Agenda item

The Board received a presentation, from Jonathan Weaver, NHS England, and Cassie Williams, Assistant Director of Primary Care Quality & Development which gave an overview of key developments relating to the development of additional Primary Care capacity, particularly in Tottenham. Following the presentation the Board discussed the findings.

A copy of the draft Strategic Premises Development Plan was included in the agenda pack; the Board noted some of the key issues raised by that report. The current progress to date was summarised as:

• The baseline for Haringey primary care locations and their conditions were identified.
• Growth areas were identified.
• Capacity plan had been undertaken in key areas of focus across predominately the east of Haringey.
• The Board was requested to give comments on the draft report prior to its submission to July FIPA (NHSE financial planning committee) for NHS England endorsement.

The main conclusions of the report were noted as:

• Haringey was identified as having a poor primary care estate – 79% of the premises were identified as being red or amber rated for non-statutory compliance.
• Haringey population predicted to increase by 37k by 2026
• All of Haringey wards fall in top half of deprived wards nationally, and 8 were in the top 500.
• GP practice capacity pressures identified in east of borough. (particularly around Tottenham Hale)
• Many residents c.28,500 (10.5%) in Haringey were registered with a practice outside of the borough.
• No evidence of a significant number of unregistered residents
• The need to plan for retiring GPs was identified as a key consideration, particularly in terms of the potential for existing capacity issues to be exacerbated. 

The key recommendations of the draft Strategic Premises Development Plan were outlined as:

• Pursuing with Primary Care Infrastructure Fund (PCIF) applications.
• Appetite to absorb current capacity issues to be determined through dialogue with GPs.
• New Primary Healthcare facilities needed to be established. The Board noted that this would be a medium to long term solution to capacity issues. Mr. Weaver commented that new primary healthcare facilities would need to be built with a view to co-location with other services and linked into planning cycles with housing developments.

Mr. Weaver advised the Board that the draft Strategic Premises Development Plan identified that, with expected population growth levels over the next 10-15 years including the current deficit, an additional primary care capacity for 70k people could be required as a worst case scenario. This translated into 39 additional doctors (Whole Time Equivalents) and 7,842 square metres of additional consulting capacity.

The following short term responses from NHS England to the recommendations from the Draft Strategic Premises Development Plan,  were noted:

• A temporary new surgery in Tottenham Hale established by autumn.
• Existing surgery premises improved, based on PCIF Bids incl. increasing consulting room capacity.
• Practices encouraged to bid for next round of PCIF & for 2015/16 Improvement Grants for existing surgery premises based on PCIF Bids.

In addition, by 31^st March 2016:

• GP succession plans developed.
• Focus on existing GP contract performance.
• Schemes explored to facilitate more efficient operational use of existing GP premises.

Proposals for the medium / long term primary healthcare needs of Haringey were identified as:

• Permanent new health facility in Tottenham Hale established (3-5 years).
• Permanent new health facilities established in other strategic locations in Haringey (3–10 years), this was yet to be determined. Suggested locations for additional sites were noted as:

·         A second site in Tottenham Hale

·         A site in Noel Park area

·         A site in Northumberland Park Area

• Each individual premises development would be required to develop a business case and further detailed analysis prior to agreement from NHS England. Mr Weaver noted that the approval of the draft Strategic Premises Development Plan by FIPA in July would expedite the process for approval of the business case for the above sites by an estimated 3-6 months.

The Chair invited the Board to focus questions around the specific issue of primary care capacity around Tottenham Hale first. The following questions and responses were noted.

Sharon Grant, Chair of Healthwatch Haringey, commented that she had concerns that delays could occur to securing the practice that would operate the temporary additional premise and requested reassurances that additional primary care capacity would be implemented quickly and would not be held up by a lengthy procurement process. Mr Weaver responded that NHS England was fairly confident that they could secure the additional practice. Mr Weaver also stated that NHS England were working as hard as they could to adopt an innovative approach to try and find a route that would put a facility onsite as soon as possible, and that the facility would include additional GP capacity.

The Board noted that the autumn timescale was based on a realistic assessment of the process and the steps required in establishing the practice. The Chair, Cllr Kober, welcomed the commitment from NHS England to find an innovative solution to the problem in the Tottenham Hale area, but reiterated the scale of the issue that existed in Tottenham Hale and reaffirmed the need to deliver the additional capacity as quickly as possible.

Cllr Kober commented that the process had highlighted the difficulties that existed in terms of being able to augment significant changes and requested reassurances that the borough would not be subject to similar circumstances in the future, whereby it was only at the point where residents have had to suffer significant shortfalls in service that remedial action was undertaken. Mr. Weaver responded that he had met with local residents and understood the sense of urgency involved, Mr. Weaver committed to get the additional facility up and running as soon as possible. The Board noted that, going forward, the challenge was to ensure that theStrategic Premises Development Plan was kept up to date and was maintained as a live document, so that the Board could use it to access funding and opportunities when they became available.

Cllr Morton, the Cabinet Member for Health & Wellbeing, thanked the contributors for the work that had been undertaken in the past months. Cllr Morton reiterated the concerns raised by the Chair and Ms. Grant that the situation as it existed in Tottenham Hale was wholly unacceptable and welcomed the evidence compiled and the progress made to rectify the primary care deficit. 

Cllr Reith welcomed the body of evidence that had been compiled, but commented that the issues were raised by residents a year ago, supported by Healthwatch Haringey, and questioned why work couldn’t have begun a year ago in parallel to the evidence gathering process. Cllr Reith requested a commitment from NHS England to work in parallel going forward to prevent further delays. Mr Weaver acknowledged Cllr Reith’s concerns and commented that the proposals included a back stop date for those parallel pieces of work, noting that that this was however reliant upon working with partners. Mr. Weaver advised that the next meeting of the primary care task and finish group would involve going through and agreeing the timetable for delivery of all of the specific pieces of work contained in the draft Strategic Premises Development Plan.

Ms. Herman enquired as to how NHS England would prevent similar issues happening again in the future, particularly around a perceived lack of adequate forward planning. Ms. Herman sought assurance that the Strategic Premises Development Plan would be kept as a live document and asked how the Board could ensure that it was updated and was something that people would take notice of. Mr. Weaver commented that the process of NHS commissioning was constantly changing and that more changes to primary care commissioning were in progress. The Board noted that a key challenge was to manage the transition in responsibility for commissioning primary care from NHS England to the CCG and to ensure that the different organisations maintained a forward facing view. Mr. Weaver commented that the draft Strategic Premises Development Plan provided the basis to move forward on the issue and that the Board would hopefully provide additional impetus to ensure that the document did not fall out of date.

Ms. Williams advised that from a CCG perspective, premises were one of the key priorities within NCL and that discussions were already underway about how to ensure that the document was kept live and how the CCG could use the information to ensure that sufficient forward planning was undertaken.

Zina Etheridge, the Deputy Chief Executive, advised that parallels existed with the process of school place planning, where the Council looked at changes in demand and a series of other key considerations on an annual basis. A set of principles were used  and the Council’s attitude was that despite legislative changes having affected the powers available to the Council, that the Council still maintained a leadership role of understanding what the overall needs of its residents were. Ms. Etheridge suggested that the Board may want to consider an annual process of bringing the Strategic Premises Development Plan back to the Health and Wellbeing Board for review. 

Dr. Dhorajiwala echoed previous comments welcoming the development of the Strategic Premises Development Plan. Dr. Dhorajiwala asked how it might tie in with the theme of the emerging community education provider networks. Dr. Dhorajiwala also asked how training practices such as the Vale, could feed into this work. Mr. Weaver noted that in addition to the task and finish group, a collaborative approach was required from all partners. Mr. Weaver welcomed other groups, such as local GP practices, being brought in who could provide solutions to issues such as training, utilisation of buildings and recruitment and retention of practices.

Ms. Grant supported Ms. Etheridge’s suggestion of holding an annual review of planning for general practices in the area. Ms. Grant suggested the Board would want a report back every quarter to monitor progress and ensure the document was live, at least until some of the shorter term issues had been resolved. Cllr Kober responded that a further primary care update would be on the next agenda, including the status of a new temporary practice in the Tottenham Hale area. Cllr Kober commented that the Board should have a discussion on the monitoring arrangements for primary care at the next meeting, once the new temporary provision was in place.

Ms. Grant commented that there was a discrepancy between the report coversheet and the body of the report in the agenda pack, around the working time equivalent projected levels of GP’s required in the Tottenham Hale area with 10.4 and 16 quoted respectively. Mr Weaver agreed to look into the discrepancy and feed back to the Board.

Cllr Morton noted that the report described the NHS England’s four stage approval process for construction, refurbishment and capital project activity and requested clarification on this process. Mr. Weaver responded that the process normally started with a PID, which was then expanded into an outline business case and then a full business case. The final stage was a sign off process by NHS England. Each stage then went through a ‘pipeline’ governance body before going to FIPA (financial planning committee). The Board noted that the Strategic Premises Development Plan document should help shorten the process in this instance.

Ms. Herman queried how the Board ensured a strategic view in the longer term was built into this commissioning work. Mr Weaver acknowledged the need for a strategic view and reiterated the need for NHS England to work with its CCG partners. Mr. Weaver noted the example of co-location of non-primary care premises with the CCG as well as the long term strategic possibilities of co-locating with Council services.

The Chair thanked colleagues from NHS England for their contributions.

RESOLVED:

I). That the content of the plan be noted, and the recommendations for the plan for substantial improvement and development of the primary health care estate in Haringey over the next 10 years, be agreed in principle.