Report to the Primary Care Commissioning Committee: Meeting In Public – 14 June 2017 Relocation of Branch Surgery to Title Health Centre Part A or B A Helen Clark, Director of Primary Care, West Sponsoring Director CCGs Terri Brunne, Interim Primary Care Commissioning Author(s) Manager, Berkshire West CCGs To seek approval for a premises move of Swallowfield’s Purpose branch surgery to purpose-built premises at Shinfield Health Centre Previously considered by None Financial impact of £50,000 approximately to be Risk and Assurance confirmed via District Valuer and not exceeded significantly Legal implications/regulatory N / A requirements Public Sector Equality Duty N / A

Links to the NHS Constitution All NHS organisations are required by law N / A to take account of the NHS Constitution in performing their NHS functions

 The proposal is clearly linked to the Primary Care Strategy delivery and specifically to Strategic How does the paper link to the Primary Objective 1: Addressing current pressures and Care Strategy? creating a sustainable primary care sector.

Consultation, public engagement & As set out in the paper and attached from the practice partnership working implications/impact

Potential conflicts of interest Swallowfield partners, neighbouring practices

Approve the proposed branch surgery re-location, The Committee are asked to subject to final agreement of financial implications.

Which CCG does this paper relate to? NHS CCG

All Wokingham CCG members excluding those with an Members eligible to vote identified conflict of interest.

Primary Care Commissioning Committee – 14th June 2017

Executive Summary

Swallowfield practice is experiencing at-scale patient list size growth which is expected to continue over the next few years and is due to new home building. To rise to this challenge the practice proposes to move its branch surgery to larger purpose-built premises within Shinfield and to diversify its workforce offering a wider range of health services gradually extending its hours. It has surveyed patients and other stakeholders and the overall feedback was positive. An additional £50,000 approximate per year will be required in rent reimbursement, possibly slightly more should conversion costs need to be rentalised. The proposed move fits with Berkshire West CCGs GPFV local implementation plan and the Wokingham CCG primary care estates strategy which requires full utilisation of the Shinfield Health Centre to meet the needs of the South of M4 Strategic Development Location (SDL).

Recommendation

The Committee is asked to:

 Approve relocation of Swallowfield branch surgery to larger space in Shinfield purpose-built health centre  Approve in principle and eventual increased rent reimbursement of an additional approximately £50,000 per annum subject to confirmation and provided that it does not significantly exceed this amount  Agree variation of the practice’s contract to reflect these changes

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Primary Care Commissioning Committee – 14th June 2017

1. Background

Swallowfield practice in NHS Wokingham CCG has a practice list size of 11,755 as at April 2017 expected to grow to 19,000-20,000 over the next four years. The rapid and at-scale list size growth that the practice is experiencing is as a result of new house building inside the practice’s boundary, estimated at up to 16,000 new residents by 2026.

The impact on Swallowfield is twofold:

1. Workforce – at-scale list size growth requires Swallowfield therefore to provide more sessions. 2. Premises – to accommodate a greater volume of GP and wider primary care team sessions, additional consulting rooms are required and larger waiting area for patients

In addition to the practice’s main site which is being extended to meet population growth from the SDL, the practice operates from two branch surgeries at:

 The Surgery, Millworth Lane, Shinfield RG2 9EN. This is a converted bungalow surgery.  The Village Hall, Eversley Road, Arborfield RG2 9PQ. The practice uses space within the Village Hall.

2. Proposal In light of the challenge of population growth, Swallowfield has been exploring potential new premises in the purpose-built Shinfield Health Centre located at School Green, Shinfield, Reading, RG2 9EH. These premises are due to be vacated by Berkshire Healthcare Foundation Trust although it is proposed that one room is retained under a sub-lease from the practice. Over time the practice proposes to broaden its clinical offering to patients to include ultrasound, physiotherapy, podiatry, and counselling and to gradually lengthen its opening hours and occupy the full space as patient demand grows. The proposal would move towards the full utilisation of Shinfield Health Centre envisaged in Wokingham CCG’s primary care estates strategy.

The practice has surveyed members of its Patient Reference Group via both an online and paper survey, a sampling that represents nearly 7% of its patient population and of these nearly 30% responded. The majority of comments were favourable and expressed understanding of the need for more space and how that would be beneficial for patients. As always, sufficient access to parking was an expressed consideration. A few patients that live in particularly close proximity to the existing branch location were understandably disappointed although the two sites are only 0.2 miles apart.

Stakeholders were also consulted including HealthWatch, Shinfield Practice which is also located in the proposed new site, patients in Millworth Lane, the pharmacists in Shinfield and , Shinfield View Care Home, and the Shinfield Parish Council. Only HealthWatch replied posing questions to which the practice manager replied. The practice’s full report of their survey is attached for information (Annex A).

Given the larger space to be occupied as compared to the practice’s current premises, an increase in required rent reimbursement of approximately £50,000 per annum is anticipated. Negotiations around the lease are still ongoing and, until these are finalised, an exact figure cannot be quoted here. If the committee approves this paper, the District Valuer will be engaged and firm figures obtained. Swallowfield

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Primary Care Commissioning Committee – 14th June 2017

Practice are seeking capital support for the conversion and equipment of the space in question, should this not be forthcoming they may look to rentalise this expenditure resulting in a slightly higher revenue impact. There is also a discussion to be concluded with regard to the possibility of NHS Property Services taking a headlease for the space in question but this will be resolved outside of the Committee.

3. Decision-making criteria

The NHS Policy Book, under the terms of which Berkshire West CCGs accepted delegated commissioning in April 2016, does not set out a policy against which a decision can be made. Therefore there is a requirement for the committee to take a view. Premises moves locally are likely to be few in number but it is important to achieve consistency with objectives already in local strategies and to ensure they are affordable, and reflect the views and wishes of the patient population. The committee is asked to note the strategic fit of Swallowfield’s proposal with the criteria set out in the Berkshire West GP Forward View Local Implementation Plan and Wokingham CCG’s primary care estates strategy as follows:

 Improve primary care sustainability – workforce development, effective use of IT, premises use and collaborative working  Provide capacity for population growth and fully utilise Shinfield Health Centre to meet the population growth associated with the South of M4 SDL – premises, IT and workforce development  Support workforce development – access to training hubs and training facilities, development of new roles working in primary care e.g. physician assistants, use of pharmacists  Best interests of patients – access and quality of service

With regard to the process to be followed, again this is not defined in the NHSE Policy Book and it is not proposed to set a local standard operating procedures as such requests are anticipated to be few in number. On this occasion the practice has been asked to follow the processes used for other similar contractual variations including consulting with patients and neighbouring practices. The output of this work is attached at Annex A. The introductory section of Annex A also provides general information about the practice’s rationale for the proposal.

4. Recommendation

In conclusion the Committee is asked to:

 Approve in principle the relocation of Swallowfield branch surgery to larger space in Shinfield purpose- built health centre  Approve in principle increased rent reimbursement of an additional approximately £50,000 per annum subject to confirmation and provided that it does not significantly exceed this amount  Agree the variation of the practice’s contract to reflect these changes.

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Primary Care Commissioning Committee – 14th June 2017

Annex A – Practice submission

Patient Consultation and Analysis of the Shinfield Relocation Patient Survey May 2017

Background

Swallowfield Medical Practice provides General Medical Services to an area which has a significantly growing population. The extent of this growth is detailed in the report commissioned by Wokingham CCG ‘Meeting the Health Needs of Wokingham Borough Council’s Major Growth Areas’ by Andrew Grimes (‘The Grimes Report’).

The Grimes Report highlights that the two SDLs which impact on our Practice Area (South of M4 and ) will have a predicted new population of approximately 16,000 over the next 10 years. It is inevitable that some of these people will wish to register with Swallowfield (patient choice). We have reached a point where we will struggle to have a room available for any additional clinicians to work from, so expansion is a necessity for us – otherwise we will probably have to apply to close our list within the next couple of years.

There is also a significant amount of non-SDL infill, both planned for the future and some which has already happened. This has caused (and continues to cause) gradual (organic) growth in our list size, which further contributes to pressure on resources. Forecasts for additional population growth in the area indicate that Swallowfield Medical Practice should expect an increase of at least 8000 by 2021 – 5000 more than our current premises, even with the extension already planned for the Swallowfield site, can manage.

The projected growth in the areas South of M4 and Arborfield Garrison are accessible to Shinfield with a direct bus route between Arborfiled and Shinfield. This, with a potential for a new town in the area would further increase the demand for health services within our boundary, and, on a much larger scale – having a greater presence in Shinfield with potential ability for further growth within the health centre and the potential to become the provider of primary care services in any new premises in or around Grazeley would provide greater certainty to both Swallowfield Medical Practice and both the Wokingham and Berkshire West CCGs whereby services are provided by a fully affiliated member of the current Wokingham CCG and Wokingham Alliance with commitment to its vision, values and priorities along with the emerging ACS, serving the residents of Wokingham and providing a consistent and agreed level of service across the Wokingham population.

Our current branch surgery at Shinfield is well utilised but with only 2 consulting rooms, the possibility of expansion of services here are very restricted. For this reason we are proposing a move to larger premises within the Shinfield Medical Centre which would allow us to increase our existing clinical capacity as well as enabling us to expand into offering other patient services such as ultrasound, physiotherapy, podiatry, counselling, etc across both our Swallowfield and Shinfield branches affording patient choice and improved access to primary care and associated services. With limited space and current pressures on finances, the ability to grow our list with adequate space and improved premises will enable the practice to better meet the needs of the community. In line with our growth and financial stability, we would look to increase the hours of operation at the Shinfield branch closer to the main branch at Swallowfield. 5

Primary Care Commissioning Committee – 14th June 2017

We are in the final stages of our application to become a training practice for GP Registrars which we believe will assist us in the recruitment and retention of good GPs in the future to further improve the practices reputation and make us sustainable in the longer-term. We have a loyal and stable work force with the desire and passion to work within the changing healthcare economy to improve outcomes for patients. Enabling the practice to move to larger purpose built premises will be beneficial to all and enable a wider set of healthcare professional to work more closely within an expanding and diverse community.

We understand that there are some facilities already in place e.g. sinks in some rooms, however, we were not able to view all areas during a visit (see below) and further understand that other facilities were removed as the area has been used for non-clinical work over the last 2-3 years. We would hope that there would be some assistance with preparing the area we propose to utilise either by the landlords (Assura) and/or by NHSPS should the lease be taken by them and sub-let to the practice.

Discussions/Consultations so Far

Following discussions with BW CCG via the Co-Commissioning Manager, Shirley Edwards (SE) during January 2017, a site visit took place and following this, further consultation with BW CCG (SE) led to the start of a period of consultation with stakeholders as well as a more formal meeting with SE on 4 April. Following the meeting, we consulted with our patients and stakeholders to ascertain their thoughts/views on our proposal. Prior to initiating this consultation a draft survey was sent to SE for comment and then to all members of the Patient Participation Group for their input and approval. All 10 members were supportive and believed that this proposal was an excellent idea and will afford Swallowfield Medical Practice the room to expand and accommodate the burgeoning numbers of patients due to the immense number of houses being built in the locality.

Wokingham practices were consulted on 20 April and individual letters were sent to stakeholders who may have had a particular interest/concern – 28 patients in Millworth Lane, the Senior Partner of Shinfield Health Centre, the pharmacists in Shinfield and Spencers Wood, Shinfield View Care Home, Healthwatch and the Shinfield Parish Council on 25th April. We received one communication on 23 May from Healthwatch – copy of this is at the end of this document.

Other than the enquiry from Healthwatch, there have been no direct communications from other stakeholders (other than patients – see below). No objections/negative comments, verbal or written, have been received from any of the other stakeholders consulted.

On 5th May emails were sent to 776 Patient Reference Group members asking them to complete a survey via Survey Monkey regarding the proposed relocation of our Shinfield Branch Surgery from the current Millworth Lane to premises contained within the Shinfield Health Centre. In addition, hard copies were available for completion in each of the Surgeries (Swallowfield, Shinfield and Arborfield). Patients accessing our website between 25th April and 13th May were also invited to participate in this patient consultation via a link to Survey Money on the front page.

Below is the analysis of the survey.

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Primary Care Commissioning Committee – 14th June 2017

Survey Results

A total of 227 responses were received by the closing date of 13th May. A summary of the results is displayed graphically below:

Q1. How often to you visit the Shinfield Branch Surgery?

How often patients visit Shinfield Branch Surgery 90.00% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Never 1 - 3 yr 1 - 2 m 1 wk more oft

Only 1.5% of respondents visited the branch surgery once a week or more; over 78% attended only once or twice per year.

Q2. Do you currently have any difficulty getting to the Shinfield Branch Surgery?

Do you have difficulty getting to the Shinfield Branch Surgery? 100.00%

50.00%

0.00% diff to get to Shinf yes no don’t know

3.6% of patients indicated they had some difficulty in accessing the surgery but over 92% experienced no difficulty at all.

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Primary Care Commissioning Committee – 14th June 2017

Q3. How do you currently get to the Shinfield Branch Surgery?

How do you get to the Shinfield Branch Surgery? 100.00% 80.00% 60.00% 40.00% 20.00% 0.00% ? Travel walk cycle car vol car serv other

100% of patients either drove or were able to walk to the surgery.

Q4. Which service do you usually use at the Shinfield Branch Surgery?

Which service to you usually use? 60.00%

40.00%

20.00%

0.00% Service used GP Nurse both

Over 55% of patients access both GP and nurse services at Shinfield and 35.5% only visited their GP.

Q5. Do you think the proposed relocation would be beneficial to the community?

Do you think the relocation would be beneficial to the community? 60.00% 40.00% 20.00% 0.00% Beneficial? very fairly not don’t know

The overwhelming majority (79.5%) believed a move to new premises would be a beneficial. 16.8% of patients failed to answer this question and only 3.5% (7 patients) thought the move was not a good idea, For the latter, the general response appeared to be linked to the individuals current location in proximity to the current branch surgery rather than not seeing a benefit for wider access to services.

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Primary Care Commissioning Committee – 14th June 2017

Q6. What is your age?

Age of respondents 40.00% 35.00% 30.00% 25.00% 20.00% 15.00% 10.00% 5.00% 0.00% Age <16 16-45 46-65 66-85 >85

This is comparable with the practice population across the 16+ age ranges

Q7. What is your gender?

Gender of respondents 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Gender Female Male Not say

This is slightly skewed toward female respondents which would generally be expected as females tend to respond in greater numbers to surveys.

Q8. What is your ethnicity?

Ethnicity of respondents 100.00% 80.00% 60.00% 40.00% 20.00% 0.00%

Precise data is not readily available, however, from local knowledge, this reflects the current practice population.

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Primary Care Commissioning Committee – 14th June 2017

Comments

Patients were able to add their own comments on the proposed move. 40 comments were received - these can be seen below.

The overwhelming majority were positive with parking issues being a common theme. Parking at Millworth Lane is very limited and more spaces should be available if we relocate to the new premises.

Positive Feedback:

Excellent practice

Great news!

Brilliant idea

Seems logical to me to relocate

We are fortunate to have the choice of branches to be seen by a GP or PN. Larger premises can only be beneficial in my opinion

With the thousands of new homes being built we are in dire need of more medical facilities

Really think the staff who work here should decide. As a patient it works fine as it is. But visits are rare and quick. Excellent service

Positive move and will aid all the new patients and developments in the vicinity

Would be a very good and beneficial move considering the increase in the local population

Pharmacy related comments

Also make it closer to pharmacy

The parking is better. On site pharmacy

Would be better to have parking & facilities of the pharmacy there

Parking related comments

The only concern I have is parking as a disabled person. I find it difficult parking for the dentist at your new location - especially at school times

Car parking is a priority - the parking lot is now overcrowded

We use Shinfield chemist so to have the surgery in the same building, plus better car parking facility is a great result

Would parking be better there? As friends say parking very difficult at present location 10

Primary Care Commissioning Committee – 14th June 2017

It would be better to move to another site as the parking at the current Shinfield surgery is poor

No parking at current branch

Better parking situation & free up space at over crowded Swallowfield Surgery

Main benefit would be parking facilities

Concerns re parking - designated parking would be necessary

Parking would be easier

Disabled parking - not enough at Swallowfield so learn from this. Thank you

Better parking options

Not found any problems with current location except for parking

Don’t mind either way but the medical centre might be easier for parking

There will be parking problems. The so called public car park is always full on working days. Is there additional parking at the health centre?

More parking spaces please

Car parking please

It will help on car parking and easy access to pharmacy

Would make parking easier

Parking is a problem - more than it is at Millworth Lane. And the free parking is full now the new residential home is there

The only concern could be the availability of parking space

Practice Comment

Parking at the proposed new site and public car park nearby is currently filled with staff employed by Talking Therapies who are often office based – once they vacate the building parking should be a lot easier – this may be an issue to address with other building users and allocate parking may be necessary to help manage this.

Premises related comments

The Shinfield Medical Centre is designed to take 8 GPs but only has 1 in situ. Will you be taking on more patients from the locality (given the 3500 new houses planned/under construction/built??)

The current building is not fit for purpose. Very small and can hear all the conversations going on so not confidential

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Primary Care Commissioning Committee – 14th June 2017

Negative

This branch is very useful to me (would have difficulty walking to new premises)

Miscellaneous

Staffing levels -more appointments?

More toys for children

I would like to see more use of Arborfield Surgery

Set of baby scales for mums to use to weigh baby would be helpful. Hard to get to clinics when you have other children

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Primary Care Commissioning Committee – 14th June 2017

Healthwatch email:

Dear Nicola

Thank you for your email below. In case you recognise my name, I communicated with you as the Practice Business Manager for Woodley Centre Surgery in October last year when we applied to reduce our opening hours at our branch. I have recently joined Swallowfield as their new Practice Manager and will be managing the application and, hopefully, the move. Very fortunately, Fran is still with us and is now the Finance Manager for the practice. I am also continuing in my role at Woodley two days a week for another 4-5 weeks pending the appointment of a new manager, just to confuse things…

In response to your questions:

1. how have the patients that will be effected been communicated with?

We have written directly to patients who live very close to the current site and under direction of Berkshire West CCG we offered access to a survey via survey monkey via our website, made paper surveys available in all 3 locations and sent the link to our patient reference group (776 patients). We received 227 responses of which 79.5% felt that the move would benefit the community, 16.8% didn’t respond to the question. The vast majority of comments were very positive and in favour of the proposed move citing things such as improved parking/access and better ability to serve the growing population. We see this proposed move as a huge positive for both our current and new patients who move into the area as the housing developments continue as it will enable us to offer more services across both our Swallowfield and Shinfield surgeries, thus improving access and choice to Wokingham residents.

And

2. how will they be able to distinguish between the 2 surgeries once the relocation has taken place?

We would be located on the first floor, whereas the current practice is on the ground floor and assuming the move is approved, we anticipate having a self-contained area within the 1st floor space. Signage would be used to identify who is in the building and how to access them.

I hope this answers your questions, but please do not hesitate to contact me if you have any further queries.

Kind regards

Shaun

Shaun Nicholson MBA Practice Manager Swallowfield Medical Practice The Street Swallowfield Berkshire RG7 1QY

01189 883134

My general working pattern is Mon, Wed and Friday

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