General Practice – Securing Capital Funding

Our population growth, new developments in our towns and villages and increased health and well-being challenges all play a major role in the need to secure new or improved general practice premises. Finance is not unlimited and a sound business case, collaborating across agencies is an absolute must. Planning change in the way general practice delivers services, more collaborative services, digital access and services and a flexible workforce will be part of your estate's strategy. To securing not just a fit-for-purpose general practice premise but one that can meet future demand.

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Background

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Ely is a thriving and growing community with housing development further increasing the population.  This brings additional pressures on health, education, and infrastructure. More patients for primary care with a consequent need for more space in which to provide medical services.  Additionally, there are increased roles for primary care, including through Primary Care Networks, and a growing wish to provide more secondary care services in a local environment. 

The net effect of the above was that there needed to be a significant increase in the space available for primary care.  This need was recognised in the primary care community and by the NHS and the local authority.  Following an exhaustive review of available options from a new build to a do-nothing option the preferred solution identified was to extend the St Mary’s Surgery to radically increase the provision of high-quality clinical space. 

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The Project

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The project involved extending the existing practice building whilst keeping within the existing footprint of the site.  The practice was keen to have the project proceed but needed to secure substantial capital funding from the NHS to augment that available to them from other sources.  To access that NHS funding, they needed to produce a business case setting out the costs and benefits of the scheme using the NHS Business Case template, based on the HM Treasury Five Case model.  Getting that business case accepted was critical in moving the project forward. Each stage of the process required a gateway signoff from Expression of Interest through to the full and final business case.

The perception that any increase in population due to significant population growth including new housing would be the pressure this would place on the existing community. This meant that engagement across a wide set of stakeholders would be required and managed. This included the CCG, NHS Property Services, the local authority, residents, the providers of the practice’s finance and the patients and the practice and its partners.  The success of the Ely Town Strategy has predicated on several criteria of which access to primary care was fundamental. All of these had an interest in seeing a project that met their needs and requirements.

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Our Assistance

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At Scale has successfully worked across multiple agencies recognising those challenges and opportunities as well as funding criteria multiple stakeholders would need. We have developed and delivered successful business cases and supported the ongoing development and delivery of those projects. At Scale were engaged to prepare a business case for the practice that would be used to secure NHS capital funding and to satisfy the requirements of the practice’s partners and funders.  The core business case was prepared using the appropriate NHS template, in accordance with the 5-business case model.

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The preparation of the business case was complicated by several factors, including the need to decant the practice during the not-inconsiderable period of the construction works, existing challenges to planning restrictions and how a long-term construction may impact local roads, premises and business as the premises is centrally located within the town. There were also issues with construction costs which were subject to fluctuation due to labour and material issues.  This meant that there had to be several iterations of the financial model, as we worked towards a financial and overall case that was sustainable and acceptable to all concerned.  The overall cost of the project was estimated at around £4 million.

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At Scale undertook the drafting of the business case and the preparation of the financial modelling that underpinned the case.  The business case was produced in liaison with the practice, the CCG, NHS England, the local authority, and the practice’s construction advisors.  At each stage of the process, all requirements and sign-offs were required to move to the next stage. Complicated but doable when likely risks, mitigations and realistic timescales were set. Collaboration was vital to get the project up and running.  The local authority was a major stakeholder, both in terms of planning permission and has a supportive agency in moving the project forward.

All this had to be undertaken at a time when construction costs were rising and constituted a major risk, we engaged directly with the Quantity Surveyor to understand options for managing the risk around construction costs and in ensuring that there was sufficient contingency included to mitigate risks of further funding being required. The balance between the funding available through the NHS and that which could be secured by the practice was a key element to the commitment the practice partners would need to secure. Substantial investment and therefore potential risk needed to be managed effectively and ensure investment was sustainable.

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The Practice Extension Engagement Strategy was developed at the early stage of the project and key requirements of each stakeholder were mapped within the project plan and communication and engagement routes and timescales were set. The result was a Business Case that was accepted for progression by the key parties. 

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Outcomes

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The planned St Marys practice extension also provided an opportunity for the practice to

• Review what and how their services were delivered and implement new ways of working.

• Consider more flexible workforce arrangements.

• Co-locate and deliver additional services with community and health providers

• Maximising the digital opportunities available within the primary care digital landscape.

The construction is underway with St Marys practice relocated to temporary accommodation in the interim.  Stakeholders and patients are kept fully engaged and there is real anticipation within the community as well as the practice workforce in regard to the new premises and new opportunities.