development of an integrated health and social care

Development of an Integrated Health

and Social Care Resource Centre in

the North of Caerphilly County

Borough

****************************

Welsh Assembly Government

Primary Care Estates Forum

Note incomplete until such time final detail received – note drafting notes (DN)

throughout

Caerphilly Locality Office

DN : Page numbers to be inserted on completion CONTENTS 1.0 Executive Summary 2.0 Strategic Context 2.1 National Strategic Context 2.2 Local Strategic Context 2.3 Caerphilly County Borough in Context 3.0 Background to Bid 3.1 Purpose of the Proposed Development 3.2 The Primary Healthcare Team and Premises 3.3 Existing Service Provision 3.4 The Primary Healthcare Team and Premises 3.5 3.6

Current Provision The Case for Change

3.7

Improvements to GMS facilities as a result of the development

4.0 Development Options and Proposal 4.1 Options Considered 4.2 Procurement Route 4.3 Selection of the Third Party Developer 4.4 Selection of the Preferred Site 4.5 Accommodation Schedule 4.6 Space Requirements 4.7 Design Evolution / AEDET 4.8 Financial Implications 4.9 Other Resource Implications 4.10 Mortgage Deficit Funding 4.11 Timetable 4.12 Management Arrangements 4.13 Stakeholder Support 5.0 Risk Assessment 6.0 Key Benefits and Outcomes 7.0 Conclusion 7.1 Summary of the Case for Change 7.2 Summary of Items Requiring Financial

Assistance

8.0 Appendices

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3

1.0 Executive Summary The development of the Integrated Health and Social Care Resource Centre responds the commitment given to the population in the North of Caerphilly County Borough during the submission of the full business case for the development of the Ysbyty Ystrad Fawr. At this time the commitment was;

“A new local general hospital in the centre of Caerphilly County Borough, all community hospitals would close as a result of the development, with the exception

of Redwood Hospital until such time that the community and professionals had worked together to develop a health and social care model relevant to their needs”.

Since this time the community and staff working within partner organisations have worked together to develop an appropriate vision for health and social care services within the locality. As a result the following model has been agreed and progressed. The integrated health and social care facility will act as a co-ordinating hub in the development and provision of services in the North locality. It will enhance existing community services capacity and bring together a number of health and social care teams who will provide services in the community and from the centre itself. The development is entirely consistent with the principles of both National and local direction, however specifically with the vision contained within ‘Setting The Direction’. The model contains the following services

• 2 GP Practices • District Nursing Service • 1 Dental Practice • Community Mental Health

Team • 1 Optometry Suite • Range of Health Promotion /

• Prevention Services • 10 Intermediate Care Beds • Health Visiting Base • 2 Palliative Care Beds • School Nursing Base • Minor Injuries Services • Older People’s Assessment

Team • Day Opportunities Model • Midwifery First Point of Access • Children’s Services Team • Therapy services e.g. podiatry • Pharmacy * (note recent

addition)

The development will enable the co-location of services that are currently provided from 9 sites in the area :

Service Current base Oaklands day Centre Oaklands Rhymney Dr Evans and partners Health Centre Rhymney Dr Potts and partners Victoria Surgery Rhymney Dentist Health Centre, Rhymney Older peoples assessment team The chapel Rhymney Optometry suite Redwood Hospital District Nursing Whiterose medical practice, New

Tredegar

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Childrens services team Trigfan, Rhymney Health Visitors Ty Coch, Rhymney and Redwood Community Mental Health Team Aberbargoed Hospital Beds New although existing provision

Redwood Specifically this bid requests reimbursement for the GMS aspects of the model, and therein the focus in the main body of the document is in this area. DN – to be completed following receipt of DV report : • Summary of GP requirements • Summary of financial assistance requested • Summary of size/design etc

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2.0 Strategic Context 2.1 National Strategic Context At the national level ‘Making the Connections’ and ‘Beyond Boundaries’, set the

context for public services in Wales. Within this framework the strategic direction for

health is set through ‘D 0020esigned for Life’: A Strategy for the NHS in Wales, and

for social care through ‘Fulfilled Lives and Supportive Communities: A strategy for

social services in Wales over the next decade. More recently the Welsh Assembly

Government have published ‘Setting the Direction : A strategic framework for primary

and community services’ which offers a useful framework against which existing

primary and community services (including social care services) can be aligned to

develop a system of co-ordinated care at sub locality levels.

2.2 Local Strategic Context There are a plethora of plans and strategies that come together in Caerphilly County

Borough that respond to the national direction. The ‘Health Social Care and Well

Being Strategy 2008 – 2011’; The Wanless Local Action Plan and a variety of

redesign programmes articulated through the previous Gwent Healthcare community

(now Aneurin Bevan Health Board) Clinical Futures programme including the

development of a New General Hospital in the Borough (Ysbyty Ystrad Fawr); the

Cardiff and Vale Programme for Health Services Improvement and the Cwm Taf

Healthy Communities Programme.

A full review of both national and local strategies is provided in Appendix A,

complimented by a statement of how the proposed development meets the current

strategic direction.

2.3 Caerphilly County Borough in Context The County Borough of Caerphilly was created in 1996 as part of the re-organisation

of Local Government in Wales. It occupies 28,000 hectares of the South Wales

valleys, stretching over 40km between the urban centres of Cardiff and Newport in

the South and the Brecon Beacons to the North, taking in all parts of the valleys of

the rivers Rhymney, Sirhowy and Ebbw. It comprises 33 wards, with approximately

50 distinct towns and villages, the largest being Caerphilly town itself with a

population of 28,000, and other significant settlements including Bargoed,

Blackwood, Newbridge, Risca and Ystrad Mynach as shown on the map below:

The County Borough is divided into three localities as follows:

• The North of the County Borough - extending from Rhymney in the North to

Ystrad Mynach in the South, including other centres of population such as

Bargoed, New Tredegar, Pengam, Gelligaer and Nelson as well as the

Rhymney and Darran Valleys;

• The East of the County Borough - extending from above Markham in the

North to Risca in the South, including Pontllanfraith and Risca as its main

centres of population as well as smaller centres such as Oakdale, Cefn

Fforest and Newbridge;

• The South of the County Borough - comprising the Caerphilly Basin and

the Aber Valley with Caerphilly as its main centre of population.

These boundaries will be utilised to guide the establishment of Neighbourhood Core

networks in the Borough.

The following map illustrates the boundaries of these localities.

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East

North

South

Population

The estimated resident population of Caerphilly County Borough in 2008 was

172,000. This number has remained relatively stable for the Borough as a whole,

however within this number, numbers within the South have increased, and numbers

within the North decreased. 49% of the population are male and 51% female, and

the age composition is broadly in line with that of the rest of England and Wales.

There is no major change in the overall population projected for 2011.

There is an age demographic shift with increasing numbers of older people and

decreasing numbers of young people. The number of people at retirement age and

over is projected to increase by about 15% by 2011. This will have a significant

impact on health and social care services within the Borough, as this age group is a

significant consumer of health and social care services.

The population of the County Borough is unevenly distributed with the areas at the

Northern extremes of the North and East localities having large electoral divisions

with fewer than 2750 people living in them. The centre of the Caerphilly basin is

more heavily populated. Bedwas, Trethomas and Machen and Penryhoel have 13

per cent of the County Borough’s total population between them.

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From an economic perspective, the past 20 years has witnessed a dramatic decline

in the traditional heavy industries of coal and steel, and the Borough now has the

third lowest rates of economic activity in Wales, exacerbated by low levels of skills,

educational achievement and lack of qualifications. Although unemployment has

declined in recent years, the legacy of poverty and deprivation continue to impact on

the health of the population. There is well-documented evidence of a high correlation

between socio economic deprivation and ill health. Some of the results of

deprivation, such as low level of car ownership, make it difficult for people to access

the services that they need.

The County Borough is shown by both the Townsend Indicator and the Index of

Multiple Deprivation (IMD) to have extremely high levels of deprivation across wide

areas.

Out of the 110 lower super output areas in the County Borough, 13 are in the “most

deprived” quartile based on the Welsh Index Multiple Deprivation 2008. There are

15 electoral divisions in the North, 11 of which are in the IMD “most deprived”

quartile. One of the other electoral divisions in that quartile is at the Northern tip of

the East locality so that the North of the County Borough is made up almost totally of

extremely deprived communities.

Selected health indicators show Caerphilly County Borough residents to have poor

health compared to Wales as a whole, for example:

• Death rates for coronary heart disease for Caerphilly borough are the worst in

Wales.

• Death rates from respiratory disease for Caerphilly borough are the 4th worst

in Wales.

• Cancer registration rates for the borough are the third highest in Wales

From a social care perspective:

• Rates of assessments of people over 65+ is higher than the Welsh average

and third highest in the region

• The area has the fourth highest percentage of people who are supported

(aged 65+ in Wales)

• Rates of older people helped to live at home per 1’000 is second highest in

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Wales

• Rate of people cared for in care homes is the lowest in the region and the 8th

lowest in Wales

• Gross costs for adults in residential and nursing care exceed the Welsh

average.

• These factors also contribute to the mental health needs of the population.

The Welsh Health Survey for 2003/5 found that in Caerphilly borough 11.8%

of adults reported being treated for a mental illness compared with 9.3% for

Wales as a whole, and ranked 4th highest in Wales.

The ‘Caerphilly County Borough Health, Social Care and Well Being Needs

Assessment 2007’ illustrates the following:

• Inequalities and Deprivation - Caerphilly County Borough has many

inequalities in health and well being; pockets of extreme deprivation exist in

areas such as Lansbury Park and Graig y Rhacca in the South, but overall

the North of the Borough is relatively more deprived. Variations in health and

well being have been shown to have clear associations with deprivation.

• Life Expectancy - Premature death rates are high. Life expectancy at birth is

the fourth worst in Wales for males, and third worst for females.

• Lifestyles - 59% of adults in the borough are overweight or obese, higher

than the average for Wales (54%). Adults in the borough have one of the

worst consumption rates of fruit and vegetables in Wales, and the second

worst physical activity levels. Smoking is the single largest cause of

preventative illness and premature death, and is strongly linked to

deprivation. The proportion of adults smoking (27%) in the borough is above

average for Wales,

• Chronic Disease – Death rates from coronary heart disease are the worst in

Wales, and death rates from chronic obstructive pulmonary disease are the

third highest. People admitted to hospital for CHD is significantly higher than

the Welsh average, and mortality rates, including premature rates, are the

worst for Wales.

• Cancer - The registration rate within the borough for cancer are below

average for Wales, but the death rate is amongst the highest in Wales). The

pattern of high cancer mortality rates and low registration rates may be

because, for example, people are not being diagnosed early enough. There

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may be different reasons for this, for example, people may not recognise their

symptoms, and thus not attend their GP for diagnosis. Early cancer diagnosis

is dependent on patient and physician level of suspicion. There may also be

a time lag between decreased registrations and decreased mortality. The

apparent mis-match between registrations and mortality is also evident with

specific cancers, for example, breast cancer. This suggests that women are

not being identified early enough. Survival is usually improved with early

diagnosis, which requires self awareness, high attendance at screening and

early referral from primary care to diagnostic clinics especially for women

aged under 50 years (the age at which women are called for routine

screening), or between screening.

• Needs of Elderly and Disabled - Rising elderly population and high levels of

limiting long term illness reflect the previous health experience of the

Borough. This includes respiratory disease, and a potential increase in

Alzheimer’ disease, orthopaedic and joint problems, along with chronic

diseases.

• Carers - There is a need for support, advice, homecare, short breaks and

appropriate housing for people with physical disabilities, which would impact

upon the quality of life for carers.

• Mental Health Needs - Integrated substance misuse services required,

ranging from prevention and education to treatment and rehabilitation.

Community Mental Health Team model needs to be enhanced to improve

accessibility, and specific day care services, home support and

accommodation needs to be more easily available to people with either a

mental health or learning disability.

• Families at Risk - There are links between deprivation and people under pressure; a range of multi-agency schemes and services are required to

support families in crisis, homeless, single parents, etc.

• Sexual Health - There is a need to reduce the prevalence of sexual transmitted infections and to improve access to contraceptive services.

Caerphilly County Borough has been identified as one of the most deprived areas in

Wales. The Borough’s very large population is coupled with some of the poorest

levels of health and social well-being in Wales, and very significant inequalities

between and within individual wards. There is also very poor local access to

services with the majority of residents having to travel outside of the County Borough

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for both outpatient and inpatient care. The population has been identified as having

significant health concerns, a situation which is exacerbated in the North of the

Borough.

New models of health and social care being developed through the ‘Gwent Clinical

Futures’ and the ‘Caerphilly Hospital and Community Services Project’ are

dependent upon more services being available in a community setting. From a

social care perspective, the ‘Domiciliary Care Strategy’ sets the direction for the

delivery of future services. The needs of the communities in the North of the

Borough must be considered specifically with regard to access, as the two main

providers of acute services for this area; Cwm Taf Health Board and Aneurin Bevan

Health Board are both subject to programmes of major strategic change. This

proposal focuses specifically on the North locality.

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3.0 Background to Development 3.1 Purpose of the Proposed Development The purpose of the proposed development is to develop the capacity to achieve a

rebalance of the system of care in the North locality ensuring that a wide range of

services are available within a primary and community setting and to increase the

numbers of people who are supported in their own home or community environment.

The development when fully operational will ensure closer alignment between all

parts of the healthcare system, enabling stronger relationships between primary,

secondary and social care providers, and indeed enabling reduction of inappropriate

admissions to the acute sector.

The resource centre is essential to the delivery of community based services in the

North of Caerphilly County Borough.

3.2 Future Vision for Health and Social Care Services In order to meet the principles of the national strategic direction and coupled with

strong evidence of local need, the plans outlined above lead to the need for a

locality, approach based on the development of enhanced primary and community

services at the local level, bringing together multi-disciplinary teams providing a

wider range of services than may have traditionally been accessed within the

community setting.

The proposed development provides the opportunity for a central co-ordination hub

for services provided in the locality, many of which will be delivered in people’s

homes, with further services being provided from the resource centre itself. The

centre will provide the base for all health and social care teams working within the

locality to be co-located and integrated.

The resource centre development correlates well with the vision of Dr Chris Jones

articulated through ‘Setting the Direction: Primary and Community Services Strategic

Delivery Programme’, for the development of locality teams enabling a co-ordinated

system of care, based on a pull system as apposed to the current push system that

is evident across much of Wales. It will aid the objective of supporting people in

their own homes through enabling a co-ordinated system of community based care,

and through the use of step up beds for the management of patients within the

community where for example a chronic condition exacerbates, however the patient

does not need an acute stay or has palliation needs.

The bid is based on the following rationale:

• The proposal addresses the current need for increased space to enable a

wider range of services to be provided; • The proposal will provide a modern well designed physical environment for

service delivery with flexible space to enable service development and innovation;

• The proposal will enable the co-location and integration of various health and social care teams (and potentially voluntary organisation) to provide a system of seamless and coordinated care within the North locality;

• The proposal will enable the co-location and integration of all primary community and social care teams and functions operating within the North of Caerphilly County Borough.

3.3 Existing Service Provision Services in the North locality are currently provided from nine different premises by a

variety of service providers, as illustrated in the model below:

A HT berb - CMargoed Hospital

Community Pharmacy

Current Service Provision

Bases

Oaklands – Day Centre

Health Centre Rhymney – Dr Evans and Partners - GMS

Health Centre Rhymney -

Dentist

Aberbargoed Hospital -

CMHT

The Chapel - Older People

Redwood - Optometry

Whiterose Medical Centre - District Nurses

Redwood - Beds

Trigfan – Childrens

Assessment

Health Visitors Ty Coch,

Rhymney and Redwood

Victoria Surgery Rhymney – Dr Potts - GMS

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Specific detail on the majority of these services, is outlined in Appendix B, however

as this document makes request for funding for General Medical Services

specifically, detail in relation to the practices of Dr Evans and Partners Rhymney and

Dr Potts and Partners Rhymney is outlined here.

3.4 The Primary Healthcare Team and Premises There are two GP practices moving into the North Resource Centre. These are: 3.4.1 Dr Evans and Partners (Rhymney) Dr Evans and Partners are a well established practice in the Rhymney area, situated

in a central position near to the main village settlements. The practice has a list size

of 6109, of which 3140 are male, and 2969 are female.

Practice details are :

Dr A Evans, Dr S D Thomas & Dr P R Owens, Health Centre, Victoria Road, Rhymney, NP22 5NU. Tel: 01685 840627 The Primary Care team for Dr Evans and Partners comprises :

Role WTE Practice Manager 1 Secretary 0.85 Computer operator/Receptionist 0.85 Data Input Clerk 0.64 Receptionist x 8 0.53

0.80 0.60 0.85 0.72 0.48 0.40 0.80

Senior Practice Nurse 0.96 Practice Nurse 0.85 Nursing assistant 0.85

Total 10.18 Dr Evans and partners practice from a 1970 Health Centre owned by Aneurin Bevan

Health Board. The premises are limited in their availability of community

rooms/library/staff room etc due to the design of the building. The building is in

constant need of repair due to its age and overall does not lend itself to either current

or future healthcare developments in the area.

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3.4.2 Dr Potts and Partners (Rhymney) Dr Potts and partners are also a well established practice in the locality. They have

a list size of 4109 of which 2001 are male and 2108 are female.

Practice details are : Dr T Potts, Dr R D Wilson, Victoria Surgery, Victoria Road, Rhymney, NP22 5NU. Tel : 01685 840614 The Primary Care Team for Dr Potts & Wilson are:

Role WTE Practice Manager 0.80 Deputy Practice Manager 0.69 Secretary 0.51 Receptionist x 4 0.57

0.55 1.00 0.89

Practice Nurse 0.80 Practice Nurse vacancy 0.67 Health Care Assistant x 2 0.53

0.08 Total 7.29

The premises were built under the Statement of Fees and Allowances Cost rent

process in 1993. The premises like Rhymney Health Centre suffer from severe

vandalism. The premises are limited for space and the development of the North

Resource Centre will enable the practice to have appropriate sized waiting area,

reception area, proper storage for patients’ medical records as well as appropriate

space to house the administration staff.

Like the Health Centre, the practice will benefit from moving into the North Resource

Centre being better able to respond to both current and future healthcare

requirements.

3.5 Current Provision The current services provided by Dr Evans and Partners and Dr Potts and Partner

are outlined in the table overleaf.

Dr Evans and Partners

Service Current Availability Current Volume

Appointment only GP am Each morning 20 – 30 people per day

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Appointment only GP pm Mon, Wed and Friday 16 – 20 people per day Same day GP am Each morning 16 people per day Same day GP pm Mon, Wed and Friday 2 people per day Registrar Appointment only am

None None

Registrar same day am None None Registrar appointment only pm

None None

Registrar same day pm None None Nurse triage surgery None None Minor ailment clinic am Each morning 12 people per day Minor ailment clinic pm Mon, Wed and Friday 17 people per day Minor surgery Infrequent 1-2 days per

month 10 people per session

Chronic disease clinic am Each morning 28 -32 people per day carried case structure includes diabetic and respiratory

Chronic diseases clinic pm Mon, Wed and Friday 24 – 30 people per day varied case structure includes diabetic and respiratory

Diabetic clinic None None Respiratory clinic None None Hypertension Phlebotomy INR ECG Spirometry Wt management

All provided daily but with no structure, Most work covered by clinical assistant and input from GP/nurse when indicated

140 – 180 appointments per week

Contraceptive services None None Minor injuries unit None None Dr Potts and Partner Service Current Availability Current Volume

Open access GP surgery Each morning 24 people per day Appointment only GP surgery

Each morning 21 people per day

Open access GP Surgery Each evening 12 people per day Appointment only GP surgery

Each evening 12 people per day

Appointment only Practice Nurse

Mon, Tues & Friday morning 31 bookable appointments


Mon, Tues & Friday evening 29 bookable appointments

Appointment only Health Care Assistant

Each morning 18 bookable appointments

Diabetic Clinic 2 sessions per week 16 bookable appointments Asthma/COPD 1 session per week 7 bookable appointments Cytology Clinic Available within normal

surgery hours Bookable appointments

Child health Surveillance/baby clinic

1 session per week 12 people per week

Maternity Services 1 session per week 16 people per week

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Contraceptive services Available within normal surgery hours

Bookable appointment

Minor Surgery 2 session per month 4 people per session INR Available through health Care

Assistant Appointments Bookable appointments

Weight management clinic

Available within normal surgery hours

Bookable Appointments

Hypertension clinic Available within normal surgery hours

Bookable appointments

Spirometry clinic Available within normal surgery hours


ECG/BP monitoring Available within normal surgery hours


Counselling Monday afternoon 3 Bookable appointments Dietician Monthly/Wednesday

afternoon 10 Bookable appointments

CHD Clinic Friday Morning 6 bookable appointments 3.6 The Case for Change National strategy sets clear direction for the way in which primary and community

services should be organised and delivered in the modern NHS. The proposal for

an Integrated Health and Social Care Resource Centre in the North of the County

Borough is clearly consistent with this direction enabling care to be both organised

and delivered closer to the patients home or in the community where they live.

As earlier demonstrated, the socio-economic profile in the North of the Borough,

scores consistently high on most indices of deprivation. In order to meet the

strategic direction and local need, the case for change in the North of the Borough

for the organisation and delivery of services is summarised here:

• Opportunities for Integration - Services within the North of the County

Borough are dispersed and fragmented. The current configuration and

location of services does not lend itself to an integrated model of service

delivery where patients are able to access one centre for a variety of service

needs, thus teams that work with the same client group have no natural

linkage

• Space - There is a lack of space in all facilities and premises for further

expansion of either health, social or integrated delivery of health and social

care services

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• Access - Access to each of the service bases is difficult with limited parking,

and varying degrees of compliance with disability discrimination act

requirements

• Security – the existing facilities are subject to continuous vandalism and both

premises have been subjected to ‘break ins’. The new facility will have state

of the art security and include CCTV, door access control for staff, improved

lighting to the exterior premises to deter intruders. Each floor will be

independently secured at the end of each day precluding anyone from

accessing areas after closure of the GP practices, dentist, optician and the

sessional clinic areas.

The vision for the delivery of health and social care services in the North of

Caerphilly County Borough is clear, it is consistent with the national direction and

also reflective and designed around local needs. The areas outlined in the table

below are current GMS restrictions in the achievement of this model of care and it is

proposed that the Integrated Health and Social Care Resource Centre for the North

of Caerphilly County Borough will provide a solution to the issues also as articulated

below :

Issue Description of Issue How Development

Overcomes Issue Opportunities for integration

There are currently 9 premises (hosting 11 services) from which services to a small geographical area are being delivered. Teams working with the same cohort of people have no natural alignment

Enables one base for the co-location and onward integration of all health and social care teams in the North locality

Space There is a lack of space to enhance service provision in all of the existing buildings specifically the modernisation of primary care services within the two practices is restricted due to absence of expansion space

The resource centre plan has been modelled with a wide range of end users, based on their service needs – the plans for the facility accommodate the need for enhanced service provision, and the continuation of core services

Car Parking Limited car parking for patients. The new development will meet the County Surveyor’s current car parking standards and thus create available car parking for patients of both practices especially those who may be disabled.

Maintenance Both GP premises have some backlog maintenance to be completed as well as being continuously vandalised

The premises will be managed by the 3PD for maintenance and Aneurin Bevan Health Board in conjunction with CCBC will provide robust support

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to ensure the Facilities management of the premises. Specifically this means : Cleaning will be undertaken by Aneurin Bevan Health Board Catering will be provided jointly between the Local Authority and the Health Board Waste disposal will be undertaken as part of contract with Aneurin Bevan Health Board Facilities management in the general sense will be absorbed as part of the ABHB contract

Internally Both GP premises are cramped and somewhat oppressive with light levels being significantly lower than would normally be expected. There is very little natural light and ventilation, and the buildings can be uncomfortably stuffy and warm during the summer months.

The future GP accommodation for both practices will meet the standard set out in WHC (2008) 055 and will meet all relevant criteria for DDA. The new premises have demonstrated an excellent response from the AEDET review and will meet the standards set for BREEAM.

Storage Storage of medical records in both practices is at a premium.

The new facility will provide appropriate storage for the medical records as both practices will be further developing to go “paper light”

Admin/Staff Areas

Administration in both premises is cramped. The lighting in the current office space for both surgeries does not meet VDU requirements and welfare facilities require upgrading.

The new premises will meet appropriate room accommodation as set out in WHC (2008) 055. Resulting in enhanced environment, and compliance with VDU and other safety standards

Vandalism Security and vandalism are key concerns for both premises with caged windows on the Health Centre and security shutters on the other. Graffiti/vandalism attacks are quite common.

The new premises will be installed with CCTV inside and out. Including controlled access to doors for staff with swipe cards being issued. The new building has been reviewed by ABHBs security Officer to ensure that staff and patients are protected at all times.

3.7 GMS facilities improvements as a result of the development The overall model for the resource centre is demonstrated below :

• 2 GP Practices • District Nursing Service • 1 Dental Practice • Community Mental Health

Team • 1 Optometry Suite • Range of Health Promotion /

• Prevention Services • 10 Intermediate Care Beds • Health Visiting Base • 2 Palliative Care Beds • School Nursing Base • Minor Injuries Services • Older People’s Assessment

Team • Day Opportunities Model • Midwifery First Point of Access

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• Children’s Services Team • Therapy services e.g. podiatry • Pharmacy * (note recent

addition)

Specifically however for GMS facilities the following improvements will be realised as

a result of the resource centre being developed :

• Design

The North Resource Centre is an innovative and exciting design which it is hoped

will act as a focal point for the community of Rhymney and its surrounding areas

catering to their health and well-being needs. The striking design aims to provide a

contemporary, safe and clinically effective environment for healthcare professionals

and the public alike, whilst serving as a beacon for future developments.

The scheme underwent formal AEDET assessment on the 26th November 2009. It

achieved an overall rating of ‘Excellent’ at this stage of design. A copy of the score

card summary completed by the AEDET facilitator, Nigel Davies of Welsh Health

Estates, and a summary of the responses to the issues raised is enclosed at

Appendix C.

• Improved patient experience

The development will afford patients and visitors the dignity, quality and privacy they

deserve and will address the space, storage, and general fitness for purpose issues

currently being experienced in the current Victoria Surgery and Rhymney Health

centre. Furthermore, the enhanced offerings which the new facility will enable will

significantly and positively improve the patient experience. Plans for the facility have

been commended for its commitment to the use of single rooms, consistent with the

standard in Ysybty Ystrad Fawr.

• Future Proofing

The facility will provide the required context to progress the service modernisation

agenda, with scope to allow further development /expansion of service with changing

need, throughout the facilities lifecycle. The model should act as a strong and

positive model for service integration within the Primary Care /locality centre context

for Wales, in line with current best practice and Assembly Government driven

agendas.

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Specifically the following growth in GMS service provision will be seen :

Dr Evans and Partners

Service Current

Availability Current Volume

Planned availability

Planned volume

% increase

Appointment only GP am

Each morning

20 – 30 people per day

Each morning 24 – 32 people per day

20

Appointment only GP pm

Mon, Wed and Friday


Each afternoon


66

Same day GP am

Each morning

16 people per day

Each morning 16 people 0

Same day GP pm

Mon, Wed and Friday

2 people per day

Each afternoon

8 people 300

Registrar Appointment only am

None None 4 mornings 9 people New service

Registrar same day am

None None 4 mornings 8 people New service

Registrar appointment only pm

None None 4 afternoons 8 people New service

Registrar same day pm

None None 4 afternoons 8 people New service

Nurse triage surgery

None None Each morning 6 people New service

Minor ailment clinic am

Each morning

12 people per day


33

Minor ailment clinic pm

Mon, Wed and Friday

17 people per day


18

Minor surgery Infrequent 1-2 days per month

10 people per session

1 or 2 sessions per week

8 – 10 people per session

60 - 100

Chronic disease clinic am

Each morning

28 -32 people per day carried case structure includes diabetic and respiratory

Each morning 32 – 38 people per day improved structure to new clinics

16

Chronic diseases clinic pm

Mon, Wed and Friday

24 – 30 people per day varied case structure includes diabetic and respiratory

Each afternoon

24 – 30 people per day improved structure to dedicated new clinics

66

Diabetic clinic None None 2 sessions per week 1 Dr and 1 nurse


New service

Respiratory clinic None None 2 sessions per week 1 Dr and 1 nurse


New service

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Service Current Availability

Current Volume


Planned volume

% increase

Hypertension Phlebotomy INR ECG Spirometry Wt management

All provided daily but with no structure, Most work covered by clinical assistant and input from GP/nurse when indicated

140 – 180 appointments per week

Dedicated clinics to be provided by clinical assistant and a newly appointed p/t nurse

160 – 200 appointment per week

10 – 15

Contraceptive services

None None 1 – 2 sessions per month

4 – 6 people per session **

New service

Minor injuries unit

None None To be further discussed with Health Board

To be further discussed with Health Board

New service

* This proposed plan is subject entirely on centralisation of service provision in the new facility. It is totally dependant on removing GP travelling time to and from branch surgeries. ** Proposal to initiate IUCD/IUCS service, implanon insertion, vasectomies dependant on GP availability and additional training.

Dr Potts and Partner Service Current

Availability Current Volume


Planned volume

% increase

Open access GP surgery


Each morning

Appointment only GP surgery


Each morning

Open access GP Surgery


Each Evening 6 extras per evening

50

Appointment only GP surgery


Each Evening 6 extras per evening

50


Mon, Tues & Friday morning

31 bookable appointments

Mornings 2 extras per day

19


Mon, Tues & Friday evening


Evenings 2 extras per evening

21

Appointment only Health Care Assistant

Each morning 18 bookable appointments

Mornings 4 extras per morning

22

Diabetic Clinic 2 sessions per week


Extra evening appointments

Varies with case

23

Service Current Availability

Current Volume


Planned volume

% increase

will vary according to demand

structure

Asthma/COPD

1 session per week


Evening Varies with case structure

Cytology Clinic



As per demand

Child health Surveillance/baby clinic

1 session per week

12 people per week

Maternity Services

1 session per week

16 people per week

Contraceptive services


Bookable appointment

As per demand

Minor Surgery 2 session per month

4 people per session

INR Available through health Care Assistant Appointments


As per demand

Weight management clinic


Bookable Appointments

As per demand

Hypertension clinic



As per demand

Spirometry clinic



Each Morning

ECG/BP monitoring



Each Morning

Counselling Monday afternoon

3 Bookable appointments

Afternoon

Dietician Monthly/Wednesday afternoon

10 Bookable appointments

CHD Clinic Friday Morning 6 bookable appointments

morning

• Training and Development

Both practices are training practices, and the facility will enable the following : Dr Potts & Partners - The practice currently accepts three final year students each

year. Each of which stay for a duration of 6.5 weeks totalling 20 weeks of the year.

The practice is also considering accepting six students.

24

Dr Evans & Partners - Dr Evans & Partners are already recognised as a training

practice. They already accept two registrars for a period of twelve to eighteen

months as well as six students per year for a period of eight weeks at a time. The

practice will be able to take on additional students in the future as they will have

appropriate accommodation but also Dr Owens is also looking to become a trainer

once they have moved into the new premises.

Service Configuration In providing flexible space and facilities it is envisaged that partner organisations

could use the facility in future to run clinics /seminars (by agreement with the GPs)

and in this way well-being and lifestyle benefits can be passed directly to the public,

allowing multi-professional assessment and access to peer support from a

centralised location.

In this way the facility will also enable improved access to educational support

services focusing on health and well-being promotion and prevention, working with

voluntary sector and community partners. It is anticipated that by, providing flexible

space to house health services together (Primary Care and Aneurin Bevan Health

Board), further service reconfiguration opportunities could become available. The

Aneurin Bevan Health Board anticipates direct referral pathways between and

across Primary and Secondary care, and therapy services, easing the well

documented pressure on Secondary care services and waiting times.

• Workforce Planning and Recruitment As has been seen in similar developments elsewhere, the Aneurin Bevan Health

Board hopes that the integrated nature of the new facility and its modern working

environment will strengthen the Aneurin Bevan Health Board and partner agencies

strategies for workforce planning and recruitment, through, for example, offering

enhanced job roles and enabling redeployment of existing staff to new models of

health and social care, in accordance with the 5 year strategic workforce and

financial framework. The flexibility of the design will allow the building and its usage

to adapt to policy and local needs beyond those which have been /can be

reasonably anticipated.

• Accessibility

25

The position of the new facility in Rhymney will allow the facility to better-address the

needs of the surgeries catchment area, vastly improving access to that population.

Access to a variety of services on one site will be enabled, and there will be

appropriate car parking facilities.

DN Conclusion top section required

26

4. Development Options and Proposals 4.1. Options Considered The agreement to develop integrated health and social care teams working on

locality bases was agreed by all partners within Caerphilly County Borough during

the development of the ‘Wanless Local Action Plan’ and articulated therein. The

development of the primary care estates strategy was therefore an enabler of the

service model and vision agreed by all partners at this time.

Through the process of formulating the ‘Primary Care Estates Strategy’, recently

strengthened by Neighbourhood Care Networks, the following options were

identified and considered:

Option 1 The present way of providing services using the existing

buildings (Do nothing)

Option 2 The present way of providing the service using the present

buildings made safe and sound (Do minimum)

Option 3 The present way of providing the service using fully safe, sound

and suitable buildings

Option 4 Changing the way the service is provided and using the existing

buildings

Option 5 Changing the way the service is provided and using the most

suitable present buildings combined with purpose built

replacements

Option 6 Changing the way the service is provided and using purpose

built replacement premises only

The following were criteria that were used to assess future delivery options:

• To provide a wider range of services in a locality setting;

• To more appropriately manage demand within a community setting;

27

• To create a physical environment that enhances the experience of service

users and staff;

• To ensure services which are sustainable within the context of increasing

demands;

• To enable the professions and agencies that provide community health and

well being services to work together in more integrated ways.

This process was strengthened through the consultation for the new hospital in

Caerphilly County Borough which following public consultation presented a preferred

option to Welsh Assembly Government as follows:

‘A new local general hospital in the centre of Caerphilly County Borough, all

community hospitals would close as a result of the development, with the exception

of Redwood Hospital until such time that the community and professionals had

worked together to develop a health and social care model relevant to their needs’.

It was agreed at this time, that the resource centre model would provide a

community resource, for the population, and would fulfil a central role in the

provision, co-ordination, modernisation and enhancement of community based

services locally.

Through consultation with the local population a service model was developed which

brought together a number of health and social care providers in the area. It was

identified early within this process that none of the existing premises would

accommodate a service model of the kind being proposed resulting in the need for a

new development to house the resource centre model. Therefore the following

options through which a resource centre model could be delivered were also

considered:

• Continuation of the dispersed model of health and social care provision in the

area;

• To integrate just health elements of the model in the North locality;

• To integrate just social care elements of the model in the North locality;

• Provision of a fully integrated health and social care resource centre model in

the area.

28

Based on strategic direction, local need and the views of the community and all

partner organisations, the option to develop a fully integrated health and social care

facility, within a new build was agreed.

4.2. Procurement Route Throughout the duration of the project a number of suggestions have been made for

the way in which the integrated health and social care facility would be procured.

Utilising the Caerphilly Local Service Board as a vehicle for debate on the most

appropriate route for this innovative scheme, a cross policy debate was enabled

facilitated by a senior civil servant.

Discussions included representation from, Welsh Health Estates, Primary Care

Capital, the Making The Connections Team and Local Government finance. Clarity

of route was provided through this debate resulting in the third party development

option being the most appropriate. The following section outlines the selection of the

third party developer.

4.3. Selection of the Third Party Developer Welsh Health Estates have previously advised the Aneurin Bevan Health Board that

the initial approach to selection of the preferred third party developer could be

undertaken in two ways:

1. An open advertisement inviting expressions of interest from interested parties.

2. Welsh Health Estates provide a contact list of known developers who have

developed primary care schemes in Wales or wish to do so in the near future.

It was subsequently agreed that the most appropriate option would be via option

one, in order to ensure the full market potential was explored, and to ensure that the

complexities of the scheme could be met through drawing on all available

expertise/experience.

In considering how the scheme should be advertised advice was sought from Legal,

Procurement and WHE colleagues. Given the multi agency nature of the scheme,

the estimated capital build costs and full term lease costs it was considered to be

29

prudent to utilize European Directives governing the tendering of schemes by public

bodies.

The legal advice being that where a public sector body requires a "work" to be built

to its specifications, the European Procurement Regulations apply, even where the

"payment" is via a rental rather than a capital payment for the building under a

traditional contract.

Although there is no LHB head lease in respect of the proposed scheme, the

analysis of the respective value of the public / private split and either build values or

rental values, this split would result in a financial value close to the relevant works

threshold of £3.497 million stipulated in European Procurement Regulations for

which the OJEU process should be followed.

The OJEU process followed in the appointment of the 3PD therefore provided a

competitive procurement process, in accordance with the Restricted Procedure

under the EU Public Procurement Directive 2004/18.

Whilst the former Caerphilly Teaching Local Health Board has had many years

experience in developing the primary care estate and in securing third party

developers, the multi-agency context within which this development is proposed, has

resulted in the need for the process to be acceptable to a number of different

partners and within a number of different procurement and decision making

structures. Throughout the process therefore much effort has been made to ensure

that each stage has been documented and decisions supported by necessary

evidence. In order to ensure that all stakeholders were integral to the selection of

the third party developer, the following process was progressed. A panel was

comprised that reflected the multi-agency nature of the project as follows:

TITLE ORGANISATION

Community Forum Representative Rhymney Community

Director of Finance and Commissioning Caerphilly Teaching Local Health Board

District Valuer District Valuation Services

Estates Officer Gwent Healthcare NHS Trust

Facilities Manager Caerphilly County Borough Council

Financial Services Manager Caerphilly County Borough Council

30

General Practitioner Rhymney Health Centre

Head of Primary Care Caerphilly Teaching Local Health Board

Head of Strategic Planning and Modernisation

Caerphilly Teaching Local Health Board

Interim Head of Strategic Planning and Modernisation

Caerphilly Teaching Local Health Board

Primary Care Advisor Welsh Health Estates

Service Manager – Children’s Services Caerphilly County Borough Council

Shortlisting - Shortlisting was undertaken by all members of the selection panel

using pre qualifying questionnaires from each organisation and using a set of criteria

against which each was considered. All members of the panel scored the pre

qualifying questionnaires individually following which 7 firms were offered

opportunity for interview.

Selection Panel - Selection was undertaken over a two day period on 2nd and 3rd of

April 2009. The panel was chaired by the Director of Finance at Caerphilly Teaching

Local Health Board and reflected once again multi-agency stakeholder interests.

The selection process included a presentation from each of the developers followed

by questions from the panel which were previously agreed and consistent with the

areas that needed to be addressed, i.e. quality of team proposed; design,

sustainability and cost control; management style; locality and site issues; funding

and planning requirements and long term ownership and property management. A

scoring process was determined in advance of the session and all panel members

scored separately. The scores were aggregated at the end of the two days with the

highest scoring development company being Primary Asset Ltd.

In accordance with OJEU requirements, a mandatory “10 day standstill appeal

period” was incorporated into the selection process during which time, unsuccessful

companies were given the opportunity to receive further feedback and potentially

challenge the decision of the selection panel. There were no requests for written

feedback within the required deadline and a public announcement of the name of the

selected developer was made on 11th May 2009 following expiry of the standstill

period.

The scoring sheet is attached as Appendix D.

31

The Third Party Developer - Primary Asset Ltd (formerly Primary Asset

Management Ltd) was established in 1997 with the sole aim of developing high

quality primary care premises through partnerships with GPs and Primary Care

Trusts\Local Health Boards. From the outset the aim has always been to continue

the relationships beyond the design and construction process though long term

ownership.

In 2006 Primary Asset Ltd was acquired by the MedicX Group and became its

development division. The group has completed numerous projects across England

and Wales including Ynyshir, South Wales and is currently on site with a further

development in Abergele, North Wales. Primary Asset has been successful in being

awarded several schemes in South Wales over the past 12 months, and are actively

progressing these to Bid submission. They are, therefore, fully conversant with

Welsh Assembly Government requirements in terms of design and financial

objectives. Their experience further includes several multi-occupier buildings. This

makes Primary Asset ideally suited to deliver the Integrated Resource Centre, which

needs to reflect the requirements of its several Stakeholders.

Primary Asset is funded through its relationship with the MedicX Fund, a London

Stock Market Listed Primary Care Investment Fund. The Fund currently holds 48

properties, including those completed by Primary Asset and has committed over

£180 million to the Primary Care sector. The relationship with the MedicX Fund

provides Primary Asset with the opportunity to provide continued support for its

tenant partners throughout the life of the building, both in the form of routine property

management and also alteration and improvement as the building needs change and

evolve over time. In addition, the strong financial position of MedicX Fund removes

some of the financial risks and allows Primary Asset to progress the scheme more

proactively than might otherwise be the case on a development of this nature. Early

during 2010, Primary Asset Ltd became known as MedicX.

4.4. Selection of the Preferred Site In order to determine the most appropriate site for the location for the Integrated

Health and Social Care Resource Centre a number of key principles were

established, these were:

• Proximity to existing centres of population;

32

• Proximity to existing service delivery sites;

• Location and its implications for the regeneration of the area;

• Process for land acquisition.

In the first phase the Local Authority was asked to identify sites in the ‘North of the

North’ locality which could accommodate the proposed resource centre. A number

of sites within council ownership where identified as being of sufficient size and

scope to accommodate the development as earlier outlined.

There were 9 sites in the area able to accommodate such a development, these were:

• Land North of Rhymney Comprehensive School;

• Land opposite to the East of Rhymney Comprehensive School;

• Land adjacent to the playing field to the North of Pontlottyn;

• Land to the North of Lower Rhymney Primary School;

• Lawn Industrial Estate;

• Playing field to the South of St David’s Church;

• Land to the North and East of Rhymney Cemetery;

• Bryn Bach Park;

• Maerdy Crossing.

Each of these sites was discussed at a community forum for the North with the

anticipation that local intelligence would add further information to the site option

appraisal. Comments received at this forum are attached in Appendix E.

As a result of discussions the three sites identified by the community and

stakeholders working in the area were as follows:

• Preferred Site Lawn Industrial Estate

• 2nd Preferred Site Maerdy Crossing

• 3rd Preferred Site Land opposite to the East of Rhymney

Comprehensive School

During the process of securing a third party developer, the preferred option of the

lawn industrial site was shared with interested parties.

4.5. Accommodation Schedule

33

The schedule of accommodation has been developed through a number of user

group forums, with users advocating specific requirements for their service areas.

Each area has had a designated design champion, who has taken the lead for

determining the design and scope of the development.

The views of design champions have been shared with the third party developer

through regular design champion meetings, and quality assured through the project

team.

The Accommodation schedule which is consistent with WHC 55&56 is attached as

Appendix F. Note this is the entire schedule, GMS space is outlined in Appendix G.

4.6. Space Requirements The overall footprint for the development is 3,887 sq ms. The total Net Internal Area

(NIA) for the GPs space (including shared accommodation) is 1116 sq ms and the

Gross Internal Area (GIA) will be confirmed following receipt of District Valuer’s

Report.

**** Drafting Note – these figures are subject to confirmation following receipt of District Valuer’s Report and confirmation of Community Pharmacy area currently estimated to be 120 sq ms. Consideration on the car parking requirements for the centre is consistent with the

County Surveyors’ Society Wales Car Parking Guidance and has been agreed with

the local planning authority. It equates to 143 car parking spaces, of which 49 are

allocated to the GMS space. This is detailed within the District Valuer’s report which

is attached as Appendix H.

The building has the potential to include expansion space of 365m2.

4.7. Design Evolution/AEDET Partners within Caerphilly County Borough have made considerable effort to ensure

that the design of the facility is functionally able, both for the current time and future

healthcare needs. Strong emphasis has also been placed on ensuring that the

design of the development has been led by the community. A number of processes

have therefore been followed / complied with as follows :

34

4.7.1 Community Design Evolution Process Throughout the development of the plans for the Integrated Health and Social Care

Resource Centre, the community forum established to guide the North project has

played a critical role in both the development of the service models and the design of

the building. As earlier noted the community themselves have played a role in the

option appraisal for the sites that were available in the North of the Borough and

have been fully informed through various fora on each design stage with plans being

shared with the public through each iteration and evolution in order to ensure their

views are fully incorporated with the process. A specific session was held on 18th

August 2009, and subsequently a forum on Tuesday 8th December 2009 for

community members to view and comment upon the plans.

4.7.2 Achieving Excellence in Design Evaluation Toolkit (AEDET) An AEDET workshop was undertaken on the 26th November 2009, and facilitated by

Nigel Davies of Welsh Health Estates. The format of the review was:

• A presentation from the design team;

• Critique of the design;

• AEDET scoring;

• Conclusions and action plan.

Due to the complexity of the end users involved within the facility, the AEDET review

was attended by a variety of personnel reflecting the multi agency status of the

project and also members of the community of Rhymney.

The workshop resulted in the following comments being made the results of which

have been incorporated into the final design of the building. The final report of the

Assistant Director for Welsh Health Estates is attached at Appendix I.

Form and Materials

• Entrances are obvious and logically positioned in relation to likely points of arrival on site

Comment – the main entrance at ground floor level could be emphasised a little more to make it absolutely cleat that it is the main entrance.

35

Response A different coloured material has been specified which will signpost the main entrance to visitors to the site.

• The external materials and detailing appear to be of high quality

Comment – Initial suggested materials appear suitable but will depend upon final selection and detailing

• The external colours and texture seem appropriate and attractive

Comment – Initial suggested colours appear suitable although the comment regarding opencast mining in the opposite side of the valley should be considered Response - Notwithstanding the fact that environmental / pollution controls will minimise the likely hood of coal dust from the mining, the materials specified are robust and will not absorb the coal dust leading to staining.

Staff and Patient Environment

• There are good views inside and outside the building

Comment – There is 1 clinical room without natural light – reconsider re-designing this area. Response - This space has been redesigned and is now a store room.

• There are high levels of both comfort and control of comfort

Comment – Explanation seems acceptable although more details required especially with regard to fittings and infection Response - Details will be provided for approval by the stakeholders and infection control team as the project progresses on site.

Access

• Pedestrian access routes are obvious, pleasant and suitable for wheel chair users and people with other disabilities/impaired sight

Comment – more information required – main entrance steps – buggy parking at main entrance Response - A level entrance is provided to the building. Buggy parking is yet to be finalised.

• Outdoor spaces are provided with appropriate and safe lighting indicating

paths, ramps and steps

Comment – more information required

36

Response - The final design will provide the necessary levels of lighting for safe operation and final details will be provided during the construction phase of the project.

• The fire strategy allows for ready access and egress

Comment – more information required Response - The fire strategy will be developed and agreed with Approved Inspector, Welsh Health Estates and the Health Board’s Fire Officer.

Urban and Social Integration

• The hard and soft landscaping around the building contributes positively to the locality

Comment – more detailed required Response - The initial design has been approved by the local Planning Authority, and again further details will be progressed as construction develops on site.

4.7.3 BREEAM Assessment The project has adopted the Welsh Assembly Government’s policy of achieving an

overall BREEAM rating of ‘Very Good’ with an ‘Excellent’ rating in respect of the

Energy credit. In order to comply with this requirement Primary Asset Ltd has

appointed GB SPM Ltd to carry out formal assessment reviews for the project.

A BREEAM Healthcare indicative design stage assessment was conducted in July

2009. Following this assessment a number of actions were recommended in order

to achieve the necessary performance rating. This report is attached at Appendix J.

The pre-assessment confirmed that a score of 74.87% is achievable if all credits

allocated in the pre-assessment are applied, indicating that the ‘Very Good’ target

will be readily achieved.

Subsequent to the initial appraisal, the design team have incorporated many of the

issues raised within the developing design. A feasibility study has also been

commissioned to consider low, or zero carbon technologies, the results of which will

be implemented through the programme.

Other areas that the design has focused on are:

37

• Developing a design that provides a comfortable and productive working

environment, including: maximising daylight; providing natural ventilation;

providing local control of heating and ventilation;

• Ensuring safe and adequate pedestrian and cycle access; limiting car parking

on site to the required levels, but still meeting the County Surveyors

Standards;

• Allowing adequate storage for recyclable waste;

• Commissioning ecological surveys to ensure that all ecological features are

protected from damage and taking account of these issues during the design

phase of the development. The development will have a net positive impact

on the ecology of the site.

As the design develops the design team will continue to take account of the action

plan and information required which is necessary to achieve the target performance

criteria. Moving forward with procurement, a contractor will be selected who is

committed to providing the necessary evidence to obtain BREEAM Certification.

4.8 Financial Implications *** Drafting note – to be completed once final detail is finalised

The estimated capital cost of the scheme is £???? This includes all consultants and

service fees payable by the third party developer.

The Aneurin Bevan Health Board seeks funding for the sum of £xxxx which will

provide reimbursement for the rental costs incurred in respect of the GMS space.

4.9 Other Resource Implications There will be a variety of resource implications for the resource centre linked to the

need to establish set up costs for all teams relocating into the premise. A planning

principle is that funding of equipment and furniture will be undertaken for the host

organisation of each service provider.

Specifically for GMS, the following applies:

• Dr Evans and Partners

38

The practice has recently migrated to a fully secure hosted clinical system

environment under the GP National ICT Refresh programme. The move has been

supported by the health board in line with a strategic approach to GP clinical

systems allowing for appropriate governance, resilience and IT supporting

arrangements. This strategic approach supports the practice in accessing patient

records from any location from within the resource centre or any secure device

connected to the NHS Wales network.

The practice has received an allocation of replacement IT equipment under the GP

IT refresh programme over the past 3 years. It is considered that this equipment is

suitable for recycling into the new resource centre. Moreover, based on current

requirements and the use of shared areas, no additional workstations or printing

resources are required.

There is an outstanding lease in place for the existing telephone system which

expires in July 2011. The practice has not yet made any decision on opting into the

resource centre wide telephone system, although there is indication that the practice

would prefer this option subject to evaluating the financial cost.

• Dr Potts and Partners

The practice is currently using a local clinical system and the Health Board highly

recommends that the practice move to a fully secure hosted clinical system

environment to alleviate concerns of information governance, resilience and IT

support implications. This approach will support the practice in accessing patient

records from any location from within the resource centre or any secure device

connected to the NHS Wales network.

The practice has received an allocation of replacement IT equipment under the GP

IT refresh programme over the past 3 years. It is considered that this equipment is

suitable for recycling into the new resource centre. Moreover, based on current

requirements and the use of shared areas, no additional workstations or printing

resources are required.

There is a 3 year lease in place for the practice telephone system with British

Telecom which expires on the 2nd April 2012. The practice has not yet made any

decision on opting into the resource centre wide telephone system and there is

39

indication that the practice would prefer retain their existing telephone system to

maintaining ownership. However, dependant on evaluating the financial cost the

practice may decide to opt into the resource centre wide telephone system.

• Funding requirements relating to IT and telephony

The overall capital cost for ICT requirements for the resource centre is £247k.

Based on an ICT shared resource of 20% for GMS equates to £50k. It is appropriate

to include a contingency of approximately £5k to cover both practices in terms of IT

GP business change and transition costs particularly around telephony

requirements. This will also cover interim operational IT resources to embed the

change. A total GMS cost for GP ICT is £55k. More detailed information is outlined

in Appendix K.

4.10 Mortgage Deficit Funding The two GP practices moving into the Integrated Health and Social Care Resource

Centre in the North of the Borough are not subject to any mortgage deficit issues

related to their existed premises and therefore Aneurin Bevan Health Board are not

seeking any financial support towards this.

4.11 Timetable The following timescale has been estimated once approval has been granted:

• Start on site in June 2011

• 15 month construction period

• Complete by September 2012

• Open for patients in October 2012

A project timeline is outlined in the Gant chart is attached as Appendix L.

4.12 Project Management Arrangements In order to reflect the multi-agency stakeholder interests within this project the

following structure has been put in place:

40

• Mrs Sian Martin, Locality Director for Caerphilly– is the locality lead;

• Mrs Claire Harding, Head of Partnerships and Development is the project

manager for this scheme working across organisations to develop the

business case and transitional plan;

• Mrs Kathryn Wall, Project Administrator is the project support for this scheme.

Stakeholder interests are Aneurin Bevan Health Board, Caerphilly County Borough

Council, Dr Evans & Partners (GP Practice), Dr Potts & Partner (GP Practice) Mr

Evans (Dental Practice) and of course the population in the North of the County

Borough. The interest and views of these are managed through the project structure

via the stakeholder forum.

The design team include:

• Third Party Developers – MedicX

• Architect – Powell Dobson

• Quantity Surveyors – EC Harris

• Engineers - RK W Consulting

All partners have collaborated to instruct Morgan Cole Solicitors to act as their legal

advisors.

North Project Steering Group

North Project Team

Access & Assessment

LTC Mental Health

Respite Children and

Families

Palliative Care

Health Prom

Information Management & Technology Group

Therapies & Diagnostics Group

Beds/Intermediate Care Group

Facilities Management Group

Finance Group

Local Service Board

Community Forum for the

North

Aneurin Bevan Caerphilly County Borough Council Health Board

Health Social Care & Well-being Partnership

41

4.13 Stakeholder Support Stakeholders’ support has been secured through letters of commitment received

from all organisations during June 2008 - February 2009, these are attached as

Appendix M.

42

5.0 Risk Assessment The management of risk is integral to the development of the Integrated Health and

Social Care Resource Centre in the North of the Borough. A dynamic risk register

has been established with consideration being given to this at each meeting of the

project team and project steering group. Full project controls are in place for the

escalation of any risks through the project structure as necessary.

A risk register prepared by MedicX is attached at Appendix N.

6.0 Key Benefits and Outcomes Anticipated benefits and outcomes of the service models can be described as:

• Enhanced and improved quality, reliability and consistency of primary care

services, particularly for long term conditions, mental health and older people;

• Extended range of primary care services through development of GPs with

specialist interests, resource centres providing access to diagnostics, nursing

and therapy input;

• Development of specialist community teams, e.g. reablement, rapid response

and emergency teams, integrating health and social care where possible;

• Development of integrated resource centres to support more local access to

care;

• A model of care developed specifically on the needs of a geographical

population;

• A reduction in inappropriate admissions as a result of enhanced level one

services.

Patient Outcomes

• To have a single point of assessment and access to community support (both

specialist and generalist);

• To have care co-ordinated around the individual;

• To feel safe;

• Professionals to provide care in own home or as close to it as possible.

43

System Outcomes

• Co-ordinated care by identified care co-ordinator;

• Integrated teams of health and social care staff;

• Optimum use of resources in community;

• Appropriate use of unified assessment and shared records;

• Where possible to integrate health and social care IT systems;

• Change of skill mix (inc growth of generic worker role);

• Reduction of inappropriate hospital admissions.

As this document makes a bid specifically for GMS provision, specific benefits and

outcomes for the two GP practices and their practice staff/population are outlined below:

• Provision of a modern Primary Care facility which promotes wellness and

raises morale in line with sector aspirations.

• Improved and appropriate staff /patient welfare conditions.

• A sustainable and attractive design which enhances its environment.

• Space and facilities to deliver enhanced Primary Care services.

• Flexible space which can be adapted to suit need in line with the requirements

of Designed for Life.

• Good access in line with DDA requirements and easily accessed by public

transport with space for parking of private vehicles and bicycles etc.

• An environment which will assist in attracting new GP’s to the area.

• Will allow all parties to concentrate on delivering services to the community

without maintenance and building fabric concerns /issues.

• Will enable the training role to be expanded.

• Will enable the delivery for more well-being /well people clinics, promoting the

community to take increased responsibility and control of their health and

well-being.

• Provides high standard expansion space for the increasing population.

• Will promote collaboration with other professionals /service providers within

the locality, giving a focal point for the communities well-being and health

needs

44

7.0 Conclusion 7.1. Summary of the Case for Change

Drafting Note -To be completed when all financial detail is known .

7.2 Summary of items requiring financial assistance The items which require financial assistance are summarised below:

Revenue Items Amount Vat Total Comment

New Annual Rent

Less: Current Re-imbursement

Net Increase in Rent Re-

imbursement

See DV’s report

Annual Business Rates

Clinical Waste

Refuse Disposal

Less: current Re-imbursement

Net Increase:

(Source District

Valuer report)

This will be subject to the amount of clinical waste moved per month.

Subject to annual

uplift.

Non Recurring Items Amount Vat Total Comment

Stamp duty land tax

N/A Based on Inland Revenue SDLT calc.

Legal Costs (Estimate)

Mortgage Deficit Grant

N/A N/A N/A

Monitoring Surveyor

45

Drafting Note -To be completed when all financial detail is known .

46

8.0 APPENDICES

Appendix A Review of Strategic Direction & Fit of Proposed Project Appendix B Existing Service Provision Appendix C AEDET Score Sheet Summary Appendix D Selection Panel Scoring Sheet Appendix E Site selection - comments from Community Forum meeting Appendix F Accommodation Schedule (Awaited) Appendix G GMS Space (Awaited) Appendix H District Valuer’s Report (Awaited) Appendix I AEDET Final Report Appendix J BREEAM Healthcare 2008 Pre-assessment Report Appendix K IMT Costs Appendix L Project Timetable Gant Chart Appendix M Stakeholders’ Letters of Commitment Appendix N Developers’ Risk Register Drafting Note – Site and floor plans will be included when submitted to Welsh Assembly Government

development of an integrated health and social care

Documents