Premises Scenarios
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Skerne Medical Group Premises Appraisal June 2019 Reminder - National Crisis impacting locally The attraction and retention of GPs continues to be a challenge. Taken significant time to fill vacancies caused by retirement, sickness and resignations Situation has worsened in last 6 months despite reducing services from 4 to 3 sites. 2 Partners, 1 salaried GP and a Clinical Practitioner We are at resigned. breaking point 15500 patients over 3 sites is unsustainable for the future. Also inability to absorb any increase due to housing developments Lack of new GP’s seeking Partnership therefore small number of partners to absorb business workload What has changed since the engagement? Recruited four new GPs, 3 we hope will commence in Aug 2019 and one to join in Jan 2020 Recruited additional Practice Pharmacist and currently recruiting What have we for an additional Clinical Practitioner achieved? Practice Paramedic and Practice Nurse achieved prescribing status Now better placed to provide support and mentorship to our whole clinical team GP Appointment Time – In Jan 2020 we will almost be back to GP appointment time of October 2016 80 70 60 50 Oct-16 Sessions 40 Feb-19 (half a day) 30 Aug-19 Jan-20 20 10 0 GP Appointment Time There has been a significant change in the split between Partners and Salaried GPs In January 2020 10 Pre October Partner FTE will 2016 the be 2.12 Partner FTE 9 was 6.12 8 7 6 5 Salaried GPs Partners 4 3 2 1 0 Number of GP's Practice Area Premises Scenarios As requested by the Primary Care Committee scenarios have been reviewed in conjunction with DDES CCG and NHS England The scenarios have included all What has locations across our practice area been The scenarios have considered the reviewed? financial implications for the Partnership The future sustainability of Skerne Medical Group has to be a balance of the above considerations What are the challenges with a multi site practice? Newly qualified GPs require mentoring and peer support to manage the transition from trainee to qualified GP Appointment time is lost due to clinical staff having to travel between sites Challenges Patients do not receive consistent continuity of care with clinical staff working across multi sites All staff do not like working in isolation and prefer working in teams where peer support is available Partnership Financial Responsibility Skerne Medical Group is a standalone business fully responsible for its profit/loss The Partners have full financial responsibility for the Practice. Premises are secured on either 25 year lease or mortgage Partnership The Partners have full responsibility for the medical care provided to patients and staff they employ The risk remains of formal termination of the formal GP contract Scenarios Extend Harbinson House, Sedgefield and retain and extend Trimdon Colliery 1 surgery Extend Harbinson House, Sedgefield and build a (larger) new surgery in Trimdon 2 (village) to accommodate 7,000 patients (plus retain Trimdon Colliery until 2027) Build a new surgery in Trimdon (village) for entire practice plus retain Trimdon 3 Colliery until 2027 Occupy a single site at Sedgefield Community Hospital plus retain Trimdon 4 Colliery until 2027 5 Extend Harbinson House, retain Trimdon Colliery and Fishburn Scenario 1 – Extend Harbinson House, Sedgefield and retain Trimdon 1 Timescale Colliery surgery (would also require extending) 18 months Fishburn would close at some point Limited public car parking in Sedgefield for Good accessibility for increase in patient Patients whole practice area numbers Patient numbers would have to be controlled at either site due to capacity issues Staff could be anchored to sites for continuity of care and maximisation Practice of available No foreseeable impact Staff appointments Opportunity to centralise some functions & achieve economies of scale Scenario 1 - Extend Harbinson House and retain and extend Trimdon 1 Colliery surgery Finance required for May be an attractive extension work in option to incoming Sedgefield and Trimdon Finance Partners Colliery Partners would have to sign new lease on TC or look at option to purchase (if available) Current room availability would leave no scope for development of services so Sedgefield Facilities Two good buildings with and Trimdon Colliery facilities would require extension to provide sufficient rooms No scope for future expansion Scenario 2 – Extend Harbinson House, Sedgefield and build a (larger) 2 new surgery in Trimdon (village) to accommodate 7,000 patients Timescale 5 Years Fishburn would close Good accessibility for and Trimdon Colliery in each side of the practice 2027 Patients New purpose built Limited car parking in facility for patients of Sedgefield for increase Trimdon in patient numbers Could be attractive Practice model for new Partners depending on finance of No foreseeable impact Staff new build Staff could be anchored to sites for continuity of care Scenario 2 – Extend Harbinson House, Sedgefield and build a (larger) new 2 surgery in Trimdon (village) to accommodate 7,000 patients Huge estimated build cost of £2.2m – would require 3 rd party ‘no risk’ investment Would require Finance significant number of additional Partners to Savings due to obtain a loan and share economies of scale repayments Sale and leaseback options debateable due to limited number of Partners New build modern and purpose built Peer support readily Facilities No major impact on available and attractive facilities for patients or operating model for GP staff training Scenario 3 – Build a new surgery in Trimdon Village for entire practice 3 and retain Trimdon Colliery until 2027 Timescale 5 years Harbinson House and Fishburn would close Improved Safety (Trimdon Colliery in Patients Improved facilities and 2027) services in a modern Not a central location purpose built surgery for entire practice population Likely to aid retention of our new GPs Peer support readily Practice available and attractive operating model for GP No foreseeable negative Staff training impact Less duplication of effort Scenario 3 – Build a new surgery in Trimdon Village for entire practice and 3 retain Trimdon Colliery until 2027 Huge estimated build cost of £3.57m – would • Improved Safety require 3 rd party ‘no risk’ Savings in running costs • Improved facilities and investment due to economies of services in a modern Would require significant scale and modern • Distance for Trimdon environment number of additional Finance premises Village patients • One stop shop for Partners to obtain a loan continued care and share repayments • Ability to offer more Sale and lease back flexible hours options debateable due to limited number of Partners Modern and purpose built Ability to offer services under one roof Proposed site is not big Peer support readily Facilities enough for a single sited available and attractive building operating model for GP training Scenario 4 – Occupy a single site at Sedgefield Community Hospital 4 and retain Trimdon Colliery until 2027 Timescale 2 Years Harbinson House and Fishburn would close at Improved Safety some point (Trimdon Improved facilities and Colliery in 2027) services in a modern Additional travelling for environment Patients all patients across the One stop shop for practice area continued care due to Access issues for less connections with other mobile patients across clinical services co- the entire practice located Not all public transport stops at SCH Will attract and retain GP’s Peer support readily Practice available No foreseeable negative Improved staff morale Staff impact Less duplication of effort Scenario 4 – Occupy a single site at Sedgefield Community Hospital and 4 retain Trimdon Colliery until 2027 Extremely high service charge as PFI building Will require sale of Savings due to practice property economies of scale (potential negative Finance Potential revenue from equity situation & hosting other PCN impact on outstanding services business loan) Service charges & running costs unknown – is it affordable through duration of agreement Modern and maintained Consistent services No pharmacy adjacent provided for all patients to site Peer support readily Unknown as to what Facilities available and attractive impact the rest of the operating model for GP used area of SCH may training have on the practice Opportunity to expand car park (we believe) Other facilities on site Scenario 5 – Extend Harbinson House, retain Trimdon Colliery and Timescale 5 Fishburn 18 Months Car Parking is limited in all sites and no scope Most patients have for expansion good access to a nearby Allied Health surgery Professionals occupy No further disruption to rooms (for convenience Patients patients and staff of patients) Current working model The range of services since last engagement offered at Fishburn will be limited in comparison to other sites Professional isolation will still exist across 3 sites. Would 3 sites remain attractive to new GPs Practice and affect retention of Staff have good local all clinical staff without Staff knowledge of patients whom the service fails Clinical and reception staff will continue to work across multiple sites Scenario 5 – Status quo operating from surgeries in Sedgefield, Fishburn 5 and Trimdon Colliery Finance required for potential extension Partners retain assets work in Sedgefield and Finance potentially Trimdon Colliery Practice would have to sign new lease on TC or look at option to purchase if available No scope for