Primary Care Infrastructure Plan 2019/2026 - Cleevelands Medical Centre, Bishop's Cleeve Kingsway Health Centre, Gloucester - NHS Gloucestershire CCG
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Primary Care Infrastructure Plan 2019/2026
Cleevelands Medical Centre, Bishop’s Cleeve
Kingsway Health Centre, Gloucester
Churchdown Surgery, Churchdown The Devereux Centre, Tewkesbury
Author: Andrew.hughes8@nhs.net
1
Final draft 12th August 2019
1. Table of contents
Page
1. Table of contents………………………………………………………………………………………………………2
2. Introduction ……………..……………………………………..…………………………………………………… 3
Section A – Where are we and where do we need to Section B – How are we going to get to get to where we
be? need to be? Page
3. Strategic context ………………………………..………………………………………………………………… 5 8. Ongoing delivery of 2016/ 2021 priorities and priorities
3.1 National policy- Long Term Plan
3.2 National policy- focus on primary care (primary care networks overview) to 2026 …………………………..………………………………………………………………………………………………… 29
3.3 National policy focus on primary care (primary care networks service development) 8.1 Methodology, approach and assumptions
3.4 Local policy Gloucestershire Integrated Care System (ICS) 8.2 strategic prioritisation 2021 to 2026
3.5 Local policy - ICS Strategic Service model 8.3 Revised priorities overall programme 2019 to 2026
3.6 Local policy –Integrated Locality Partnerships
3.7 Local policy - Primary Care Strategy 2019 to 2024 9. ILP, PCN and Practice summary ………………………..…………………………………………… 33
3.8 Service strategy implications on the primary care estate 9.1 Overview
4. The estate in 2019 …………………………………………………………………………………. 14 9.2 Cheltenham
4.1 The Challenge of the existing estate 9.3 Cotswolds
4.2 Increasing alignment across the ICS estates 9.4 Forest of Dean
4.3 Current primary care estate 9.5 Gloucester
4.4 Condition and suitability of primary care estate 9.6 Stroud & Berkeley Vale
9.7 Tewkesbury
5. Rising population ………………………………………………………………………………… 19
9.8 Programme 2019 to 2026 and estimated capital costs
5.1 – Forecast housing growth 2019 to 2031 by District
9.9 Revenue financial framework
5.2 - Housing growth and population growth estimates by District
5.3- Population growth and allocation to practices within Integrated Locality Partnerships
10. Process and Governance ………………………..………………………………………………………… 43
6. Delivery of 2016 to 2021 priorities ………….………………………………………… 23 10.1 Business case requirements
6.1 Completed and approved schemes 10.2 Improvement grants
6.2 Remaining priorities - progress status 10.3 Engagement and equality
6.6 Financial investment 10.4 Fees
7. Summary ……………….……………………………………………………………………………..…………… 27 10.5 Decision making and approvals
7.1 Where are we now? 2
2. Introduction
NHS Gloucestershire Clinical Commissioning Group (GCCG) has had delegated authority for primary
care commissioning since April 2015. The CCG’s responsibilities with regards to premises are set out
in The National Health Service (general medical services premises costs) Directions 2013 and
include:
• Managing the rents reimbursed to practices for the provision of general medical services in
buildings owned by practices or another body, where the practice is a tenant
• Managing the reimbursement of business rates for the provision of general medical services in
buildings owned by practices or another body, where the practice is a tenant
• Determining improvement grant priorities: the NHS is able to provide some funding to help
surgeries improve or extend their building
• Determining new primary care premises priorities
• Funding the annual revenue requirements of new premises as a result of additional/new rent
reimbursement requirements
Currently, any capital funding requirements is not delegated to the CCG and NHS England approval is
required.
GCCG developed a five year prioritised Primary Care Infrastructure Plan (PCIP) to set out where
investment is anticipated to be made in either new or extended buildings, subject to business case
approval and available funding for the period 2016 to 2021. The PCIP was approved in March 2016.
This is an updated version of the PCIP, which takes into account progress made on priorities, NHS
policy development, a review of housing and associated population growth. It reaffirms existing key
priorities and using the agreed methodology of the original plan, also sets out additional priorities
for the period 2021 to 2026 and provides a revised programme for 2019 to 2026. This document
replaces the previous version published in March 2016.
3
Section A
Where are we and where do we need to be?
4
3. Strategic policy context
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5
3.1 National policy -NHS Long Term Plan The PCIP in 2016 highlighted that a number of strategic plans recognised that whilst day-to-day primary care services were still core, some care currently provided in hospitals needs to provided in community settings. It assumed extended primary care services would include increased community services, Out of Hours services, other specialist-based services such as diagnostics, case management of vulnerable patients and closer links with non-statutory bodies. It anticipated that Practices would increasingly employ bigger teams which would work together as well as with other health and social care providers through formal ‘Networks’. It referenced emerging ‘super’ practices, where one practice operates from a number of sites and that Increasingly, local primary care services will be delivered for around 30,000 to 50,00 people. It noted that in order to deliver this strategy, some literature referred to the development of local primary care hubs within which practices are likely to be co-located. Published in January 2019, the NHS Long Term Plan builds on the Five Year Forward View and articulates a need to further integrate care to meet the needs of a changing population over the next decade. Focus is on the following: - A new service model in which patients get more options, better support and properly joined-up care at the right time - The NHS will strengthen its contribution to prevention and health inequalities - Care and quality outcomes improvement ( cancer, mental health, diabetes, multi-morbidity, healthy ageing, including dementia, children’s health, cardiovascular and respiratory conditions, learning disability and autism amongst others) - Workforce development - Upgrade technology and digitally enabled care across the NHS - Increased financial investment of 3.4% over the next 5 years to support implementation The PCIP still needs to respond to a commitment to increase care outside hospitals and for there to be 6 expansion of primary care services. Further detail is provided in the following sections.
3.2 National policy- Focus on primary care (Primary Care
Networks- overview)
Set out in the Long Term Plan, over 1,250
Primary Care Networks (PCNs) came into
existence from 1 July 2019. These are based
on minimum registered list sizes of 30,000
patients – not usually more than 50,000 –
commissioned through general practice in the
form of a Directed Enhanced Service (DES) that
forms the network contract. Between the
practices, a mandated network agreement,
with associated schedules, sets out the
relationship and operating protocols of the
PCN. Guaranteed real-terms investment of
£4.5bn has been pledged for primary and
community care from 2019/20 to 2023/24.
7
3.3 National policy - Focus on primary care (Primary
Care Networks – service development and delivery)
The Key focus of service development and delivery over the next few years includes the stabilisation of
the GP partnership model; the creation of 20,000 new staff working in general practice through
additional roles; further dissolving the historic divide between primary and community care; a clear,
quantified, positive impact for the NHS system and patients, with fewer patients being seen in hospital
and more being seen and treated in communities.
Working at this new Primary Care Network (PCN) level service provision is wider than just general
practice. It includes all of primary and community care staff, working together to deliver preventative, out
of hospital, care for their patient population. So while GP practices are at their heart, and the initial
partners from July 2019, they must grow from April 2020 to begin including these other partners. This
will enable them to start commencing the new service specifications that will go live from April 2020,
with some mirrored service specifications for community teams to support the staff integration and joint
working:
• Structure Medications Review and Optimisation
• Enhanced Health in Care Homes;
• Anticipatory Care for high need patients with several long term-conditions;
• Personalised Care
• Supporting Early Cancer Diagnosis
• CVD Prevention and Diagnosis (from April 2021
• Tacking Neighbourhood Inequalities
From April 2020, every PCN will also receive a new national Network Dashboard to measure impact,
including A&E attendances, admissions, prescribing and performance against these specifications. Also
commencing in 2020 is a new national Network Investment and Impact fund, linked to performance
against metrics in the Network Dashboard. This will mean that PCNs which demonstrate a positive,
demonstrable, impact in these measures will receive further investment to support their growth.
8
3.4 Local policy - Gloucestershire Integrated Care System
Gloucestershire’s Integrated Care System (ICS) is underpinned by the shared mission to have a
population which is healthy and well, with residents taking personal responsibility for their
health and care and reaping the personal benefits that this can bring. These can include being
less dependent on health and social care services for support, living in healthy, active
communities and benefitting from strong networks of community services and support.
People should be able to access consistently high-quality, safe care in the right place, at the
right time.
The ICS vison
‘To improve health and wellbeing, we believe that by all working better together, in a more
joined up way, and using the strengths of individuals, carers and local communities, we will
transform the quality of care and support we provide to all local people.’
The key strategic objectives are to:
• place a greater emphasis on personal responsibility, prevention and self-care, supported by
additional investment in helping people to help themselves
• place a greater emphasis on joined up community based care and support, provided in
patients’ own homes and in the right number of community centres, supported by
specialist staff and teams when needed
• continue to bring together specialist services and resources in to ‘Centres of Excellence’,
where possible reducing the reliance on inpatient care across our system by repurposing
the facilities we have in order to use them more efficiently and effectively in future
• develop new roles and ways of working across our system to make best use of the existing
workforce and bring new people and skills into our system to deliver patient care
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3.5 Local policy - Strategic service model
Greatest impact on primary care
facilities:
Enabling Active Communities
Building increased personal
responsibility, promoting independence
and supporting community capacity to
make it easier for voluntary and
community agencies to work in
partnership with the NHS.
One Place, One Budget, One System
Gloucestershire is taking a place-based
(locality) approach to the expansion of
integrated working focused upon
primary care, and encompassing
community services, social care, mental
health and the voluntary sector. The first
priority focussed on a strengthened
approach to urgent care.
Clinical Programme Approach
Reorganising care pathways to ensure
that the right care is provided in the
right place at right time.
103.6 Local policy – Integrated Locality Partnerships
Operational and Strategic partnership of senior leaders of health
and social care providers and locally elected government and lay
representatives informing and supporting integration at PCN level,
unlocking issues and sharing responsibility for finding local solutions
to deliver ICS priorities and tackling issues which arise locally which
can only be resolved collectively.
Clinically-led integration, involving staff and local people in
decisions, to support more people in the community and out of
hospital.
ILP Plan to deliver defined population strategy including prevention
and public health, with aligned priorities agreed to improve
outcomes.
Develop multidisciplinary workforce models which will operate at
PCN level.
ILPs will need to translate ICS objectives to meet the needs of their
local population while enabling the PCNs to realise their plans to
implement multi-disciplinary teams around the needs of their
patients
113.7 Local policy – Primary Care Strategy (2019 to 2024)
Vision Strategic objectives
Patients in Gloucestershire can stay well for longer and receive joined-
up out of hospital care wherever possible, we will provide a • Continue the dissolution of the historic divide between
sustainable, safe and high quality primary care service, provided in services through 14 Primary Care Networks and 6
modern premises that are fit for the future. Integrated Locality Partnerships*;
• Provide patients with more control over their own health,
anticipatory care and personalised care when they need it
and support early cancer diagnosis;
• Utilise population health to tackle inequalities, assessing
our local population by risk of unwarranted health
outcomes to make services available where they are most
needed;
• Grow our multi-disciplinary primary care teams, attracting
and retaining the best staff through promoting
Gloucestershire as a great place to live and work, creating
a better work-life balance for staff, and offering excellent
training opportunities;
• Ensure good access to primary care 7 days a week,
meaning better support for patients while also reducing
urgent demand at our hospitals to enable them to care for
the most acutely poorly patients;
• Digitally-enable primary care to maximise the use of
technology;
• Support Primary Care Networks and Integrated Locality
Map of Gloucestershire Integrated Locality Partnerships and Primary Care Partnerships to explore how they can provide a greater
Networks range of services for larger numbers of patients.
Further detail on Gloucestershire Integrated Locality Partnerships
and Primary Care Networks provided in section 9 and appendix 3
of this document
123.8 Service strategy implications on estate
Service
Estate implications
strategy
• Greater use of primary and community facilities
Enabling active • Increased number of services to be accommodated
communities • Greater use by community and voluntary sector
• Increased group activity, some of which likely to take place in local surgeries as well
as non health-related venues
Reducing • Whilst partially offset by increased population, less requirement for acute-based
unwarranted outpatient facilities for face-to-face appointments
clinical • Greater requirement for primary and community facilities, in many instances
variation provided through new models of care
Clinical • Ensure suitable primary and community care facilities
programmes • Assess the implication on acute hospital facilities
• Assess the implication of hub and spoke service models
One place, • Development of the acute hospital estate
One budget, • Development of community hospital infrastructure
One system • Development of primary care facilities
• Greater range of services in local surgeries and increased numbers of professionals
Long Term Plan • Some services offered across large populations of 30,000 to 50,000
and Primary • Building capacity of primary care infrastructure as many of the existing surgeries are
care too small to accommodate increased populations and additional services
• Development of large scale centres with co-location/merger of practices into fewer
buildings4. The estate in 2019
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144.1 The challenge of the existing estate
Across England, 40% of practices surveyed by the British Medical
Association felt that GP premises were not adequate to deliver
existing services and 70% were too small to deliver extra services.
GCCG needs to ensure there is sufficient capacity for future need
whilst maximising use of facilities and delivering value for money
as limited financial investment is available to fund requirements.
There needs to be a focus on enhancing patients’ experience and
improving the environment for staff to provide the best care.
GCCG commissioned an estates survey in spring 2015 which
highlighted that some buildings have spatial constraints, whilst
Winchcombe
others are unsuitable for the long term and have unsatisfactory
Medical
functionality/layout. This was used to help determine the key
Centre,
priorities set out in the 2016/ 2021 plan. The survey suggests that Winchcombe
Gloucestershire still needs a programme to improve the quality
and capacity of primary care buildings.
Whilst it is still essential to ensure that core primary care services
are available, there is a also a need to modernise premises to
ensure that more services can be delivered out of hospital and
that this additional capacity will not be at single practice level.
Improved and/or enlarged infrastructures can be both a catalyst
for delivering change or an enabler to deliver agreed service
models.
154.2 Increasing alignment across the ICS estate
The ICS needs a modern and flexible estate infrastructure to support
the service ambitions and day-to-day working of Gloucestershire’s
ICS and to maximise health and well being, improve the quality of
care and patient experience, and deliver financial efficiency.
Organisations are now increasingly working together to understand,
collaborate and deliver the following objectives.
• The strategic development and configuration of acute hospital
sites to deliver new clinical models
• The development of community infrastructure to deliver One
Place, One Budget, One System requirements and the Clinical
Programme Approach
• Improved GP premises that accommodate planned population
increases and changes in working practice within primary care.
These will also facilitate aspects of enabling active communities
with closer links to the voluntary sector
• Support a resilient and sustainable primary care Kingsway Health Centre site, Gloucester
• Bring the estate up to and date and reduce backlog maintenance
requirements across the ICS
• Dispose of surplus and unused buildings which are no longer
required
• Maximise opportunities to share space to facilitate service
integration with the community and voluntary sector, minimise
running costs and generate capital receipts
164.3 Current buildings
There are now 74 GP practices providing
general medical services to 652,497
registered patients in January 2019.
Appendix 1 highlights list sizes, building from
the original baseline in July 2014, and
projecting forward to March 2031.
Services are provided in 100 buildings. There
are 74 main buildings and 26 branches,
although some practices operate as split
sites.
Sixty of the buildings are owned by the
practices themselves and 39 of the buildings
are leased, where the GP practice is a tenant.
One building is part leased and part owned
and in this situation, the practice is expecting
Leckhampton Surgery, Cheltenham to have to vacate this site in the near future.
174.4 Condition and suitability of estate
A key part in determining future investment priorities for 2021 to 2026 relates to the current building condition. It comprises six
separate surveys:
• Facet 1 – Physical Condition Survey (including mechanical and electrical aspects). A risk-based survey providing practical
information for assessing building stock condition, covering 23 elements
• Facet 2 – Functional Suitability Review - assesses the appropriateness of the function/facility in relation to the activities taking
place
• Facet 3 – Space Utilisation Review - assesses the physical use of the building, identifying low use, empty and overcrowded rooms
• Facet 4 – Quality Audit - based on factors which relate to the quality of the internal spaces when assessed. Enables premises to be
judged and compared with one another. It determines those that are most and least pleasant for both staff and visitors
• Facet 5 – Statutory Compliance Review - an assessment of statutory requirements which helps practices understand their position
against their legal obligations and the extent to which the facilities comply with the regulations
• Facet 6 – Environmental Management Review - an assessment of the policies and procedures at the practice relating to the
management of water consumption, energy usage, waste control and procurement (if applicable). It should be noted that facet 6
is not available for the Gloucestershire survey
NHS England guidance recommends prioritising existing buildings where the physical condition and the functionality
suitability review are deemed to be unsatisfactory. An updated summary of scores for Gloucestershire practices which have not
been replaced are included as part of the strategic prioritisation in appendix 2. Scores of A and B are deemed as acceptable and
scores of C and D are deemed not satisfactory (where buildings are likely to require improvement in the future).
185. Rising population
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195.1 Housing growth 2019 to 2031 - District
Out of scope
Stroud District Local Plan
review – possible changes
including Berkeley,
Whaddon, additional
4,887 housing at Stonehouse,
10,325 Wisloe-Green
Future of MOD site at
Beachley, Gloucestershire
9,368
Forest of Dean post 2026
3,417* Ministry of Defence site at
Ashchurch and the concept
7,295 5,030 of a Garden Town
Any further Joint Core
Strategy review across
Cheltenham, Gloucester City
1,370 and Tewkesbury
Any further review of
Cotswold District Council
* Published housing plans in the Forest of Dean are to 2026. A further estimate is provided to
increase list sizes to align with the County in addition to the number of homes provided in this 20
diagram5.2 Housing forecasts and population growth by
district council
District Number of new houses Population growth
April 2019 to March assumption**
2031
Cheltenham 9,368 15,176
Cotswolds 5,030 8,149
Forest of Dean* (2026) 3,417 5,535
Gloucester 10,325 16,727
Stroud 7,295 11,818
South Gloucestershire 1,370 2,219
Tewkesbury (including Wychavon) 4,887 7,917
Total 41,692 67,541
*Forest of Dean housing plans to 2026
** Based on 1.62 people per household – assumes 1/3 of homes are bought/rented by single individuals and that 10% result from individuals leaving
existing households ( a dilution effect of existing homes)
215.3 Allocated assumed registered list size growth 2019
to 2031 to each Integrated Locality Partnership
List size Revised
PCIP 2016 PCIP predicted Allocation of
Baseline List size growth list size
ILP version growth list size 2031 in number of
(July 2014) Jan 2019 assumption estimate
assumption 2016 plan homes*
** in 2031
Cheltenham 151,475 21,000 172,475 158,483 10,219 16,555 175,038
Cotswolds 85,707 18,000 103,707 90,405 5,030 8,149 98,554
Forest of 4,818+
62,495 11,000 73,495 63,678 2,974 71,937
Dean*** 3,441
Gloucester 165,612 25,500 191,112 174,477 13,536 21,928 196,405
Stroud &
120,003 9,000 129,003 121,509 6,368 10,316 131,825
Berkeley Vale
5,775+
Tewkesbury*** 42,253 6,000 48,253 43,945 3,565 50,230
510
Total 627,545 90,500 718,045 652,497 41,692 71,492 723,989
* Based on an assessment of existing housing strategies and discussion of these plans with District Councils. It is recognised plans change and these are forecast assumptions
** Based on 1.62 people per household – assumes 1/3 of homes are bought/rented by single individuals and that 10% result from individuals leaving existing households ( a dilution effect of
existing homes)
*** Additional 5 years list size growth added from April 2026 to March 2031 based on average annual estimated housing growth until 2026 . Two practices in Tewkesbury ILP included
226. Delivery of 2016 - 2021 priorities
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236.1 PCIP 2016/ 2021 completed or approved schemes
ILP Practice(s) Status
Gloucester City Longlevens surgery - extension Completed and opened in Jan 2017
Tewkesbury Church Street & Mythe – a new primary care centre Completed and opened in March 2017
Cheltenham Sevenposts surgery (now Cleevelands) – new building Completed and opened in January 2019
Cheltenham Stoke Road Surgery – refurbishment and extension Completed and opened in June 2018
Stroud &
Culverhay - refurbishment of existing building Completed in March 2018
Berkeley Vale
Gloucester City Churchdown - new surgery Completed and opened in March 2018
Gloucester City Hadwen Medical Practice – refurbishment and extension Completed and fully opened in September 2018
Gloucester City Rosebank health – new Kingsway surgery Completed and opened in December 2018
Cotswolds Stow Surgery – new surgery Approved and due to be open autumn 2019
Dockham Road and Forest Healthcare – new surgery in Approved and due to open in June 2020
Forest of Dean
Cinderford
Approved and subject to planning, construction is
Berkeley Place, Crescent Bakery and Royal Crescent
Cheltenham expected to start before the end of 2019 and open by
surgeries
New Year 2021
Gloucester City Health and Gloucester Health Access Centre Approved and subject to planning, construction is
Gloucester City co-locating into one Primary Care Hub at the Quayside, expected to start before the end of 2019 and open by
Gloucester City Centre New Year 2021
246.2 2021/2026 remaining priorities – progress status
ILP Practice(s) Scheme Status
Locking Hill, Stroud Business case expected autumn
Stroud & Berkeley Locking Hill and Stroud Valleys are progressing a 3rd Party led Town Centre
Valleys and Beeches 2019 and Beeches Green Plan
Vale development. Secondly, long term strategic plan for the Beeches Green site
Green 2020/ 2021
Stroud & Berkeley Business case expected Autumn
Minchinhampton Replacement of existing surgery
Vale of 2019
Development of primary care facilities for around 11,500 patients as part of Business case expected
Cotswolds Phoenix
the Chesterton housing development Autumn/ Winter 2019
Cirencester Health Development of single facility to replace the Avenue and St Peters Road
Cotswolds Site options being scoped
Group buildings
Brockworth & Development of single facility to replace existing surgery sites for up to Business case expected August
Gloucester City
Hucclecote 25,000 patients 2019
Coleford and Brunston Business case anticipated New
Forest of Dean Development of primary care facilities in Coleford for around 12,500 patients
surgery Year/spring 2020
Development of new facility for around 10,000 patients to replace Romney Business case expected Autumn
Cotswolds Phoenix (Tetbury)
House 2019
New GP building to serve a population of around 10,000 by 2028 to 2031.
Cheltenham North West Elms Delivery route to be agreed
The housing development is likely to be phased over a number of years.
Lydney Health Centre, In light of the Forest of Dean Community Hospital programme, to bring
Forest of Dean Severnbank and forward and scope the development of primary and associated community Delivery route to be agreed
Blakeney surgeries based services facility for around 17,000 patients
Assumed a new surgery would be built on the west of Stonehouse as part of
Stroud & Berkeley
Stonehouse practices the new housing development led by Regent Street surgery for around 7,000 Need to review options
Vale
to 10,000 patients
256.3 Financial investment
The delegated premises budget agreed with NHS England for 2015/2016 was is made up of the following items and
the 2019/2020 budget includes part year funding of schemes opening in 2019/2020 (new Stow surgery only)
2015/ 2016 2019/ 2020
Item
budget £m* budget £m*
Rent 5.632 6.835
Rates 1.765 1.361
Clinical
0.134 0.109
waste
Refuse 0.109 0.226
Water
0.076 0.091
rates
Glevum Way Surgery, Gloucester
Grand
7.716 8.622
Total
*Source: NHS Gloucestershire CCG
267. Summary
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277.1 Where are we now?
• Acceleration in strategies to develop more integrated care through NHS Long Term Plan
• Gloucestershire is now an established Integrated Care System, with organisations developing shared service strategies and plans. It
is expected that the strategic development of primary care premises will become even more aligned with other organisations and
care sectors
• Ongoing changes within primary care, with extended teams providing a greater range of services seven days a week in larger
facilities or through practices working together (typically for around 30,000 - 50,000 patients) as part of Primary Care Networks
• A number of new primary care premises have been completed, whilst others have been approved and are progressing in line with
plans
• Significant investment made around £1.3m of additional annual revenue to support around £45m capital costs of developments
• Population growth in Gloucestershire between 2019 and 2031 (12 years) forecasted to be 71,492 people (in line with the 2016
plan)
• The number of people in each new household has been adjusted from 2.19 to 1.62 people to take into account assumptions around
the number of single people buying homes and the proportion coming from existing Gloucestershire households
• There are still a number of practices providing services in facilities significantly smaller than would be expected. This position
worsens over the next ten to fifteen years if there is no investment in new buildings or extensions
• The current physical condition and functional suitability of some main GP surgery building are no longer satisfactory for the long
term
• There are likely to be a very small number of unique situations which the CCG will need to take into account as part of the strategic
prioritisation process
• As anticipated, the PCIP has been informed by other strategic developments. The Forest of Dean community services review
means that the development of options for new facilities for primary and community-based services in the south of the Forest of
Dean has been brought forward
• Due to financial constraints, the CCG will not be able to invest in all the schemes it would like to. It will therefore strategically
prioritise against the challenges and business cases for each proposal will ensure they provide a compelling case for change and
represent value for money for the period beyond 2021, up to 2026 28Part B
How are we going to get there?
Delivering the 2016 to 2021 plan and
identifying priorities for 2021 to 2026
298. Ongoing delivery and future priorities
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308.1 2021/2026 PCIP – strategic prioritisation
How premises are prioritised
• Only include practices not already prioritised
• Have a high level assessment across five elements
Condition of • Practices are awarded a point for each element it appears in
building
(normally maximum of five points)
• Buildings assessed as being in an unsatisfactory condition in the
recent estates survey receive one point
Capacity of • Buildings assessed as unsatisfactory in the recent estates survey
building in 2031
45% or more
Determining Functionality of
receive one point
building
smaller than it
should be key priorities • If the physical capacity of a building (the internal area in square
– the metres) is 45% or more smaller than current NHS England sizing
regulations. Two points are awarded (highlighting the importance of
strategic prioritising practices that have a lack of space in 2019)
elements • If the physical capacity of building (the internal area in square
metres is estimated to be 45% or more smaller than current NHS
Capacity of
building in 2015 England sizing regulations, one point is awarded
Specific, unique
45% or more
smaller than it
factors • If there are specific, unique factor, these have been taken into
should be account
• Priorities have then been put into groups
Priority Groups explained
Appendix 2 sets out the CCG’s additional priorities:
• Priority group 1 schemes - top priorities
• Priority group 2 schemes - important priorities expected to be developed over the five year period
• Priority group 3 schemes – will continue to be reviewed but unlikely to be taken forward during the period unless there is
significant change
• Priority group 4 schemes – unlikely to be considered during 2021 - 2026 unless there is a fundamental change to existing
circumstances
318.2 Forward look new priorities – 2021 to 2026
Integrated
Locality Premises proposal
Partnership
Development/replacement of facilities for the
Overton Park and Yorkleigh surgeries, ideally
Cheltenham
as colocated services in one building for
around 22,000 patients
Review of primary care facilities requirements
across Drybrook and Mitcheldean to support
Forest of Dean
long term provision of local services with a
single site for around 11,000 patients
Review of options for the development of
Gloucester City Bartongate surgery in Gloucester City for
around 9,000 patients – expected extension
Review of options for the development or
replacement of Cheltenham Road Surgery in
Gloucester City Cleevelands Medical Centre site, Bishop’s Cleeve
Gloucester for around 10,000 patients in
addition to extension of Highnam surgery
Review of options for the development or
Cotswolds replacement of Campden surgery in Chipping
Campden for around 6,000 patients
Development of Chipping surgery in Wotton-
Stroud & Berkeley under-Edge, which was adopted as a priority
Vale in 2018/ 2019 (being delivered through an
improvement grant)
329. ILP, cluster and practice programme framework
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339.1 Overview
A full breakdown of plans and
supporting evidence is attached
at appendix 3 and the following Gloucestershire
section provides a summary for
each ILP ICS
Cheltenham Cotswolds Forest of Dean Gloucester Stroud Tewkesbury
ILP* ILP* ILP* ILP* ILP* ILP*
PCN PCN PCN PCN
PCN PCN
North Berkeley
Aspen
St Paul's Cotswolds Vale Tewkesbury
Central Forest of Dean HQR Winchcombe
South Stroud
Peripheral Cotswolds Newent
Inner City Cotswold
Staunton
North South Severn Health
Gloucester
(NSG)
*
Integrated Locality Partnerships (ILPs) are Gloucestershire’s localised version of NHS England’s ‘Place’ level
The ILPs will help to deliver ICS, Health & Wellbeing and local priorities
ILPs will also support PCNs to deliver
Each ILP will collectively develop an ILP plan for their place9.2 Cheltenham ILP summary
• Population projections - 175,000 patients by
PCN Practices 2031
Corinthian Surgery • New Cleevelands Medical Centre completed
Portland Practice and open
St Paul's Royal Well Surgery • Stoke Road refurbished and extended
St Catherine's Surgery
St George's Surgery
• Winchombe extended
Berkeley Place Surgery • Delivery of Prestbury Road Primary Care
Crescent Bakery Surgery Centre due to be open end of 2020
Overton Park Surgery • Delivery and procurement approach for a
Central
Royal Crescent Surgery
surgery at North West Elms housing
Underwood Surgery
Yorkleigh Surgery development
Cleevelands Medical Centre • Condition of remaining estate relatively
The Leckhampton Surgery acceptable but some surgeries undersized
Peripheral Sixways Clinic
• Overton Park and Yorkleigh – 2021 to 2026
Stoke Road Surgery
Winchcombe Medical Centre
priority
• Reviewing options around Leckhampton and
Sixways
359.3 Cotswolds ILP summary
• Population projections - 98,554 patients
Chipping Campden
by 2031
Cotswold Medical Practice
North
Mann Cottage Surgery
• Completion of Cotswold Medical Practice
Cotswolds refurbishment
Stow Surgery
White House Surgery • Completion and opening of Stow surgery
Cirencester Health Group • Completion of new surgery in Tetbury
Hilary Cottage Surgery • Completion of new surgery at Chesterton,
South Phoenix Health Group Cirencester
Cotswolds Rendcomb Surgery
• New surgery to replace Avenue and St
Upper Thames Medical Peters Road buildings
Group
• Business case for a new Campden surgery
369.4 Forest of Dean ILP summary
Blakeney Surgery • Population projections – 71,937 patients
The Brunston & Lydbrook by 2031
Practice
Coleford Family Doctors
• Completion of new Cinderford Health
Centre
Dockham Road Surgery
• Complete of new single surgery building in
Drybrook Surgery
Coleford
Forest of Dean Forest Health Centre • Development primary care facilities across
The Lydney Practice the wider Lydney (South of the Forest) area
Mitcheldean Surgery • Review of primary care facilities to support
Newham Surgery operational working across the Drybrook
Severnbank Surgery
and Mitcheldean areas
Yorkley & Bream Practice
379.5 Gloucester City ILP summary
Rosebank Health • Population projections - 196,406
HQR The Hadwen Medical Practice patients by 2031
Quedgeley Medical Centre • Completion of new Gloucester City
Bartongate Surgery Centre Primary Care Hub to replace
Gloucester City Health Centre Gloucester Health Access Centre and
Inner City Gloucester Health Access Centre
Gloucester City Health buildings
Kingsholm Surgery • Development of extension at Highnam
surgery
Partners in Health
The Alney Practice
• Development of options for Bartongate
surgery
Brockworth Surgery
North South • Development of options for Cheltenham
Churchdown Surgery
Gloucester (NSG) Road surgery building
Hucclecote Surgery
• Potential small scale extension to
Longlevens Surgery
Quedgeley Medical Centre
Aspen Aspen Medical Practice
389.6 Stroud & Berkeley Vale ILP summary
Acorn Practice • Population estimated to increase to 131,825
Cam & Uley Family Practice by 2031
Berkeley The Chipping Surgery • Culverhay refurbishment and extension
Vale Culverhay Surgery completed
Marybrook Medical Centre • Delivery of new Minchinhampton surgery
Walnut Tree Practice • New joint surgery for Stroud Valleys and
Beeches Green Surgery Locking Hill in Town Centre
Frithwood Surgery
Stroud • Development of strategic Plan for Beeches
Minchinhampton Surgery
Cotswold Green Health Centre site for 2021/2026
Painswick Surgery
• Development of primary care facility in
Rowcroft Medical Centre
Stonehouse remains a key priority for
Frampton Surgery
2016/2021
High Street Medical Centre
Locking Hill Surgery
• Refurbishment of Chipping surgery and
Severn business case finalisation for phase 2
Prices Mill Surgery
Health extension key priority for 2021/2026 or
Regent Street Surgery
sooner
Stonehouse Health Clinic
Stroud Valleys Family Practice
• Review development requirements in light of
Stroud District Council housing review,
39
particularly around Berkeley, Cam, Dursley9.7 Tewkesbury ILP summary
• Population projections expected to increase
to 50,230 by 2031
• The possibility of the Ministry of Defence site
Church Street Medical at Ashchurch being developed as part of a
Practice new Garden Town of around 11,000
Mythe Medical Practice homes is not included. If the site goes ahead
TWNS assume another surgery site will be
Newent Doctors Practice required. However, in early years of, it is
Staunton & Corse Surgery anticipated patients will register at the
Deveraux Centre
West Cheltenham*
• Parts of Tewkesbury Borough housing targets
impact on practices outside of Tewkesbury
• Condition of remaining estate
• West Cheltenham Medical Practice included in Cheltenham relatively acceptable but
ILP Newent undersized and remains a priority
figures
• West Cheltenham housing (North West
Elms) aligned with Cheltenham
ILP geography
409.8 Overarching programme 2019 to 2026
Estimated Estimated
Estimated
ILP Premises proposal delivery capital
m2 (GIA)
year (open) cost
Cheltenham Single development for Overton Park and Yorkleigh surgeries for around 22,000 patients 2024/ 2025 1,626 £6.7m
Cheltenham New surgery for North West Cheltenham due to new housing developments for around 10,000 patients 2025/ 2026 869 £3.5m
Cotswolds Development of new GP surgery in Chipping Campden to replace existing building for around 6,000 patients 2023/ 2024 520 £2.2m
Phoenix Health Group - development of new facility at Chesterton to replace existing building and accommodate housing
Cotswolds 2021/ 2022 980 £4.0m
development for around 11,500 patients
Cirencester health Group – new primary care centre to replace Avenue and St Peters surgery and possible Park Surgery
Cotswolds 2023/ 2024 1,658 £6.5m
(Upper Thames) for around 22,000 patients
Cotswolds Replace Romney House with a new surgery building in Tetbury for around 10,000 patients 2021/ 2022 874 £3.8m
Forest of Dean Development of a single primary care centre for Lydney and south of the Forest of Dean area for around 17,000 patients 2022/ 2023 1,315 £4.7m
Forest of Dean Development of primary care facilities for Drybrook and Mitcheldean for around 11,000 patients 2024/ 2025 926 £3.4m
Development of a single primary care centre in Coleford to replace current health centre and Brunston surgeries for
Forest of Dean 2021/ 2022 993 £3.9m
around 12,500 patients
Development of primary care facilities for Alney Practice at Cheltenham Road for around 10,000 patients and a small 2026 onwards for
Gloucester City 869 £3.5m
extension to Highnam surgery new surgery
Development of existing Bartongate surgery through refurbishment of overall building to accommodate up to 9,000
Gloucester City 2020/ 2021 150 £ 0.5m
patients – brought forward as improvement grant funding likely to be available
New surgery to replace the Brockworth and Hucclecote surgeries and cover major population growth with total list size of
Gloucester City 2021/ 2022 1,892 £8.0m
23,000 - 25,000
Refurbishment and extension of Chipping Surgery in Wotton under Edge to accommodate up to 10,500 patients- brought
Stroud & Berkeley Vale 2019/ 2020 £1.6m
forward as ETTF improvement grant funding available
Stroud & Berkeley Vale Joint development of new facility for Locking Hill and Stroud Valleys Family Practice for around 15,500 patients 2021/ 2022 1,300 £4.4m
Stroud & Berkeley Vale Development of Beeches Green Health Centre for around 9,000 to 10,000 patients 2025/ 2026 788 £3.1m
Stroud & Berkeley Vale Replace the existing Minchinhampton surgery for around 8,500 patients 2021/ 2022 808 £2.5m
Grand total £62.3m
419.9 Revenue financial framework
The table below shows the budget changes and potential budget changes up to 2025/2026.
Any proposals identified as opening after March 31 2026 are not included.
2015/ 2019/ 2020/ 2025/
2016 2020 2021 2026
Item
budget budget budget budget
£m* £m* £m* £m*
Rent 5.632 6.835 7.290 9.155
Rates 1.765 1.361 1.477 1.949
Clinical
0.134 0.109 0.111 0.122
waste
Refuse 0.109 0.226 0.240 0.265
Glevum Way Surgery, Gloucester
Water
0.076 0.091 0.093 0.103
rates
Grand
7.716 8.622 9.211 11.594
Total
*Source: NHS Gloucestershire CCG
4210. Process and governance
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4310.1 - Business case requirements
New proposals will be subject to a two stage process:
Stage 1 - a short proposal should be completed on the PID template (appendix 4) for revenue requests. NHS England
documentation will be used for improvement grants and other capital requirements. Appendix 5 for proposals less than £1m and
appendix 6 for proposals over £1m.
Stage 2 – detailed business case, following stage 1 approval. This should demonstrate viability and service benefits to obtain CCG
support and the necessary funding. It will need to be compliant with the principles set out in the HM Treasury’s Five case model
style of business case development and should include:
• Executive summary
• Strategic context and the case for change
• Options and options appraisal
• The preferred option
• Financial appraisal
• Commercial case, including benefits and outcomes, value for money and affordability assessment
• Patient and stakeholder engagement/consultation including, where appropriate, other health and wellbeing partners
• Travel plans, if appropriate
• Risk analysis
• Project development adviser team and project timetable
Practices, their advisors and/or their developers have some flexibility in producing their business case . If there is a capital
requirement from NHS England, the NHS England business case format should be used.
Practices are responsible for completing the documents. The CCG may offer help, advice and facilitation.
Business cases need to be at least 8 weeks prior to the proposed Primary Care Commissioning Committee formal review.
4410.2 Improvement grants
The CCG recognises the importance of utilising the Improvement Grant (IG) Scheme as defined in the current 2013
Premises Costs Directions (PCDs) to assist practices expand and/or upgrade their existing premises.
Using IGs to make improvements to primary care premises deliver a direct benefit to patients, e.g. increased clinical
capacity, improved access to services and compliance with national standards such as CQC, DDA, confidentiality, etc.
Larger IG projects such as an extension could also help to ensure more services can be delivered out of hospital.
Improving/expanding existing practice estate can also assist the wider Primary Care Network achieve its aspirations
and in turn the wider CCG/NHS strategic aims.
All practices in Gloucestershire are eligible to bid for an IG in line with national guidance and governance
arrangements, regardless of whether the premises are owned by the practice or leased:
• The PCDs provide a prescriptive list of the types of projects that can and cannot be funded
• The maximum award that can be granted is up to 66% of the overall eligible project costs (meaning the practice
needs to contribute at least 34%)
• The IG scheme works on a reimbursement basis, meaning practices must pay invoices first; there is no scope for
the CCG to reimburse contractors directly
• If a practice is awarded an IG, the building works need to be completed and all funds spent in the same financial
year that the grant is awarded (although exceptions have been made for larger projects)
• The CCG has little flexibility in the application of the rules
Where applicable, relevant documentation attached at appendices 5 and 6 will be used
4510.3 Engagement and equality
Engagement in proposed primary care premises developments
• The key stages for engagement begin with the involvement of the Patient Participation Groups and extend to wider
engagement with registered patients
• An engagement checklist and Standard Operating Procedures set out a framework for engagement during both the
development of a business case and the detailed design and construction period
• The NHS Constitution and other legislation establish the rights of patients to be involved in planning of healthcare services,
the development and consideration of proposals for changes in the way those services are provided, and in decisions to be
made affecting the operation of those services
Equality and health inequalities
• The CCG is required to commission accessible services that respond to
the diverse needs of communities in Gloucestershire and meet its
obligations under the Public Sector Equality Duty (2011)
• There is an expectation that primary care practice development will
consider the needs of all registered patients. Appropriate impact
assessments should be completed to demonstrate that proposals
consider equity of access and seek to reduce health inequalities
For further information and support about patient engagement and equality visit
https://www.gloucestershireccg.nhs.uk/about-you/ or contact the Patient Engagement and Experience team:
glccg.consultation@nhs.net
4610.4 Fees and other cost assumptions
The CCG will follow the National Health Service (General Medical Services – Premises Costs) Directions 2013. Key elements regarding
the reimbursement of fees:
1. In the case where notional rent payments are to be paid in respect of newly built or refurbished practices, the reimbursable
professional expenses are:
• Project manager costs to oversee and give advice to the contractor, up to a maximum reimbursable amount of 1% of the total
reasonable contract sum relating to the construction or refurbishment
• Reasonable surveyors, architects and engineers fees, which taken together may be paid up to a maximum reimbursable amount
of 12% of the total reasonable contract sum relating to the construction or refurbishment
• Reasonable legal costs in connection with the purchase of a site (where applicable) and the construction or refurbishment work
2. Where the practice premises are, or are to be, leasehold premises, the professional expenses are:
• The reasonable costs of engaging a project manager to over the interest of and give advice to the contractor, up to a maximum
reimbursable amount of 1% of the total reasonable contract sum relating to the construction or refurbishment work
• The reasonable legal costs incurred by the contractor
In the case where other fees may need to be paid by the contractor, such as Stamp Duty Land Tax (SDLT), there is no obligation for
the CCG to reimburse any of these costs to the contractor.
It is assumed that that fees will normally either be part of the overall financial appraisal considered for rent reimbursement, paid by
the practice or paid by the third party developer. Only in exceptional circumstances will the CCG consider reimbursement. In such
circumstances, there will be no commitment to 100% reimbursement.
4710.5 Decision making and approval
Wider ICS Capital
Review for strategic fit and financial
strategic proposals
envelope of approvals granted by the
Primary Care Commissioning
alignment ICS Board and
Committee Stage 1 and stage 2
Governing Body executive
Detailed review and formal approval Primary Care NHS England/
of proposals – stage 1 and stage 2
within the overall allocated budget Commissioning Improvement (for
Committee Impact on capital elements)
business cases
Review of draft proposals, provision of of NHS England
feedback on scheme details to practices Primary Care capital decisions
will need to be
and decision to recommend for approval Operations considered by
to Primary Care Commissioning
Committee for stage 1 and stage 2 Group CCG
The Group and team members will
oversee the day-to-day delivery of the Premises
Primary Care Infrastructure Plan. This is
Development ICS Health
the key resource for progressing plans with
Practices and developers to ensure Group/Team Estates Group
proposals meet agreed priorities, provide
necessary patient benefit and represent
value for money. Involvement, development opportunities
Practice/ (constituent member organisation to fund
Production of initial proposals Developer capital requirement/headlease for
(Project Initiation Document ) and primary care proposal), alignment,
Premises proposal implication and review, where appropriate
business case documentation
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