4.0 Wood Wharf cost breakdown
Wood Wharf Capital Area Breakdown M2 1056 £/m2 £ Measured Works 1,830 1,933,000.00 Prelims & OH&P 25% 506,000.00 Sub-Total incl. Prelims and OH&P 2,310 2,439,000.00 Contingencies 25% 506,000.00 Sub-Total incl. Contingencies 3,215 3,395,000.00 Inflation 5.66% 190,000.00 Sub-Total Estimated Construction Costs 3,395 3,585,000.00
Consultant Fees & Surveys 532,550.00 FFE & IT Group 3 & 4 548,600.00 BREEAM Allowance 150,000.00 Sub-Total Project Costs 1,231,150.00
Total (less VAT) 4,816,150.00
VAT @ 20% 963,230.00
Total (incl. VAT) 5,780,000.00 *
* Rounded as per AECOM RIBA 0 Report
10 5.0 Construction delivery options
5.1 The options for the progressing the construction delivery of the £5.78m fit out project include the following:
• THCCG to procure the multi-disciplinary professional services directly and in due course the works contract (along with the client direct items that THCCG normally procures e.g. furniture and IT) • LBTH to do so as they would for one of their own projects • ELFT to do so as per Aberfeldy Village project • NHSPS to do so as per other St Paul’s Way, Wellington Way, Sutton’s Wharf and Goodman’s Fields projects
6.0 Appraisal of delivery options
6.1 Direct procurement by THCCG of the multi-disciplinary project team and in due course the building contract is in theory an option, however, the normal CCG approach is clearly to out- source service provision. The additional client side resource which would take time to put in place even if direct procurement were agreed and there is not time for this on this particular project.
6.2 In theory LBTH should be an option given they are a trusted partner that works very closely with THCCG. LBTH also has a well-resourced property team that manages its own projects, however, in practice THCCG has not yet been able to sufficiently engage with the LBTH property team in connection with the THCCG estates strategy and related opportunities for joint working e.g. co-location of social care with NHS care . If there were an appetite to work in this way then it would take time to agree between THCCG and LBTH and there is not time to do so on this occasion.
6.3 For this reason the options appraisal below is a comparison of ELFT and NHSPS:
11 Score ELFT NHSPS Note (1, 2 or 3) Affordability 3 - Green 2 - Yellow NHSPS 3% of main contract cost. ELFT 2% of main contract cost, however, NHSPS would need to review the ELFT design and approve it and would require payment for doing so which would reduce the difference in cost. Programme 2 – Yellow 3 - Green ELFT proposal allows a more rapid commencement, however, the complexity of ELFT undertaking works to an NHSPS building is highly likely lead to significant delays at a later stage as the complexity of this is worked through. Quality 3 - Green 3 - Green Both providers are able to procure and mobilise suitably qualified and experienced (out-sourced) professional teams e.g. architects, quantity surveyors etc. Risk 1 - Red 3 - Green While ELFT are performing well on Aberfeldy there is a great deal of risk in terms of the property issues involved in ELFT undertaking works to an NHSPS owned building i.e. in terms property legalities. For example the landlord approval of a Licence For Alterations (LFA) would be complicated given no tenant has been identified to “own” what are technically regarded as “tenant improvement works”. NHSPS are a far lower risk option given the programme urgency here in part because they will hold the head lease.
Result 9 11 NHSPS is preferred.
7.0 Recommendation to SFIC
7.1 THCCG to instruct NHSPS to commence design as soon as possible and to complete to RIBA Stage 2 by the end of 2019 calendar year. 7.2 Prior to approval of Section 106 funding by LBTH (anticipated October 2019) the cost of the initial design work (RIBA stage 1) to be underwritten by THCCG revenue (approx. £20,000).
END
12 GRANTS DETERMINATION (CABINET) SUB- SECTION ONE (UNRESTRICTED) COMMITTEE, 11/09/2019
LONDON BOROUGH OF TOWER HAMLETS
MINUTES OF THE GRANTS DETERMINATION (CABINET) SUB-COMMITTEE
HELD AT 5.30 P.M. ON WEDNESDAY, 11 SEPTEMBER 2019
COMMITTEE ROOM ONE - TOWN HALL MULBERRY PLACE
Members Present:
Councillor Candida Ronald (Chair) (Cabinet Member for Resources and the Voluntary Sector) Mayor John Biggs (Executive Mayor) Councillor Asma Begum (Member) (Deputy Mayor and Cabinet Member for Community Safety and Equalities) Councillor Sabina Akhtar (Cabinet Member for Culture, Arts and Brexit) (Substitute for Councillor Sirajul Islam)
Other Councillors Present: Councillor Tarik Khan (Scrutiny Lead, Resources)
Officers Present:
David Esdaile (Environmental Sustainability Officer) Afazul Hoque (Head of Corporate Strategy & Policy) Abdul Khan (Service Manager - Energy & Sustainability) Rachel Mckoy (Head of Commercial & Contracts, Legal Services Robert Mee (Interim Voluntary & Community Sector Team Manager) Matthew Quin (Healthy Environment’s Programme Lead, Public Health)
Zoe Folley (Committee Officer, Governance)
1. APOLOGIES FOR ABSENCE
Councillor Sirajul Islam.
2. DECLARATIONS OF INTERESTS
Councillor Asma Begum declared a Non-DPI interest in Agenda Item 6.1 This was on the basis that Councillor Tarik Khan was a Trustee of Tower Hamlets Youth Sports Foundation.
1 13 GRANTS DETERMINATION (CABINET) SUB- SECTION ONE (UNRESTRICTED) COMMITTEE, 11/09/2019
Councillor Tarik Khan declared a Non-DPI interest in Agenda Item 6.1. This was on the basis that he was a Trustee of Tower Hamlets Youth Sports Foundation
Councillor Sabina Akhtar declared a Non-DPI interest in agenda items as she knew some of the organisations listed in the agenda.
Councillor Candida Ronald declared a Non-DPI Interest in agenda item 6.6 Wood Wharf Health Centre. This was because she was a Trustee of the Island Health Medical Trust that had a Trust in Blackwall
3. UNRESTRICTED MINUTES
RESOLVED:
The minutes of the meeting held on 3rd July 2019 were presented and approved as a correct record of proceedings.
4. CONSIDERATION OF PUBLIC SUBMISSIONS
There were none.
5. EXERCISE OF MAYORAL DISCRETIONS
None
6. OVERVIEW & SCRUTINY COMMITTEE- ADVICE OF KEY ISSUES AND QUESTIONS
Councillor Tarik Khan (Scrutiny Lead for Resources) presented the feedback from Overview Scrutiny Committee Members during each of the items.
7. REPORTS FOR CONSIDERATION
7.1 Local Community Fund
Afazul Hoque, (Head of Corporate Strategy & Policy) presented the report setting out proposals for implementing the mitigating actions identified for the Local Community Fund agreed at Cabinet on 31st July 2019 including the extension of mainstream grants (MSG) funding for community language strand and for lunch club from 1 October 2019 to 31 March 2020. Appendix A listed the funding proposals. It was noted the 4 organisations that had been successful in securing LCF funding had not been listed. He also provided an update on the MSG transitional Arrangements and Equality Mitigation actions as set out in Appendix B.
Councillor Tarik Khan (Scrutiny Lead, Resources) advised of the Overview and Scrutiny Committee’s questions on this report regarding: the duplication of funding in terms of organisations recommended for LCF funding and the availability of support to organisations unsuccessful in the LCF process. It was
2 14 GRANTS DETERMINATION (CABINET) SUB- SECTION ONE (UNRESTRICTED) COMMITTEE, 11/09/2019
noted that the written responses to these questions had been circulated and would be published on line.
In response to questions about the feedback and support provided to unsuccessful applicants, it was noted that Officers had provided feedback to such organisations and were waiting for few organisations to confirm their availability to meet. The Council was also actively working with the THCVS, (who they have commissioned to provide capacity support) to help organisations with business planning and applying for appropriate grant funding. Applications for funding from the Emergency Funding scheme were assessed on a case by basis against the revised criteria agreed by the Grants Determination Sub Committee. Unforeseen circumstances could include issues arising from the LCF.
The mitigations measures included support for maintaining participation and access for BME Communities.
In response to further questions from the Sub – Committee, Officers agreed to bring a further report to the next meeting of the Grants Determination Sub Committee on:
Somali Groups - in terms of the mitigations measures and the support available for these groups. Somali Senior Citizens Club - details of any urgent issues, particularly around the provision of infrastructure in time for the opening of Granby Hall Centre. Renaming of the Emergency Fund to make the purpose of the funding clearer. Provide an update on the play sports, older people, early years reports, as requested by Cabinet.
In response to questions about ‘hard to reach groups’, Officers reported that they would explore with the TH CVS, the option of providing a more tailored service. Officers would also check the following theme to clarify the focus of this.
‘provision for early years age children or pregnant and new mothers’
RESOLVED:
1. Agree to extend funding to the organisations listed at Appendix A at the current level of funding under the council’s mainstream grants programme (MSG) for a period of six months from 1st October 2019 to 31st March 2020, subject to the same funding conditions as those in place for MSG funding and also subject to continued satisfactory performance.
2. To note the progress relating to the transitional arrangements and equality mitigation actions for services whose current MSG funding
3 15 GRANTS DETERMINATION (CABINET) SUB- SECTION ONE (UNRESTRICTED) COMMITTEE, 11/09/2019
comes to an end on 30 September 2019 as set out in appendix B of the report
7.2 ESF Community Employment programme update
Robert Mee (Interim Voluntary & Community Sector Team Manager) presented the update report on grants that have been awarded through the European Social Fund (ESF) Community Employment Programme which is co-financed through the European Union and administered by London Councils. The reported included a closure report for round 1 and updates on rounds 2 and 3, the latter was the final round.
Councillor Tarik Khan advised of the Overview and Scrutiny Committee’s questions on this report. These related to: the use of unallocated funding. Written responses to these questions would be provided and published on line.
In response, Officers advised that they had yet to formulate proposals on the use the unallocated funded, (once it had been returned to the Corporate Match funding budget for community projects). It was possible that the funding may be allocated towards funding community groups and to help mitigate any impacts from the LCF. Given this, Officers advised that they intended to wait for further information on the impact of the LCF mitigations measures, before formulating plans.
The Sub – Committee also agreed with the Officers proposals to not participate in round 4.
RESOLVED:
1. Note the organisations and projects provisionally funded through Round 3 of the ESF Community Grants Programme as detailed in 3.8 and 3.9 of the report.
2. Note the update on the outcome of Round 1 as detailed in 3.4 and 3.5 and Appendix 1.
3. Note the progress of projects funded in Round 2 as detailed in 3.6 and 3.7 and Appendix 2.
7.3 Community Benefit Rent Reduction update
Robert Mee (Interim Voluntary & Community Sector Team Manager) presented the report on grants that have been awarded by the Community Benefit Rent Reduction Panel at its meetings on 6 February and 3 July 2019. 7 organisations had been successful in gaining funding for the 80% rent reduction.
4 16 GRANTS DETERMINATION (CABINET) SUB- SECTION ONE (UNRESTRICTED) COMMITTEE, 11/09/2019
Councillor Tarik Khan advised of the Overview and Scrutiny Committee’s questions on this report. These related to the requirements around the provision of evidence demonstrating a projects commitment to the Equality Act 2010 in their application. It was noted that written responses to the questions would be circulated and published on line.
In response, Officers provided assurances about the requirements in relation to this. It was confirmed that projects were required to show that they had achieved a quality standard or accreditation. Equalities and diversity are assessed as part of these standards, for example the Matrix Standard.
In response to questions about the publicity arrangements, Officers outlined how the projects were identified. In particularly, they highlighted the role of the Council’s Asset Management Team in identifying projects that met the criteria for the rent reduction scheme and providing information on the scheme.
RESOLVED:
1. Note the organisations and projects funded through the LBTH Community Benefit Rent Reduction Scheme as detailed in 3.6 of the report.
7.4 MSG Project Performance Report - Extension Period 03 (April to June 2019)
Robert Mee (Interim Voluntary & Community Sector Team Manager) presented the report. The report covered red and amber performance rated projects for the extension period April to June 2019.
Councillor Tarik Khan (Scrutiny Lead Resources) advised of the Overview and Scrutiny’s Committee’s question on this report. This related to the need to provide additional resources to manage the Toynbee Hall, Wellbeing in Tower Hamlets project improvement plan– which was Amber rated.
In response, it was confirmed that Officers worked with groups that underachieved to develop improvement plans. Officers would continue to provide support to the Toynbee Hall project by way of helping them to deliver the revised targets, (agreed for the extension period). There has been no indication that the organisation is using additional resources for this.
RESOLVED:
1. Note the performance of the Mainstream Grants (MSG) programme as set out in 3.3 – 3.6 and the premises update 3.7 – 3.9 of the report
5 17 GRANTS DETERMINATION (CABINET) SUB- SECTION ONE (UNRESTRICTED) COMMITTEE, 11/09/2019
7.5 Schools Energy Retrofit Programme - Phase 2
Abdul J Khan, (Service Manager – Energy Sustainability & Private Sector Housing) and David Esdaile, (Environmental Sustainability Officer) presented the report regarding the deliver the Schools Energy Retrofit Programme.
Councillor Tarik Khan (Scrutiny Lead Resources) advised of the Overview and Scrutiny Committee’s questions on this report. These related to: the work that had been carried out to ensure all schools are aware of the opportunities, the plans to target schools who may be in greater need and the support provided to schools to apply for the funding.
In response, Officers advised of how the Council publicised the initiatives to schools, through school bulletins for example. The application process provided a window for schools to raise expressions of interests and allow smaller schools to prepare applications. Officers also provided technical support to help schools with their applications. Regarding the targeting of particular schools, it was noted that the funding was available to all schools - given that the primary aim of the initiative was to reduce carbon emissions.
Officers would provide a list of all the schools funded.
Officers also outlined a number of the other carbon reduction grant programmes to support Small and Medium Sized Enterprises and community centres.
RESOLVED:
1. Approve the grant funding of £250,000 to deliver the Schools Energy Retrofit Programme.
2. Delegate Officer Authority to the Service Manager for Energy, Sustainability & Private Sector Housing to approve grants up to £30,000
7.6 Goodman's Fields Health Centre - To approve the additional grant funding of £2,055, 526 from £4,824,474 (incl. VAT) to £6,880,000.00 (incl. VAT).
Matthew Quin, (Healthy Environment’s Programme Lead, Public Health), presented the report relating to the release of an additional £2,055,526 of funding to NHS Tower Hamlets Clinical Commissioning Group (CCG). He advised of the need for the request to meet the additional unforeseen costs set out in the report. This project would enable the treatment of additional patients and provide high quality health facilities.
Councillor Tarik Khan (Scrutiny Lead Resources) advised of the Overview and Scrutiny’s Committee’s questions on the report. These related to: the key difference between the council’s internal estimate and the consultants and the
6 18 GRANTS DETERMINATION (CABINET) SUB- SECTION ONE (UNRESTRICTED) COMMITTEE, 11/09/2019
actions that have been undertaken to prevent this type of deficit occurring again. Written responses to these questions would be circulated and published on line.
The Sub - Committee also asked questions about the escalation in the costs of the project, and asked about the work that had been carried out to ensure the request was reasonable. Members also discussed the consequences of not agreeing this funding for the project. Members also noted the need for new health facilities in this area.
In response, Officers confirmed that the Tower Hamlets CCG supplied the original cost estimates based on an in house assessment, to progress the application for LBTH support. The estimates were subsequently revised at the design stage. TH CCG have now taken steps to prevent such requests, and the Council’s Infrastructure and Viability Team felt this was request was justifiable.
Officers also provided reassurances about the revised costs report, in light of the the appointment of an international design and construction consultancy as costs and design consultants.
RESOLVED:
1. To approve the additional grant funding of £2,055,526 from £4,824,474 (incl. VAT) to £6,880,000.00 (incl. VAT).
7.7 Wood Wharf Health Centre - To approve the additional grant funding of £5,780,000.00 (incl. VAT).
Matthew Quin, (Healthy Environment’s Programme Lead, Public Health), presented the report relating to the grant funding of £5,780,000.00 to provide a modern health facility within the Wood Wharf development.
Councillor Tarik Khan advised of the Overview and Scrutiny Committee’s Questions on this report. These related to the costs of the project, how it had been calculated and whether the CCG were obliged to return any underspend to the Council. Written responses to these questions would be circulated and published on line.
In response, Officers provided details of the cost assessment - based on benchmarking information to identify lessons learnt. The costs included funding for a variety of facilities and full details of which would be set out in the supplemental agenda with the written responses. As the Council only pay based on invoices, the Council would only pay for spend incurred and any residual balances would be retained and reprogrammed.
RESOLVED:
1. To approve the grant funding of £5,780,000.00 to provide a modern health facility within the Wood Wharf development. This will provide
7 19 GRANTS DETERMINATION (CABINET) SUB- SECTION ONE (UNRESTRICTED) COMMITTEE, 11/09/2019
sufficient capacity to meet projected population demand and support the introduction of new models of care to deliver a broader range of integrated primary care and community health services to the local community.
8. ANY OTHER UNRESTRICTED BUSINESS CONSIDERED TO BE URGENT There were none.
The meeting ended at 6.50 p.m.
Chair, Councillor Candida Ronald Grants Determination (Cabinet) Sub-Committee
8 20 Capital Programme Delivery Wood Wharf – a new primary healthcare facility for the Isle of Dogs (Blackwall & Cubitt Town Wards) Project Initiation Document (PID)
21 Document Control
Jack Dunmore – Estates Project Officer 25th June 2019 (NHS THCCG) Authors Date Matthew Quin – Programme Lead for Healthy Environment (LBTH) Department Public Health Phone 6037
Quality Log Review Date Review Method Reviewers
Version Date Summary of Changes Author Initial
1 25/06/2019 Draft WW Document JD
2 27 June 2019 Review and Comments MP
Authorisation (Service Director) Name Date Version Somen Bannerjee 27 June 2019 2
22 Contents
1 PURPOSE AND OVERALL AIM 4 1.1 Purpose 4 1.2 Background 4
2 PROJECT DEFINITION 5 2.1 Strategic Business Case 5 2.2 Risks 11 2.3 Assumptions 13 2.4 Constraints 13
3 PROJECT INTERFACE AND DEPENDENCIES 13 3.1 Interfaces 13 3.2 Dependencies 13
4 OBJECTIVES, SCOPE AND EXCLUSIONS 14 4.1 Objectives 14 4.2 Scope and Exclusions 14
5 EQUALITY IMPACT ASSESSMENT: INITIAL SCREENING 14
6 PROJECT APPROACH 15
7 REFINED OUTCOMES AND PROJECT DELIVERABLES 15 7.1 Desired Outcome Error! Bookmark not defined. 7.2 Project Deliverables Error! Bookmark not defined.
8 PROJECT ORGANISATION 16
9 PROJECT BUDGET ERROR! BOOKMARK NOT DEFINED.
10 PROJECT MANAGEMENT CONTROL 20 10.1 Programme/Project Board 20 10.2 Risks and Issues Log 20 10.3 Reporting 20 10.4 Change Control Procedures 20 10.5 Tolerance Boundaries Error! Bookmark not defined.
11 PROJECT PLAN – KEY MILESTONES 21
12 PROJECT QUALITY PLAN 21
13 PROJECT COMMUNICATION PLAN 22
14 APPENDICES 22
23 1 Purpose and Overall Aim
1.1 Purpose 1.11 Wood Wharf is a new mixed use community located east of Canary Wharf in the Blackwall and Cubit Town wards and forms part of the LBTH local plan completing the Canary Wharf character place in the centre of the Isle of Dogs.
1.12 London Borough of Tower Hamlets placed an obligation of the developer Canary Wharf Group PLC to allocate an s106 site dedicated for health use within the Wood Wharf development to aid in the provision of primary health care for the project population increase of the wa rd; estimated at 23,079 increase to 2018-2033. The Wood Wharf health centre is well pl aced for the new developments in the local area, and will be designed to accommodate a s ignificant proportion of this projected population increase.
1.13 The allocated site has a target GIA of 1,076sqm and is located in close proximity to the new primary school being developed within the Community. With the new health centre s erving both the existing and new population of the catchment area, with sustained residential growth on the Isle of Dogs – with the Wood Wharf site being central to the central and North East of the areas developments.
1.14 Tower Hamlets Clinical Commissioning Group and NHS Property Services (NHSPS) ha ve been working with Canary Wharf Group PLC on the allocated site, negotiating on the uni t a nd are now in a position to work towards an Agreement for Lease between NHSPS and Canary Wharf Group PLC to take a head lease of the facility.
1.15 Within the context of increasing financial challenges it is becoming ever more difficult for health services to fund new facilities and alternative funding sources are being pursued to cross-subsidise this development. The NHS in Tower Hamlets has a successful record in delivering health infrastructure initiatives for the benefit of Tower Hamlets residents, aided by S106/CIL contributions in partnership with the Council.
1.16 This Project Initiation Document (PID) will define the Wood Wharf project and bring together the key components needed to start the project on a sound basis. It also provides the basis for building the principles of project management into the project right from the start by confirming the business case for the undertaking, ensuring that all stakeholders a re clear of their role, agreeingimportant milestones, and ensuring that any risks involved have been assessed.
1.2 Background Project Drivers
1.2.1This project is aligned with the strategic priorities for improved health facilities to ena ble more people in Tower Hamlets to live healthily; ICT investment to facilitate smarter, integrated working; and employment initiatives to create good jobs for local residents.
1.2.2 Improving the physical infrastructure of Tower Hamlets is one of five priorities s et out i n the borough’s Health and Wellbeing Strategy 2017-2020. Physical infrastructure includes the provision of good quality healthcare facilities to support the health and wellbeing of the Tower Hamlets population.
1.2.3 NHS Tower Hamlets CCG Estates Strategy identifies a requirement to development new facilities in the South East Locality to meet future demand for primary care services. The Wood Wharf Health Centre will contribute to delivery of the extra clinical capacity that i s required in the Locality.
24
1.2.4 To enhance the delivery of infrastructure and address the demands that development places on an area, maximising health infrastructure was prioritised through the Tower Ha mlets l ocal infrastructure fund.
Project Objectives
1.25 The project objectives are::
Carry out local consultation in line with NHS process and procedure of the pa ti ent l ist a nd local stakeholder to enable the procurement of a successful provid er to operate the new practice Provide a modern health facility within the Wood Wharf development with sufficient capacity to meet projected population demand and support the introduction of new model s of care to deliver a broader range of integrated primary care and community health services to the local community Ensure the Wood Wharf Health Centre development represents value for money and is affordable to the local health economy To ensure the health and wellbeing needs are met within the Blackwall & Cubitt Town Ward to meet the demand for the growing population of the east of the borough.
2 Project Definition
2.1 Strategic Business Case 2.11 When making decisions, the Council must have due regard to the need to eliminate unlawful conduct under the Equality Act 2010, the need to advance equality of opportunity and the need to foster good relations between persons who share a protected characteristic and those who do not (the public-sector equality duty). A proportionate level of equality analysis is required to discharge the duty.
2.12 Tower Hamlets has one of the lowest healthy life expectancies for both men and women i n the country and health inequalities particularly for BME people are a significant challenge for our communities. Additional infrastructure for GP services, in line with project population increase in the local area, will provide additional resource for the council’s Public Hea lth service (through commissioning) and local health partners to tackle these health inequalities and improve outcomes for local residents, see section 6 for further information.
25 Figure 1: Tower Hamlets Population Projections 2018-2033 by Ward
2.13 The Isle of Dogs region is particularly in need of additional health infrastructure, and extending healthcare provision will enable improved access for the existing population a nd provide future capacity for new residents in the local area. The Wood Wharf Hea lth Centre will therefore be increasing health service availability in a location of appropriate need. By way of example Figure 2: GLA 2016-based Housing-led population projections highlights significant increases in the population demographic of Tower Hamlets. Figures show that the period covering 2018 – 2028, the 0-3yr and 65+yr are higher users of primary health care services compared to other age groups, with an 8% and 39% increase respectively.
26 Figure 2: GLA 2016-based Housing-led population projections
2.14 The Wood Wharf Health Centre will be fully compliant with the requirements and philosophy of the 2010 Equality Act and the Disability Equality Duty contained within the Di sability Discrimination Act. All referenced standards and planning guidance within these documents will be adhered to.
Overview of the Project
2.15 The Isle of Dogs is an area of development opportunity within Tower Hamlets, with significant population increases projected through to 2033, as illustrated in Figure 1: Tower Hamlets Population Projections 2018-2033 by Ward.
2.16 London Borough of Tower Hamlets as planning authority has granted significant areas of the Isle of Dogs planning permission for new development, or redevelopment of exi sting s ites. Figure 3: Vision for Isle of Dogs and South Poplar, extract from LBTH Local Plan to 2031 highlights the areas on the Isle of Dogs with areas of granted planning permission (highlighted in pink); with the population increase for Blackwall & Cubitt Town of 23,079 being associated to these areas of opportunity.
27
Figure 3: Vision for Isle of Dogs and South Poplar, extract from LBTH Local Plan to 2031
2.17 Through London Borough of Tower Hamlets infrastructure planning department, s ites of healthcare need were identified with the Wood Wharf development by Canary Wharf Group PLC being identified.
2.18 Figure 4: Wood Wharf Site and Population Access illustrates the current population access by walking time to the Wood Wharf healthcare facility, prior to any additional access infrastructure constructed by Canary Wharf Group PLC as part of the overall Wood Wharf scheme. Reviewing the access to the areas of development in Blackwall & Cubitt Town, the Wood Wharf site enables a significant proportion of the new residents in the area access to the Wood Wharf facility; whilst enabling greater patient choice to other fa cilities (such as Island Medical) in the local area.
28
Figure 4: Wood Wharf Site and Population Access
2.19 The Wood Wharf Health Centre premises will be constructed to shell and core specification by the site developer, Canary Wharf Group PLC, in fulfilment of a planning obligation under the terms of a Section 106 Agreement. The premises will comprise a target GIA of 1,076sqm. The building is expected to be completed and handed over to the NHS in February 2021. The fit out works is expected to take approximately 12 months, with the health centre becoming fully operational in winter 2022.
Financial Note Year 1 NHS Project 2019-20 Autumn 2019 - Project development will Development commence following grants approval. 2 Contractor Appointed 2020-21 February 2021 - Handover from developer (subject to change) 3 Commencement on Site 2021-22 April 2021 - Start on site following mobilisation circa 3-6 months (Pending handover from developer). 4 Practical Completion 2021-22 April 2022 – approximate 12 month works programme (Pending handover from developer and works period).
29 5 NHS Commissioning 2022-23 6 Months commissioning and practice mobilisation (Pending available overlap with contract works). 6 Facilities Open to the 2022-23 Estimated Winter 2022. Public 7 Project Final Account 2023-24 Estimated Winter 2023/24.
Figure 5: Wood Wharf Outline Project Timeline
2.20 The fitted-out premises will provide up to 18 clinical rooms, a multi-purpose group room, GP training rooms, and associated supporting rooms to deliver community healthcare services. The complete schedule of accommodation will be scoped by Tower Ha mlets CCG through various workshops and modelling with the clinical user group identified for the practice. The additional capacity provided in the new building will enable the practice to deliver an extended range of integrated primary and community health services to tackle health inequalities and improve health outcomes for their patients, in line with the objectives a nd goals set out in the Tower Hamlets Health and Wellbeing Strategy 2017-2020. The facility will also be equipped with the latest information technology to enable patients to access a wide range of primary care services online and to facilitate integrated working across hea lth and social care.
2.21 The proposed development at Wood Wharf, with the support of S106/CIL capital grants, will increase clinical capacity on the Isle of Dogs, access and service provision in primary care and maintain continuity of GP services in the South East Locality of the borough.
2.22 The aim of the proposal is to overcome potential future inadequacies in primary care facilities in the South East Locality due to population increase in the local area. Failure to deliver this development would create a potential risk of insufficient primary ca re capacity being available to meet demand for primary care services in future years arising from planned population growth in the Isle of Dogs Locality of Tower Hamlets. This could result i n reduced access to primary healthcare, longer waiting times for GP and nurse appointments and an increase in the volume of avoidable attendances at accident and emergency services at the Royal London Hospital.
2.23 The new facility project timeline outlined in Figure 5: Wood Wharf Outline Project Timeline, will align with NHS Tower Hamlets CCG’s APMS primary care provider strategy in the l ocal area. The aim of the project is to align the estates strategy with the Island Medical APMS practice procurement which will be carried out in 2021/22 to procure the practice provision from both buildings. This will enable seamless management of the local populations health needs and associated buildings facilities in order to facilitate the del i very of care for the patients. This is subject to formal consultation with the local population and sta keholders , and will build on the expansion of the Island Medical practice which is already underway in its current building.
2.24 NHS Property Services have been negotiating on behalf of the NHS to hold the offered l ease for the premises from Canary Wharf Group PLC. At present this is an operational head l ease of approximately 30years (to be confirmed). As the practice is unable to hold a di rect l ease from Canary Wharf Group PLC, due to at time of negotiation the provider not being identified (due to procurement) and only being able to hold a lease length as l ong a s their contract term (approx. 10-15years).
2.25 The delivery and construction teams will be procured in-line with NHS procurement policy and procedure.
Business Case
30
Overview
2.26 Tower Hamlets Council is working in partnership with NHS Tower Hamlets Clini cal Commissioning Group to improve healthcare facilities in the Borough. Health commissioners have identified an urgent need to improve the healthcare infrastructure i n the South Ea st Locality of the borough to mitigate the impact of current and future increases in population.
2.27 The practices already in the Blackwall & Cubitt Town; Island Medical and Island Health practices do not have the facilities nor capacity to take on the projected population increase in the wards of 23,079 to 2033.
2.28 The Wood Wharf Health Centre will provide the modern facilities and clinical capacity needed to enable a new premises to grow and accommodate a patient list of approximately 17,500 (this is based upon a traditional model of care – NHS THCCG will carry out scoping work as part of the practice procurement as to how digital delivery of healthcare s ervices can a id i n the patient care of the local residents).
2.29 The proposed one-off capital investment in a new health facility at the Wood Wharf development in Blackwall & Cubitt town will enable extra capacity for the l ocality provider, which will include Island Medical and Wood Wharf with modern, fi t for purpose fa cilities where currently they are under increasing pressure to meet local health need.
Demand Modelling
2.30 Future clinical capacity requirement is mainly driven by population growth, as the model projects relatively minimal infrastructure growth being required from shifting activity out of hospital into primary care. As illustrated in Figure 1: Tower Hamlets Population Projections 2018-2033 by Ward.
2.31 The Wood Wharf Health Centre development will create up to 18 new clinical rooms. Tower Hamlets Council is working closely with NHS Tower Hamlets CCG and other s takeholders to develop further initiatives to build primary care capacity in the South East Locality, i ncluding other sites identified through LBTH site planning allocation.
2.2 Risks
2.21 The key risks to this project are set out in the table below:
Table 1
Risk Triggers Consequences Controls
Risk No. Risk Likelihood Impact Total 1 Building Delay while Confirm 1 2 2 Control / permissions these are Developmen obtained not required t control before approvals commencem are required ent of work 2 Cost overrun Additional Costs exceed Extensive 1 1 1 on building works budget planning and
31 Table 1
Risk Triggers Consequences Controls
Risk No. Risk Likelihood Impact Total works requirement quotes not foreseen in obtained for quotes building work. Learning from previous experiences. 3 Service Inability to Alternative Project 1 1 1 disruption provide normal premises managemen GP function requirement or t discussion from the reduction of with existing site service provision developer in when works are order to being minimise undertaken disruption of service 4. Slippage on Project overrun Project 1 1 1 building managemen works t and causing penalties overrun built in 5. ICT Inability to fully Only 1 2 2 equipment utilise new equipment not required equipment meeting the specification necessary / specification incompatibl will be e with ordered existing infrastructur e 6 Uncertainty The UK leaving Project cost Quantity 3 5 15 in the the European increases, and surveyors construction Union reduced ability to (once market forecast appointed) fluctuating effectively. to offer prices and ongoing supply input into chain. market for Project Team. 7 APMS No tender No provider to NHS THCCG 1 1 1 provider returns at point operate from the primary care procuremen of procurement. new premises. team to t design an unsuccessful attractive
32 Table 1
Risk Triggers Consequences Controls
Risk No. Risk Likelihood Impact Total . APMS package within the new build facility.
2.3 Assumptions
2.3.1 The main assumption surrounding the requirement for Wood Wharf is the projected population increase on the Isle of Dogs; this is due to the level of housing development i n the immediate area. The Wood Wharf scope balances these projections in both Blackwall & Cubitt Town and the neighbouring ward Millwall; with its location well located for access to the new property. As outlined in section 2; Figure 3: Vision for Isle of Dogs and South Poplar, extract from LBTH Local Plan to 2031 & Figure 4: Wood Wharf Site and Population Access.
2.4 Constraints
2.4.1 As the project develops a specific Wood Wharf risk register will be maintained and monitored by the project management consultant appointed to oversee the cradle to grave of the construction project. Any constraints will be allocated to the risk register and monitored throughout the lifetime of the project by the associated responsible person(s) and/or project board.
3 Project Interface and Dependencies
3.1 Interfaces
Related Projects
3.11 This project builds on the strong relationship between London Borough of Tower Ha mlets and NHS Tower Hamlets CCG on delivering improved access to good healthcare facilities in the borough. Other capital projects that are being implemented to expa nd a nd upgrade primary care healthcare facilities in Tower Hamlets include:
Re-provision of the St Paul’s Way Medical Centre to a new facility within the William Cotton Place development PID which was approved at IDB in April 2014) Re-provision of the Merchant Street and Stroudley Walk GP practi ces a t the refurbished Wellington Way Health Centre PID which was approved in October 2016 and proposed new ground floor extension at the site, for which a PID was approved in October 2017. Maximising existing health infrastructure PID which was approved in 2016; a project that involves alterations to GP practice premises to create extra clinical capacity to meet increased health need. Goodman’s Fields, which enables the re-provision of the Whitechapel and East One Hea lth practices to a new purpose built facility; this was approved in March 2018.
3.2 Dependencies
33 3.21 There are no other funding sources available for this project and there is no requirement or expectation for match funding. Due to the financial pressures facing the NHS, Tower Ha ml ets CCG does not have access to any capital resources for building projects. However, the NHS wi l l meet the revenue costs for ongoing rental and service charges, the employment of clinical and administrative staff that will be required at the Wood Wharf Health Centre.
4 Objectives, Scope and Exclusions
4.1 Objectives
Deliver a new, fully equipped modern health facility with capacity to accommodate the current and future population of the Isle of Dogs population. The practice should work in synergy with local practices to enable coordinated patient care for the local population.
4.2 Scope and Exclusions
Deliver a new, fully equipped modern health facility with up to 18 clinical rooms in the South East Locality, Deliver new health infrastructure with capacity for up to 17,500 registered patients, Provide up to 147,000 new patient appointment slots in the South-East Locality, based on a utilisation rate of 60%, Upgrade ICT and medical equipment to allow patients to take more control of their care a nd to allow more patient monitoring to be undertaken within primary care, Enable an expansion of the primary care workforce in the South East Locality, equivalent to approximately 1 GP per 1,800 new patients and associated support staff,
5 Equality Impact Assessment: Initial Screening
Target Groups Positive Negative Neutral Reason(s) (Y/N) (H/M/L) (Y/N) Gender Y
Race / Ethnicity Y
Religion / Faith Y
Age Y
Disability Y
Sexual Orientation Y
Socio-economic Y
Any link to Child N/A Poverty Strategy?
As a result of completing above table, what is the potential impact of your project on the various equality groups?
A completed EA analysis can be found in the appendices.
34
Impact Designation High Medium Low x
6 Project Approach
Project Team
6.1 Information regarding the project team is set out below:
Project Sponsor: Somen Banerjee, Director of Public Health, Katy Scammell, Associate Director Public Health (Children & Families) and Matthew Quin Programme Lead for Healthy Environments. Project Manager: Dean Musk, Head of Estates Tower Hamlets CCG and Jack Dunmore Estates Projects Officer Tower Hamlets CCG.
Project Management
6.2 The Project will be managed by NHS Tower Hamlets Clinical Commissioning Group. The CCG has established robust programme management arrangements to ensure consistent des ign and completion of S106 healthcare infrastructure schemes within the requi red programme and budget parameters. The programme is managed by NHS Tower Ha mlets CCG Primary Care Committee (PCC) and Strategic Finance and Investment Committee (SFIC), with regional NHS strategic management governed by East London Health Care Partnershi p. Additional local sign-off through the System Wide Estates and Capital Strategy Group, which is chaired by members of Tower Hamlets Together (THT). The membership of the Estates Strategy Group includes a representative from the Borough.
6.3 The operational delivery of this project will be managed by the Wood Wharf Health Centre Project Board, which reports into and is accountable to NHS Tower Hamlets CCG PCC & SFI C. Membership of the Project Board comprises officers from NHS Tower Hamlets CCG a nd the London Borough of Tower Hamlets and will compromise the construction design and management teams and appropriate clinical representatives from the l ocal practices and patient representatives.
6.4 The Project Board will manage project delivery against programme milestones and the benefits realised against project objectives and the benefits sought. Project evaluation will be an integral part of the overall project management, contract management and commissioning processes.
6.5 Project sponsor and Project Manager will meet monthly with NHS Es ta te project tea m to oversee delivery of all Health s106 related NHS Infrastructure work programmes.
7 Refined Outcomes and Project Design / Deliverables
Deliverables, Project Outcomes and Benefits
7.1 This project will:
Deliver a new, fully equipped modern health facility with up to 18 clinical rooms in the South East Locality, Deliver new health infrastructure with capacity for up to 17,500 registered patients,
35 Provide up to 147,000 new patient appointment slots in the South-East Locality, based on a utilisation rate of 60%, Upgrade ICT and medical equipment to allow patients to take more control of their care and to allow more patient monitoring to be undertaken within primary care, Enable an expansion of the primary care workforce in the South East Locality, equivalent to approximately 1 GP per 1,800 new patients and associated support staff,
7.2 The purchased equipment for the new facility will include IT equipment, examination couches, cabinetry, task chairs and other furnishings required for a fully equipped primary care medical facility.
7.3 It is expected that the new facility will be operational in Winter 2022.
8 Project Organisation
Approach to Delivery and On-going Maintenance/Operation
8.1 NHS Tower Hamlets CCG will apply effective public procurement, prioritising good design outcomes to maximise the social, environmental and economic benefits of the development.
8.2 NHS Property Services will lease (the superior lease) the Wood wharf facility from Canary Wharf Group PLC (CWG) and sublet the entire premises to the successful APMS provider. NHS Property Services do not charge any rent on top of that charged by CWG. Canary Wharf Group PLC will be responsible for external repairs, whilst it the maintenance of internal furnishings and equipment, utilities, rates and insurances will be the responsibility of the successful APMS provider (pending lease structure), in accordance with the terms of the practices’ lease agreements with NHSPS. IT equipment will be maintained by Tower Hamlets CCG.
8.3 All on-going revenue costs arising from this project will be funded by the NHS.
Procurement
8.4 The proposed contractual arrangements in this procurement are as follows:
NHS THCCG will procure an appropriate team of professionals to take forward the scheme design and fit-out works and manage the construction of this development, with capital funding provided via Section 106/CIL capital grants. Construction works are expected to be procured via a traditional form JCT tender (pending professional expertise), with invitations issued to a selected list of contractors who are proven at this scale and scope of NHS fit-out, in accordance with tendering guidelines. The appointed team will include a professional design team, including a contract administrator who will be responsible for compliance in terms of valuations, payments and acceptance of practical completion prior to handover. NHS Property Services will lease the entire shell and core health premises at the Wood Wharf Development for a term to be agreed between the developer, Canary Wharf Group PLC and NHSPS. (Pending lease structure and agreed Heads of Terms between NHSPS and CWG). NHSPS will sub-let the fully fitted out medical suite to the successful APMS GP Practice provider via a full repairing, insurance lease agreement for a term in line with providers contract length (Pending lease structure and agreed Heads of Terms between NHSPS and CWG, & NHSPS and the practice). NHS Tower Hamlets CCG will procure furnishings and IT equipment for the fitted out medical suite, with capital funding provided via a Section 106 capital grant Procurements will be undertaken in accordance with NHS Standing Financial Instructions.
Name Role/Position Organisation/Dept.
36 Matthew Quin Programme Lead – LBTH Healthy Environments Dean Musk Head of Estates NHS THCCG
Jack Dunmore Estates Project Officer NHS THCCG
Key Project Stakeholders
8.5 The principal stakeholders are shown in Table 2 below and will be engaged from the ea rliest stages of the project and through to project closure. The key stakeholders will be enga ged a s required, after delivery is completed.
8.6
Key Stakeholders Role Communication Frequency Method
LBTH Sponsor and Project Board Monthly client lead
NHS Tower Hamlets CCG Supplier Project Board Monthly
Clinical User Group Service Provider Project Board Monthly Expertise
Construction Delivery Building Client Project Board Monthly Team
9.0 Project Budget
9.1 A copy of the RIBA 0 feasibility capital budget can be found in appendix 1.
9.2 Figure 6: AECOM RIBA 0 Feasibility Capital Cost Estimate below sets out the details of the project’s budget and funding sources:
37 Figure 6: AECOM RIBA 0 Feasibility Capital Cost Estimate
9.3 AECOM are an international multi-disciplinary construction & infrastructure consultancy. The cost estimate for construction works have been benchmarked against similar projects
38 currently being progressed, which include Goodman’s Fields and an Outpatient Clinic (further information enclosed within appropriate appendix). No adjustment for l ocati on has been made as this is assumed to be within the Price and Design Risk percentage.
Financial Profiling including Outputs/Milestone and Spend Profile
9.4 Figure 7: Wood Wharf Capital Expenditure vs Project Milestone below sets out the profile of the project’s expenditure over its lifetime. Please note the spend profile is subject to change, pending negotiations with the landlord and unit handover:
Approx (%) £ Financial Year 1 NHS Project Development 1% £57,800.00 2019-20 2 Contractor Appointed 5% £289,000.00 2020-21 3 Commencement on Site 20% £1,156,000.00 2021-22 4 Practical Completion 20% £1,156,000.00 2021-22 5 NHS Commissioning 15% £867,000.00 2022-23 6 Facilities Open to the Publc 30% £1,734,000.00 2022-23 7 Project Final Account 9% £520,200.00 2022-23 Total (incl. VAT) 100% £5,780,000.00
Figure 7: Wood Wharf Capital Expenditure vs Project Milestone
Financial Year Totals Amount 2019-20 £57,800.00 2020-21 £289,000.00 2021-22 £2,312,000.00 2022-23 £2,601,000.00 2023-24 £520,200.00 Total £5,780,000.00
Figure 8: Wood Wharf Capital Expenditure - Total Per Year
Funding Streams Components Total Annual Budget
S106
HRA
Home Office
Dept. of Health
GLA grant
£5,780,000.00 CIL Others (specify)
39 Figure 9: Details of the estimated funding components of the project]
10.0 Project Management Control
10.1 Programme/Project Board arrangements and membership. Project Team
10.11 Information regarding the project team is set out below:
Project Sponsor: Somen Banerjee, Director of Public Health Project Manager: Dean Musk, Head of Estates Tower Hamlets CCG and Jack Dunmore Estates Projects Officer Tower Hamlets CCG.
Project Management
10.12 The Project will be managed by NHS Tower Hamlets Clinical Commissioning Group. The CCG has established robust programme management arrangements to ensure consistent des ign and completion of S106 healthcare infrastructure schemes within the required programme and budget parameters. The programme is managed by NHS Tower Ha mlets CCG Primary Care Committee (PCC) and Strategic Finance and Investment Committee (SFIC), with regional NHS strategic management governed by East London Health Care Partnership. Additional local sign-off through the System Wide Estates and Capital Strategy Group, which is chaired by members of Tower Hamlets Together (THT). The membership of the Estates Strategy Group includes a representative from the Borough.
10.13 The operational delivery of this project will be managed by the Wood Wharf Health Centre Project Board, which reports into and is accountable to NHS Tower Hamlets CCG PCC & SFI C. Membership of the Project Board comprises officers from NHS Tower Hamlets CCG a nd the London Borough of Tower Hamlets and will compromise the construction design and management teams and appropriate clinical representatives from the l ocal practices and patient representatives.
10.14 The Project Board will manage project delivery against programme milestones and the benefits realised against project objectives and the benefits sought. Project evaluation will be an integral part of the overall project management, contract management a nd commissioning processes.
10.15 Project sponsor and Project Manager will meet monthly with NHS Es ta te project tea m to oversee delivery of all Health s106 related NHS Infrastructure work programmes.
10.2 Risks and Issues Log
10.2.1 Risk log can be found above.
10.3 Reporting
10.3.1 The CCG will report to the Health, Adults and Communities Capital Delivery Working Group Monthly on financial profiling and performance management, chaired by Public Health.
10.3.2 Public Health will represent LBTH on project working group.
10.4 Change Control Procedures
10.4.1 All change controls will be initially managed through the Health, Adults and Communities Capital Delivery Working Group, receiving approval from project sponsor.
40
10.4.2 Appropriate exception report documentation will be completed and submitted to appropriate decision making forums.
10.5 Tolerance Boundaries
10.5.1 A breakdown of financial tolerances and contingencies can be found in s10.2.
11.0 Project Plan - Key Milestones - Gantt
FINANCIAL NOTE YEAR 1 NHS Project 2019-20 Autumn 2019 - Project development will Development commence following grants approval. 2 Contractor Appointed 2020-21 January 2021 - Handover from developer (subject to change) 3 Commencement on Site 2021-22 April 2021 - Start on site following mobilisation circa 3-6 months (Pending handover from developer). 4 Practical Completion 2021-22 April 2022 – approximate 12 month works programme (Pending handover from developer and works period). 5 NHS Commissioning 2022-23 6 Months commissioning and practice mobilisation (Pending available overlap with contract works). 6 Facilities Open to the 2022-23 Estimated Winter 2022. Public 7 Project Final Account 2023-24 Estimated Winter 2023/24.
12.0 Project Quality Plan
Quality Statement
12.1 For quality assurance, the Wood Wharf Health Centre will be developed in accordance with all relevant NHS guidance for healthcare building design, technical requirements and good practice in stakeholder engagement, including the following:
Health Building Note 00-01 General design guidance for healthcare buildings. HBNs give best practice guidance on the design and planning of new healthcare buildings and on the adaptation or extension of existing facilities. Any derogations from HBN’s will be s igned off by the Wood Wharf project board team, and a derogation schedule kept for record. Health Technical Memoranda (HTMs) give comprehensive advice and guidance on the design, installation and operation of building and engineering technology used in the delivery of healthcare. BREEAM Healthcare sets the standard for best practice in sustainable building design, construction and operation and has become one of the most widely recognised measures of a building’s environmental performance. The aim is for this development to achieve a BREEAM rating of ‘very good’, in accordance with BREEAM Criteria for fitted out premises. This will be the minimum rating, pending obligations set out in the s106 a greement which may stipulate an ‘excellent’ rating to be achieved. On-going design assurance – such as Design Quality Indicator (DQI) wi ll be a fa cilita ted process that takes the form of structured workshops to assess and evaluate the qua lity of building design. As an example, the Design Quality Indicator empowers the building’s stakeholder community by providing a structured way to talk about their new building. By
41 encouraging effective communication between suppliers and the eventual users of the building, the process helps suppliers deliver excellent buildings attuned to the users’ needs.
13.0 Project Communication Plan
Stakeholder Communications
13.1 As part of its remit, the Wood Wharf Health Centre Project Board will develop a communications strategy that will aim to:
provide clear, consistent information to stakeholders at key stages of the project issue and publish the key messages to patients and key stakeholders ensure that the parties delivering the project are aware of their communications responsibilities raise awareness of the project via the local media ensure patients and key stakeholders of local practices are fully informed in a timely manner about the arrangements for the relocation to the new premises at Wood Wharf.
13.2 Target audience may include, but not exclusive to:
Local practices, Registered patients of local Practices, Local Patient Participation Groups, Tower Hamlets Health watch, London Borough of Tower Hamlets, Ward Councillors, Tower Hamlets CVS, NHS England, Local MP Local Medical Committee Local Pharmaceutical Committee Tower Hamlets CCG Local media
13.3 A communications plan will be compiled at the appropriate point in the project.
9 Appendices
- AECOM RIBA 0 Wood Wharf Feasibility Capital Estimate - Equalities Analysis
42 Wood Wharf Health Centre Project and Clinical Service Brief
43 Document control Version Date Detail Author Distribution Draft Version 09/07/2019 Outline heading draft J JD, LP, CC 1.0 Dunmore Draft Version 15/07/2019 LP & JD Input L Phillips JD, LP, CC 2.0 Draft version 01/08/2019 LP input L Phillips JD, LP, CC 3.0 Draft Version 09/08/2019 JD Input J JD, LP, CC, 4.0 Dunmore Draft Version 12/08/2019 Final draft J JD, LP, CC, DM 5.0 Dunmore Draft Version 13/08/2019 Minor sourcing and J LP 6.0 formatting Dunmore
44 1. Introduction This document sets out the background for a new health and wellbeing centre to be located at the Wood Wharf development on the Isle of Dogs, London. Wood Wharf is a new build residential development being built by Canary Wharf Group, with the facility due for completion in January 2021. The facility provides a space with a total GIA1 of 1,076sqm. This will provide space for primary and community care services and treatment for a local population planned to grow up to ~15,000 patients. The new facility will provide additional capacity in the area to support the growing population. The services are to be commissioned by Tower Hamlets Clinical Commissioning Group (THCCG). The capital funding will be provided by London Borough of Tower Hamlets, sourced from Section 106 and Community Investment Levy funding.
The document is in three parts. The first section (background) summarises the role of Wood Wharf Health Centre in the context of health care provision and premises development in Tower Hamlets, the second section describes the overarching principles and ambitions of the project and the final section describes the clinical service brief.
1 GIA = Gross Internal Area
45 2. Background
2.1 Healthy Spaces programme Wood Wharf forms part of Tower Hamlets’ Healthy Spaces programme, which is the story of how health and wellbeing facilities are being transformed in the borough and the journey that is being undertaken to get there. The programme is not only about how facilities are being developed, but about the approach to providing services, changing the way health and social care professional’s work, and the way staff involve each other and patients in the delivery of care and embedding technology at every stage. The Healthy Spaces programme is evolving with the delivery of each new health centre and is currently being shaped by the following live developments: St Paul’s Way Health Centre Wellington Way Health Centre Sutton’s Wharf Health Centre Goodman’s Field Health Centre Aberfeldy WellOne Health Centre Wood Wharf Health Centre 2.2 Evolving service models Health and social care services are constantly evolving and the way the population want to access services is changing too. Patients’ expectations are growing and more and more people want to manage their own healthcare and be involved in the care of their loved ones. At the same time, the local workforce is diversifying and what staff want and need from a health and wellbeing facility is growing in ambition every year. Multidisciplinary teams from local organisations need to be able to work together across different sites accessing data from a number of information systems either directly with patients or remotely. To lead the way, premises need to be more agile, connected and creative in the way they enable services to be designed and delivered to meet the needs of the population. To do this best practices in design and construction needs to be combined with population health analysis and evidence- based health and wellness interventions.
2.3 Wood Wharf Health Centre opportunity Wood Wharf Health Centre is key in enabling the way health and social care can be delivered to the growing population on the Isle of Dog. The Draft London Plan, published by the GLA in December 2017, set Tower Hamlets the second highest housing target in London after Newham. Over 54,000 new homes are expected to be built in the borough by 2030/31 with 49% of these concentrated in the Isle of Dogs (Canary Wharf and Blackwall and Cubitt wards). Wood Wharf has been designed to provide a new residential led, mixed use, waterside community defined by the quality of its public spaces, the diversity of its land uses and activities, and its exemplary architecture. The health and wellbeing centre will provide primary and community services and treatment for a local population planned to grow to ~15,000 patients and will sit
46 alongside over 3,300 new homes, nearly 2 million sq. ft. of high quality commercial office space, and a further 490,000 sq. ft. of shops, restaurants and community uses. The site represents one of central London’s largest privately owned development sites extending to 23 acres and is recognised as being of major importance on a local, national and international level. Completion is currently expected in 2023. With this in mind, as a Clinical Commissioning Group, it is strongly held that the health and wellbeing centre represents the leading thinking in healthcare delivery and accountability to its local community.
2.4 Wood Wharf Health Centre vision The design will need to meet the needs of a wide variety of stakeholders who will be using the health and wellbeing facility, whilst maximising resources.
The vision for the facility is to provide a flexible, modern service which responds to the unique demographics and needs of the local population and provides an innovative, responsive and accessible primary care service. The model of care will move away from the traditional GP-led service, based on face-to-face consultation, to offer a more proactive service with a greater focus on preventative medicine. The service will evolve to offer patients a more responsive, triage-led model which takes advantage of the opportunities presented by new ways of working and technology, whilst maintaining the close links with the local community and a person-centred approach; THCCG foresee that with further developments to the NHS App, we expect patients to be active partners in their care and app utilisation will be monitored as its functionality develops and taken account in design. Within the Wood Wharf premises, the concept is for space to be used flexibly, with the opportunity for multiple providers to work from the same accommodation. Using the space more efficiently is key, with the plan being to create space for the community to share, creating something relevant for now, but which can also grow in the future as the population increases and services evolve. In doing so, it will create the space to work in a new way, enabling new thinking between teams, fostering innovation and starting new conversations between staff, patients and the public. It will enhance relationships between healthcare professionals, patients, the local community and the public allowing the achievement of even more in terms of health outcomes.
47 3. Project Brief 3.1 Guiding principles Four local principles guide the approach to developing the new facility:
People-led: The space will be uniquely designed to fit the population and workforces needs. Staff and the public will feel inspired by the space itself, and by the possibilities it offers in terms of health and wellbeing. It needs to be a space that works for today, and enables future needs to be met. A place which caters for a multitude of working styles, personalities and preferences so that staff, patients and the public can all use the facilities in the way they want whilst providing the best access and achieving the best patient outcomes possible.
Wellbeing-focused: As part of the philosophy, it will combine best practices in design and construction with evidence-based health and wellness interventions. It will harness the built environment as a vehicle for supporting human health, well-being and comfort.
SMART-designed: With Smarter London Together1 in mind, the facilities will be easy and uncomplicated to access and work in, and technology and the services environment will work smoothly and effortlessly.
Technology-enabled: Staff need to easily connect with each other and the public in an era of agile working – face-to-face and through technology. The design will enable better engagement with teams across the system allowing better management of care and new ideas to flow and links to be made. 3.2 Overarching ambitions There are 5 overarching ambitions for the space.
3.2.1 Inspiring the public, patients and staff
Data driven design insights from current and projected population and workforce, supported by health outcome analysis will be at the heart of the development of the health and wellbeing centre and provision of services. Data analysis will inform CCG design decisions and underpin the entire development. In-depth research into the population and premises over a number of years will allow the population to be understood – their needs, access and service preferences. The future of clinical practices, trends in workforce and service provision, evolving integrated care systems and the impact of the technological disruptors will shape the space and how staff, patients and the public engage with it. Aligned to the goals of the workforce Staff want to shape how they work, and many come to work for an experience and to be part of a community. The multidisciplinary workforce will be listened to carefully in the planning of this health facility with a view to creating an inspiring space that is enjoyable to use and helps staff deliver at their best. There will be collaborative spaces, social spaces, individual and team spaces, formal and informal spaces creating a stimulating, dynamic environment that inspires staff to deliver to their potential. It
48 will represent the local health system as an innovative, future-focused health system, and by enabling and engaging the workforce it will play a critical role in attracting and retaining the very best talent for the population.
We will also look to rebrand traditional healthcare room names, with more relaxed and friendly references; as an example moving away from the negative connotations surrounding ‘waiting rooms’ and moving into ‘lobby’ or ‘foyer’, ‘consult exam rooms’ to ‘Suite #’ to illustrate that any kind of clinical or non-clinical delivery can take place from the space. 3.2.2 Wellbeing and sustainability The sustainability vision for Wood Wharf health centre is factored around creating a health centre which puts wellbeing at the forefront and achieving a high level of sustainable design in line with environmental goal. Using a user-centric biophilic philosophy the design will prioritise light with sensors ensuring optimal levels. Temperature, air quality, humidity and ambient noise will also be monitored. Ergonomic design will be inherent throughout, with consideration of sit-stand desks to cater for individual needs. Breakout areas will allow for meals away from desks, with healthier food choices promoted both for staff, and patients. Facilities supporting wellbeing such as a multi-faith room, a nursing area, cycle bays (where required), and shower facilities will be designed in and there is also the ambition for a small calming tech-free haven for quiet time. Natural materials, calming colours and warm textures will be incorporated throughout the interiors. Living plants, moss walls and images of nature will bring the building to life. BREEAM and inclusion of International WELL Building Standards will be used to guide decisions at every stage. Environmental impacts will be fundamentally considered to safeguard against, where possible, the premise that if a population attains a given level of health by exploiting the environment unsustainably, then it is likely to be doing so at the expense of other populations – now or in the future. 3.2.3 Connecting people Building effective relationships is fundamental to achieving better health outcomes, so this is at the very heart of this development. The design of a health centre enables staff, patients and the public to meet and connect in different ways, providing new opportunities to create ideas and share perspectives.
Flow of interactions and cohesive team working The physical space itself will be designed to bring people together, encouraging movement around the building and across teams. The space will encourage people to meet in a variety of environments to suit different activities. For example navigation and promotion will take place in an open atrium, education and community activities will take place in group spaces, office space will be configured for agile flexible approaches and clinical
49 space will enable care to delivered around the patient instead of around room configurations and historic siloed working practices.
Connecting through technology As well as being connected by the space, people – staff, patients and the public – will be connected by technology which is simple to use and reliable. This will include but is not limited to registrations, appointment booking, patient information, remote consultations, online prescriptions and health record access. 3.2.4 Working efficiently Intelligent building technology Wood Wharf Health Centre will aim to embed intelligent building technology as part of creating an efficient health centre for the future.
Intelligent building data will provide a new level of insight, informing decisions on how to occupy the building to drive real value in terms of efficiency and an improved user experience providing a foundation on which continuous learning and improvement can be made. As an example, digital wayfinding screens throughout the building will support users; connected to sensors, this shows real time availability and usage of rooms and the occupation levels of difference spaces (e.g. waiting rooms, reception areas and clinical rooms). 3.2.5 Flexing to our needs Thinking about space differently Wood Wharf will move away from the traditional allocation of space. Instead it will be shaped around clinical, non-clinical and public zones and flexibility will be designed in. Capacity is critical, and incorporating shared spaces and non-assigned seating where possible will change the way the health centre works. This will allow all staff to be accommodated efficiently whilst maximising resources. Staff numbers across the borough will continually fluctuate as the system of care evolves and therefore this approach will enable future proofing. The possibility of exploring flexibility within the physical elements of the building, enabling clinicians to move between providing services face-to-face to digitally via a computer screen and video link and multipurpose areas such as the waiting area and team spaces which adapt as required will be explored with modular seating that can be shaped and reshaped.
Behind the scenes The efficiency and patient-centricity of the health and wellbeing centre will be reliant on an effective centre management service. The centre management team will have a have a concierge style role within each zone of the centre, building close relationships with visiting patients and staff teams to make navigation and flexible, agile working simple.
50 4. Clinical Service Brief 4.1 Provision of care Tower Hamlets primary care services have been rated amongst the best in London by the Care Quality Commission (CQC) with many of its practices rated as providing an ‘outstanding’ or ‘good’ quality of care to patients. Wood Wharf Health Centre will enable the borough to continue to meet these standards by:
Offering patients improved access to NHS primary medical care services through additional capacity, opening hours and consultation methods Maintaining, and where necessary improve, the quality of primary medical care services available to patients; Delivering affordable and Value for Money (VfM) NHS primary medical care services; Ensuring the service is underpinned by effective audit and best practice; and Ensuring that the Provider is properly integrated into the local health community, at both the existing and future practice premises locations, and has effective links with all acute trusts within the locality, with the local authority, the CCG and other local Providers.
4.2 Service range The services to be provided will be centred on primary medical care, delivered by a combination of clinicians including GPs, Nurses, Pharmacists and associated practitioner groups. Services will be delivered on a face-to-face and remote consultation basis, and will extend from health information, public health and prevention through to advice, treatment and referral onwards to specialist secondary and community services. This service will focus on models similar to Integrated Practice Units (IPUs). IPUs are a structure for delivering care through highly coordinated multidisciplinary teams, organised around the patient.
4.3 Catchment
51 2
4.4 Population characteristics There are two populations of differing need to which Wood Wharf will serve:
Resident population, Working population, The current local resident population have the following top four highest percentages of long term conditions based upon registered patients3:
Hypertension (High blood pressure), Asthma, Depression, Diabetes, As such THCCG would aim for the new building to mitigate any potential negative health impacts by designing in line with the principles of the WELL Building Standards. The local working population may choose to register with their local practice for work in order (if required) to visit a clinical professional during their working hours. The practice will be able to offer remote triaging of the patient with a view to book quick appointments where required on the day.
2 Source: Shape Mapping Tool – Estimated Catchment Area – Subject to Change 3 Source: Edenbridge August 2019
52 4.4.1 Population projections 4 %change by %change by Ward 2019 2025 2030 2025 2030 Blackwall and Cubitt Town 32025 44405 51244 39% 60% East India and Lansbury 20001 25498 30012 27% 50% Millwall 33117 41843 47720 26% 44%
4.5 Service exclusions Although there will be a Pharmacist advisory service to patients and clinicians, the scope of services offered will not include a retail Pharmacy. However, there are plans to provide a retail Pharmacy elsewhere in the Wood Wharf development. Note that all patient records and notes will be stored electronically; there will be no paper records either for current or historic patient care.
4.6 Primary Care Commissioning model The services at Wood Wharf will be procured by THCCG using an Alternative Provider Medical Services (APMS) contract. This will be procured with a focus on:
Digital access to primary healthcare, Population patient and resident preventative healthcare, 4.7 The Legal Model The facility at Wood Wharf will be leased by NHS Property Services (NHS PS), on behalf of THCCG from Canary Wharf Group ltd. (CWG Ltd.) with a sub-lease to the successful APMS provider. 4.7 Functional working environments There will be five different environments within the health centre:
4 Population Projections supplied by GLA
53 Staff Open
Support Private
Work
The different environments will comprise different rooms which include standard consulting rooms, training consulting rooms, treatment rooms – to which we would look to define as ‘Suites’ and a work environment which include facilities for remote consultations including telephone triage and video conferencing.
54 4.8 Functional relationships
55 4.9 Pathways, processes and flows – overview 4.9.1 Patient Pathway - Planned
4.9.2 Triage Typically, following Triage, there will be there possible outcomes; the split out of 30 patients handled through remote triage is as follows:
5 patients will be seen for quick (5 minute) check-ups, 5 patients will be seen for full appointment (15 minute) or referred on to another service, 20 patient cases will be dealt with on the phone either by self-care, medications, prescriptions etc. 4.9.3 Appointments Appointments booked may be either quick (for rapid examination and decision making around 5 minutes), a full appointment (15 minutes) or a double appointment (up to 30 minutes), depending on the presenting condition and the nature of the patient determined as part of the triaging process. This may also include, at time of booking, the allocation of two members of the clinical team to be part of the appointment e.g. doctor and nurse.
56 4.9.3 Patient Pathway - Unplanned
57 4.9.3 Admin Pathway – Back of House
58 4.9.4 Admin Pathway – Front of House
59 4.10 Anticipated future service developments There are a number of potential developments which could impact on the model of care and patient flows, and the overall use of the facilities:
Improving self-diagnostic tools: the current patient interface via the self-check-in screens and the apps used for appointments booking could be extended to allow patients to input key health metrics (e.g. height and weight) and also to carry out self-diagnosis using a set of interactive algorithms, which would either refine the clinical decision-making process or make a face to face consultation unnecessary (e.g. providing self-care advise, dispensing prescriptions for minor conditions) The volume of patients who are able to be consulted with, and treated, remotely may increase given the local demographic of projected population; this could lead to a future model where remote consultation were taken outside of the practice (e.g. to a central facility). The space vacated could be returned to face to face clinical use. This should be considered when design office accommodation. Patients may have the ability to access their health records in the future, either using their own devices (remote) or via the technology in the practice. Further developments to the NHS App, we expect patients to be active partners in their care and app utilisation will be monitored as its functionality develops and taken account in design.
4.11 Schedule of Accommodation
60 Wood Wharf - Schedule of Accomodation RIBA 1 Instruction Unit Area Allowance Total Preferred Environment Space / Room Quantity (m2) Area (m2) Storey Open 1 Entrance Foyer 1 6 6 2 Reception (4 places) 4 5.5 22 G 3 Meeting Room 1 8 8 G 4 Interview Room 1 8 8 G 5 Public Space - Seating Area 14 1.7 23.8 G or 1st 6 Public Space - Childrens Seating Area 6 2 12 G or 1st 7 WC Semi Ambulant 3 2.5 7.5 G or 1st 8 WC indepdent wheelchair 2 4.5 9 G or 1st 9 Infant Changing Room 1 6 6 G or 1st 10 Infant Feeding Room 1 8 8 G or 1st 11 Self Health POD's Private Space 2 5 10 G Private 11 C/E Rooms - Standard 6 15 90 G or 1st 12 C/E Room - Large 1 18 18 G or 1st 13 Treatment Rooms - Double sided couch 6 18 108 G or 1st 14 Treatment Room - Large 1 21 21 G or 1st 15 Treatment Room - Three sided couch 1 18 18 G or 1st 16 Multi-use Health Space (incl. Store) 2 20 40 G Support 17 Dirty Ultility Room 1 8 8 1st 18 Clean Utility Room 1 12 12 1st 19 Cleaners Room 1 8 8 G 20 Disposal Hold 1 11 11 G 21 Server Room 1 12 12 22 Facilities Store 1 10 10 G 23 Plant Room 1 30 30 G Work 24 Private office (2 spaces) 1 12 12 1st 25 Open plan office 25 5.5 137.51st 26 Reception back office 6 5.5 33 G 27 Meeting Room 1 12 12 28 Print Room 1 8 8 29 General Store 1 8 8 Staff 30 Staff changing suite 9 1.5 13.5 G 31 Staff Shower 2 4 8 G 32 Staff WC ambulant 2 2 4 G or 1st 33 Staff WC indepdent wheelchair 3 4.5 13.5 G or 1st 34 Staff Living Suite - Kitchen, dining and relax 1 40 40 G or 1st Sub-Total Room requirements (sqm) 795.8 Clinical Rooms + Group + Interview / Meeting 19 Clinical Rooms + Group 17 Clinical Rooms 15
Circulation Allowance 25% 198.95 Engineering Space Allowance 5% 39.79 Plant & Engineering Allowance 5% 39.79 35% Total Allowances 278.53
Total Sq. M 1074.33 Total Sq. M Building 1076 Variance -1.67 61 Financial Year Equality Analysis (EA) 2019/20
See Section 1 – General Information (Aims and Objectives) Appendix A
Name of the proposal including aims, objectives and purpose Current decision (Please note – for the purpose of this doc, ‘proposal’ refers to a policy, function, strategy or project) rating
Wood Wharf – a new primary healthcare facility for the Isle of Dogs.
Carry out local consultation in line with NHS process and procedure of the patient list and local stakeholder to enable the procurement of a successful provider to operate the new practice, Provide a modern health facility within the Wood Wharf development with sufficient capacity to meet projected population demand and support the introduction of new models of care to deliver a broader range of integrated primary care and community health services to the local community Ensure the Wood Wharf Health Centre development represents value for money and is affordable to the local health economy To ensure the health and wellbeing needs are met within the Blackwall & Cubitt Town Ward to meet the demand for the growing population of the east of the borough.
Conclusion - To be completed at the end of the Equality Analysis process (the exec summary will provide an update on the findings of the EA and what outcome there has been as a result. For example, based on the findings of the EA, the proposal was rejected as the impact on a particular group was unreasonable and did not give due regard. Or, based on the EA, the proposal was amended and alternative steps taken)
Name: (signed off by)
Date signed off: (approved)
Service area:
Team name:
Service manager:
Name and role of the officer completing the EA:
Section 2 – Evidence (Consideration of Data and Information)
62 What initial evidence do we have which may help us think about the impacts or likely impacts on service users or staff?
Section 3 – Assessing the Impacts on the 9 Groups
Please refer to the guidance notes below and evidence how you’re proposal impact upon the nine Protected Characteristics in the table on page 3?
For the nine protected characteristics detailed in the table below please consider:-
What is the equality profile of service users or beneficiaries that will or are likely to be affected? Use the Council’s approved diversity monitoring categories and provide data by target group of users or beneficiaries to determine whether the service user profile reflects the local population or relevant target group or if there is over or under representation of these groups
What qualitative or quantitative data do we have? List all examples of quantitative and qualitative data available (include information where appropriate from other directorates, Census 2001 etc) - Data trends – how does current practice ensure equality
Equalities profile of staff? Indicate profile by target groups and assess relevance to policy aims and objectives e.g. Workforce to Reflect the Community. Identify staff responsible for delivering the service including where they are not directly employed by the council.
Barriers? What are the potential or known barriers to participation for the different equality target groups? Eg- communication, access, locality etc.
Recent consultation exercises carried out? Detail consultation with relevant interest groups, other public bodies, voluntary organisations, community groups, trade unions, focus groups and other groups, surveys and questionnaires undertaken etc. Focus in particular on the findings of views expressed by the equality target groups. Such consultation exercises should be appropriate and proportionate and may range from assembling focus groups to a one to one meeting.
Additional factors which may influence disproportionate or adverse impact? Management Arrangements - How is the Service managed, are there any management arrangements which may have a disproportionate impact on the equality target groups
The Process of Service Delivery? In particular look at the arrangements for the service being provided including opening times, custom and practice, awareness of the service to local people, communication
Please also consider how the proposal will impact upon the 3 One Tower Hamlets objectives:-
Reduce inequalities
63 Ensure strong community cohesion Strengthen community leadership.
Please Note - Reports/stats/data can be added as Appendix
64
Target Groups Impact – Reason(s) Positive or Please add a narrative to justify your claims around impacts and, Adverse Please describe the analysis and interpretation of evidence to support your conclusion as this will inform decision making What impact will Please also how the proposal with promote the three One Tower Hamlets objectives? the proposal -Reducing inequalities have on specific groups of -Ensuring strong community cohesion service users or -Strengthening community leadership staff? Race Neutral On the specific item of ‘race’, Wood Wharf will enable access to primary healthcare facilities for all residents of Tower Hamlets. Disability Neutral On the specific item of ‘disability, Wood Wharf will enable access to primary healthcare facilities for all residents of Tower Hamlets – and will be developed in line with appropriate DDA compliance. Gender Neutral On the specific item of ‘gender’, Wood Wharf will enable access to primary healthcare facilities for all residents of Tower Hamlets, immaterial of their gender identity. Gender Neutral On the specific item of ‘gender reassignment’, Wood Wharf will enable access to primary healthcare Reassignment facilities for all residents of Tower Hamlets, immaterial of their gender identity.
Sexual Orientation Neutral On the specific item of ‘sexual orientation’, Wood Wharf will enable access to primary healthcare facilities for all residents of Tower Hamlets, inconsequential of their sexual orientation. Religion or Belief Neutral On the specific item of ‘religion/belief’, Wood Wharf will enable access to primary healthcare facilities for all residents of Tower Hamlets, inconsequential of their religion or personal beliefs. Age Neutral On the specific item of ‘age’, Wood Wharf will enable access to primary healthcare facilities for all residents of Tower Hamlets. Marriage and Neutral On the specific item of ‘partnerships’, Wood Wharf will enable access to primary healthcare facilities for Civil all residents of Tower Hamlets. Partnerships.
Pregnancy and Positive On the specific item of ‘pregnancy – maternity and paternity’, Wood Wharf will enable greater access to Maternity primary healthcare facilities for all residents of Tower Hamlets requiring access to support during pregnancy. The new healthcare facility will increase the available space to deliver these services in the locality, as other accommodation is not large enough to support group functions. Other Neutral On the specific item of ‘Other socio-economic carers’, Wood Wharf will enable access to primary Socio-economic healthcare facilities for all residents of Tower Hamlets.
65 Carers
66 Section 4 – Mitigating Impacts and Alternative Options
From the analysis and interpretation of evidence in section 2 and 3 - Is there any evidence or view that suggests that different equality or other protected groups (inc’ staff) could be adversely and/or disproportionately impacted by the proposal?
Yes? No? x
If yes, please detail below how evidence influenced and formed the proposal? For example, why parts of the proposal were added / removed?
(Please note – a key part of the EA process is to show that we have made reasonable and informed attempts to mitigate any negative impacts. An EA is a service improvement tool and as such you may wish to consider a number of alternative options or mitigation in terms of the proposal.)
Where you believe the proposal discriminates but not unlawfully, you must set out below your objective justification for continuing with the proposal, without mitigating action.
Section 5 – Quality Assurance and Monitoring
Have monitoring systems been put in place to check the implementation of the proposal and recommendations?
Yes? x No?
How will the monitoring systems further assess the impact on the equality target groups?
Please refer to PID document for further information.
Does the policy/function comply with equalities legislation? (Please consider the OTH objectives and Public Sector Equality Duty criteria)
Yes? No?
If there are gaps in information or areas for further improvement, please list them below:
None
How will the results of this Equality Analysis feed into the performance planning process?
The PID is for the benefit of all residents in Tower Hamlets and will not adversely affect the population.
67 Section 6 - Action Plan
As a result of these conclusions and recommendations what actions (if any) will be included in your business planning and wider review processes (team plan)? Please consider any gaps or areas needing further attention in the table below the example.
Recommendation Key activity Progress milestones including Officer Progress target dates for either responsible completion or progress Example
1. Better collection of 1. Create and use feedback forms. 1. Forms ready for January 2010 1.NR & PB feedback, consultation and Consult other providers and experts Start consultations Jan 2010 data sources
2. Non-discriminatory 2. Regular awareness at staff 2. Raise awareness at one staff 2. NR behaviour meetings. Train staff in specialist meeting a month. At least 2 courses specialist courses to be run per year for staff.
Recommendation Key activity Progress milestones including Officer Progress target dates for either responsible completion or progress
68 Appendix A
(Sample) Equality Assessment Criteria
Decision Action Risk As a result of performing the analysis, it is Suspend – Further Red evident that a risk of discrimination exists (direct, Work Required indirect, unintentional or otherwise) to one or more of the nine groups of people who share Protected Characteristics. It is recommended that the use of the policy be suspended until further work or analysis is performed. As a result of performing the analysis, it is Further Red Amber evident that a risk of discrimination exists (direct, (specialist) advice indirect, unintentional or otherwise) to one or should be taken more of the nine groups of people who share Protected Characteristics. However, a genuine determining reason may exist that could legitimise or justify the use of this policy. As a result of performing the analysis, it is Proceed pending Amber evident that a risk of discrimination (as agreement of described above) exists and this risk may be mitigating action removed or reduced by implementing the actions detailed within the Action Planning section of this document.
As a result of performing the analysis, the policy, Proceed with Green: project or function does not appear to have any implementation adverse effects on people who share Protected Characteristics and no further actions are recommended at this stage.
69 Enclosure C
Primary Care Committee Enclosure Date of meeting: 11 December 2019 C Agenda item: 1.3 Title of report: Island Medical Centre: Refurbishment and proposed patient decant
Author(s): Alison O’Grady, Interim Programme Manager Primary Care
Presented by: Dean Musk Head of Estates, WEL CCGs
Alison O’Grady, Interim Programme Manager Primary Care IMC is being renovated and remodelled to meet essential maintenance requirements as well as providing much needed additional clinical capacity to meet the primary healthcare needs of the population.
The building work will take a maximum of 6 months, from Spring to Autumn 2020. Patients will be seen (temporarily de-canted) at another practice, within the local Primary Care network, Docklands Medical Centre for the duration of building work. Executive summary
This paper outlines proposals to effectively manage this temporary decant. This includes proposals for engaging patients and for their views on how they can be as well as measures to minimise disruption, ensure continuity of care and meet the needs of vulnerable patients.
These proposals have been developed with support from Tower Hamlets Healthwatch. Recommendation
Information Approval X To note Decision Conflicts of Interest N/A Key issues The building work will take a maximum of 6 months, from Spring to Autumn 2020. Patients will be seen (temporarily de-canted) to another surgery, within the local Primary Care network, Docklands Medical Centre for the duration of building work.
Report history N/A Patient and Public Engagement due to begin December 2019 involvement Link to the Board N/A Assurance Framework Impact on Equality N/A and Diversity Resource Primary Care Team requirements Next steps Provider to undertake patient engagement to develop and refine proposals further.
70
Island Medical Re-furbishment and patient decant
1. Background and Summary
The Island Medical Centre (IMC) is operated by the Hurley Group and has a registered list of 8662 (October 2019 figures on Open Exeter) patients. The head lease of the premises is held by NHS Property Services
IMC is being renovated and remodelled to meet essential maintenance requirements as well as providing much needed additional clinical capacity to meet the primary healthcare needs of the population.
The building work will take a maximum of 6 months, from Spring to Autumn 2020. In order to enable the works to be carried out, the practice is required to temporarily decant the premises and relocate to another practice within the local Primary Care network, Docklands Medical Centre, for the duration of building work.
This paper focuses on proposals to effectively manage this temporary decant, it covers: • Proposals for engaging patients and for their views on how they can be supported – to influence further planning • Proposed measures to be put in place to minimise disruption for patients, ensure continuity of care and give particular attention to the needs of vulnerable patients.
The construction work has been approved by the Tower Hamlets Estates Committee and is funded under section 106 funding.
Anaylisis of the geographical distribution of patients and travel time to practices is shown under appendix 1 The draft Communications Plan for this project is presented under appendix 2
These proposals have been discussed with Healthwatch and refined further to reflect their advice.
2. Indicative timeline
Milestones Completion date Specification of works Mid January 2020 Patient engagement December – January 2020
Tender process January – February Commencement of building work April May 2020 Completion of building work September 2020
3. Practice Decant
71 Given the nature of the renovation works the CCG advises that patients should be decanted to another site for the duration of the building work for safety and financial reasons rather than remaining open.
The proposal is that patients will be re-located to Docklands Medical Centre which is 0.9 miles away from the Island Medical Centre and also operated by the Hurley Group. The CCG will not be charged for the decant to this practice but will need to fund the letters to patients.
4. Who will be affected?
All patients registered with IMC will be affected if IMC relocates its services to other premises. Since the introduction of the hub appointments during 2017, patients have been used to travelling to other practices on the Isle of Dogs, or in Tower Hamlets to be treated by a clinician.
5. Docklands Medical Centre
Patients will be decanted to Docklands Medical Centre (DMC) which is O.9 miles away. This is a 19 minute walk or a 10 minute bus ride away from Island Medical Centre.
Transport between Practices The number 135 bus serves both IMC (Jack Dash House/ Stewart Street) and DMC (Spindrift Avenue). It circles the main roads on the Island. The DLR train stops at Mudchute for DMC and South Island Quay for IMC. There are several DLR train stops on the Island. There is street parking at both sites – paid and permit holders. There is no surgery parking for patients at either premises.
6. Benefits of DMC
• DMC is an underutilised building, there is sufficient clinical space for patients to be seen at this practice – and this will not impact on patients at DMC. • DMC has capacity to relocate IMC patient services for duration of the project. There are 5 clinical rooms available • DMC clinical rooms are on 3 floors including the ground floor. Each floor has a patient waiting area. • There is a separate room on the ground floor that is used for baby clinic. IMC will also be able to hold baby clinics at DMC using this facility • All floors have toilet facilities • There is capacity to locate all the clinical and administrative staff on the 2nd floor at DMC. 72 • DMC is DDA compliant with lift access to all floors • It is a Hurley Group Practice – staff currently work over both sites so there is familiarity with the premises, patients, and policies. • As both practices are Hurley Group practices there will not be any issues of segregating stock, as would be if sharing another practice premises.
7. Other options considered
There are no other local options available to IMC for patients to be seen within the vicinity of Island Medical Centre.
• Island Heath Centre Distance from IMC: 0.4 miles IMC did explore the possibility of using clinical space within the nearby Island health service, but unfortunately there was no space available. • Barkantine Health Centre Distance from IMC: 1 mile: This practice is further geographically from IMC and therefore not a viable option.
8. Services and appointments
• IMC and DMC both promote online consultations (e-Consult) and online access. They are currently working to increase the use of e-Consult and this will be beneficial during this time of relocation. • IMC and DMC would pool their clinical resources during this period and have dedicated clinicians to respond to e-Consult queries on the day -currently they respond within 24 hours
9. Out of Hours Out of hours provision is undertaken by GP Out of Hours Tower Hamlets GP Care Group CIC There would not be any need to change the current arrangements as the relocation does not affect the way out of hours care is provided to patients of IMC or DMC.
10. Clinics The weekly ante-natal clinic will be moved from IMC to DMC. Nine ante-natal appointments are offered per week.
Patients attending the post natal and health visiting 6-8 week check appointments will be seen at DMC. The health visitors providing these appointments cover both IMC and DMC. All other child health reviews will not be affected as this service will continue to be delivered from Isle of Dogs Children's Centre.
11. Vulnerable Patients
IMC has identified 743 (data from the Network and PCN) patients with a diagnosed long term condition such as diabetes or cardio vascular disease and a further 71 patients with complex needs who may be receiving services such as palliative care.
IMC has identified 51 patients as particularly vulnerable shown in the table below.
73
Vulnerable patients registered at IMC
Number of vulnerable patients on Number of vulnerable patients Number living near to DMC register living near to IMC
51 43 8
These patients will be offered the following to ensure continuity of care:-
• Priority appointments, home visits or other clinical contact, whichever is most appropriate to the patient at the time.
• The practice will allow time for those that arrive late for their appointments and will not penalise or discriminate. Appointment layout will be altered to maximise the best use of the clinician’s time for appointments and clinical administrative work – getting the balance right.
• Once the development date has been agreed IMC will contact these patients by letter and follow up in person to discuss what is happening and to talk with the patient and their carers about what support we can offer them during this period.
• IMC will also talk to patients opportunistically to inform them that we are renovating the premises and will continue to keep them informed of what is happening and asking what help they think they might need during this period.
• When making appointments they will ensure the appointment address is clearly stated in all communication with the patient.
• Housebound patients: They will ensure that they provide additional time each day for home visits. All home visits requests are assessed within the hour. They will plan home visits geographically, where possible, to make the best use of the clinician’s time.
• Palliative Care Patients: As part of their care package to these patients they will contact them proactively on a regular basis. This care will continue and they will continue to see the patients at home if required.
• Mental Health: Severe Mental Illness (SMI) Patients will be contacted by letter and in person to discuss their needs during the period of relocation. They will proactively contact the patient on a 2- weekly basis to ensure that they are compliant with their medications and take appropriate action if/ when required.
• Learning Disabilities: Patients will be proactively contacted to arrange their annual reviews. Should they need to be seen by a clinician the practice upon making the appointment for the patient/ carer will also make clear the new location address. They will offer a home visit if that is the more suitable option for the presenting issue
• Cancer Patients: They will offer priority bookings on the same day or home visits if required
• The complex care cohort already have their own slot in each session offered by the practice and those that need care will be prioritised or home visited if required.
• All patients that need care on the day will be assessed by a clinician and the most appropriate care will be given.
74 • When all other methods of being able to see the patient (eg by a home visit) have been exhausted taxi fares may be reimbursed for vulnerable patients to attend DMC if clinically required. This will be available on a discretionary basis, not advertised and a risk assessment will be undertaken in each case.
Minimising disruption • Annual clinical reviews will be timed to occur before the move to reduce inconvenience for patients • The Hurley Group have a centralised team of GPs, Clinical Pharmacists, and a Nurse Practitioner that review all the online eConsultations daily and these are in addition to the practices daily appointment offering.
• Patients will be encouraged to utilise eConsult. This will be particularly beneficial during the decant in managing capacity/demand.
• More time will be allocated for home visiting and visits reorganised geographically, to maximise clinical time. If there are no home visits, this time will be converted back to clinical care.
• IMC routinely plan winter demand annually and are prepared
Patient engagement A patient engagement process will be undertaken including two patient engagement meetings. We will seek the views of patients from both IMC about how we can inform and support them during the relocation period. IMC will hold 2 patient engagement events for their current patients to inform patients of the plan to renovate and relocate and to hear their views of how they can support them. They will use this opportunity to inform patients of:
• The premises development • The practice relocation • Seek their views on what needs to be considered to support patients at this time
The indicative time frame for the patient engagement will be from the 1st to the 31st January 2020. Patients will be informed by:
• Patient engagement meeting • Text • Website • messages on prescriptions/ letters • posters/ leaflets in the practice • in writing • local newspaper • local library/ convenience store/ post office/ community centres • need’ clinics for both IMC and DMC patients with the ANP and GP. • Social media
75 APPENDIX 1 Island Medical Centre – Geographical distribution of patients and journey time to practices.
76
77
78 APPENDIX 2 Island Medical Centre – Communications Plan
Overview: Island Medical Centre (IMC) is being renovated and remodelled to meet essential maintenance requirements as well as providing much needed additional clinical capacity to meet the primary healthcare needs of the population. During the renovation, IMC will be temporarily co-located within Docklands Medical Centre (DMC), which is approximately 0.9 miles away. The distance between IMC and DMC is shown below
There will be no disruption to care and patients will have the same GPs and clinicians as previously to look after their health care needs. DMC offers five consulting/examination rooms, a separate waiting/reception area, as well as ample administrative space. There is a large meeting room that both practices will have use of, as well as a separate baby clinic area on the ground floor. The rooms will be kitted out with the furniture, medical equipment, and IT hardware that will be transferred from IMC during the move. The project has been made possible by a £986,000 Section 106 (S106) social infrastructure capital grant from the London Borough of Tower Hamlets (LBTH) to Tower Hamlets CCG. The grant is funding that local government has received from private residential developers working in Tower Hamlets and then allocated to developing additional primary care capacity in line with the population increase. This investment forms part of a LBTH £22 million S106 investment in the primary care estate in Tower Hamlets over the next 6 years.
The proposed completion of the IMC premises is Autumn 2020. The exact date will be subject to completion of building works. As always, patients have the choice to register with any practice whose catchment they reside in. All local practice lists are open, patients can find their nearest practice by either: Looking on the NHS website: www.nhs.uk/service-search/GP/Location - or Contacting Tower Hamlets CCG on 020 3688 2500 or Email: [email protected]
79 Aim: The aim of this communication plan is to ensure that patients and key stakeholders of IMC are informed in a timely manner about the temporary relocation to DMC.
Objectives: • To set out agreed communication responsibilities for IMC • To ensure NHS England is aware of the process • To provide clear, consistent information of the relocation and repatriation to IMC once renovation works are completed. • To agree a timetable for the circulation and distribution of information • To issue the key messages, below, to patients and stakeholders
Key Messages:
• IMC will be temporarily relocating to DMC • The doctors/ clinical staff and services will remain the same • The core services will remain the same • Patients will remain registered with IMC • The renovation works will result in an increase in the number of consulting rooms at IMC thus meeting the demands of the growing population • The temporary location at DMC is 0.9 miles away and is served well by public transport • The temporary premises will have its own reception and waiting area, and all the staff and clinicians on the same floor • The temporary premises are accessible to those with mobility problems and has lift access • The move will take place over the weekend to minimise disruption to services
Target Audience:
For the practices
• Staff at IMC and DMC • Registered patients of IMC • Patient participation groups of both practices
For THCCG
• Tower Hamlets Health Watch • London Borough of Tower Hamlets • NHS England • Other local GP practices /Tower Hamlets Network PCN • Local MP • Local LMC • Pharmacy Committee • NHS Property Services • Membership • Local media • Tower Hamlets CVS
80
Timetable:
Date Owner Audience Method Notes
December 2019 Practice Practice staff Briefing/information explaining: manager/ • partners What’s happening and when of IMC • FAQs and DMC • procedure to be followed in response to patient queries
December 2019 Practice Patients/public Information on GP Practice website explaining:
• What’s happening and when • FAQs • Who to contact in the event of queries, with a phone number and email address
December 2019 Practice Patients Posters on display in practice waiting room/public areas explaining: (with • project What’s happening and when team • Who to contact in the event of queries, with a phone support) number and email address
Timing TBC – depending on date of Practice Patients Letter from IMC explaining: Letter will be Relocation provided by the • What’s happening and when practice (with THCCG • Address/contact details of temporary location of DMC support) for
81 • Who to contact in the event of queries, with a phone distribution to number and email address patients by NHS England
Timing TBC – depending on date of Practice Patients with Identify all vulnerable patients and those with communications Relocation additional needs (as required under the Accessible Information Standard) and: communication • needs phone patients, where appropriate, and ensure they are aware of the proposed move and have the support they need • produce printed materials (Easy Read and large print) and post to patients where required • Provide information/ materials to patients for whom English is not their first language, to ensure they are aware of the proposed move and have the support they need. THCCG will assist with advice on translations if required.
Timing TBC – depending on date of Practice Patients • Follow-up text message to those patients with mobile Relocation phones reminding them what’s happening and when
Timing TBC – depending on date of Project Patients Signage at old premises explaining: Relocation team • Location of new practice with map, contact details and opening hours Timing TBC – depending on date of THCCG Patients/public • Information on website explaining: Relocation • The practice has moved – and giving new address, with map
Timing TBC – depending on date of Practice Patients/ • Date of return to IMC return public/ staff/ • Information on website/ posters/ text messages/ key notifications stakeholders
82 Enclosure D
Primary Care Committee Enclosure
Date of meeting: 11 December 2019 D
Agenda item: 1.4
Title of report: Practice re-location – Wellington Way Health Centre
Author(s): Alison O’Grady, Interim Programme Manager Primary Care
Presented by: Alison O’Grady, Interim Programme Manager Primary Care Two Tower Hamlets practices, Merchant Street and Stroudley Walk are due to be co- located within the modernised Wellington Way Health Centre. Both practices were operating from small and unsuitable premises. There will be no disruption to care, and patients will have the same GPs and clinicians as previously to look after their health care needs. The proposed opening date for the new practice is late 201/2020. The actual move is Executive summary subject to completion of building works and is to be confirmed. The attached communications plan gives full details on how patients/other stakeholders will be informed about the move. These proposals have been developed with support from Tower Hamlets Healthwatch.
Recommendation
Information Approval X To note Decision
Conflicts of Interest N/A As outlined in the Executive Summary and relevant enclosures. Key issues
Report history N/A
Patient and Public As per communication plan involvement
Link to the Board N/A Assurance Framework
83 Impact on Equality N/A and Diversity
Resource Primary Care Team requirements
Next steps Letters to patients with confirmed details to be sent to patients
84 Enclosure D
Wellington Way – communications plan
Overview:
Two Tower Hamlets practices, Merchant Street and Stroudley Walk are due to be co-located within the modernised Wellington Way Health Centre in late 2019.
Both practices were operating from small and unsuitable premises.
The Wellington Way site is
From Merchant Street – 0.1 mile, a 3 minute walk From Stroudley Walk - 0.6 miles, a 12 minute walk.
Distance from Merchant Street Practice Distance from Stroudley Walk Practice to to Wellington way Health Centre Wellington way Health Centre
There will be no disruption to care, patients will have the same GPs and clinicians as previously to look after their health care needs.
Wellington Way health centre offers nine consulting-examination rooms, six treatment rooms and two phlebotomy rooms as well as a large group room – as well as ample administrative and waiting areas.
The new facility will be kitted out with new furniture and medical equipment, as well as best practice technology including self-diagnostic facilities, self-service arrival screens, and a high speed broadband link.
The project has been made possible by a Section 106 capital grant from the London Borough of Tower Hamlets, which is money that local government receives from private developers in the local area. It forms part of a £22million investment in the primary care estate in Tower Hamlets over the next 6 years.
The site was previously occupied by the Children’s Development Team (Barts Health) who re-located to new re- furbished accommodation at Mile End hospital.
The proposed opening date for the new practice is late 2019/2020. The actual move is subject to completion of building works and is to be confirmed.
As always, patients have the choice to register with any practice whose catchment they reside in. All local practice lists are open, patients can find their nearest practice by either
- Looking on the NHS website: www.nhs.uk/service-search/GP/Location - or - Contacting Tower Hamlets CCG on 020 3688 2500 or Email: [email protected] 85 Aim:
The aim of this communications plan is to ensure patients and key stakeholders of Stroudley Walk and Merchant Street Practices are fully informed in a timely manner about the move to the new premises
Objectives: • To set out agreed communications responsibilities for Stroudley Walk and Merchant Street Practices • To ensure NHS England is aware of its communications responsibilities • To provide clear, consistent information on the move to/opening of the new practice • To agree a timetable for the circulation/distribution of information • To issue and publish the key messages, below, to patients and key stakeholders • To raise awareness via the local media
Key messages: • The two practices are moving to new, modern purpose-built premises • The doctors/clinical at the practice and the core GP services offered are not changing • Patients will remain registered at the practice • The current premises of both practices are small and unsuitable • The new premises will have one single shared reception area for both practices, which should reduce wait time • The new premises will be accessible to all – including those with mobility issues – and help improve patient experience • Some new services will be available on site • The move is taking place over a weekend to minimise disruption for patients • Patients were involved in the development of the new building: the PPG ensured the new site had access arrangements and resources.
Target audience: For practice:
• Staff at Merchant Street and Stroudley Walk practices • Registered patients of Merchant Street and Stroudley Walk practices • Patient Participation Group
For THCCG
• Tower Hamlets Health watch • London Borough of Tower Hamlets • NHS England • Other local GP practices • Local MP • Local LMC • Pharmacy Committee • NHS Property Services • Membership • Local media • Tower Hamlets CVS 86 Timetable:
Date Owner Audience Method Notes
June 2019 THCCG/ Tower Hamlets THCCG has been linking with the LBTH Communications team on the THBTH residents and Wellington Way project: patients http://publia.co.uk/towerhamlets/013/OurEastEnd-Issue013- June2019.html ref. page 19
https://www.eastlondonadvertiser.co.uk/news/health/new-5m- wellington-way-health-centre-for-bromley-by-bow-1-6056061
https://www.towerhamlets.gov.uk/News_events/2019/May_2019/ Bow_to_get_new_multi_million_pound_health_centre.aspx
August 2019 Practice Practice staff Briefing/information explaining: manage r/ • What’s happening and when partners • FAQs • procedure to be followed in response to patient queries
September 2019 Practice Patients/public Information on GP Practice website explaining:
• What’s happening and when • FAQs • Who to contact in the event of queries, with a phone number and email address
September 2019 Practice Patients Posters on display in practice waiting room/public areas explaining: (with
87 project • What’s happening and when team • Who to contact in the event of queries, with a phone support) number and email address
Timing TBC – depending on date of Practice Patients Letter from practice explaining: Letter will be official opening provided by the • What’s happening and when practice (with THCCG • Address/contact details of new practice premises support) for • Who to contact in the event of queries, with a phone distribution to number and email address patients by NHS England
Timing TBC – depending on date of Practice Patients with Identify all vulnerable patients and those with communications official opening additional needs (as required under the Accessible Information Standard) and: communication needs • phone patients, where appropriate, and ensure they are aware of the proposed move and have the support they need • produce printed materials (Easy Read and large print) and post to patients where required • Provide information/ materials to patients for whom English is not their first language, to ensure they are aware of the proposed move and have the support they need. THCCG will assist with advice on translations if required.
Timing TBC – depending on date of Practice Patients • Follow-up text message to those patients with mobile official opening phones reminding them what’s happening and when
88 Timing TBC – depending on date of Project Patients Signage at old premises explaining: official opening team • Location of new practice with map, contact details and opening hours
Timing TBC – depending on date of THCCG Patients/public • Information on website explaining: official opening • The practice has moved – and giving new address, with map
Timing TBC – depending on date of THCCG Public • Media release to promote official opening THCCG will draft and official opening (NEL issue media release CSU) in cooperation with practice and London Borough of Tower Hamlets
Timing TBC – depending on date of official opening
THCCG Key stakeholders/ Official opening ceremony public (NEL CSU)
89 Enclosure E
Primary Care Committee Enclosure
Date of meeting 11th December 2019 E
Agenda item 1.5 M07 Primary Care Finance report Title of report: Steve Collins – Finance Adviser –TH CCG Author(s): Olya Klufas – PC Liaison Officer –TH CCG
Steve Collins – Finance Adviser –TH CCG Presented by: Sponsor (if different): For further information
This summary provides an update on the Primary Care Co- commissioning financial position for the Clinical Commissioning Group. At Month 07 (October 2019) we are reporting a year to date spend of £28.08m, which is £212k over budget and full year outturn position of Executive summary £48.06m, which is £366k over budget. This reporting position is primarily due to the inclusion of “forecasted” charges for financial year 2019/20 resulting from a reported increase in expenditure at Hammersmith & Fulham CCG.
Recommendation
Information Approval To note X Decision To note the contents of the report
Conflicts of Interest There are no identified conflicts of interest.
Key issues Although for the primary care budget at the start of the financial year did not show a deficit of allocation against expenditure, this situation has now changed. Cost pressures resulting from GP at Hand recharging and an increase in void-space charges, as affecting the outturn position. This approach is approved by the CCG as it reflects the potential of these charges becoming a reality. Any shortfall in allocation will have to meet out of CCG reserves.
Report history Director of Primary Care reviewed this finance report.
90 Patient and Public N/A involvement Link to the Board The financial risk of the Primary Care cost pressure is the key risk Assurance Framework identified on the BAF. The main areas of risk lie in Estates (recharge of rental and business rates charges) which represents 16.3% of the whole and the contract payments, which represents 74.8% of the total budget. Another consideration is the risk that NHS England will seek to recover additional costs, incurred by Hammersmith & Fulham CCG (resulting from GP at Hand) through the re-distribution of CCG allocations.
Impact on Equality and N/A Diversity Resource requirements None.
Next steps Continue to monitor.
91
Enclosure E
Month 07 Finance Report – 2019/20
1. Summary
This report provides an update on the Primary Care Co-commissioning financial position for the Clinical Commissioning Group (CCG).
2. Key Risks and Issues
Since April 2016, the CCG has had full delegation for Primary Care Co-commissioning. This means that the CCG is responsible for the budgeting and authorisation of primary care payments, and meeting any shortfalls in expenditure.
This summary provides an update on the Primary Care Co-commissioning financial position for the Clinical Commissioning Group.
At Month 07 (October 2019) we are reporting a year to date spend of £28.08m, which is £212k over budget and full year outturn position of £48.06m, which is £366k over budget. This reporting position is primarily due to the inclusion of “forecasted” charges for financial year 2019/20 resulting from a reported increase in expenditure at Hammersmith & Fulham CCG.
92 3. Primary Care Revenue financial position for October 2019
The summarised CCG’s revenue financial position;
Table 1: Primary Care Co-commissioning - 2019/20 Financial position – October
2019
Variance Variance YTD YTD YTD FY Full Year as % of as % of budget Actual Variance Outturn Variance YTD FY budget Outturn £000's £000's £000's £000's £000's
General Practice - APMS 7,121 7,121 0 0.00% 12,207 0 0.00% General Practice - GMS 13,590 13,786 196 1.44% 23,634 337 1.43%
QOF 1,649 1,655 6 0.36% 2,837 10 0.35%
Premises Cost Reimbursement 3,490 3,797 307 8.80% 5,983 0 0.00% Other Premises costs 51 51 0 0.00% 87 0 0.00%
Direct Enhanced Services 1,338 1,340 2 0.15% 2,210 0 0.00% Dispensing/Prescribing Drs 97 97 0 0.00% 166 0 0.00% Other GP Services 342 333 (9) (2.26)% 587 0 0.00%
Other delivery 0 (300) (300) 0.00% 0 0 0.00%
Non-PFI Oprtng Leases Blgs 139 149 10 7.19% 256 19 7.42%
Grand Total 27,816 28,085 212 48,064 366
• APMS Contract payments The APMS contract budget line represents eight GP practices and is 26% of the total budget.
Of the remaining six “local” APMS contracts practices, East One Health, Barkantine and St Andrew’s and St Paul’s Way are currently being re-procured. These procurement are at various stages of progression and to-date no procurement has been completed.
• GMS Contract payments The large budget on this line reflects the fact that the majority of practices in Tower Hamlets hold a GMS contract. This line represents 28 GP practices, who hold 49% of the total budget.
93 This budget also contains the monies paid as “transitional” payments to ex-PMS practices as well as minimum practice income guarantee (MPIG) monies, which are being reduced on an annual basis, with a view that they will not exist as of 1st April 2021.
The overspend shown on this line is due to the inclusion of “forecasted” charges GP@Hand for financial year 2019/20 resulting from a reported increase in expenditure at Hammersmith & Fulham CCG.
• QOF With the exception of six practices, all practices remained with the “Local QOF” scheme offered by the CCG. For these practices, the annual costs are known and are being paid in 12 equal instalments.
The overspend shown on this line is due to the inclusion of “forecasted” charges GP@Hand for financial year 2019/20 resulting from a reported increase in expenditure at Hammersmith & Fulham CCG.
• Premises Costs Reimbursement When the budgets are set, estimates are made as to the level of rent and business rates chargeable on GP practice premises.
The emerging overspend is a result of rental reviews, and the corresponding increases in business rates which are higher than the allocated budget.
This is potentially an area of risk. The growth in property prices has been significant and not fully reflected.
• Other Premises Costs This is a small budget for “external repair and maintenance” for leases held by seven practices.
• Direct Enhanced Services (DES) This budget represents expenditure on the following Direct Enhanced Services: Minor Surgery DES, Extended Hours DES, Learning Disabilities Health Check DES and Violent Patients DES.
This year new Network DESs have been added. Please refer to Table4 for a more detailed explanation of that this includes. Payments have already been made to
94 practices and to Networks for the Patient Participation DES and the Clinical Director DES. These started in July 2019.
• Other GP Services This line represents a multiple of different budgets, mainly Locum costs covering GP illness, CQC invoice recharges, Seniority payments, GP Retainer costs and Maternity cover assistance. These costs are variable.
4. Breakdown of Primary Care Allocation for financial year 2019/20
Breakdown by % of primary care allocation for financial year 2019/20
0% 1% 5% 13% 26% APMS Contracts 6% GMS Contracts QOF Premises Costs DES 49% Other GP Services & Dispensing Void Space
95 Table 2: PC Allocation by category - 2019/20
FY FY
Outturn Outturn
£000's £000's APMS Contracts 12,207 25.64% GMS Contracts 23,297 48.94% QOF 2,827 5.94% Premises Costs 6,070 12.75% DES 2,210 4.64% Other GP Services & Dispensing 753 1.58% Void Space 238 0.50% Grand Total 47,602 1
5. Comparison of the Primary Care Allocation for financial years 2018/19 and 2019/20
Table 3: Comparison of PC Allocations by category by financial year Variance PC PC between Allocation Allocation financial 2019/20 2018/19 years £000's £000's £000's APMS Contracts 12,207 10,751 1,456 GMS Contracts 23,297 23,166 131 QOF 2,827 2,810 17 Premises Costs 6,070 7,841 (1,771) DES 2,210 571 1,639 Other GP Services & Dispensing 753 1,300 (547) Void Space 238 238 0 Other Delivery (1,168) 1,168 Grand Total 47,602 45,509 2,093
This table highlights where the changes have occurred;-
• in Premises where the budget had been optimistically reduced in the belief that rental reviews will not negatively impact on spend in this financial year even though they will in future years, • on the DES line which includes several new initiatives (as specified in the publication: A five year framework for GP contract reform to implement The NHS Long Term Plan) • the disappearance of the negative budget under Other Delivery.
96 6. Breakdown of allocation for the component parts of the Primary Care Network DES.
Table 4: PC Network Allocation - 2019/20
PCN Budget as Budget % of 2019/20 Allocation
£000's £000's PCN DES Clinical Pharmacists 422,934 17.00% PCN DES Social Prescribing 381,580 15.34% PCN DES Clinical Director 172,485 6.93% PCN DES Participation (Networks) 940,954 37.82% PCN DES Participation (Practices) 570,152 22.92% Grand Total 2,488,105 100%
Breakdown of the primary Care Networks DES (PCN) by %
17% 23%
PCN DES Clinical Pharmacists 15% PCN DES Social Prescribing PCN DES Clinical Director 7% PCN DES Participation (Networks) 38% PCN DES Participation (Practices)
Primary Care Network DES
This Primary care Network DES is a new addition for this financial year. This is part of the strategy, more fully described in A five year framework for GP contract reform to implement The NHS Long Term Plan, published in January 2019, where the Department of Health describes how the NHS will meet the challenges facing primary care.
97 7. HUBs provision financial position.
Table 5: HUBs block contract- 2019/20 Annual Monthly
budget Allocation £000's £000's
Barkantine (WIC) 808,553 67,379
St Andrew's (WIC) 880,017 73,335
Grand Total 1,688,569 140,714
• HUBs Primary care access is delivered through locality-based hubs, offering routine and urgent appointments, with a range of primary care professionals, from 8am – 8pm, 7 days a week, including bank holidays, 365 days a year.
These block contracts are scheduled to end in August 2020.
8. Network Improvement Services (NIS) revenue financial position for October 2019
Table 6: Network Improvement Schemes (NIS) - 2019/20
October 2019
Annual YTD YTD
budget Actual Variance
£000's £000's £000's
NIS - Immunisations And Vaccinations 120 70 0
NIS - Bacillus Chalmette–Guérin (BCG) vaccine 41 24 0
NIS - Anti-Coagulation 255 149 0 NIS - Nursing Homes 66 39 0 NIS - Cost Effective Prescribing 36 21 0 NIS - Integrated Clinical & Commissioning Quality 6,819 3,977 0 (ICCQ) NIS - NHS Health Check 61 36 0 NIS - Phlebotomy 581 339 0 NIS - Surgical Aftercare 102 60 0 NIS - Network Catering 7 4 0
Grand Total 8,088 4,719 0
98 • Network Improvement Schemes Because it is difficult to forecast the final activity outcomes, the expenditure is matched to budget, on a monthly basis, through accruals. Primary Care Commissioners meet with the Network Providers on a quarterly basis to review the activity levels, and “more accurate” forecasts will be available after the Q3 meetings have taken place.
Appendix A Basis of NIS payment methodology
Network Improvement Schemes (NIS) - 2019/20 NIS Payment Basis NIS National Diabetes Prevention Programme Activity paid at year end NIS - Latent Tuberculosis (TB) Activity paid at year end NIS - Immunisations And Vaccinations 50% upfront :50% year end NIS - Bacillus Calmette–Guérin (BCG) vaccine 50% upfront :50% year end NIS - Anti-Coagulation 100% upfront with performance payment at year end NIS - Nursing Homes 100% upfront ICCQ NIS - Commissioning Facilitator 100% upfront ICCQ NIS - Depot injections Upfront 80%: Performance 20% ICCQ NIS - ECG Activity paid at year end ICCQ NIS - Cancer Tool Activity paid at year end ICCQ NIS - Zoladex Activity paid at year end ICCQ - Clinical Delivery Upfront 80%: Performance 20% ICCQ - Enabler Function Upfront 80%: Performance 20% ICCQ - NW Def. Outcome Upfront 80%: Performance 20% NIS - NHS Health Check Payment is made by Pubic Health NIS - Prescribing Payment is made on year end achievement NIS - Phlebotomy 70% upfront: 30% year end NIS - Surgical Aftercare 70% upfront: 30% year end NIS - Network Catering On presentation of invoice
99 Appendix B
Tower Hamlets Exeter list size comparison
Inc. /Dec RAW list Inc. in % Inc. in WEIGHTED % Inc. in Date Period in size RAW RAW list size WEIGHTED WEIGHTED Q4 01/01/2016 295,924 291,228.81 15/16 Q1 01/04/2016 299,212 3,288 1.11% 293,596.62 2,368 0.81% 16/17 Q2 01/07/2016 301,806 2,594 0.87% 295,540.17 1,944 0.66% 16/17 Q3 01/10/2016 305,874 4,068 1.35% 298,717.33 3,177 1.08% 16/17 Q4 01/01/2017 309,603 3,729 1.22% 301,382.20 2,665 0.89% 16/17 Q1 01/04/2017 312,187 2,584 0.83% 303,294.40 1,912 0.63% 17/18 Q2 01/07/2017 315,395 3,208 1.03% 305,973.54 2,679 0.88% 17/18 Q3 01/10/2017 319,512 4,117 1.31% 309,297.03 3,323 1.09% 17/18 Q4 01/01/2018 322,224 2,712 0.85% 311,615.75 2,319 0.75% 17/18 Q1 01/04/2018 324,397 2,173 0.67% 313,589.10 1,973 0.63% 18/19 Q2 01/07/2018 326,249 1,852 0.57% 315,915.08 2,326 0.74% 18/19 Q2 01/07/2018 326,249 1,852 0.57% 315,915.08 2,326 0.74% 18/19 Q3 01/10/2018 330,134 3,885 1.18% 320,400.82 4,486 1.42% 18/19 Q4 01/01/2019 332,632 2,498 0.75% 322,435.28 2,498 0.77% 18/19 Q1 01/04/2019 335,573 2,941 0.88% 324,897.34 2,462 0.76% 19/20 Q2 01/07/2019 337,046 1,473 0.44% 325,255.07 358 0.11% 19/20 Q3 01/10/2019 339,584 2,538 0.75% 326,022.91 2538 0.78% 19/20
100