Report to Primary Care Commissioning Committees in common

CCGs applicable to NHS West Sussex CCG

Meeting date 25 November 2020

Report title Proposed new build branch surgery, Copthorne, Pound Hill Medical Group: Project Initiation Document

Report from Karen Sallis, Head of Primary Care (West)

Clinical lead Dr Glyn Williams

Report author Karen Sallis

Item number 2.3.6

Recommendation/action required:

Members of the Primary Care Commissioning Committee (PCCC) are asked to give their support, and approval for the Project Initiation Document (PID) for a new purpose built primary care facility at St Modwens, Copthorne.

Executive summary The Pound Hill Medical Group is seeking to relocate from its current branch surgery in Copthorne, to a new purpose built facility in a new housing development at St Modwens, Copthorne.

Pound Hill medical Group has 15,920 registered patients, which is the second highest within the former Crawley CCG area. The Group’s existing surgeries in Pound Hill and Copthorne are no longer suitable to serve its current registered population and are well under the recommended premise size for the number of patients, this is particularly acute at the branch surgery site in Copthorne.

The attached Project Initiation Document (PID) (Appendix A) describes the background to the proposed new build, together with the reasons behind it, and the finances to support it.

In brief, the PID describes a proposed new building in Copthorne, which will replace the existing branch surgery, whilst providing sufficient capacity to relocate some of the existing practice staff from the main Pound Hill site to the new build in Copthorne.

As this proposal forms part of a Crawley project which links to a developer led site, the time frame is critical as the premises build needs to tie into the development site.

NHS England approved the PID subject to three outstanding queries, which have now been addressed as follows:

1. Build Cost The build cost reported was slightly over a guide £4,500 per square metre. This is now below that level and will be further reviewed by the District Valuer if / when PCCC recommend the PID moving forward 2. Lease Costs Initial lease costs were based on a range of estimates. These have been revised. This again will be picked up at Business case submission, where the DV will be instructed to do a formal Value for Money report 3. Room Size There was a question around treatment room sizes that were stated as circa 15.9m. The guide is 16m. These have been set at 16m now.

Members of the Primary Care Commissioning Committee (PCCC) are asked to give their support, and approval for the Project Initiation Document (PID) for a new purpose built primary care facility at St Modwens, Copthorne.

Previously considered by [governance/ engagement pathway to date] Org./Group/ Name Date Outcome

NHS England-Primary February Agreed subject to cost and room size updates Care 2020

PCOG 25/09/2020 PCOG agreed to refer the proposal to PCCC for approval What happens next?

The PID will be progressed to a Business case and presented at LMT and the next PCCC where approval will be sought for it to move to the next stage of progression.

Implications Corporate • Improved population health outcomes and patient objectives this experience relates to • Improved quality of services, access and operational performance • Improved financial performance • Delivering system reform • Effective and well led organisation with an empowered and inclusive workforce • Local priority objectives Financial Section 106 monies. Further details are given in the PID

Risk, legal and Non identified at this stage though these will be explored further as other compliance the application is progressed Quality and safety A full quality impact assessment will be completed at the next Business Case stage if approved.

Equality, diversity A full equality impact assessment will be completed at the next and health Business case stage if approved inequalities Patient and public Not at the moment, though a full public and patient engagement engagement exercise will be undertaken. Health and The need for more primary care premises is recognised within the wellbeing JCNA.

List of appendices

• Appendix A: PID: Proposed new build branch Surgery, Copthorne – Pound Hill Medical Group.

Project Appraisal Unit

Capital Investment, Property, Equipment & Digital Technology proposals

NHS England Project Appraisal Unit Project Initiation Document - Type 1 Clinical Premises Not to be used for NHS England administrative premises - see PID Type 2

Sponsors and authors of documents seeking appropriate authority to fund or proceed with a scheme or project must consider whether the content or strategy to which the document applies at this stage is sensitive or may have commercial implications. If it is considered necessary, the document should be headed and watermarked appropriately.

Unless building and premises based PIDs are informed by sufficient detail and forward planning this can hinder a prompt and informed decision on PID approval. A PID is the first stage in the process, but there are fundamental issues to be considered before progressing to business case stage. This particular PID type for clinical premises is therefore designed to support authors in considering some of those important issues that need to be covered in the PID to inform local decision making. It is also acknowledged that at PID stage not all of the information asked for may be available. However, all PIDs for this type of proposal must be as complete as possible and, where information is not known, a brief explanation should be provided.

Document version Version No. Status Issue date Notes control Addressing points raised by (for use by PID sponsors) NHSE & Crawley CCG 4 Approval Requested 15/05/20 Add rows as required. following November 2019

Last entry should read: submission (version 3). ‘Final for signatures’ Revised target BREEAM 5 Approval Requested 11/08/20 rating and benchmark cost adjustment.

1. TITLE OF SCHEME Proposed New Build Branch Surgery, Copthorne – Pound Hill Medical Group Scheme reference number and source of number (organisation). Reference No. -

Please ensure the relevant unique reference (for all Schemes) is used Confirm the in all correspondence and reporting Organisation West Sussex CCG using an appropriate format: e.g. issuing the NHS England XXX – YY - XXX (Org Code – 17 – reference Sussex and East Surrey Health and Care Partnership (STP) 001) number.

2. DATE OF FORMAL PID Date August 2020 SUBMISSION

A PID was submitted to the former Crawley CCG (now

3. IS THIS A RESUBMISSION amalgamated with the West Sussex CCG effective 1st April OF AN EARLIER PID? 2020) and NHSE in March, June and November 2019, as Reference No. If so, provide details and reference part of a proposed revenue funding bid for a new branch no. surgery in Copthorne. This PID is an enhanced re-submission

of those documents previously submitted, which also

NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 1 of 31 includes a Q&A section set out under PID Appendix G which seek to address matters raised by NHSE in their letter to the practice dated 6th January 2020, which followed the June (version 2) and November 2019 (version 3) PID submissions.

A further revision has been made in respect of v5 which incorporates changes requested by the West Sussex CCG concerning BREEAM target ratings and also acceptable benchmark costs for the new build – these changes have been made as requested.

IF YES: Will this resubmission result OR potentially result in a duplicate funding application already covered by another Please provide PID, etc.? No. details Is any element of this PID actually, or potentially funded through any other previous (already approved), parallel (current) or planned (future) application for funds?

4. NHS ENGLAND CAPITAL If applicable, FUNDING STREAM (from any funding Estates Technology and Transformation Fund source) initiative name

Please confirm the NHS England Scheme Not known capital funding stream relevant to reference No. this investment e.g. BAU, etc. Funding ETTF Financial tables should clearly show stream the NHS England commitment.

Where capital funding is from a Cost Centre Not known special initiative e.g. ETTF, please use the first two rows opposite to Subjective Not known denote initiative name and scheme Code reference number Total value of The Pound Hill Medical Group has to date, received £30k in Please use standard NHS finance NHS England relation to project management fees. codes when completing this section funding. £

Funding Local Authority – Section 106 Planning Gain 5. DETAILS OF ANY source name ADDITIONAL CAPITAL There are a number of planning applications for housing FUNDING SOURCE (where developments that fall within the Pound Hill Medical Group applicable) patient catchment area. The Mid and West Sussex District Please confirm and briefly explain Council in conjunction with Crawley CCG have secured ANY additional capital funding stream relevant to this investment planning contributions in support of infrastructure e.g. NHSPS Customer Capital. improvements to the Pound Hill Medical Groups surgery Brief premises at either Pound Hill in Crawley or branch surgery The additional/alternative funding explanation of should be clearly shown in Table 3 funding in Copthorne. below with relevant totals.

The implications of the additional The s106 amounts and description of housing projects, funding must be clearly shown in including the relevant local authority granting planning the Economic and Financial approval and planning reference number is provided below sections of this PID. for ease of reference.

NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 2 of 31 Local Authority: Mid and West Sussex County Councils

Project Details: Copthorne West Mixed-Use Development - 500 units

Planning Reference: 13/04127/OUTES

S106 Amounts Granted:

(1) Land for new build surgery as part of the Copthorne West development.

Or where land is not transferred for a new build surgery.

(2) A healthcare contribution used towards improvement of facilities at the Pound Hill Surgery or Copthorne Branch Surgery in the sum of £232,190.

Note this sum is indexed linked with the following obligations around payment.

(1) £77,397 on occupation of first residential unit. (2) £77,397 on occupation of 15% of total number of units. (3) £77,396 on occupation of 30% of total number of units.

At the time of writing the PID, it is not known whether any further s106 or CIL contributions have been secured from other nearby housing developments. These specifically would be secured by any planning applications lodged with Mid-Sussex District Council.

Since the original PID submissions of March, July and November 2019, it had been established via the Crawley CCG that Crawley Borough Council have adopted a CIL regime for new housing developments located in Crawley. There is potential scope to establish via the Crawley Borough Council whether CIL contributions can be allocated to the Pound Hill Medical Group towards the costs associated with the planned development of a new branch surgery in Copthorne. The CIL contributions will be sort on the basis of mitigation against new housing developments and investment in primary care infrastructure.

At the time of producing the PID re-submission (version 4), it is understood that Crawley CCG had pursed additional CIL funding for improvements to health infrastructure, which specifically references the Pound Hill Medical Group – the application relates to the Forge Wood housing development [Application CR/2019/0694/OUT]. It is not known if this CIL request has been successful. This would be for West Sussex

NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 3 of 31 CCG / NHSE to take-up formally with officers at Crawley Borough Council.

Is this funding S106 contributions have been specifically allocated to the to be used for Pound Hill Medical Group – this will be in the form of a land a specific purpose? transaction. Is any element There is a requirement to commit all s106 funds to the of this funding project or pay the sums back to the housing developer. liable for There can be no diversion of s106 capital to other NHS repayment? proposals. If yes, please give details Detail and dates will be subject to clarification between the including Crawley CCG and the relevant Local Authority. reason, amounts and dates.

Land for new branch surgery in Copthorne OR, a monetary Total value of sum of £232,190. The Pound Hill Medical Group are additional funding. £ securing land from St Modwens in respect of the Copthorne West development.

6. NHS ENGLAND Region South East REGION/LOCAL DIRECTOR OF COMMISSIONING DCO OPERATIONS (DCO) OFFICE

Organisation Pound Hill Medical Group 7a. SPONSORING Title/position GP Partner and Project Lead ORGANISATION No. 1 AND LEAD CONTACT Name

Please include a named lead Office tel. contact for this application who can answer any queries relating to this Mobile tel. - PID e-mail Organisation West Sussex CCG 7b. SPONSORING Executive Director of Primary Care ORGANISATION No. 2 Title/position (where applicable) Name Please include a named lead contact for this application who can Office tel. answer any queries relating to this Mobile tel. PID e-mail Organisation NHS England 7c. SPONSORING Assistant Contract Manager / Senior Programme Lead – ORGANISATION No. 3 Title/position ETTF (where applicable)

Please include a named lead Name contact for this application who can Office tel. answer any queries relating to this PID Mobile tel. e-mail Organisation N/a Title/position - NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 4 of 31 8. NHS PROPERTY SERVICES Name - OR COMMUNITY HEALTH Office tel. - PARTNERSHIPS CONTACT (where applicable) Mobile tel. -

Please include a named contact as e-mail - appropriate

CCG West Sussex CCG 9. OTHER LOCAL STAKEHOLDERS OR Local Authority Mid and West Sussex County Councils TENANTS

Please add further lines where Other (1) NHSE required Other (2) Sussex and East Surrey Health and Care Partnership (STP)

10. SCHEME DESCRIPTION

Include a brief description of the Scheme Description scheme, which should include, but need not be limited to: The Pound Hill Medical Group are seeking to re-locate from its current branch • scope and content surgery in Copthorne, to a new purpose-built facility which will be situated • the scheme type - new build, refurbishment or a lease within a new housing development being delivered by St Modwens which is • objectives and benefits – these situated on the western periphery of Copthorne village. may be financial and/or non- financial The proposals will see land transferred from the developer St Modwens to the • location – address and name of practice, as part of s106 obligations – see section 5 of the PID. It is also the facility proposed that in addition to transferring land to the Pound Hill Medical Group, • NHSPS/CHP premises code where known and available St Modwens will also be commissioned to build a new GP Surgery which will • wider stakeholders and their consist of 516m2 (GIA) of healthcare accommodation (GMS) and 100m2 of interest e.g. potential occupants pharmacy accommodation. In total, St Modwens will deliver a 616m2 (GIA) • indicative scheme value for new build facility. approval purposes • confirm other stakeholders are signed up to the general terms, The practice intends to own the completed facility (which is a GP led owner costs and implications of the occupier model) and have appointed advisors Apollo Capital Projects proposal. Development Ltd to project manage the development process on behalf of the • confirm that where details are practice. Subject to securing the necessary approvals, the new building will be known, any proposed leases, are operational from March 2022. appropriate and acceptable to all participants. • if the scheme requires temporary Practice Overview accommodation • if costs for enabling works are The information contained within this PID relates to the Pound Hill Medical required and, if so, included in Group, which is located in Crawley, West Sussex. the overview costs.

The practice currently operates from two surgeries located on the east of Crawley, the practices main branch is located off Crawley Lane in Pound Hill, whilst the practice also operates from a small branch surgery, located in Copthorne Bank, Copthorne.

The practice catchment area covers approximately 2 square miles to the east of Crawley which includes the suburbs of Pound Hill, Worth and also the village of Copthorne.

The practice is ranked as the second largest practice in terms of registered patient list size within the former Crawley CCG locality, where across the two surgery sites, the practice currently serves a patient population of 15,920 patients. NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 5 of 31

Although the Copthorne site is a branch surgery for the practice, patients from both Pound Hill and Crawley use the surgery facility in Copthorne. It is proposed that this arrangement will continue once the new build is operational.

The practice currently comprises of 9 GPs, , 1 Physician Associate, 4 Nurses, 3 HCAs, 12 Receptionists, 8 Admin staff, 1 Practice Manager and 1 Deputy Practice Manager - the practice staff operate across both surgery sites.

Pound Hill Medical Group – Surgery Location and Patient Catchment Area

Primary Care Networks

In January 2019, NHS England outlined ‘A five-year framework for GP contract reform to implement The NHS Long Term Plan’ which set out planned changes around the contracted arrangements for the delivery of primary care services across England.

One of the main components of the GP contract reforms centred around the formation of Primary Care Networks (PCNs) where GP practices would arrange themselves into geographically aligned networks providing services to a patient population of between 30,000 – 50,000 patients.

One of the main drivers of the new PCNs, is to encourage greater collaboration between GP practices, whilst also facilitating greater integration of services across the whole healthcare system which would include primary care, the acute sector, community teams, mental health providers, social care teams, pharmacists and allied healthcare providers.

The PCN arrangements include the introduction of a new Direct Enhanced Service (DES) contract arrangement effective from July 2019, where practices via its PCN will receive payment for the provision of services. A range of new investment measures have also been announced, with a particular emphasis around introducing new skills into primary care aimed at addressing the workforce shortfalls within the primary care setting.

In response to the new contracted arrangements, the Pound Hill Medical Group has formed a PCN with Ifield Medical Practice (11,200 patients), Furnace Green Surgery (8,200 patients) and the Woodlands & Clerklands Partnership (Woodlands Surgery 7,800 patients), where the new PCN are now NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 6 of 31 contracted to provide services to its PCN patient population of circa 42,000 patients.

With limited opportunities to expand or adapt the practices existing surgeries, coupled with a lack of available capacity at any of the other PCN partner practice premises, the planned new build in Copthorne provides a great opportunity to create extra capacity within the practices premises which will facilitate the PCN roll out effective from July 2019, not only for the Pound Hill Medical Group, but also for the PCN partner practices. Without additional premises capacity, there will be limitations around the effectiveness of new service provision by the PCN.

Over the coming months, the Pound Hill Medical Group, alongside its PCN partner practices, will look to introduce a range of new clinical and non-clinical staff to the practice team, where funding has been made available for the new practice team roles from 2020/2021. These include:

• Social prescriber link worker • Clinical pharmacist • First Contact Physiotherapist • Physician Associates

Existing Premises

The practices existing surgeries in Pound Hill and Copthorne are no longer suitable in serving a patient population in excess of 15,920 patients. The premises are considerably under-sized in comparison to current guidance, this problem is particularly acute at the practices branch surgery in Copthorne.

Other issues associated with the Copthorne branch include:

• Inadequate clinical capacity to serve the growing patient list size and range of services that patients require and that the practice would like to deliver, particularly to meet the expected needs of the Primary Care Networks as part of the ne GMS contract 2019/20 • In sufficient capacity to accommodate MDTs, in line with the new GP Contract arrangements. • Not being fully DDA compliant in respect of facilities such as toilet and disabled access. • Inadequate waiting area space and a lack of confidentiality within the reception areas. • Inadequate clinical rooms • Inadequate parking capacity at either surgery location.

The proposals are therefore to progress a new building in Copthorne which will replace the existing branch surgery in Copthorne, whilst providing sufficient capacity to re-allocate some of the existing practice staff from the main Pound Hill surgery to the new build in Copthorne.

NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 7 of 31 Scope and Content

The vision of the practice is to create a new branch surgery in Copthorne, which is correctly sized and provides the practice with extra capacity required to cater for its existing patient population of 15,920 patients, but also absorb additional patient growth that will result from housing developments being

delivered within (and close to) the practices patient catchment. It is also proposed that a new branch surgery will incorporate an on-site pharmacy which replicates the existing arrangements at the current Copthorne branch surgery where a pharmacy is currently operated by the Medipharmacy Group Ltd. It is proposed that the practice will lease the pharmacy unit to the Medipharmacy Group Ltd, essentially replicating their current arrangements, where in doing so, the pharmacy arrangement can contribute to the on-site service provision offered to patients, but the presence of a pharmacy will also help contribute to overall cost of the project, whilst off-setting the capital costs that would ordinarily be underpinned via NHS revenue funding (notional rent).

The proposed new branch surgery will be located on land which forms part of the Copthorne West housing development which is being delivered by St Modwens on the western periphery of Copthorne village. The housing development will consist of 500 housing units, together with a new school and a new doctor’s surgery. Additionally, there is another development of 75 homes adjacent to this development.

The arrangements with St Modwens will see a parcel of land being released to the PHMG at nil cost for the new surgery development, which aligns to the planning conditions that form part of the Outline Planning approval that was granted to St Modwens by Mid and West Sussex County Council in March 2016. The formal legal arrangements are set out within a s106 agreement between all main stakeholder groups involved in the Copthorne West housing scheme.

The proposals will see the practice build a new medical centre which will measure in the order of 516m2 (GIA), together with a pharmacy (100m2). The GMS reimbursed surgery accommodation provides sufficient space for the following:

4 No. Consulting Rooms 2 No. Training Rooms 1 No. Enhanced Treatment Suite 1 No. MDT/Visiting Clinician Room 2 No. Visiting Clinician Room 2 No. PCN Rooms 1 No. Utility Space 1 No. Administration Office 1 No. Reception and Waiting 1 No. Staff Room

Details of the room types and proposed utilisation schedule are contained under Appendix B.

NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 8 of 31 The practice is currently engaged in detailed discussions with St Modwens around the proposed delivery of the building and transfer of land, where it is proposed that the land will be transferred to the practice at nil value. In addition to the land transfer at nil cost, St Modwens have confirmed that the site will be subject to a ‘health use’ covenant, which will ensure that the site will remain in health use in perpetuity – this directly addresses requests made by NHSE following earlier PID submissions.

Progressing discussion further is all now predicated on the practice gaining ‘in- principle’ funding support from the West Sussex CCG around the recurrent revenue (and potential capital) implications of supporting the practice with the proposals.

• Scheme Type

The project is a GP led development by the Pound Hill Medical Group and is based upon a new build owner occupier model.

• Objectives and Benefits

Primary Care Related Benefits

• New state of the art, purpose-built premises that have sufficient capacity to service the Pound Hill Medical Groups existing patient population, together with additional capacity to serve the wider PCN.

• New premises with sufficient capacity to absorb additional patient growth resulting from housing developments within the Crawley and Copthorne locality – these include Copthorne West and Forge Wood developments.

• Provide sufficient capacity premises that will provide the practice with sufficient capacity and flexibility to work at greater scale and to be able to do more from a community setting including:

o Tissue viability / dressing clinic, o Hospital post-op clinic o Minor injury and effective triage o Minor surgery – lump and bumps o Family planning

• Provide capacity to introduce a new skill mix to primary care which will free up valuable GP time and as a by-product, will enable GPs to offer patients with improved accessibility to GP consultations e.g. provide an urgent care clinic with telephone triage, emergency appointments and integrate this with ambulance service primary care paramedic practitioners.

• Provide more services closer to home which will assist in reducing non- planned hospital admissions and help the drive towards creating system wide savings for the local health economy e.g. physiotherapy, mental health, EOL care.

• Provide continuation of services to patients of the Pound Hill Medical Group within a new facility that is suitably located to enable better accessibility to services.

NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 9 of 31 • Provide capacity to be able to expand training provision, enabling the practice to train more clinicians which will contribute towards addressing the national shortfall of new GP and Nurse recruits.

• Location – address and name of facility

Land at Copthorne West, Copthorne Way, Copthorne, West Sussex, RH10 3RX.

• NHSPS/CHP premises code where known or available

N/a – there is no involvement in the project by either NHSPS or CHP.

• Wider stakeholders and their interest e.g. potential occupants

The proposals to date involve a number of key stakeholders. A brief description of each, together with their involvement in the proposals are outlined as follows:

• Pound Hill Medical Group – Proposed commissioner of the new premises where the practice will own the facility based.

• St Modwens – Currently the owners and lead developer of the Copthorne West site and party to the s106 agreement where there is an obligation on St Modwens to either transfer land or pay s106 instalments to the Pound Hill Medical Group. It is proposed that St Modwens will not only transfer land to the practice, but they will also be commissioned to build the new surgery on behalf of the practice.

• Medipharmacy Group – Currently a tenant of the Pound Hill Medical Group at the existing Copthorne branch surgery where they lease a small pharmacy unit. It is proposed that the Medipharmacy Group will operate a pharmacy from the new site, subject to securing a pharmacy licence.

Should this PID submission be supported by the West Sussex CCG, the practice will engage in further discussions with other health and social care providers around the opportunities that exist in providing additional services at the new site alongside the Pound Hill Medical Group.

This could include the following potential groups:

• Community Services • Hospital Trust • Charitable and Voluntary Sector • Local Authorities – Crawley Borough Council

This is not an exhaustive list and the practice look forward to engaging with the West Sussex CCG around the opportunities to expand the practices wider service offering.

• Indicative scheme value for approval purposes

As part of the proposals, it is planned that a building in the order of 616m2 (GIA) will be developed for the practice, this will comprise of 516m2 (GIA) of surgery accommodation (516m2 GIA) and a pharmacy unit of 100m2 (GIA).

NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 10 of 31

The estimated cost of the new building inclusive of the pharmacy unit will be £2.5m - £2.763m (£4,058/m2 - £4,485/m2 GIA) which is inclusive of land costs (nil), VAT, professional fees and associated finance costs.

The figures are provided for indicative purposes and are subject to further refinement as the project progresses e.g. subject to surveys, detailed design and specification, and also the prevailing market conditions at the time of construction.

The CCG are requested to provide notional rent support for the Practice in support of the capital costs associated with the construction of the surgery element only.

The capital costs associated with the pharmacy unit will be supported by the lease rent arrangements agreed with the proposed pharmacy operator.

• Confirm other stakeholders are signed up to the general terms, costs and implications of the proposal.

All project stakeholders involved in discussions to date are aware of the likely cost implications of the new building. In terms of a formal sign up and commitment to the proposal, this can only follow once general NHS support is gained.

• Confirm that where details are known, any proposed leases, are appropriate and acceptable to all participants.

The project will be based on a GP led owner occupier structure, where there will be no lease arrangement in place. The practice has held constructive discussions with its funder Natwest around the funding arrangements for the capital cost of the new build facility and they have agreed to fund in principle – please refer to section 15 for further detail.

There will however be a lease arrangement between the Pound Hill Medical Group and the pharmacy operator Medipharmacy Ltd. Initial discussions with the pharmacy operator have been based upon a 20-year lease arrangement. Formal terms are to be progressed once NHS PID approval is gained.

11. STRATEGIC NEED Existing Premises • Provide the strategic drivers and justification for the scheme. Copthorne Surgery • Confirm and outline alignment with other strategies as appropriate

NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 11 of 31 The existing Copthorne surgery is a bungalow built in 1954 and converted to be used as a surgery in approximately 1984.

The Copthorne surgery measures approximately 167m2 (NIA) and is arranged over a single floor, which includes 1 consulting room, 1 treatment room, a waiting area, admin office and also reception.

There are 10 parking spaces available for use by GPs and patients, 1 of which are designated accessible parking bays for disabled patients.

There is also a small retail pharmacy located at the surgery which is independent of the practice and is operated by the Medipharmacy Group.

Pound Hill Surgery

The existing Pound Hill Surgery is a purpose-built surgery which was built in the mid-90’s.

The Pound Hill Surgery measures approximately 480m2 (NIA), which is arranged over two floors, which includes 8 consulting rooms, 4 treatment rooms, a waiting area, administration offices, reception, waiting and associated welfare facilities for staff and patients.

There are 19 car parking spaces available for use by GPs and patients, 2 are designated accessible parking bays for disabled patients.

Premises Issues

The current issues associated with the Copthorne branch include:

• Inadequate clinical space to serve the growing list size and range of services that patients require and that the practice would like to deliver, particularly to meet the expected needs of the Primary Care Networks as part of the new GMS contract 2019/20 • Not premises are not fully DDA compliant in respect of facilities such as toilet and patient access. • There is inadequate waiting area space. • There are insufficient clinical rooms.

NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 12 of 31 • Insufficient capacity to be able to host more services or accommodate additional staff at the site. • There is a lack of available patient carparking.

Patient Population

The Practice list size has seen steady increases during the 1990s until approximately 2006 when there has been a year on year organic growth of registered patients, approximately 100 per year, to its existing number of 15,920 as of the 1st of May 2020.

The below chart shows the list patient list size growth over the past 10 years, the past three of which are with the Practice having a capped patient list:

Mar-09 / 14,900 patients Mar-15 / 15,350 patients Mar-10 /14,890 patients Mar-16 / 15,310 patients Mar-11 / 15,100 patients Mar-17 / 15,420 patients Mar-12 / 15,120 patients Mar-18 / 15,550 patients Mar-13 / 15,200 patients Mar-19 / 15,690 patients Mar-14 / 15,240 patients Mar-20 / 15,920 patients

Based on the Practice current growth and patient population of 15,920, it is expected that the practice registered population will increase to approximately + 16,500 in the next 5 years which does not include additional patients that will result from the planned housing growth within Crawley.

Housing Growth

Crawley is currently the subject of significant housing development within the borough and across into the neighbouring Mid-Sussex District. As outlined within Crawley Borough Councils Local Plan, which covers development within the borough over the plan period of 2015 – 2030, Crawley Borough Council sets out its proposed housing development in which the Borough Councils Housing Trajectory provides for a target of 5,462 housing units that will be delivered over the plan period.

Of the strategic housing sites allocated within the Housing Trajectory, three of the major strategic site allocations will impact considerably on the practice.

NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 13 of 31 The three main housing sites in question, are:

• Forge Wood – Consisting of a proposed 1,900 units, the development sits in between the Pound Hill Surgery and the Copthorne Branch Surgery and to the north of Copthorne Road. Whilst the housing development sits outside of the practice boundary, its close proximity to the existing surgeries will mean that the Pound Hill Medical Group (alongside the Saxonbrook Practice in Maindenbower) will likely absorb additional patient numbers generated from the new housing development – this housing development alone will generate an additional 4,275 patients.

• Copthorne West – Consisting of 500 units, the housing development led by St Modwens obtained Outline Planning approval in 2018 and the scheme is now being constructed with the first phase of housing to be delivered by 2021.

• Holly Farm – Consisting of 75 units, the development is under construction with the new housing expected to be completed by late 2019.

The housing developments will give rise to a further increase in patient population to the west of Crawley which we estimate to be in the order of + 5,569 additional patients (utilising 2011 census data which is based on an average occupancy of 2.25 occupants per unit), this includes the Forge Wood housing development.

In considering the additional patients generated from the new housing developments at Copthorne West and Holly Farm alone, in conjunction with the practices organic patient list size growth, it is estimated that the Pound Hill Medical Group patient list will increase to 18,000 – 19,000 by 2027. There is no scope to absorb such an increase within the practice’s patient population without investment in the practice’s surgery premises. Absorbing such increased patient numbers is considered unsustainable and unsafe.

Premises Capacity

There is no capacity at present to cater for the practices existing patient population, and this issue will only be compounded once the housing developments in Crawley and Copthorne are delivered.

The practice currently operates from approximately 647m2 (NIA) across both the Pound Hill (480m2 NIA) and Copthorne surgeries (167m2 NIA). In comparison to modern premises space allowances, current planning guidance indicates that the surgery premises should be in the order of 1,241m2 (NIA) – based upon a projected list size of circa 18,000 as at 2027. Taking this into account, there is an approximate shortfall in reimbursed space in the order of 594m2 (NIA). This is also confirmed via NHS England direction in the letter form Richard Woolterton dated December 2013. Furthermore, the practice is aware of previous efforts by Crawley CCG to seek financial contributions via CIL bids from Crawley Borough Council to contribute towards premises infrastructure improvements.

NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 14 of 31

There is very little scope to extend either the Pound Hill Surgery or the Copthorne branch surgery, hence the practice proposal to pursue a new build option in Copthorne, which will replace the existing branch and to also provide sufficient additional space to address the current and future capacity issues resulting from a growing patient population.

Training and GP Retention

With the drive to provide more services from a community setting, coupled with an increasing patient population, there will be a need for additional GPs.

Many GPs locally are approaching retirement age, which will lead to a drop in GP numbers at a time of increased need. The Practice has had two Partners retire in 2019, two more Partners are retiring in 2020 and another within the next 5 years.

Better training facilities within general practice can encourage greater integration of other trainee health and allied professionals (nurses, HCAs, paramedics, social prescribers, medicines management etc) and create opportunities around local health innovation, that could enhance future community based primary care solutions, with the added benefits of improved patient care and potential cost savings to the wider health economy.

The practice is therefore committed to the continuation and expansion of its training status, and consideration and provision of expanded training facilities as part of the new build proposal is a key component of the practices training strategy in the future.

Health Needs

NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 15 of 31

Pound Hill Medical Group

• With a registered patient population of 15,920, the practice is the 2nd largest practice within the former Crawley CCG locality, and 6th largest practice within the wider West Sussex CCG locality • The practice has a significantly higher number of registered patients in comparison to the average registered patient population the West Sussex CCG locality (10,934) and NHS England (8,583). • The practices registered patient list represents 11.67% of total patient population falling within the former Crawley CCG catchment, and 1.76% within the West Sussex CCG catchment.

Practice Health Profile

• In terms of patient demographics, the practice has a considerably higher number of elderly registered patients that are aged 60 years and above, in comparison to NHSE average benchmarks. • The practice has a high number of registered patients that are registered nursing home patients in comparison to CCG Crawley and NHSE benchmarks. • The practice has a significant ageing patient population, however those patients which are categorised as having long-standing health conditions are similar to national and CCG benchmarks. • The ageing population of the practice patient profile, it is unsurprising that this reflects around trends disease prevalence, with a proportionally higher number of patients suffering from conditions such as cancer, CHD, stroke and dementia. • Those patients registered with the practice requiring palliative care is significantly above the CCG and national benchmarks.

With increasing requirements for improved access to primary care services with the aim of treating patients closer to home, there is a continual shift of work from secondary care to primary care that will accelerate as pressure builds to reduce NHS costs through commissioning initiatives.

The practice aspires to deliver a more cost-effective service for the ageing local population and work collaboratively with partner agencies; to service rising patient expectations; to put the individual needs and choices foremost and plan a care programme that will support them to achieve optimal health and wellbeing. There is also the potential to incorporate advances in medical technology that will help ease the burden on the secondary care providers by triaging patients and treating, assessing and managing patients in a community setting. We believe this will improve health outcomes for people with long term conditions and by offering a personalised care plan for vulnerable people most at risk will help create system wide savings through improved care in a primary care and community setting.

NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 16 of 31

12. CONSISTENCY WITH • Confirm alignment with the NHS England Five Year Forward View and related SUSTAINABILITY AND implementation plans. TRANSFORMATION PLANS

(STP), COMMISSIONING AND The New NHS Plan and the GMS 5-year contract provides the Practice with a ESTATES PLANS unique opportunity to work differently with other local GP Practices under the • Confirm alignment with the NHS Primary Care Network but would be constrained from doing so in its current England Five Year Forward View and related implementation premises. The practice currently would not be able to provide the space for plans. those additional health professionals who are essential to the plan and • Confirm that the proposed contract in terms of delivering a sustainable General Practice model its scheme is consistent with the paradigm shift from reactive to proactive care. relevant STP, commissioning, Key aspects of the FYFV incorporated within the proposals include: clinical and (where appropriate) estates and or technology strategies. • Opportunities to create new models of care for the practices existing • Confirm whether formal public patients and also wider PCN. consultation is required. • Opportunities to create MDTs and general expansion of services • Confirm whether any planning permission (including change of wrapped around primary care services. use) is required and its current • Opportunities for greater integration between primary and acute status. service providers e.g. hosting hospital outpatient clinics within the • Confirm that any proposed community. property development brief to • Opportunities to work at greater scale as part of the new PCNs. designers will require and ensure compliance with appropriate and • Opportunities to address workforce shortfall through expanded relevant NHS guidance, such as training provision creating a new primary care workforce. BREEAM, Health Building Notes, • Opportunities for greater collaboration between health and social common minimum standards for care colleagues and ancillary partner agencies. the procurement of built environments in the public • Opportunities to encourage greater involvement of the voluntary sector, etc. sector.

• Opportunities to expand ‘self-help’ initiatives with greater use of social prescribing tools e.g. links to leisure providers/ community groups.

In order to realise these opportunities listed, as outlined within the FYFV, adequate investment in infrastructure is required in order to create capacity within primary care to deliver service transformation.

• Confirm that the proposed scheme is consistent with the relevant STP, commissioning, clinical and (where appropriate) estates and or technology strategies.

The proposed new build is consistent with STP strategy, and will help support service transformation and delivery by:

• Creating more capacity and flexibility within the practice by permitting greater focus on lifestyle management through active programmes within the community – prevention is better than cure. • Reducing emergency and unplanned admissions by offering greater access to services within the community e.g. effective triage / minor injuries. • Offering greater flexibility and ‘space’ within the practice to work collaboratively between health and social care organisations. • Providing investment to ‘expand’ community-based care, which is more accessible for patients, whilst transferring non-specialist clinics from the acute setting into primary care.

NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 17 of 31 • Improve access to GP services – greater capacity within primary care allow the GPs to develop new ways of working.

• Confirm whether formal public consultation is required.

The proposals will require formal consultation in terms of both patient consultation and wider public consultation.

It is proposed that patient and wider public consultation will take place in the form of drop in events, where detailed proposals will be outlined. The drop-in events will be held at both the Pound Hill Surgery and Copthorne Surgery where a patient specific event will take place and will focus on service change and the re-provision of the Copthorne Surgery.

Wider public consultation events will likely be held at another pubic venue within Copthorne (to be confirmed) which will cover the proposals in wider context around the new build in the lead up to a formal planning application being submitted.

• Confirm whether any planning permission (including change of use) is required and its current status.

The proposed new build will require detailed planning consent(reserved matters), having already secured outline planning approval as part of the St Modwens ‘Copthorne West’ planning application reference 13/04127/OUTES.

Please refer to project milestones detailed under section 16.

• Confirm that any proposed property development brief to designers will require and ensure compliance with appropriate and relevant NHS guidance, such as BREEAM, Health Building Notes, common minimum standards for the procurement of built environments in the public sector, etc.

Apollo Capital Projects Development Ltd is working alongside the practice as its appointed Project Manager. Apollo is an experienced development organisation working exclusively within the primary care development sector.

Apollo has fully briefed the extended project team in the requirements to design and construct the new building to address all requirements under the DOHSC Health Building Notes.

We can also confirm that in line with standard project arrangements, Apollo will ensure that a completed VOA Questionnaire for Primary Care Estate Improvements and New Developments will be provided as part of the work leading up towards the Outline Business Case submission.

In terms of BREEAM, on the basis that the total capital costs for the development will exceed £2m, a BREEAM rating of ‘Excellent’ will be achieved which we understand aligns with NHS requirements.

All requirements under current NHS health design guidance documents will be been transferred to the new build Outline Specification. This document

NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 18 of 31

outlines, as a minimum, core design and specification criteria and will ensure that the technical and regulatory criteria is transferred across to the procurement team which contractually maintains the requirement for design and construction quality, and the correct translation of conformity with NHS design standards by the appointed construction team.

13. ESTIMATED PROJECT DEVELOPMENT COSTS Cost per Stage of Development Funded by Project Sponsor Total incl. VAT

£ £ Incurred Pre PID Approx. £30,000 £30,300 PID to Option Appraisal Approx. £3,000 £3,600 Option Appraisal to OBC Approx. £30,240 £36,288 OBC to FBC Approx. £60,600 £72,720 Total £ 142,908

14. CAPITAL COST Capital Total ESTIMATES Financial tables must clearly show the total NHS England commitment only.

(Inc. VAT) Table 2. Total Capital requirement inc. VAT for current and future years This section is Description £ £ £ £ £ anticipated to be very Current Current PID total Third year Total high level (but based on year year Years 1+2 only across evidence), prior to any (year 1) (year 2) 20[21/22] three formal options 20[19/20] 20[20/21] years appraisal. Benchmarked Land construction costs can (generally, only be accessed through apply to year 1) the NHS England PAU Development team. costs from Table

Please use table 2 (and, 1 above. if and where available, (generally, only append any more apply to year 1) detailed ready prepared Project tables that are Management considered fees appropriate), to detail Enabling works, the capital requirements where applicable to deliver this scheme in Construction years 1, 2 and year 3 Fixed equipment where applicable. Totals

Please use Table 4 to confirm capital funding sources that should sum to the total in Table Two-site schemes - see notes on left). 2.

Two-site scheme If this is part of a 2-site scheme, please provide details by year, by site in the following Two-site schemes may tables to show the total estimated value of the overall project, and these should collectively potentially occur where, sum to the total capital requirement in Table 2, above. say, there is a move from one site to another Explanation and description of any two-site scheme covered by this PID and to achieve this there may be some level of expenditure on two sites. The total scheme costs for both related sites are to be provided in the tables.

NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 19 of 31 This does not mean that 2 unrelated sites or N/a schemes can be approved under a single PID.

Please ensure that all proposed costs set out in these tables are for capitalisable expenditure. CAPITAL FUNDING SOURCES

Please insert the The table below will therefore show the full capital cost of the scheme relevant dates in the [square brackets] Table 3. Total Capital requirement Inc. VAT for current and future years Capital funding £ £ £ £ £ source Current Current Scheme Third year. Total year year total only across (year 1) (year 2) Years 20[21/22] three 20[19/20] 20[20/21] 1+2 years Funded by Practice £39,888 £127,008 £166,896 £2.565m £2.732m ETTF £30,600 - £30,600 - £30,600 Land (via s106) £0 £0 £0 £0 £0 Totals £197,496 £2.763m

15. REVENUE AFFORDABILITY / IMPACT The following outlines the recurrent revenue impact on the West Sussex CCG • Net Recurrent Revenue Impact: in connection with the new build. £’x’k over the following years. • Outline any additional revenue £ Notes costs of capital investment beyond current costs, and other Recurrent Revenue additional costs if applicable e.g. Estimated Headline £110,000 - £126,000 Projected notional rent additional rates, energy, FM Rent Requirements – requirements will fall costs and any planned offsetting per annum between £110k - £126k per savings annum. Proposals based • Specify funding source for any adverse net revenue impact on 486m2 (NIA) and • £’x’k Estimated lifecycle costs: illustrative finance quotes • £’x’k Gross Recurrent Revenue – refer to narrative Impact beneath revenue tables and Appendix C. VAT 0 Owner occupier – notional rent does not attract VAT. Rates 23k 40% of CMR (applicable to GMS reimbursed area only) Sub-Total £133,000 - £149,000 Less Current 19,500 Cost rent and business Reimbursement rates as at 2019 applicable to the Copthorne branch surgery. Total Net Recurrent £113,500- £129,500 Estimation – subject to Revenue Increase detail costings prior to OBC stage.

NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 20 of 31

Non-Recurrent Costs Professional Fees – 15,000 Formal quote provided. Legal Professional Fees – 15,000 Formal quote provided. Monitoring Surveyor Total 30,000 Excluding IM&T budget.

In respect of the non-recurrent costs covering the legal and professional fees for the project, it has been requested by the Crawley CCG and NHSE that in order for the practice to secure reimbursement of these costs, the Practice will have to write formally to the CCG where any decision to reimburse the costs is subject to a separate approvals to the PID.

In respect of the GPIT costs, a formal estimate has been provided by the GP IT Manager for the Central Sussex and East Surrey Commissioning Alliance where it is anticipated that the GPIT requirements will cost in the order of £42,190 + VAT (costs provided October 2019).

The GPIT spend would be required at the point where the building is near operational May 2022, therefore budgets will need to be allocated within the NHS financial year ending March 2023.

Details of the quotation can be found under Appendix D.

Value for Money

It is acknowledged by the practice that the main concern of the Crawley CCG and NHSE to-date is the general impact that the proposals will have in creating a relatively high notional rent figure in comparison to general rental tone within the locality which has wider implications for the wider primary care estate.

Given the pressing need for the Practice to progress with a new build proposal at the Copthorne West site, it is requested that the West Sussex CCG engages in dialogue which builds on previous discussions with Crawley CCG and NHSE which took place in January 2020.

The principles of the Premises Cost Directions 2013 (and with the proposed revised Premises Cost Directions where details have been circulated by the BMA) is that GP Practices should receive 100% reimbursement of rental costs.

In this instance, Crawley CCG and NHSE following input via the DVS have previously offered to reimburse £96,000 per annum (notional rent only).

It is still considered that the proposed notional rent figure offered by Crawley CCG and NHSE falls short of recent national comparable evidence agreed by the DVS as reflecting VFM on other new build schemes. Furthermore, the rent figure would need to be adjusted to reflect an increased building size.

St Modwens have provided a projection of costs as at the current time which provides for an

NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 21 of 31

anticipated construction cost of £2.05m (excluding VAT and Practice direct costs). It is anticipated that the development costs can be reduced, thus the Practice and their advisors Apollo consider that the final project costs will fall between a lower bracket of £2.56m and an upper bracket of £2.763m (all- inclusive cost).

The Practice has obtained quotes from Natwest which illustrate the loan servicing requirements to reflect the project cost of between £2.456m and £2.860m which would fall between £130,092 - £145,776 per annum.

Based upon the previous NHS offer of £96,000 of notional reimbursement, this would result in a potential shortfall in notional reimbursement costs (see appendices C) of between £14,000 - £29,776 per annum, working on the basis that the Practice will be able to lease the pharmacy unit to Medipharmacy Ltd for a rent in the order of £20,000 per annum.

Further dialogue with the West Sussex CCG is therefore requested to establish if there is scope to reduce the Practices projected funding gap so that Practice is not disadvantaged due to their aspirations of progressing the project based on an owner occupier model.

St Modwens have outlined a clear commitment to work with the Practice, Apollo and the NHS on an open book basis so as to satisfy any concerns raised by the West Sussex CCG that the proposals do not reflect VFM.

In the event that following dialogue with West Sussex CCG that there is still a funding shortfall (i.e. gap between notional rent reimbursement and loan servicing costs incurred by the Practice), the Practice would not be averse to the idea on funding the shortfall direct – of key importance to the Practice is to realise the opportunity of increasing clinical capacity as part of a new build proposal for their Copthorne site.

16. PROPOSED PROCUREMENT STRATEGY The Pound Hill Medical Group is progressing the project as a GP-led project, which following detailed due diligence undertaken by the practice, the Please describe the procurement strategy, who will be leading, and practice has appointed a specialist primary healthcare premises consultant when it is anticipated to complete, called Apollo Capital Projects Development Ltd to act in the capacity as the and capital spend will be incurred. practice’s development manager and project managers. For new build solutions, please confirm if the proposal is likely to be within a LIFT geographical area. The practice has been working with Apollo Capital Projects Development Ltd since May 2019, which will see Apollo act for the practice in the capacity of Where available attach a key milestones plan. As a minimum, lead consultant. this should include, as appropriate:

• Option Appraisal Apollo Capital Projects Development Ltd is a specialist primary care • Procurement Route Confirmed development and investment company that has an established and successful • OBC/New Project Proposal track record in developing primary care facilities throughout the UK, and in • OBC Approval/Stage 1 Approval • FBC/Final Project Proposal 2014, set up a consultancy offering to GP Practices wishing to progress new • FBC Approval/Stage 2 Approval builds based upon an owner occupier/GP self-build model. • Date of procurement • Planned start of works • Estimated completion date

NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 22 of 31

Apollo to date, has delivered projects through a variety of procurement routes, including LIFT, Hub (Scotland) and Third-Party Development.

Please visit www.apollomedical.co.uk for further details.

It is proposed that the new build will be built by St Modwens, as part of its wider development activity at the Copthorne West housing scheme. The intention is that Apollo will oversee the entire process and a key part of their consultancy role will include:

• Agree specification with St Modwen • Agree funding arrangement to purchase the building from St Modwens. • Agree legal terms of transfer of land and property to the practice. • Agree the rent with the district valuer • Prepare and submit both the project initiation document and outline business cases for approval • Ensure St Modwen obtain the necessary statutory consents • Obtain the necessary collateral warranties and guarantee from the design and build teams. • Advise on design, planning and procurement processes • Monitor and report on the build phase • Ensure the correct information is provided at handover to comply with the Construction Design and Management Regulations 2015 • Advise the practice on move management and budgets for new equipment in the facility. • Monitor occupation for the initial 12 months defects liability period and provide an end of defects inspection.

The proposed development programme for the new Copthorne branch surgery will be based upon achieving the following key milestones:

• PID Re-submission – August 2020 • West Sussex CCG PID feedback – September 2020 • Commercial Terms Agreed with St Modwens - October 2020 • Outline Business Case – December 2020 • Detailed Public Consultation – January 2020 onwards • Reserved Matters Planning Application (submitted by St Modwens) – April 2021 • Procurement phase commence – May 2021 • Planning Outcome – June 2021 • Contractor selection - July 2021 • Full Business Case – August 2021 • Financial and Legal Close – September 2021 • Construction Starts – October 2021 • Building Operational – October 2022

The development timetable is closely aligned to the St Modwens project delivery for the Copthorne West housing development where it is expected that the first tranche of housing will be completed by December 2021.

NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 23 of 31 Where the programme is subject to change, this will be communicated clearly to all stakeholders.

A project steering group will be formed by Apollo with participants from all stakeholders ensuring close coordination of the project as we work towards achieving the key project milestones outlined above.

4r 17. CONSIDERATION OF The following options have been considered by the practice. Details of the OTHER OPTIONS initial option appraisal with indicative costings is contained under Appendix Describe other options under consideration, including the ‘Do E. Nothing’ Option.

Briefly consider the advantages and Do Nothing disadvantages of each option under consideration and identify the one The existing building at Copthorne falls significantly below current standards. used for benchmarking to indicate This option would fail to resolve the fundamental estate issues which are the scheme value in this PID detrimental to the current and future provision of primary care by the Pound Hill Medical Group and limits the practices ability to work towards the strategic direction of the GPFYV where there is an emphasis towards ‘care closer to home’. There is no available capacity to provide more services within the current surgery setting. Such pressures on the practice will only be compounded further by the significant housing growth currently taking place within the practice locality. The current situation is no longer sustainable. The ‘do nothing’ option has severe ramifications for the long - term sustainability of the Pound Hill Medical Group.

Do the Minimum

The existing premises have minimal scope for expansion due to the constraints of each site.

In respect of the existing Copthorne branch, there is little scope to create additional capacity by way of extending the premises, there is the possibility of creating one number extra clinical room, however, this would result in the loss of valuable patient parking. It is also questionable whether planning would be granted given the only area where an extension could be created would be to the front of the existing surgery.

The Pound Hill Surgery is particularly constrained in terms of options to extend/refurbish at the rear of the surgery at first floor level, where the site sits within a conservation area. Opportunities to extend the Pound Hill Surgery would require re-allocation of core business and clinical functions to another site given that there is no available capacity at the Copthorne site. Such a proposal would almost certainly necessitate the need for temporary accommodation during the course of any refurbishment/extension works. One further factor to consider is that extra accommodation would require additional patient parking facilities – there is no available space to create additional carparking facilities.

Having considered the significant shortfalls of standards (both in terms of building regulations and healthcare) it is considered that it would not be economically viable to undertake any significant form of refurbishment or reconfiguration of either existing surgery site, and alterations would cause

NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 24 of 31

significant disruption to the practice which would interrupt service provision for its patients.

The Preferred Option

The practice believes that doing nothing, or doing the minimum are not considered viable options. The only way that the practice can develop a strong, adaptable, high quality service for its patients, whilst introducing aspects such as training and working at scale, is to move to new purpose-built premises. A new build solution provides the practice with a sustainable future.

St Modwens, via the planning arrangements at the Copthorne West site provides the practice with an excellent opportunity to relocate its current branch to a new site within the village. The arrangement would also see St Modwens transfer land at nil cost for health provision, in order to mitigate the impact that the new housing will have upon local service delivery.

We believe the arrangements will offer an affordable value-for-money solution for the West Sussex CCG in terms of opportunities to invest and modernise its primary healthcare estate.

The benefits of a new build include:

• The new Copthorne site provides sufficient space for a new building including room for patient car parking including fully accessible disabled parking facilities. • The site and proposed GP Surgery already benefits from an outline planning approval and therefore de-risks this element of the project for the practice. • A site is located between the existing practice surgeries in Pound Hill and Copthorne so will be accessible to all practice patients and will be well placed to absorb the growth in patient numbers that will result from the new housing being built within, and close to the practice catchment area. • A site will be located in prominent position within the Copthorne West development, close to public transports links which will aid access to services from the existing village. • A site will be large enough to accommodate a building with flexible accommodation which will also future proof the practice for any future changes in its service needs. • The proposed new building will be built to current standards in terms of layout but also sustainability measures, which will minimise ongoing operational costs for the practice across the two surgery sites. • The proposed new building will facilitate the re-allocation of some staff functions from the Pound Hill Surgery to Copthorne, and therefore create opportunities to re-purpose non-core space at the Pound Hill site into much needed extra clinical space.

NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 25 of 31

18. SITE PLAN The following outlines the proposed new facility at the Copthorne site. Where available and for larger schemes (>£1m), please provide a simple site plan to demonstrate the proposal.

Development Boundary of St Modwens Led Copthorne West Housing Scheme

Land Allocation for Proposed New Surgery

Revised Site Plan (April 20)

NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 26 of 31

Revised Floor Plans for the New Copthorne Surgery – Revised April 2020

Revised drawings are contained under Appendix A.

19. OTHER ISSUES A No Confirm and provide brief explanation about: a) Is the output from One Public Estate planning known for the B No – no input required. relevant locality? b) Have NHS PS / CHP / or other named party provided input C None that would be suitable for the practice needs into the PID? c) Is there spare service (or accommodation) capacity in No – the proposals will involve only the expansion of primary care neighbouring, cross boundary D areas? services. d) Are any service or accommodation closures Yes – St Modwens will release land for the development at no cost as anticipated as a result of these E part of the S106 arrangements. See section 5 of the PID for further proposals? detail. e) Will any land be released? f) Is the proposal dependent on reinvestment from disposals? f No. g) Where applicable, is the land clearly identifiable and Yes – the land is subject to a s106 agreement which required St available. g Modwens to release land for a health facility – see section 5 of the PID h) Is the land in the ownership of the NHS? for further detail. i) Are there any known constraints that could No – the land will be transferred to the Pound Hill Medical Group h influence the outcome of this however this will be predicated on a ‘health’ use covenant as part of the scheme in construction or land transfer arrangements.

NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 27 of 31 use? E.g. in a flood zone, listed building, etc.? i None as far as we are aware. j) Where GP or other organisations will share the facility, are there plans to There is the potential for the wider PCN to utilise space within the new integrate the common areas, j or are the organisations intent building on a sessional basis. on remaining fully separate entities in practical terms? The No – although budgets for GPIT have been provided by the IT team at Central Sussex and East Surrey Commissioning Alliance. Budget costs latter may not be acceptable k for this PID to be approved are set out under section 15 of the PID. k) Has any IT infrastructure been factored into the costs for this scheme in the tables 2, 3, 4 l Assumed that the West Sussex CCG is the IM&T budget holder. and 5? If yes, please quantify. l) If not, please confirm source Approximately £43,000 + VAT – see section 15 for further details. A and certainty of funding for m breakdown of the costs is also provided within section D of the this item. m) In schemes involving GP’s, appendices. what is the anticipated value Assumed that the West Sussex CCG are IM&T budget holders and of the GPIT requirement? n n) please confirm source and certainty of funding is not known. certainty of funding for GPIT.

20. KEY RISKS Risk Mitigation

Please provide adequate Risk categorised as Low - Given the information to enable reviewers to unsuitability for redevelopment at understand the level and likelihood the existing surgery locations, a site of risk and how it is to be mitigated. has been identified (owned by St Please list any risks to delivery, for example if the spend is dependent Modwens) where there is a legal on a practice merger other estates planning agreement placed on St investment, involvement of a 3rd Modwens to transfer a healthcare Difficulty in identifying and securing party, etc. site for the development of a new land that in a suitable location surgery. St Modwens continue to engage in discussions with the practice and are keen for the practice to progress the necessary NHS governance arrangements that will help secure the land for primary care use. Risk categorised as Low/Medium - The main stakeholders are St Modwens (site owner and developer), the Pound Hill Medical Group (facility owner), Medipharmacy Group (pharmacy tenant) and West Sussex CCG (notional rent reimbursement). All Failure to secure approvals and stakeholder appears committed to general stakeholder participation delivering a new build in Copthorne, however this is all subject to formal NHS support, which the practice is now pursuing in conjunction with their advisor Apollo. Apollo will ensure that the proposals put forward to West Sussex CCG are sensible, affordable and provide a

NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 28 of 31 value for money proposal which addresses all key NHS criteria concerning new premises development. Risk categorised as Low – The Copthorne West development, including a new surgery facility currently benefits from outline planning consent. The risk of not securing detailed consent is minimal, on the proviso that a sensible building design is presented to LA planners, and that the proposals Failure to secure planning approval align with the initial outline planning application. A detailed consultation process will be undertaken by the practice, St Modwens and Apollo, allowing any major points of contention being addressed by the project team, before a formal detailed planning application is lodged. Risk categorised as Low - Potential for stakeholders to seek to alter design parameters. There will be an agreed process for design approval Changes to building design and requiring formal consent by GPs specification before a final design and detailed planning application is submitted for the project. This process will be managed by Apollo on behalf of the practice. Risk categorised as Medium – s106 funding - this is already approved under the terms of the s106 agreement entered into by St Modwens which sets out a formal requirement to transfer land or money on completion of the initial phase of housing. This is enshrined within a legal deed.

Failure to secure Sources of funding ETTF funding - it is not envisaged – s106/ETTF/NHS that there will be a need for any large tranches of capital funding associated with the new build.

NHS support – there are concerns around the CCGs ability to support the ongoing revenue commitment associated with the new build and efforts have been made to engage relatively early in the process with

NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 29 of 31 the Crawley CCG and NHSE to discuss this aspect further. Every effort will be made by the project team to present a proposal that the Crawley CCG is able to support in terms of revenue affordability. The site transfer arrangements are a key part in ensuring that the project represents value for money. Risk categorised as Low – All projected costs are outlined and set as at the Outline Business Case stage with the project risk in terms of Project cost increase delivering to an agreed financial envelope is transferred to the Developer (St Modwens) as at the Outline Business Case stage. Risk categorised as Medium - The project team will continue to coordinate progress with each stakeholder to ensure that project delays are minimised. A key part of the strategy is to engage with all main stakeholder relatively early in Project delays the process, with a long lead into the final delivery date of the new building. Over and above this, the development programme provides sufficient flexibility to absorb delays without impacting detrimentally in achieving the specified milestone dates.

21. SCHEME OR PROJECT ENDORSED BY:

NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 30 of 31 I hereby confirm that I am satisfied the investment of capital as set out in this PID is necessary expenditure and offers value for money. I also confirm that any commitments made in this PID to the covering of revenue will be honoured by the CCG and/or its Statement relevant stakeholders. I am satisfied that the capital funding CCG CHIEF FINANCIAL requirement set out in this PID is not replicated in any other OFFICER NHS capital funding request, e.g. under other parallel capital investment initiatives Organisation Name Signature Date

I hereby confirm that I am satisfied the investment of capital as Statement set out in this PID is necessary expenditure, offers value for NHS ENGLAND DCO money and conforms with relevant policy. DIRECTOR OF DCO COMMISSIONING Name Signature Date

NHS ENGLAND DCO I hereby confirm that I am satisfied the investment of capital as set out in this PID is necessary expenditure and offers value for DIRECTOR OF FINANCE Statement money. I also confirm that I am satisfied with the financial commitments made by the CCG in this PID. DCO Name Signature

Date

I hereby confirm that I am satisfied the expenditure of capital as set out in this PID is necessary expenditure and offers value for money. I also confirm that I am satisfied with the assurance provided by the relevant local DCO office Director of Finance in this PID in relation to the covering of revenue costs. I confirm Statement that any NHS England capital expenditure assumed in this PID NHS ENGLAND REGIONAL is funded within the Regional capital budget for the relevant DIRECTOR OF FINANCE year(s). I am assured that there is a credible plan in place to account for any assumed NHS England capital expenditure in the appropriate financial year in accordance with NHS England standard accounting practice. Region Name Signature Date PRIORITISATION (For regional use only where applicable)

NHS England PAU. PID Type 1 Clinical Premises VF2 28/06/17 Page 31 of 31 Copthorne PID Re-submission (v5) – August 2020

Appendices Index Appendix A – Updated Drawings / Floor Plans

Appendix B – Utilisation Schedule Outlining Proposed Premises Utilisation

Appendix C – Natwest Loan Illustrations

Appendix D – GPIT Quotation

Appendix E – Option Appraisal

Appendix F – Questions and Answers to NHSE Letter of 6th January 2020

Copthorne PID Re-submission (v5) – August 2020

Appendix A – Updated Drawings / Floor Plans

This drawing is the copyright of Roberts Limbrick Ltd and should not be reproduced in whole or in part or used in any manner whatsoever without their written permission.

Do Not scale off this drawing, use only figured dimensions and report any discrepancies or omissions to the Architect immediately. Rev. Date Description A 30.08.2019 Scheme amended in line with client comments received. B 27.03.2020 Scheme redesign as agreed to an 'L' shape form.

E FO XT R E C NT O O N F TI W NU O AT RK IO S N S P E O

T E S A BO

S V

D U

Y E B N

P L A

S N O

U T O

B S 9 11

P

4 O

T

S

14 BUS

AND 13 1 12 ONLY 1

4 S 2 K

R

O

W

F 11 O 1 T

N

E T

X

E f f 35 Car Spaces o (inc 3 Accessible p

o r spaces) d 1

1 10 4 1

S TOP 3

BUS 1 KEY TO EXTERNAL MATERIALS

1 Brick setts to parking bays, drop off and cycle parking PROJECT 10 4 2 600 x 600mm modular paving Copthorne GP Surgery 3 Tarmac roadway 4 Soft landscape areas 5 Standing seam pitched roof 6 Flat roof single ply with aluminium parapet coping CLIENT 7 600 x 1200mm modular paving St Modwen Properties

8 Gravel layers to courtyard DRAWING landscaping beds 9 Cycle hoop parking bays with Proposed Site Plan canopy over

S 10 Boundary treatment - close boarded K fence R

O 11 Boundary treatment - knee rail STATUS W 12 Vehicle barrier F FOR APPROVAL O 13 Clinical bin store T

N 14 General waste bin store E ROBERTS LIMBRICK LTD T 15 Solar panels (quantity shown X E indicatively) The Carriage Building, Bruton Way Gloucester, GL1 1DG The Estates Office 25 - 26 Gold Tops Newport, NP20 4PG N T. 03333 405 500 [email protected] www. robertslimbrick.com

0 Registered Office: England No. 06658029 . 1 Site Plan SCALE ORIGINATOR NO 0 2 :

5 1 : 200 As indicated@A1 9371 3

: S

4 DATE AUTHOR 1

0 11/03/2019 MJ 2

0 DRAWING NUMBER: REVISION: 2 /

3 0 2 4 10 20 m

0 9371 (SK) 008 B /

0 PROJECT | ORIGINATOR | YEAR | LEVEL | TYPE | ROLE | NUMBER 3 This drawing is the copyright of Roberts Limbrick Ltd and should not be reproduced in whole or in part or used in any manner whatsoever without their written permission.

Do Not scale off this drawing, use only figured dimensions and report any discrepancies or omissions to the Architect N immediately. Rev. Date Description A 08.04.2018 IT Hub room position amended and glazed screen added onto reception. B 30.08.2019 Scheme amended in line with client comments received. 12100 C 07.11.2019 Room names adjusted in line with General Waste comments received. S 10.00 m² D 27.03.2020 Scheme redesign as agreed to an 'L' shape form.

WC WC Acc WC / Nappy Shower / Acc WC Disposal Hold 2.25 m² 2.25 m² Change Clinical Waste 7.21 m² 4.51 m² 4.50 m² 8.09 m²

Store Acc WC 1.69 m² 2.33 m² Accommodation Schedule Name Area Comments Baby Feed 3.98 m² Key Staff Room Plant Room 16.74 m² 11.18 m² Acc WC 2.33 m² Admin / Ancilliary Spaces Acc WC / Nappy Change 4.50 m² Pushchairs Circulation Admin Office 18.44 m² 1.41 m² Consulting Rooms Baby Feed 3.98 m² Other Clinical Rooms Store Interview Rm Circulation 55.25 m² 3.52 m² 7.15 m² Pharmacy Circulation 60.00 m² Waiting Area Plant Equipment Cleaners 4.50 m² 31.21 m² n

o Clinical Waste 8.09 m² ²

i Waiting Area t m

a l 5 2

u Consulting Rm 1 16.04 m² . WC's 5 c 5 r i Consulting Rm 2 16.00 m² Admin Office C Bin Stores 18.44 m² Consulting Rm 3 16.00 m² Consulting Rm 4 16.00 m² s

e Reception Patient Call Screen

n Consulting Rm 5 16.00 m² 6.89 m² o h ) p

n Consulting Rm 6 16.00 m² e i l a e t 5 r T 6 u Consulting Rm 7 16.00 m² 1 C

8 r Entrance Lobby i Surgery 2

A 6.00 m² Consulting Rm 8 16.00 m² Entrance m Patient r Pharmacy a Consulting Rm 9 16.00 m²

Check - in W Entrance ( MDT / Visiting Consulting Rm 10 16.00 m² Clinician Dirty Utility Rm 8.32 m² 16.00 m² Cleaners IT Hub 4.50 m² 5.86 m² Disposal Hold 4.51 m² Enhanced Treatment Suite 20.00 m² Entrance Lobby 6.00 m² Enhanced Treatment Consulting Rm 10 Consulting Rm 9

© Suite Crown pyightADB20.4 16.00 m² 16.00 m² Equipment St 11.31 m² 20.00 m² Consulting Rm 1 Dirty Utility Rm Equipment St k n 16.04 m² 8.32 m² 11.31 m² i General Waste 10.00 m² S

b

u Interview Rm 7.15 m² r c S IT Hub 5.86 m² MDT / Visiting Clinician 16.00 m² Sized as an additional Consulting room

0 for added flexibility Pharmacy 0

Circulation 1

60.00 m² 100.00 m² 2 Pharmacy 100.00 m² 1 Plant Room 11.18 m² Pushchairs 1.41 m² Reception 6.89 m² Shower / Acc WC 7.21 m² Consulting Rm 2 Consulting Rm 3 Consulting Rm 4 Consulting Rm 5 Consulting Rm 6 Consulting Rm 7 Consulting Rm 8 16.00 m² 16.00 m² 16.00 m² 16.00 m² Staff Room 16.74 m² 16.00 m² 16.00 m² 16.00 m² Sub-Waiting 9.86 m² Store 1.69 m² Store 3.52 m² Sub-Waiting 9.86 m² Waiting Area 31.21 m² WC 2.25 m² WC 2.25 m²

34000 Floor Plan PROJECT 1 : 100 Copthorne GP Surgery

CLIENT St Modwen Properties

DRAWING Proposed Floor Plan

Gross Internal Area 616.08 m² STATUS FOR APPROVAL

ROBERTS LIMBRICK LTD The Carriage Building, Bruton Way Gloucester, GL1 1DG

© Crown pyightADB20.4 The Estates Office 25 - 26 Gold Tops Newport, NP20 4PG T. 03333 405 500 [email protected] www. robertslimbrick.com

0 Registered Office: England No. 06658029 . 1 SCALE ORIGINATOR NO 3 0 :

1 As indicated@A1 9371 3 :

4 0 2 4 10 20 m DATE AUTHOR 1

0 11/03/2019 MJ 2

0 DRAWING NUMBER: REVISION: 2 / 3

0 0 1 2 5 10 m 9371 (SK) 009 D /

0 PROJECT | ORIGINATOR | YEAR | LEVEL | TYPE | ROLE | NUMBER 3 Copthorne PID Re-submission (v5) – August 2020

Appendix B – Utilisation Schedule Outlining Proposed Premises Utilisation

UPDATED JUNE 2020 PID RE-SUBMISSION

Practice Name Pound Hill Medical Group, Crawley Subject Property Poundhill Surgery and Copthorne Surgery Proposed Proposed Room Matrix Opening Hours 8am - 6.30pm 8am - 6.30pm 8am - 6.30pm 8am - 6.30pm 8:00 AM - 6.30pm

Mon Tue Wed Thu Fri Sat Notes Ref Room Use M2 AM PM AM PM AM PM AM PM AM PM AM PM

Ground Floor - Consulting Room COPTH 1 - Consulting Room COPTH 2 - Consulting Room COPTH 3 - Consulting Room COPTH 4 - Consulting Room COPTH 5 - Consulting Room COPTH 6 rs - Consulting Room COPTH 7 - Consulting Room COPTH 8 New Nurse New HCA New Doctor New Doctor New Doctor New Doctor New Doctor New Doctor New Doctor New Doctor - Consulting Room COPTH 9 New PCN ROLE New PCN ROLE New PCN ROLE New PCN ROLE New PCN ROLE New PCN ROLE New PCN ROLE New PCN ROLE New PCN ROLE New PCN ROLE - Consulting Room COPTH 10 New PCN ROLE New PCN ROLE New PCN ROLE New PCN ROLE New PCN ROLE New PCN ROLE New PCN ROLE New PCN ROLE New PCN ROLE New PCN ROLE - Treatment Room/Minor Ops COPTH 11 HCA Janice Butler New PCN ROLE New PCN ROLE New PCN ROLE New PCN ROLE New PCN ROLE New PCN ROLE New PCN ROLE New PCN ROLE New PCN ROLE - MDT/Viisting Clinician COPTH 12 New PCN ROLE New PCN ROLE New PCN ROLE New PCN ROLE New PCN ROLE New PCN ROLE New PCN ROLE New PCN ROLE New PCN ROLE New PCN ROLE

37 Dirty Utility COPTH n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 38 Reception COPTH Patients Patients Patients Patients Patients Patients Patients Patients Patients Patients 39 Interview Room COPTH Patients Patients Patients Patients Patients Patients Patients Patients Patients Patients 40 Waiting COPTH Patients Patients Patients Patients Patients Patients Patients Patients Patients Patients 41 Baby Feed Room COPTH Patients Patients Patients Patients Patients Patients Patients Patients Patients Patients 42 Wc COPTH Patients Patients Patients Patients Patients Patients Patients Patients Patients Patients 43 Accs Wc/Baby Change COPTH Patients Patients Patients Patients Patients Patients Patients Patients Patients Patients 44 Accs Wc COPTH Patients Patients Patients Patients Patients Patients Patients Patients Patients Patients 45 Admin Office COPTH Staff Staff Staff Staff Staff Staff Staff Staff Staff Staff 46 IT Hub COPTH n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 47 Staff Room COPTH Staff Staff Staff Staff Staff Staff Staff Staff Staff Staff 48 Clinical Waste COPTH n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 49 General Waste COPTH n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 50 Equipment Store COPTH n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 51 Cleaners Store COPTH n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 52 Staff Shower/ Acc Wc COPTH Staff Staff Staff Staff Staff Staff Staff Staff Staff Staff 53 Staff Acc Wc.COPTH Staff Staff Staff Staff Staff Staff Staff Staff Staff Staff 54 Store COPTH n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 55 Plant Room COPTH n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

0

0

TOTAL 0

1 Enter the practice name and your opening hours in the yellow boxes 2 Change the room names in column C to reflect your practice 3 insert or delete rows if you need to (select the row number right click and choos insert or delete) 4 Write the name of the person booked in the room for clinical rooms for each session (AM/PM) 5 Office space or rooms used less than once a week you can use a percentage if you wish (ie 50% if use every other week) 6 Empty rooms leave blank or put 'bookable' if others are allowed to use them 7 If you know the size of the room put it in column D 8 If you are proposing to build new rooms you can use the proposed tab below to show how you would use them Copthorne PID Re-submission (v5) – August 2020

Appendix C – Natwest Loan Illustrations

Customer Indicative Quote Summary

IMPORTANT NOTICE: The purpose of this summary is solely to illustrate the different types of products available to your business based on our discussion of your requirements. The quotes below are for indicative purposes ONLY and do not constitute an offer. If you choose to apply, a full credit and affordability check will be carried out and your actual quote may vary. A full glossary of terms has been provided overleaf. This is solely intended to assist in understanding the basis on which we provided these illustrations, and will not be part of the agreement for any product you take out. If you would like to discuss other options or obtain further information about the terms and conditions for each product, please contact your relationship manager. Please note that should you enter into either a fixed or capped rate loan you could pay more than the variable rate loan in the event that variable interest rates are lower by comparison.

Quote ID: Quote Date: 31 Mar 2020 Customer ID: Customer Name: Pound Hill

Your Requirements

Capital Loan Amount £2,500,000 Repayment Style Capital + Interest Loan Security Level Fully Secured Loan Term 10 years 0 months Fixed/Capped Term 10 years 0 months Payment Frequency Monthly Final Lump Sum Yes Tranche Drawdowns No Initial Capital Repayment Holiday Not Required

Products available for your requirements

Product Variable Rate Fixed Rate Loan - No ERC Interest rate is variable for the duration of the loan, increasing and/or Interest remains the same for the duration of the fixed term. decreasing in line with Base rate changes. Cashflows are fixed and certain during the fixed term, reducing if Cashflows will go up or down. lump sum early repayments are made. There is also no Early Redemption Charge.

All In Rate Now 3.15% 4.05%

Arrangement Fee** £37,500 £37,500

Repayments - Now £10,726 £11,976

Maximum Early Redemption £0 £0 Charge (ERC)

Base Rate Now 0.10%

Total Amount Repayable £3,197,325 £3,408,493

Final Lump Sum £1,910,217 £1,971,415

Affected by Base Rate Yes No Change

** These fees are indicative.

ANY PROPERTY USED AS SECURITY, WHICH MAY INCLUDE YOUR HOME, MAY BE REPOSSESSED IF YOU DO NOT KEEP UP REPAYMENTS ON A MORTGAGE OR OTHER DEBT SECURED ON IT.

Glossary of Terms

Your Requirements

• Capital Loan Amount - Core amount being lent, excluding any arrangement fee or other fees that may be charged. • Repayment Style: - Capital and Interest (actuarial), whereby a regular single repayment of capital and interest is made periodically to the loan account. - Bullet Repayment (interest only), whereby a single repayment of capital is made at the end of the loan, with interest being applied on a quarterly basis to a current account. - Straight Line (capital only), whereby a regular repayment of capital is made periodically to the loan account, with interest being applied separately on a quarterly basis to a current account. • Loan Security Level - Amount of security provided by you against the loan capital amount being borrowed. • Loan Term - Legal duration of loan, at the end of which the loan must be fully repaid. • Fixed/Capped Term - Period of the loan that is fixed/capped. After this time an agreed follow on variable rate will apply. • Payment Frequency - Frequency at which loan repayments will be made to the loan account. • Final Lump Sum - Loan Capital amount remaining at the end of the loan term. • Initial Capital Repayment Holiday - Break at the start of the loan from repaying the capital loan amount, however interest will continue to accrue and must continue to be paid during the holiday.

Product Options Available for Your Requirement

• All in Rate - The interest rate you will pay, which includes the bank's borrowing rate and product rate. • Arrangement Fees - Fees for arranging the product. This may be added to the loan amount or pay separately in advance. • Repayments Now - This is the repayment amount, either monthly, quarterly, six-monthly or annually, repaying both the capital loan amount and interest that is charged quarterly. For Fixed Rate Loans this never changes, for Capped/Variable loans this repayment amount will change if Base Rate changes. • Base Rate - References to Base Rate are to the NatWest Plc Base Rate, which may change at anytime with immediate effect. • Maximum Early Redemption Charge - If you decide to break the loan agreement early this will be the maximum charge to you. • Total Amount Repayable - Total amount repayable over the loan term including capital and any interest accrued. An Early Redemption Charge may be added to this. • Affected by Base Rate Change - If Base Rate increases/decreases this can affect the interest on the loan, which may increase or decrease payments. • Tranche Drawdowns - Staged drawdown of loan amount taken over term of the loan (available on Variable Rate Loan - please refer to your relationship manager).

Customer Indicative Quote Summary

IMPORTANT NOTICE: The purpose of this summary is solely to illustrate the different types of products available to your business based on our discussion of your requirements. The quotes below are for indicative purposes ONLY and do not constitute an offer. If you choose to apply, a full credit and affordability check will be carried out and your actual quote may vary. A full glossary of terms has been provided overleaf. This is solely intended to assist in understanding the basis on which we provided these illustrations, and will not be part of the agreement for any product you take out. If you would like to discuss other options or obtain further information about the terms and conditions for each product, please contact your relationship manager. Please note that should you enter into either a fixed or capped rate loan you could pay more than the variable rate loan in the event that variable interest rates are lower by comparison.

Quote ID: Quote Date: 13 May 2020 Customer ID: Customer Name: Pound Hill Medical Group

Your Requirements

Capital Loan Amount £2,546,000 Repayment Style Capital + Interest Loan Security Level Fully Secured Loan Term 10 years 0 months Fixed/Capped Term 10 years 0 months Payment Frequency Monthly Final Lump Sum Yes Tranche Drawdowns No Initial Capital Repayment Holiday Not Required

Products available for your requirements

Product Fixed Rate Loan - No ERC Interest remains the same for the duration of the fixed term. Cashflows are fixed and certain during the fixed term, reducing if lump sum early repayments are made. There is also no Early Redemption Charge.

All In Rate Now 3.09%

Arrangement Fee** £38,190

Repayments - Now £10,841

Maximum Early Redemption £0 Charge (ERC)

Base Rate Now

Total Amount Repayable £3,242,180

Final Lump Sum £1,941,227

Affected by Base Rate No Change

** These fees are indicative.

ANY PROPERTY USED AS SECURITY, WHICH MAY INCLUDE YOUR HOME, MAY BE REPOSSESSED IF YOU DO NOT KEEP UP REPAYMENTS ON A MORTGAGE OR OTHER DEBT SECURED ON IT.

Glossary of Terms

Your Requirements

• Capital Loan Amount - Core amount being lent, excluding any arrangement fee or other fees that may be charged. • Repayment Style: - Capital and Interest (actuarial), whereby a regular single repayment of capital and interest is made periodically to the loan account. - Bullet Repayment (interest only), whereby a single repayment of capital is made at the end of the loan, with interest being applied on a quarterly basis to a current account. - Straight Line (capital only), whereby a regular repayment of capital is made periodically to the loan account, with interest being applied separately on a quarterly basis to a current account. • Loan Security Level - Amount of security provided by you against the loan capital amount being borrowed. • Loan Term - Legal duration of loan, at the end of which the loan must be fully repaid. • Fixed/Capped Term - Period of the loan that is fixed/capped. After this time an agreed follow on variable rate will apply. • Payment Frequency - Frequency at which loan repayments will be made to the loan account. • Final Lump Sum - Loan Capital amount remaining at the end of the loan term. • Initial Capital Repayment Holiday - Break at the start of the loan from repaying the capital loan amount, however interest will continue to accrue and must continue to be paid during the holiday.

Product Options Available for Your Requirement

• All in Rate - The interest rate you will pay, which includes the bank's borrowing rate and product rate. • Arrangement Fees - Fees for arranging the product. This may be added to the loan amount or pay separately in advance. • Repayments Now - This is the repayment amount, either monthly, quarterly, six-monthly or annually, repaying both the capital loan amount and interest that is charged quarterly. For Fixed Rate Loans this never changes, for Capped/Variable loans this repayment amount will change if Base Rate changes. • Base Rate - References to Base Rate are to the NatWest Plc Base Rate, which may change at anytime with immediate effect. • Maximum Early Redemption Charge - If you decide to break the loan agreement early this will be the maximum charge to you. • Total Amount Repayable - Total amount repayable over the loan term including capital and any interest accrued. An Early Redemption Charge may be added to this. • Affected by Base Rate Change - If Base Rate increases/decreases this can affect the interest on the loan, which may increase or decrease payments. • Tranche Drawdowns - Staged drawdown of loan amount taken over term of the loan (available on Variable Rate Loan - please refer to your relationship manager). Copthorne PID Re-submission (v5) – August 2020

Appendix D – GPIT Quotation

GPIT Cost Summary ‐ Copthorne New Build

Pound Hill Medical Group PID Re‐submission December 2019

Item No. Unit Cost Sub‐Total

PCs, Keyboards, Monitor etc 9£ 1,740.00 £ 15,660.00 Printers 8£ 211.00 £ 1,688.00 Software licences 9£ 300.00 £ 2,700.00 Surge Proection Unit 2£ 55.00 £ 110.00 Patch Panels 4£ 49.00 £ 196.00 RJ45's 168£ 1.75 £ 294.00 Cable Managemeny Tray 2£ 15.00 £ 30.00 Side Management Rings 16£ 5.00 £ 80.00 Contingency Sum 1£ 1,500.00 £ 1,500.00

Site Connectivity

HSCN Installation 1£ 3,932.60 £ 3,932.60

Sub‐total£ 26,190.60 Excl. VAT

Budget Figures ‐ Based Upon Similar Primary Care Projects and Quotes Obtained by NHS GPIT Team

Project Management NEL 1£ 15,000.00 £ 15,000.00 Wireless Access Points 1£ 500.00 £ 500.00 Public Wi‐FI 1£ 500.00 £ 500.00

Sub‐total£ 16,000.00 Excl. VAT

Proposed Budget ‐ Total£ 42,190.60 Excl. VAT

Exclusion

Comms cabinet ‐ inclusive within build Telephony ‐ by practice Network hard‐wired infrastructure/ data points ‐ inclusive within build Patient Call screen ‐ by practice Air‐con within comms room ‐ inclusive within build Comms lines ‐ by practice

Notes Quotations have been provided by Chris Creation, IT Manager for Central Sussex and East Surrey Commissioning Alliance. GPIT spend will be required as of March 2022. Copthorne PID Re-submission (v5) – August 2020

Appendix E – Option Appraisal

Options Considered Benefits Analysis 1 2 3 4 5 Summary Do Nothing Extend Copthorne Extend Copthorne Extend Pound Hill New Build in Branch Only Branch & Pound Hill Surgery Only Copthorne – Surgery Alternative Site (Copthorne West) Weighted Score Weighted Score Weighted Score Weighted Score Weighted Score Assessment Criteria 1-10 1-10 1-10 1-10 1-10 Accessibility/Location 7 7 8 8 8 Solution/Sustainability 1 2 2 2 10 Operational Benefits 1 2 4 3 10 Service Benefits 1 2 5 3 10 Capacity Created 1 2 4 4 9 Patient Benefits 1 2 4 4 10 Feasibility/Viability 1 2 3 3 10 Total Weighted 13 19 30 27 67 Benefits Score Benefits Appraisal (Ranking 1 = Highest 5 4 2 3 1 Benefit)

Preferred Option and Rationale

The preferred option is 5) A purpose designed new build solution on a site capable of re-locating the existing Copthorne branch with additional capacity to service the increased patient population of the Pound Hill Medical Group, operating extended hours. This preferred option and has been sized accordingly to the NHS England PID space estimator resulting in an estimated gross internal floor area of 516m2. Appendix Section F – Option Analysis

Copthorne PID Re-Submission (v4) – June 2020

Options – Long List Favoured Option Rationale for not shortlisting 1. Do nothing × Untenable given current premises and operational and service constraints – ramifications for long term sustainability of the Pound Hill Medical Group. 2. Do Minimum - Extend Copthorne × Does not address capacity issues and insufficient scope to extend without the loss of branch Only patient carparking – not feasible with ramifications for long term sustainability of the Pound Hill Medical Group. 3. Do Minimum Plus - Extend × Does not address capacity issues and insufficient scope to extend both sites. Extension Copthorne branch & Poundhill of both sites expensive (capital cost circa £750,000 incl. VAT), with requirement of Surgery temporary accommodation due to loss of clinical accommodation during works. Also requires additional carparking created where there is no spare space to provide. Limited benefit in terms of extra clinical capacity created, say 4-5 rooms – not feasible with ramifications for long term sustainability of the Pound Hill Medical Group. 4. Do Minimum - Extend Poundhill × Extension of Pound Hill Surgery expensive (capital cost circa £625,000 incl. VAT) with Surgery Only requirement for temporary accommodation due to loss of clinical accommodation during works. Also requires additional carparking created where there is no spare space to provide. Limited benefit in terms of extra capacity created, say 4-5 rooms – not feasible with ramifications for long term sustainability of the Pound Hill Medical Group. 5. New Build Copthorne – alternate  Whilst comparatively expensive (£2.5m - £2.8m Incl. VAT), a new build option will site (Copthorne West) result in a significant operational benefit for the practice, whilst providing sufficient capacity within the practice surgery setting to be able to do more. This will result in tangible ‘patient’ benefits with the added advantage of allowing the practices ‘service offering’ to contribute to system wide savings for the NHS as envisaged within the FYFV. This is considered the only realistic option which provides a long-term sustainable future for the Pound Hill Medical Group.

The floor area requirement to deliver the preferred solution is based on current best practice guidance as included in the sizing protocol contained within HBN11-01. Generic standardised room sizing has been adopted to maximise flexibility and utilisation of space.

While the PID space estimator establishes the baseline clinical and support accommodation for general practice services, the current modelling tool may not adequately reflect the additional needed for space to support a wider range of services ambitioned within the 5 Year Forward View. Therefore, the floor area assumptions within this PID should be seen as a minimum requirement to be confirmed as part of the development of the Outline Business Case when there will likely be more clarity on the future accommodation needs associated with new models of care e.g. the new contracted arrangements of the PCN.

Copthorne PID Re-submission (v5) – August 2020

Appendix F – Questions and Answers to NHSE Letter of 6th January 2020

1. Functionality & Purpose

The Panel acknowledged the inclusion of utilisation schedules across Pound Hill and the proposed new premises. However, concerns continued to be raised around whether the development would offer enough space. With a projected list size of 18,000 by 2027 the PID states that 1,241m2 would be optimal, yet the new development provides a combined floor area of 926m2.

It would be useful to understand in further detail the following:

a. The proposed new models of working to ensure that the practice can adapt to meet increased demand and growth.

The world has changed significantly in the past three months and form the top to the bottom, we are unsure what new models of care look like. We have been developing a strategic focus documents – the New Normal – to look at how we can continue to provide our services in a manner that is safe to our patients, our staff and our community. It is obvious that this will require more space, more clinicians and more time to do this and with space already limited.

Our model will develop as the pandemic does, and whilst we would hope that life in general practice would return, we are planning that this will be the new normal and every appointment were we see patients face to face are going to take longer.

b. Clarity on whether any further increase in the floor space is possible within the new development and if not, why?

The scheme design has been updated reflecting concerns raised by NHSE around providing sufficient clinical capacity at the site. There is also further scope to extend the surgery at first floor level should the need arise in the future. c. Understanding the proposed new models of working to ensure the practice can adapt to meet increased demand and growth

As above the Pandemic has changed everything and with the expected growth in patient numbers we will still require the additional space to provide our services. Whilst our new normal means that more clinicians can work from home, we will require more time to see patients face to face, on average double, whilst PPE is changed and rooms are cleaned. Limiting footfall within the Practice is essentially to prevent further spread of infection.

During the crisis we have successfully recruited to our PCN a clinical pharmacist and plans are in place for more positions such as first contact physiotherapists, more pharmacists social prescribers and physician associates to meet the demand of the Practice and our PCN. d. Clarify on whether any further increase in the floor space is possible within the new development and if not, why?

It is acknowledged that the previous utilisation had highlighted that the building would be operating at near capacity with the inclusion of new PCN roles. In order to address this point, St Modwens and the Practice have reviewed the design to now include 2 no. additional clinical rooms to provide extra capacity.

An updated ‘space utilisation’ schedule is provided under Appendix B. e. Four of the consulting rooms within the new floor plans have reduced marginally from 16m2 to 15.82/88m2. As per HBN 11-01 there is an expectation that all new build premises incorporate consulting rooms of 16m2. No derogations below 16m2 will be acceptable; therefore, it is expected that design revisions will be made to reflect this.

The floor plans and design has been reviewed and this point is now addressed by provision of ‘standardised’ HTM11-01 compliant clinical rooms.

The revised drawings are provided under Appendix A. f. Boundary expansion and patient list management and how will practice manage this?

The Partners of the Poundhill Medical Group are confident that the new premises will allow us to manage the demand from our existing population as well as the growth expected organically and from the new development. There is no intent to expand our boundary further. g. Reallocation of staff functions from Pound Hill to Copthorne - Does this relate to delivery of core essential services/administrative functions?

The new Copthorne surgery will be mainly used for clinical care with limited reception / administration function being carried out. This will alleviate some of the pressure on the Poundhill Surgery parking and room utilisation. The bulk of the administration, reception and management services will be carried out from the Poundhill Practice. h. Would Copthorne essentially become the main site for delivering essential services with Pound Hill taking the lead as a PCN hub?

Copthorne is not a suitable location for a PCN Hub given proximity to Crawley, however, PCN staff will be based at the site where it is expected that they will provide services to patients registered with the Pound Hill Medical Group. Furthermore, all practices within the PCN group will provide PCN services from each respective PCN practice premises where capacity allows.

i. Would the proposed PCN use of rooms at Copthorne include service delivery and/or administration?

PCN use of rooms at Copthorne would include service delivery, and administrative functions for the PCN activity. It is understood that PCN activity is covered under the new GP contract arrangements and should therefore be treated as GMS funded activity relative to the Pound Hill Group registered patients. Furthermore, all practices within the PCN group will provide PCN services from each respective PCN practice premises where capacity allows.

2. Value for Money

Referring to the draft Development Appraisal recently shared, it appears that the yield being applied is higher than that seen in the third-party developer market and requires some revision to better reflect the arrangements and the owner-occupier proposal. That will drive a lower rental expectation.

The yield applied is typical of an owner occupier scheme and this is supported by independent valuations undertaken on similar investment structures to that being proposed at Copthorne. This can be evidenced; however, it would ordinarily be appropriate to review detailed costings post PID approval. To reiterate the desire that the project team are happy to progress discussions on an open book basis and would welcome further dialogue with the DVS.

• Removal of the practices assumed £20k CMR subsidy from the CCG must also be actioned.

Indicative funding quotes obtained from Natwest are included under Appendix C, which sets out an upper and lower limit of likely costs to the Pound Hill Medical Group in terms of loan servicing costs. This is provided to demonstrate transparency where ultimately, the Practice wishes to engage in dialogue with the CCG and DVS to look at ways in which the gap between an affordable notional rent figure and actual loan servicing costs can be closed so that this does not prejudice the Practice – working on the understanding that the Premises Cost Directions seeks to provide 100% reimbursement of costs applicable to GMS floor area.

In January 2020, the Practice met with NHSE and Crawley CCG where an offer of £96,000 per annum of reimbursement was made to the Practice, together with a request to explore funding options to see if the repayment terms could be extended therefore reducing the loan service costs. Having actioned this request, the Practice would welcome further dialogue with the CCG.

• The ‘payback’ period assumed by the Practice may need to be adjusted to provide for a longer term which may better reflect the local current market rent assessment. We need further assurance with regards to the assumption presented.

Please refer to Appendix C where loan illustrations have been obtained from Natwest. The loan illustrations reflect a potential upper and lower bracket of cost, which is supported by detailed Cost Plans provided by St Modwens.

Reiterating the general view of the project team that the costs are projected to a construction start date of Q2 2021, and therefore the costs may fall within an upper and lower bracket. Funding illustrations will ultimately be refreshed nearer the time of construction, and it is envisaged that the Practice, CCG and Project team would be in a better position to refine costs at that time.

• Pharmacy remains at risk – given the assumed rights to relocation by the existing provider, assurance must be sought from the NHSE/I Pharmacy team that the transfer of the licence is indeed possible.

The pharmacy remains a risk for the Practice and Pharmacy Operator, however, the expert opinion of the Pharmacy Operator and Independent Advisors indicate that there is a high likelihood that a pharmacy licence will be secured. Ultimately, comfort can only be provided with a pharmacy licence application by the Operator and we envisage an application being made within 3 months of the commencement of the construction phase.

Furthermore, it is understood that NHSE would establish via discussion with the local relevant pharmacy board what their views are around general pharmacy service provision within the Copthorne locality. As at the time of writing, feedback is awaited.

• The proposal to purchase a fully completed building is unusual and not something we see very often. This may be adding layers of costs in that St Modwen will be looking to fully offset all of its costs associated with the development, employing monitoring surveyors and a professional team; equally the GP practice is employing a further set of professionals, which will increase scheme costs.

The proposals are based upon a forward purchase arrangement, with St Modwens assuming all development risk – this is not considered an unusual arrangement. As outlined, there is a willingness by St Modwens to progress the project on an open book basis to ensure transparency, whilst ensuring cost headings fall within acceptable tolerances as assessed by the DVS on behalf of the NHS.

Projected costs, by way of an upper and lower bracket are reflected within the loan illustrations provided under Appendix C.

• Legal fees in the project are seemingly unduly high where there is to be no land purchase but a transfer under the S106 agreement, followed by a simple purchase of the completed building by the practice, meaning that legal support for the GP contractors should be relatively minimal.

Projected legal fees reflect the structure of the project, which include the following:

• Land Transfer • Legal Charge (if deemed necessary) • Forward Funding Agreement between the Pound Hill Medical Group and St Modwens • Review and agreement of Collateral Warranties provided by the Developer, Contractor and associated professional team • Pharmacy lease – please note that this cost element would be met by the Practice and would not be subject to reimbursement.

I respect of reimbursement, NHSE and CCG have advised the Practice that this is all discretionary and would be subject to a separate funding application. Nonetheless, all projected costs are catered for within the Natwest Loan illustration provided under Appendix C.

• A review of all of the ‘site’ and ‘construction - all professional fees’ costs may be necessary to determine whether the new building is to be purchased on a full cost recovery basis, or an open-market value basis, and then an assessment of all costs should be undertaken to ensure they are to be appropriately covered by the GP practice as a purchaser. Essentially, it would be useful to understand on what basis the purchase deal is being made.

As outlined previously, there is a willingness by St Modwens to progress the project on an open book basis to ensure transparency, whilst ensuring cost headings fall within acceptable tolerances as assessed by the DVS on behalf of the NHS.

3. S106 Funding and land transfer

In most cases, a grant agreement will need to be entered into between NHSE&I and the GP practice to ensure that the property continues to be used for the provision of primary care, prior to the transaction taking place. The grant agreement will also ensure that any rent reimbursement or notional rent payments made by NHSE&I / the CCG to the practice will be abated. Without such abatement, the taxpayer would in effect be paying twice for the same scheme.

As part of the meeting that took place in January between the Pound Hill Medical Group, NHSE and the CCG, an offer of £96,000 per annum was made to the Practice in terms of notional reimbursement, which it is understood this included an ‘abatement’ reflecting a nil land value.

It is understood that the proposed abatement will amortise over a 15-year period, which reflects the guidance as set out within the Premises Cost Directions. This principle is agreed by the Pound Hill Medical Group.

For this scheme, the CCG will lead on direct conversations with the Local Authority to ensure that both Mid Sussex District Council and St Modwen are familiar with the NHS/GP contracting arrangements and the necessary Legal Charge or restrictions are incorporated into the deal, to protect the land for NHS use, as obligated under the Section 106 agreement.

Any restriction on use can be dealt within a land transfer between St Modwens and the Pound Hill Medical Group, this has been confirmed in writing by St Modwens which is set out under Appendix C within the PID dated June 2020 – this was an established principle as confirmed within the PID submitted November 2019.