Minutes
Newham’s Estates Strategy 2016-2026
11th February 2016 at Stratford Library E15 1EL
1. Welcome and Introductions
Satbinder Sanghera Director of Partnerships welcomed everyone and introduced the
panel. The panel consisted of:
Dr Prakash Chandra
Steve Gilvin
Bev Norton
Neil Hamer,
Chair NCCG
Chief Officer NCCG
Estates Strategy Lead, NCCG/LBN
Associate Director of Primary Care Commissioning
NCCG
Satbinder Sanghera said that access was the number one issue raised by patients
about primary care. One way to improve access is through an Estates strategy,
which fits in with the future direction of the NHS and its partners. It will help us
develop services and how they can be delivered in a different way. The CCG will be
holding another meeting specifically around primary care access.
Everyone was informed about the comment/question cards which were distributed to
all participants, along with a summary of the Estates Strategy, at the beginning of the
event. Participants were told that they could use the card to ask questions and the
CCG would then respond if they have left their contact details. People could ask
questions as we went along but this was provided to ensure everyone has a chance
to raise key issues, as we invariably run out of time for questions.
2. The Context: the journey so far and what we hope to achieve
Neil Hamer Associate Director of Primary Care Commissioning NCCG
Neil Hamer explained why the CCG had prepared the draft Estates Strategy as a
bespoke element of our Primary Care strategy. Primary care is usually the first point
of contact for patients needing to access healthcare and as primary care is changing
so estates need to change. Estates projects take time to develop and we need to
plan way ahead of time. We have to look at our current capacity, where that capacity
is in the borough, and what we want to do in the future. We have information from
different partners and we are looking at their strategies e.g. London Borough of
Newham, East London Foundation Trust. It is important to get feedback and we
therefore started this process in Summer 2015, involving clinicians, stakeholders and
patients.
Newham is one of the fastest developing areas in terms of population in London.
Population will increase by about 50K residents, and we will have to deliver to, the
equivalent of a new town in five years’ time. We have to be ready to deliver to the
new population and therefore we have to look at the condition of our current estates.
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We are looking at moving the providers of some secondary care services closer to
patients, and we need to ask ourselves if we have the right premises or the right
technology, for that. We put together a draft Estates strategy in December 2015 as a
result of the consultation held so far with providers and patients. This has been
circulated and people are invited to provide feedback. It is still in draft form and will
be signed off after further consultation. We will then make sure it is integrated with
other linked strategies.
Bev Norton Estates Strategy Lead, NCCG/LBN
Bev Norton gave a background to the work to date. All CCGs have had to develop
Estates strategies. The CCG have to look at the current stock of buildings across
Newham and identify how to use everything to the absolute maximum. We have
undertaken the development of the strategy over a period of 2-3 months and we are
awaiting further links to work from Barts Health and East London Foundation Trust.
In Stage Two we will be looking at the strategy and identifying gaps. We are keen
that you help us shape the future of healthcare in Newham. For example we need
services in the right place, with access to public transport, and estates in good
condition that are meeting modern day standards. These are easier to maintain than
old buildings. We need to offer safe access and facilities of adequate in size to
enable a range of services to be delivered. Newham has a large number of small
and singlehanded practices and we need GPs to join with other GPs to create bigger
practices. This will lead to more services and a range of services being offered
closer to communities. Therefore we need estates and buildings that will meet this
need. The next generation of doctors and nurses will want to work in bigger practices
and we are trying to attract them to Newham. We are carrying out clinical reviews
which are leading to more services in the community so that people can access
services more locally.
We need to invest in and spend on premises in the right way. The six key drivers for
change across Newham are around the huge population increase and the move of
activity out of hospital. We will be looking for more premises to support new models
of care. There are also significant developments that LBN are supporting. Two to
three new premises are needed and the borough has huge regeneration plans. We
can make big changes if we make the right decisions. We have approximately 60
practices in Newham, and we want our GPs to work together and show innovation.
For example Dr Prakash Chandra is working with 3 other small GP practices and
there is a new surgery in planning for them to move into. This will have twelve
consultation rooms and two treatment rooms, with space for training new clinicians.
This is the model we want to see. There will be opportunities to develop health and
wellbeing activities alongside services and we will be able to have a whole system
approach.
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The Sir Ludwig Guttmann Centre is only operating at 60% of its capacity and it is a
fantastic facility. We need to use it more and get better value for money. Local hubs
would also be more convenient for people. We also want to explore new ways of
working and new technology. This will offer more options for patients to consult with
GPs, and also enable GPs and specialist consultants at other sites to talk to patients
together.
Bev showed a slide with potential hub locations. New premises will be supported for
practices that have a potential to have 10,000-15,000 patients.
Questions and Answer session led Chaired by Satbinder Sanghera Director of
Partnerships, NCCG
Q. There are a number of new hubs and they will require money to be built and
funded. How will it be funded will it be funded through PFI or NHS England?
A. Steve Gilvin NCCG said that the CCG hold the purse strings. There will be a
variety of ways to fund plans. Some will be in collaboration with LBN through
regeneration schemes. There will be funding combinations and we are working with
developers to achieve it. Capital costs are less of an issue it is the annual running
costs that are the issue. New buildings are expensive resources so we have to have
cost effective models. PFI is not a viable option.
Q. I work for a charity and I am aware that there is a problem in attracting GPs
especially young GPs that are newly qualified to Newham. Does Newham have
a strategy to attract GPs?
A. Steve Gilvin NCCG said there was a shortage of GPs and we need to cope with
the expanding population. There are a number of GPs due to retire and we have a
number of things in place. There is a programme with UCL partners. We are looking
at other types of workers to support GPs e.g. physician assistants who won’t be fully
qualified GPs but have skills that can be utilised. We are trying to create the right
environment and make Newham an attractive place to work.
A. Prakash Chandra Chair NCCG said that there was a shortage of nurses and other
health professionals and we have to think outside the box. We need to ask ourselves
if all people need to see a GP and escalate according to the need of the patient. We
have to find different ways of first contact and that may be through GP assistant
positions and other healthcare professionals. We also need to see how we can
integrate them more in the system e.g. pharmacists being part of a surgery.
We need to look at managing medication and how people take medicines as well.
We need enough space in practices to develop young GPs and independent GP
single practices limit that.
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Q. Can you please explain what a Vanguard site means?
A. Bev Norton Estates Strategy Lead, NCCG/LBN said ‘Vanguard sites’ were pilot
hubs introduced as part of the NHS Five year plan and stated that a glossary
explaining NHS terms would be included in the final version
A. Neil Hamer Associate Director of Primary Care Commissioning NCCG stated that
they want 8,000-10,000 people in each practice. People are keen to work together in
groups to enable sharing of experiences plus practical benefits e.g. holiday cover
and opening for longer hours. There is a drive for 7 days a week services open from
8am-8pm. We need sites to make Newham attractive to new health professionals.
They need to be in the right place and geared up to deliver the right service. It will
not happen overnight but we need to feed into Hubs with a whole collection of
services. This whole approach includes everyone of our stakeholders including
charities, LBN and our clinical services. Fifty-thousand people could be served via a
Hub. Hubs will offer a wider range of services closer to homes.
Q What about hidden workforce e.g. carers who have not been mentioned?
There is a need to work more closely with them. There is also a need to work
with young people and schools to educate them on how to use primary care
and when to use A&E.
A. Satbinder Sanghera Director of Partnerships said that they engaged young people
through the Youth Council and their engagement forum Future Generation. They
also have Diabetes Youth Champions. The young people themselves tell us how
they access services and how they would like to access services. They believe they
should go into schools themselves rather than NHS staff and that we need to use
social media more. This will help us engage more effectively. We also acknowledge
the huge contribution of carers. The CCG have three groups of people that they have
focused on and one was carers. We wanted to know how we could meet their needs
and we developed a Carers strategy. We have held meetings with the lead LBN
Councillor to look at what we can do more of to support carers.
Q. How are you taking account of energy conservation and green strategies?
Hubs and Clusters also need a strategic approach to releasing small practices.
It would be useful to have small teams to visit sites.
A. Satbinder Sanghera Director of Partnerships said he was happy to arrange site
visits. One could be to the Sir Ludwig Guttmann Centre. It is developing all the time
and has lots of different activities.
A. Neil Hamer Associate Director of Primary Care Commissioning NCCG said single
handed practice premises were mostly owned by GPs so it was more of a challenge
for the GPs. But we will have discussions with them.
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A. Bev Norton Estates Strategy Lead, NCCG/LBN said that there were green
principles in NHS design to meet government and building regulation ‘BREEAM’**
requirements.
**BREEAM (Building
Methodology
Research
Establishment
Environmental
Assessment
Q. The Sir Ludwig Guttmann Centre needs a bus route from Stratford as it is
difficult to access. I also want to know about GP retention and salaried GPs
and those that are partners. Recently junior doctors have been reluctant to
work under contract because of uncertainty. Where do you stand on salaried
GPs?
A. Satbinder Sanghera Director of Partnerships said they were lobbying TFL
regarding bus access to the Sir Ludwig Guttmann Centre.
A. Prakash Chandra Chair NCCG said the current discussions on the new contract
may impact of doctors wanting to leave the country e.g. they can cross the border to
Scotland and get a better work life balance.
A. Steve Gilvin Chief Officer NCCG said that 60% of GPs in Newham were salaried.
It is a step at the beginning before becoming a partner. It is seen as a transition a
few years after they qualify. We are encouraging that. The changes to the hospital
doctor contact may encourage more to become GPs rather than work in hospitals.
Q. Why are Walk in Centres being closed down?
A. Satbinder Sanghera Director of Partnerships said the future estates strategy
needed to look at who uses them and to look at where resources go. They are more
expensive than going to a GP. NHS England have said that we have to run Walk In
centres now and with less money. So we had to make a decision about access for all
the population. We have to think of value for money and longer term plans and not
short term plans.
A. Prakash Chandra Chair NCCG said access had improved and that there was no
evidence that Walk In Centres have improved experience or access or health
outcomes. They have failed miserably so we did not want to waste funds.
Q. This was around individual practices and how much control the CCG had or
could manipulate estate. Most people are not near their GPs during the day
between 8am-5pm but we have to be registered near our house. What about
registering near your place of work and could you place GPs in schools?
A. Steve Gilvin Chief Officer NCCG said many GP practices are owned by GPs but
all premises have to meet regulations and standards. If the CCG considers it would
be advantageous to move services options can be discussed with the GP owner and
as the residential value of property has gone up and some might now want to sell
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their practices. We have to take an individual approach and work towards the aims of
the strategy.
We also have to look at how primary care is organised. People are at work when
they are well and at home when they are ill, thus it is important that a patient’s GP is
accessible should a home visitbe required. We are trying to make sure there are
‘extended hours’ offered so people can access a GP before and after work and at
weekends, so people do not have to take time off. We are also looking at new
technology and successful pilots e.g. young people with diabetes using SKYPE.
There are different ways you can get advice. GPs will also need to manage the
technology from their end.
A. Prakash Chandra Chair NCCG said that you can register near where you work as
long as you understand that you cannot get a home visit.
Q. What do Estates include?
A. The draft Estates strategy is about NHS estates. As the next version is prepared
we need to include more on the linkages with community partners and hospitals.
Then the next stage is to include pharmacy premises.
Q. This question was about looking at spaces in a holistic way and co-location
with community groups. How can community groups co-locate and is this a
priority with the Sir Ludwig Guttmann Centre?
A. Steve Gilvin Chief Officer NCCG said that it was a high priority with the CCG to
get practices and the community to work together, as sometimes GPs are not the
best people to support someone. The CCG are mapping resources that are out
there. The Sir Ludwig Centre is of a high standard and not cheap to run, Running
costs are high and we cannot charge that to a community group which is a dilemma
for us. We want to look at development of new opportunities together e.g. Canning
Town.
A. Prakash Chandra Chair NCCG said he was already planning to be based within a
community centre. We are trying to work in hubs and the 8 clusters in Newham so
we can develop a system where we can support each other and work more
holistically.
A. Satbinder Sanghera Director of partnerships said that 35% of the Sir Ludwig
Guttmann Centre was for the Community Trust and that they were trying to develop
a community trust to have its own lease. They will want to give some space as
commercial rent that will give them revenue. They will have space for community
groups. Satbinder said he was a trustee and they have recruited the first residents
on the community trust. They are nearly ready to think about services local people
need. This is a model we have envisaged.
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Q. This was a question about new buildings and facilities as new services do
not have hoists or changing facilities that met the needs of a participant’s son.
A. Satbinder Sanghera Director of Partnerships said that was helpful to know.
Q. How will social services be able to cope with the population increase
especially around discharge?
A. Satbinder Sanghera Director of Partnerships said that A&E meet the 4 hour target
for people to be seen and will make sure the health and social care system works
well. The discharge system was good. We are aware of the huge financial pressures
on LBN and we are joining up and working together so people can navigate through
the system and reduce waste. Integrated care is important to get right and will save
us a lot of money in the long run. It is worrying though.
A. Prakash Chandra Chair NCCG. Two years ago there were big improvements.
Hospitals and social workers have been working together on discharge. We have to
commission in a new way to meet demands.
Q. I am worried about the Sir Ludwig Centre income generating from the
community.
A. Satbinder Sanghera Director of Partnerships said that the Government said a big
part of the centre has to be for community use. The Centre has also given space to a
pharmacy, the rental from which resources other activities. We need to think of the
vision of the Centre. All the funds earnt through private enterprise working alongside
the NHS elements will be spent on the community. Part of the space has gone to a
community café and we could have a rehab unit there and other providers providing
exercise therapy. Trustees will have to demonstrate income generated and usage.
Q. What does SLG stand for and what are HCPS and HSBs? Please explain if
you are using abbreviations.
A. The CCG will explain abbreviations in the glossary and try and limit use.
SLG = Sir Ludwig Guttman Centre
HCPs = Healthcare professionals
Q. Services provided at home by LBN not being managed and some health
services as well. Health services can get into debt but LBN cannot go into debt
by law.
A. Steve Gilvin Chief Officer NCCG said LBN work well with us. Newham Hospital is
the best functioning hospital around discharge. LBN play a big role in that. Steve
Gilvin said that the CCG leads would be in trouble if they overspent.
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Next Steps
The CCG will take the feedback away and have further engagement. While they are
developing a strategy they try to respond to resident’s concerns and suggestions.
We have talked about services we want in the community and we have talked about
workforce. We will also feed this into the Primary Care Strategy. There will be a lot of
engagement on the Primary Care Strategy.
We have the largest number of developments in Newham. There are 22
developments currently underway. There is a lot going on in the borough and it is
very exciting.
On a final note Steve Gilvin Chief Officer CCG said that he was a big fan of general
practice. Relationships people have with their GP were important and we need to
preserve the best features and modernise into the 21 st Century. At the heart of
developments will be the relationship between GP and the patient.
The CCG thanked all the participants
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Questions Handed in on Cards
1:
If new Hub is to be built, then will it be built using PFI Finance of
financed directly via the government. We want to avoid the disaster of
new Barts hospital crippled by interested payments. Money saved
(drawn arrow pointing to) patient care.
New premises in Newham will be built using a number of routes. GPs, either
as a practice or working with third party developers will fund the build and be
reimbursed through an annual rental payment from the NHS. Some capital
funding may come through local government funds (section 106 or community
infrastructure levy) or through the NHS Primary Care Transformation funding.
Some new builds may be as part of the planning permission delivered by
developers giving a shell and core building for NHS use. This will need to be
fitted out.
The PFI route is very unlikely to be used.
2:
Why so many patients are still in hospital after Surgery is due to lack of
rehabilitation centre and activity centre for the recovery of patient
health.
The CCG commissions a number of community services that may be
appropriate for someone who has had surgery. These include:

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3:
Cazaubon Rehabilitation ward at East Ham Care Centre
Extended Primary Care Team service which includes
- Virtual ward, hospital in reach and supported discharge and rapid
response
- Integrated care enhanced services – including health and social care
navigators, case management and community specialist support
(dedicated community geriatrician)
- Adult community nursing (District Nursing, Out of Hours nursing, End of
Life Care, Telehealth)
- Occupational Therapy for palliative care patients
- Speech and language therapists and capacity to support physiotherapy
needs of patients within the VW (including RR patients)
We must have full integrated care with social care and diagnostics and
mental health.
We are working with LBN on seamless services for the residents of Newham
for mental health. Our provider East London Foundation Trust is redesigning
the services they offer to make them more integrative, Social Care services
are accessed through the MHAT (mental health access and treatment team)
that can contacted via the LBN switchboard.
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4:
Define what services are provided at a Hub
The hubs will offer a wide range of services, which may include - see table
below:
HUB activity (opportunities to be confirmed)
Diagnostics
OPD- One stop clinics
Ultrasound
Audiology
X-rays
Cardiology
ECG/Echo
Community Paeds
Phlebotomy
Dementia clinics
Minor surgery
Dermatology
Family planning
Elderly care
Point of care testing
EMH
ENT
District nurses
Gynae
Health visitors
IAPT
Baby clinics
Ophthalmology
Mental health team
Physiotherapy
Podiatry
Voluntary sector
Psychiatry
Benefits counsellor
Sexual health
Pharmacy
Speech and language
Social services
5:
Opening hours of a hub – 7 days?
Hub will offer extended hours, which may be 08.00 – 20.00 over 5, 6 or 7 days
6:
What is the difference between Hub and a Polyclinic?
Nothing.
7.
Hub should have expert mental health teams rather than centralised at
hospitals.
This option is being considered.
8.
Have you thought about providing an e-clinic – live chat – to keep
people out of surgeries but to get professional clinical advice?
Yes the plan to reduce appointments at GP surgeries is to use modern
technology such as email and SKYPE (or similar) – Hurley group already
offer.
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8:
How far is Newham CCG interested in the Tower Hamlets integrated
intermediate care development?
Three boroughs – Newham, Tower Hamlets and Waltham Forest are following
the Integrated Care Model developed by McKinsey and this has been agreed
with the three CCGs. Each CCG is adapting the model to suit local needs to
flex around the needs of local patients. Newham CCG is implementing the 9
core integrated care interventions.
Comments and suggestions

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

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SLG GP centre has poor transport link. Can we ensure proper integrated care
as patients are shifted away from hospital? Only 60% utilised.
Mapping services third sector and social care all under one centre.
Educating young population in school, importance of primary care and patient
groups facilitated in GP practices?!
Carers’ unpaid workforce. Need to be valued.
Supporting bad GP practices some good practice.
Access needs (learning disabled people PA to support them, BSL for deal
community at GP Practice, visual impairment sighted guidance’s to attend GP
practices, speaking voice for visually impaired public in GP surgery)
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