Woodside Medical Group Premises Development

Initial Agreement

Introduction

The purpose of this document is to present the Initial Agreement to support the investment proposed in the new premises development for Woodside Medical Group. The Initial Agreement is where the position of the proposed project is established in relation to the overall NHS Grampian organisational and service delivery strategy.

Background

In 2002 NHS Grampian undertook a review of GMS Premises across Grampian and agreed a prioritised 10 year programme of replacement.

Woodside Medical Group was ranked Number 6 on the 10 year programme.

There was a Standard Business Case approved by NHS Grampian in 2003 and subsequently an addendum in 2006. No progress has been made until recently due to the lack of a suitable site.

Early in 2010, NHS Grampian undertook a prioritisation of the whole Capital Programme in light of constraints on capital funding. The exercise confirmed that replacement of the Woodside Medical Group is still a high priority for NHS Grampian.

Since the approval of the Standard Business Case in 2003, the market has changed and this project is now likely to incur a cost in excess of £5 million and will therefore now need to be progressed following the Scottish Investment Manual (SCIM) including production of an Initial Agreement, Outline Business Case and then a Full Business Case.

This document seeks to confirm the strategic context for the project inclusive of indicative costs; to make a robust case for change; and to provide stakeholders and customers with an early indication of the proposed way forward (not the preferred option), having identified and undertaken SWOT analysis on a wide range of available options.

Strategic Context

National Context

The Scottish Government has set out its single overarching purpose – to focus government and public services on creating a successful country, with opportunities for all of Scotland’s population to flourish through increasing sustainable growth. Primary Care in its role as “gatekeeper” has a significant contribution to make to the achievement of the five objectives – Wealthier & Fairer, Smarter, Safer & Stronger and Greener.

Demands within Primary Care continue to increase. Demographic change within Scotland is significant. The increasing number of people with long term conditions presents a major challenge for health and social care services and for society. As detailed in Better Health, Better Care, Action Plan, someone living in a deprived area is more than twice as likely to have a long term illness compared with someone in an affluent area and people living with long term conditions are likely to be more disadvantaged across a range of social indicators such as employment, educational qualifications, home ownership and income. The ministerial task force has identified the need to place more emphasis on tackling health inequalities through Primary Care.

Better Health, Better Care, Action Plan continues to recognise that Scotland’s healthcare challenges require a continuation to shift the balance of care towards community based services. It requires a greater emphasis on anticipatory rather than reactive care and action to develop the services offered in primary care including; guaranteed access to see a member of the GP Practice team within 48 hours, advanced booking arrangements; innovative methods of increasing access to services to allow for the differing commitments to patients and through the National Improving Patient Experience Programme and Framework for GP Practice Based Experience Surveys, develop a robust evidence base to support the drive to improve access and patient experience.

The Healthcare Quality Strategy for NHS Scotland outlines an approach which aims to put quality right at the heart of Scotland. It recognises that patients’ experiences of the NHS is about more than speedy treatment – it is the quality of care they get that matters to them.

As part of the Healthcare Quality Strategy, the government released a Delivering Quality in Primary Care National Action Plan in August 2010 where Nicola Sturgeon, Deputy First Minister and Cabinet Secretary for Health and Wellbeing details in her Foreword address:

“Primary Care is at the heart of the NHS Scotland and will be central to delivering these quality improvements. Indeed, for many patients it is the NHS. It accounts for around 90 per cent of all patient contact and, as the gateway to secondary care, is both the start and end point of most patient journeys. It provides the key elements of coverage, continuity and effective risk management.”

Some of the actions detailed within the Delivering Quality in Primary Care Action Plan include:-

  • Improve access to patients, including working with NHS boards and professions to deliver support to those practices which experience the most difficulties.
  • Ensure we have in place an up-to-date, agreed suite of care pathways. In the first instance the focus on the pathways will be where the behaviour of Primary Care has the greatest impact, examples will include Care of Diabetes, Asthma, COPD, Dementia, Congestive Heart Failure and support to older people.

Better Health, Better Care, Action Plan also identifies a number of steps to improve access to dentistry in Scotland, including providing new or substantially improved premises to support the delivery of NHS dentistry in areas with gaps in provision.

Local Context

The NHS Grampian Health Plan for 2010-2013 (Healthfit) was based on a comprehensive public and staff consultation process. Five key areas of work were identified:-

  1. Improving health and reducing inequalities
  1. Involving patients, staff and partners
  1. Delivering safe, effective and timely care in the right place
  1. Developing the workforce and empowering staff
  1. Improving efficiency, productivity and sustainability – getting the best from our resources

The context for this plan is described by NHS Grampians Medical Director as being “the most challenging that NHS Grampian has ever experienced – but possibly the most exciting in terms of what will be achieved”.

Within Healthfit it is recognised that “In Aberdeen a major project to revolutionise the way in which Primary Care services are provided in the City will be taken forward during the three year life of this Health Plan”.

It is ensured that this project and other initiatives will result in patient centred, consistent and easy access to GP services.

The Aberdeen City Primary Care Redesign Programme originated due to the fact that the development and planning of Primary Care Services in Aberdeen city has reached a critical point due to a combination of powerful forces affecting future health care provision for the city population. Over the next 10-15 years there will be a significant increase in the proportion of elderly requiring care combined with NHS Grampians aim to deliver more of this care in community settings. This has to be delivered in a landscape of increasing cost pressures, through a network of independent GP contractors who operate from locations and premises that need to be reviewed in light of these changing demographics and future expansion of housing within the city.

The prioritisation process has focussed on:

  • Strategic fit – consistent with strategic aims and objectives of NHS Grampian as set out in the Grampian Health Plan and other national and local strategies
  • Service and business need – the extent to which need has been clearly identified through a needs assessment with outcome measures clearly established. This should include examining the distributional impact of the project in terms of the benefits and costs across geographic, income, gender and age groups.
  • Non-financial benefits – the extent to which there are non-financial benefits arising from the project i.e. improved accessibility, extended range of services, quality of environment, equity of service provision, carbon reductions etc.
  • Risk Reduction
  • Value for money – the benefit/cost ratio of the project, lifestyle costs etc.
  • Acceptability – political and social acceptability of the project – the extent to which expectations have already been raised, the ability to manage the response to changes in the projects delivery timetable.

The Hubco procurement model has been developing on a parallel timescale with Woodside Medical Group, giving alternative options for procurement of the project.

Organisational Overview

This section includes an overview of Woodside Medical Group including their Business Strategy and Aims. It also seeks to demonstrate how this links with other Organisational Strategies including the Primary Care Redesign programme. This section also identifies their current arrangements and service gaps to be filled.

Woodside Medical Group is a partnership of ten GP’s (8 wte) with a current patient list size of 10,913. The practice holds both training and teaching status. Woodside Medical Group currently offers a broad range of General Medical Services (GMS). As a result the practice, currently based at 80 Western Road, Woodside, Aberdeen, has outgrown its premises which do not comply with the Disability Discrimination Act (DDA).

Many patients of the Woodside Medical Group encounter problems with the current service before even entering the premises. A number of accessibility issues create difficulties for several less mobile patient groups. The practice is located on an incline which poses an inconvenience and danger to the disabled and elderly. There is no designated parking and on-street parking is very limited. Poor access to the practice means that many less mobile patients are reluctant or unable to visit the surgery, necessitating costly and time-consuming home visits.

Internal accessibility continues to present problems to both patients and staff. Clinical areas are appointed overt two floors and corridors and doors are too narrow for wheelchairs to get through. Although this would not necessarily be problematic in a modern building with facilities for the disabled such as a passenger lift, the current ageing premises make no such provision. Furthermore there is no changing area for staff who wear uniforms and the existing reception staff area is restrictive in that it cannot comfortably accommodate all members of staff who require to use the space at any one time. The resultant pressure on available space holds implications for health and safety compliance.

Constraints on available space at the premises impact upon the ability of the practice to offer a range of quality services to their patients. Essentially, the practice list size has outgrown the total floor area available which means that the introduction of new services is simply unachievable and causes frustration among practice staff for e.g. not being able to provide comprehensive Long Term Conditions clinics or taking part in the Keep Well Programme. The constraints also put pressure on their provision of teaching and training.

The practice are unable to take on ST1s and can only take on 1 ST3 but constantly battle with room usage and have to be fairly creative to comply with the requirements of having a GP registrar. The practice continue to take Phase 3 Medical Students but experience the same logistical problems as before to try and allow the students to see as many patients as possible.

The ultimate aim of Woodside Medical Group is to provide comprehensive primary healthcare services to the population of Woodside and surrounding areas, in a modern, high quality environment, enabling the practice to fully meet patients’ needs and expectations.

The proposed strategic direction of Woodside Medical group includes aspirations for joint working with services such as Allied Health Professionals, Counselling as well as Nurse Led Clinics in Long Term Conditions.

The Community Nursing team is located in a separate building which leads to increased travelling time and communication challenges. It is also proposed that the new premises will incorporate the Integrated Health and Social Care Team and a Dental Practice.

AberdeenCity has a population of over 210,000 people and according to the Health and Wellbeing Profiles in 2008 scores significantly better than the Scottish Average in areas around Mortality, Mental Health and Function Indicators, Education, Employment and Prosperity.

However using the same profiles for the population registered with Woodside Medical Group the following identifies which indicators demonstrate their practice population scoring more than 5% higher than the Scottish Average:-

People living in 15% Most Deprived Areas of Scotland: 41% of patients registered with Woodside Medical Group resided in areas where the people living in the 15% most deprived areas of Scotland is more than 5% higher than the Scottish Average.

Mortality – death all ages: 57% of the patients registered with Woodside Medical Group reside in areas where death for all ages is more than 5% higher than the Scottish Average.

Alcohol Related Deaths: 51% of the patients registered with Woodside Medical Group reside in areas where alcohol related deaths is more than 5% higher than the Scottish Average.

Adults with Long Term Limiting Illness: 75% of the patients registered with Woodside Medical Group reside in areas where adults living with long term limiting illness is more than 5% higher than the Scottish Average.

Population Income Deprived: 57% of patients reside in areas where the population income deprived is more than 5% higher than the Scottish Average.

Work Age Population Employment Deprived: 60% of patients registered with Woodside Medical Group reside in areas where the working aged population employment deprived is more than 5% higher than the Scottish Average.

The project is developing in parallel with the NHS Grampian Health Plan “Healthfit”, the Long Term Conditions Collaborative and the Aberdeen City Primary Care Redesign Programme.

There is a set of clear strategic agreements in the NHS Grampian Healthplan “Healthfit” which support the requirements for the Woodside Medical Group premises development i.e. the key areas of focus – improving health and reducing inequalities and delivering safe, effective and timely care in the right place.

Investment Objectives

The key objective of the project is as follows:-

“To create a modern, fit for purpose facility to provide a wide range of healthcare services to the patient population of Woodside Medical Group that is sustainable and is good value for money”.

The investment objectives for the project are outlined below and were developed by the Woodside Premises Project Group in light of the work undertaken with both internal and external stakeholders.

The following objectives are consistent with the principles of the Grampian Health Plan, Healthfit. The Investment Objectives have been ranked into three categories ‘essential’, ‘important’ and ‘beneficial’.

Essential
1. / Need to vacate unfit premises which are not DDA compliant, too small to provide high quality services and is subject to the need for backlog maintenance.
2. / Improve patient experience by ensuring a wide range of general medical services is available that facilitate social inclusion by improving access to health information, patient education and services by people living in the priority areas.
3. / Better facilities to ensure continued and further improved teaching and medical training for future healthcare professionals and contributes to the recruitment and retention of staff.
4. / Identify an affordable solution in terms of revenue and capital.
5. / Supports improvement in health through timely access to diagnosis, treatment or improved learning for people with e.g. long term conditions
Important
6. / The solution will deliver improved efficiency and integration by enabling multi-disciplinary working, efficient skill mix of staff, sharing of resources and high levels of room occupancy.
7. / Good access to services in terms of public transport, car parking, timely appointments but also easy way finding throughout the facility.
8. / Patient and staff safety to be improved through creation of a fit for purpose building with good access and health and safety standards.
Beneficial
9. / Provides flexible, modern, high quality accommodation with expansion capability “built-in” to allow for future growth if population need requires it.
10. / Ability to facilitate multi-agency working with other community planning partners e.g. Aberdeen City Council and Voluntary Sector.
11. / Provides business visibility so that people know where to go for services and is viewed as a positive structural addition to a re-generation area.

Benefits Criteria

The Benefits Criteria for the project were developed by the Woodside Premises Project Group, including stakeholders, where there was a full discussion with a broad range of suggestions being put forward across the team. After further discussion the list of suggestions was firmed up into the list of 11 Criteria shown on the table below.

This was followed by a discussion on the relative importance of each of the criteria – which resulted in a weighting being applied to each.

The weightings uses are in increments of 5-20 on the following basis:-