Wrington Vale Medical Practice Development Detailed Business Case

1. Wrington Vale Medical Practice Development Detailed Business Case Extraordinary Board Meeting 17th December 2010

2. Background • OBC approval May 2009 - financial envelope £170k, clarity on benefits, consultation, space • Consultation – Nov.2009 to March 2010. Report received by Board in July 2009. • Strong message re potential loss of local service in Wrington • Detailed Business Case received – Nov 2010 • 6 week Assurance Process • Addendum from practice reflecting changes arising from the assurance process.

3. Public Involvement and Engagement • PCT collated post-consultation feedback • Health Overview and Scrutiny Panel update • Project Board with lay membership • Two recent public meetings by the practice: • Stronger voice from patients in other areas served by the practice in support of single site • Concerns from Wrington people re longevity of solution to meet their needs

4. Assurance Process • Consultation outcomes reflected in Practices review of options appraisal • Non-financial Benefits Appraisal • Space requirements that are in line with national guidance, list size and service needs • Financial Appraisal • Project Board consideration; PCT Directors, Lay members drawn from Consultation Reference Group

5. Non-financial Benefits Appraisal • Weighting of criteria reflected response from consultation • Ease of access most important • More services for patients next in importance • 5 service delivery model options appraised • Remaining 3 options scores close but practices preferred option, single site + presence in Wrington, consistently highest

6. Financial Assurance – Space comparisons • List size, GP full time equivalents, no of clinical sessions have informed table below:

7. Value for Money • District Valuer’s opinion led to consideration of and changes to baseline assumptions including build cost, fees and developer costs • Benchmark of other schemes in region • National guidance on space for practices of the size of WVMP • Reduction in build cost saves 5% • Car park spaces significantly reduced in number

8. Conclusion of Financial Appraisal • Space allowance = 890m2 • Car park spaces reduced to 56 • Project cost brought below £2m • Build cost £m2 reduction • Site value appraised independently • Fees and developer costs reduced • Current market rent p.a. £145k for main site

9. Key Benefits for Patients • Sustainable high quality, local, primary healthcare • Better patient experience and environment • Additional services • Extra clinics, GP and nurse, some more evenings and at weekend • New services e.g. Physiotherapy, Hot Foot clinic, visiting consultants and nurse specialist • Preventative and self-care health shop • Opportunities for the future: • One stop shops and visiting diagnostics e.g. ultrasound • Increased collaboration with community groups

10. Benefits for the Practice and Staff • Improved working environment and facilities • Expansion of training facilities • Better communications between multi-disciplinary team • Strengthens recruitment and retention • Improved job satisfaction due to integrated team working • More efficient business model • Reinvestment of productivity in services to attract and retain patients

11. Key challenges - planning permission • Sequential test will apply to any development site eg consideration of: • Forest of Avon/area of protected species and habitats • Settlement boundaries • Flood zones • Safeguarding of land by policy • Pudding Pie Lane site constrained but: • All other sites more constrained at time of appraisal for this business case • Centrally located for the practice population • Best meets Practice’s business model

12. Other Key Challenges • Time of uncertainty • Policy direction - detail of this emerging • Economic challenge ahead • Timeliness of development: • Meeting CQC standards by 2012 • Practice sustainability • NHS delivery challenges; QIPP, shift closer to home, integration of services

13. Recommendations • Note the outcome of the assurance process • Approve the Practice’s preferred service option of consolidating onto one main site • If main site is Pudding Pie Lane/Langford, approve a presence in Wrington • Approve a maximum financial envelope of £158.5k per annum: • £145k for Current Market Rent (CMR) on the new main site and • £13.5k per annum rent for the presence in Wrington if required.

14. Next Steps for the PCT • Support the practice/developer in relation to the planning application etc • Support and advise the practice on public involvement and engagement • Agree detailed benefits realisation plan (service and facilities) and timescales with the practice • Continue to work with practice to demonstrate value for money solution • Rent review detail to be agreed with practice/ developer as part of DV “sign off”