OAKENHALL MEDICAL PRACTICE DR N M S GILMORE DR H C ROUGHTON DR S M STURROCK DR S WEBSTER

Bolsover Street, , , NG15 7UA Tel: 0115 963 3511 Fax: 0115 968 0947

9 March 2017

Application for Practice Boundary Change at Oakenhall Medical Practice (C84095)

Proposal

Oakenhall Medical Practice wishes to apply to remove from the practice’s current agreed practice boundary area. The practice intention is to provide NHS Services to patients currently registered with the practice who live in Bestwood Village, but would like to cease future registrations of patients who move into Bestwood Village, with the exception of babies born, fostered and adopted children who become resident in the household to patients currently registered with the practice. This would mean overtime a natural reduction of patients registered with the practice who resided in the area of Bestwood Village.

Reasons

• Geography • Increasingly untenable list size • Inability to expand due to restricted premises

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Current Practice Boundary

Oakenhall Medical Practice is located in Hucknall, serving a growing population. This is due to National/Government planning for housing. Oakenhall Medical Practice current boundary includes Hucknall, Linby, and Bestwood Village.

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Information on Hucknall, the Surrounding Areas and its Population

Hucknall is located 7 miles north west of Nottingham in the district of Ashfield with a population of 32000 (2011 census). This population is increasing.

In relation to Hucknall, Bestwood Village lies to the furthest most point of the Practice Boundary and is only accessible by vehicle via one main road through the Village (there are no connecting roads accessible to a driver/vehicle. In the event of the closure of this one road, the visiting clinician would have no option to travel into to obtain access to Bestwood Village.

Patients travelling to Hucknall would require vehicle transportation. On researching public transportation there is only one bus available hourly. Whereas, both Linby and Papplewick are within walking distance to Hucknall (20 minutes).

The current population in the present practice boundary are as per 2011 National Census is:

Hucknall: 32117 (increasing): Local Authority – Ashfield (population 119,497) Linby: 232 : Local Authority – Gedling (113,543) Papplewick: 756 : Local Authority Gedling (113,543) Bestwood Village: 1969: Local Authority Gedling (113,543)

The population of Hucknall is served by four General Practices. Oakenhall Medical Practice covers ten care homes including the Nottingham Brain Injury Unit (Neurological Care Centre) which has 3 units and also two additional residential homes for people with learning disabilities. Currently there is capacity for 383 beds within the 10 care homes.

There are two care homes in Bestwood Village, Eden Lodge Care Home (60 bed capacity) and Hawthorne Nursing Home (36 bed capacity) of which to the best of our knowledge from discussions with other GP practices that the registered population is as follows:

Eden Lodge: Torkard Medical Practice: 5 Registered Patients Medical Practice: 0 Registered Patients Om Surgery: 0 Registered Patients Oakenhall Medical Practice: 0 Registered Patients

Hawthornes: Torkard Medical Practice: 17 Registered Patients Whyburn Medical Practice: 0 Registered Patients Om Surgery: 0 Registered Patients

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Oakenhall Medical Practice: 1 Registered Patient

Hucknall has a higher proportion of permanently sick/disabled people - 7% of the population (5% nationally. As a consequence there are a higher percentage of the population claiming benefits – 17.3 % (13.5 % nationally).

The population of Hucknall is predominantly White British.

Current Practice Population

The population (32117 2011 Census) of Hucknall is served by Four GP Practices:

Oakenhall Medical Practice: 7,190 Om Surgery: 2,005 Torkard Hill Medical Practice: 14,570 Whyburn Medical Practice: 11,887

The current population for patients registered in Oakenhall Medical Practice is:

Hucknall: 6788 (Population total of 32117 – 2011 Census - 21%) Linby: 62 (Population total of 232 - 2011 Census -26%) Papplewick: 94 (Population total of 756 – 211 Census – 12%) Bestwood Village: 246 (Population total of 1969 - 2011 Census – 12%)

Total: 7,190

Therefore only 3% of patients registered with this practice reside in Bestwood Village.

Whyburn Medical Practice does not currently register any patients from Bestwood Village and Torkard Hill Medical Practice has already placed an application to reduce Bestwood Village from their registered practice boundary. Om Surgery currently registers patients from Bestwood Village and does not have plans at present to change their practice boundary area.

National and Local Housing Plans

The National plans for local housing have resulted in a policy plan to increase housing by a predicted 15,000 population. This figure is based on residential occupation of (2.8) persons per household and is based upon local planning for housing in the Council area which includes, Hucknall, Linby and Papplewick. Oakenhall Medical Practice in addition is required to consider local planning housing policies also in the Gedling area which aligns with Hucknall which includes Bestwood Village.

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Local Housing requirements for the Ashfield District for a plan period of 15 years (2013 – 2033) are documented as 9120 dwellings required, with Hucknall housing trajectory plan for a total of 2242 dwellings.

Local Housing planning for the Gedling District includes proposed dwellings of 7250 (2011 - 2028) and includes:

• Land North of Papplewick Lane (within current Practice boundary) – 600 dwellings • Top Wighay Farm (within current Practice boundary – 1,000 dwellings • Bestwood Village – 579 dwellings

Total 2,179 dwellings

Predicted Growth in Hucknall (Ashfield District): 15,000 Predicted Growth for Linby, Papplewick, and Bestwood Village (Gedling District): 6,100 (Calculated at 2.8 persons per dwelling)

Total Predicted Growth 15 year plan: 21,100 (Potential patient registrations for Hucknall).

In addition, there are planning applications for three new care homes in the Hucknall area, one application includes 70 beds. Oakenhall Medical Practice currently covers ten care homes which included 383 beds.

Oakenhall Medical Practice

Oakenhall Medical Practice is served by four part-time General Practitioners (three whole time equivalent) working in a partner owned premises. Oakenhall Medical Practice is the only practice located within this building. Oakenhall Medical Practice has a rising practice patient register of 7190.

Oakenhall Medical Practice opens between the hours of 08:00 to 18:30 Monday to Friday. The practice does not shut with the exception of Protected Learning Event arranged or agreed to by Nottingham North and East Clinical Commissioning Group.

In addition to the full range of General Medical Services the Oakenhall Practice also provides the following services to its patients: • Minor Surgery • Contraception Services • Smoking Cessation - in conjunction with Smokefreelife

The practice staff includes:

• Four GP Partners (3 whole time equivalent) • Three Practice Nurses (2 ¾ whole time equivalent) • One Healthcare Assistant • 9 Administration Team (including Practice Manager)

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The Whole Time Equivalent for the four GP Partners is equal to Three Whole Time Equivalent. Oakenhall Medical Practice is currently over capacity by approximately 1790 patients, in relation to the number of GP’s, i.e. 2404 per three WTE which is significantly over the recommended list size per WTE GP. We are severely limited by our building size so cannot expend team further, as we are already using consulting rooms to capacity.

Oakenhall Medical Practice is a member of the Nottingham North And East Clinical Commission Group. All GP partners equal engage within the NNE CCG, in relation to meetings, service specification, and work streams deliveries.

All the four GP Partners are involved and engage within leadership areas with the practice e.g. Safeguarding Lead, Prescribing Lead etc. to provide a practice ethos in line with the Care Quality Commissioning Inspection Requirements. Oakenhall Medical Practice received a CQC inspection on the 16 th of June 2016 and was rated as “GOOD” in all areas.

Oakenhall Medical Practice employs three Practice Nurses and One Healthcare Assistance to deliver nursing care within the practice. All four members of the Nursing team are experienced in their individual roles. The Whole Time Equivalent for the Nursing team is equal to two and three quarter’s Whole time equivalent.

Oakenhall Medical Practice employs nine administrative staff (including Practice Manager) – the Whole Time equivalent is seven and three quarter WTE. The members of staff have various levels of experience. We have recently recruited a part time receptionist, in addition to confirming a permanent employment of our apprentice. The staffing Rota ensures that there is a mix of experience staff from 08:00 until 18:00 to ensure all staff has supervision, support (mentorship) and ongoing training in place throughout the working day. All staff are also trained in multiple roles to ensure that all aspects of administration of the practice can fully function throughout the working day – to ensure whether ever possible, that patient enquiries are dealt within one patient contact.

Practice Forward Planning

Oakenhall Medical Practice is located in a converted and much extended former Victoria dwelling house set within a terrace of similar properties. Parking is restricted and there is an absence of dedicated parking spaces with a reliance on street parking. The property is generally at Condition B/C, below the recommended Condition B (noted in the NNE CCG’s Strategic Estates Plan) and is also rated at Condition F for space utilization.

Oakenhall Medical Practice has a projected growth of 1500. The current list size is 7190 (7152 May 2016 – which required a reimbursable floor area (GIA) of 589 m2. However the actual accommodation is much smaller at 284 m2). There is no space to expand, which therefore limits the services we are able to offer our patients. The Practice is already over capacity by circa 1813 patients and we are continually looking at how to best.

The practice has recently engaged with Nottingham North and East Clinical Commissioning Group and Hucknall GP Practices (Whyburn Medical Practice, Torkard Hill Medical Practice and the Om Surgery to look at ways to meet predicted population growth in Hucknall. A

7 need was identified for a development to provide accommodation comprising of 1850 2 for GP Services, which would enable Whyburn Medical Practice and Oakenhall Medical Practice (both currently rated Condition F for space utilization) to relocate to new premises (appropriate modern facilities as required by HBN 11-01 – Hucknall Primary Care Hub). This would provide greater access with primary care, whilst reducing emergency care access by patients. A bid was made to the Estates and Technology Fund for the Hucknall Primary Care Hub. Unfortunately, this bid did not result in sufficient release of funds to commence this project immediately and review of other sources of funds e.g. “106” funds will not release sufficient funding to enable commencement. There will be another opportunity to bid for the Estates and Technology Fund in 2019.

Therefore, Oakenhall has positive plans for expansion of the practice with relocation to other premises.

NHS is investing £500 million in national sustainability. The NHS General Practice Forward View includes investments in care redesign – “support for individual practices and for federations and super partnerships; direct funding for improved in hours and out of hours access, including clinical hubs and reformed urgent care; and a new voluntary contract supporting integrated primary and community health services”

The Hucknall Primary Care Hub will provide a hiatus within Hucknall for Hucknall patients to support these plans, allowing Hucknall practices to move forward with NHS England future planning for patient access to primary care 8am – 8pm seven days a week.

Practice/Patient Capacity at Oakenhall Medical Practice

In May 2016 the patient list size was 7152 and has risen to 7190. Despite natural deregistration from the practice due to patients who are deceased or who are leaving the area, the practice has seen an increase in the patient list size. Oakenhall Medical Practice is currently over capacity by approximately 1790 patients, in relation to the number of GP’s, i.e. 2404 per three WTE which is significantly over the recommended list size per WTE GP. We are severely limited by our building size so cannot expend team further, as we are already using consulting rooms to capacity.

Current Working Levels/Pressures

Oakenhall Medical Practice is providing NHS services to the maximum capacity. All consulting rooms are presently in continual use, for all clinicians (including Nursing and HCA team members) in order to maximize usage.

Oakenhall Medical Practice whilst providing contracted cores services are also providing NHS England, Nottingham North and East Clinical Commissioning Group and Local Authority Directed Enhanced Services (detailed below), but due to rising patient activity (acute and routing patient access) in the practice, we are not in the position to offer all enhanced services, namely: contraceptive implants and One Care Home specification (although we are happy to continue to align with two named care homes a linked named GP Practice to those patients who choose to register with Oakenhall Medical Practice). There are two care

8 homes in Bestwood Village. Currently we only have one patient registered with the practice, who resides in one of the care homes. Information provided by the NNE CCG in respect of the One Care Home Specification, has indicated that the majority of the residents in these care homes are registered with Practices in the Nottingham City CCG (Bulwell). Bestwood Village is aligned with Gedling Borough Council, who provides their own primary care services.

The rising patient practice registration list size, increases patient activity, in the practice, which includes increasing numbers of patient with long term conditions (this will be particularly noticeable, in the case of three potentially new care homes in Hucknall), which will effect rising referrals into our linked primary care team e.g. District Nurses, Macmillan Team, Care Home Liaison Nursing, Midwifery and Health Visiting Team, who are all based in Hucknall and provide their own clinics in Hucknall. A reduction in our boundary area, will therefore impact on our linked primary care team, in eventually providing a Hucknall based (Hub) if preparedness for NHS England Forward View increased access to General Practice.

Oakenhall Medical Practice engages with the Nottingham North and East Clinical Commissioning Group. The practice attends clinical cabinet, Locality and managerial meetings. The practice continually strives to review and monitor all services provided by the practice to ensure, patient centered care is delivered effectively and safely. The practice continues to monitor prescribing and referral provisions, and where necessary implement improvements.

Oakenhall Medical Practice has never previously closed the practice registration list, but the GP Partners have discussed this as a consideration, but are conscious that this would have an overwhelming impact not only on our neighboring practices, but could have an impact on the practice’s future sustainability. During our CQC inspection on the 16 th of June 2016, this was discussed with the visiting inspectors and the alternative of making a change to the practice boundary was felt to be appropriate way of dealing with excessive workload pressures.

NHS Services Provided In addition to the full range of General Medical Services the Oakenhall Practice also provides the following services to its patients:

• Minor Surgery • Contraception Services • Smoking Cessation - in conjunction with Smokefreelife • NHS Health checks • Learning Disability Health Review • Child hood Vaccination and Immunisation in addition to Core services • Annual Flu immunisation • Shingles immunisation • Monitoring of PSA, DMARD’s and Anticoagulation • Unplanned Admissions/Care Planning

How Oakenhall Medical Practice has sought to Engage with Patients and Colleagues

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The GP Partners has taken considerable time and reflexion prior to submitting this application.

The practice initially communicated our intentions in 2015 during NNE CCG Locality meetings, Hucknall Planning (development of GP Practices in Hucknall which involved, the four local practices, NNE CCG representatives, LMC representatives and NHS England Representatives) and during Practice Patient Participation Meetings.

The practice has now sent a formal letter of intent to the following organisations and individuals:

GP Practices in Hucknall

• Om Surgery, 112 Road, Hucknall, Nottingham, NG15 7JP • Torkard Hill Medical Centre, Farleys Lane, Hucknall, Nottingham, NG15 6DY • Whyburn Medical Practice, Curtis Street, Hucknall, Nottingham, NG15 7JE

GP Practices in Rise Park and Bulwell

• Rise Park Surgery, Rise Park, Nottingham, NG5 5EB • Springfield Medical Centre, 301 Main Street, Bulwell, Nottingham, NG6 8ED • Leen View Surgery, Bulwell Riverside, Bulwell, Nottingham, NG6 8QJ • Parkside Medical Practice, Main Street, Bulwell, Nottingham NG6 8JQ • Riverlyn Medical Centre, Station Road, Bulwell, Nottingham NG6 9AA

Organisations

• Head of Primary Care Operations - Nottingham North and East CCG • Nottinghamshire Local Medical Committee • PALS Officer, Patient Advice and Liaison Service – Nottingham North and East CCG • Patient Experience Manager, Patient Complaints Team – Nottingham North and East CCG • Fourteen Members of the Practice Patient’s Participation Group

Feedback Received from Practice Engagement

Oakenhall Medical Practice has received acknowledgement from the Nottingham North and East CCG, Patient Experience Team and offers of assistance from the Nottinghamshire Local Medical Committee.

To date the only other communication that I have received is verbally from one the Patient Participation Group members. He said that he was supportive in this measure, to address the needs of present registered patients and patients requiring registration who were new to the Hucknall area. He particularly supported the intention of the practice to retain 10 patient already registered with the practice until natural deregistration and said it was reassuring that the practice intended to register both children born into the family and children moving into foster care.

Conclusion

Oakenhall Medical Practice wishes to apply to remove Bestwood Village from the practice’s current agreed practice boundary area. This is to:

• Address geographical needs of the patients residing in Bestwood Village and the growing lack of sufficient capacity of the practice to meet those needs. • Increasing practice list size as a result of local housing plans • The practice has presently reached, and is indeed over capacity for its current premises. Although practice plans are in place for expansion this remains dependant on funding sources.

We look forward to your decision in due course.

Dr H C Roughton On behalf of GP Partners of Oakenhall Medical Practice.

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