Case studies

The following are examples of how the Estates and Technology Transformation Fund (ETTF) is benefitting local GP services and their patients.

Area: South Harrow, Middlesex | ETTF investment: £320,424

Roxbourne Medical Centre is creating a ground floor extension to provide a new wing to the medical centre, consisting of additional consulting, rehabilitation and clinical support space. It will be used primarily as a community cardiopulmonary rehabilitation unit. With major housing developments underway in the area there
is potential for an increased list size and requirement for additional clinical space. It is the intention of the practice to work with the local hospital based cardiology and respiratory teams to develop and run a rehabilitation service for Harrow patients to aid recovery and prevent further admissions.

Area: Bromley, Kent | ETTF investment: £658,049

The scheme at Links Medical Practice comprises a two story extension. The ground floor has four new consultation rooms, an additional counselling room and clinical support spaces. Reconfiguring the ground floor has provided
increased reception and waiting areas. A new multipurpose room has been added in the second floor extension along with improved administration areas. The primary reason for undertaking this extension is to improve patient access for a deprived population which has a high level of health needs. The practice has one of the largest populations of over 75s for Bromley.

The objectives were to overcome the spatial inadequacies of the current accommodation and to provide clinical rooms that met current NHS guidelines, to be fit for purpose and enable the practice to offer improved access and enhanced services. The development further offers support to integrated care and case management by creating additional clinical space to accommodate Bromley Healthcare staff (particularly the community matron) and a meeting room for clinical meetings to review patients with care plans.

Area: Thornton Heath, Surrey | ETTF investment: £252,998

Brigstock Medical Practice is undergoing an internal reconfiguration to develop a suitable walk-in treatment area, which allows safe and effective management of people with minor injuries. The premises are sited in an area of high health deprivation in Croydon. Enhanced services will be provided due to improved diagnostic facilities and treatment facilities such as phlebotomy, wound management, spirometry, ECGs and emergency nebulisation facilities. This should result in a reduction in emergency attendances.

Area: Wandsworth, London | ETTF investment: £79,000

An internal reconfiguration of the Chatfield Health Centre has provided five new consultation rooms and a new dirty utility on the second floor of the practice, replacing an under-used multipurpose group room.

With significant residential development going on in the area, including the construction of 900 apartments with a remaining 450 to be constructed in 2019, the health centre recognised a need for increased capacity in this community of high deprivation levels.

The additional rooms will provide additional sessions for extended services such as alcohol and substance misuse workers. The patient reference group expressed their interest in providing additional services such as citizen’s advice sessions and diabetic outreach programmes. Additional clinical rooms will also allow the practice to perform at greater levels of clinical activity designed to optimise quality of care and reduce emergency admissions.

Area: South Tottenham, London | ETTF investment: £557,640

Lawrence House Surgery is developing a new temporary Alternative Provider Medical Services (APMS) practice – initially commissioned as a pilot – from a temporary modular building on the site.

The temporary accommodation will house a practice capable of providing primary medical service to an expected list size of up to 6,000 patients, offering around 500 consultations per week covered by four GPs working nine sessions per week.

At the end of the pilot scheme a new provider will be selected through an open and transparent procurement process, and it is hoped that the new provider would move into a purpose built permanent health centre in the locality.

Area: Camden, London | ETTF investment: £485,400

Gower Place Practice is refurbishing new premises to accommodate the relocation of an existing practice in order to meet NHS standards. The practice has a list size of 15,500 patients, 80% of which are aged 16–35 (most of which are students) and delivers a wide range of additional and enhanced services.

The new site is 33% larger than their current premises and as it is all contained within an exclusively controlled area, the space will be used more effectively. The new practice will be designed with fully flexible facilities in mind, with multifunctional consulting rooms to make best use of the space.

Area: Wirral | ETTF investment: £59,400

On the ground floor two new consulting rooms will be established, along with a larger waiting area. To the first floor there will be an extension to provide a training room for clinical staff and patients. This will result in increased capacity and more opportunities for providing additional services to patients. New services will include minor surgery and physiotherapy, training room for staff nurses and a patient education room on chronic long term diseases.

Area: New Brighton | ETTF investment: £100,584

St Georges Medical Centre wanted to provide a new model of personalised and co-ordinated health care services for their registered patients by integrating local, community and secondary care services in-house. The supported improvements saw three administrative rooms totalling 137 square metres being renovated into six consulting rooms to support delivery of primary medical services. The new rooms increase space utilisation for the practice in order to increase patient contact time and help reduce emergency admissions of the frail and elderly by offering more preventative care and support.

In line with the Five Year Forward View, the additional consulting space will also create opportunities for the practice to host 8-8 working as part of a single organisation, federation or network of practices, enhanced services to support patients manage their conditions in community settings and host outpatient consultations.

Area: Devon, Cornwall & Somerset | ETTF investment: £100,000

ETTF funding was awarded to Northern, Eastern and Western Devon on behalf of the Devon, Cornwall and Somerset areas to develop a scope and vision for interoperability across the whole health and social care system, including 320 GP practices. This project has enabled the four CCGs to understand in which areas they can work together collaboratively by reviewing technical landscapes and current interoperability functionality.

Part of this project involved a clinical engagement and priorities workshop, attended by over 50 health and social care professionals. This event helped to set out a shared vision, scope and goals for the use of digital information across the area and to start setting out what the priorities are. These range from implementation of new Electronic Patient Records to better sharing of information with social care systems in local authorities. This is an important first step towards a range of benefits such as creating a system that can bring together the relevant information from across the dozens of health and social care organisations working in the South West Peninsula.

Area: Wiltshire | ETTF investment: £350,000

51 of Wiltshire’s 56 GP practices, out-of-hours and adult community health services already use the same clinical system: TPP’s SystmOne. The Wiltshire Interoperability Programme, with membership from all key health and social care providers across the county, approved an approach which would exploit the sharing capabilities of SystmOne, in addition to the Summary Care Record with additional information (SCRAI). The funding application would support purchase of three TPP Viewers for acute, social care and mental health settings, and laptops to support mobile working for adult community services.

In care settings where it was proposed that the TPP Viewer would provide benefit, SystmOne was demonstrated to staff – mental health leads visited an acute trust already using the TPP Viewer. Learning and experience from another implementation of mobile hardware was shared with adult community services in a consultation with them on preferences for the make and model of laptops which should be deployed.

Patient leaflets and posters have been developed and distributed to GP practices and made available on the CCG’s website, providing information on consent to share records. The programme’s communication plan includes ngagement events with Healthwatch and practice Patient Participation Groups.

The deployment of the TPP Viewers is in planning stage – the Viewers have been purchased, high level plans have been shared with host organisations and further clinical engagement is ongoing ahead of agreement on the optimum time to implement. 25% of the laptops have been delivered to site from bonded warehouse storage, for phased configuration and roll-out to users. Anticipated benefits derived from both implementations include:

  • For patients – improved safety e.g. by enabling a rich dataset of information to be accessed in real time so that clinicians may deliver the right care at the right time
  • For staff – efficiency savings e.g. real time online confirmation of medications may spare the need for phone calls/faxes to GP practices to inform prescribing
  • For commissioners – financial savings delivered by reducing unplanned admissions, re-admission, length of stay.

Project managers working on the programme will attend a Benefits Realisation workshop this month in order to develop their skills in supporting benefits realisation. Board members have been asked to report back in June on their consultations with clinicians on key benefits they hope to realise from the programme.

Area: Aylesbury Vale | ETTF investment: £677,000

Aylesbury Vale CCG was awarded funding to support the design and development of digitalisation of care homes and primary care. This business case was built on work commissioned by the CCG to examine and explore new models of care. This involved working with all three localities of the CCG and their 19 member practices, which was clinically led and governed by a series of clinical forums and the AVCCG Executive Team.

During this time there was an unexpected loss of a practice due to the pressures within primary care, which meant that existing partners could no longer continue. Increased long term conditions management and an increase in emergency care home admissions by 23.2% in two years alone added to these pressures. The digitalisation of care homes and primary care provided an opportunity to reshape the patient journey and experience using technology. Digital Life Sciences (Modality Vanguard) and Immedicare (Airedale Vanguard) have supported the development of this project to ‘lift and shift’ and develop a digital solution for our patient population.

The project has involved an extensive shift in culture and improving relationships to support system change, for both primary care and care homes. Detailed engagement workshops have taken place to ensure that all stakeholders are supported through this digital transition, and that digital solutions are tailor fit for our patient population. Technology is being deployed throughout all 30 care homes and primary care is being supported to develop a primary care digital solution to manage demand and access. All practices are on an EMIS platform and reports have been designed to measure impact of digitalisation in primary care and care homes. Quarterly EMIS reports will be produced to measure impact as the project moves into implementation. Final evaluation will be made available in 12 months’ time.

Area: Lincolnshire | ETTF investment: £1m

Care Portal is a ground-breaking new IT system allowing doctors to see a patient’s complete medical record for the first time. The new system, installed across Lincolnshire, will allow instant access, if a patient gives permission, to a complete set of medical and care records, helping health and care professionals make decisions quickly and appropriately. It will also allow patients to access their own records online an enable them to choose to share their records with others, such as family members and carers.

Care Portal is powered by InterSystems’ global leading health informatics platform ‘HealthShare’. The initiative was developed as part of the Lincolnshire Health and Care (LHAC) programme – a partnership of 13 health and care
organisations across the county working together to find ways of transforming services.

As part of this work, which has involved hundreds of clinicians and included engagement with over 15,000 residents in the county, the lack of access to full medical records emerged as a key problem. Medical and care professionals identified the issue as a crucial hurdle to joined up services and a problem which currently wastes valuable staff time. Patients also made it clear they were frustrated when they often had to repeat their story several times to different people during their care.

LHAC has managed to secure nearly £1m of NHS funding to support the introduction of the Care Portal and implementation will be phased over the next two years. As well as improving the experience and treatment of patients it is believed the new Care Portal will make a real difference to the over stretched finances of the local health community. For example:

  • It is believed the Care Portal would release time to devote to patient care, saving nurses and doctors between 10 and 15 minutes a day by avoiding the need to access several different systems a day. Multiplied across the hundreds of staff across the county it will free up huge amounts of time.
  • Based on figures from other Trusts, ULHT estimates that the Portal may lead to a reduction of 8% in the number of patients sent for imaging tests and result in up to 27% less lab tests ordered.
  • It is estimated that reductions in the number of patients sent for tests could save around £4m a year in Lincolnshire.

Area: Birmingham and Solihull | PCTF investment: Around £1.3m (across five GP practices)

Five GP practices in Birmingham and Solihull will receive a £1.3 million boost from the Primary Care Transformation Fund to improve their facilities and expand services for patients in their area:

Richmond Medical Centre,  Richmond Road, Solihull will get £389,920 towards the complete refurbishment and redesign of the practice buildings, plus two new consulting rooms that will allow more integrated care for patients and provision of additional services.

Druids Heath Surgery, Pound Road, will receive £249,345 towards building an extension to provide two additional consulting rooms, create a wheelchair accessible entrance, new reception area and larger waiting room.

Weoley Park Surgery, Weoley Park Road, will get £279,309, which will be used to increase the number of treatment and consultation areas from five to eight. The three extra rooms will include a nurse’s room, a minor surgery room and a training area.

West Heath Road Surgery, will receive £287,100 for four new consulting rooms by building an extension.

A funding of £106,666 will go to GPS Healthcare. This will be used to create a central admin centre at its Tanworth Lane site and to convert admin rooms at GPS Healthcare’s five other sites into clinical rooms.

These improvements will help make a wider range of services more accessible to people who need them.

Area: Theale, Reading | PCTF investment: £23,870.88

A GP practice in Reading has received just under £24,000 from the Primary Care Transformation Fund to improve facilities and access to services for local people.

Theale Medical Centre, Englefield Road, Reading, has added new treatment areas to their existing building. Work is now on going to expand its car park to accommodate the extra patients that will be using the new treatment areas.

A second expansion phase to the car park is currently underway and will be competed in late 2015.

Area: Dorking, Surrey | PCTF investment: £56,500

Medwyn Surgery, Reigate Road, Dorking, has received a £56,500 financial grant from the Primary Care Transformation Fund, which will go towards refurbishment and the addition of four extra consulting rooms.The rooms, named Cotmandene Suite, will be used to provide more dedicated care to patients, extending the services available and making more appointments available.The surgery has also recruited an extra GP and practice nurse, which will allow the practice to take on more patients than it can at the moment.

Area: Ashford, Kent | PCTF investment: £850,000

New Hayesbank Surgery, Kennington, has received an £850,000 cash boost from the NHS England Primary Care Transformation Fund.

The money will be used to carry out a major extension of the practice building, adding seven clinical rooms, a theatre for minor operations, along with recovery rooms and a larger reception area.

The additional treatment areas will enable the practice to offer more appointments and provide more vital local treatment.

Building work started in November 2015 and the new premises are to be open to patients in July 2016.

Area: Wallasey, Wirral | PCTF investment: £151,923

Grove Road surgery, Wallasey, has received a £151,923 NHS contribution, through the Primary Care Transformation Fund to enable installation of a lift, the conversion of an admin room to turn it into additional clinical space, significant extension and refurbishment to its current building for clinical use of the GP-purchased adjoining property.  The practice has an ambition to increase services offered to patients substantially once these works are complete.

Area: St Helens, Merseyside | PCTF investment: £63,790

NHS England’s Primary Care Transformation Fund, has provided a £63,790 contribution to support the development of St Helens Rota, Albion Street. The development, which includes an extension to the existing building, will allow the practice to create an additional consulting room plus additional office / meeting room space.  The project will also create an additional internal triage/Skype triage room within the current patient waiting room. This will allow clinicians to undertake more urgent care such as Children’s clinics and general clinics especially during the day-time i.e. in hours, particularly during times of increased demand such as winter, when urgent care services such as A&E are under most pressure.

Area: Southport, Merseyside | PCTF investment: £114,843

Norwood Surgery, Southport, Merseyside, has received £114,843 of NHS England contribution. This fund will support the practice to install a lift and reconfigure existing rooms to increase clinical capacity, including the provision of a new phlebotomy clinic.  The money will also enable the creation of wheelchair access to the front of the building and the reconfiguration of the reception area to be wheelchair friendly.