Skerne Medical Group Premises Appraisal June 2019
Reminder - National Crisis impacting locally The attraction and retention of GPs continues to be a challenge. Taken significant time to fill vacancies caused by retirement, sickness and resignations Situation has worsened in last 6 months despite reducing services from 4 to 3 sites. 2 Partners, 1 salaried GP and a Clinical Practitioner We are at resigned. breaking point 15500 patients over 3 sites is unsustainable for the future. Also inability to absorb any increase due to housing developments Lack of new GP’s seeking Partnership therefore small number of partners to absorb business workload
What has changed since the engagement? Recruited four new GPs, 3 we hope will commence in Aug 2019 and one to join in Jan 2020 Recruited additional Practice Pharmacist and currently recruiting What have we for an additional Clinical Practitioner achieved? Practice Paramedic and Practice Nurse achieved prescribing status Now better placed to provide support and mentorship to our whole clinical team
GP Appointment Time – In Jan 2020 we will almost be back to GP appointment time of October 2016 80 70 60 50 Oct-16 Feb-19 40 Sessions Aug-19 (half a day) 30 Jan-20 20 10 0 GP Appointment Time
There has been a significant change in the split between Partners and Salaried GPs In January 2020 Pre October 10 Partner FTE will 2016 the be 2.12 Partner FTE 9 was 6.12 8 7 6 Salaried GPs 5 Partners 4 3 2 1 0 Number of GP's
Practice Area
Premises Scenarios As requested by the Primary Care Committee scenarios have been reviewed in conjunction with DDES CCG and NHS England The scenarios have included all What has locations across our practice area been The scenarios have considered the reviewed? financial implications for the Partnership The future sustainability of Skerne Medical Group has to be a balance of the above considerations
What are the challenges with a multi site practice? Newly qualified GPs require mentoring and peer support to manage the transition from trainee to qualified GP Appointment time is lost due to clinical staff having to travel between sites Challenges Patients do not receive consistent continuity of care with clinical staff working across multi sites All staff do not like working in isolation and prefer working in teams where peer support is available
Partnership Financial Responsibility Skerne Medical Group is a standalone business fully responsible for its profit/loss The Partners have full financial responsibility for the Practice. Premises are secured on either 25 year lease or mortgage Partnership The Partners have full responsibility for the medical care provided to patients and staff they employ The risk remains of formal termination of the formal GP contract
Scenarios Occupy a single site at Sedgefield Community Hospital plus retain Trimdon 1 Colliery until 2027 Build a new surgery in Trimdon (village) for entire practice plus retain Trimdon 2 Colliery until 2027 Extend Harbinson House, Sedgefield and build a (larger) new surgery in Trimdon 3 (village) to accommodate 7,000 patients (plus retain Trimdon Colliery until 2027) Extend Harbinson House, Sedgefield and retain and extend Trimdon Colliery 4 surgery 5 Extend Harbinson House, retain Trimdon Colliery and Fishburn
Scenario 1 – Occupy a single site at Sedgefield Community Hospital and 1 retain Trimdon Colliery until 2027 ❑ Harbinson House and Fishburn would close at ❑ Improved Safety some point (Trimdon ❑ Improved facilities and Colliery in 2027) services in a modern ❑ Additional travelling for environment Patients all patients across the ❑ One stop shop for practice area continued care due to ❑ Access issues for less connections with other mobile patients across clinical services co- the entire practice located ❑ Not all public transport stops at SCH ❑ Will attract and retain GP’s ❑ Peer support readily Practice available ❑ No foreseeable negative ❑ Improved staff morale Staff impact ❑ Less duplication of effort
Scenario 1 – Occupy a single site at Sedgefield Community Hospital and 1 retain Trimdon Colliery until 2027 ❑ Extremely high service charge as PFI building ❑ Will require sale of ❑ Savings due to practice property (potential negative economies of scale ❑ Potential revenue from equity situation & Finance impact on outstanding hosting other PCN business loan) services ❑ Service charges & running costs unknown – is it affordable through duration of agreement ❑ Modern and maintained ❑ Consistent services ❑ No pharmacy adjacent provided for all patients to site ❑ Peer support readily ❑ Unknown as to what Facilities available and attractive impact the rest of the operating model for GP used area of SCH may training have on the practice ❑ Opportunity to expand car park (we believe) ❑ Other facilities on site
Scenario 2 – Build a new surgery in Trimdon Village for entire practice and 2 retain Trimdon Colliery until 2027 ❑ Harbinson House and Fishburn would close ❑ Improved Safety (Trimdon Colliery in • ❑ Improved facilities and Distance for Trimdon 2027) Patients ❑ Not a central location Village patients services in a modern ❑ Fewer public transport purpose built surgery options into Trimdon (village) from the rest of practice area. ❑ Likely to aid retention of our new GPs ❑ Peer support readily available and attractive Practice ❑ No foreseeable negative operating model for GP Staff training impact ❑ Less duplication of effort
Scenario 2 – Build a new surgery in Trimdon Village for entire practice and 2 retain Trimdon Colliery until 2027 ❑ Huge estimated build cost of £3.57m – unlikely to be • Improved Safety ❑ Savings in running costs affordable for Partners and • Improved facilities and NHS England (reimbursable due to economies of services in a modern costs) • Distance for Trimdon scale and modern Finance environment ❑ Current Partners unlikely to premises Village patients • One stop shop for get a loan to cover costs so not a viable/affordable continued care investment • Ability to offer more ❑ Sale and lease back options flexible hours debateable due to limited number of Partners ❑ Modern and purpose built ❑ Ability to offer services under one roof ❑ Proposed site is not big ❑ Peer support readily Facilities enough for a single sited available and attractive building operating model for GP training
Scenario 3 – Extend Harbinson House, Sedgefield and build a (larger) new 3 surgery in Trimdon (village) to accommodate 7,000 patients ❑ Fishburn would close ❑ Good accessibility for and Trimdon Colliery in each side of the practice Patients 2027 ❑ New purpose built ❑ Limited car parking in facility for patients of Sedgefield for increase Trimdon in patient numbers ❑ Could be attractive model for new Partners Practice depending on finance of ❑ No foreseeable impact Staff new build ❑ Staff could be anchored to sites for continuity of care
Scenario 3 – Extend Harbinson House, Sedgefield and build a (larger) new 3 surgery in Trimdon (village) to accommodate 7,000 patients ❑ Huge estimated build cost of £2.2m – unlikely affordable for Partners ❑ Current Partners Finance unlikely to get a loan to cover costs and not a ❑ Savings due to viable investment economies of scale ❑ Sale and leaseback options debateable due to limited number of Partners ❑ New build modern and purpose built ❑ Peer support readily Facilities ❑ No major impact on available and attractive facilities for patients or operating model for GP staff training
Scenario 4 – Extend Harbinson House, Sedgefield and retain Trimdon 4 Colliery surgery (would also require extending) ❑ Fishburn would close at some point ❑ Limited public car parking in Sedgefield for ❑ Good accessibility for Patients increase in patient whole practice area numbers ❑ Patient numbers would have to be controlled at either site due to capacity issues ❑ Staff could be anchored to sites for continuity of care and maximisation Practice of available ❑ No foreseeable impact Staff appointments ❑ Opportunity to centralise some functions & achieve economies of scale
Scenario 4 - Extend Harbinson House and retain and extend Trimdon 4 Colliery surgery ❑ Finance required for ❑ May be an attractive extension work in Sedgefield and Trimdon option to incoming Finance Colliery Partners ❑ Partners would have to sign new lease on TC or look at option to purchase (if available) ❑ Current room availability would leave no scope for development of services so Sedgefield ❑ Two good buildings with Facilities and Trimdon Colliery facilities would require extension to provide sufficient rooms ❑ No scope for future expansion
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