Written evidence submitted by Mr David Tindell (FGP0194)

  1. Scope

The Committee has launched an inquiry to explore the future of NHS general practice, examining the key challenges facing general practice over the next five years as well as the biggest current and ongoing barriers to access to general practice (I have highlight in a different colour text key issues)

I am submitting the following because I have personal experience of it, and I understand that the committee can't help out with an individual problem or a specific complaint but I hope you will look on this as more of a case study on how the process is not working locally, in the new/redevelopment of medical centres in Brighton and Hove.

  1. Terms of Reference
  1. What are the main barriers to accessing general practice and how can these be tackled?

 

1.1          I am asking the committee to look at this question in a slightly different way part of accessing general practice is not only about GPs and nurses but the buildings being fit for purpose, flexible to cater for future needs e.g., annual check-ups, screening, preventative actions, mental health, from space for baby buggies, baby changing facilities, to high tech consulting rooms all need to be available at a medical centre.

As an example the initial consultant consultation at the Hospital would involve which tests are required e.g. blood test, scans etc to help identify the condition, this could be done at the medical centre if the consulting rooms were equipped with high definition tv and cameras and linked to the local hospital this would reduce the number of patient visits to the Hospital, allow the consultant to concentrate on the next phase of the treatment, a nurse could carry out this part of the initial consultation via video link, giving a greater role for nurses to play in the medical centre (as it is important acknowledge the roll of nurses have in the running of the medical centres) and then book the required tests/scans through the NHS booking system.

 

1.2          The redevelopment of St Peter medical centre (Brighton), the waiting rooms are over three floors so one of the issues will be getting patients to the GP on time. When visiting hospital for a consultant’s appointment staff seat patients outside the consulting rooms ready to go straight in, the corridors in the redevelopment of the medical centre are not wide enough to allow for seating and wheel chair access? (See section C, St Peters medical centre)

 

1.3          Number of consulting and treatment rooms Catchment population for redeveloped for St Peters medical centre: 22000 (target) at present almost 20000

 

Number of patients (target)                                                            22000

              Number of Consulting/ Examination Rooms Req.               22.7

              Number of Treatment Rooms Req.                                                             6.05

              The Actual number of Consulting rooms                                          14

              The Actual number of Treatment rooms                                              4

Well short of the number required 9 consulting rooms and 2 treatment rooms

 

See section C. St Peters medical centre below

2.                            What part should general practice play in the prevention agenda?

2.1              Space (rooms) Abdominal aortic aneurysm (AAA) screening programme has issues in finding rooms at various locations in Sussex

              Email dated 6/11/20 from Sussex AAA Screening Programme

              “most GP practices are not keen to permit use of their clinic rooms by external services at this time. Even in the absence of covid many GP practices cannot host external services due to their size and prioritising their own services. In Brighton we have always struggled to find a venue that allows us to use their clinic rooms; Preston Road is the only venue that is able to host us consistently.”

              My comments (at the time)

              Other services e.g. blood donning, prostate screening blood test can be run from church halls/hotels (blood donning). I am sure that there are numerous venues in Sussex e.g. Brighton Library has rooms, small community centres who could also provide volunteers. I know that there would be some issues still to sorted out but these could be resolved as I do not see why the testing needs to be at a GP surgery.

              Additional

              I would also add that locally we have a new medical centre at Preston Barracks Brighton (which is due for fitting out in April 2022) and St Peters Medical Centre which is having a major redevelopment but has not allowed for mobile MRI scanners to use the car park (provide services) and has no space for external services such as the AAA Screening Programme which only requires a room to setup the portable ultrasound unit but the lack of consulting rooms in the new development limits any screening/preventative services. (See section C. St Peters medical centre)

 

2.2              At present the St Peters medical centre does not have the space to carry out flu vaccinations on site and the local Salvation army hall has been used, with the redevelopment you would have thought that this would not be an issue but again it is short of treatment rooms for nurses to carry out the vaccinations (See section C. St Peters medical centre)

 

3              How can the current model of general practice be improved to make it more sustainable in the long term?

I cannot comment on this here due to limited space to make comments

4. Has the development of Primary Care Networks improved the delivery of proactive, personalised, coordinated and integrated care and reduced the administrative burden on GPs?

I cannot comment on this here due to limited space to make comments

5. To what extent has general practice been able to work in effective partnerships with other professions within primary care and beyond to free more GP time for patient care?

I cannot comment on this here due to limited space to make comments

  1. St Peters medical centre

 

St Peters medical centre is in the process of a major redevelopment, there is £1.3 million Estates and Technology Transformation Fund ETTF funding “It is part of the General Practice Forward View commitment for more modernised buildings and better use of technology to help improve general practices services for patients.” I looked at the planning information for the medical centre as my GP Surgery merged with St Peters medical centre (completed October 2021).

 

  1.           St Peters medical centre (in the process of redevelopment)

The documents provided to Brighton and Hove councils, planning department and available on the council’s planning web site https://planningapps.brighton-hove.gov.uk/online-applications/applicationDetails.do?activeTab=documents&keyVal=PQITSKDMIQU00

BH2019/01258 | Demolition of existing medical centre and erection of a four storey medical centre (D1) with integrated pharmacy (A1), access via Oxford Street, landscaping & parking. | 30 - 36 Oxford Street Brighton BN1 4LA

PLANNING_STATEMENT-15405697.pdf - Lewis and Co Planning

 

“St Peter’s Medical Centre and the Sussex Partnership NHS Foundation Trust – which provides additional mental health services.”

“The proposed scheme will allow the St Peters Medical Centre to increase its capacity from 15,000 to 22,000 patients. Furthermore, the ability to house both the St Peter’s Medical Centre and the Sussex Partnership NHS Foundation Trust

 

APPLICANT_-_CONSULTING_ROOMS_TREATMENT_CALCULATOR_22000_PATIENTS-15920929.pdf

“Health Building Note 11-01: Facilities for primary and community care services” provides details on the calculation for the number of consulting and treatment rooms

These calculations are used to define the number of consulting and treatment rooms a medical centre requires for the number of patients the practice has (excluding any additional Sussex Partnership NHS Foundation Trust need to access treatment rooms for its patients)

 

 

 

Calculations submitted by St Peters medical centre as part of the planning documents (available on the council’s planning web site)

 

Catchment population:                                                              22000

Number of Consulting/ Examination Rooms Req.               22.7

Number of Treatment Rooms Req.                                             6.05

                           

The Actual number of Consulting rooms                                          14

The Actual number of Treatment rooms                                          4

Well short of the number required

  1. Reference Sussex Partnership NHS Foundation Trust Freedom of Information requests Reference: SPFT FOI 21/22-178 Dated 5 August 2021 extract

Within St. Peter’s Medical Centre, the Sussex Partnership NHS Foundation Trust will have six interview rooms (when built) located across the first and second floors; one room on the first floor and the remaining five on the second floor, providing 240 hours of mental health clinical services space per week (and will be of significant benefit to patients in Brighton and Hove). It will also provide some hot desking space for staff with shared use of the reception and waiting areas, group room and staff accommodation?.

 

I would expect the interview rooms to comply with the, Health Building Note 03-01: Adult acute mental health units document in relation to the use of the interview rooms

 

Health Building Note 03-01: Adult acute mental health units

 

Interview room

8.23 An interview room is required for confidential interviews. This room is required to have comfortable seating, access to a telephone and outside views. Good soundproofing will be required for privacy. For further information see Health Technical “Acoustics”.

 

St Peters medical centre second floor plan room marked as Int.7 (allocated to the Trust) does not appear to have a window or outside views (it does have a skylight)? And most of the interview rooms are at the back of the medical centre.

  1. Quiet areas

As the waiting area is shared with 5 consulting rooms and has a play area should there be a quiet area for the Trust’s patients?

 

  1. Some of the interview rooms tend to be on the small side (12m2, 12m2, 10m2, 10m2, 9m2, 9m2) Health Building Note 11-01: Facilities for primary and community care services, lists interview rooms as 8m2 or 12m2 a store room is listed as 8m2 so allowing for wheel chair access 12m2 maybe the preferred size (sizes taken from the floor plans).

 

 

 

 

Committee brief - “Key challenges facing general practice over the next five years as well as the biggest current and ongoing barriers to access to general practice”

 

Issues relating to access to general practice

 

Lack of consulting rooms and treatment rooms this was known about when the plans for the medical centre were submitted to Brighton and Hove planning Dept, the submission even included calculations for 28,000 patients

 

With various organisations stating that the medical centre complies with the current Department of Health & Social Care Health Building Note and Health Technical Memorandum (from the lifts, infection control, number of lockers for staff, changing rooms etc) design and construction standards and with Building Regulations and other relevant legislation. See sections relating to Brighton and Hove CCG, Sussex Partnership NHS Foundation Trust, the Care Quality Commission and NHS England,

 

  1. Sussex Partnership NHS Foundation Trust

 

I contacted Sussex Partnership NHS Foundation Trust as the trust will have 6 interview rooms as part of the development at St Peters medical centre (which is the way medical centres should go, in providing much needed mental health and other services for the local community). Also, some of the trust’s patients may need access to treatment rooms, has this been allowed for in the development?

 

  1. Sussex Partnership NHS Foundation Trust Freedom of Information request Reference: SPFT FOI 21/22-252 Dated 14 October 2021 Extract

I would like copies of minutes the trust has relating to the new St Peter’s Medical Centre (not any financial information which can be redacted), along with copies of the latest floor plans of the building which the trust has ref the consulting rooms from the 1st January 2019 to the 18th September 2021.

THE TRUST’S RESPONSE

“Extract from the minutes of the Finance and Investment Committee, 22 November 2019, pertaining to the Trust's involvement with St Peter's Medical Centre.

 

Ian Reading presented a paper seeking approval to the Trust acquiring a head lease of a new primary care development and in turn granting a sub-lease to the St Peter's Medical Practice, Oxford Street, Brighton.

 

The St Peter's medical practice premises need to be redeveloped urgently and we were approached by the GPs and CCGs to see if we would take a head lease to include 5 yearly break options.

 

 

 

The Finance and Investment Committee previously approved this in August 2018.

Since then planning permission for the scheme has been granted; the construction tendered, terms agreed for the head lease to be taken by the Trust and the sub-lease to be granted to the GP practice.

 

A discussion took place and the capital funding and revenue funding figures were reviewed.

 

It was noted that this will be the most modern surgery in the middle of Brighton. Car parking and access were discussed and it was recognised that this is an issue in every central city site, but that it would be very accessible by public transport.

 

Sally Flint thanked Ian Reading for his work on this complex project. The benefits it will bring have been worth pursuing as a model.

 

Ian Reading advised that we are being asked to make a formal commitment on this in the next 10 days. It has previously been agreed by the Board in principle.

 

Decision: The Finance and Investment Committee approved that the Trust progresses with the acquisition of the head lease and the grant of the sub-lease on the terms outlined in the report.”

 

 

  1. Sussex Partnership NHS Foundation Trust Freedom of Information request Reference: SPFT FOI 21/22-279 Dated 8 November 2021 Extract

 

3. The Freedom of information request states “Trust acquiring a head lease of a new primary care development and in turn granting a sub-lease to the St Peter's Medical Practice, Oxford Street, Brighton.” As the trust is in effect sub leasing the rest of the building to St Peters medical centre is the trust then responsible for ensuring that the design of the space will comply with the NHS guidance for planning new Primary and Social Care Premises as set out in the Department of Health’s Design Guidance, including compliance with the relevant Health Technical Memoranda and Health Building Notes?

THE TRUST’S RESPONSE

3. The scheme complies with the current Department of Health & Social Care Health Building Note and Health Technical Memorandum design and construction standards and with Building Regulations and other relevant legislation.

 

Please note the project is funded by a combination of private finance and NHS England finance. Sussex Partnership is not required to contribute to the development cost. The development is being procured and managed by a third-party developer. Therefore, the Trust is not project managing this scheme.

 

 

  1. Logged the issues as a complaint with PALS ('pals@sussexpartnership.nhs.uk') on the 28 September 2021 but again received no response
  2. There is £1.3 million Estates and Technology Transformation Fund ETTF funding “It is part of the General Practice Forward View commitment for more modernised buildings and better use of technology to help improve general practices services for patients.” Web site https://www.england.nhs.uk/gp/infrastructure/estates-technology/

 

Committee brief - “Key challenges facing general practice over the next five years as well as the biggest current and ongoing barriers to access to general practice

Issues relating to access to general practice

“The St Peter's medical practice premises need to be redeveloped urgently and we were approached by the GPs and CCGs to see if we would take a head lease to include 5 yearly break options.”

What involvement did the CCG have and what documentation was provided?

Should Trusts become involved with this type of funding for a medical centre?

“The scheme complies with the current Department of Health & Social Care Health Building Note and Health Technical Memorandum design and construction standards and with Building Regulations and other relevant legislation.”

No documentation has been supplied to back this up.

See Section F Care Quality Commission Ian Trenholm Chief Executive letter dated 25 November 2021 

“The people who deliver services (‘providers’) must make sure they meet the requirements of the regulations, and we hold providers to account to these regulations.”

“Extract from the minutes of the Finance and Investment Committee, 22 November 2019, pertaining to the Trust's involvement with St Peter's Medical Centre. Which states “head lease of a new primary care development and in turn granting a sub-lease to the St Peter's Medical Practice, Oxford Street, Brighton

As the Trust acquired the head lease the granting a sub-lease to the for St Peter's Medical Practice, Oxford Street, Brighton then is it not correct that in this case they are the “providers”?

“Providers retain this legal responsibility under the regulations when they delegate responsibility through contracts or legal agreements to a third party, independent suppliers, professionals, supply chains or contractors.”

Then sub leasing the rest of the building to St Peters medical centre the trust still has a legal responsibility under the regulations when they delegate responsibility through contracts or legal agreements?

 

 

“we hold providers to account to these regulations.”

I would expect the CQC to act when the medical centre has been built in applying the statutory requirements

Has the Trusts Property Management Department reviewed the floor plans of the medical centre in relation the current Department of Health & Social Care Health Building Note and Health Technical Memorandum design and construction standards and with Building Regulations and other relevant legislation? not just rely on the medical centre developers who may look at the requirements as a medical centre?

Asked that the documents be forwarded to Sam Allen - Chief Executive of Sussex Partnership NHS Foundation Trust, but to date have not received a response.

All of the above will create barriers to access to general practice locally in not applying the Department of Health & Social Care Health Building Note and Health Technical Memorandum e.g. interview rooms, layout etc that are required along with interview rooms to allow for mental health issues which are much needed locally.

 

  1. Brighton ang Hove Clinical Commissioning Group

I contacted Brighton and Hove Commissioning Group as I had concerns over the plans I saw on Brighton and Hove planning web site concerning Preston Barracks (Brighton) and St Peters medical centre (Brighton), and wished to know the involvement of the CCG in this (number of consulting rooms, lockers for staff changing room etc)

  1. Chief Executive

 

Adam Doyle has been appointed as the new Chief Executive Officer Designate of the future Integrated Care Board (ICB) for Sussex, following a nationally competitive recruitment process, ahead of the ICB becoming fully functional from April 2022, subject to Parliamentary approval of the current plans.

The ICB for Sussex will be responsible for a health budget of over £2bn and will oversee the commissioning, performance, financial management and transformation of the local NHS, as part of the Sussex Integrated Care System (ICS).

Adam has worked within the Sussex system for the last five years and is currently the leader of the Sussex ICS as well as the Chief Executive Officer for the three Sussex Clinical Commissioning Groups (CCGs).

  1. Documents (Freedom of Information requests)

I have put in Freedom of Information requests to the Brighton and Hove CCG

My request

 

“CCGs across the country seem to produce various documents outlining what any new medical practice should contain, e.g. the number of consulting rooms etc, and in developing local GP Practices, has any similar documents been produced for any of the medical practices in Brighton and Hove by Brighton and Hove CCG. e.g

PROOF OF EVIDENCE/ CIL COMPLIANCE STATEMENT by Brighton and Hove CCG

Or in line with

NHS Oversight Framework 2019/20

NHS Oversight Framework 2019/20 annex 1: Provider oversight approach  Or previous CCG improvement and assessment documents

For GP/medical Practices in Brighton and Hove for say the last 5 years

See enclosed example from Warrington CCG, and provide copies”

“nick_armstrong_peel_hall_healthcare_proof_february_2021_with_appendices.pdf”

Various CCGs seem to produce the type of document produced by Warrington CCG as in Feasibility & Options Appraisal Reports on new or redeveloping medical centres which includes increases in population, the number of consulting rooms etc.

Reference:               FOI 39408 BH 09D

Subject:                Proof of Evidence/CIL Compliance Statements

I can confirm that the CCG does hold the information requested; please see response below:

Response

The CCG does not currently have a document that outlines this, to date reliance to inform this is based on the Health Building Notes (HBN) and Health Technical Memorandas (HTM) guidance notes in combination with general demand within the respective area.”

 

  1. Public involvement

The NHS England document - Patient and public participation in commissioning health and care: statutory guidance for clinical commissioning groups and NHS England clearly layouts the requirements

 

“3.3  What is public involvement in commissioning?

Public involvement in commissioning is about enabling people to voice their views, needs and wishes, and to contribute to plans, proposals and decisions about services. Our use of the term ‘patients and the public’ includes everyone who uses services or may do so in the future, including carers and families.”

 

“The NHS belongs to the people. It is there to improve our health and wellbeing, supporting us to keep mentally and physically well, to get better when we are ill, and when we cannot fully recover, to stay as well as we can to the end of our lives.””

 

  1. Governance

 

I provided the CCG Executive Director of Corporate Governance with a copy of the document (Draft article 14-10-21.pdf) which highlighted my concerns on the 7th October 2021 and gave the CCG the opportunity to comment, I received no response from the CCG that is why I contacted NHS England.

 

Governance – “In practice this means that governance is all about how an organisation is run – how it structures itself, how it is led and how it is held to account.

 

  1. Statutory

CCGs have a number of statutory duties. Section 14Z2 of the NHS Act 2006, as amended by the Health and Social Care Act 2012 - covers the duties in relation to public involvement and consultation by CCGs when commissioning health and care services.

Section 14Z2 of the NHS Act 2006, as amended by the Health and Social Care Act 2012 - public involvement and consultation by CCGs

(1) This section applies in relation to any health services which are, or are to be, provided pursuant to arrangements made by a clinical commissioning group in the exercise of its functions (‘commissioning arrangements’).

(2) The clinical commissioning group must make arrangements to secure that individuals to whom the services are being or may be provided are involved (whether by being consulted or provided with information or in other ways):

(a) in the planning of the commissioning arrangements by the group

(b) in the development and consideration of proposals by the group for changes in the commissioning arrangements where the implementation of the proposals would have an impact on the manner in which the services are delivered to the individuals or the range of health services available to them and

(c) in decisions of the group affecting the operation of the commissioning arrangements where the implementation of the decisions would (if made) have such an impact.

Section 13Q of the Act – Public involvement and consultation by NHS England

(1) This section applies in relation to any health services which are, or are to be, provided pursuant to arrangements made by the Board [NHS England] in the exercise of its functions (‘commissioning arrangements’).

(2) The Board [NHS England] must make arrangements to secure that individuals to whom the services are being or may be provided are involved (whether by being consulted or provided with information or in other ways):

(a) in the planning of the commissioning arrangements by the Board [NHS England]

(b) in the development and consideration of proposals by the Board [NHS England] for changes in the commissioning arrangements where the implementation of the proposals would have an impact on the manner in which the services are delivered to the individuals or the range of health services available to them; and

(c) in decisions of the Board [NHS England] affecting the operation of the commissioning arrangements where the implementation of the decisions would (if made) have such an impact.

 

6.               NHS-Brighton-and-Hove-CCG-Constitution states

 

1.6 Accountability and Transparency

 

f) procure services in a manner that is open, transparent, nondiscriminatory

and fair to all potential providers and publish a Procurement Strategy;

 

g) involve the public, in accordance with the CCG’s duties under section 14Z2 of the 2006 Act, and as set out in more detail in the CCG’s policies and procedures, including those in the Handbook. In addition, the CCG will adopt the measures set out in paragraph 1.6.2 below;

 

h) when discharging its duties under section 14Z2, the CCG will ensure that it operates in an open, fair and transparent manner; will involve its stakeholders at an early stage and throughout change programmes, at varying degrees; and, by having due regard to its equalities duties;

 

7.               Health Building Note 00-01 - General design guidance for healthcare buildings

 

About Health Building Notes

Health Building Notes give best practice guidance on the design and planning of new healthcare buildings and on the adaptation/ extension of existing facilities.

They provide information to support the briefing and design processes for individual projects in the NHS building programme

 

3. Strategic planning

 

3.5 Discussion and consultation should also take place with patients and the public from the very beginning of the process. This could be achieved though planning meetings, interviews, questionnaires, patient stories, design workshops, care pathways workshops and regular meetings that discuss the design and the functional content of the proposed development. Events can be publicised through local patient and public involvement groups or public notices

 

 

 

 

 

 

 

5. The design brief

 

5.18 However, any information on the size of rooms and circulation space within departments as provided in HBNs and ADB should be thoroughly reviewed by the clinicians and users – including patients and the publictogether with technical advisers to establish the organisation’s brief for the spatial requirements.

 

Health Building Note 11-01: Facilities for primary and community care services

 

This document provides best practice guidance on the selection and zoning of facilities for delivering primary and community care services.

The guidance is applicable to the following building types:

• GP premises;

• Health centres;

• Primary care centres;

• Resource centres;

• Urgent care centres (including walk-in centres and minor injuries units);

• Community hospitals (also known as intermediate care hospitals).

 

Guiding principles

1.11 Primary and community care buildings should be:

 

• informed by consultations with clinicians, stakeholders, the public and relevant statutory bodies during the planning and design process;

 

  1. Letter from Adam Doyle Chief Executive Officer - Sussex Health and Care Partnership letter

3 November 2021

Dear Mr. Tindell,

RE: St. Peter’s Medical Centre and Preston Barracks developments

Thank you for copying me into your email to the Chief Executive of NHS England and Improvement.  I note that you have also contacted Sussex Community NHS Foundation Trust and the Care Quality Commission about the Health Building Notes and Health Technical Memoranda.  I am sure they will respond separately.

We are aware of your concerns about the premises developments in Brighton and Hove and appreciate the time you spend researching the issues and writing to key individuals across the system. 

I would like to clarify the role of the CCG in St. Peter’s Medical Centre and Preston Barracks developments as follows:

              The layout and suitability of the building is the responsibility of the Care Quality Commission.

              These developments are commercial transactions between the developer and the practices.  The CCG does not have a formal statutory role at this.

              To our knowledge no member of the CCG Primary Care Team has been involved in meetings regarding Preston Barracks since the onset of the COVID-19 pandemic.  We are not part of any internal design team, though have we have contacted the practices offering assistance should they require it.

              The CCG has a formal role in the development when the practices approach the CCG for rent reimbursement.  At that time the CCG will instruct the District Valuer to assess the proposed rent.  The outcome of this will be reported to the Primary Care Commissioning Committee, which is held in public.

I hope this clarifies the position of the CCG’s current responsibility for these developments.  If you need to clarify anything further, please do not hesitate to get back in touch with us.  We would very much appreciate meeting you to discuss these issues to make sure these premises are developed appropriately, so please do get in contact should you wish to meet with us directly.

Thank you for bringing these matters to my attention.

              Yours sincerely,

Adam Doyle

Chief Executive Officer

Sussex NHS Commissioners “

 

  1. Letter from the Chief Executive CCG dated 3 November 2021

 

No mention of what the CCG role is or its statutory duty in response to my comments (and as the Primary Care Organisation)

 

The Governance of the CCG had a copy of the draft article (not published) but failed to respond no mention of this within the letter

 

              The layout and suitability of the building is the responsibility of the Care Quality Commission.”

 

The CQC Chief Executives letter contradicts this statement, and the CQC has written to the CCG about this

 

  To our knowledge no member of the CCG Primary Care Team has been involved in meetings regarding Preston Barracks since the onset of the COVID-19 pandemic.  We are not part of any internal design team, though have we have contacted the practices offering assistance should they require it.

 

The email from Assura dated 27/07/21

 

“The design of the space will comply with the NHS guidance for planning new Primary and Social Care Premises as set out in the Department of Health’s Design Guidance, including compliance with the relevant Health Technical Memoranda and Health Building Notes. The Design Guidance is a taken into account in the design and specification agreed between our design team and the advisors to the GP’s and the Primary Care Organisation, currently the Clinical Commissioning Group. Although that structure is scheduled to change from April 2022 under an NHS reorganisation the design requirements will not change.”

 

The advisors to the “GPs and the Primary Care Organisation, currently the Clinical Commissioning Group”, so there must be CCG involvement in the medical centres?

 

“Reference:               IR 1402 BH 09D

Subject:                Internal Review of FOI 39408 BH 09D extract

 

QUESTION              

The Design Guidance is a taken into account in the design and specification agreed between our design team and the advisors to the GP’s and the Primary Care Organisation, currently the Clinical Commissioning Group”

 

If the CCG is part of any internal design team for any of the Brighton and Hove medical centres?, then any the documents should be a matter of public record

 

If you are relying on “Information held by a public authority for the purposes of FOIA” you have not stated which part of the document, you are relying on?

 

I would point out that other CCGs do provide such information

 

Part on the internal review was the following question which has not been answered “Did the NHS South, Central and West (CSU), decide to withhold the information or was this at the review stage by the Executive Managing Director for Brighton and Hove CCG ?.”

 

RESPONSE

 

Whilst the CCG may attend project meetings on an ad-hoc basis, they are not usually a part of the design team and do not become involved in specific design detail unless a specific question is asked of them, or the CCG is alerted to any particular risks which would instinctively trigger involvement.

 

The link to the ICO website was for further information and did not relate to an exemption as no information was withheld. 

 

The decision on whether to withhold or release information is solely down to the CCG as data controller.  SCWCSU will provide advice and guidance on its application should the CCG seek it.

 

The information provided in this response is accurate as of 2 September 2021 and has been authorised for release by NHS Brighton and Hove CCG.”

 

 

 

 

 

 

 

 

  1. Preston Barracks

Email from Assura (owners of the Preston Barracks medical centre site, part of Brighton University development)

 

Email Dated 27/07/21Extract

“The design of the space will comply with the NHS guidance for planning new Primary and Social Care Premises as set out in the Department of Health’s Design Guidance, including compliance with the relevant Health Technical Memoranda and Health Building Notes. The Design Guidance is a taken into account in the design and specification agreed between our design team and the advisors to the GP’s and the Primary Care Organisation, currently the Clinical Commissioning Group. Although that structure is scheduled to change from April 2022 under an NHS reorganisation the design requirements will not change

Email dated 11/08/21

 

I raised your requests with the various organisations involved in the project – Council and CCG – during the internal design team meeting last Friday and subsequently.

 

I am waiting to be given the best direct contact details to pass on to you and am chasing this down. As soon as I have a name etc I will forward this to you.

 

Regards”

 

  1. Applying section 14 to Freedom of Information request

Email from the CCG - Senior Corporate Governance Manager dated 22/09/21 extract

“I am afraid I don't have anything further to add on this FOI, either on the request itself, or the internal reviews.  Inline with section 14 of the ICO guidance on vexatious requests, you are becoming unreasonably persistent in your pursuit of further information around this FOI, could I ask that you take this matter to the ICO.”

 

Internal review requested

 

Reference IR 1501 BH 09D

Internal Review of FOI 39752 BH 09D Extract

 

“The reviewers can confirm that s.14 has not been applied to FOI 39752 BH 09D”

 

 

 

 

 

 

 

 

 

  1. Email from Sussex Partnership NHS Foundation Trust Dated 22/09/21

“David, your queries are best directed to Brighton & Hove CCG. I believe you are in contact with the CCG. It is the CCG that has responsibility for the commissioning of GP services and oversight of GP practice premises.

 

Many thanks.

 

Ian Reading

Deputy Director Property Management

Sussex Partnership NHS Foundation Trust”

 

 

Committee brief - “Key challenges facing general practice over the next five years as well as the biggest current and ongoing barriers to access to general practice

 

Issues relating to access to general practice

 

There are numerous shortcomings by the CCG which will impact on access to general practice, all I wanted as being able to comment on the St Peters medical centre and Preston Barracks medical centre, but this has not been the case. The CCG even tried to apply section 14 of the Freedom of Information Act to my requests for information and even then, they did not follow their own procedures, when challenged they withdrew applying section 14 to my requests

 

 

Letter from Ian Trenholm Chief Executive Care Quality Commission (CQC) dated 25 November 2021  *See section F.              Care Quality Commission (CQC))

 

“We are not involved in the commissioning of primary care services, nor building design for such services. I understand that you have been told by Sussex NHS Commissioners that the layout and suitability of the building is our responsibility. This is a misunderstanding on their part, and I apologise for any confusion this may have created. 

 

I have written to the commissioners, to ensure that our responsibilities are clearly understood I future.”

 

The CCG does not understand the function of the CQC ?

 

The CCG have not clearly stated what their responsibilities are, who is looking at the design of medical centres which the local community needs and Sussex Partnership NHS Foundation Trust sayoversight of GP practice premises” but this does not seem to be happening.

 

 

 

 

 

 

 

 

 

  1. Care Quality Commission (CQC)

 

I contacted Ian Trenholm Chief Executive Care Quality Commission (CQC) to try and find out the responsibilities of the CQC in redevelopment/new medical centres, I had asked NHS England about Health Building Notes and Health Technical Memoranda as I felt that these documents are being overlooked in the development of the medical centres

 

  1. Freedom of Information request NHS England

From: FOITEAMCRMMAILBOX (NHS ENGLAND & NHS IMPROVEMENT - X24)<england.foicrm@nhs.net>

Sent: 09 August 2021 15:57

To: David Tindell

Subject: Freedom of Information Request (Our Ref: FOI - 2107-1509172) NHSE:0141516

 

“Dear David Tindell,

 

Thank you for your Freedom of Information (FOI) request dated 16 July 2021.

Your exact request was:

 

" The Department of Health and Social Care (DHSC) has pointed out the responsibility for these documents rests with you

Department of Health Document (HBN_11-01_Final.pdf - Health Building Note 11-01:Facilities)

 

Who is responsible for implementing this document Could you provide a contact person who is familiar with the document (and related document's Health Building Note 00-03, Core elements Health Building Note 00-02: Sanitary spaces, Health Technical Memorandum 08-02 Lifts)

 

Who is responsible for enforcing the documents"

 

NHS England holds information in relation to your request.

 

The NHS Estates team of NHS England and NHS Improvement are responsible for the publication of Health Technical Memorandum (HTMs) and Health Building Notes (HBNs).

 

Enquiries relating to them should be sent to nhsi.estatesandfacilities@nhs.net and they will be passed to the appropriate person for a response.

 

The Care Quality Commission (CQC) is responsible for the enforcement of these documents. You can contact the CQC via their website: https://www.cqc.org.uk/

 

 

 

 

 

 

 

  1. Letter from Ian Trenholm Chief Executive Care Quality Commission (CQC) letter

 

25 November 202

Dear Mr Tindell,

 

Thank you for taking the time to contact us regarding your concerns over the development of medical centres in Brighton and Hove. 

 

As the independent regulator of Health and Social Care in England, we monitor, inspect, and regulate primary care services to make sure they meet fundamental standards of quality and safety. Our regulatory powers are underpinned by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 

 

The people who deliver services (‘providers’) must make sure they meet the requirements of the regulations, and we hold providers to account to these regulations.

 

We register, monitor and inspect providers to ensure the premises where care and treatment is delivered are clean, suitable for the intended purpose, maintained and where needed, appropriately located. 

 

Providers retain this legal responsibility under the regulations when they delegate responsibility through contracts or legal agreements to a third party, independent suppliers, professionals, supply chains or contractors.

 

We are not involved in the commissioning of primary care services, nor building design for such services. I understand that you have been told by Sussex NHS Commissioners that the layout and suitability of the building is our responsibility. This is a misunderstanding on their part, and I apologise for any confusion this may have created. 

 

I have written to the commissioners, to ensure that our responsibilities are clearly understood I future.

 

Thank you for taking the time to write. 

 

Yours sincerely, 

 

Ian Trenholm Chief Executive

 

Committee brief - “Key challenges  facing general practice over the next five years as well as the biggest current and ongoing barriers to access to general practice

Issues relating to access to general practice

It would appear that the CQC is responsible once the development has been completed, but not responsible at the development stage? The issue is that any NHS funding money would have been spent and to make changes to the medical centre could incur significant costs.

“and we hold providers to account to these regulations.” Which I will ask the CQC to do once the medical centre has been completed.

 

So who should be looking at the design stages of medical centres CCG?

 

  1. NHS England

 

  1. Contact NHS England

 

From: David Tindell

Sent: 24 October 2021 10:18

To: CE, England (NHS ENGLAND & NHS IMPROVEMENT - X24)

Cc: DOYLE, Adam (SUSSEX NHS COMMISSIONERS)

Subject: Urgent - Brighton and Hove CCG

 

Amanda Pritchard - Chief Executive

          

Brighton and Hove CCG are not following the CCG constitution and The NHS England document - Patient and public participation in commissioning health and care: statutory guidance for clinical commissioning groups (see Appendix A)

 

My concerns are over the local medical centres (Preston Barracks medical centre and particularly St Peters medical centre Brighton) at present they are in the process of being built and I have concerns over the implementation of the various Department of Health, Health Building Notes (HBN) and Health Technical Memoranda’s (HTM) documents (now the responsibility of NHS England and the Care Quality Commission) for NHS buildings from the type of windows to disposing of clinical waste, to provide best practice for any NHS building.

 

I have contacted the medical centres and Brighton and Hove CCG without any result (See Draft article 14-10-21.pdf  enclosed). As a member of the public who will use at least one of these medical centres (my GP surgery has merged with St Peters medical centre). I have an interest in ensuring that the medical practice is fit for purpose.

 

I know that the St Peters medical centre is in the process being redeveloped but now is the time to make changes (as part of the design review process) it will be too late once the building has been completed, as in the number of consulting rooms and the other requirements under the health documents, and will add significant costs to the NHS if changes are needed. The CCG has a statutory duty to ensure that the medical centres meet all the requirements.

 

In addition, I believe The Sussex Partnership NHS Foundation Trust has acquired the head lease for the new primary care development and in turn are granting a sub-lease to the St Peter's Medical Practice, Oxford Street, Brighton.

 

Is there a legal and certainly a moral duty on the trust to ensure that the building meets the Health Technical Memoranda and Health Building Notes? (I have asked them but as yet not received a response)

 

So could I please ask you to contact Brighton and Hove CCG for their comments I have cc the Chief Executive Adam Doyle into this email

 

I have also sent an email to the Care Quality Commission as you both have responsibilities for this in controlling the Health Building Notes (HBN) and Health Technical Memoranda’s (HTM) documents and the other for implementing them

 

Appendix A

 

The NHS England document - Patient and public participation in commissioning health and care: statutory guidance for clinical commissioning groups and NHS England clearly layouts the requirements and this is not being met by the CCG

 

“3.3  What is public involvement in commissioning?

Public involvement in commissioning is about enabling people to voice their views, needs and wishes, and to contribute to plans, proposals and decisions about services. Our use of the term ‘patients and the public’ includes everyone who uses services or may do so in the future, including carers and families.”

 

“The NHS belongs to the people. It is there to improve our health and wellbeing, supporting us to keep mentally and physically well, to get better when we are ill, and when we cannot fully recover, to stay as well as we can to the end of our lives.””

 

  1. Follow up emails

Email sent 17/11/2021 10:18

 

With reference to my emails,

 

Email 24/10/21 (Draft article 14-10-21.pdf) – Not received answers to my questions e.g. being able to be part of the consultation process (public)

 

Email 4/11/21 (shortcomings of CCG 04-11-21) – No response from the CCG at all

 

Email 13/11/21(Sussex Partnership Trust 10-11-21.pdf) – I sent this to the Trust, but could you confirm that this has been passed to the Chief Executive for her comments

 

How do you want to progress this e.g. do you want me to log this as a complaint with NHS England?

Thanks

 

David

 

 

 

 

 

Committee brief - “Key challenges  facing general practice over the next five years as well as the biggest current and ongoing barriers to access to general practice

 

To date I have not received a response from Amanda Pritchard - Chief Executive or from follow up emails (see above)

 

  1. Other Issues (St Peters medical centre)

Committee brief - “Key challenges  facing general practice over the next five years as well as the biggest current and ongoing barriers to access to general practice

 

Issues relating to access to general practice

 

              There are, no consulting rooms on the ground floor, so any elderly or disabled patients will have to use the stairs/lift or make special arrangements to use one of the treatment rooms and then the doctor will then have to come down and see the patient there. Taking a lot more of the doctor’s time?

 

The Interview rooms for the Sussex Partnership NHS Foundation Trust are on the 1st floor (1 room) and 2nd floor (5 rooms) the Health Building Note 00-10 Part D: Windows and associated hardware.

 

One issue from this: Health and Safety Executive - Falls from windows or balconies in health and social care (hsis5.pdf) and Review of window restrictors used in health and social care (rr1150.PDF)

 

Estates and Facilities Alert Ref: EFA/2013/002 - Window restrictors

“An incident has occurred in which a patient died following a fall from a second-floor hospital window. He forcibly overcame the window restrictor while in an acutely confused and agitated state following major surgery. Evidence at the subsequent inquest showed that the restrictor could not be relied upon to prevent a determined effort to force the window open beyond 100 mm.”

 

Your interview rooms are on the second floor and one floor up (staff floor) there is access to the roof terrace (type of glass used in the windows along with falls from windows) what steps have been taken and is this down to the Trust or the medical centre?

 

Sussex Partnership NHS Foundation Trust Freedom of Information request Reference SPFT FOI 21/22-200 Dated 2 September 2021

 

“With reference to the “Within St. Peter’s Medical Centre, the Trust will have six interview rooms (providing 240 hours of mental health clinical services space per week).” I have been reading the related NHS England documents relating to the medical centre e.g. Health Building Note 00-10 Part D: Windows and associated hardware.

 

One issue from this: Health and Safety Executive - Falls from windows or balconies in health and social care (hsis5.pdf) and Review of window restrictors used in health and social care (rr1150.PDF)”

 

 

THE TRUST’S RESPONSE

 

Under Section 1(1)(a) of the Act, the Trust can confirm that it holds information relevant to your request and this has been provided where possible below.

 

The new surgery is being built in compliance with Health Building Notes and Health Technical Memoranda and will be managed to ensure patient safety. Patients will not have access to the roof terrace and all windows will have restricted openings.

 

As can be seen from the Trusts response just relaying on window restrictors the Health and Safety Executive say “restrictor could not be relied upon to prevent a determined effort to force the window open beyond 100 mm.”

 

Has the Sussex Partnership NHS Foundation Trust - Property Management Department reviewed the floor plans of the medical centre in relation the current Department of Health & Social Care Health Building Note and Health Technical Memorandum design and construction standards and with Building Regulations and other relevant legislation? not just rely on the medical centre developers who may look at the requirements as a medical centre?

  1. Conclusions

“NHS general practice, examining the key challenges facing general practice over the next five years”

  1.           With the shortage of GPs, the current model is not sustainable, the way doctors work, and how patients access services need to change. If you do not have the GPs then a different approach is required, some else will need to carry out that function, as I pointed out nurses could help fill some of the gap, along with the use of remote appointments/consultations with high definition tv and cameras and linked to a database of free appointments at other medical centres that have spare capacity around the country. I am not talking about telephone appointments or logging onto a laptop appointment, they do not work. The key to carrying out a proper diagnosis is the body language of the patient the visual clues that GP picks up on, this is why high definition tv and cameras are required in medical centres to detect these types of symptoms. As some parts of the country have difficulty in recruiting GPs remote appointments may be the way ahead. Space will be required at the medical centres to allow for this.

Longer term AI and automated health pods with sensors to monitor patients’ vital signs not requiring a GP but this would be beyond the 5 years.

  1.           The requirement that the medical centres need to be fit for purpose, in the layout to allow for change, to ensure that the centres are welcoming, that local people can have an input into not only the services provided but the medical centre layouts. And that the medical centres are large enough to have the required number of consulting rooms for other services e.g., remote appointments.

 

As pointed out in the email dated 6/11/20 from Sussex AAA Screening Programme

              “many GP practices cannot host external services due to their size” 

So, when new builds/redeveloping of medical centres the number of consulting/treatment rooms is a factor in what services can be provided, that is why the health documents are critical to ensuring that any development will have the space for future services and that they are enforced.

  1.           Providers of the services Clinical Commission Groups (Integrated Care Board (ICB)), that there is public involvement, transparency, governance, all impact the on accessing general practices locally, which in this case does not work. We all want the best possible services for local people

 

  1.           There is an issue with who is responsible for overseeing the design of medical centres, In this case (St Peters medical centre) is it the Sussex Partnership NHS Foundation Trust (provider?) or the Integrated Care Board (ICB) ? as pointed out by Ian Reading- Deputy Director Property Management, Sussex Partnership NHS Foundation Trust “Brighton & Hove CCG. I believe you are in contact with the CCG. It is the CCG that has responsibility for the commissioning of GP services and oversight of GP practice premises”

The email from Assura (providing the Preston Barracks medical centre) dated 27/07/21 extract

“The Design Guidance is a taken into account in the design and specification agreed between our design team and the advisors to the GP’s and the Primary Care Organisation, currently the Clinical Commissioning Group. Although that structure is scheduled to change from April 2022 under an NHS reorganisation the design requirements will not change.”

  1.           Should NHS Foundation Trusts become involved with this type of funding for a medical centre?

“The St Peter's medical practice premises need to be redeveloped urgently and we were approached by the GPs and CCGs to see if we would take a head lease to include 5 yearly break options.

  1.           The St Peter’s medical centre has £1.3 million Estates and Technology Transformation Fund ETTF funding “It is part of the General Practice Forward View commitment for more modernised buildings and better use of technology to help improve general practices services for patients.” I cannot see that the lack of consulting/treatment rooms and other issues relating to the current Department of Health & Social Care Health Building Note and Health Technical Memorandum will help and the financial implications if changes are required after the medical centre has been built.

 

 

 

 

 

  1.                 No response from Amanda Pritchard - Chief Executive NHS England over the local issues concerning the points raised (see section G. NHS England).

 

  1.           The Clinical Commission Groups (Integrated Care Board (ICB)), does not seem to understand the function of the Care Quality Commission?.

 

Letter from Adam Doyle Chief Executive Officer - Sussex Health and Care Partnership letter 3 November 2021

 

              “•              The layout and suitability of the building is the responsibility of the Care Quality Commission.”

 

Letter from Ian Trenholm Chief Executive Care Quality Commission (CQC) dated 25 November 2021 

We are not involved in the commissioning of primary care services, nor building design for such services. I understand that you have been told by Sussex NHS Commissioners that the layout and suitability of the building is our responsibility. This is a misunderstanding on their part, and I apologise for any confusion this may have created. 

I have written to the commissioners, to ensure that our responsibilities are clearly understood I future”

The Care Quality Commission responsibility only comes into effect once the building is in use?

 

December 2021