Report to Primary Care Commissioning Committees in common

CCGs applicable to NHS and Clinical Commissioning Group

Meeting date 12 May 2021

Report title St Lukes Boundary Expansion

Report from Elizabeth Tinley, Senior Manager Primary Care Contracting

Clinical lead Dr James Simpkin, Primary Care Clinical Lead

Report author Grant Foster, Manager Primary Care Contracts

Item number 2.4.2

Recommendation/action required:

The NHS CCG Committee is asked to approve the application from St Luke’s Surgery to extend their current boundary to include the areas of and .

Executive summary Introduction St Luke’s Surgery (BN2 8BU) submitted an application (appendix 1) to extend their practice boundary westwards to cover the areas of Rottingdean and Ovingdean, which currently fall outside the practices boundary. This request was considered at the April 2021 Primary Care Oversight Group (PCOG) meeting and was recommended for approval to the Primary Care Commissioning Committee (PCCC). The decision was not finalised at the PCOG due to concerns raised by neighbouring practices.

St Luke’s Surgery currently covers the areas of and Rottingdean and has a current list size of c.2000 patients. The proposed expansion seeks to include the entirety of the Rottingdean and the area of Ovingdean. Maps of the current and proposed boundaries are included within appendix 1.

Background The extended boundary area proposed is currently fully or partially covered by the seven practices listed below, all of which were contacted by the CCG for comment on this proposal: • Ardingly Court Surgery • Medical Practice • Saltdean and Rottingdean Medical Practice • Arch Healthcare • Wellsbourne Health Care Community interest Company (CIC)

• Regency Surgery • Brighton Station

The reasons for the practice wishing to extend the boundary is to provide more patient choice to those patients living in the Rottingdean and Ovingdean area, and to help take pressure off other local practices.

Feedback from surrounding practices The CCG contacted all seven neighbouring practices for comment on the proposal, allowing 10 days for response. Six of the seven practices responded and the feedback is summarised in the table below.

Support Practice name Comments yes/no Ardingly Court • Yes No further comment provided Surgery The practice raised the following concerns: • The expanded boundary may destabilise Woodingdean Medical Centre should the practice see a list size decrease because of Woodingdean No the expanded St Luke’s boundary. Medical Practice • The practice has already seen a list decrease further to covid-19 related deaths. • Adequate patient choice is available within current provision. Saltdean and • No response received. Rottingdean / Medical Practice • The impact to this practice is minimal Arch Healthcare Yes because it is commissioned specifically to serve the homeless population. • While the practice has no objections, if approved, the expansion may not enable Wellsbourne Yes Wellsbourne Healthcare CIC to increase its Healthcare CIC (caveat) list size to meet the requirements of its contract. Regency Surgery Yes • No further comment. • No objections as patients will register Brighton Station Yes wherever they choose.

The feedback from practices was considered as part of the review at the PCOG where it was noted that improved patient choice through overlapping boundaries is a benefit to patients and practices, serving to make an area more resilient to any future emergencies.

With regards to the objections from Woodingdean Surgery, it was noted at the PCOG that St Luke’s Surgery is some distance away and an inconvenient journey for patients who would usually be served by Woodingdean Surgery and not the intuitive choice for patients to register with. There is no obligation for patients to re- register with a practice when a boundary expansion is approved.

The overlap between the proposed increased St Luke’s Surgery boundary and the Woodingdean Surgery is minimal, as the Woodingdean Surgery boundary does not cover the entirety of Ovingdean. The overlap does not extend beyond Ovingdean Road, which constitutes the far edge of the Woodingdean Surgery boundary.

Conclusion The proposed boundary expansion would provide people living in the Rottingdean and Ovingdean areas with more choice of GP Surgery with which to register. As there is no obligation for people to re-register on approval of a list expansion, the impact to neighbouring practices is considered minimal.

The NHS Brighton and Hove CCG Committee is asked to approve the application from St Luke’s Surgery to extend their current boundary to include the areas of Rottingdean and Ovingdean.

Previously considered by [governance/ engagement pathway to date] Org./Group/ Name Date Outcome 14 April Recommended approval. Primary Care 2021 Oversight Group (PCOG)

What happens next? If the PCCC approves the application for the boundary expansion, a contract variation to the General Medical Services (GMS) contract for St Luke’s Practice will be issued to the practice.

Implications Corporate goals • Improved population health outcomes and patient this relates to experience. • Restoring high quality and safe services prioritised to meet clinical needs. Financial There would be no financial impact to the CCG. GP practices are funded on a per patient basis from national budgets, which are not managed by the CCG. Risk, legal and The CCG has a legal duty to provide primary care services to other the population of Brighton and Hove. Patient choice can help

compliance to ensure this legal duty is met as patients can continue to access services in the unlikely event of practice closures or breakdown of relationships. Quality and This proposal will impact positively on patient experience by safety providing increased patient choice of Primary Care services to those living within the expanded boundary. A Quality Impact Assessment (QIA) has been completed with the outcome that the boundary change proposal will have a neutral or positive impact. See Appendix 5.

Equality, An Equality Impact Assessment (EHIA) has been completed diversity and with the outcome that the boundary change proposal will have health a neutral or positive impact. (See Appendix 6) inequalities Patient and There is no requirement for the practice to undertake patient public engagement as there is no change to services. engagement Health and The proposal is providing patients with more choice of wellbeing services through which to access Primary Care services that support the health wellbeing priorities, strategies, and goals.

List of appendices Appendix 1 Current and proposed boundary maps Appendix 2 Boundary Change Application form Appendix 3 Woodingdean Medical Practice Patient capitation figures 2018-2021 Appendix 4 Woodingdean Medical Practice Patient Population map Appendix 5 Completed Quality Impact Assessment Appendix 6 Completed Equality Health Impact Assessment

Appendix 1 – Current and proposed boundary maps

Map 1: St Luke’s Surgery’s current practice boundary

Map 2: St Luke’s Surgery’s proposed boundary expansion

Appendix 2 - Boundary Change Application form

EAST CLINCIAL COMMISSIONING GROUP Application Form – Primary Care Commissioning Committee Application to Change Practice Boundary Introduction

Contractors should complete and return this application form outlining any proposed changes to their practice boundary.

PLEASE COMPLETE ALL SECTIONS OF THIS APPLICATION WHERE APPROPRIATE. Incomplete forms will not be submitted to the Committee for discussion.

Practice Name St Luke’s

Practice Code G81667

Practice Site Main Address 20-21 Grand Ocean, Longridge Ave Brighton BN2 8SN Branch Surgery Address N/A

Names of GP Partners Dr Rifaat Amin Practice Opening Hours 8.30 am – 6.00 pm (Mon – Fri)

Current List Size 2,000

Number of GP WTE per week 1.00, to increase to 1.4 as of 1.10.20

Number of Nurse WTE per 0.5, to increase to 0.8 as of 1.10.20 week

Is the practice list open or closed to new patients? OPEN x CLOSED

If closed, date of re-opening?

Are you a dispensing practice? YES NO x

If YES, how many dispensing patients do you currently dispense to?

Proposal

Please provide details of your proposal:

We propose to increase the practice area to include Rottingdean.

Does your proposal have any impact on patient care or delivery of YES x NO services? If YES, please provide details This will offer greater choice to the people of Rottingdean, take pressure off the other local practices and fulfil one of the commitments made by SPC to the CCG for receipt of support funding for the practice.

Information to support application

Please provide a map of your current Please attach to this application practice boundary including any outer (electronic if possible) boundary if you have one Is the proposal to change your inner boundary or outer boundary (if Inner x Outer applicable) Is the proposal to reduce or extend your boundary Extend

Please provide a copy of your new Please attach to this application proposed boundary (electronic if possible) If your proposal is to increase your ?200 over the next year boundary, approx. how many new patients do you envisage this will create for the practice? Does your new boundary proposal cross over into another local authority or YES NO x CCG area?

If YES, please provide the names of which other areas will be affected by this change

Will the cross boundary create any YES NO x access issues or service provider issues to patients? If YES, please provide details Will the proposal result in any of your current patients being required to find a YES NO x new GP? If YES, please provide details of why: i.e. will the practice retain all existing patients but not accept any new applications within the reduced area? Please confirm the names of Wellsbourne, Woodingdean, Saltdean, neighbouring practices sharing part or Meridian all of your boundary Do the neighbouring surgeries have Open open or closed lists to new registering patients?

Reason for the change to the practice We have given a commitment to the boundary? CCG to do this and we wish to expand the practice, to offer greater choice and access to local people. Have you changed your boundary within the last 3 years? YES NO x

If YES, please provide brief details and when this occurred.

CONSULTATION

Has your proposal been discussed with your patients? YES x NO

If YES, please explain how this has Phone call with chair of PPG been communicated.

Has any form of patient survey been undertaken? YES NO x

If YES, what were the results of the Please provide detailed summary of survey? results. (Supporting evidence)

Have the results of the survey been reported back to patients? YES NO

If YES, how?

Have you had any discussions with the If YES, please provide details and following? outcome of discussions CCG - YES Health watch - NO NHS - NO Local Councillors - NO Any others you wish to declare in relation to your application: We have consulted informally with the other local practices and they have no objections to this

PLEASE NOTE: ALL PROPOSALS MUST BE APPROVED BY CCG BEFORE ANY CHANGES ARE INTRODUCED.

DECLARATION

I confirm that all the information provided in this application is accurate and truly reflects the proposal that is being put forward for consideration by East Sussex Clinical Commissioning Group.

Signed

Print Name MURRAY KING

Title Senior Group Manager

Date 28.9.20

Appendix 3 – Woodingdean Medical Practice patient capitation totals 2018-2021

Quarter Raw list size January 2018 8596 April 2018 8706 July 2018 8741 October 2018 8811 January 2019 8902 April 2019 8948 July 2019 9006 October 2019 9057 January 2020 9028 April 2020 9026 July 2020 8987 October 2020 9010 January 2021 9024

Appendix 4 – Woodingdean Medical Practice boundary map, including registered population distribution

Appendix 5

Quality Impact Assessment Tool

The following assessment screening tool will require judgement against all listed areas of risk in relation to quality. Each proposal will need to be assessed whether it will impact adversely on patients / staff / organisations.

Where an adverse impact score greater than eight is identified in any area, this will require a more detailed impact assessment to be carried out, using the escalation proforma.

Insert your assessment as positive (P), negative (N) or neutral (N/A) for each area. Record your reasons for arriving at that conclusion in the comments column. If the assessment is negative, you must also calculate the score for the impact and likelihood and multiply the two to provide the overall risk score. Insert the total in the appropriate box.

Title of scheme: St Luke’s Surgery Boundary Change proposal 2020

CCGs covered by the scheme: (only one QIA is required for each scheme even Brighton and Hove CCG in multiple CCGs are involved) Lead CCG: (the CCG that will coordinate the completion Brighton and Hove CCG of the QIA in consultation with involved CCGs) Project Lead for scheme: Assistant Manager Primary Care Contracts

Senior Manager/ Executive Sponsor: Senior Manager Primary Care Contracts Brief description of scheme: St Luke’s Surgery are proposing to extend their boundary to the west to include the areas of Rottingdean and Ovingdean which currently fall outside the current practice boundary.

The reasons for the proposed expansion is to offer greater choice of Primary Care services to patients living in the Rottingdean and Ovingdean area.

Intended Quality Improvement Outcome/s: The aim of this QIA is to provide assurance that there will be no reduction in the quality of services being provided to patients currently registered with St Lukes practice and will improve the patient choice for residents in a wider area of Brighton.

Page 1 of 8

Methods to be used to monitor quality • NHS Choices GP surveys impact: • Friends and Family tests • CQC inspections • CCG Quality Monitoring Groups (e.g. PCOG, PCCC)

P/N Risk Score Comments Risk > 8 or (if N) (include reason for identifying Stage 2 N/A impact as positive, negative or Assessment neutral) required) Y/N. If Y complete stage 2 proforma) Duty of Quality Could the proposal impact positively or negatively on any of the following: a) Compliance with NHS Primary Care services provided to N Constitution right to: patients by St Luke’s Surgery will - Quality of Care not be affected. St Luke’s Surgery and Environment has capacity both in surgery - Nationally approved space and clinical staffing to treatments/drugs support this proposed expansion. - Respect, consent and P confidentiality Patient choice for Primary Care

- Informed choice and services for those patients within

involvement the extended part of the practice - Complain and redress boundary will be improved.

An EHIA has been carried out.

The practice will continue to monitor complaints, and serious incidents. b) Partnerships There should be no impact on the N partnership.

N/A

c) Safeguarding Children There should be no impact to N and Adults safeguarding of children and adults, N as the practice will continue to provide the same services that they do currently. Page 2 of 8

NHS Outcomes Framework Could the proposal impact

positively or negatively on the delivery of the five domains: 1. Preventing people There should be no impact when N from dying compared to services currently prematurely being provided. Clinical services will be maintained for all patients N registered with the practice, both those existing and any newly registered patients.

2. Enhancing quality of There should be no impact when N life compared to services currently being provided. Clinical services will be maintained for all patients

N registered with the practice, both those existing and any newly registered patients.

3. Helping people There should be no impact when N recover from episodes compared to services currently of ill health or being provided. Clinical services following injury will be maintained for all patients registered with the practice, both N those existing and any newly registered patients.

4. Ensuring people have a Patient choice for Primary Care N positive experience of services for those patients living care within the extended part of the practice boundary will be improved.

Patients who are not satisfied with any services received can P follow the practice complaints procedure if they wish or choose to re-register at another practice whose boundary covers the patient’s address.

Neighbouring GP practices have been notified of the boundary extension proposal and given the Page 3 of 8 opportunity to comment. The effect on the neighbouring GP practices is expected to be minimal but any comments (negative or positive) will be included in the report to be considered by the Primary Care Commissioning Committee.

Page 4 of 8

5. Treating and caring for There should be no impact when N people in a safe compared to services currently environment and being provided. Clinical services protecting them from N will be maintained for all patients within a safe environment. avoidable harm

Access Could the proposal impact positively or negatively on any of the following: a) Patient Choice Patient have a choice of six N alternative GP practices that cover or partially cover the extended practice boundary area.

P If patients choose to re- register at another practice the CCG can assist any patient in doing so if needed.

b) Access Physical access: Patients N who choose to register at St Luke’s Surgery from the extended boundary have access to good public transport links. General access: Patients will N be able to register and book appointments for all Primary Care services during standard GMS contracted hours. Access to extended hours are provided through the Primary Care Network c) Integration There should be no impact when N compared to services currently being provided. All services will be maintained. N

Name of person completing the assessment Page 5 of 8

Positon Assistant Manager Primary Care Contracts Signature

Date of assessment 10/03/2021

Reviewed by: Position: Senior Manager Primary Care Contracts

Signature:

Date of review: 10.03.21

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Proposed frequency of review: Six monthly/ Quarterly/ Monthly/Weekly Six months N.B. minimum monitoring is six monthly (scores 6 or below) Every 4 months (scores 8-9) Quarterly (scores 10-12) Monthly ( 15-20)- Weekly (score 25) Use boxes below to record outcome of reviews

Signed off by:

Position:

Signature:

Date of sign off:

Requires review at Quality Committee: Y/N

Date considered at Quality Committee:

Logged on spreadsheet: Y/N

Post Implementation Review (use the template below to record outcomes of reviews- if more than one is required cut and paste the box below)

Y/N Comments

Have the anticipated quality impacts been realised?

Have there been any unanticipated negative impacts?

Are any additional mitigating actions required?

Do any amendments need to be made to the scheme?

Page 7 of 8

Reviewed by:

Position:

Signature:

Date of review:

Page 8 of 8

Appendix 6

SCREENING

Equality and Health Inequality Impact Assessment (EHIA)

An EHIA is a tool to explore the potential for a policy, strategy, service, project or procedure to have an impact on a particular group, groups or community. This includes the impact on one or more of these groups:

• Protected characteristic groups (as outlined in the Equality Act 2010) • Disadvantaged or marginalised groups or communities • Deprivation and socio-economic disadvantage within local communities • Local health inequalities for groups and communities

The main purpose of this Screening Tool is to help you decide whether or not you need to undertake a more in depth Equality and Health Inequality Impact Assessment (EHIA) for your project or piece of work.

Please complete this Screening Equality and Health Inequality Impact Assessment (EHIA)

• After you have identified your project as a no or low impact project, following discussion leading up to the change proposal

• When you are unsure about the level of impact your project may have on groups of people.

• As stand-alone document (e.g. for a policy change)

• As a precursor to the Extended EHIA.

Please note The outcome of this Screening EHIA assessment may highlight significant impact on the groups above and will then warrant the need to complete an Extended EHIA.

For further support or advice please contact: • Elaine Colomberg – Equality and Diversity Manager [email protected] • Jane Lodge – Head of Engagement [email protected]

• Nicky Cambridge – Stakeholder Engagement Lead [email protected]

Screening EHIA v.2 – 09.07.19

1. Introduction and overview

ID Title of EHIA St Luke’s Surgery Boundary Change proposal 2021 No.

Team / Department Primary Care

Assessor

Completing the EHIA

Date EHIA Date EHIA Started 10/03/2021 19/03/2021 Completed Workforce Organisational CCG funded CCG Clinical Other: What is the focus of Policy strategy services policies Please this EHIA? X state St Luke’s Surgery are proposing to extend their boundary to the west to include the areas of Rottingdean and Ovingdean which currently fall outside the current practice boundary.

The reasons for the proposed expansion is to offer greater choice of Primary Care services to patients living in the Brief description of Rottingdean and Ovingdean area service, policy, strategy, function St Luke’s Surgery has capacity both in surgery space and clinical which this EHIA staffing to support this proposed expansion. Primary Care relates to. services provided to patients by St Luke’s Surgery will not be

affected. Patients from the Rottingdean and Ovingdean area have access to good public transport links to St Luke’s Surgery should they decide to register with the practice.

This EHIA assesses the impact of the proposed boundary change on registered patients and the patients’ communities.

2. Impact assessment – Protected Characteristics

Does your service, policy, strategy or function impact on any of the Equality Act 2010 protected characteristic groups below:

Positive Neutral Negative No Comments Impact Race The proposed boundary change is not likely to have any specific impact X on patient’s race or ethnicity including patients from the BAME community.

Screening EHIA v.2 – 09.07.19

Positive Neutral Negative No Comments Impact Registered patients will continue to access primary care services as they currently do.

All patients living within the extended boundary will have increased patient choice as to their Primary Care provider.

Interpretation and translation services will continue to be provided by the surgery. Sex The proposed boundary change is not likely to have any specific impact on patient’s gender including male, female and those who identify as non-binary.

X Registered patients will continue to access primary care services as they currently do.

All patients living within the extended boundary will have increased patient choice as to their Primary Care provider. Gender reassignment The proposed boundary change is not likely to have any specific impact on all patients including Trans.

Registered patients including Trans X will continue to access primary care services as they currently do.

All patients living within the extended boundary will have increased patient choice as to their Primary Care provider. Age The proposed boundary change is not likely to have any specific impact on patient’s age including younger adults, older and elderly patient group. X Registered patients will continue to access primary care services as they currently do.

All patients living within the extended boundary will have increased patient

Screening EHIA v.2 – 09.07.19

Positive Neutral Negative No Comments Impact choice as to their Primary Care provider. Religion and belief The proposed boundary change is not likely to have any specific impact on patient’s religious belief or no beliefs.

Registered patients will continue to X access primary care services as they currently do.

All patients living within the extended boundary will have increased patient choice as to their Primary Care provider. Disability The proposed boundary change is not likely to have any specific impact on patient’s disability including physical and learning disabilities, sensory impairment and patients with long term health conditions.

Registered patients will continue to access primary care services as they X currently do.

All patients living within the extended boundary will have increased patient choice as to their Primary Care provider.

Interpretation and translation services will continue to be provided by the surgery. Sexual orientation The proposed boundary change is not likely to have any specific impact on patient’s sexual orientation including LGBTQ+ patients

Registered patients including X LGBTQ+ patients will continue to access primary care services as they currently do.

All patients living within the extended boundary will have increased patient choice as to their Primary Care provider. Marriage or civil partnership X The proposed boundary change is not likely to have any specific impact

Screening EHIA v.2 – 09.07.19

Positive Neutral Negative No Comments Impact on patient’s marital status including patients who are married, unmarried or in civil partnership.

Registered patients will continue to access primary care services as they currently do.

All patients living within the extended boundary will have increased patient choice as to their Primary Care provider. Pregnancy and maternity The proposed boundary change is not likely to have any specific impact on patients who are pregnant or in maternity.

Registered patients will continue to access primary care services as they currently do. Maternity care for pregnant women and their babies X will continue to be provided by the surgery, and at other facilities within the community where this is provided.

All patients living within the extended boundary will have increased patient choice as to their Primary Care provider.

3. Impact assessment – disadvantaged, inclusion groups and communities

Does this service, policy, strategy or function impact on any other disadvantaged or inclusion groups? Please give details. The proposed boundary change is not likely to have any specific impact on any other disadvantaged or inclusion groups including carers, homeless people or asylum seekers. Carers and people with mental health conditions living within the extended boundary will have increased patient choice as to their Primary Care provider.

Access to GP surgeries is mainly via patients’ registration however, homeless people and asylum seekers living within the extended boundary may be able to access the GP services provided by the surgery if they are able to register or in emergency situations

Screening EHIA v.2 – 09.07.19

Does this service, policy or function impact on deprivation and socio-economic disadvantage of local communities? Please give details. The proposed boundary change is not likely to have any specific impact on deprivation and socio-economic disadvantage of local communities including Gypsies and travellers. All patients living within the extended boundary including gypsies and travellers will have increased patient choice as to their Primary Care provider.

4. Health inequalities YES NO DON’T Comments KNOW Will the initiative help to reduce The proposed boundary change health inequalities for any specific will not help to reduce health groups and communities? inequalities for any specific groups and communities. However, all X patients living within the extended boundary could benefit from having increased patient choice as to their Primary Care provider.

5. Engagement

YES NO DON’T Comments KNOW Has there been any engagement Neighbouring GP practices have activity relating to this service, policy, been notified of the boundary X strategy or function? extension proposal and given the opportunity to comment. Does there need to be any further The proposed boundary change engagement? will provide those living in the Rottingdean and Ovingdean area If yes, add this as an action to the Action plan X below with more choice and primary care and it is unlikely to have a negative impact on patients

6. Extended EHIA

Is an Extended EHIA required? No Give details The proposed boundary change will provide those living in the Rottingdean and Ovingdean area with more choice and primary care and it is unlikely to have a negative impact on patients. Therefore, an extended EHIA is not thought to be required.

7. Actions

Record your Screening EHIA assessment concerns and actions below

Screening EHIA v.2 – 09.07.19

Concerns Action Lead Deadline Person 1 None. 2 3

EHIA written by: Date: 10/03/2021

EHIA reviewed by: Date: 19/03/2021 EHIA authorised by: Date: (manager) EHIA approved: Date: YES NO (governance) Further comments Date:

EHIA published on the Date SES website Person to review EHIA Date post implementation

Screening EHIA v.2 – 09.07.19