Local Strategic Estates Plan (Interim)

NEWHAM CLINICAL COMMISSIONING GROUP

Local Strategic Estates Plan (interim)

December 2015

[Type the abstract of the document here. The abstract is typically a short summary of the contents of the document. Type the abstract of the document here. The abstract is typically a short summary of the contents of the document.] Contents 1. Executive summary ...... 4 1.2 Introduction ...... 5 1.3 Newham existing population and estate ...... 6 1.4 Drivers for Change ...... 6 1.5 Newham Clinical Commissioning Group’s vision for the estate ...... 7 1.6 Options for change ...... 8 1.7 Financial implications ...... 8 1.8 Delivering the strategy ...... 9 2. Scope and Methodology ...... 10 3. Current Position ...... 12 3.1 Geography ...... 12 3.2 Transport ...... 13 3.3 Population background and demographics ...... 14 3.3.1 Index of multiple deprivation ...... 14 3.4 The Current Physical Estate ...... 19 3.4.1 Overview ...... 19 3.4.2 Current premises ...... 20 3.4.2.1 Newham University Hospital- Plaistow, E13 ...... 20 3.4.2.2 East London Foundation Trust (ELFT) ...... 20 3.4.2.3 GP practices ...... 22 3.4.3 Occupation, condition and utilisation ...... 23 3.4.4 Backlog maintenance ...... 25 3.5 Financial summary ...... 26 4. Drivers for Change...... 28 4.1 Introduction ...... 28 4.2 Population predictions as drivers for change ...... 28 4.2.1 Distribution of Growth ...... 29 4.2.2 Implications of the Population Growth ...... 30 4.3 Future model of care and service priorities ...... 31 4.4 Socio-economic changes impacting on services ...... 32 4.5 Highlighted service change ...... 33 4.5.1 Joining up primary, community and acute care services ...... 33 4.5.2 Improve access to a wider range of primary care services ...... 33

4.5.3 Provide more proactive care ...... 33 4.5.4 Improve access to specialist advice and improve the quality of referrals ...... 34 4.5.5 Maternity and paediatric services ...... 34 4.5.6 Out of hospital clinical services ...... 34 4.5.7 Workforce to deliver ...... 34 4.6 Technology and service delivery changes ...... 35 4.7 Using estates to accommodate the changes ...... 35 4.8 Approach to commissioning for quality 2013-4 extracts ...... 38 4.9 Challenges in respect of the current estate ...... 39 4.9.1 Planning and regeneration context ...... 39 4.9.2 Community Infrastructure Levy / Section 106 (s106) ...... 39 4.9.3 Other sources of capital funding ...... 40 4.9.4 Cross boundary demand and opportunities ...... 41 4.9.5 Opportunity Areas ...... 41 4.9.6 Housing targets ...... 42 4.9.7 Newham Local Plan ...... 43 4.9.8 Phasing of New Residential Development ...... 43 4.9.9 London Borough of Newham (LBN) Local development Plans ...... 43 4.9.10 Identification of sites where new health facilities may be required ...... 44 4.9.11 Drivers Summary ...... 44 5. Estates Options for Change - How to get there ...... 46 5.1 Key principles and service models ...... 46 5.2 Estates strategy assumptions and vision for primary care ...... 46 5.3 Addressing the future need ...... 48 5.4 Opportunities and investments required...... 49 5.5 Summary ...... 51 6 Financial implications ...... 53 6.1 Background ...... 53 6.2 Financial elements associated with the Strategy...... 53 6.3 Revenue Costs ...... 54 6.4 Potential Financial Costs ...... 54 6.5 Funding the requirement ...... 55 7 Delivering the Strategy and Outline Implementation Plan ...... 57 7.1 Priorities for years 1 -5 of the stategy (2016 -2021) ...... 57

7.2 Development of the strategy ...... 57 7.3 Ongoing work plan and timescales ...... 58 Planned and potential developments: ...... 58 7.3.1 NCCG led projects – new developments...... 58 7.3.2 Practice led NCCG supported projects ...... 58 7.4 Resources ...... 59 7.4.1 Manpower ...... 60 7.4.2 Enablers of change and managing constraints ...... 60 7.4.3 London Borough of Newham Regeneration Plans ...... 60 7.4.4 Working with the developers...... 61 Section 3 Appendix 1 ELFT locations across Newham ...... 63 Section 3 Appendix 2 Complete list of practices...... 66 Section 3 Appendix 3 - Utilisation reviews ...... 71 Section 3 Appendix 4 backlog maintenance ...... 73 Section 4 Appendix 1 Outpatient transfers ...... 75 Section 5 Appendix 1: Applications from practices for improvements, relocations and other developments ...... 78 Section 5 Appendix 2 Transforming Services Together (TST) analysis of additional space ...... 80 Section 7 Appendix 1 DRAFT Newham Clinical Commissioning group - Strategic estates decision framework ...... 82

1. Executive summary

NHS England has requested all CCGs develop a local strategic estates’ plan, by 31st December 2015. This strategy builds on national and regional guidance and more local work to develop the case for change and strategic commissioning plans which clearly document the scale of the challenge facing Newham health and social care services. The strategy has an important role to play in enabling change, delivering savings, reducing running costs and ensuring that all investment, including the Primary Care Transformation Fund, is properly targeted.

The NHS faces funding constraints and in east London there is currently a significant financial gap across all organisations. Whilst funding will increase due to the rising population, this will not be enough and ways of working will need to change too. To continue to provide safe, high quality and sustainable services in the future, Newham Clinical Commissioning Group (NCCG) needs to work effectively and efficiently.

The key priorities of the strategy are to achieve a more efficient estate, identifying resources to deliver new service models and ensure future investments are identified and prioritised through the strategy. Areas where there is underutilisation or inappropriate use of valuable estate need to be identified and brought into clinical use, where required. The estates strategy will contribute to the delivery of Newham CCG’s primary care strategy and will contribute as an enable to the Transforming Services Together programme as well as Better Health for London1 and the financial challenge faced by the NHS.

The opportunities envisaged in respect of using the existing estate more effectively include: • reconfiguration of the estate to better meet commissioning needs • shared property (particularly with social care and the wider public sector) • more effective future investment and better value • benefits for clinicians, staff and patients.

1 The Better Health for London report of the London Health Commission, published in October 2014 identified the need for significant investment in the infrastructure of GP premises, to enable both primary care commissioners to realise their strategic plans and providers to respond to them

The improvement grant application process launched in January 2015 as

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/184017/NHS__General_Medical_Services_- _Premises_Costs__Directions_2013.pdf

The strategy has been produced in conjunction with: i. the Transforming Services Together (TST) workstream, which has identified the potential changes to estates required to support delivering out of hospital services ii. the healthy urban development unit (HUDU), iii. London Borough of Newham (LBN) regeneration and public health teams the latter two organisations providing information in respect of growth and population demographics. Three initial consultation workshops have been held during the autumn of 2015 with i. the strategic estates working group ii. Newham’s primary care clinicians and

iii. patient participation group leads 1.2 Introduction

Newham Clinical Commissioning Group (NCCG) has been granted full delegation for the commissioning and performance management of primary medical services. Alongside the transformation of services, a decisive approach needs to be taken to improve primary care quality, by sharing the good practice high performers have developed and thus reducing variation in outcomes for the population.

Primary care estates in Newham face a number of challenges. Significant parts of the existing buildings and infrastructure fail to meet current and future standards and needs. These poorer general practice facilities do not have the space to offer a wide range of services nor support multi-disciplinary team working and this can contribute to a poor patient experience.

However, Newham also has some excellent primary care facilities, although some of these are not fully utilised. NHS England’s Five Year Forward View suggests primary care needs to work at greater scale in facilities that enable teams from across health, and social care, as well as a wider range of community services, to work together.

The London Borough of Newham (LBN) faces unprecedented demographic growth in one of the most deprived areas of the UK, as well as epidemiological pressures due to a population that experiences more years of life lived with poor health. The growth in population is anticipated to be over 90k residents over the next 15 years which means the plans will need to offer sufficient flexibility and be sustainable to meet the changes.

There is substantial financial pressure within all health economies: London alone will be required to make a £2.4 billion saving by 2020/21, which means that finding ways to use existing resources more effectively is urgently needed.

High level modelling suggests that in order to deliver a modern, high quality service for all, between £310 and £810 million will need to be invested in primary and community services in London annually. This is expected to begin with a gradual shift in total health spend of 0.40% – 1.07% each year over five years. This shift in total health spend has the potential to deliver a significant increase in primary and community care capacity in the medium term. Additional funding is being provided nationally in the form of:

• An increase of the primary care budget from 1.7% to 2.3%

• Primary/community care infrastructure funding of £250m recurrent for four years from 2015-16

• An additional transformation budget of £200m for developing ‘vanguard’ sites

Within this context the CCG is committed to re-balancing NHS investment towards out of hospital services and infrastructure.as set out in ourlocal commissioning intentions and in line with the Strategic Planning Group’s five year strategic plan. The funding streams for this programme are being identified to enable these changes. 1.3 Newham existing population and estate

Newham has a registered population of 332,582 (October 2015), the vast majority are between 20 and 50 years, a young population, compared to the rest of the UK. Many of the younger population are transient and do not register with general practice, favouring use of A & E, which is a more costly intervention for the NHS. Newham was recorded overall as the second most deprived area in England (2010).

In 2010 Newham was the second most deprived area in England, the three main factors contribute to poor health being:

• Deprivation • Ethnicity and language. • Population mobility

Life expectancy in Newham has increased over the last 10 years, but despite this, the healthy years of life remain fewer than for residents in other parts of London, putting strain on the health and social care services required. NCCG needs to work closely with LBN to improve the public health messages and access to appropriate services.

NCCG has over seventy buildings from which primary and community services are delivered. The premises are owned by a large number of different organisations and individuals, making changes more complex. Many of the GP premises are small (less than 200m2) and conversion/further development of most would not be possible or economical. Thus the strategy sets out its vision to increase the capacity and facilities within a fewer number of premises. This will encourage the use of shared facilities and increased collaboration through collocation. 1.4 Drivers for Change

NCCG recognises its unique position as a borough with huge demographic change and an increasing population predicted. This will be supported with the opportunity for regeneration and an energy that can promote and deliver change.

The majority of the new population will live in six wards, within the area known as the ‘opportunity areas’ and additional estate and practices will be required for these residents. Also in parallel, the existing population, many of whom have poorer life expectancy than those in other parts of England, will be aging and are at risk of increasingly developing long term conditions. Their needs must be considered in the development of improved facilities.

The key drivers for change in Newham are: • Changes in population –increasing numbers and changes to demographics • Opportunities from the regeneration programme of the borough

• Need to further improve the health outcomes for residents • The need to use resources more effectively • Primary care workforce challenges and the need to address shortages • Benefiting from increased and improved technology • The economic environment • Using commissioning effectively through GP federations and out of hospital services transfers • Listening to the patient voice

A broader approach to the whole health economy challenges is illustrated in Fig 1 below:

Fig 1.1 Some of the challenges facing estates planning2

1.5 Newham Clinical Commissioning Group’s vision for the estate

The overarching vision for Newham is to ensure out of hospital estate is of a high quality, statutory compliant and in locations that support clinicians deliver the range of services to support the health needs of their community. i. ensure good value for money and an efficient use of resources

2 NCL SPG Workshop slides, The London Office of CCGs, 4th September 2015

ii. maximising the use of space within existing buildings before investing in new builds’, which will only be supported where they offer opportunities for 10-15,000 patients which, and were possible, support the merge of smaller practices iii. to develop a number primary care locality hubs, with the facilities to offer flexibility for delivery of a wider range of services for a larger population, supported by GPs and community providers working collaboratively, also wherever possible, co-locating with wider local authority and third sector services that offer social, health and well- being services iv. to provide a small number of multispecialty community centres in which a wider range of more specialist services are offered to a larger group of patients.

Developing these themes Newham will be looking to ensure those practices delivering services from key modern facilities, for populations over 10,000 patients are invested in and commissioned to deliver quality extended primary care services.

There will also be geographical spread of larger practices, able to offer more specialist services to communities of over 50k residents; this will include diagnostic testing, maternity services and long term condition clinics. At a larger scale the CCG may consider the use of multispecialty community centres providing more specialised services for a population of over 100k residents.

Establishing locality hubs at cluster level and multispecialty centres support patients’ preference to travel slightly further but receive a ‘one stop’ service covering all their regular needs.

1.6 Options for change NCCG will work on a cluster basis to determine the key premises within each locality for investment and development, recognising the diverse ownership and interests of current parties and its overarching need to reduce the number of properties and drive up quality. Expansion and development of the current estate will be limited to those that fit the needs of the area in being of sufficient size and condition to provide a valued patient experience.

The growth in population and increased health needs will mean a number of key new opportunities will be NCCGs partnership with the London Borough of Newham and its development partners, to secure investment in the regeneration areas or where there are other needs are identified, to meet the patient pathways.

1.7 Financial implications

Capital investment over the period of the strategy will be available from a variety of sources, including the CCG itself, NHS E, CIL/section 106, CHP, NHS PS or 3rd party developers. The revenue impact on the CCG is a more significant long-term commitment required to cover rent and rates.

This strategy will enable the forecast to be made of the required additional funding and how this can be afforded, looking at opportunities to generate savings from mergers, utilising space more effectively and sharing the facilities and costs with other agencies.

1.8 Delivering the strategy

Delivering the strategy will require NCCG to share its vision and undertake further work practices and other stakeholders to secure change, ensuring full patient and public engagement at the same time.

Following analysis of the premises condition and utilisation surveys the investment priorities will be reviewed and supported accordingly, assuring alignment to the geographical and demographic need of the population. The improved facilities will enable services out of hospital to be commissioned, increasing the range of diagnostic and community services to be available more locally.

NCCG will need to identify resources, both financial and workforce to take forward the change agenda and secure the estate that will enable delivery of care well into the 2020’s.

2. Scope and Methodology

Newham Clinical Commissioning Group (NCCG) has prepared this interim estates strategy to set out its plans and vision for the primary care estates. These will support the clinicians to deliver the required services, in modern, fully equipped, safe, local facilities that enable all members of the community to access their care in a patient focussed environment.

The timing of the strategy is to:

• Meet the request from NHS England, requiring every CCG to provide a strategy that will inform the allocation of its capital investment budget, • Plan for the predicted significant population growth in Newham, • Plan for the service delivery changes required to move care out of hospital, for what is currently one of the most deprived areas of the UK and facing epidemiological pressures due to an aging population. • Ensure estates development are considered as part of NCCGs primary health care strategy refresh and its strategic commissioning framework intentions • Address the substantial financial pressure within the local health economy and the saving requirement, which means finding ways to use existing resources more effectively, is a priority.

Newham has set out to produce this local estates strategy in collaboration with a wide range of local stakeholders (including the wider public estate). The formation of a Local Strategic Estates Group (SEG) has been key to developing a robust understanding of the available estate and aligning it to the NCCG’s commissioning intentions to extract maximum value from NHS resources and reduce wastage.

The strategy has been challenged and endorsed by NCCGs Primary Care Commissioning Committee.

Newham’s strategy proposes system-wide transformation and partnership working, involving the London Borough of Newham and a range of other key organisations:

• Neighbouring CCGs - in particular Tower Hamlets, Waltham Forest (through the Transforming Service Together programme), City and Hackney, Barking and Dagenham, Havering and Redbridge • Barts Health NHS Trust • Homerton University Hospital NHS Trust • East London NHS Foundation Trust (ELFT) • North East London NHS Foundation Trust • Local authorities (including public health teams) – in particular London Borough of Newham; London Borough Tower Hamlets; London Borough of Waltham Forest; London Borough of Redbridge • NEL Commissioning Support Unit (CSU) • NHS England (NHSE) • Trust Development Authority (TDA) • Healthy Urban Development Unit (HUDU) • Transport for London (TfL)

Initial consultation with the community has taken place through the practice patient group leads and wider engagement will follow the publication of the interim strategy early in 2016.

It is vital that service and estates planning are integrated to ensure the availability of high quality estate to deliver healthcare, driving the need for well-founded investment decisions that maximise the use of existing property, recommend where new estate should be developed to meet service needs and where, if appropriate, surplus estate can be sold.

NCCG will seek to identify partners to offer the community a single point of access, developing the vision of linking health, well-being and social services together.

3. Current Position

3.1 Geography The London Borough of Newham (fig 3.1) forms part of London’s East End dockland area, situated with the river Thames as its south border, five miles east of the City of London. It stretches 6.5miles by 6.8 miles at its widest points and covers, 22 hectares (14m2 miles /36.2 km2). The resident population density (number of persons per hectare) is 85, which is denser than the average for greater London (52) and England (41).

Fig 3.1 Location of the London Borough of Newham (LBN) within greater London and the UK

3.2 Transport The borough (fig 3.2) is well served by a wide network of public transport links from all other parts of London, Kent, East Anglia, as well as internationally through the Eurotunnel and London City Airport. Transport includes the underground, Docklands Light Railway, high speed rail to the south east and St Pancras, the new Crossrail as well as a network of other over ground rail and bus transport systems.

Fig 3.2 Transport connectivity across Newham

The borough is crossed by several major road networks, the A13, A118 and A124, which in turn link to the Blackwall tunnel and M25, and bordered to the east by the North circular road (A 406).

Through its Local Implementation Plan, (Transport Policies and Programmes Document) the London Borough of Newham has set out its key objectives to achieve transport improvements- summarised in table 3.1 below.

Local Implementation Plan Objectives

Objective 1 Addressing key movement corridors, tackling congestion and improving movement for all modes of travel Objective 2 Connecting neighbourhoods and enabling local movement Objective 3 Improving streetscape and environmental quality Objective 4 Improving the condition of roads and footpaths Objective 5 Encouraging sustainable and healthy travel behaviour Objective 6 Tackling deprivation, improving the local economy and supporting new development Objective 7 Improving road safety Objective 8 Reducing crime and fear of crime Objective 9 Promoting the use of low emission transport including Reducing carbon emissions from transport

Table 3.1 Key objectives to achieve transport improvements

3.3 Population background and demographics

Newham has one of the largest populations in London. In 2011, the resident population stood at 311,912, of which 52% were male and 48% female. According to the GLA 2014 Round SHLAA Capped Population Projections, the population has continued to grow, by circa 20,700 to some 332,582 in 2015, and is set to rise by another 55,156 persons over the next decade.

Newham was recorded overall as the second most deprived area in England (2010). Three particular factors contribute to poor health in Newham:

Deprivation: there are high levels of deprivation in parts of Newham. In some areas, the levels are amongst the highest in the country.

Ethnicity and language: many people in Newham do not speak English as a first language. This adds to the complexity of providing healthcare services. For example, interpreters are sometimes required and consultations can take longer.

Population mobility: the East End is often the area where new immigrants move to first and then move on, meaning the people and the ethnic mix of the population are constantly changing. This can mean difficulties in providing continuity of care (particularly in general practice) and health conditions remaining undiagnosed for long periods. It is also now the area where lots of young people come and live on a temporary basis - that causes issues for urgent care services because many young people do not register with GP’s.

Higher level of deprivation in Newham increases demand for GP services based on weighted average of 5.3 appointments per person/year.

3.3.1 Index of multiple deprivation Figure 3.3 below shows how the high and low growth areas (Opportunity Area boundary) relate to where deprivation is concentrated within the Borough (the Index of Multiple Deprivation (IMD) is one indicator of population level need.

Figure 3.3 Spread of Deprivation in Newham - Index of Multiple Deprivation (2015)

The IMD is released by the Department for Communities and Local Governments (DCLG) and measures relative deprivation across England. The results are based on 37 different indicators across seven domains and cover Lower Super Output Areas (LSOAs).

Whereas the 2010 release of the IMD ranked Newham as the 14th most deprived local authority in England, the recent 2015 release shows Newham now lying outside the top 25, suggesting significant improvements in relative deprivation.

Nevertheless, Fig 3.3 shows that there are still many parts of Newham with high levels of deprivation. These include a large concentration of LSOAs within the top 12.5% of the most deprived across England within the Canning Town and Custom House wards, with scattered smaller concentrations elsewhere across the Borough.

If the next band of deprivation is considered, then even larger parts of the Borough both within and outside the Opportunity Areas3 fall within the top 25%.

As the indicators cover a range of factors which directly and indirectly affect health and access to healthcare, the geographical spread of deprivation offers both challenges and opportunities for the health system. Whilst, within the Opportunity Areas, there is potentially more scope to transform the built environment and provide new facilities, elsewhere in Newham, there needs to be a different approach to generating and realising opportunities for

3 The opportunity area is identified on fig 3.3 being the wards in the south and west of the borough where regeneration and population growth is planned. 15

change and improvement including making the most of existing assets and collaboration with other health partners and stakeholders to both share and pool resources and to innovate.

The age distribution across the borough (figs. 3.4, 3.5 below) shows the proportion of the population under 15 years (fig 3.4) and between 60 -74 (fig 3.5) years by ward – highlighting the different challenges across the borough.

Figure 3.4 Age distribution by ward <15 years Figure 3.5 Age distribution by ward 60-74 years

The average life expectancy in England is 79.5 years for men and 83 years for women, but shorter in Newham where men can expect to live to age 76 years and females to age 81years. This varies further still between wards where the difference is up to 7 years for both genders. This is more to do with environmental factors and deprivation in the area than a reflection on the quality of healthcare.

In Newham cardio-vascular disease, cancers and respiratory disease accounted for approximately 70% of all deaths from 2011 -13 (Table 3.2)

Top 3 causes of death Men Women 2011-2013 Total deaths = 1975 Total deaths = 1792 Cardio-vascular disease 593 470

Cancers 528 507

Respiratory disease 271 269

Table 3.2 Top 3 causes of death in the population of Newham

This is expanded on in the figure below showing the top ten causes of death by male and female (figure 3.6).

Other

Figure 3.6 Top 10 causes of death in the male and female population of Newham 2011-134

The Joint Strategic Needs Assessment(JSNA) 2015 states ‘Newham has made very good progress in improvements in life expectancy for both men and women but overall has made poor progress in improving healthy life expectancy5 in step with this’.

. for Newham women there is a predicted 25 years of ill health before death (6 years longer than in England). This equates to nearly one third of their lives compared to one quarter for women on average in England.

. For Newham men a predicted 19 years of ill health before death (3 years longer than in England). This equates to one quarter of their lives compared to one fifth for men in England.

. Newham has a young population with an average age of 31 years compared to England average age of 40 years, but Newham’s population shows signs of early ageing leading to a higher than expected burden of disease for health and care services

. There are growing health inequalities in Newham

4 Source: ONS Public Health files, 2011-2013

5 Healthy life expectancy is a measure of the number of years that a person would expect to live in good health based on contemporary mortality rates and self-reported good health.

The Case for Change showed that preventing ill health; better management of conditions by care providers before they become severe (and providing support for patients to self-care) and treating people holistically by looking at their physical and mental health needs together is essential to the long term future of healthcare. In Newham the top priorities for health improvement are to tackle inactivity, obesity, high blood pressure and smoking, which relates to improving the diseases having mot impact on ill-health, (table3.3).

Top 3 causes of ill health Men Women

Mental health illness caused 16,000 23,000 mainly from depression and anxiety

Diabetes 11,500 10,000

Musculo-skeletal

Knee and hip arthritis 9,000 13,000

Table 3.3 Top 3 causes of ill health in the population of Newham

3.4 The Current Physical Estate

3.4.1 Overview Newham currently delivers healthcare to its residents from Newham General Hospital and 70 primary medical practices and community services buildings.

This section provides an overview of the current estates across Newham, based on the NHS asset database6, comprising all the NHS estate, acute and community trust, individual GP practices and NHS England. Additionally, the residents are supported by a network of pharmacies, dentists and opticians. The map (fig. 3.7 below) shows the current distribution of health services in and around Newham.

Figure 3.7 Current distribution of health services in and around Newham

6 Source .The London NHS Asset database v5’ 19

The quality of the out of hospital estate in Newham is highly variable. There are a number of buildings that exemplify the specification of excellent design and facilities. However, there are a number of premises that are a real challenge to be able to improve. A poor estate potentially means poorer patient experiences, poor working conditions for clinicians and fewer opportunities to improve health and healthcare.

There are currently significant gaps in the register’s formal analysis in respect of the condition and utilisation of the privately owned or third party developer leased general practice primary care estate. Work is being planned to address by early 2016.

3.4.2 Current premises

3.4.2.1 Newham University Hospital- Plaistow, E13

Newham University Hospital is part of the Barts Health NHS Trust. It offers a range of local services including a 24 hour emergency department, an urgent care centre, a modern purpose built outpatient facility and care of the elderly unit. The hospital also houses the local stroke and TIA centre.

The maternity facilities opened in 2011 offer a much improved, high quality, modern and vibrant environment for mothers-to-be. The completion of the new area has also brought many services – including 24 hour maternity assessment, induction of labour and inpatient antenatal care – together into one purpose-built section of the hospital, accommodating up to 6,500 births per year.

3.4.2.2 East London Foundation Trust (ELFT)

ELFT is currently commissioned to provide a wide range of community and mental health services from 18 locations across Newham, as listed in appendix Section 3 Appendix 1 ELFT locations across Newham. The provider owns 6 premises, with funding for these coming as part of the charge for services.

ELFT has prepared a separate Estates Strategy 2013-18, with the key statement in respect of Newham set out in fig 3.8 below and the plans for a reduction/review of some facilities- as set out in table 3.4 below.

Inpatient facilities are provided through a PFI managed building and are well maintained and generally of a good standard. The service has plans to increase capacity by adding a number of additional bedrooms throughout its acute wards. There are also a number of options to reconfigure the ward space currently facilitating the Triage ward and this too will require some capital investment.

Community services in Newham will call on a mixture of modernisation, reconfiguration and in some cases relocation to different and fit for purpose buildings.

Fig 3.8 ELFT overview of Newham estates

Facility Proposal Method Rationale

Take advantage of a Services expanding, insufficient space, Francis House Disposal break-clause in the lease dated property, not Condition B or DDA compliant Take advantage of a A more suitable environment required The Hub Disposal break-clause in the lease as soon as possible Take advantage of a Willow Suite Disposal Lease terminates 2014 break-clause SW Children’s Services Appleby Health Re-utilise move in from Royal The use of all CHN properties needs to Centre Docks Medical Centre be reviewed with a view to improving efficiency and sustainability of use for Lord Lister Re-utilise Internal development the future Joyce Campbell Re-utilise Internal development West Ham Lane Redevelop Internal development

Table 3.4: ELFT Strategy extract on premises changes plans in Newham

3.4.2.3 GP practices

Newham has over 60 GP practices, caring for a total registered population of 368,021 patients (as at 1.10.2015), the list size of practices ranging from 926 to 16,478 patients. The fig 3.9 below shows the geographical distribution of the practices and with a representative of list size by circle size and colour.

Fig 3.9 Practice distribution across Newham by location and size of practice list

The full list of practices and their ownership is set out in appendix 7 Section 3 Appendix 2 Complete list of practices. Table 3.5 below gives a summary of the ownership and partnership arrangements.

Owner/leaseholder Number of properties Number of practices Number of which are single handed NHS PS 12 15 4

CHP 3 8 0 (1 branch) 3rd party 18 18 5 developer/private (2 branch) GP owned 24 24 11 Table 3.5 Summary of the ownership and partnership arrangements.

7 As taken from London Asset register v 5 October 2015- note this changes as GPs retire/merge 22

NCCG has committed through its Approach to Quality Commissioning strategy to support GPs to deliver a quality framework of services promoting improved outcomes. Whilst there is minimal evidence to connect the quality of the estate to successful outcomes, it has been demonstrated that patients are more likely to attend healthcare services where these are local and familiar, thus delivering a wider range of primary care services from larger premises will support this aim.

The fig 3.10 shows the current GP estate and a 400m and 800m zone around. This indicates that the vast majority of the population are well within the NHS E travel distance from a surgery (1.3 km).

Fig 3.10 400m and 800m distance zones from practices

3.4.3 Occupation, condition and utilisation8

3.4.3.1 Occupation and ownership Barts Health own Newham General Hospital – further work needs to be undertaken through TST to agree opportunities for full utilisation.

8 Source of information -The London Asset base v5 identifies

Across Newham there are four LIFT9 premises, operated by Community Health Partnerships (CHP)10 which offer accommodation to GP practices, ELFT and Barts health. These are: • Boleyn Medical Centre • Centre Manor Park • East Ham Care Centre • Vicarage Lane There are 16 properties for which NHS Property services holds the lease, 18 premises privately rented or rented through third party developers and c20 premises owned by individual GPs Section 3 Appendix 2 Complete list of practices

3.4.3.2 Utilisation The chart below illustrates the net internal areas of the five largest non-acute sites in Newham, used by a range of providers, including GP practices.

Shrewsbury Road Vicarage Lane Health East Ham Care Centre Health Centre Centre LIFT NHSPS LeaseholdLIFT LIFT 6,083m2 3,060m2 3,289m2

Sir Ludwig Guttmann Centre Manor Park Health Centre LIFT NHSPS Leasehold 2,280m2 5,211 m2

Detailed utilisation studies have been carried out by CHP on the three LIFT properties, shown in Section 3 Appendix 3 - Utilisation reviews Occupancy utilisation is based on 21 sessions being available over a 7 day period- thus the expectation on Monday – Friday opening alone is 71%. NCCG is undertaking further work to establish the utilisation of all premises, in order to inform where developments are required, linked to service need.

The accommodation’s gross internal area (GIA), as used by GP practices (where the information is available is set out in table 3.6 below).

9 LIFT is Local Improvement Finance Trust 10 Community Health Partnerships is a Department of Health owned company in the United Kingdom. Its role is to set up public-private partnerships to invest in new healthcare facilities in England via the NHS Local Improvement Finance Trust programme. 24

Available space Number of practices

<100m2 5

101m2 - 200m2 26

201m2 - 300m2 10

301m2 - 400m2 6

401m2 - 500m2 5

501m2 - 750m2 5

>750m2 4

Unconfirmed 5

Table 3.6 Accommodation gross internal area (GIA)

Reviewing areas of under-utilisation within the existing estate will enable NCCG to maximise the existing estates ahead of developing new facilities. Two key opportunities are:

• to convert under-utilised or administration space into new clinical areas • to ensure that paper records are digitised to minimise on-site storage requirements

3.4.3.3 Asset condition NCCG has not undertaken a full asset condition survey of GP premises (a 6 Facet survey) since 2005, but is working with the London-wide LMC to rectify this situation early in 2016. A 6 Facet survey will review the primary care estate and assess the physical condition, functional suitability, space utilisation, quality audit, statutory compliance, environmental management, disabled access, reception privacy and public transport accessibility. In turn this will facilitate the appropriate approval of practices requesting improvement grants and primary care transformation funding.

From soft intelligence it is known that a number of premises require urgent work to rectify maintenance issues or require critical investment to improve patient care. Investment will be prioritised by NCCG, as part of this strategy.

3.4.4 Backlog maintenance Backlog maintenance is the investment required by the landlord of the property or the head lease tenant (eg NHS PS) to bring these premises up to condition B standard.

A risk-based methodology for establishing and managing backlog, provides trusts with guidance on how to review the estate and indicate immediate and future investment requirements. The breaking down of backlog costs together with a risk-adjusted backlog figure is a compulsory requirement of the Estates Return Information Collection (ERIC) data set for all trusts, including NHS foundation trusts.

Taking into account the different levels of risk to patients, visitors and staff arising from deficiencies in statutory safety and physical condition of the built environment provides a representation of the investment priorities and is a methodology supported by the secretary

of state, Monitor and the CQC. This relates to the concept of risk adjusted backlog maintenance, which focuses on where investment needs to be undertaken, based on risk.

NCCG is not responsible for this cost directly as it should be covered within the rental agreements with GP practices11 or within the cost for delivered services. All contractors must comply with the NHS – GMS Premises directions 2013, schedule 1, Minimum Standards for Practice Premises, Statutory and contractual standards12 (or the equivalent clause within their PMS contracts). Those paid notional rents are required to bear the ‘costs of internal repairs and decoration maintain’

However, it is a cost to the system and providers. There has been a history of under- investment in the fabric of the buildings hence there is a high accumulated backlog cost. TST have provided some estimates eg Barts Health has £144m in backlog cost further details in, Section 3 Appendix 4 backlog maintenance

3.5 Financial summary

The NHS Five Year Forward View (FYFV) released in October 2014 outlines the following three challenges facing the NHS: 1. The health and wellbeing gap: if the nation fails to get serious about prevention then recent progress in healthy life expectancies will stall, health inequalities will widen, and our ability to fund beneficial new treatments will be crowded-out by the need to spend billions of pounds on wholly avoidable illness. 2. The care and quality gap: unless we reshape care delivery, harness technology, and drive down variations in quality and safety of care, then patients’ changing needs will go unmet, people will be harmed who should have been cured, and unacceptable variations in outcomes will persist. 3. The funding and efficiency gap: if we fail to match reasonable funding levels with wide-ranging and sometimes controversial system efficiencies, the result will be some combination of worse services, fewer staff, deficits, and restrictions on new treatments.

All planning for the future will be underpinned by these three foundations and all future investment will have to prove that these meet these core principles.

Even with an £8bn national funding increase, the NHS in London faces a £4.76bn affordability gap between forecast funding levels and rise in demand for healthcare by 2020/21, see Figure 3.11.

11 12 http://www.pcc-cic.org.uk/sites/default/files/articles/attachments/5196903.pdf 26

Fig 3.11: NHS London funding gap

There are several other areas which will contribute to the financial shortfall, these include the need to renegotiate Private Finance Initiative (PFI) contracts; the reconfiguration of estates to maximise utilisation; and making efficiencies in order to have the capacity to treat patients currently diverted to the private sector.

There is also a need for provider organisations to make general efficiencies as required by Monitor (of at least 3.5%).

4. Drivers for Change

4.1 Introduction Newham faces unprecedented population growth in one of the most deprived areas of the UK, as well as epidemiological pressures due to an anticipated high birth rate and an aging population, with poor health expectations. There is substantial financial pressure within the local health economy, which means that finding ways to use existing resources more effectively is urgently needed.

There are significant opportunities to invest not just in new and re-configured health infrastructure, but to pilot new models of care and ways of working, and to harness the wider opportunities to create healthier places and people.

The major drivers for change are the need to support:

• A significantly increasing population • An aging and deprived population • Progressing the out of hospital care programme • Addressing the current use of estate and support reconfiguration of general practice

4.2 Population predictions as drivers for change

Newham’s population is growing and changing and the local NHS and its workforce need to respond accordingly. The Greater London Authority predicts that in the next 20 years:

• The population of Newham will grow by over 100,000 residents • Growth will occur in all age bands, but the greatest increases will be among people of working age • Over 65s will increase by 37,000 (60%) and form 9% of the population. There will also be 15,000 extra children. As children and the over 65s are heavy users of health services, this shift will significantly raise demand for health services.

There is a predicted 16.6% increase in population up to 2025 which means Newham has the fourth highest increase across London over the period, (as set out in table 4.1 below).

Borough Population 2015-2025 2015-2035 % 2011 2015 2025 2035 Increase Increase Increase % Increase

Newham 311,912 332,582 387,738 417,415 55,156 16.6% 84,833 25.5%

Table 4.1 10 and 20 Year Population Growth (GLA 2014 round SHLAA Capped Borough Projection)

4.2.1 Distribution of Growth Figure 4.1 shows how this growth is distributed by ward across Newham. Growth is concentrated in the 6 wards which border the western and southern boundaries of the borough which are within the boundaries of the London Plan Opportunity Areas (red boundary and cross hatching) -the area is often referred to as Newham’s ‘arc of opportunity’.

Figure 4.1 Population growth 2015-2025 by ward (GLA 2014 round SHLAA Capped Projection)

Table 4.2 sets out the actual population change figures which underpin the map.

Ward 2015 2015-2025 2015-2020 2020-2025 2015-2035 Population Change Change Change Change (10 Years) (5 Years) (5 Years) (20 Years) Stratford and New Town 28,066 25,116 10,810 14,306 37,214 Royal Docks 13,311 9,998 4,599 5,399 15,638 Canning Town South 17,717 5,767 3,923 1,844 6,433 Beckton 15,589 5,074 3,611 1,463 10,581 Custom House 14,081 3,610 610 3,000 5,071 Canning Town North 16,592 2,990 1,611 1,379 4,647 Forest Gate South 18,011 945 362 583 1,168 Little Ilford 17,397 925 382 543 1,411 West Ham 16,030 712 433 279 701 East Ham Central 16,440 584 352 232 1,111 East Ham South 16,087 356 229 127 824 Plaistow South 16,760 296 392 -96 485 Plaistow North 16,077 38 187 -149 -138 Green Street East 16,651 -21 188 -209 -13 Green Street West 15,745 -54 75 -129 -138 Boleyn 16,547 -66 -118 52 -198 Wall End 15,451 -128 101 -229 -219 Manor Park 15,591 -177 23 -200 66 East Ham North 14,037 -371 -208 -163 622 Forest Gate North 16,420 -451 -130 -321 -472 Total 332,600 55,143 27,432 27,711 84,794 Table 4.2 Population Growth by Ward (GLA 2014 round SHLAA Capped Projection)13

4.2.2 Implications of the Population Growth This geographical pattern of growth has significant implications for the NCCG estates strategy as the scale of growth in the arc of opportunity/growth wards is likely to require investment in additional capacity.

Table 4.2 above shows the predicted changes for all wards and table 4.3 (below) summarises this for the opportunity area wards:-

• Stratford and New Town is the highest growth ward by a significant margin, with growth of over 25,000 people projected over the 10 years 2015-25 (45.5% of the total). • Royal Docks, Canning Town South and Beckton wards are the next highest with projected ten year growth of 9,998, 5,767 and 5,074 respectively. • A further 2 wards (Custom House and Canning Town North) have growth of 3,610 and 2,990 respectively; with growth in Canning Town South and Beckton projected to be significantly higher over the first the 5 years of the period 2015-25 than the second half.

13 The GLA produce different population projections variants, but recommend the use of housing-linked projections incorporating data from the 2013 Strategic Housing Land Availability Assessment (SHLAA), short term (five year) migration trends and using a Capped Household Size projection model (April 2015). Projections are available at a borough and ward level. *Note discrepancies in totals may occur due to rounding 30

• Growth in the Boroughs remaining 14 central and north eastern wards ranges from 945 to a decrease of 451 over 10 years. Net growth across the entire area covered by the wards amounts to 2,588 people – ie less in total than projected growth in the 6th highest growth ward of Canning Town North. • The twenty year projections show a broadly similar ranking, with Stratford and New Town remaining the highest growth ward over the second decade.

There are over 20,000 new units being built but the borough is unable to predict who might move into these housing developments. There are houses designated for social housing but other units will form part of the open market. Thus, it is also difficult to make assumptions based on the size/type of dwelling, four/five bedroom houses may not end up being occupied by families instead it may be a group of young sharers, especially as some of the new dwellings are expensive in comparison to other parts of Newham and some may also end up being bought by corporations and empty for large periods at a time.

Population Estimated % Estimated % 2015 growth increase growth increase 2021 2026 Royal docks 13292 4599 34.6 9982 75.1 Stratford New Town 28078 10810 38.5 25130 89.5 Canning Town South 17751 3923 22.1 5787 32.6 Beckton 15565 3611 23.2 5059 32.5 Custom House 14186 610 4.3 3632 25.6 Table 4.3 Summary of the population changes in the 5 key wards – opportunity areas

Each of these has a different local planning and development context which affects the nature of the opportunity for change.

The TST programme work described below in section 4.7 has modelled predicted increased activity levels across a range of primary care and out of hospital services and highlighted the relative strength of population growth as a key driver of change in Newham. Other drivers such as shifts in outpatient activity away from hospitals are less dominant, but nevertheless need to be considered in terms of potential estate impacts.

4.3 Future model of care and service priorities

NCCGs challenge is to commission high quality services meet the needs of its local population and reduce health inequalities, whilst managing demand and improving the efficiency and effectiveness of the local health system. It shares this role as local NHS commissioner for shaping local health and public services with the LBN. The ‘Case for Change’ showed there are significant opportunities to make patients’ experience of care safer and quicker across the health and social care system, though for example, better access to tests and outpatients. It identifies that demand for services will increase during the coming years with a growing population and increasing health needs. Some services need to be provided more sustainably, closer to home, meaning there will continue to be a shift of care away from

31 traditional hospital settings to be cared for in community based services. The estate’s strategy needs to support these ambitions.

NCCG is developing a broad ambition for the service model with a number of key themes:

i. To improve patient experience and better manage demand, joining local primary, community and acute care services together through integrated care pathways, to help people prevent and manage long term conditions, promote resilience and independence, and secure high quality acute services at Newham University Hospital for patients with acute needs.

ii. Recognising the central role for general practices, as providers, providing a cradle to grave prevention (primary, secondary and tertiary) and treatment service, with the GP as the named and accountable clinician for his patients and ensuring continuity of an individual’s care.

iii. Ensuring meaningful, quality collaboration between clinicians across settings and provider boundaries, both in managing the care of individual patients and in reviewing and optimising practice. This will be supported through shared technology and increasing multidisciplinary team working.

iv. Developing a model for primary care that will enable a wide range of services to be offered more locally across an appropriate population and ensuring there is the necessary estate and workforce to deliver the out of hospital care.

v. The availability, with patient consent, through compatible information technology systems of real time data that supports the care of patients to the clinician and ultimately to the patients wherever and whenever care is being delivered or planned

vi. Building and harnessing commissioning expertise with its member practices in neighbourhood clusters to get best access and healthcare outcomes for its residents.

vii. Working with LBN, community groups, third sector, charities and self-help groups to ensure care pathways most support the patient.

Without system change through primary care, by 2020 there is a predicted 10,000 more hospital admissions every year and in just five years, 71,000 more A&E attendances across the Barts Health and Homerton sites. The additional A&E attendances equate to roughly a 15% increase in current activity and would lead to a 19% increase in bed days across the Barts Health sites alone.

4.4 Socio-economic changes impacting on services

Through close collaboration between the providers and commissioners of health services, Newham CCG and Transforming Services Together (TST) are working on ways to commission and deliver care in the right setting for patients, whether in or out of hospital, with the ultimate aim of improving their health and well-being outcomes.

However Newham CCG is facing a significant financial gap by 2020 and the commissioning strategy will play an important part in commissioning services that enable the current

financial challenges to be managed and restore the balance but still ensure future growth in the population is prepared for. 4.5 Highlighted service change NCCG’s way of commissioning services in general practice is changing from a traditional list base to an outcome focussed population based one. Out of hospital developments combined with more services being delivered in the community will increase the focus on primary care. Services provided closer to the patient with the GP as the focal point coordinating integrated care – the right service, right time and right place.

4.5.1 Joining up primary, community and acute care services

The model proposed through the primary health care strategy (2013-18) combines a range of interventions for multiple conditions along the full disease lifecycle, spanning prevention, diagnosis, self-care, disease management, the management of co-morbidities and palliative care. The long term conditions of focus include diabetes, cardiovascular disease, respiratory disease, cancer and tuberculosis and long term mental health conditions such as dementia.

Newham’s primary healthcare care strategy proposed that a range of extended GP primary care contracts be developed to deliver better health outcomes for: • Diabetes, covering the pre-diabetes annual check and the diabetes SMI pilot • CVD, covering heart failure, hypertension, lipid control, atrial fibrillation and anticoagulation/warfarin services • Chronic Obstructive Pulmonary Disease (COPD), covering identification of those with the disease and its management • Mental Health, covering SMI • Self-care, covering tuberculosis prevention • Integrated care, covering planning for high risk patients

To ensure equitable access for patients GPs unable to deliver the full range within the practices will be encouraged to provide services across localities in groups. The stretch ambition is that access will be provided to a range of standard primary medical services 8am to 8pm, 7 days a week through a combination of GP practice, extended hours and Out of Hours services provision with full access to a patient’s notes irrespective of how or where access occurs. This will include use of technology to develop shared appointment booking systems, non-face-to-face consultations including emails and telephone triage of the majority of appointment requests.

4.5.2 Improve access to a wider range of primary care services Access will be extended and improved for those with urgent care needs; through offering more appointments during the day, in the evening and at weekends and offering more appointments via Skype and over the phone. Primary care centres will also be established at hospital sites, strengthening existing urgent care centres and providing convenient access to those who want to access primary care in these locations. This will be trialled at one of the hospital sites and if successful, implemented across. 4.5.3 Provide more proactive care By supporting people to better manage their own health, primary care is well placed to deal with this as 90% of all health care contact happens in general practice. This will be done through a number of initiatives including providing longer appointments for care planning sessions for those with long term conditions. Patients will also have access to health

33 coaches and nutritionists in larger primary care facilities who will provide health and well- being inductions to all newly registered patients to help them stay well and manage their own health better.

NCCG will need to work with LBN to ensure the transient population are encouraged to register with general practice, their health records completed and advice provided where appropriate.

4.5.4 Improve access to specialist advice and improve the quality of referrals The aim will be to support people in managing their own health closer to home. Primary care will have quick access to specialist advice over the phone or by email before making a referral, so that all people who can be managed through primary care, are cared for this way. The greater provision of multidisciplinary teams working in shared facilities will also reduce the need for unnecessary referrals.

Alongside the transformation of services, a decisive approach needs to be taken to improving quality. Variation in outcomes needs to be reduced and the good practice that high performers have developed will be shared.

4.5.5 Maternity and paediatric services The population changes will result in additional investment needs for maternity and paediatric services. Newham has the highest birth rate in England, the second highest proportion of new-borns with low birth weight in London, and a higher than national average proportion of children in poverty. NCCG aims to work with LBN to support the existing Children and Adult Mental Health Service (CAMHS) to enhance provision, particularly for patients aged 16-18.

Additionally there needs to be improvements in maternity services and services for children and young people which aim to: • Reduce emergency admissions for children and young people with respiratory problems, diabetes and epilepsy • Create effective GP and paediatric service collaboration with reengineered health visiting and school nursing services • Increase in the number of normal births at home or in a midwife-led unit

4.5.6 Out of hospital clinical services

The CCG has identified a number of clinical specialities within which elective services could be better and more affordably delivered in a community rather than acute setting. So far, services have been established for dermatology, gynaecology, ENT and ophthalmology. Further work will be undertaken to develop a map of health and map of need to support care pathway design that enable more specialties to be delivered out of hospital.

The stretch ambition is for NCCG to initiate a review of all elective hospital-based outpatient services to identify appointments that could be held in a local community setting.

4.5.7 Workforce to deliver

Primary care workforce in Newham actively undertakes to provide services, however due to the failure to employ alongside this the necessary workforce the outcomes do not always match the plan. NCCG will need to ensure the commissioning plans are not just contracted for but followed through and delivered successfully.

4.6 Technology and service delivery changes

Technology changes

Sharing care records and vital information across Newham’s health and social care organisations will be crucial to improving outcomes, timeliness of care, reducing wastage and improving people’s experience of care.

The main changes in terms of technology are considered to be: i. Developing a shared electronic health record between health and social care providers, with patients consent: This will be mainly based on connecting existing systems up so that those caring for patients have access to vital information. This could include information on medication or care plans, recent discharge letters or details of recent emergency department attendances. ii. Making progress on sharing hospital test results instantly across the system: This will reduce duplicate testing and mean much more co-ordinated care. GPs will be able to access test results as soon as they are ready. iii. Working with pharmacists to improve collaborative working systems and education for patients and clinicians iv. Supporting people in accessing their care records: This will help people manage their health better from home. If people wish, they will be able to upload their results directly. This is already possible if patients are participating in telemedicine and in the future it is likely people will be able to upload and share personal health information from smart-devices. v. Making use of Skype style technology to enable consultations to take place remotely, which will require consideration of accommodation with secure connections, wi-fi, cameras, soundproofing and EMIS. 4.7 Using estates to accommodate the changes To enable the out of hospital plans to be delivered NCCGs estate will need to fit the service needs. The TST team has developed the modelling for Newham illustrating the potential changes to service delivery and the impact on the estate requiring the provision of additional consultation and treatment rooms in the community. In line with the strategy these cover the changes from 2016-2026 and are illustrated below:

The additional infrastructure requirements in 2021 based on a 6% transfer (25,667 appointments) of Barts Health outpatient appointments (441,111) across Newham and the increase in population are identified below, table 4.4

Total primary care appointments Additional Consulting Treatment Estimated GIA 2015 baseline appointments rooms rooms 2 required (m ) 1,732,887 2021 required required

Total increase in outpatient appointments 25,667 4 1 419 (TST Shift)

Total increase in GP appointments based 177,044 25 7 2,605 on population growth

Total appointments in primary care 202,711 29 8 3,024

Table 4.4 Additional accommodation required in primary care 2021

The additional infrastructure requirements in 2026 based on a 6% transfer (27,425 appointments) of Barts Health outpatient appointments (441,111) across Newham and the increase in population are identified in Table 4.5 below:

Total primary care appointments Additional Consulting Treatment Estimated 2015 baseline appointments rooms rooms GIA required 2 1,732,887 2026 required required (m ) Total increase in outpatient appointments (TST Shift) 27,425 4 1 419

Total increase in GP appointments based on population growth 349,636 49 13 5,186

Total appointments in primary care 377,061 53 14 5,605

Table 4.5 Additional accommodation required in primary care 2026

It is recognised that the additional primary care capacity will be needed to provide access for the new population in the wards with significant growth identified.

The transfer of 6% of outpatient activity, if undertaken in 6 geographical hubs on a monthly or fortnightly basis will only require one consulting room, which could be programmed within the available capacity plans. The impact of the three largest outpatient transfers are shown in table 4.6 below and the full list in Section 4 Appendix 1 Outpatient transfers

T & O Obstetrics Gynaecology

Total appointments to be transferred 1316 5771 1257 out

OP appointments per month 110 481 105 transferred out

OP appointments - assume 6 hubs 18 80 17 running monthly clinic

OP appointment assume 6 hubs/twice 9 40 9 monthly clinic

Table 4.6 The impact of the three largest outpatient transfers

The modelling illustrates the significant need to redirect patients from A&E into more appropriate care, which will be GP appointments, using pharmacies and self-care. The capacity that will be required will be related to the success of these reviewed pathways as well as the increased use of technology, multidisciplinary teams and integrated working.

To support this service delivery change NCCG’s model is to offer locality based services across a network of primary care facilities. This will have the patient at the centre with the

GP as the coordinator of the patient’s care provision across a network of services, as illustrated in the fig 4.2 below.

Each patient will be registered with their own practice, which will in turn be in either a standalone primary care premises, in a larger locality hub premises or within a Multispecialty Community Provider (MCP) buildings. Table XXX sets out the range of services to be delivered from practices, hubs and the MCPs, their indicative size and gives an indication of the population to be served across the locality.

Multi specialty community facility

Primary care locality hub

GP practice

Patient

Fig 4.2 NCCGs Model for the level of service delivery in primary care

Range of services available

GP practice Locality hub MCP list of Serving the GP Serving the GP Services <6000 practice list + 20K practice list + 60K+ patients local residents local residents 1500m2- 2500m2 Over 2500m2 Primary medical services including extended primary care services, √ family planning, LTC services and all DES Extended access to primary care √ (a&b) √( a &b) (a 8-8 opening Mon- Fri b Sat-Sun) Community services √ √ District nursing, community matrons, HVs

Prescribing advisors √ √

Diagnostics including point of care testing Phlebotomy √ √ ECG/Echo √ √ Ultrasound √ √ X-rays √

Minor surgery √ √ Baby clinics with breastfeeding area √ √ Sexual health √ √ Out of hours services √ Elderly care √ √

Mental health IAPT √ √ Elderly mental health including dementia √ √ clinics Outside agencies Benefits counsellor √ Voluntary sector √ Patient education and public health √ Social services √ √ Speech and Language therapy √ Physiotherapy √ Podiatry √

OPD Outreach clinics inc GPwSI Cardiology /Community Paediatrics Dermatology / ENT Gynaecology / Ophthalmology √ Psychiatry/ Rheumatology Urology Audiology √ Dietetics √

Table 4.7 The range of services to be delivered from practices, hubs and the MCPs,

4.8 Approach to commissioning for quality 2013-4 extracts

Objectives of approach The objectives of this approach will be embedded across everything Newham CCG does directly and/ or through its contracted relationship with North and East London Commissioning Support Unit. The objectives are:

 to ensure that high quality, safe and effective services are being commissioned for the local population  to drive up quality through managing the market and ensuring existing providers are robustly managed against quality indicators and outcomes

 to ensure that the appropriate quality monitoring mechanisms are in place so that standards of quality are understood, met and providers are able to effectively demonstrate achievement against them  to provide assurance that quality outcomes are being realised and recommend action if the expected quality is not being met  to promote the continuous improvement and innovation in the quality of commissioned services  to monitor the quality of commissioning services through a robust governance structure  to work alongside NHS England and North and East London Commissioning Support Unit to improve the quality of services commissioned for the population of Newham  to monitor and support the management of the quality of care provided by our Member practices to support primary care quality improvement

4.9 Challenges in respect of the current estate

4.9.1 Planning and regeneration context Whilst population projections are an important indicator of change, they are based on a series of assumptions that can and do change. One of the key assumptions is the level and distribution of planned growth – ie new homes and other development all of which may be impacted upon by the economy and affordability.

The overall planned growth context is set by the London Plan which was recently updated and adopted in March 2015. Newham also has a Borough wide local plan. Two of the most important policy instruments used by the Mayor are Borough Housing Targets and the designation of Opportunity Areas - these are the areas with the greatest potential for housing and/or employment growth.

Linked to this the CCG will need to map by cluster the location of facilities, estimated capacity and the gaps in available estate.

4.9.2 Community Infrastructure Levy / Section 106 (s106) Newham implemented its Community Infrastructure Levy (CIL) on 1 January 2014 and, in time, this will replace section106 as the main means of securing developer contributions towards mitigating the impact on health infrastructure of growth from new development.

The estates strategy will provide a basis for discussions with LBN about what CIL funds are available and how and where CIL receipts can best be deployed dependent on development needs.

In the meantime, HUDU periodically undertakes checks on the level of s106 funds and other in kind contributions. This includes an overall assessment of money already secured from developers and available for use - subject to meeting any specific requirements of the relevants106 agreements. From the update in July 2015 it is understood there was c£2m in financial contributions which had been secured, of which some £580,000 had been received by the local authority.

Additionally, there are a number of in kind facilities which have been secured within individual developments – notably in Canning Town, at Minoco Wharf in Royal Docks ward,

and in Pudding Mill Lane within the LLDC area. The map below, fig 4.3, shows the position in March 2015 when a more detailed review of the position was undertaken by HUDU.

Fig 4.3 Distribution of potential section 106/CIL funded opportunities

Given the implementation of CIL in Jan 2014, the overall amount of s106 potentially available will clearly diminish over time as monies are received and allocated to specific schemes.

There is also the possibility that some developments may not proceed and/or that schemes are revised and may therefore fall under the new CIL regime – especially where a new consent is required. Either way, it will be important to monitor the availability of s106 to ensure any legacy funds are utilised.

4.9.3 Other sources of capital funding The estates strategy seeks to coordinate and make best use of all available funding for investment in new facilities where required and to make the best use of existing assets. This includes Primary Care Transformation (previously Infrastructure) Fund (PCTF) and Improvement Grants, NHSPS customer and landlord capital, CHP investment, NHS Trust capital investment, and Section 106 developer contributions (financial and in-kind) and Community Infrastructure Levy.

There is a need to distinguish proposals where growth arising from new development is the principal driver from those where other factors (eg mergers of smaller GP practices, a reconfiguration of community healthcare services, building condition or fitness for purpose 40

considerations) are the key drivers of change. These issues around the co-ordination of different funding sources are dealt with in later chapters.

4.9.4 Cross boundary demand and opportunities The Opportunity Areas that cover Newham extend into adjacent boroughs, so a coordinated approach towards estate and service strategy needs to be adopted. This is especially true in the London Legacy Development Corporation area covering the former Olympic Park where significant numbers of new homes are planned. More generally, there are high levels of growth planned in adjoining areas of Tower Hamlets and in Barking and Dagenham (especially Barking Riverside) which, along with associated transport improvements will have some impact on Newham.

Other opportunities for cross border working include:-

• large acute and mental health facilities which form part of the wider WEL health system

• the use of larger assets located close to Borough boundaries, which might serve a wider catchment eg the Sir Ludwig Guttman Centre in the NW of the Borough and Loxford Polyclinic in the SW of Redbridge

4.9.5 Opportunity Areas Figure 4.4 shows the boundary of the two designated Opportunity Areas - the Lower Lee Valley (including Stratford) and the Royal Docks and Beckton Waterfront Opportunity Area. As can be seen from the map, together these cover most of the southern and western growth wards in Newham.

The overall housing capacity potential in the Lower Lea Valley OA (which extends into Tower Hamlets, Hackney and Waltham Forest) is estimated at 32,000 homes with potential for more. The bulk of this sits within Newham, with capacity for some 20,000 homes in the Stratford Metropolitan Master Plan, Stratford City and Olympic legacy areas – see areas highlighted below.

Fig 4.4 The boundary of the two designated Opportunity Areas

Source: Stratford Metropolitan Masterplan (Feb 2011)

In contrast, the potential capacity across the Royal Docks OA is estimated at 11,000 new homes. The latter figure reflects the mix of land uses which include the large area covered by the docks themselves, London City Airport, the ExCel Centre and designated employment areas).

It is for local plans to develop the detailed planning framework for these areas.

4.9.6 Housing targets The London Plan sets out 10 year minimum housing targets, which each borough should achieve and exceed until such time as a revised plan is released. Over the next decade Newham is accountable for 19,945. Many of these new homes will be built in the Opportunity Areas as mentioned above.

In addition, the Stratford and New Town ward forms part of London Legacy Development Corporation (LLDC) area, which also covers parts of Hackney, Tower Hamlets and Waltham Forest.

The LLDC is the local planning authority for this area and sets its own planning framework - including its own Community Infrastructure Levy (CIL) charges. It also now has its own London Plan housing target of which some 10,800 are expected to be built within Newham.

Added together, the combined target for Newham equates to the second highest housing target for a Borough area in London (after Tower Hamlets).

4.9.7 Newham Local Plan Newham’s Local Plan sets local planning policy in the area to 2027 and is the basis on which planning applications are determined. The Local Plan comprises a series of documents including the Core Strategy (adopted Jan 2012) and Proposals Map. Plans are usually reviewed every 5 years.

Newham has consulted on its Detailed Sites and Policies DPD which explains how the Borough will manage development and develop or protect smaller sites, plus comprehensive regeneration plans for Stratford Metropolitan area (Feb 2011) and for Canning Town and Custom House (July 2008).

4.9.8 Phasing of New Residential Development A critical consideration with housing and development opportunities is to understand the likely phasing of development and to monitor their implementation and cumulative impact as these will determine the level and pace at which new population arrives in the main growth locations.

The Regeneration Team at Newham have been working on this and these more detailed local assessments should in turn facilitate more detailed consideration of issues and opportunities in each of the main growth and regeneration localities (as with the options appraisal for a new facility in Canning Town).

Understanding the phasing of development and rate and distribution of population growth is crucial in making sure infrastructure and services are provided in the right place at the right time, and that a critical mass of people are in place to support the provision of a new facility.

Given the steady rate of growth in the north-east of the borough, and the existence of some larger buildings such as the Sir Ludwig Guttman Centre and Vicarage Lane an approach might be to maximise the use of current estate and modernise existing premises to meet short-term increases in demand. In the south-west of the borough it is likely that additional premises will be required to absorb the growth over the next decade and beyond.

4.9.9 London Borough of Newham (LBN) Local development Plans

The Local Development framework masterplan developed for Newham by LBN was originally determined in 2004 and throughout the production various stakeholders and the local community have been involved in shaping the ideas and aspirations. The plan has been revised to take account of changing circumstances – particularly land values, changing national policy requirements in the delivery of additional housing, the effects of the Olympics and Crossrail to the area and other regeneration and urban development opportunities being brought forward.

LBN work has been to: • identify the Council’s strategic aspirations to inform the regeneration of the area; • explain how planning policies will be applied at this neighbourhood level; • provide guidance to support the determination of planning applications; • ensure sites coming forward for development fit together coherently and contribute to the regeneration objectives for the area; and • provide guidance for developers, land owners and residents.

4.9.10 Identification of sites where new health facilities may be required Although the setting of CIL and any subsequent reviews of CIL requires an assessment of future (health) infrastructure requirements, the process of engaging with Borough around where new sites or premises may be needed and ensuring they are recognised and properly allocated in any reviews of statutory planning documents is a different one.

Whilst a number of new facilities have been provided for in development proposals in the past, it is important to keep these under review as, not only may some developments not proceed, but there may be new or different opportunities which can be pursued.

More detailed work is needed to ensure these shell and core facilities still meet the needs of the emerging strategy (as has happened for example in relation to Canning Town).

More generally, regular engagement with local authority planners and other relevant stakeholders will be an important part of the ongoing delivery arrangements for the strategy.

4.9.11 Drivers Summary

The key drivers to change in Newham are: • Over the next 15 years it is expected to be the largest borough area for population growth and regeneration in Europe. An anticipated 80,000 new residents will move to Newham. • It is an area where many residents move freely in and out of the borough creating problems for providing long-term care. • The new population is expected to be of a different demography to the existing and will be younger; this will impact on the availability of funding for health care • The existing population has high levels of deprivation and health needs, both currently met and unmet. • The GP workforce in Newham has a high number of practitioners likely to retire within the next 10 years • There is a national shortage of practice nurses and action needs to be taken now to attract this workforce and develop their skills

Section 4 Appendix 1

5. Estates Options for Change - How to get there

5.1 Key principles and service models Primary care is where the majority of contact with patients takes place in the NHS and should meet the majority of people’s health needs. Newham’s primary care system currently operates to a large extent on the traditional GP model. Newham has 59 GP practices providing services out of 55 buildings, of which 20 operate as single-handed practices. This indicates these GPs tend to work in isolation in relation to service delivery and managing a practice and may not be able to maximise the opportunities of partnership working, such as sharing knowledge on their special interests. Patients rarely seek help or advice from other health care professionals (eg pharmacists) and this has led to capacity and access problems.

The service model should be one that delivers improved levels of access over extended hours, proactive and coordinated care, multidisciplinary team working and other innovative approaches using technology. Generally these can only be provided sustainably in larger facilities where practitioners can support one another.

Newham has engaged with a number of key stakeholders to determine how the estates should be designed over the next 10 years. Taking into account guidance from the Five Year strategy (see Box 1), work through the SEPG, patient and clinician feedback (Box 2)

5.2 Estates strategy assumptions and vision for primary care v. align to the clinical service requirements of the system by providing fit for purpose buildings and facilities in-line with operational requirements vi. to maximise the use of space within existing buildings before investing in new builds’ thus ensure good value for money and an efficient use of resources vii. where required, to support the development /expansion /improvement of primary care estate that provides sufficient accommodation and space to enable practitioners to provide extended primary care and key diagnostic tests at one site on one patient visit viii. to ensure premises are of high quality, meet all health and safety and statutory compliance requirements being DDA compliant and supporting less able or physically impaired patients with access and moving around the building, ix. to develop a number primary care locality hubs, with the facilities to offer flexibility for delivery of a wider range of services for a larger population, supported by GPs and community providers working collaboratively x. new premises will only be supported where they offer opportunities for 10-15,000 patients which, where required, support the merge of smaller practices xi. ensuring that wherever possible, primary care locality hubs can be co-located with wider local authority and third sector services that offer social, health and well- being services xii. to provide a small number of multispecialty community centres in which larger GP practices could bring in a wider range of skills – including hospital consultants, nurses and therapists, employed or as partners

In line with the Five Year Forward View (October 2014) NCCG supports the need to: . shift investment from acute to primary and community services. . expand funding to upgrade primary care infrastructure and the range of services delivered through this route . provide new funding through schemes such as the Challenge Fund to support new ways of working and improved access to services . work to design new incentives to encourage new GPs and practices to provide care in under-doctored areas and tackle health inequalities . build the public’s understanding that pharmacies and on-line resources can help deal with minor ailments without the need for a GP appointment or A&E visit.

Box 1: Five Year Forward Plan view

The clear message from patients, engaged in early consultations and clinicians, is a desire to see: • Strong support for the development of ‘locality hubs’:  Patients will be prepared to have fewer practices and increase the travel distance if they need to make fewer appointments at different locations to receive the full range of tests  More services delivered locally, with good transport links and  Practices working more collaboratively together, sharing GP skills where there is an expertise in a specialty and office functions • All buildings meeting the needs of those with physical and mental disabilities, including adequate parking and public transport access • Improved access – in terms of ease of getting an appointment, extended opening hours and all the test facilities available at one appointment (some demand until 10pm or for limited Sunday opening – possibly shared across an area) • Services in the building should be flexible and centre on the needs of people, recognising centres may have different needs as the population accessing the services will be different, thus opening timings should be adjusted accordingly e.g. people near Stratford may be young working population who may prefer evening opening hours compared to people in the north where patients may prefer day appointments. • CCG should undertake analysis of population trends and needs of people moving in the area to ensure correct services are put in these hubs to maximise resources. • Wards where there are younger residents with high churn will need a different service focus to those areas with an ageing long term resident population. • Technology –  use this more to improve access e.g. virtual consultations on Skype or other platforms  use to book appointments but to be supported in using with clear guidance for those less familiar with Apps/smart phone systems, NCP or touchpoint technology. • As well as providing quality care closer to home, consider how these spaces can be used as information hubs to improve health and wellbeing in more holistic ways e.g.  co-location with community, common interest, self-help groups and charities  access information and advice (benefits, community groups)  address fragmentation between health and social care. Box 2: Feedback form patient consultation November 2015 47

5.3 Addressing the future need In addressing the need for future developments the key drivers are:

• Population growth and changing demographics and their associated health needs • Locality hubs provision, enabling a wider range of services to be provide from a smaller number of primary care facilities including out of hospital transfer of services and colocation with community/ health and well-being services • Best use of existing estate and regeneration opportunities

The maps below (figs 5.1, 5.2) illustrate the change from 2016 -2026 in projected population by ward:

Fig 5.1 Population by ward 2016 Fig 5.2 Population by ward 2026

Linking this to the TST predictions on additional primary care appointments required through growth and the transfer of out of hospital services, NCCG needs to consider the following ‘additional’ provision of accommodation, in the five wards where there is significant growth, (full table appendix Section 5 Appendix 2 Transforming Services Together (TST) analysis of additional space and table 5.1 gives a summary, below).

Additional Additional Additional Additional Additional Additional consulting treatment GIA consulting treatment GIA Ward rooms rooms required rooms rooms required required required (m2) required required (m2) 2021 2026

Stratford and New Town 6 2 414 13 3 841

Canning Town South 3 1 207 5 1 317

Custom House 1 0 55 4 1 262

Royal Docks 3 1 331 6 2 662

Beckton 4 1 262 5 1 317

Total 17 5 1269 33 8 2399

Table 5.1 Summary of additional space requirements due to population growth and out of hospital changes

The remaining wards in Newham only expect minimal changes in their population- so the key driver to changes here will be:

• Increasing the opportunities for practices to co-locate in suitable premises, merge and work together • Reducing the number of premises that have unaffordable levels of backlog maintenance and do not meet health and safety standards • Ensuring that practices are meeting the required standards as determined through the Care Quality Commission and infection control

5.4 Opportunities and investments required.

To reach the planned longer term goals, NCCG will need to make some important decisions regarding investment. The plans for estates developments often need to be proposed and supported years ahead of the final opening of the accommodation, to fit in with local planning requirements and funding opportunities available. Within LBN’s regeneration programme NCCG needs to take advantage of the availability of accommodation included within the developers’ planning permission negotiations.

NHSE has received over 20 applications from Newham practices for improvements, relocations and other developments, these are listed in Section 5 Appendix 5.1. Some have been agreed as legacy projects, from when the Newham primary care trust held responsibility for estates development or have been prioritised for investment through NHS E, recognising that they will support the strategic needs of the transformation programme. Others are in the planning stage and will need to be reassessed against the strategy to ensure they fit with the direction set out.

NCCGs strategy is to initially consider each cluster area, review the key estate to be maintained, the opportunities available and gaps, with the intention of delivering locality hubs and adequate primary care estate. Those premises currently supporting over 7000 patients will be considered as the locality hub practices, subject to further negotiations with the clusters.

A brief summary of each cluster is given below.

North west 1– Stratford and New Town

The area is expected to grow by 20,000 residents over the period of the strategy. There are several excellent premises all with spare capacity able to support the need, including the Sir Ludwig Guttman Centre, Lantern Health at Stratford High Street and Vicarage Lane. Others are being reviewed for improvement, (Stratford Village surgery and Stratford Health Centre).

There are section 106 monies identified for Pudding Lane in the south of the Queen Elizabeth Olympic Park, however, NCCG do not consider this a priority.

North west 2- Forest Gate and West Ham

There are four main sites practices, three of which have applied for premises for development (Woodgrange, Claremont Clinic and Upton Lane Medical Centre), as well as opportunities in respect for the practices within Lord Lister Health Centre to maximise their estates utilisation and improve their clinical performance.

North east 1 and 2

These two clusters are extremely densely populated and with the highest incidence of elderly patients with long term conditions.

Centre Manor Park (LIFT) is being reviewed which give the opportunity to increase the range of services delivered from the building. Further development is planned for Shrewsbury Road surgery, which could become a second hub, as it is already collocated with a number of community services. ELFT are keen to look at opportunities for East Ham Care Centre and East Ham Memorial Hospital, which are adjacent to each other and Shrewsbury.

Three practices in the locality are seeking to merge and develop on a new site, the Froud Centre, which will be co-located with community facilities, enabling the existing premises to be closed. The practice will be offering added social and well-being focus to the care. Together these three facilities will offer improved health care, range of services and access for the locality.

There are a number of small practice in East Ham require improvement and possible collocation.

Wordsworth is another large practice that could offer accommodation for more services.

Central 1

Although the Boleyn LIFT building is located in this cluster area, there is minimal opportunity for additional services to be provided, as the premise is well utilised. Market Street however, has the potential for clinical space to be reviewed and utilisation increased, providing a potential hub for the cluster. Several opportunities are being explored for the St Bartholomew’s surgery, Greengate and Newham Medical Centre to improve their facilities and collocate with other smaller practices.

Central 2

A merger is currently being undertaken relocating Balaam Street with Essex Lodge practice, to potentially offer hub services.

Other practices will be seeking to collocate and supporting investment will be proposed to enable this.

There are two key opportunities for developing new facilities being explored, with a health and well-being focus on the West Ham Football Club site and/or the Rainbow Centre, near the East Ham Jewish Cemetery.

South 1 – Canning Town and Custom House

NCCG recognise these wards as key areas of need for increased capacity with their anticipated additional population. Star Lane Medical practice has space to increase on their existing site. New developments in conjunction with LBN will be undertaken in Canning Town and Custom House. All three will have the potential to offer hub services. NCCG will work with the smaller practices in this cluster to identify ways of merging and/or collocating.

South 2 Royal Docks and Beckton

The area is currently served by five premises. Tollgate, the Royal docks and Albert Road practices have opportunities to develop and offer additional capacity with investment. New developments in conjunction with LBN will be undertaken in Silver Town Quays, with CIL funding.

Based on the principles above, alongside the projected developments planned the premises map for 2025 would look resemble the following:

Fig 5.3 Premises currently supporting over 7000 patients or planned within the strategy period 5.5 Summary

Newham CCG’s strategy for primary care is to support practitioners to deliver the required services to their patients that provide the best health outcomes. Estates are an enabler. By

51 providing safe and well-appointed accommodation in the right location, staffed by a motivated and trained workforce, NCCG will be able to better commission health care services for its population. There is a good foundation of high quality premises already in place across borough, but the number of these need to increase. In parallel the facilities need to be used over longer opening hours and supporting community, social and voluntary services.

All of the changes will require co-operation and collaboration of the GP practices to ensure the locality hubs and multispecialty centres are fully utilised and the assets deliver value to all stakeholders and the community.

6 Financial implications

6.1 Background Current costs to the CCG for premises cannot be fully quantified as a single figure as relevant premises costs for services that the CCG commissions are not separately identified. However, the following (table 1) summarises the premises cost for ELFT Community Service premises and the costs attributable to GP premises for the primary care budgets delegated to the CCG from NHSE as well as void and head office premise costs.

Estates Average costs - Existing Estate Total M2 Total Cost

Primary Care Contract services Freehold (notional rent) 11,718.00 £2,019,198 Leasehold 5,845.00 £2,360,437 Total 17,563.00 £4,379,635 Community and other CCG Attributed cost in CHP Premises 484.25 £404,577 CCG Attributed cost in NHSPS Premises 5,074.00 £1,662,735 Provider in CHP Premises 7,974.01 £6,318,199 Provider in NHSPS Premises 6,952.70 £2,194,844 Provider - Premises transferred to block 3,116.00 £948,634 Other Total 23,600.96 £11,528,989

Overall 41,163.96 £15,908,624 Table 1: Premises costs

6.2 Financial elements associated with the Strategy There are a range of key financial elements that need to be taken into consideration by the CCG in relation to the Estates strategy as follows: • CCG Capital funding o The CCG has a very limited access to capital and this is unlikely to be a source of funding for the Estates Strategy. • NHSE Capital (the Primary Care Transformation Fund) o This fund is approximately £750m nationally over three years (the first £250m having been awarded) and will be provided to primary care against approved business cases either direct to practices where bids are approved for freehold practices, or to third parties where practices are leased. CCGs will be involved in supporting and reviewing the business cases, and these will need to address the priorities identified in the Estates Strategy.

• Other capital sources o This could be capital funding from a range of sources including S.106, CIL, CHS/NHSPS, NHS Providers, 3rd party sourcing or other grants. The CCG will engage with such providers to ensure they are aware of and reflecting the CCG Estates Strategy but we may not always be able to assert full influence over estate development decisions.

6.3 Revenue Costs All additional capital investment is likely to carry a revenue cost risk for the CCG, the key elements of which are: • Premises related costs – This would be either direct depreciation/capital charges, lease costs, or in the case of GP premises notional rent costs arising either from the cost of capital or the rental valuation. In this context it should be noted that without any additional development there is a risk of additional cost arising from the move from 2016/17 by NHS PS to charging commercial as opposed to historic rent for NHS occupancy of its properties. An analysis indicates that the risk for Newham CCG will lie between £500,000 and £2.6m with £1.8m being most likely. • Costs of fit-out where it is agreed that premises are developed to a certain level that requires additional funding by the CCG to make them specifically fit for clinical use or the services the CCG wishes to commission. • Additional commissioning or contracting costs where premises development generates additional capacity or other activity.

However, the strategy also highlights opportunities for savings including those generated by: • Increased asset use (for example a GP practice moving from offering 11 or 12 sessions to 18 or 21 sessions). It should be noted that current estimates suggest a 30% under-utilisation of the overall estate. • Merging of practices or consolidation of services into smaller, more cost effective premises footprints. This option may also generate non-recurrent gains from sales which can be offset against elements of development or transition cost. • Use of IT and other options to reduce the average number of premises based appointments for patients or to switch activity volumes to lower cost premises to reduce the premises element.

All the above opportunities will be informed by the development of benchmarking analysis to ensure that the priorities and options in the strategies are pursued with knowledge of the how they affect or deliver value for money from the estate.

6.4 Potential Financial Costs The financial challenge and opportunity over the period of the strategy will be modelled using a number of factors, the main ones being: • Average cost per m2 of estates (differentiated by existing provision and ownership, and combined to generate a working averaged cost) • Estimated additional space requirement (differentiated by proposed provision and ownership and combined to generate a working averaged cost). • Anticipated efficiency (delivered through a variety of measures)

• Development profile • Sensitivity impact (based on target, best case and prudent scenarios)

The initial draft of the model is summarised below in table 6.2. For 5 years to 2021 Estates Financial Planning Model Target Best case Prudent

Cost components £'s per M2 (av) £386 348 580 M2 requirement (av) 1269 1269 1904 Total £ requirement 490,430 441,612 1,104,320 Transitional cost % 5% 2% 10% Non-recurrent cost % 5% 2% 10% Commercial rent risk % 40% 20% 50% Uplift element (valuation/inflation) % 10% 5% Total Cost % 60% 29% 70% Total Cost element 784,688 569,679 1,877,344

Offset/savings components Improved Asset Utilisation (%) -10% -30% 0 Merger/closure efficiencies (%) -5% -10% 0 Technology efficiencies (%) -5% -10% 0 Care Pathway efficiencies. (%) -5% -10% 0

Total Offset % -25% -60% 0% Total offset Impact (£) 35% -31% 70%

Net Financial impact 662,081 304,712 1,877,344

Table 6.2: Estates financial plan modelling

Based on a ‘target’ assessment the likely additional revenue cost of developments over the next 5 years is estimated to be £662,081 with a potential cost of £1.88million. If efficiencies are fully delivered the overall cost of premises could reduce to approximately £300,000.

Taking the additional risk into account the overall annual impact of ‘target’ estates development is currently estimated to be as follows: (table showing per annual increase).

6.5 Funding the requirement As part of the TST programme the CCG has developed a balanced 5 year plan, with a total QIPP delivery required of £47million.

Development of the estate would require funding additional to this plan. The CCG will be required to refresh the 5 year plan following the release of allocations later this year and following discussion

55 with key stakeholders the ‘target’ costs will be incorporated into this model. At this point in time specific measures to ensure the proposed developments are affordable are still to be identified.

7 Delivering the Strategy and Outline Implementation Plan

7.1 Priorities for years 1 -5 of the stategy (2016 -2021)

The priorities for NCCG over the next 5 years are:

A To complete the gap analysis that will fully inform investment opportunities:

• whether the existing estate is suitable/adequate to deliver existing and future primary, community and related services, in terms of condition, access, utilisation, clinical safety and affordability, with particular reference to the priorities; • whether the existing estate needs to be modified to accommodate existing and future service provision. with particular reference to the priorities; • where there are gaps in infrastructure supply to deliver existing and future services. with particular reference to the priorities.

B Work with LBN and primary care practitioners to maximise the development opportunities within the key growth wards where new premises will be required:

• Canning Town • Silvertown Quays

and where there will be a need for improvement /expansion/ increased utilisation of the estate in: • Stratford • Royal Docks • Custom House • Beckton

C Support the merger and co-location of smaller practices into higher quality estates through rationalisation, especially in areas of high health care need, including: • Manor Park • East Ham • West Ham

D Continue to develop care pathways and commission services out of hospital that offer residents more local access to a wider range of services, over extended hours, through the identification and development of community locality hubs.

7.2 Development of the strategy Following presentation of the interim estates strategy to the Primary Care Commissioning Committee and NHS England, NCCG will undertake further consultation with key stakeholders, including Bart’s Health, ELFT, LBN and GPs to test the proposed models.

This will be undertaken in conjunction with the refresh of the primary health care strategy, to be finalised by March 2016.

The key pieces of work to deliver the full strategy are:

• Utilisation and condition survey of all GP premises and analysis of opportunities • Recommendations to NHS E to invest in properties that fit with the CCG’s model for service delivery • Undertake early discussions with LBN and developers to ensure health facilities are included and funded, where strategically required • Development of a strategic decision tool- sample in appendix Section 7 Appendix 1 DRAFT Newham Clinical Commissioning group - Strategic estates decision framework • Financial framework completed

7.3 Ongoing work plan and timescales

Planned and potential developments: These are summarised in sections 7.2.1 and 7.2.2 and table 7.1

7.3.1 NCCG led projects – new developments East Ham locality development and amalgamation of practices to fewer premises Canning Town Silvertown Quays West Ham Rainbow project Capacity utilisation for Stratford – Sir Ludwig Guttman, Vicarage Lane, Carpenters Road

7.3.2 Practice led NCCG supported projects Tollgate Medical Centre Custom House Manor Park Care Group Star lane

Timeframe for Practice Locality Practice development Code completion

C 1 F84010 ST. BARTHOLOMEWS SURGERY 2017/18

C 1 F84053 GREENGATE MEDICAL CENTRE 2016/17

F84052 ESSEX LODGE C 2 2016/17 F84681 BALAAM STREET

NE 1 F84670 WESTBURY ROAD MEDICAL PRACTICE 2016/17

F84658 SANGAM PRACTICE NE 1 F84091 57 GLADSTONE ROAD 2017/18 F84658 KATHERINE ROAD

NE 2 F84006 THE SHREWSBURY CENTRE 2016/17

NW 1 F84009 STRATFORD VILLAGE SURGERY 2016/17

2016/17 NW 1 F84022 STRATFORD HEALTH CENTRE

2016/17 NW 2 F84014 UPTON LANE MEDICAL CENTRE

2016/17 NW 2 F84086 DR N DRIVER & PARTNERS

2016/17 NW2 F84097 CLAREMONT CLINIC

S 1 F84017 STAR LANE MEDICAL CENTRE 2017/18

S 2 F84093 TOLLGATE MEDICAL CENTRE 2017/18

C 2 RAINBOW CENTRE 2018/19

C1 WEST HAM FOOTBALL CLUB 2020

F85666 S 1 CANNING TOWN 2020/21 F84749

S 1 F84047 CUSTOM HOUSE 2019/20 S 2 SILVER TOWN QUAYS 2022

S 2 ALBERT ROAD/BRITTANNIA VILLAGE 2019/20

Table 7.1 Potential developments and their timescale for completion

7.4 Resources The financial resources available to the CCG will include:

• S106/CIL monies • Primary Care Transformation Funding • Redistribution of current rent and rates payments from premises relocating/closing • Monies secured from the commissioning of out of hospital services • Increase capitation payments following increased population

7.4.1 Manpower NCCG will need to consider resourcing an estates developments officer through the primary care team who will:

• Receive and review applications for primary care transition funding against the strategic direction set out in this strategy • undertake analysis of the GP premises surveys to determine the condition and development opportunity, if appropriate • engage with stakeholders (including GP community, Bart’s Health, ELFT, LBN and their developers) • engage with residents and practices’ communities, • review practice delivery against the quality framework to ensure practices are meeting their contractual targets • offer guidance to practices for developing PIDs and business cases for schemes with NCCG agreement

7.4.2 Enablers of change and managing constraints Analysis of data from the 6-facet and utilization surveys

Undertaking the surveys of the condition of GP premises, whether there is underutilised accommodation and whether there is a potential to extend/develop will provide clarity for investment priorities. It will also provide information on where additional out of hospital services may be offered.

Development of GP locality hubs

Fundamental to the strategy is the development of larger premises that can support the delivery of a wider range of services to a population. There is support for this from many GPs and patients. The CCG will need to work through the constraints and concerns of smaller practices not wishing to connect or relocate to larger locations, through available commissioning routes and funding opportunities. This may be using:

• Identifying levers to ‘encourage’ relocation • Encouraging occupiers of one premises share limited resources across a wider patient base • Providing the patients with information on how and where to access services, which may encourage change • Federation development • Workforce development and enlargement

7.4.3 London Borough of Newham Regeneration Plans The Health and Wellbeing Board, will be a key driver in delivering the public health message and subsequent driver for making service delivery changes. NCCG will need to obtain

support for schemes within the regeneration areas, which where required, attract the S106/ CIL monies. Support will be secured by aligning plans for health facilities as part of wider community activities, developing the opportunities for patients to consider other options in respect of self-care.

7.4.4 Working with the developers NCCG will set up an open day, inviting building companies linked to the regeneration schemes and practitioners interested in developing sites to explore available opportunities.

Risks and mitigations

Risk Mitigation Failure to obtain engagement for the Through development of Federations long term CCG ambition for the borough with GPs

Failure to obtain engagement for the Ensuring effective shared vision and long term CCG ambition for the borough building on the work of the Health and with LBN Wellbeing Board/ public health links Consideration of shared posts across estates Failure to obtain engagement for the Need to link with ELFT Estates strategy long term CCG ambition for the borough Agreement through commissioning on with ELFT the timescale of relocation and recommissioning of hospital services that will impact on estates requirements Failure to obtain engagement for the Need to link with Barts Estates strategy long term CCG ambition for the borough Agreement through commissioning on with Barts health the timescale of out of hospital services moves and the impact Financially unaffordable projects Need to maximise opportunities to obtain funding from available sources

Predicted population growth does not Ensure that plans include a timeframe materialise that is realistically ahead of the population growth curve and includes options for alternative temporary use of facilities by other stakeholders Requirement to pay current market rent Work with NHS E and NHS PS to for schemes where a lower rate would progress changes in regulations that be appropriate permit more flexibility in rental agreements Negotiate opportunities for leases to be held by the CCG Unable to attract a sufficient and Ensure training opportunities within effective primary care workforce as practices are maximised, recognising

nationally there are predicted shortages GPs often practice from where they of GPs and practice nurses and NCCG has have trained a high number of GPs over 70 years of Work with universities to encourage age nurses to undertake APN roles and support the backfill Subsidise training programmes

Section 3 Appendix 1 ELFT locations across Newham

Property Name Address of Property ELFT provided services

Community Children Nursing The Boleyn Medical Centre 152 Barking Road Services.

District Nurse Dressing Clinic Heath Visitors Family Planning Phlebotomy Clinic Midwives Leg Ulcer Clinic BCG Clinic Baby Clinic Vicarage Lane Health Centre 10 Vicarage Lane HIV Rapid Response Testing Clinic C13 Breath Test Community Mental Health - Depo Clinic Diabetic Nurse Vicarage Lane HC - First Floor Physiotherapy Audiology Talking Therapies

Immunisation Clinic, Health Visitors Clinics, Health Visitors Clinics, One Balaam Park Health Centre 113 Balaam Street Year Health Reviews, Looked after Children, Development Advisory Clinic

Child Immunisations East Ham Memorial Hospital Shrewsbury Road GP Services Support Services

• Support Services • Looked After Medical • Health Visiting • School Nursing • Immunisation • Safe Guarding Services Lord Lister Health Centre 121 Woodgrange Road • Speech & Language Services • Diabetic Community Nurse Clinic, • Family Nurse Partnership (FNP), • Psychology (CBT) Services. • Mobile Ultrasound Scan • Development Advisory Clinic • Family Planning Services • Shine Services 63

• Anticoagulant Services

Asthma Clinic - Asthma Clinic Child Immunisations - Child Immunisations Asthma/COPD Clinic Shrewsbury Road Health Centre Shrewsbury Road Diabetic Clinic Minor Surgery GP practices Travel health with yellow fever - Travel Clinic

Newham Health Team for People Stratford Office Village 4 Romford Road with Learning Disabilities

Shine, Family Planning Adult Clinic, Community Neuro Service (holds West Beckton Health Centre 2 Monarch Drive ad hoc psychology clinics), Physiotherapy (in WB gym)

Child Development Service which includes the following Paediatricians Specialist Health Visitors West Ham Health Centre 84 West Ham Lane Children’s Physiotherapy Children’s Occupational Therapy Children’s Speech & Language Therapy

In-patient and community mental Newham Centre For Mental Health Glen Road health services

In-patient and community care East Ham Care Centre Shrewsbury Road facilities for older people

Viability. Health Visiting, School Nursing, Immunisation, Transitional team GP services, Dressing clinic, The Centre Manor Park 30 Church Road Phlebotomy services, Diabetic Community Nurse Clinic, Cardiac Rehab, Psychology services.

Newham Psychological Treatment Katherine Road Psychological Treatment Centre Centre

Dressing Clinic, Anti Coag, Podiatry, Adult Physio, Children Physio, Cardiac, Leg Ulcer, Speech And Language, Patient Appliance, Stoma, Diabetic Clinic, Cmo, SN2 63 Appleby Road, (Children’s Services), Looked After Appleby Health Centre Canning Town Children (Children’s Services),Health Visitors Clinics (Baby Clinic), Asq Clinics (Health Visitor Clinic), Health Reviews (1 And 2½) Yrs (Health Visitor), Immunisations, Phlebotomy

Immunsation, CMO, School Nursing Joyce Campbell Clinic 478 Barking Road & Health visiting

19-21 High Street Sickle Cell & Thalassaemia Centre Sickle Cell & Thalassaemia South

University of East The Clinical Education Building Foot Health Team London, The Green

29 Romford Road and Stratford Physiotherapy Centre The Romford Road Centre Lyon House Wheelchair Service

Section 3 Appendix 2 Complete list of practices

Propert Postco Raw y de of List Practi Owner the Size ce Type of /Landlo propert Oct Owners Code Business rd Property Name/Provider Address of Property Ward y 2015 hip type F8474 Unit C - 236-252 High street - Unit C - 236-252 High Leasehol E15 2JA 9 GP Branch NHSPS Stratford street Stratford 11,438 d F8400 Shrewsbury Road Health Leasehol E7 8QP 6 Partnership NHSPS Centre Shrewsbury Road Forest Gate 12,713 d F8465 E12 Leasehol 8 Partnership NHSPS Greenhill Centre 31a Snowhill Road Manor Park 6BE 6,229 d F8467 Westbury Road Medical E7 8BU 0 Partnership NHSPS Practice 45 Westbury Road Forest Gate 4,180 Freehold F8468 E13 8AF 1 Partnership NHSPS Balaam Park Health Centre 113 Balaam Street Plaistow 6,249 Freehold F8471 E6 5NA 7 Partnership NHSPS Royal Docks Health Centre 21 East Ham Manor Way East Ham 9,071 Freehold F8474 2 St Luke's Square, Leasehol E15 2LJ 9 Partnership NHSPS St Luke's Health Centre Tarling Road Stratford 11,438 d F8570 2 St Luke's Square, Canning E16 Leasehol 7 Partnership NHSPS St Lukes Health Centre Tarling Road Town 1HT 4,079 d Y0292 North E16 8 Partnership NHSPS Albert Road Surgery 76 Albert Road Woolwich 2DY 7,771 Freehold Y0292 Canning E16 Leasehol 8 GP Branch NHSPS Britannia Village 12a Wesley Avenue Town 1RZ 7,771 d Y0427 Olympic E20 Leasehol 3 Partnership NHSPS Sir Ludwig Guttman 40 Liberty Bridge Road Park 1AS 7,891 d F8408 E7 OEP 6 Partnership NHSPS Lord Lister Health Centre 121 Woodgrange Road Forest Gate 6,666 Freehold

Propert Postco Raw y de of List Practi Owner the Size ce Type of /Landlo propert Oct Owners Code Business rd Property Name/Provider Address of Property Ward y 2015 hip type F8463 Single E7 OEP 1 Handed NHSPS Lord Lister Health Centre 121 Woodgrange Road Forest Gate 3,641 Freehold F8470 Single E7 OEP 6 Handed NHSPS Lord Lister Health Centre 121 Woodgrange Road Forest Gate 3,175 Freehold F8474 Single E7 8QR 1 Handed NHSPS East Ham Memorial Hospital Shrewsbury Road Forest Gate 1,987 Freehold F8474 Single E7 8QR 2 Handed NHSPS East Ham Memorial Hospital Shrewsbury Road Forest Gate 2,309 Freehold F8405 E6 3BD 0 Partnership CHP The Boleyn Medical Centre 152 Barking Road East Ham 9,259 LIFT F8473 E6 3BD 5 Partnership CHP The Boleyn Medical Centre 152 Barking Road East Ham 9,089 LIFT F8474 E12 9 GP Branch CHP The Centre Manor Park 30 Church Road Manor Park 6AQ 11,438 LIFT F8412 E12 1 Partnership CHP The Centre Manor Park 30 Church Road Manor Park 6AQ 11,814 LIFT F8407 E15 7 Partnership CHP Vicarage Lane Health Centre 10 Vicarage Lane Stratford 4ES 7,790 LIFT F8470 E15 0 Partnership CHP Vicarage Lane Health Centre 10 Vicarage Lane Stratford 4ES 926 LIFT F8473 E15 0 Partnership CHP Vicarage Lane Health Centre 10 Vicarage Lane Stratford 4ES 5,788 LIFT Y0282 E15 3 Partnership CHP Vicarage Lane Health Centre 10 Vicarage Lane Stratford 4ES 3,945 LIFT F8403 3PD/Priv Not Barking Road Medical Centre 34 Barking Road East Ham E6 3BP 2 GP Branch ate 3,186 Known F8474 3PD/Priv E15 Not Vicarage Lane Health Centre 10 Vicarage Lane Stratford 0 GP Branch ate 4ES 4,718 Known F8400 Partnership 3PD/Priv Market Street Health Group 52 Market Street East Ham E6 2RA Not

Propert Postco Raw y de of List Practi Owner the Size ce Type of /Landlo propert Oct Owners Code Business rd Property Name/Provider Address of Property Ward y 2015 hip type 4 ate 11,979 Known F8401 3PD/Priv Not E6 3BA 0 Partnership ate St Bartholomews Surgery 292A Barking Road East Ham 9,816 Known F8404 3PD/Priv Canning E16 Not 7 Partnership ate Custom House Surgery 16 Freemasons Road Town 3NA 11,422 Known F8405 3PD/Priv E13 Not 3 Partnership ate Greengate Medical Centre 497 Barking Road Plaistow 8PS 7,596 Known F8407 3PD/Priv Not E6 2DU 0 Partnership ate Lathom Road Medical Centre 2A Lathom Road East Ham 4,622 Known F8407 3PD/Priv E12 Leasehol 4 Partnership ate The Graham Practice 19 Wordsworth Avenue Manor Park 6SU 10,293 d F8409 3PD/Priv E12 Not 1 Partnership ate Gladstone Avenue Surgery 57 Gladstone Avenue Manor Park 6NR 4,510 Known F8409 3PD/Priv Not E7 8AB 7 Partnership ate Claremont Clinic 459-463 Romford Road Forest Gate 8,589 Known F8411 3PD/Priv Leasehol E15 3LT 1 Partnership ate Abbey Road Medical Practice 28A Abbey Road Stratford 7,589 d F8467 3PD/Priv Leytonstone Road Medical Not E15 1LH 2 Partnership ate Centre 157 Leytonstone Road Stratford 3,667 Known F8474 3PD/Priv E12 Not 0 Partnership ate The Centre Manor Park 30 Church Road Manor Park 6AQ 4,718 Known F8408 Single 3PD/Priv Not E12 5AJ 9 Handed ate Manor Park Medical Centre 688 Romford Road Manor Park 1,337 Known F8412 Single 3PD/Priv E13 Not 4 Handed ate The Project Surgery 10 Lettsom Walk Plaistow OLN 4,452 Known F8467 Single 3PD/Priv Not E13 8LJ 3 Handed ate Esk Road Medical Centre 12 Esk Road Plaistow 2,075 Known F8472 Single 3PD/Priv Not E12 5JG 9 Handed ate Romford Road Surgery 778 Romford Road Manor Park 4,044 Known

Propert Postco Raw y de of List Practi Owner the Size ce Type of /Landlo propert Oct Owners Code Business rd Property Name/Provider Address of Property Ward y 2015 hip type F8473 Single 3PD/Priv Not E12 6SJ 9 Handed ate E12 Medical Centre 243 High Street North Manor Park 4,533 Known F8464 GP Birchdale Road Medical E7 8AR 1 Not Known Owned Centre 2 Birchdale Road Forest Gate 3,355 Freehold F8467 GP E13 7 Not Known Owned East End Medical Centre 61 Plashet Road Plaistow 0QA 5,112 Freehold F8400 GP E15 4BZ 9 Partnership Owned Stratford Village Surgery 50C Romford Road Stratford 8,727 Freehold F8401 GP E7 9PB 4 Partnership Owned Upton Lane Medical Centre 75/77 Upton Lane Forest Gate 7,358 Freehold F8401 GP Canning E16 7 Partnership Owned Star Lane Medical Centre 121 Star Lane Town 4QH 14,035 Freehold F8405 GP E13 2 Partnership Owned Essex Lodge 94 Greengate Street Plaistow OAS 8,487 Freehold F8408 GP E13 8 Partnership Owned Plashet Road Medical Centre 152 Plashet Road Plaistow 0QT 3,559 Freehold F8409 GP E13 2 Partnership Owned Glen Road Medical Centre 1-9 Glen Road Plaistow 8RU 6,226 Freehold F8409 GP E6 5JS 3 Partnership Owned Tollgate Medical Centre 220 Tollgate Road East Ham 16,478 Freehold F8464 GP E13 2 Partnership Owned Sinha Medical Centre 1A Lucas Avenue Plaistow 0QP 5,621 Freehold F8466 GP E7 8LZ 0 Partnership Owned Jephson Road Surgery 2 Jephson Road Forest Gate 2,049 Freehold F8471 GP E6 2DS 3 Partnership Owned East Ham Medical Centre 1 Clements Road East Ham 2,329 Freehold F8472 GP E7 OQH 4 Partnership Owned Woodgrange Medical Practice 40 Woodgrange Road Forest Gate 12,086 Freehold F8402 Single GP Stratford Health Centre 121-123 The Grove Stratford E15 Freehold

Propert Postco Raw y de of List Practi Owner the Size ce Type of /Landlo propert Oct Owners Code Business rd Property Name/Provider Address of Property Ward y 2015 hip type 2 Handed Owned 1EN 6,295 F8403 Single GP E6 3RW 2 Handed Owned Inayatullah I 154 High Street South East Ham 3,186 Freehold F8465 Single GP E13 8LS 7 Handed Owned Cumberland Medical Centre 179 Cumberland Road Plaistow 2,828 Freehold F8466 Single GP E15 3DJ 1 Handed Owned West Ham Medical Practice 401 Corporation Street Stratford 2,193 Freehold F8466 Single GP E13 9 Handed Owned Newham Medical Centre 576 Green Street Stratford 9DA 5,694 Freehold F8467 Single GP Katherine Road Medical E7 8DR 1 Handed Owned Centre 511 Katherine Road Forest Gate 1,286 Freehold F8467 Single GP E13 9 Handed Owned Upper Road Medical Centre 50 Upper Road Plaistow ODH 3,377 Freehold F8469 Single GP E15 9 Handed Owned Stratford Medical Centre 60 Leytonstone Road Stratford 1SQ Freehold F8470 Single GP E16 3JL 8 Handed Owned The Surgery 343 Prince Regent Lane Plaistow 4,915 Freehold F8472 Single GP E13 0LY 7 Handed Owned Stopford Road Surgery 17 Stopford Road Plaistow 1,953 Freehold F8473 Single GP E7 9QJ 4 Handed Owned Boleyn Road Practice 162 Boleyn Road Forest Gate 7,613 Freehold

Section 3 Appendix 3 - Utilisation reviews

Vicarage Lane Health Centre

Multi-occupant facility

Combined current list size of the 3 GP practices within the facility is 17,860

Managed by CHP and is also occupied by ELFT (46%) and Barts (2.86%)

Utilisation results:

• 29 Clinical Rooms – Average usage of 63% • 23 Meeting / Interview rooms - Average usage of 28%, (five of the interview rooms were classed as vacant having a 0% utilisation rate during the week) • 24 Office spaces – 40% or less

East Ham Care Centre

Modern facility occupied by ELFT with in-patient mental health and community care facility with a Day Hospital

Wards cover dementia, end of life care and rehabilitation

Managed by CHP

Utilisation results: • Overall 64% bed usage on the inpatient wards (83 beds in total) • Clinical room usage of over 40% for 11 clinic rooms outside of the wards • Lack of clinical space for particular specialties reported by staff • 6 meeting/group rooms of which only one reached 50% occupancy • 22 office spaces in total including hot-desking areas. This was less than 50% utilised due to staff work patterns

Centre Manor Park

Medium size multi-function primary care facility and office accommodation

Occupants include ELFT, E12 Health, Lantern Health, Just 1 and In Health

Managed by CHP

Utilisation results: • Average of 70% occupation for all clinical rooms • Low weekly usage of office space – only 3 areas reach 50% occupancy • Bookable clinic room usage varies from 20% to 100% on particular days • Several waiting areas under-utilised • Services could be delivered more effectively by using vacant space within the centre

Section 3 Appendix 4 backlog maintenance

Backlog maintenance

The chart below (Appendix 3 Fig 1) details Risk Adjusted Backlog (RAB) maintenance values where known within the borough. RAB varies across the area, but there are some sites with significant values e.g. West Ham Lane Health Centre and East Ham Memorial Hospital.

Appendix 3 Fig 1 Risk Adjusted Backlog vs GIA across Newham

The chart below Appendix 3 Fig 2 details Risk Adjusted Backlog maintenance values against GIA of the site where this information is known. The sites plotted are located across the whole Newham borough.

There is no trend between Risk Adjusted Backlog and owner of the area. Specific sites have been highlighted which either have small area and high RAB or large area and low RAB; both categories are likely to be of strategic importance. The identified sites are:

• West Ham Lane Health Centre • Lord Lister Health Centre • East Ham Memorial Hospital • Sir Ludwig Guttmann Health Centre • Shrewsbury Road Health Centre • Balaam Park Health Centre • Royal Docks Practice • Ruston Street Clinic

• Beaumont House • Wellington Way Health Centre • Wapping Health Centre

Appendix 3 Fig 2 Risk Adjusted Backlog maintenance values against GIA

Section 4 Appendix 1 Outpatient transfers

Sum of Sum of % 2020 % 2025 2020 2025 Activity Activity Activity Activity Accident & Emergency -UCC 6156 6258 0 0 Obstetrics 5771 5860 0 0 Trauma & Orthopaedics 1316 1464 0 0 Gynaecology 1257 1336 0 0 Ophthalmology 861 975 0 0 Clinical Haematology 850 972 0 0 Physiotherapy 750 830 0 0 General Surgery 706 792 0 0 Respiratory Medicine 566 621 0 0 Urology 457 520 0 0 Ent 456 502 0 0 Paediatrics 463 491 0 0 Dermatology 416 458 0 0 Cardiology 378 429 0 0 Gastroenterology 359 400 0 0 Nephrology 296 328 0 0 Breast Surgery 280 308 0 0 Oral Surgery 268 295 0 0 Orthodontics 230 253 0 0 Diabetic Medicine 220 247 0 0 Midwife Episode 174 188 0 0 Restorative Dentistry 169 187 0 0 Podiatry 167 187 0 0 Dietetics 164 177 0 0 Plastic Surgery 153 166 0 0 Rheumatology 147 162 0 0 Neurology 125 139 0 0 Occupational Therapy 116 128 0 0 Geriatric Medicine 107 123 0 0 Endocrinology 108 120 0 0 Paediatric Dentistry 106 115 0 0 Other 716 800 0 0

SPECIALTY SPLIT 10 YEARS 7000

6000 6258 5860 5000

4000

3000

2000

1000 1464 1336 125%1 24% 5% 5%9754%9723%8303%7923%6212%5202%5022%4912%4582%4292%4001%3281%3081%2951%2531%2471%1881%1871%1871%1771%1661%1621%1391%1280%1230%1200%11 0

Section 5 Appendix 1: Applications from practices for improvements, relocations and other developments

Locality Practice Code Practice Brief outline

New purpose built health F84010 ST. BARTHOLOMEWS SURGERY centre C 1 or an extension?

F84053 GREENGATE MEDICAL CENTRE Additional clinical space C 1 Relocation of practice to F84052 ESSEX LODGE Greengate Street, will support F84681 BALAAM STREET closure and merger of two C 2 practices premises Expansion of clinical space not F84734 BOLEYN ROAD PRACTICE supported as could move into C 2 the LIFT

Relocation of practice F84670 WESTBURY ROAD MEDICAL PRACTICE development of practice taking place NE 1 Relocation of practice to F84658 SANGHAM PRACTICE Romford Road, will support F84091 57 GLADSTONE ROAD closure and merger of three F84671 KATHERINE ROAD NE 1 practices

F84006 THE SHREWSBURY CENTRE Additional consulting rooms NE 2

F84009 STRATFORD VILLAGE SURGERY Additional consulting rooms NW 1 Additional consulting room. F84022 STRATFORD HEALTH CENTRE NW 1

Y04273 LIBERTY BRIDGE - SIR LUDWIG GUTTMAN Expansion of clinical space for NW 1 practice as list increases

F84014 UPTON LANE MEDICAL CENTRE Additional consulting rooms NW 2 Additional clinical space as F84086 DR N DRIVER & PARTNERS part of Lord Lister- requires a NW 2 lease agreement NW2 F84097 CLAREMONT CLINIC Additional consulting rooms.

F84017 STAR LANE MEDICAL CENTRE Additional consulting rooms S 1 S 2 F84093 TOLLGATE MEDICAL CENTRE Additional clinical space S 2 F84708 DR T LWIN Additional consulting rooms NE2 F84121 LEYTONSTONE/ E12 HEALTH CENTRE Relocation of practice

Potential CCG led developments

New premises co-located with C 2 RAINBOW CENTRE community facilities New premises co-located with C1 WEST HAM FOOTBALL CLUB community facilities New premises /enabling move from F85666 S 1 CANNING TOWN St Luke’s potentially co-located with F84749 community facilities New premises as part of regeneration S 1 F84047 CUSTOM HOUSE /growth New premises as part of regeneration S 2 SILVER TOWN QUAYS /growth

S 2 ALBERT ROAD/BRITTANNIA VILLAGE New developments/ premises as part of regeneration /growth

NW 1 Y04273 LIBERTY BRIDGE - SIR LUDWIG GUTTMAN Expansion of clinical space available for practice as list increases

Section 5 Appendix 2 Transforming Services Together (TST) analysis of additional space • # # Estimated Consulting Treatment GIA Royal Docks Total Appointments Rooms Rooms required Required Required (m2) Total increase in outpatient appointments (TST 976 0 0 0 Shift) - 5 years Total increase in GP appointments based on 23,671 3 1 331 population growth - 5 years Total increase in outpatient appointments (TST 1,239 0 0 0 Shift) - 10 years Total increase in GP appointments based on 46,576 6 2 662 population growth - 10 years

# # Estimated Consulting Treatment GIA Stratford and New Town Total Appointments Rooms Rooms required Required Required (m2) Total increase in outpatient appointments (TST 1,565 0 0 0 Shift) - 5 years Total increase in GP appointments based on 42,342 6 2 414 population growth - 5 years Total increase in outpatient appointments (TST 2,205 0 0 0 Shift) - 10 years Total increase in GP appointments based on 94,414 13 3 841 population growth - 10 years

# # Estimated Consulting Treatment GIA Canning Town South Total Appointments Rooms Rooms required Required Required (m2) Total increase in outpatient appointments (TST 1,377 0 0 0 Shift) - 5 years Total increase in GP appointments based on 20,980 3 1 207 population growth - 5 years Total increase in outpatient appointments (TST 1,476 0 0 0 Shift) - 10 years Total increase in GP appointments based on 32,883 5 1 317 population growth - 10 years

# # Estimated Consulting Treatment GIA Total Appointments Beckton Rooms Rooms required Required Required (m2) Total increase in outpatient appointments (TST 1,384 0 0 0 Shift) - 5 years Total increase in GP appointments based on 27,749 4 1 262 population growth - 5 years Total increase in outpatient appointments (TST 1,451 0 0 0 Shift) - 10 years

Total increase in GP appointments based on 39,591 5 1 317 population growth - 10 years

# # Estimated Consulting Treatment GIA Custom House Total Appointments Rooms Rooms required Required Required (m2) Total increase in outpatient appointments (TST 1,086 Shift) - 5 years 0 0 0 Total increase in GP appointments based on 6,958 population growth - 5 years 1 0 55 Total increase in outpatient appointments (TST 1,311 Shift) - 10 years 0 0 0 Total increase in GP appointments based on 25,418 population growth - 10 years 4 1 262

Section 7 Appendix 1 DRAFT Newham Clinical Commissioning group - Strategic estates decision framework

The prioritisation grid helps quantify the impact the estates opportunity will have for Newham residents and whether to support the investment. It should be scored and where appropriate, weighted DRAFT ESTATES STRATEGIC OUTCOME MATRIX

The purpose of the strategic outcome matrix is to quantify the impact an estates opportunity could have on Newham residents. A shared outcome matrix provides a means of aligning consideration of estates opportunities across dispersed decision makers. The matrix should be used when considering investment in property, relocation of service or other estates related decisions. The output of the matrix should then be incorporated into existing governance arrangements for formal consideration and approval.

Impact Ranking: Consider the impact based on the size of the impacted population Low (1) Moderate (2) High (3) Brief justification for score Score Quality Negligible Moderate Major impact or vital (urgent space requirement, new 3 contribution to improvements in part of patient safety premises would improve patient improving patient patient safety or or clinical care in respect of safety, improved

safety or clinical clinical effectiveness effectiveness control of infection, CQC effectiveness compliance and improved environment for workforce )

Health and Care Care Health and Outcomes 60%

Individual Negligible impact in Moderate impact in Major impact in 3 health and health or life health or life health or life well-being expectancy expectancy expectancy

Health Negligible Some (smaller) Substantially (consider additional areas of care 3 inequalities improvement in impact on narrows inequality to improve greatest health reducing inequalities inequalities between within the patch and inequalities, which may vary with within the patch and groups in the patch between Islington demographics) between the patch or with the rest of the and the rest of the and the rest of the country. country country

Access to Negligible Moderate Major improvement (including improving 7 day access, 3 care improvement in improvement in in access to service additional clinicians available, access to service for access to services for local people access to out of hospital services local people for local people and increased transportation links)

Co-location Negligible Opportunity to Opportunity to (consider integration priorities 3 opportunity to collocate a moderate collocate a across health and social care, collocate health, number health, social substantial number mental health and physical health, social care or wider care or wider public of health, social care adults and children, voluntary public services services or wider public sector) services

Training and Negligible impact on Moderate impact on Major impact on (consider alignment with workforce 3 workforce training capacity training capacity training capacity strategy)

IT Negligible impact Moderate impact Substantial impact (scanning of records to reduce 3 accelerating digital accelerating digital accelerating digital static storage, IT systems for and technological and technological and technological shared records, opportunity of developments and/or developments and/or developments and/or offering skype and doctor first sharing patient sharing patient sharing patient consultations) information across information across information across pathway pathway pathway

Cost Negligible reduction Moderate Major improvement (repurposing of existing building 3 effectiveness in running and/or improvement (1-5%) (5%+) in the running avoids investment in new holding costs; in the running and/or and/or holding costs; premises, increasing utilisation of including commercial holding costs; including commercial existing suitable premises, income including commercial income decreasing environmental impact income of building, impact of capital source on ongoing revenue, cost of fit out) Capital Negligible Moderate opportunity Substantial (cash flow from sale either from 3 flexibility opportunity to to generate capital opportunity to sale or reduction of lease generate capital receipts for generate capital expenses) receipts for reinvestment/revenue receipts for reinvestment/revenue or to share risks reinvestment/revenue or to share risks or to share risks

Financial Sustainability 40%

Sustainability Financial viability of Financial viability of Financial viability of (practice size, financial position, 3 the service is high the service is a the service is a low external support required) risk moderate risk risk