Investment in Primary Care Estates in Bedfordshire, Luton and Milton Keynes
Many GP practices and Primary Care Networks (PCNs) across BLMK aspire to improve their premises to meet the growing needs of their local populations. These aspirations include, but are not limited to, the development of new premises, extensions to existing premises and the relocation and consolidation of existing surgeries to Integrated Health and Social Care Hubs.
To support these ambitions, Bedfordshire, Luton and Milton Keynes Integrated Care Board (BLMK ICB) intends to invest an additional £1.95m per annum in primary care estates. This represents a 22% increase in the ICB’s investment in primary care and takes the full amount spent on primary care estates to just under £11m per annum by 2025/26.
This additional funding will enable twenty-three local projects to progress, with benefits for a wide range of communities across Bedford Borough, Central Bedfordshire, Luton and Milton Keynes.
The ICB’s current revenue budget for primary care services was, unfortunately, not able to support all those GP practices and Primary Care Networks wishing to make improvements. The ICB carried out a robust prioritisation exercise, based on national criteria with aligned clinical leadership, to arrive at the list of the twenty-three schemes that can be supported. The criteria used can be viewed here.
There were thirty schemes unable to be supported through this process. The ICB will work with partners to explore opportunities to progress these schemes and will continue to support practices and PCNs with addressing operational pressures as necessary.
For full details of the decisions made at the extraordinary meeting of the Primary Care Commissioning and Assurance Committee on 11 January 2023, click here for the brief.
The decisions of the Primary Care Commissioning and Assurance Committee will not be reconsidered or discussed at the next Integrated Care Board meeting on 27 January 2023.
As a result of the announcement that a by-election will be held in the Mid Beds constituency on 19 October 2023, the ICB will hold the September Primary Care Commissioning and Assurance Committee (PCCAC) meeting in Private. This is because the ICB is responding to the rules which surround the activity that can take place in public before an election. Any decisions will be shared following the election to ensure we continue to be transparent with residents about the services we are delivering locally.
On the 11 January 2023, an extraordinary meeting of the Primary Care Commissioning and Assurance Committee took place to discuss a prioritisation programme of primary care estates across Bedfordshire Luton and Milton Keynes. The decision of the Primary Care Commissioning and Assurance Committee will not be reconsidered or discussed at the next Integrated Care Board meeting on 27 January 2023.
The Committee meeting was held in public and was well attended by elected officials and residents. You can see the papers that went to the Committee here. The Committee made the following resolutions. It:
Received the outcome of the primary care estates prioritisation process.
Approved the recommended list of schemes to be supported in principle, including the schemes with marginal revenue impact, even though the scores for some of these were lower than others, noting that individual business cases are required for final approval to be given and should the revenue impact become higher than expected it may not be possible to ultimately approve the business case for these schemes.
Approved the recommended indicative budget of £1.95m to invest recurrently in primary care estates. £1.54m of this cost relates to schemes already committed / operational.
Supported the alternative funding approach for the £1m revenue shortfall for the schemes as outlined by the Chief Financial Officer in the meeting and that primary care budget will be spent on primary care.
Noted that these proposals enable circa £468k and £472.5k of the BAU capital to be directed towards primary care estates in 2022/23 and 2023/24 respectively (but note the risk that delays to concluding the prioritisation process may cause some slippage with capital spend between years).
Requested the Board and Finance and Investment Committee of the ICB to consider making additional revenue available for primary care estates as part of the 23/24 resource allocation process, noting that a Board seminar on primary care and the development of Fuller neighbourhoods will include discussion of primary care estates as an enabler of neighbourhood working and is planned for 24 February 2023.
Recognised that there are other primary care providers with estates needs who are not within the 23 and we are committed to working with them and system partners on their needs.
Confirmation of Mahesh Shah as the Deputy Chair of the Committee
The ongoing work to progress the safe delegation of Community Pharmacy, Optometry and Dental (POD) contracts to the ICB; ICB expected to take delegation from 01 April 2023; the national timeline for NHS England (NHSE) to approve and ICB commissioned an internal audit for additional assurance of the ICBs readiness
Actions being taken and contingency arrangements for The Village Medical Centre
The deep dive review to take place in January at Cauldwell Medical Centre, Bedford further to whistleblowing complaint. Findings will be shared with the Primary Care Delivery Group to help inform assurance levels on quality of care and be considered when looking to invoke a potential two-year extension in April 2023. Assurance provided to ICB by East London Foundation Trust (ELFT) Medical Director and Executive Director that a review of the whistleblowing concern had been undertaken and mitigations put in place which will be reviewed as part of the deep dive
The update and actions taken since previous meeting for Ashcroft Practice Luton further to inadequate Care Quality Commission (CQC) report. Remedial notice served 02.12.22. with 28-day turnaround. Assurance given that majority of actions required had been resolved or being actively worked through
A branch closure form submitted for Ampthill Road Branch Surgery further to patient engagement and assurance this would not impact number of appointments available or service provided. Report to go to Primary Care Delivery Group Chairs Action Group for formal approval to close the site
Applications to close lists received from Leagrave Surgery (Luton), Great Barford Surgery, Bedfordshire, Greensands (Ampthill) and Cobbs Gardens (Olney). Cobbs Gardens and Greensands applications will be presented to Primary Care Delivery Group Chairs Action Group in December. Assured that primary care policy guidance manual process was followed and both patient and practice engagement had taken place. Great Barford and Leagrave currently at application stage
Discussed and noted payments and cashflow issues for practices and outlined actions taken by ICB
Request for boundary change by Conway Medical Centre, Luton
Application to incorporate and novate contract by Malzeard Road, Luton
The current position across BLMK for refugees, evacuees and asylum seekers
Updates on GP Alternative Provider Medical Services (APMS) Contracts Reprocurement: - re-procurement exercise for Brooklands Heath Centre, Milton Keynes and Kingsway Health Centre and Bramingham Park Medical Centre, Luton will be taking place from January 2023 - plan to offer Neath Hill Health Centre and Kingfisher Surgery in Milton Keynes as branches with patient lists in the new year - forward planning and ongoing contract monitoring for the other APMS contracts continues
Status update of (i) programme of work for the Universal Offer Personal Medical Services (PMS) reinvestment proposal and principles for 2022-24/2025; (ii) phase 1 services implementation (January 2023) and (iii) phase 2 in development implementation planned for April 2023
Risks relating to the primary care directorate are being identified and managed appropriately. Risk registers presented separately for Digital and Estates. All risks logged and monitored in the 4Risk system
The Primary Care Estates Report highlights: - Risk raised by King Street Surgery (Kempston) in relation to their premises, and the mitigating actions being considered/taken forward - Risk raised by the developer of Biddenham New Surgery that scheme may not be viable to go ahead due to increase in borrowing rates. Mitigation includes consideration of increase to the previously agreed rent reimbursement levels - An addendum to the North Bedford Hub Full Business Case was submitted to NHSE in line with end of November deadline previously reported to the Committee and the risk of approval delay by NHSE
Estates Prioritisation Process highlights: - Outcome of the scoring to-date of the 53 current/proposed primary care estates schemes across BLMK - Review of affordability next step in the process (revenue and capital), risks and delivery factors, to agree a final list of schemes expected to be supported in 2022/23 and 2023/24, subject to individual business cases and that - Final list to be signed-off virtually by members of the Primary Care Delivery Group and ratification by chairs action from PCC&AC (see Extraordinary PCC&AC Chairs Report)
Discussed under review of meeting effectiveness how as the Committee develops it can also provide assurance on patient experience rather than just outcomes
approved terms of reference for Primary Care Delivery Group and updates to PCC∾ noted that both would continue to be developed during 2022-23
noted progress against the Primary Care Workforce Programme strategic workstreams
endorsed progress on North Bedford Primary Care Hub project; outcome and response rate to the Patient Engagement exercise and actions being taken to mitigate concerns of the population in relation to availability and cost of parking on site
noted process, criteria and timeline agreed by the Estates Working Group for prioritising primary care estates schemes
endorsed the proposed BLMK Fuller Programme to implement national recommendations; supported the approach for the principle of subsidiarity
noted primary care access oversight group update and next steps. Requested focus on digital developments in terms of telephony and wider digital offer as future agenda item for the Primary Care Delivery Group
accepted that risks relating to the primary care directorate and digital transformation programme were identified and managed by the relevant teams; all risks continue to be logged and monitored in the 4Risk system
noted the July 2022 delegated primary care financial position
