Keeping Healthcare Services in step


Keeping Local Healthcare Services in step with changes in need and population

Note: The information in this FAQ has been provided by the CCG and NHS England and is correct as at 19 September 2017

 While there is no single recognised ratio for GP numbers across England, the average GP number per 1,000 patients per practice nationally is 0.58 (as of 2015). There has always been considerable variation across regions. 
The new models of care that the Clinical Commissioning Group (CCG) is working on with its member practices and partners in mid Essex should reduce the importance of the ratio over time.

The national General Medical Services contract, under which most GP practices in mid Essex operate, sets out a requirement for ‘core services’ but is not specific on exactly what the services are. The services provided are often discussed and agreed locally.

There is no single model of GP services that is considered ideal. Provision will vary depending on the needs of the population and any local agreements in place with health and care commissioners to meet those needs effectively. The services and needs may change over time.

The CCG buys maternity services principally from Mid Essex Hospital Trust. These are available in several places across the area, including Broomfield Hospital and Braintree Community Hospital.

The CCG and NHS England work with local practices to ensure there is capacity for the primary care needs of the local population. Their forward planning takes into account the construction of new housing. Essex is also one of three pilot sites for NHS England’s International GP Recruitment Programme which has already seen some success locally.
Just as importantly, new models of care include different skill mixes at GP practices. This should help address patients’ needs, while reducing the need for a GP appointment when it is more appropriate for another healthcare professional to see a patient.

Each development is assessed on its own merits taking into account the overall development impact in the wider area. There is no ‘rule’ on whether a new facility is required or how big it should be. Requirements for new facilities are based on a number of factors and detailed strategic planning. 
When the need for a new facility is established, there is a standard NHS procurement process for GP practices, but before that process begins commissioners may work with existing practices to identify whether they can absorb extra patient numbers.

If current premises are no longer suitable, commissioners would look to secure alternative accommodation for local GP services. These could be delivered in a variety of ways.

The s.106 calculation is carried out by the planning authority and is intended to cover all aspects of infrastructure, not just health. The NHS contributes to this in two ways. For smaller developments there is a calculation based on patient numbers and current practice space with monies sought for any shortfall against a notional best practice area. These can be ‘banked’ from several developments before being spent and would normally relate to the premises closest to the development. For larger developments – say 600 or more dwellings – it is likely that there would be specific negotiations between the developer, planning authority and NHS on local needs.
Braintree District Council is considering the introduction of a new legal charging system around developments, called the Community Infrastructure Levy (CIL), later in 2017, which may be more focused on infrastructure. CIL as already practised in Chelmsford City sees the NHS bid for funds for specific projects along with any other infrastructure providers.

Leaseback is where the owner of the property sells to another party, then immediately leases the same property back and takes any capital gain. This is called ‘Third Party Development’. It involves a developer offering to build premises with a steer from a local authority (acting with the health commissioner) about an area’s needs. The practice and developer agree proposals and the commissioner evaluates the proposals with regard to need, suitability, value for money and affordability. The commissioner then assesses and accepts or rejects the proposal. If the facility is approved, is then leased to the occupying provider.

• ‘Suitability’ covers building standards, compliance with health specific regulations e.g. control of infection, space standards and working to achieve future plans.
• ‘Value for money’ is determined by current market rent. This is independently assessed by the District Valuation Office, which is part of the government’s Valuation Office Agency.
• ‘Affordability’ is an assessment of whether the commissioner has the budget to support the development. This also covers in general terms the suitability of any proposed contract between the developer and the practice. It is a new lease to the NHS commissioner.
GP practices are private businesses and can therefore make their own commercial arrangements with the developer. However, the NHS can only reimburse costs including rental costs if it has agreed in advance of any contracts/leases being signed. 

This is a matter for the individual practice and its partners. Reimbursement of any applicable lease costs from the NHS is subject to approval prior to signing the lease.

All GP practices have a defined catchment area and patients living inside that area could normally expect to be registered with their local practice. The size of these catchment areas varies according to the local geography and population and there is no set maximum. However, GP services are usually commissioned so that no patient has to travel unreasonably far in order to attend a practice in person. There is no set distance specified as being “reasonable”, and the distances will vary between rural and more urban locations.

In 2012, all GP practices were asked to agree an outer practice boundary. Outer practice boundaries are an expansion of a GP's original catchment area. In the past patients may have had to register with a new GP even after only moving a few streets away. The outer boundaries can enable a patient to stay registered with their existing GP.
Since 5 January 2015, all GP practices in England have been free to register new patients who live outside their practice boundary area. This means patients can register with a GP practice somewhere that's more convenient e.g. near their workplace or closer to their children’s schools. This will give greater choice and aims to improve the quality of access to GP services.
These arrangements are voluntary for GP practices. If the practice has no capacity at the time, or feels it is not clinically appropriate or practical for individual patients to be registered so far away from home, they can still refuse registration. The practice should explain their reason for refusing any registration.