Governing Body report
Paper: 4.1
Date 18 th March 2014
Title of paper
Presenter
NHS West London CCG Strategic Service Development Plan
Alison Kemp NHS West London Clinical Commissioning Group
Author Kate Brady project Manager
Responsible Director Carolyn Regan Managing Director
Clinical Lead
Confidential
Fiona Butler Chair
Yes No (items are only confidential if it is in the public interest for them to be so)
The Governing body is asked to:
Note the approach and content of the Strategic Service Development Plan (SSDP)
Endorse the estates evaluation process to identify options for hubs in the north and south localities
Note the further work required in relation to Primary Care Estate
Adopt the SSDP subject to finalisation of the Primary Care Estate assessment
Summary of purpose and scope of report
The report provides the outputs of the extensive review of the impact of the CCG vision for Out of Hospital care in terms of projected activity volumes for different elements of the service and offers a way forward in terms of delivering the required capacity in respect of the workforce, informatics and estates.
In preparing this SSDP the CCG has worked closely with the Commissioning Support Unit to ensure consistency of approach, methodology and assumptions with the parallel work being developed across the whole of NW London.
Given the overarching strategy articulated by SaHF there is recognition that key planning assumptions will be reflected across the 8 CCGs and the methodology for the evaluation of primary care estate plus the identification, selection and prioritisation of hubs will be consistent.
However this SSDP does reflect the local needs.
The SSDP has two distinct parts:

Part 1 outlines the local context and the wider (regional and national) strategic context. These directly influence the likely increase of demand in out of hospital settings and the local response to this (the proposed model of out of hospital care)

Part 2 presents a summary of the implications for workforce, informatics and estates but focuses most heavily on the implications for the estate in West London, which will need to be of sufficient quality and have sufficient capacity to successfully deliver the new model of out of hospital care.
This SSDP identifies how we might transform our existing estate to ensure its effective use and where we might need to invest in our estate. We focus in particular on the additional space requirements and the case for the
Page 1 of 5

Governing Body report
Paper: 4.1 development of locality-based hubs. We briefly outline the plans being developed for the GP estate before looking in detail at the associated idea of hubs.
The CCG has undertaken considerable work in terms of understanding the workforce and informatics infrastructure required to support the future vision and this is fully reflected in the SSDP. The new outputs provided by the document relate specifically to the estate and at this stage more specifically the quantification of the size of hub required for each locality and the options available within the existing health estate to accommodate these needs.
The OOH vision, in line with the broader NW London approach, has classified activity in terms of its likely location for delivery and has highlighted the importance of hubs. The CCG has always perceived a need for a hub in both the north and south of the catchment area. This SSDP reflects that vision. However it has also recognised the potential impact of alternative developments adjacent to the CCG- and specifically the potential for the development of an
Integrated Primary/Secondary Care Hub on the St Mary’s site.
The key highlights within the report include
1.
Key activity assumptions and projections
In modelling the projected activity there are number of key principles which the CCG has accepted:

20% of GP activity will be provided within the hubs

Population growth of 7.7%

Average attendances per patient per annum 6.4

Transfer of 55,000 appointments from secondary care (35%)

Shift of 50% community mental health activity

All high and low level out of hospital diagnostics to be provided at the hub
The above assumptions have been applied to both the north and south locality to provide indicative activity volumes, which will be anticipated for each hub. In completing this exercise the team have been mindful of the potential development of a further hub at St Mary’s and this has then been translated to the next stage of confirming capacity required in each location
2.
Impact on Capacity
A standard modelling approach has been taken to the translation of activity levels into space requirements and these have been mapped based on the patient population distribution.
This has confirmed that the estimated space requirement for each locality will be:

North: 2400m 2

South: 1800m 2
3.
Hub locations and options
A standard approach has been adopted across NW London to the selection of options to be taken forward for hub locations.
For each long listed location key threshold criteria have been identified:

Size (minimum 500m 2 )
Page 2 of 5

Governing Body report
Paper: 4.1

Evidence of sufficient out of hospital activity, demand and patient catchment population

Sufficient available or underutilised space to accommodate the projected requirements
Application of these criteria identified three potential locations in the north and four in the south.
The following prioritisation criteria were applied to each:

Achievement of the out of hospital strategy

Value for money

Accessibility (transport and Disability Discrimination Act)

Commitment to space utilisation

Condition of the estate

Population- including mapping of 65+

Deprivation
This has resulted in a short list of options to be fully worked up at Outline Business Case stage which are as follows:

North: St Charles Centre for Health & Wellbeing and St Quintin Avenue

South: Violet Melchett, World’s End and New Marlborough School
4.
Primary Care and Community Estate Assessment
In parallel to the work on hub provision it is essential to ensure that the quality and capacity of the wider primary care estate is capable of absorbing the projected changes in service delivery and are fit for purpose.
The assessment has been based on three criteria:

Physical condition

Accessibility (specifically Disability Discrimination Act Compliance)

Utilisation
A number of the local practices and community buildings have been physically surveyed and a methodology developed to extrapolate the findings across the 54 practices within the CCG.
The findings in terms of physical condition and accessibility have rated practices in terms of whether against each criteria the practices are:

Acceptable

Requires refurbishment

Requires reprovision
The implications for WL CCG would suggest that against each of the condition and accessibility criteria there will be a requirement to reprovide a number of practices (between 2 and 19 based on the extrapolation methodology) although work is ongoing to confirm the extent and detail of the required investment. The quantification and approach to prioritisation is being developed in conjunction with NHSE Primary Care together with the assessment of capital and revenue funding availability.
The utilisation assessment has focused on the ability of practices to absorb activity that it is projected will be
Page 3 of 5

Governing Body report
Paper: 4.1 delivered within specific practices rather than at a hub level. This exercise would suggest that much of the required activity could be absorbed through improved utilisation of existing facilities – however there is an overall shortfall however further analysis is required to understand how the impact of integrated ways and working and provision of relevant access and opening hours (including telephone/virtual access/extended opening) will enable the CCG to derive maximum benefit from estate/facilities
More detailed feedback on this will be provided as the position is clarified, however a capital funding estimate of
£17m within the Shaping a Healthier Future Decision Making Business Case remains valid.
Quality & Safety/ Patient Engagement/ Impact on patient services:
The Strategic Service Delivery Plan is a key vehicle for the translation of the Out of Hospital Strategy and the OOH
Delivery Strategy into an assessment of capacity and capability of the Estates/Facilities within the CCG to accommodate the service model and activity levels. The proposals confirm the extent and value of the investment profile to ensure that patients are treated at facilities, which fit the vision for the future and are fit for purpose.
Adoption of the Plan will allow the CCG to work with NHS Property Services an NHSE Primary Care in establishing the optimum estates profile to match patient needs.
The future provision of estate to facilitate the delivery of the OOH vision has been widely shared with stakeholder groups however the detailed modelling and capacity implications have to date been subjected to internal scrutiny
Financial and resource implications
The high-level assessment of capital investment for construction/building works required:
1Hub pipeline- £6-7m
2Primary Care Estate- £17m
Discussion is required with NHSE in terms of funding streams
Preparation of the document and the key findings have been shared with the Chief Financial Officer and team
Equality / Human Rights / Privacy impact analysis
An equality impact assessment will be undertaken as part of each business case arising from adoption of this SSDP
Risk
The specific risks of each development proposal will be established as part of the business case development process
Supporting documents
Attached
Governance and reporting (list committees, groups, or other bodies that have discussed the paper)
Committee name Date discussed Outcome
Page 4 of 5

Governing Body report
St Charles Redevelopment Project
Board
11/03/2014 Supported
Paper: 4.1
Page 5 of 5