South Nottingham Ccgs Interim Strategic Estates Plan

GB 15/160

South Nottingham CCGs Interim Strategic Estates Plan

November 2015

V1.2

Contents

1. Executive Summary

2. Introduction

3. National Context

4. Local Context

5. Estate Overview

6. Local Estates Strategies

6.1 NHS Nottingham North and East CCG 6.2 NHS Nottingham West CCG 6.3 NHS Rushcliffe CCG

7. Next Steps

8. Conclusion

1. Executive Summary

NHS Nottingham North and East, NHS Nottingham West and NHS Rushcliffe CCGs have formed a Local Estates Forum (LEF) to plan and agree actions needed to produce this Strategic Estates Plan.

A Strategic Estates Advisor has been identified from Community Health Partnerships and has confirmed the support available in developing the strategy.

The intention is to work strategically on a South Nottingham unit of planning footprint with local estates strategies for each CCG as a subsection of the overall document.

Initial local estates strategies are limited in scope to primary and community care estate, and non-clinical estate such as office and administration bases, and provide an overview of the current estate, with immediate priorities and challenges identified.

The Strategic Estates Plan articulates the longer term aim to develop the LEF to include secondary and tertiary care estate and the wider public sector estate. This will create a firm basis on which future plans can be developed, covering the wider footprint of planning.

The CCGs view this as ‘core business’ in order to achieve the efficiency requirements of the Five Year Forward View and have identified the Chief Finance Officer as the lead for developing the plan with support from individual CCG leads.

2. Introduction

This is the first draft of the South Nottingham Strategic Estates Plan for NHS Nottingham North and East Clinical Commissioning Group, NHS Nottingham West Clinical Commissioning Group and NHS Rushcliffe Clinical Commissioning Group. It has been developed through the Local Estates Forum, membership of which includes the three CCGs, NHS Property Services (NHSPS) and Community Health Partnerships (CHP). This first South Nottingham Strategic Estates Plan deliberately focuses on the next one to four years. However, it is intended that the plan will continue to develop in line with emerging commissioning priorities and local need. Therefore future versions of the plan will focus on the mid-term (five to ten years) as well as including a longer-term vision.

The plan focusses on primary and community premises and non-clinical administrative accommodation within the geographical areas covered by each of the three Clinical Commissioning Groups (CCGs) and implementation of the plan aims to ensure that:

 Utilisation of the existing estate is maximised  The estate is configured to better meet future commissioning needs  Surplus estate is removed from the system  Patients’ experience of care is enhanced  Running and holding costs are reduced  Sharing of premises is maximised where this results in efficiencies  The local estate delivers value for money  There is effective future investment in the estate.

The plan reflects the joint priorities of the three CCGs in South Nottingham and the wider South Nottingham health economy. It also includes a number of CCG specific priorities identified in order to meet local service changes or changes in demand and has links to existing Information Technology, commissioning and workforce strategies.

It is intended that over time the Local Estates Forum will expand to include local provider organisations and the local authority, and that the Strategic Estates Plan will be extended to also incorporate secondary and tertiary care provider estate within the South Nottingham footprint, as well as local and central government estate.

3. National Context

The NHS is facing extremely challenging times. Demand for services is rising faster than funding. The cost of drugs and new medical technology continue to rise. The population is changing, with an increasing number of older people, often with greater health and social care needs. The traditional approach of targeted service improvements and contract variations has in the main been successful to date. However it is now necessary to find new, transformational solutions to meet this unprecedented challenge.

In October 2014 NHS England’s Five Year Forward View was published setting out a clear direction for the NHS in respect of whole system integration of services, implementation of alternative care delivery models, a greater emphasis on prevention and self-management, and improving the quality of services by using its resources more effectively. The ‘Forward View’ clearly set out the financial challenge facing the NHS and the actions required. In addition, NHS England’s ‘Everyone Counts: Planning for Patients 2014/15 – 2018/19 identifies GPs and other primary care providers being at the heart of integrated care.

As the NHS works to redesign the delivery of services in response to the Forward View high quality local estates planning is crucial and will require all parts of the NHS to work together to enable system wide transformation. It will be necessary for the estate to be reconfigured to accommodate the associated increase in services in the community and to provide opportunities for greater integration. Although the benefits for patients and the NHS as a whole may be clear, implementation of the ‘Forward View’ will inevitably place additional pressure on existing primary and community services and the estate from which they operate. The NHS estate is therefore both a key enabler, and risk, to the delivery of the objectives set out in the Forward View through its impact on quality and patient experience and its potential to deliver efficiencies.

In June 2015, the Department of Health (DH) issued guidance on the development of Strategic Estates Plans. A substantial improvement in the management of the NHS owned and occupied estate is required to respond to the challenges of the NHS Five Year Forward View.

The NHS Constitution (Department of Health 2012) includes a requirement for health services to be delivered in fit for purpose, accessible, clean, and safe environments protected from risks associated with unsuitable and unsafe premises.

4. Local Context

Nottinghamshire Health and Wellbeing Strategy

The Nottinghamshire Health and Wellbeing Board (HWB) brings together key local stakeholders including CCGs, local councils and the public with a shared aim of working together to improve health and wellbeing. The main responsibility of the Health and Wellbeing Board is to identify current and future health and wellbeing needs, and to develop a Health and Wellbeing Strategy. The most recent strategy was approved at a meeting of the Health and Wellbeing Board in March 2014. In summary the strategy has four ambitions: A good start – for everyone to have a good start in life Living well – for people to live well, making healthier choices and living healthier lives Coping well – that people cope well and that we help and support people to improve their health and wellbeing, to be independent and reduce their need for traditional health and social care services when we can Working together – to get everyone working together

South Nottinghamshire Transformation Partnership

The three CCGs have a strong history of collaboration and cooperation, with established partnership arrangements across health and the local authority coordinated and led via the South Nottinghamshire Transformation Partnership (SNTP). The partners are:

 NHS Nottingham City Clinical Commissioning Group  NHS Nottingham North and East Clinical Commissioning Group  NHS Nottingham West Clinical Commissioning Group  NHS Rushcliffe Clinical Commissioning Group  NHS England  Nottingham University Hospitals NHS Trust  Nottinghamshire Healthcare NHS Trust including County Health Partnerships  Nottingham CityCare Partnership  Circle Partnership  East Midlands Ambulance Service  Nottingham City Council

 Nottinghamshire County Council

The SNTP was formed to develop and ensure sustainable, high quality health and social care services for the future, in the context of a predicted £140m financial gap forecast across the south Nottinghamshire area (including NHS Nottingham City) by 2018/19.

The key aims of the partnership are to:

 Maintain and improve population health and wellbeing  Achieve excellent citizen experience and outcomes  Deliver value (health and social care outcomes divided by cost)  ‘Join up’ / integrate service provision  Increase responsibility and accountability for the quality and sustainability of health and social care services.

The Partnership has defined outcomes for the desired future state as:

 Care organised around individuals, not institutions  The removal of organisational barriers, enabling teams to work together  Resources shifted to prevention and proactive care with care based closer to people’s homes  Hospitals, residential and nursing homes only for people who need to be in these care settings  High quality, accessible, sustainable services based on the real needs of the population.

The twelve partners worked together to develop a high level five year strategy aimed at reshaping the local health and social care system. The strategy acknowledges and responds to the ever increasing demands being placed on health and social care services as a result of a rapidly ageing population (often with multiple complex mental and physical health needs) and in the context of pressures on limited NHS and social care resources going forward. This is coupled with rising citizen and patient expectations which will become increasingly more difficult to meet.

The strategy also recognises that if we are to continue to provide safe and effective care for our patients and citizens unprecedented changes will need to be made across all services to meet the enormous future challenges. Organisations will need to work together collaboratively to redesign systems and streamline services. Services will need to be commissioned in a way that maximises the use our collective resource, focuses on improving patient and citizen outcomes and shares risk equitably between organisations.

The strategy therefore identifies how the local health community plans to transform health services across South Nottinghamshire to deliver care within the available resources and to meet the requirements set out in the planning guidance. This will be supported by a shift of resources from secondary care to primary and community care to help ensure a sustainable NHS for future generations, all of which will inevitably have a significant impact on the estate.

The scope of the Strategic Estates Plan will therefore need to continue to develop over time in order to respond to emerging and changing care delivery models as defined and developed through the South Nottinghamshire Transformation Partnership.

5. Estates Overview

Across the South Nottingham area there are in total 45 GP practices covering a total registered patient population of approximately 360,000. GP practices and community providers operate from a mixture of old and new properties in varying conditions. Space utilisation is often perceived as an issue with many providers across the patch reporting a lack of space having an impact on their ability to effectively deliver services. A significant number of GP practices operate from premises that they own, others are located in rented accommodation, often in NHS health centres.

Geographical access to GP practices across the area is generally good. However the population across the three CCGs is set to rise by xx% over the next few years. In addition plans to increase the local housing stock will add significant pressure to existing health and local authority services with an inevitable impact on the estate.

Overview of Existing Estate and Providers

The reorganisation of the NHS has seen the ownership of the NHS Estate change over the past year. Property is now owned by either the Community Providers, NHS Property Services, Community Health Partnerships or Acute Trusts. The challenge faced by the system is to ensure that the NHS Estate responds to the needs of the local population and is used to support providers to deliver services that are accessible to patients and service users.

Estate Review Summary

The South Nottinghamshire local health economy has a total of XXX buildings. Together, these buildings have a total space of XXXsqm (NIA).

Of these XXX properties, XX% are leasehold and XX% are freehold. Additionally, of these properties, XX% and XX% are LIFT properties.

In total, the annual cost of the South Nottinghamshire health economy properties is £XXm. Provider Estate

The total floor area of the South Nottinghamshire estate is XXsqm. This is made up of:

XX% of Primary Care XX% of Acute Care

XX% of Community Estate

The total annual cost to providers for the estate is:

£XX million annually £XX for Primary Care £XX for Acute Care £XX for Community Estate

GP Estate

Office Estate

The total number of holdings in the estate is XX, the total sqm NIA is XX and this makes up a total of XX hectares of land.

Statement here about the number of buildings leased and owned.

The lease break dates on these leases are XX.

The total cost of the office estate, per annum, is £XX.

Void Space The utilisation of the estate is a very important aspect in delivering efficiencies to the local health economy. Within the South Nottinghamshire estate there is a total of XXsqm void space and it is estimated that a further XXsqm could be identified following space reconfiguration.

Within this space, XX% of space has been identified as medium or low utilisation.

The total annual cost of void space in the South Nottinghamshire health economy is £XX p/a (£XXm or XX% in L/T PFI/LIFT estate)

In order to improve primary care and access for patients, CCGs have developed a set of core principles based upon which the CCGs will prioritise decisions on developments or disinvestment.

CCGs will prioritise schemes which:

 Address or remove problems associated with buildings in poor condition.  Address the impact of residential developments in the area  Make full use of premises and ensure that any void primary care estate is fully utilised.  Support GP practices to work more efficiently, including mergers, and which will allow for consolidation of or disposal of existing surplus or sub-standard estate.  Support developments that provide sustainability of service provision  Establish integrated care networks of practices to collaborate with other health and social care providers on population based services. It is expected that the patient will have an improved experience, with better managed episode of care by reducing duplication across the provider services.  Act as a catalyst for encouraging practices to work together with a focus on enablement and empowerment of member practices to build a shared sense of responsibility and capacity to support the implementation of the strategy.  Develop hubs made up of services that make sense for the community and are not based on a pre-prescribed model.  Enable access to local services seven days a week.  Enable more care to be delivered outside of hospitals, in primary care and community settings where patients will benefit from care provided closer to their home.

6. Local Estates Strategies

6.1 NHS Nottingham North and East CCG

Introduction

NHS Nottingham North and East Clinical Commissioning Group has been a statutory NHS organisation since 1st April 2013 and is responsible for commissioning health services for the population covered by the CCG area. The CCG is led by general practitioners using their knowledge and understanding of patients’ needs, with the key principles of putting patients at the centre of the NHS and focussing on clinical outcomes. Pivotal to the success of the CCG is the requirement to continuously improve the quality and safety of care whilst ensuring that the available healthcare resources are used as effectively and efficiently as possible. The CCG comprises 21 GP practices covering a population of almost 150,000, organised collectively to commission health services for the patient population living in and around Arnold, Burton Joyce, Calverton, Carlton, Colwick, Daybrook, Gedling, Giltbrook, Hucknall, Lowdham, Mapperley, Netherfield, and Newthorpe.

The population of NNE CCG is spread across a mixture of urban areas and rural villages. The Index of Multiple Deprivation (IMD) 2010 shows a wide variance in overall deprivation across the NNE area. Higher scores mean greater deprivation,

and, while the CCG average (18.2) is below the England average of 21.5, there are areas of significant deprivation in the area, particularly around Hucknall. The population profile for the CCG shows that the population is slightly older than the national average, whereas the proportion of people under 40 is lower than the national average. Across the CCG area, it is estimated that the population will grow by 11.66% between 2010 and 2025. The CCG has been working in three localities of approximately 50.000 resident population for a number of years as per the table below (Table x). Community services are organised around this locality structure and increasingly primary and community teams are becoming more integrated with a focus on implementation of a Care Delivery Model approach. GP practices are also adopting the three localities as the basis on which they are working together to explore opportunities for greater collaboration or federation going forward.

List Size (June 2015) Locality 1 Giltbrook Surgery, Giltbrook 4,243 Newthorpe Medical Centre, Eastwood 6,717 Oakenhall Medical Practice, Hucknall 7,163 Om Surgery, Hucknall 2,050 Torkard Hill Medical Centre, Hucknall 14,545 Whyburn Medical Practice, Hucknall 11,730 Locality 2 Apple Tree Medical Practice, Burton Joyce 3,437 Calverton Practice, Calverton 9,418 Daybrook Medical Practice, Daybrook 9,358 Highcroft Medical Centre, Arnold 12,715 Ivy Medical Group, Burton Joyce 3,831 Jubilee Practice, Lowdham 2,300 Stenhouse Medical Centre, Arnold 11,912 Locality 3 Park House Medical Centre, Carlton 7,507 Peacock Practice, Carlton 5,049 Plains View Surgery, Mapperley 5,928 Trentside Medical Group, Netherfield 11,651 Unity Surgery, Mapperley 3,842

West Oak Surgery, Mapperley 5,185 Westdale Lane - The Surgery, Gedling 7,643 Willows Medical Centre, Carlton 3,656 149,880

Current Estate

The CCG estate comprises 25 buildings which are a mixture of GP owned, NHS Property Services properties, one LIFT building and the CCG leased headquarters.

There are 21 GP practices ranging in list size from approximately 2,000 to 15,500. There are two branch surgeries belonging to two practices. The CCG headquarters is within the Gedling Civic Centre, leased from Gedling Borough Council.

Over the last 10+ years the CCG and predecessor organisations have made some progress in improving and developing the local estate with two new builds and a number of minor improvements.

A 7 Facet Survey conducted in summer 2015 highlighted that 4 buildings were below the recommended B overall rating with a further 8 rated at B/C . Residential Developments

The population of Nottingham North and East CCG is distributed across five local authority areas within Nottinghamshire County, namely Gedling Borough, Ashfield District, Broxtowe Borough, Nottingham City, and Newark and Sherwood District. The majority of patients registered with GP practices in the CCG area live within three areas: Ashfield District (mainly Hucknall), Gedling Borough, and Broxtowe Borough (parts of Eastwood). The remainder live in Nottingham City, Newark & Sherwood District and other parts of Nottinghamshire.

Ashfield District Council Ashfield District Council is currently reviewing its Local Plan with a view that this will be available for consultation during Autumn 2016, for final approval 2017. However in order to reach its target the Council has identified that approximately 480 new dwellings need to be built annually across the whole Ashfield District (as documented within their Strategic Market Housing Area Assessment). The following new builds are underway within Hucknall;

 Lovelace Gardens, Watnall Road, Hucknall – 23 homes  Retirement Homes, Nottingham Road, Hucknall – 39 retirement apartments  Abby Fields, Broomhill Farm, Off Nottingham Road, Hucknall – 141 homes  Rolls Royce, Hucknall – 900 homes.

All the developments detailed above are due for completion within the next five years and some have already commenced.

Gedling Borough Council Gedling Borough Council has published its Aligned Core Strategy which identifies new developments of 7,250 new homes between 2011 and 2028. The council is currently in the process of identifying specific sites for development, however the majority of new build will be located in or adjoining the main built up area of Nottingham, with development adjacent to the sub regional centre of Hucknall aimed at regeneration and supporting its role. Key locations where significant growth is planned are;

 Bestwood Village - up to 560 homes  Calverton - up to 1055 homes  Ravenshead - up to 330 homes  Gedling - up to 260 homes  Other village locations not specified to meet the local needs.

Further clarification on exact locations will be available early 2016 and as yet no planning permission has been granted for housing developments related to any of the above.

However, the following new builds are being progressed within Gedling with planning permission granted and construction either about to commence or already started;

 North Papplewick Green – 300 homes approved  Linby, Top Wighay Farm – 805 homes over four phases  Netherfield, Teal Close – 800 homes – outline planning permission granted.

Broxtowe Borough Council Broxtowe Borough Council’s Aligned Core Strategy indicates that the Borough will plan to provide 6150 new homes between 2011 and 2028. Some of the sites identified include;

 Boots and Severn Trent site (550 homes)  A Sustainable Urban Extension at Field Farm, north of Stapleford (450 homes)  A strategic location for growth on land east and west of Toton Lane including Toton Sidings in the vicinity of the proposed HS2 station at Toton, in Broxtowe. This will include a minimum of 500 homes with the approximate mix of this and other developments to be recommended by Broxtowe HS2 Working Group and determined in Broxtowe’s Part 2 Local Plan.

It is not anticipated that any of these will impact on primary and community capacity within the NNE CCG area.

Key areas where significant growth is planned are: -

 Awsworth (up to 350 homes)  Brinsley (up to 150 homes)  Eastwood (up to 1,250 homes)  Kimberley (up to 600 homes). Of these Awsworth, Eastwood and Kimberley may have an impact on primary and community capacity within the NNE CCG area.

Further clarification on exact locations is required from Broxtowe Borough Council.

Key priorities for change

This section identifies the key estates priorities across the NNE area for the next one to four years. They have been identified either because planning approved housing developments will have an impact on primary/community access, or because the physical condition of the existing premises means that remedial work will be required in the next two to three years.

 Hucknall

The town of Hucknall is within the Ashfield District Council area and is located to the north of Nottingham, famous for its industrial links to the Nottinghamshire coal mining heritage between 1861 to 1986. Easily accessible from the city of Nottingham by tram, bus and the rest of the county by train, Hucknall is fairly easy to get around with a central high street offering shops, pubs, restaurants and more.

GP primary care provision within Hucknall is predominantly provided by four practices (population data as at June 2015):

Total GPwte Pts per wte Training Practice Name Population Practice TORKARD HILL MEDICAL 7.64 1,903 Yes CTRE 14545 OAKENHALL MEDICAL 3.5 2,046 No PRACT 7163 WHYBURN MEDICAL 7.47 1,570 Yes PRACTICE 11730 THE OM SURGERY 2050 1 2050 No 35,488

Significant regeneration is underway within Hucknall. There are an anticipated 1,103 new homes planned within the Ashfield District Council area. In addition, bordering onto Hucknall Gedling Borough Council has plans to develop 1,105 new homes. Gedling Borough Council is expecting these will be developed over the next five to ten years. Further housing developments are also anticipated in line with the Ashfield District Council commitment to develop 480 dwellings a year in line with their Strategic Market Housing Area Assessment. Further information in respect of the locations of these new developments is awaited.

Although all four GP practices currently remain open to new patient registrations it has been recognised that access will become an increasing issue as the population rises as a result of the planned new homes. Maintaining and/or improving access to GP and Community services within and around Hucknall has therefore been identified as a priority for the CCG and it is acknowledged that this is likely to require an estates response.

 Netherfield

Netherfield is a small town three miles east of Nottingham. It lies just outside the city boundary in the Borough of Gedling.

Primary Care provision within Netherfield is provided by one key provider. Within a mile radius residents can travel to a further two practices, listed below (Population data as at June 2015):

Total GPwte Pts per Training Practice Name Population wte Practice Trentside Medical Group – Netherfield & Colwick 11,727 5.81 2018 Yes

Practices within a mile Park House Medical Centre 7220 4.56 1583 No Westdale Lane 7610 4.1 1856 No

Significant regeneration is underway within Netherfield, with an anticipated 800 homes being developed. It is expected that these homes will developed over the next one to eight years.

Although the three GP practices identified above currently remain open to new patient registrations it has been recognised that access will become an increasing issue as the population rises as a result of the planned new homes. Maintaining and/or improving access to GP and Community services within and around Netherfield has therefore been identified as a priority for the CCG and it is acknowledged that this is likely to require an estates response.

 Estate Utilisation

Byron Court

Byron Court is a privately leased building located close to Arnold Town Centre. The building was originally a factory but in recent years has been adapted and currently provides office accommodation for community staff. Nottinghamshire Health Informatics Service also occupies space within the building. The building is significantly under-utilised and as such the CCG is subject to substantial void costs. In addition the building is no longer deemed fit for purpose, and staff based in Byron Court perceive issues around health and personal safety, particularly when working from the building in the evening. Disposal of Byron Court has therefore already been identified as a priority and work has commenced to achieve this.

 Estate Quality Issues

A 7 Facet Survey conducted in summer 2015 highlighted rated a number of primary care premises within the CCG area as C in terms of physical condition. This means they are below the recommended B overall rating and are likely to require major repair/replacement within the next one to three years dependent on the issues identified.

The buildings rated as C are; Locality 1  Whyburn Medical Practice (based in Hucknall Health Centre)

Locality 2  The Ivy Medical Group  Jubilee Practice

Locality 3  Westdale Lane Surgery  Unity Surgery

In addition a number of premises were rated B/C which indicates they are currently condition B but may fall to C within 5 years and are therefore likely to need improvement.

The practices rated as B/C are; Locality 1  Oakenhall Medical Practice  Om Surgery

Locality 2  The Calverton Practice  Daybrook Medical Centre (Daybrook Health Centre)  The Ivy Medical Group (Lowdham Surgery – branch)  Stenhouse Medical Centre

Locality 3  Trentside Medical Group (Netherfield Medical Centre)  West Oak Surgery

Over the next one to four years the CCG will therefore need to work with the GP practices detailed above to ensure that all premises within the NNE area meet the required minimum standards in terms of physical condition.

 Strategic Impact Assessments of Large Residential Developments

Assessments will be completed for each significant housing development across the CCG area to enable the CCG to understand the associated impact on primary and community services.

 Other Issues

Park House Primary Care Centre (LIFT) – there is a lack of clarity around costings and underleases. These present a barrier to fully understanding space utilisation and therefore limit the potential of the building to work to full capacity. The result is that the CCG is subject to void costs. The CCG is working with Community Health Partnerships to resolve these issues.

6.2 NHS Nottingham West CCG

Current Estate

The CCG estate comprises 16 buildings which are a mixture of GP owned, NHSPS properties, one LIFT building.

There are 12 GP practices ranging in list size from 3,200 to 14,000. There are two branch surgeries belonging to two practices. The CCG headquarters is in a LIFT building that also includes two practices. There are also three health centres which do not include GP practices.

Over the last 10+ years the CCG and predecessor organisations have made significant progress in improving and developing its estate with one new build, a number of extensions and improvements and two surgeries in old buildings closed.

A 7 Facet survey conducted in summer 2015 highlighted one GP practice premise, Bramcote Surgery, below the recommended B overall rating, at C, and 5 further practice premises below B for some aspects.

GP Practices

List Size (Sept 2015) Church Walk Surgery, Eastwood 11,566 Church Street Medical Centre, Eastwood 8,344 Hama Medical Centre, Kimberley 5,240 Linden Medical Group, Stapleford 10,483 Linden Medical Group, Wollaton (Branch) Saxon Cross Surgery, Stapleford 7,455 Hickings Lane Medical Centre , Stapleford 4,745 Bramcote Surgery, Bramcote 3,167 The Oaks Medical Centre, Beeston 8,435 The Manor Surgery, Beeston 11,078 West End Surgery, Beeston 4,858 Abbey Medical Centre, Beeston 5,12 The Valley Surgery, Chilwell 14,116 Chilwell Meadows Surgery, Chilwell (Branch) 94 ,612

The practices’ locations can be found on the map above in purple. The majority of patients registered with GP practices in Nottingham West CCG live in Broxtowe Borough. The remainder live in Nottingham City, where one practice has a branch surgery in Wollaton, and Erewash Borough in Derbyshire.

Broxtowe Borough

Broxtowe has a population of 109,500 (2011 census) and covers an area of some 31 square miles. It is characterised by a more urban south with the separate settlements of Attenborough, Chilwell, Beeston, Bramcote, Stapleford, Toton and part of Trowell together comprising over 60% of the Borough’s population and forming part of the western side of the built up area of Greater Nottingham. The north is more rural with the largest settlements at Eastwood (population approximately 11,000) and Kimberley (population approximately 6,200).

The Borough has good access to East Midlands Airport via junction 24 of the M1, together with rail connections at Beeston and Attenborough stations and the close by stations of Nottingham and East Midlands Parkway. The M1 bisects the Borough, with junction 26 within the Borough at Nuthall, while junction 25 is just outside the Borough with links to this and the City Centre via the A52.

The preferred location for a HS2 hub station at Toton will significantly improve the accessibility of the Borough to London and several Core Cities both in Britain and in mainland Europe. It will make the area attractive to inward investment, will lead to significant job creation and will add to the sustainability of appropriate mixed use development in close proximity to the station.

Broxtowe Borough Council’s Aligned Core Strategy published in September 2014 proposes a minimum of 6,150 new homes between 2011 and 2028. It includes summary assessments and indicative plans of each potential development.

Plans include:

 Boots and Severn Trent site (550 homes);  A Sustainable Urban Extension at Field Farm, north of Stapleford, (450 homes);  A strategic location for growth on land east and west of Toton Lane including Toton Sidings in the vicinity of the proposed HS2 station at Toton. This will include a minimum of 500 homes.  Awsworth (up to 350 homes);  Brinsley (up to 150 homes);  Eastwood (up to 1,250 homes);  Kimberley (up to 600 homes).

Since the publication of the strategy a proposal for housing on Beeston Business Park adjacent to Beeston train station has received planning approval from Broxtowe Borough Council for 200-250 new homes.

Key priorities for change

The CCG has been working in three localities of approximately 30,000 resident population for a number of years based on a Community Ward model, with integrated Primary and Community teams, most recently enhanced with the addition of Local Care Teams to support people over 75.

Geographically, this represents:

 Eastwood & Kimberley – 3 practices plus 2 health centres  Stapleford & Bramcote – 4 practices including two in the Stapleford Care Centre LIFT building. There is also a branch surgery in Wollaton (Nottingham City)  Beeston & Chilwell Ward – 5 practices plus 1 health centre and 1 branch surgery

The strategic direction for premises for a number of years has been for the NHS to support larger developments for financial and clinical service reasons. In larger practices there is potential for a greater range of services to be offered to patients, a greater range of clinical expertise, more opportunities for peer review and economies of scale which present opportunities for wider clinical Multi-disciplinary Teams. In addition, larger buildings provide more opportunities for moving services from secondary care to primary care.

A recent report by the National Audit Office supports this. For example, the report states that patients registered with larger GP practices are less likely to attend A&E – on average, for every extra GP in a GP practice there is a 4% reduction in the rate of A&E attendance.

The following have been identified as priorities:

 Eastwood Health Centre

The current health centre is a purpose built CLASP building constructed c1974. The majority of health centres of this type of construction have already been replaced, for example the original Stapleford Health Centre. Eastwood HC was prioritised for replacement with a new build some years ago but these plans were shelved. It has had a number of remedial works in recent years due to failing in facet appraisals. There is a recognised need for clinical capacity in the Eastwood area and CCG commitment to maintain clinical services in Eastwood, this may lead to replacement of the current Eastwood Health Centre. This is the CCG’s top priority. The CCG is participating in an options appraisal in Autumn 2015 to ascertain the optimum solution to enable clinical capacity to be maintained and extended.

 Beeston

The next priority would be to create additional clinical capacity in the Beeston & Chilwell area. A central Beeston practice (The Oaks) has approval in principle from the PCIF to expand its clinical space, but further development will be required to meet growing demand for community services at local level.

A practice in Stapleford (Hickings Lane) has secured PCIF support to increase their clinical capacity significantly, and with the large Stapleford Care Centre building there is deemed to be sufficient clinical space at present in this locality.

 Estate Utilisation

Practices based in premises that were not specifically built as healthcare facilities tend to have poorer space utilisation, notably West End, Wollaton and Bramcote due to accessibility constraints.

 Estate Quality Issues

Bramcote Surgery A number of rooms are not used on a regular basis. Rooms are not compliant with modern standards and there is no scope for extension. The practice is in early discussions with Hickings Lane regarding a potential future merger.

Wollaton branch surgery is located in a converted old house in the middle of a residential area. The building has an overall 7 Facet rating of B but scored BC in physical condition and C for fire, health & safety. Discussions with the practice (Linden Medical Group) have commenced regarding the future use and/or potential for the Wollaton Branch, which serves a population resident in Nottingham City although registered in Nottingham West.

 Strategic Impact Assessments of Large Residential Developments

Strategic impact assessments from the main developments in the CCG’s patch should be conducted. Summary assessments form part of the core strategy.

 Other Issues

Stapleford Care Centre opened in 2006 and is a large LIFT building in the centre of the town. It includes two practices and further clinical space for community services and visiting services, as well as office accommodation over three floors. It used to have a walk in centre facility which closed in 2011. It is only in recent years that the majority of the space has been utilised, and maintaining this is a priority due to the expense of unused space.

6.3 NHS Rushcliffe CCG

Current Estate

The CCG estate comprises 17 buildings which are a mixture of GP owned, NHSPS properties, one LIFT building and the CCG leased headquarters.

There are 12 GP practices ranging in list size from 5,299 to 23,856. There are five branch surgeries belonging to three practices. The CCG headquarters is a Grade II listed building leased from a private landlord until March 2020.

Over the last 10+ years the CCG and predecessor organisations have made significant progress in improving and developing its estate with four new builds, a number of extensions and improvements and two not fit for purpose branch surgeries closed.

A 7 Facet survey conducted in summer 2015 highlighted that 6-7 buildings were below the recommended B overall rating, with three at C/D.

Rushcliffe Borough

The CCG is largely coterminous with the Rushcliffe Borough Council area with the exception of its Orchard Practice in the village of Kegworth north west Leicestershire. The borough lies immediately south of the City of Nottingham and the River Trent, extending across towards Newark in the North East and Loughborough in the South West. Rushcliffe covers 157 square miles (around 400 sq km) and the circumference of the Borough is 123.3km

Although parts of the Borough lie close to Nottingham, Rushcliffe has a strong identity of its own. The main centre of population is West Bridgford, where around 41,000 of the Borough's 111,100 population live. The remainder of the district is largely rural, with the centres of population split between small towns and villages. The largest include Bingham, Radcliffe-on-Trent, Cotgrave, Keyworth, Ruddington and East Leake.

Rushcliffe Borough Council’s Core Strategy revised draft published in February 2014 proposes a minimum of 13,150 new homes between 2011 to 2028 - 774 per annum. This is the largest growth proposed in the whole county of Nottinghamshire and presents a significant challenge for all infrastructure services.

The housing stock in Rushcliffe will increase from 47,350 in 2011 to 60,500 in 2028 representing a 28% increase. This will generate a potential new population of over 30,000, representing an increase of 25% to the CCG’s patient population. The impact of this significant increase in new patients will undoubtedly require comprehensive planning of health service provision in both primary and secondary care.

The main strategic allocations are:

 Land South of Clifton/A453 – 3,000 new homes  Melton Road Edwalton – 1,500 new homes  Land East of Gamston/North of Tollerton – 2,500 new homes up to 2028 and a further 1,500 post 2028

Other site specific proposals are:

 Land north of Bingham – 1,000 new homes, planning approved development not started  Former RAF Newton – 550 new homes, planning approved development not started  Former Cotgrave Colliery – 470 new homes, planning approved and development started

Plus new housing on the edge of main villages – specific locations for development yet to be identified:

 East Leake – minimum 400 new homes (already planning permission for around 700 homes)  Keyworth – minimum 450 new homes  Radcliffe on Trent – minimum 400 new homes  Ruddington – minimum 250 new homes

Key priorities for change

The CCG has been working in three localities of approximately 40,000 resident population for a number of years based on a Community Ward model, with integrated Primary and Community teams, which has suited the nature of the geography and travel times for patients and clinicians.

Geographically, this represents:

 Central Ward – the most urban most dense population with 5 practices of differing sizes in West Bridgford and Gamston  North Ward – Bingham, Cotgrave and Cropwell Bishop (one practice, 3 surgeries) and practices in East Bridgford and Radcliffe on Trent  South Ward – practices in Kegworth, East Leake, Ruddington and Keyworth

Apart from Cotgrave, there is no priority order:

 Cotgrave Health Centre

This health centre is a 1960 CLASP building with an overall 7 facet appraisal rating of C/D failing significantly in the physical condition, quality and environmental management facets particularly.

Rushcliffe Borough Council is leading a town regeneration project linked to the housing development on the old colliery site. The health centre is located in the middle of the existing shopping precinct and is key to unlocking the potential of the development.

The GP practice has developed an outline business case to provide accommodation for the public sector services and this is currently being discussed with the practice, particularly in terms of the financial analysis. There is a community chest comprising pooled section 106 contributions part of which will be available for the development.

The overall project is a complex multi-agency scheme. Cotgrave is the area of most deprivation within the CCG and the town population is set to grow due to the housing development on the Colliery Site which has already started.

This is the CCG’s top priority. The CCG has supported the practice in a 15/16 bid to the PCIF which was deferred requiring further work.

 Estate Utilisation

West Bridgford

Embankment Primary Care Centre Wilford Lane opened October 2014 housing four merged practices and one further separate practice. Space was included also for one community team which is attached to Embankment practices to move from West Bridgford Health Centre, but has yet to re-locate.

Trent Bridge Medical Practice’s former accommodation now stands empty following the merger and relocation of the practice to Embankment Primary Care Centre. This property is leased from a private landlord until September 2024.

West Bridgford Health Centre is a 1960/70’s built traditional health centre which is one of the oldest buildings within the CCG’s estate. It is located adjacent St.Georges Medical Practice which is a purpose built surgery constructed in the last 15 years.

 A review of health facilities in central West Bridgford would be useful to maximize integrated working across the NHS teams.

 Estate Quality Issues

Branch Surgeries

Sutton Bonington (East Leake Medical Group) is located in a converted bungalow in the middle of a residential area. The building has an overall 7 Facet rating of C scoring badly in physical condition, quality and functional suitability.

The practice has made some progress in developing an option to develop a new build with support from the Parish Council. This should be further worked up with a view to finding a cost neutral build solution.

Gotham Branch Surgery (Orchard Surgery, Kegworth) is located in part of the village hall. The building has an overall 7 Facet rating of C/D scoring badly in physical condition, functional suitability, quality and environmental management.

A review of the premises should be undertaken especially in relation to the impact of the potential south of Clifton/A453 housing development.

Radcliffe-on-Trent

This building is a 1960s CLASP building which was purchased by the GP practice from the NHS several years ago.

It has an overall 7 Facet rating of C scoring badly on physical condition and whilst some increase in the space available has been achieved by way of extending the property in the past, there are no further opportunities for expansion.

The practice has done some work on options for a new building including demolishing and rebuilding but costings have been prohibitive.

There are new residential developments proposed for the area which will place further pressure on an already undersized building. The practice has worked with a potential developer to identify a potential new site. A Neighbourhood Plan is in consultation which states a preferred location for the health centre in the centre of the village.

The CCG will work with the practice to explore all options and also to secure funding from the PCIF for improvements to the existing building for the short term.

East Leake Health Centre

This building is a 1960s CLASP building with an overall 7 Facet rating of C/D scoring badly on physical condition, functional suitability, quality and environmental

management. However, recent investment of over £500k has addressed some immediate problems.

Previous attempts to explore options for a new site have not produced any potential plans. Several housing developments have received planning consent recently which has added pressure to the existing facilities. The Neighbourhood Plan urges no further development around the village without major improvements to the infrastructure including the possibility of a new health centre.

The practice recently merged with another local practice and closed two not fit for purpose branches.

The CCG will keep a watching brief on any further development of the village and work with the practice as and when opportunities arise.

 Strategic Impact Assessments of Large Residential Developments

- Land South of Clifton/A453 – affecting the Orchard Surgery Kegworth and East Leake Medical Group and their branches listed above; Ruddington Medical Centre and the three NHS Nottingham City practices in Clifton

The cumulative effect on Gamston Medical Practice and potentially Radcliffe-on- Trent Surgery:

- Melton Road Edwalton - Land East of Gamston/North of Tollerton

Strategic impact assessments from the three main developments in the CCG’s patch should be conducted

 Other Issues

Keyworth Primary Care Centre (LIFT) – lack of clarity around costings and underleases is presenting a barrier to utilizing vacant space for moving services from secondary to primary care.

Community Health Partnerships to resolve.

Easthorpe House CCG HQ – less than 5 years left on the lease. The building has been recently sold to a new landlord whose future plans beyond the end of the lease are unclear.

NHS Property Services to explore options for the CCG.

7. Next Steps

Drivers for Change

Within this draft strategy a number of drivers for change in terms of strategic plans, changing populations and associated housing developments and clinical capacity requirements have been identified. An initial Gap Analysis has been undertaken based on core strategies, commissioning plans and the most recent surveys of current estate, and each CCG has identified priorities for change. The analysis will be further developed to inform more detailed proposals and longer term strategy. Stakeholder Engagement and Partnership Working

The CCGs have developed strong clinical relationships and local partnerships as the foundation for successful redesign of clinical pathways and are focussed on developing closer clinical engagement and integration between primary care, secondary care, community services and social care.

The CCGs each have a communication and engagement strategy which details the locally agreed approach with patients, public and local partners. The values, strategic objectives, local plans and priorities evolve from listening to patients, the public, partners and stakeholders.

Each CCG has established patient fora which include representatives from each GP Practice’s Patient Participation Group. In addition to engaging with patients and carers, the CCGs work with local stakeholders including Borough Councils, Nottinghamshire County Council, healthcare providers and voluntary sector members.

In developing plans, the CCGs reflect the priorities detailed in the Health & Wellbeing Strategy and Better Care Fund Plans. All draft plans are consulted on with internal committees and external stakeholders. Every opportunity is taken to work collaboratively with local partners and providers to redesign and integrate care pathways and improve outcomes.

The CCGs will continue to engage with all stakeholders on all plans and on each specific proposal regarding changes to the estate.

Financial Summary

The CCGs are developing a summary of the capital resources required to implement the strategy including the revenue consequences and any potential revenue savings associated with improving the estate. These will be included in the CCGs’ financial plans going forward.

Risk Management

The property landscape in the NHS has changed considerably since the last reorganisation when the Health and Social Care Act 2012 came into force. CCGs have no ownership or operational responsibility for premises which fall within the remit of a number of different bodies including NHS Property Services, Community Health Partnerships or NHS acute and community providers and GP practices. This complex picture of property ownership presents a number of issues, not least of which is the availability of good quality data and financial information on which to base the identification of priorities and ultimately decisions. This presents a very real barrier to progress and risk to benefits realisation.

The CCGs will develop a risk management framework for the strategy that will highlight the critical dependencies and major barriers or risks to implementation. It will include a risk register, the cumulative risk exposure, and the overall risk management strategy.

8. Conclusion

The Local Estates Strategy will be fully aligned with the commissioning plan for the area, including the Health & Wellbeing Strategy, South Nottinghamshire Transformation Plan and CCG priorities and local health needs.

The CCGs will take a strategic overview of the planning of the estate in consultation with various local stakeholders, including providers of health and social care and other public sector organisations, to set the future direction for development, investment and disinvestment. The Local Estates Strategy has an important role to play in enabling change, delivering savings, reducing running costs and ensuring that all investment, including the Primary Care Infrastructure Fund, is properly targeted.

This draft initial Strategic Estates Plan outlines the development of the vision for the estate, based on the Five Year Forward View (5YFV) and commissioning plans. The CCGs have included core information about the current estate in the area, highlighted current and planned locations for the delivery of services, showed commitment to maximising utilisation of premises and improving integration wherever possible and using gap analysis identified initial priorities for change.

The strategy will continue to evolve over the coming months to include risk management, implementation plans and financial modelling. It will articulate how the existing estate needs to change to meet the future health and social care requirements in the local area.