BEXLEY CCG
ESTATES STRATEGY –
May 2016
Version 2.2 17 May 2016
Important Notes
1.
With regard to any need to undertake service change and comply with various
statutory duties: -
The options set out in this document are for discussion purposes. The involved NHS bodies
understand and will comply with their statutory obligations when seeking to make decisions
over estate strategies which impact on the provision of care to patients and the public. The
options set out do not represent a commitment to any particular course of action on the part
of the organisations involved.
2.
In respect of any request for disclosure under the FoIA: -
This is a confidential document for discussion purposes and any application for disclosure
under the Freedom of Information Act 2000 should be considered against the potential
exemptions contained in s.22 (Information intended for future publication), s.36 (Prejudice to
effective conduct of public affairs) and s.43 (Commercial Interests). Prior to any disclosure
under the FoIA the parties should discuss the potential impact of releasing such information
as is requested.
2
Contents
1.
2.
3.
4.
5.
Executive Summary................................................................................................................... 6
1.1
Introduction ......................................................................................................................... 6
1.2
Drivers for Change............................................................................................................. 6
1.3
Vision for the Estate .......................................................................................................... 8
1.4
Overview of Existing Estate ............................................................................................ 9
1.5
Estates Gap Analysis ...................................................................................................... 10
1.6
Delivering the Strategy ................................................................................................... 13
1.7
Conclusions and Actions ............................................................................................... 15
Introduction and Local Overview ......................................................................................... 16
2.1
Objectives and rationale ................................................................................................ 16
2.2
NHS Bexley: Mission, Vision, Values and Outcomes ............................................. 16
2.3
Scope................................................................................................................................... 18
2.4
Methodology ...................................................................................................................... 19
2.5
The local borough (geography, transport, population and demographics): .... 21
2.6
Estate partners ................................................................................................................. 23
Drivers for Change................................................................................................................... 27
3.1
Service drivers .................................................................................................................. 27
3.2
Population, Health Needs and Regeneration Drivers ............................................. 33
3.3
Technological drivers ..................................................................................................... 35
3.4
Estates drivers .................................................................................................................. 38
Bexley’s Vision for the Estate Infrastructure.................................................................... 42
4.1
Future Model of Care and Service Priorities ............................................................. 42
4.2
Our vision ........................................................................................................................... 45
4.3
Hub sites............................................................................................................................. 47
The Current Estate ................................................................................................................... 49
5.1
Overview ............................................................................................................................. 49
5.2
GP Estate............................................................................................................................ 52
5.3
Community & Mental Health Estate ............................................................................ 58
5.4
Bexley CCG HQ................................................................................................................. 62
5.5
Financial Summary .......................................................................................................... 62
5.6
Current Disposals ............................................................................................................ 63
3
5.7
Challenges and Opportunities ...................................................................................... 64
Planning for Growth ................................................................................................................ 68
6.
6.1
Planning for Growth ........................................................................................................ 68
6.2
Population growth and demographic change .......................................................... 68
6.3
Sources of Investment .................................................................................................... 76
7.
Gap Analysis ............................................................................................................................. 79
8.
Estates Options for Change .................................................................................................. 93
8.1
Summary of estates options ......................................................................................... 93
8.2
Evaluation process and criteria for Investment ....................................................... 96
Delivering the Strategy ........................................................................................................... 98
9.
9.1
Short term work actions ................................................................................................. 98
9.2
On-going medium and long term work actions ....................................................... 98
10.
Financials ............................................................................................................................. 100
11.
Outline Implementation Plan........................................................................................... 101
11.1
Programme plan and milestones ............................................................................... 101
11.2
Enablers of change and managing constraints ..................................................... 101
11.3
Risks and mitigations ................................................................................................... 101
12.
Summary .............................................................................................................................. 102
Appendices:
Appendix A: Map of Borough
Appendix B: Southeastern Rail services
Appendix C: Crossrail Services map
Appendix D: River Crossings map
Appendix E: NHSPS and CHP Community clinics
Appendix F: Community Provider summary
Appendix G: GP map
Appendix H: LA map
Appendix I: Oxleas community and mental health map
Appendix J: GP summary tables
Appendix K: Summary of GP Utilisation studies
4
Appendix L: Risk matrix
Appendix M: Site fact sheet
Appendix N: Local Authority sheet
Appendix O-T: Bexley Gap analysis
5
1. Executive Summary
1.1 Introduction
This Local Estates Strategy is an essential element of the strategy programme to support the
delivery of new models of care. It is important to understand the capacity of the capital
assets, estates and facilities across the borough to utilise, reduce or develop these in the
most appropriate way to meet the needs of the population. The strategy has been compiled
by engaging within the CCG and with the Local Authority, NHS England, GPs, Providers,
neighbouring Commissioners and the NHS Property Companies. This collaborative input
helps to ensure that this is a fully functioning working estates strategy for the borough that
shapes the way that the estate is used as an enabler for change.
1.2 Drivers for Change
A number of recent national, London-wide and local strategies have recognised the
importance of infrastructure in terms of enabling the delivery of new models of care. This
section summarises key drivers and changes that are anticipated over the next few years
and the resulting implications for infrastructure.
The NHS five year forward view sets out an integrated agenda and new care models over
this and the next four years. In addition, Better Health for London outlines the evidence
base for re-evaluating the utilisation and value of NHS estate in London which is being
progressed via the Healthy London Partnership Estates Programme. The development of
this estates strategy reflects this wider London level estates programme that is led by CCGs
and NHS England. It will inform part of the Sustainable & Transformation Plan (STP) that is
being developed by the SPG for South East London and for submission to the Department of
Health in June 2016.
The main drivers for change, impacting on the infrastructure requirements of the borough,
are summarised in table 1 under four key themes:
Table 1: Drivers for Change
Drivers
Service drivers
Summary






Our Healthier South East London strategy and working with the
SPG in South East London
The Trust Special Administrator (TSA) recommendations and
Secretary of State support regarding Queen Mary’s Hospital,
Sidcup
Out-of-hospital and 24/7 care to reduce use of hospitals
Increase provision of care in people’s own homes – particular
significance to patients requiring care at the end of life
The significance of primary care is recognised including its role
in larger care organisations and operating at scale
Greater emphasis on organisations being integrated and
6



Population,
health needs
and
regeneration
drivers









Technological
drivers








working together in Local Care Networks to provide community
based care and joined up services to whole populations
Unprecedented financial pressures facing the NHS and social
care is driving different models of care
Preventative care – supporting people to remain healthy &
independent and avoid inappropriate use of hospitals and care
homes
Growing need to address lifestyle risk factors
Growing population will increase the burden on physical
infrastructure and demand for services
Increasing demands arising from an ageing population & noonhealthy lifestyles.
Changing disease burden – increase in life expectancy coupled
with greater proportion of comorbidity
The need for improvement in health inequalities
Ambitions in the Council’s growth strategy set out to regenerate
the north of the borough including 24,500 additional new homes
by 2030 set out in the London Borough of Bexley’s publication
“Direction of Travel” (it should be noted that these figures have
since been revised upwards and shall be revised again)
Lack of community resilience in the population and families
The proposed river crossing at Belvedere or Gallions Reach
The Crossrail development to Abbey Wood and possible
extension to Belvedere / Erith
Need to create sustainable neighbourhoods within higher
density mixed use developments, focussed on public transport
hubs.
Alignment of the CCG technological drivers against those from
the south east London IM&T Steering Group and which are
derived from the local digital roadmap working group.
Ensuring that the benefits identified are realised across the
SPG.
Greater use of technology in the provision of healthcare making
services better connected and more efficient
Drive to digitalise GP patient records as a means to free up
capacity (space) in primary care
Digitalisation of patient records is facilitating change in where
and how patients can access services
Move towards patients accessing their medical data online
through patient online services and longer term through the
materialisation of the NHS London citizen account.
Move to more remote and flexible working has implications on
the type and use of infrastructure
Facilitation of extended hours at new hub sites or within existing
7



Estates drivers









practice sites
Investment in technology that reduces the need for face-to-face
consultations and meetings
On-going investment in infrastructure to ensure practices
maintain fit for purpose hardware that will enable them to
operate efficiently and remotely as necessary.
Ensuring that the GP systems are fit for purpose and the future
and can support technological change (e.g. GP system of
choice)
Pressing need for housing in London with all public sector
organisations under pressure to release sites
Variability in the quality of primary care estate where space is
not always functional
Under-utilisation of some assets provides opportunities for more
services, or estate, to be rationalised as well as providing
capacity for the anticipated growth
The financial pressure facing the NHS and public sector
partners means that there is a need to unlock value from the
estate where possible
Co-location and joint working with other organisations can be a
more efficient model
Bexley has a significant number of branch sites which can lead
to inefficient working practice
The move to market rents for NHS organisations means that
there is a case for reviewing options for locating some services
and functions longer term
Premises to be compliant with CQC and DDA requirements
Ensuring General Practice premises close to population sites in
Frognal/Clocktower are suitable for service expansion
1.3 Vision for the Estate
The development of Local Care Networks (LCNs) will be the mechanism by which Bexley
responds to the need to change how services are organised and delivered locally. The
services available will be proactive, accessible, coordinated, integrated and provide
continuity, with a flexible, holistic approach to ensure every contact counts. This will be
primary care led to geographically coherent populations, at scale, whilst still encouraging
self-reliance. In Bexley there are three emerging LCNs, North Bexley, Clocktower and
Frognal. There is a single GP federation, Bexley Neighbourhood Care Community Interest
Company (CIC), of which all practices are members.
Bexley CCG and its partners are committed to the following principles and priorities for
ensuring that the primary and community care infrastructure facilitates the required service
change:
8

Secures Queen Mary’s Hospital, Sidcup, and Erith & District Hospital as the health
hub and spoke for Bexley’s population in recognition that Bexley has no acute site.

Aligns with the London Borough of Bexley’s Growth Strategy and addresses any
service and infrastructure needs that result

Ensures there is sufficient capacity for primary and community care services to be
provided in out of hospital settings in line with population needs

Advance technological solutions that reduce the need for face-to-face consultations,
better equip patients to self-manage, enable more preventative care and strengthen
communication and collaboration between organisations

Reduce reliance on clinical and office space through use of remote and mobile
working

Improve seven day access to effective care

Seeking to rationalise GP branch sites where this enables more efficient ways of
working, without hindering patient access

Ensuring there is sufficient training and workforce development capacity

Greater partnership working across providers through co-location of services

Delivery of the emerging LCN strategy including provision of hub sites, preferably in
the most accessible locations

Maximising use of purpose built, high quality, affordable estate for clinical purposes
including exploring the potential for offsite administrative and storage functions at a
lower cost

Identify where buildings are surplus to requirements for all partners and consider
options for utilisation before disposing of assets

Ensure any changes are beneficial to patient access and do not exacerbate health
inequalities

Maximise the use of space through exploring with partner organisations how space
can be reconfigured to deliver maximum value to the public sector.
1.4 Overview of Existing Estate
Across Bexley there are 27 GP practices occupying 40 premises (including multi-occupied &
branches and 1 admin support site). In addition there is one main health provider with 27
occupations. The main provider is as follows:
Oxleas NHS Foundation Trust (Oxleas) provides a range of health services in south east
London, specialising in community health, mental health and learning disability services.
9
Amongst its sites, it owns Queen Mary’s Hospital and Erith & District Hospital where a
range of community and acute providers occupy space to provide services. Queen
Mary’s Hospital and Erith & District Hospital are the CCG’s health hub and spoke and
are located in Frognal and North Bexley localities / LCNs (see below).
Other providers include:

King’s College Hospital Foundation NHS Trust (King’s),

Lewisham & Greenwich NHS Trust (LGT),

Guy’s & St Thomas’ Foundation NHS Trust (GSTT),

Dartford & Gravesham NHS Trust (DGT) and

South London & the Maudsley Foundation NHS Trust (SLAM).
Bexley CCG has divided the borough in to three Local Care Networks and for the purposes
of planning is proposing to divide the borough into these three constituent areas:

North Bexley (inc. Thamesmead East, Belvedere and Erith)

Clocktower (inc. Welling and Bexleyheath)

Frognal (inc. Sidcup and Bexley)
1.5 Estates Gap Analysis
The estates gap analysis has used demand modelling to analyse the current health provision
within the borough. The demand modelling summarised the current provision and analysed
its capacity to cope with anticipated population growth, providing some key findings.
Wards that have Bexley Council population growth greater than 10% between 2015 and
2035 were analysed. Seven Wards across the Borough satisfied these criteria:


North Bexley LCN/Locality:
o
Belvedere
o
Erith
o
Thamesmead East
o
Crayford
o
North End
Clocktower LCN/Locality:
o
Christchurch
o
Lesnes Abbey
10
11
Table 2: Key estates gap analysis
Ward
Key Findings
Belvedere
No health centres in the Ward; Erith
Health Centre, Erith and District
Community Hospital and Lakeside
Health Centre in neighbouring wards;
good GP provision in south of the
Ward. 11,000 new homes predicted by
Bexley Council in addition to GLA
projections; significant potential for
development in Lower Belvedere
through East Thamesmead Industrial
Area and the Pirelli Site
One large health centre (Erith HC) and
one community hospital; good GP
provision; some spare capacity;
significant anticipated population
growth; Slade Green to contribute to
population pressures with some large
developments due for completion in
short-medium term. 2,500 new homes
predicted by Bexley Council in addition
to GLA projections.
Lakeside Health Centre is a LIFT
building within the ward that could act
as a core hub site, and is generally
under-utilised; scope to reconfigure
non-clinical space as clinical space.
Ward not predicted to undergo
significant growth according to GLA
projections. More than 5,000 new
homes predicted by Bexley Council in
addition to GLA projections.
Additionally, significant potential for
development in Lower Belvedere that
could impact this Ward and across
border with Greenwich.
No health centres in the Ward;
Crayford Town Surgery has some
spare capacity; Lyndhurst Medical
Centre in Barnehurst Ward
approximately 2km west; development
in Crayford Town driving population
growth; current facilities likely able to
absorb population growth if GLA
population projections are correct.
However, approximately 1,000 new
homes predicted by Bexley Council in
addition to GLA projections.
Erith
Thamesmead East
Crayford
New Health
Facilities
Required?
Yes - Dependant on
realisation of
Bexley Council
Projected Housing
Figures
Detailed feasibility
study
recommended
Yes - Dependant on
realisation of
Bexley Council
Projected Housing
Figures
Yes - Dependant on
realisation of
Bexley Council
Projected Housing
Figures
12
Ward
Key Findings
North End
No health centres in the Ward; Slade
Green medical practice is being
expanded which will absorb capacity
from current new build; Erith Health
Centre in neighbouring ward has
under-utilisation and should be able to
absorb some capacity. Approximately
2,500 new homes predicted by Bexley
Council in addition to GLA projections.
Cross-border issues with Dartford may
also impact.
Some incremental population growth;
one health centre in the Ward. Upton
Road site has been designated surplus
to requirements by Oxleas and has the
potential to be a core hub site in
Clocktower. However, it is not
expected that new facilities will be
required.
No health centres in the Ward; 2 GP
practices in the ward, Bexley Medical
Group (BMG) and Cumberland Drive
Surgery. Both are converted houses
with limitations therefore further
analysis required.
Christchurch
Lesnes Abbey
New Health
Facilities
Required?
Yes - Dependant on
realisation of
Bexley Council
Projected Housing
Figures
No – current
provision is
sufficient
Yes - Dependant on
realisation of
Bexley Council
Projected Housing
Figures
Successful IT rollout, culture change and training could also alleviate pressure on the current
health estate, for example through digitalisation or offsite storage of Lloyd George records,
hot-desking and remote/mobile working, tele-health and the implementation of a training hub
across Bexley practices.
Additionally the opportunities to do things differently and to relieve pressure in the system
needs to be explored with the local pharmacies, dentists, opticians and the voluntary sector.
However, areas of anticipated high population growth are likely to necessitate new
investment in integrated health facilities.
1.6 Delivering the Strategy
Delivering the Local Estates Strategy for the CCG will be complex and time consuming. It
will require skilled programme and project management resources and involve multiple
stakeholders with their own service strategies.
Collectively, the stakeholders need to see the advantage and benefits of working
collaboratively across health and social care, to achieve the new models of care that will
maintain or improve patient health and social care outcomes whilst realising system savings.
13
Organisations that are successful in delivering complex change adopt excellent programme
and project management practices and have:
1. Well-defined milestones and metrics
2. Committed senior management
3. Ownership and accountability
4. Standardised project management practices
5. Strong sponsorship
Short term work actions
These are the actions that we believe should be undertaken April to June 2016, to inform the
Estates & Technology Transformation Fund (ETTF) applications in June. However, a
number of these require investment and is therefore dependant on external resources being
available.

Incorporate the latest LBB growth data, PH5, in assessing future health service and
infrastructure needs

Procure estates/project management expertise to take the Local Estates Strategy
forward post April 2016

Test the interim gap analysis at locality level with stakeholders

Procure further utilisation studies to key estate to better understand capacity to
inform future ETTF bids

Procure joint feasibility study for Thamesmead

Agree the criteria for investment and then consider which sites/projects might need
funding

Continue involvement in SEL estates strategy meetings to ensure awareness of
cross border issues and sharing of best practice

Link estates, IT and workforce strategies

Identify and start planning pilot projects and quick wins
Longer-term work actions
We believe the following medium and long term actions will need to be progressed, which
again in some cases are dependent on available investment:

Obtain greater clarity of stakeholders estates strategies

Greater clarity around LCNs in terms of specific services to be housed and where to
be located
14

Develop workstream for stakeholders to discuss and agree co-location and
integration opportunities

Investigate voluntary and community use of buildings

Options appraisal and business case development for core sites and where
investment is required

Procure condition surveys of core buildings requiring investment

Develop communications plan for engaging with stakeholders

Better understand ICT and workforce implications on the estate

Continual review of the estates strategy and individual project governance for new
schemes, with a formal review every 12 months

Ensure robust communications between the SEL estates, ICT and workforce
workstreams

CHP to roll out Procurement of project managers, health planners and design team
for working up refurbishment projects or new schemes

On-going development and maintenance of the SHAPE database

Further engagement with Local Planning Authority to ensure CCG and stakeholders
have early warning of development proposals and to give them time to consider the
health impact and to apply for developer contributions

Develop a timeline for the proposed new housing developments.
1.7 Conclusions and Actions
Delivering for the first time a borough wide Local Estates Strategy, for health and other
public sector stakeholders, is a huge, complicated and time consuming challenge. It will
need skilled leadership and resources, experienced in programme and project management
of health facilities and other skillsets. This will need additional support to that currently held
within the CCG and will need to be obtained within current running cost constraints.
The CCG will need to lead and use its influence to bring stakeholders together and to obtain
their agreement to a combined strategy that benefits all.
All providers and the local authorities need to work together to develop opportunities for colocating, integrating services and then rationalising their respective estates
The IT and workforce strategies and their delivery are key to enabling new ways of working,
without which major estate rationalisation will be difficult to achieve.
Funding for project resources will have to be identified and applied for in a timely manner, so
early action for ETTF applications has started and discussions held about accessing CIL
monies, when they are available.
15
2. Introduction and Local Overview
2.1 Objectives and rationale
This document sets out Bexley CCG’s local estates strategy which will support the delivery
of Bexley’s Commissioning Intentions including the transformation of primary care.
Set out below is the strategic context, drivers and vision for the development of the estate
and supporting infrastructure that will underpin the delivery and transformation of health care
in Bexley over the next few years.
The Department of Health wrote to CCGs in June 2015 setting out the need for a Local
Estates Strategy to be developed by commissioners with relevant health partners, to be
ready by December 2015. The strategy would set out the context for further investment in
clinical infrastructure locally. The letter also confirmed that each CCG would have a Strategic
Estates Advisor (either from NHS Property Services or Community Health Partnerships
(CHP)) that would assist commissioners in taking an independent whole healthcare system
approach, generate improvements and efficiencies from the estate and the services it
supports, and to help deliver future changing estate infrastructure needs. This will help local
healthcare systems to:

Fully rationalise its estate

Maximise use of facilities

Deliver value for money

Enhance patients’ experiences.
Bexley CCG has been appointed a strategic estates advisor from CHP, supported by
Essentia.
The strategy has been compiled by engaging within the CCG and with the Local Authority,
NHS England, GPs, Providers, other Commissioners and the NHS Property Companies.
This collaborative input helps to ensure that this is a fully functioning working estates
strategy for the borough that shapes the way that the estate is used as an enabler for
change.
2.2 NHS Bexley: Mission, Vision, Values and Outcomes
This strategy seeks to support the delivery of the CCG’s objectives. Our mission, vision and
values are consistent, with national priorities and also the vision and priorities of the “Our
Healthier South East London” strategy.
16
NHS Bexley CCG’s Mission
NHS Bexley CCG’s mission, or overarching purpose, is to commission high quality services
locally that improve the physical and mental health and wellbeing of Bexley residents. Our
mission statement is “Excellent healthcare, locally delivered.”
The ambition to keep services local wherever possible means appropriate and sufficient
capacity must be in place.
NHS Bexley CCG Vision
“Our vision is for Bexley’s residents to stay in better health for longer, with the support of
good-quality integrated-care, available as close to home as possible – backed up by
accessible, safe and expert hospital services, when they are needed.”
In order to deliver this vision the configuration of acute and community services is key to
ensure that services are accessible but high quality and sustainable in the long-term.
NHS Bexley CCG Values
In working towards realising its vision for local health services, the CCG adopts the following
values in how it operates with others to achieve the ambition. The mnemonic, aspire makes
these more memorable:

We are accountable to our members, stakeholders, partners and ourselves

We support our staff to be the best they can be, so we can deliver the best for our
population

We commission for quality to deliver improved outcomes for our patients

We encourage new ideas and innovation

We respect the diverse needs of our population and the expertise of our delivery
partners

We aim for excellence, working to high standards and increasing transparency
Bexley CCG’s Commissioning Intentions – Our Plans 2016-2018
This is the CCG’s main strategic plan and sets out what is to be achieved from 2016-18. It is
built on the foundation of the South East London strategy ‘Our Healthier South East London’,
and sets out how these plans and aspirations will be implemented in Bexley over the next
two years and beyond under the following areas:

Primary & Community based care

Planned care

Urgent and emergency care

Maternity
17

Children’s and young people

Cancer (including end of life care)
Under each area, local Bexley initiatives supplement all that is to be delivered across south
east London to improve these services for all and address the inequalities in access and
patient experience currently present.
The CCG’s commissioning intentions also includes the continued development of our hub &
spoke - Queen Mary’s & Erith Hospitals, securing them into the future. The model is a multiprovider health ‘hub’ – at Queen Mary’s Hospital and a ‘spoke’ – at Erith Hospital.
2.3 Scope
The focus of the Bexley Estates Strategy is to ensure there is the required community based
healthcare infrastructure in place to meet the needs of the population over the next decade.
This is the first iteration that will evolve into a final strategy document by 31st March 2016. It
will need to be reviewed and refreshed annually to ensure that it is still relevant and reflects
the current and future infrastructure needs of the borough.
The Government will be looking at the Estates Strategies during 2016 with a view to
providing further advice on the drafting of longer term strategies.
The scope of this estates strategy includes:

All 27 GP practices operating out of 40 sites (including one admin only site)

All community sites where healthcare services are provided

Non-clinical NHS estate, such as office/administrative bases.

Assets owned or leased by the London Borough of Bexley where there are strong
working relationships with health services (e.g. bases/sites for Social workers,
children’s centres etc.).

Pharmacies, Dentists, Ophthalmology premises will be considered where relevant to
this strategy.
Whilst this estates strategy does not seek to address every organisation’s estates plans, the
aim of the engagement process has sought to identify where there are clear synergies,
opportunities and needs that partners can help each other to address in an efficient and
cost-effective way.
Historically, public sector departments and organisations have tended to work in silos, which
have meant that there was no transparency about the size, tenure, condition and utilisation
of the respective estates. This estates strategy, covering all health and social care premises,
allows, the CCG and its partners the opportunity to understand the whole estate across the
borough.
18
As there are no acute hospitals within the borough or significant assets owned by acute
trusts, engagement with this sector has been at a South East London level. The main acute
providers have been asked to share any estates plans that currently exist to ensure
alignment with this local strategy but none have been provided. As more defined plans are
formed around occupation of specific sites, engagement with secondary care, community
and third sector organisations will be undertaken where necessary.
The CCG has a track record of working with providers on multi-provider sites and their
development. It will therefore build upon the success of QMH & Erith to implement this
strategy. The continued development of services at QMH and Erith will future proof these
sites.
2.4 Methodology
Since June 2015 and with the assistance of the Strategic Estates Advisor from CHP, NHS
Bexley CCG has engaged and collaborated with its various partners to develop this estates
strategy.
In doing so, the following activities have been conducted:

Monthly estates working group meeting with representatives from key local partner
organisations (see section 2.6 below)

An estates survey questionnaire was completed by all practices in August 2015 to
assess capacity constraints

An estates workshop was held in October, with partners and adjacent CCGs, to aid
development of the strategic priorities and consider cross-border implications; A
further workshop was held in January to consider ETTF applications

Collation of key strategic and estates documentation from all partner organisations

Estates database information collated by NHS England and consolidated into Shape
by Essentia

Assets identified for disposal shared

Financial information collated

Desktop utilisation studies, of key purpose built health facilities that are in areas of
growth, initiated
Data gathered during the process is being uploaded to the Public Health England (PHE),
Strategic Health Asset Planning and Evaluation (SHAPE) database. This is a web-enabled,
evidence-based application which informs and supports the strategic planning of services
and physical assets across a whole health economy.
This estates strategy is the product of this work with further engagement and analysis to be
undertaken moving forward and translation into a delivery plan.
19
The figure below pictorially represents the process that has been followed in developing this estates strategy:
Figure 1: The Estates Strategy Delivery Process
The Delivery Process
H&WB Boards
CCGs
Trusts
JSNA
Public Health
Data
Demand for
Property &
Service
Requirements
Local
Authorities
CCGs
NHSE
Trusts
GPs
Location
Rationalisation
Utilisation
Integration
Service Need
Challenge
Centre Management
Accountability
Benefit realisation
Commissioning &
Service Plans
Financial
allocations
Resources
Service
contract
Estate surveys
Condition
surveys
Supply of
Property
Commissioning
Plans
Service Plans
National Policy
QIPP plans
Gap Analysis
and
Hypothesis
Development
Estates
Strategy &
Delivery
Plan
Estate
Condition
Estate
Capacity
Occupation &
utilisation
Costs
Location
Ownership
Hypothesis
Testing &
Revision
Estate Use
Agreed
Objectives /
Evaluation
Criteria
Approvals
Risk/benefit
sharing
Change
management
NHSPS
CHP
LIFTCos
20
2.5 The local borough (geography, transport, population
and demographics):
Geography
The London Borough of Bexley is an outer London borough in south-east London which
borders the Thames to the north, the boroughs of Greenwich to the west, Bromley to the
south and the County of Kent to the east.
It covers an area of 23 square miles (6,400 hectares) and has four major district centres Crayford, Erith, Sidcup and Welling. The town of Bexleyheath is the main town centre, and
there are nine primary employment areas in the north of the borough where industry is
based.
A map of the Borough of Bexley is shown at Appendix A.
Transport
The principal roads through the borough include the A2 trunk road and the A20 Sidcup
bypass which serves as the southern boundary and both connect with the M25.
The nearest Thames River crossings are the Dartford QEII Bridge, Blackwall Tunnel and the
Woolwich Ferry.
There are three Southeastern railway lines crossing the borough, all predominantly running
east-west and serving the centres of Belvedere, Erith, Slade Green, Welling Bexleyheath,
Barnehurst, Sidcup, Bexley and Crayford (See Appendix B. for Southeastern rail services
map) .
Bexley has no London underground lines, Docklands Light Railway or London Overground.
However, from December 2018, Crossrail services will commence from Abbey Wood (just
over the borough border in North Greenwich), linking North Kent services with new high
speed connections to Central London and west to Heathrow/Reading and via Thameslink to
the South and North (See Appendix C. for Crossrail services map).
There has been some debate about extending Crossrail to Gravesend and whilst the route
has been safeguarded by the Department for Transport, currently there is no plan to extend
it beyond the current scheme. LB Bexley advises that if approved this extension might be
delivered between 2026-2031.
Transport for London has a consultation underway for further river crossings at Belvedere
and Thamesmead, together with various associated public transport options. If approved the
crossings are some 10-15 years away from the date of this strategy (See Appendix D).
Demography
The latest Greater London Authority (GLA) borough population projections recorded Bexley’s
resident population at 240,644, in 2015. The population of Bexley’s registered population is
slightly lower at 233,654 as at June 2015.
21
Key characteristics of Bexley’s population as identified in the 2011 census include the
following:

the population aged 90 and over increased by 37% (1,700) between the 2001 and
2011 censuses

adults aged 35-39 decreased by17% to 15,000 over the same period

children aged under 5 increased by 14%
The population pyramids (below) created using 2011 census resident population data, show
pictorially how Bexley’s population has changed.
Figure 2: 2011 census population pyramids
The population is predicted, by the GLA, to increase by 9% between 2011 and 2020,
compared to a national estimated increase of 7.8%. This increase is predicted to continue
beyond 2020, rising to 280,000 by 2035, an overall increase of 22% compared to a projected
overall increase of 17% across England. The increase is expected to be seen across all age
bands with the most significant increase being those aged 65+ with a much smaller increase
for those of working age (16-65 years). This is shown in the following graph.
22
Figure 3: Bexley population projections by age bands
Source: Population Projections Unit, ONS. Crown copyright 2012.
2.6 Estate partners
NHS Bexley CCG established the Estates Working Group in June 2015 to bringing together
all key partners to progress the estate infrastructure agenda locally. A series of meetings
and two workshops have been held to engage all key partners, to help inform the
development of this strategy. The Estates Working Group includes the following
organisations:
1)
Commissioners
1a) NHS England (NHSE) - Its main role is to improve health outcomes for England’s
residents. NHSE sits on the group as they directly commission Primary Care, including
Primary Medical Services (General Practice, nationally commissioning enhanced primary
care services and out of hours primary medical services (where practices have retained
responsibility).
23
1b) NHS Bexley CCG – responsible for planning, monitoring and commissioning the
majority of health services used by Bexley residents. This includes:
Figure 4: Health services
Since April 2015, NHS Bexley Clinical Commissioning Group (CCG), along with the other
CCGs in South East London, has taken greater responsibility and involvement in the design,
shaping and commissioning of local general practices, in a level 2 joint commissioning
arrangements with NHS England, known as co-commissioning. This arrangement allows the
CCG to work more closely with those responsible for securing the provision of general
practice, NHS England, and will support local plans to improve primary care services in the
borough including the estate infrastructure. The Primary Care Joint Committee meets
regularly in public to consider and take decisions on local primary care services including
changes that relate to the estate.
1c) London Borough of Bexley (LBB) - The Local Authority is responsible for
commissioning social care and local public health services including:

Social care services

The Healthy Child programme for school age children, including school nursing

Sexual health services

Mental health promotion, mental illness prevention and suicide prevention

Local programmes around nutrition, physical inactivity and obesity

Substance misuse services

Early diagnosis of dementia and delivery of dementia services
24
LBB also formulates the wider regeneration and development plans for the borough enabling
infrastructure and population growth to be adequately taken into account in planning for
future population pressures, service impacts and hence estate needs.
1d) NHS Dartford, Gravesham & Swanley (DGS) CCG – this CCG is represented to
ensure that there is alignment between the plans for the two adjacent CCGs and cross
boundary implications are fully considered and planned; particularly around the proposals for
17,270 new homes in Dartford with an estimated additional population of 41,448.
Bexley CCG is also actively involved in the South East London Estates Working group,
which ensures that there is alignment across South East London.
2)
Providers
2a) General Practice (GPs) – General Practitioners look after the health of people in their
local community and deal with a range of health problems. A LMC representative and a
Practice Manager have recently joined the Estates Working Group.
2b) Oxleas NHS Foundation Trust (Oxleas) – Oxleas provides a range of health services
in south east London, specialising in community health, mental health and learning disability
services. Oxleas occupies over 80 properties and utilises sessional clinical space in a variety
of locations across the London Boroughs of Bexley, Bromley and Greenwich and into Kent. It
owns the Queen Mary’s Hospital, Sidcup and Erith & District Hospital sites where a range of
community and acute providers occupy space to provide services. These two hospital sites
are the CCG’s health hub and spoke.
2c) GP Federation – There is a single GP federation operating in the borough, Bexley
Health Neighbourhood Care CIC. This consists of all member practices and provides the
entity for practices to work together at scale. This is both a strategic response to the
commissioning framework for primary care but is also necessary to mitigate the workload
and financial pressures which practices report that they are experiencing.
2d) Acute – As there are no acute sites within Bexley, acute providers are engaged at the
South East London Estate Strategy group (SPG level)
3)
DH Property Companies
NHS Property Services (PS)
manages the former Primary Care
Trusts’ (PCTs) property portfolio
amounting to some 3500 buildings
across England. See Appendix E.
showing the NHS PS freehold and
leasehold interests in the borough.
Community Health Partnerships (CHP)
manages the Department of Health’s
investment in the LIFT companies and 300
new healthcare projects built around the
country in approximately the last 10 years.
See Appendix E showing CHP’s head
leasehold interest in the borough.
The Estates Working Group is also supported by the NHS Healthy Urban Development Unit
(HUDU), the CHP Strategic Estates Advisor who is supported by Essentia.
25
4) Recently Peabody Housing Association, who is working on regeneration of the
Thamesmead area, has also joined to group to strengthen links between its plans and any
impact on healthcare services.
5)
Other Primary Care Providers
Provider
Number
Dentists
29 (with 125 performing dentists)
Opticians
14
Pharmacies
45
Care Homes
35
These other Providers are not currently represented on the Estates Working Group but will
be played in as appropriate.
A spreadsheet of community provider data is at Appendix F.
26
3. Drivers for Change
There are a number of factors leading to the need for a clear strategy for changing the way
that services are delivered in Bexley and hence the estate infrastructure. These drivers for
change are described in this section under the following themes:

Service drivers

Population, health need and regeneration drivers

Technological drivers

Estates drivers
3.1 Service drivers
We know that a 'one size fits all' healthcare model will not work for the NHS, which is why
Bexley CCG is responding to local needs and taken the insight, evidence and direction
provided by NHSE London, south east London and national policy agendas and embedded
these into this emerging local strategy. This includes the following key strategy documents:

The TSA recommendations and Secretary of State support regarding Queen Mary’s
Hospital, Sidcup.

NHS Five Year Forward View

Better Health for London

Transforming Primary Care in London: A Strategic Commissioning Framework

Our Healthier South East London

Bexley CCG’s Commissioning Intentions

Bexley CCG’s Primary Care Strategy
It has also taken into account the One Public Estate, the Better Care Fund and such other
initiatives that are current and relevant.
Further details of a number of these are provided below.
Five-Year Forward View
The NHS 5 Year Forward View (5YFV) was published in October 2014 and sets out a clear
direction and vision for the NHS showing why change is needed and what it will look like. It
recognises that in the last 15 years the NHS has dramatically improved, but we can still do
more. The key points of the 5YFV are:
27

There needs to be radical upgrade in prevention and public health. The NHS needs
to back hard hitting national action on obesity, smoking, alcohol and other major
health risks.

When people do need health services, then patients need far greater control over
their own care.

The NHS must take decisive steps to break down the barriers in how care is
provided. It recognises England is too diverse for a “one size fits all” care model, but
we need to support and develop new delivery options (not letting “a 1,000 flowers
bloom”). There are opportunities for new integrated care models and these will be
tested and developed, some of these will be similar to Accountable Care
Organisations being used in other countries.

The national leadership of the NHS needs to act coherently together, and provide
meaningful local flexibility. Growing demand could mean a resource gap of £30 billion
a year by 2020/21. Action therefore needs to be taken on the three fronts of demand,
efficiency & funding to help close the gap.

The significance of primary care is recognised including its role in larger care
organisations.
The need to upgrade primary care infrastructure and scope of services was recognised and
the integration agenda will all lead to different locations and infrastructure requirements.
Transforming Primary Care in London: A Strategic Commissioning Framework
The Framework was developed by the London Primary Care Transformation Board and
published in 2015. It captures some of the core aims of primary care transformation centred
on three “specifications”: proactive care, accessible care and coordinated care. The
framework recognises that to deliver the specification, larger primary care organisations will
be necessary as well as Multispecialty Community Providers (MSP): organisations that align
to a single population catchment. The commissioning framework also sets out the various
enablers needed to deliver the transformation agenda with estate and technology
recognised as key. However, it is recognised that this is an aspirational strategy requiring
significant investment.
Our Healthier South East London (OHSEL)
“Our Healthier South East London” is a five year commissioning strategy which aims to
improve health, reduce health inequalities and ensure all health services in south east
London meet safety and quality standards consistently and are financially sustainable in the
longer term. There are nine key issues identified with the south East London heath system:

Too many people live with preventable ill health or die too early

The outcomes from care in our health services vary significantly and high quality care
is not available all of the time
28

We don’t always treat people early enough to have the best results

People’s experience of care is very variable and can be much better

Patients tell us that their care is not joined up between different services

The social care system is under increasing pressure

The money to pay for the NHS is limited and need is continually increasing

Every one of us pays for the NHS and we have a responsibility to spend it wisely
This all means that the way in which some health services are delivered will need to change,
with more care provided in community settings outside hospital and with a greater focus on
helping people to stay well, making services more joined up and making sure that everyone
gets the care and outcomes they expect from their NHS. This is not about closing a hospital,
but about avoiding the need to build a new one, which would not be affordable, by improving
health and outcomes and delivering services which better meet people’s needs.
Six areas of healthcare have been identified as the priorities for improvement across South
East London:

Primary & Community-based care

Planned care

Urgent and emergency care

Maternity

Children and Young People

Cancer (including End of Life Care)
Mental Health is relevant to all areas and is therefore fundamentally considered within each
workstream.
The community based care strategy sets out a whole system integrated model with Local
Care Networks (LCNs) being the foundation to providing person-centred services to
populations. The diagrams below set out the vision for LCNs and all that they must
encompass. General practice working at scale is a key component of the model. Each CCG
within South East London is responsible for ensuring that the LCN strategy is developed and
implemented locally. This strategy sets out Bexley’s approach to LCNs (section 4).
29
Figure 5: Community Based Care / Local care Networks model
30
Figure 6: The Community Based Care / Local Care Networks Target model
Bexley CCG’s Commissioning Intentions
The development of our Commissioning Intentions 2016 (public strategy document) is an
iterative process with our GP membership, clinical leads, managerial leads, and public and
stakeholders.
For 2016, the cornerstone of these is the Our Healthier South East London project/ strategy.
We have then worked across the CCG to determine necessary additions to these.
A very successful stakeholder event was held on 3rd November 2015 where these were
discussed in detail and further input sought. Feedback from the event has been extremely
positive and demonstrates the CCG’s on-going commitment to our stakeholder engagement
programme. The GP membership has also been asked for comments. The outputs from
both of these work streams will be synthesised and the attached document, updated in
December 2015, to enable the development of the final version for January 2016 Governing
Body approval.
As a result of the development of these – and our on-going QIPP programmes we have then
developed Provider Commissioning Intentions issued to our main providers at the end of
September and in October 2015. These are completed to reflect national good practice as a
first point in the 2016/17 contracting processes.
31
Bexley CCG’s Primary Care Strategy
Bexley CCG’s Primary Care Strategy was approved in September 2015. It sets out the
CCG’s plans to improve coordination of care, access to services and take a more proactive
approach to our patients’ health and wellbeing. This is set in the context of the specific
challenges that Bexley faces such as a growing and ageing population, variability in access,
over-use of hospital services, significant health inequalities, high obesity rates and an ever
increasing prevalence of dementia. The strategy also recognises that change cannot happen
without having the necessary workforce, estate and technological infrastructure in place, so
plans on how we can make meaningful change in these areas is also detailed.
Whilst this strategy has been driven by local need and circumstances, it responds to the
same range of national, London-wide and South East London strategies (detailed above),
that all place a significant focus on the change needed in Primary Care. Most notably the
Five Year Forward View, Better Health for London and the Strategic Commissioning
Framework for Transforming Primary Care in London have all provided the strategic context
for this Bexley strategy.
Figure 7: Bexley CCG’s Primary Care Commissioning Intentions
Figure 7 pictorially shows the CCG’s high level primary care commissioning priorities for the
next two years responding to the challenges faced in Bexley.
32
3.2 Population, Health Needs and Regeneration Drivers
Health challenges for Bexley
The health of people in Bexley is good when compared to other areas in England. However
Bexley residents do experience health inequalities, and there are some health measures
where we are performing less well. In Bexley, the Joint Strategic Needs Assessment (JSNA)
shows that:

Life expectancy for men living in the least deprived parts of the borough is nearly 6
years higher than for men living in the most deprived parts of the borough. In women,
the difference is over 4 years.

The changing make up of our communities, especially the ageing population and the
growth in black and minority ethnic (BME) communities, particularly in the north of
the borough, will have an impact on how we deliver against our priorities.

Life expectancy in Bexley is steadily increasing in line with the trends nationally and
in the London region and has been constantly higher than both the London and
national averages

As with the rest of the UK the main causes of death in Bexley are cancer,
cardiovascular disease, COPD and digestive disease.

Mortality from circulatory disease has fallen dramatically in recent years and there
has been a steady fall in cancer mortality but this has not been as dramatic.

Mortality from digestive disease in Bexley has increased by 4.5 per 100,000
population compared to a national fall of 2.9 per 100,000.

Mortality from chronic obstructive pulmonary disease (COPD) has decreased at a
faster rate in Bexley (5.9 per 100,000 decrease) compared to a fall of 2.9 per
100,000 nationally.

Bexley has lower levels of deprivation than the England average with less than 10%
(9.2%) of its population living in the most deprived quintile and approximately 53%
living in the two least deprived quintiles (24.3% in least deprived). Despite this, the
most deprived part of the borough is in the north where modifiable lifestyle risk
factors are highest.
Services therefore need to be tailored to reflect the following key messages from the JSNA:

To target health inequalities – targeting the north of the borough,

To increase levels of physical activity and reduce obesity in adults and children – the
approach to address this needs to take account of environmental, behavioural and
community driven methods,

To improve early detection of illness – increased focus on screening uptake,
33

To better co-ordinate end of life care – there is a need for more care to be provided in
people’s own homes and to address patients with increasingly complex health needs.

Supporting people with addictions (including smoking, alcohol and drugs)

Dementia
Bexley’s Growth Strategy
Population growth pressures are already being felt in the borough and this is going to
continue. Bexley is already flagged as one of the borough’s most able to respond to
London’s pressing need for more housing and is at the heart of a South East London/North
Kent ‘Productivity Corridor’ which embraces the North Bexley opportunity areas, the
Ebbsfleet Garden City and the associated Paramount Leisure theme park development at
the Swanscombe peninsula. The London Borough of Bexley (LBB) has developed its
emerging vision for growth over the next 15-20 years that sets out plans for the delivery of at
least 24,500 new homes, 10,500 new jobs and supported by significant investment in
transport infrastructure. The growth scenario, known as PH3, is set out in the LBB
publication “Direction of Travel” and the figures are summarised in the figure 7. However, it
must be noted that these figures are the subject of further work and will continue to be
refined as the Council develops its more detailed growth strategy.
Figure 8: Bexley’s Indicative growth
Indicative growth
figures:
1: 5,000 new
homes
2: 11,000 new
homes
3: 2,500 new homes
4: 2,000 new homes
5: 1,000 new homes
Rest of the
borough: 3,000 new
homes
34
Much of the development will be dependent upon the transport infrastructure improvements
such as Crossrail being extended to Gravesend and further river crossings being built.
Realisation of development potential in opportunity and growth areas will significantly
increase the burden on physical infrastructure and demand for services (including health).
Ensuring there is the health infrastructure and sufficient workforce to meet this increased
demand needs to be planned in line with the growth strategy.
The CCG will need to look at the areas where there is planned growth to ensure that there is
sufficient GP and other (e.g. community health) provision especially where current
healthcare provision is scant, e.g. Lower Belvedere, Slade Green and Thamesmead. Other
areas of focus are Erith and Crayford. To accommodate growth of the scale envisaged, it will
be necessary to plan for high density mixed use development concentrated around highly
connected public transport hubs. The nature and location of health provision will also need to
reflect the more intensive configuration of development within Bexley.
Further details on regeneration and population growth and change are shown in section 7.
3.3 Technological drivers
Primary and community care services are already making considerable advances in the use
of information technology and this will continue to grow over the years benefiting patients,
providers and practices whilst facilitating more cost effective services. The emphasis will
continue to be on reducing paper processes and putting in place systems and procedures
that will speed up services whilst at the same time improving data quality and data capture.
The aim is also to enable more holistic patient care through the sharing of patient data with
local Bexley providers for the purposes of direct patient care.
Information and IT is a key enabler for service transformation locally and can support staff in
new ways of working and empower patients to be active participants in their care.
Each CCG has its own IM&T strategy and implementation plans. In Bexley, technological
investment priorities will focus on a number of key programmes as follows, some of which
are already implemented, some that require focused work to enhance usage, whilst others
will need investment before being progressed:

Digitalisation of patient records – exploring whether hard copies of the GP patient
record (Lloyd George notes) can either be stored off site or scanned and destroyed.
This will help free up capacity within practices allowing space to be used for clinical
purposes.

Electronic Discharge Notifications (EDN) – aimed to eliminate the need for sending
discharge summaries by post and include automated capture into GP system work
flows. Most acute hospitals have migrated to fully compliant systems; however the
CCG is providing support where necessary to those providers that are still in the
process of automating EDNs so that all patient correspondence to GPs is done
electronically.
35

The CCG has worked with Oxleas to implement the Docman Hub solution with all
practices to ensure efficient electronic clinical communications with practices.

Electronic Prescription Service Release (EPSR2) has been rolled out to all practices
and pharmacists to enable GPs to send prescriptions directly to a chosen pharmacy.
The CCG is driving the implementation and utilisation of this system.

The CCG is also working with HSCIC to pilot EPS phase 4 in two Bexley practices
which will allow prescriptions to be sent electronically where nominations are not set.

Business grade secure WIFI devices for all practice sites and the CCG have been
installed as part of the second phase of the wireless router programme.

Web conferencing using the Omnijoin software has been rolled out within the CCG
as a resource to facilitate accessibility of meetings for both CCG staff and practice
members. The aim being to reduce time spent travelling and to maximise effective
use of time and resource.

The CCG is now working with partners and providers to encourage the use of web
conferencing in a bid to improve communications across the SPG. In addition this is
being piloted across a number of practices who have expressed an interest in trialling
the benefits of this technology for a range of patient and internal practice services
e.g. practice to branch meetings, with care homes and MDT meetings.

Through the CCG’s Bexley Linked Care programme the CCG has facilitated the
sharing of patient data across Bexley GP practices and the two Urgent Care Centres.
Agreement has recently been reached to integrate the GP data into the UCC’s
clinical system (Adastra).

The next phase of the Bexley Linked Care programme moves into providing GP
patient data access to the local providers in the acute and community setting. Bexley
CCG has committed to the LGT Connect Care Programme which will join up patient
records across practices, Lewisham and Greenwich NHS Trust, Oxleas for
community and mental health data and the London Borough of Bexley. The
aspiration will be that social care data will also be shared via the Connect Care
programme. In addition to the Connect Care initiative, the CCG is also pursuing
record sharing with Dartford and Gravesham NHS Trust.

Longer term, the CCG will be looking to connect with the King’s Health Partnership
online portal for those patients who receive services from King’s, GSTT & St
Thomas’. The aim would be for all of the CCG’s portals to be integrated to ease
access for GPs and improve patient care. The CCG will also review the London
digital tools for information exchange between these systems. This will include the
exploration of the Citizen’s account portal and the data controller portal along with the
health information exchange portal.

Mobile devices such as iPads and laptops are increasingly being used by practices
and providers.
36

Patients Online Services is supporting GP practices to offer and promote online
services to patients, including access to records, online appointment booking and
online repeat prescriptions. The CCG is exploring alternative methods and
opportunities to enhance the utilisation and uptake of patient online services through
the wider health and care network.

iPlato is a SMS replacement service for NHS Mail SMS which allows practices to
send appointment reminders to patients and enables patients to respond to the text
alert to confirm or cancel the appointment. It also allows health promotion messaging
to be sent to patients. The CCG is also utilising the module to capture responses for
the Friends and Family test. The App to replace messaging has now been shared
with EMIS practices for testing.

Electronic Referrals (eReferrals) integrated into the GP IT system with longer term
development including the ability for GPs and patients to track where the patient is in
the system following the initial referral. The CCG has also worked with DXS to build
and develop an automatic email facility from within the clinical system so that
practices can email 2 week waits and district nurse referrals directly from within their
GP system.

The implementation of the Vibe system which serves as a web-based virtual platform
for sharing documentation that needs to be accessed for collaborative purposes to
assist GPs and Practice Managers in administration and assisting in CQC visits.

Utilising Web GP, a web-based system for accessing a range of self-help resources
and the ability to complete an e-consult for review by a GP. This is currently being
piloted in Bexley and the CCG would wish to roll this out to all practices.

Use of health Apps need to be explored and scoped to identify which might be of
benefit to our population.

Ensuring that GP systems of choice are fit for purpose and the future and capable of
delivering the technological change agenda.

Training hubs will focus training within localities in order to deliver efficiencies and
make the most out of staff time. Bexley CCG together with Bexley Community
Education Provider Network (CEPN) are proposing the development of a main
training hub with satellite and spoke sites across GP practices and care homes in the
borough. This will increase the number of training sites where staff can access
training opportunities in the workplace and significantly improve the digital and
technological infrastructure in primary care sites across the Borough.

The CCG would want to explore out of hospital care and the continuity of care
provision using tele-healthcare service developments.

To facilitate improved access, the CCG will need to initiate a central bookings facility
in order to manage this enhanced service, ensuring fair access to appointments and
ease for patients.
37

The provision of extended hours (8-8) in new hubs or existing GP practice sites. This
may include a Federated level central telephone hub or central telephone hubs per
LCN. This will improve patient experience and facilitate both working at scale and
extended opening hours.

As the CCG becomes aware of practice mergers and / or practice developments, or
practice system migrations take place, the CCG would need to support this and
funding would be required. Core GP IT infrastructure & software investment will need
to be available to meet the needs of practice organic/incremental growth, practice
developments e.g. mergers and possibly significant primary care developments such
as new builds or the development of a local care network.
There are a number of IM&T priority areas that are being driven forward nationally and South
East London CCGs are collaborating to ensure that there is a consistent approach at a
South East London level. A primary requirement is for health and care systems to be
interoperable to enable South East London health information systems and professionals to
work together within and across organisational boundaries in order to more effectively
deliver healthcare to people and communities.
Collaborative work with the Healthier London Partnership, through the local digital roadmap,
and its interoperability programme is a key area that the CCG is linked in with and this
strategy ensures that the work undertaken within Bexley Linked Care and the Connect Care
programmes are fully aligned with the principles and standards that follow from the
interoperability framework.
3.4 Estates drivers
There are a number of London-wide estates issues that are driving the need for the public
sector to review its estates strategy. These are summarised below, as well as how they
apply to Bexley.
Table 3: Estates Issues
London Pressure
London is facing a huge land challenge.
There is not enough land to meet the current
and future needs of the population and
therefore all boroughs are encouraged to
release sites for alternative development.
The quality and efficiency of usage of
London’s NHS estate is highly variable and
much does not meet evolving needs. There
is significant scope to transform the way that
estate is used across London.
Bexley Relevance
As an outer London borough, Bexley has
more space relative to the more densely
populated inner boroughs. Bexley is already
flagged as one of the boroughs most able to
respond to London’s pressing need for more
housing. The regeneration plans described
in section 7 shows how the north of the
borough will be regenerated to develop at
least 24,500 new homes and supporting
infrastructure (PH3 scenario set out in LBB’s
Direction of Travel).
In Bexley there is considerable variability in
the quality of the primary care estate. There
are a number of practices that operate out of
converted residential or retail premises that
do not necessarily provide the functional and
38
London Pressure
flexible space required. Opportunities for site
reconfiguration, practice mergers and branch
rationalisation will be considered to improve
the efficiency of practices’ operations and
services to their patients.
Bexley Relevance
A proportion of the estate is under-utilised.
Poor utilisation and unsuitable types of
estate has been a result of:-
There are currently some buildings that are
not fully utilised.
Desktop utilisation studies of the largest
practices located in the areas of planned
growth have recently been undertaken to
 Perverse incentives, insufficient
investment and fragmented decision- assess whether there is sufficient long-term
making on primary and out-of-hospital capacity to meet the needs of a growing
population. Whilst this needs further analysis
estate,
the study found that a number of sites have
 A lack of incentives for GPs to
capacity. Linked with the technological
rationalise the use of estate, and
changes that are taking place in primary
 Inflexibility of lease arrangements
care, this has an impact on the utilisation of
space and the type of infrastructure needed.
However, the reconfiguration of space to
better utilise it will likely take significant
investment and could involve the re-location
and / or centralisation of services, as well as
changes in tenants to ensure that
appropriate capacity is available to Bexley’s
growing population. This could involve
buildings e.g. in Lakeside Health Centre and
Erith Health Centre, that are owned by
Property services companies.
There is a need to unlock value:
Both Oxleas and the London Borough of
Bexley have identified sites that are surplus
 The NHS does not have any new
to requirement which can free up valuable
money and therefore must look at
capital without prejudicing efficient and
how to unlock value from the current
effective service provision in the future,
estate and capital regime to address
which must be re-invested within Bexley.
the issues within the system.
The implementation of the Oxleas’ estates
strategy is predicated on the re-investment
of this capital to improve its existing
healthcare estate.
The CCG must ensure that the QMH and
Erith sites are secured for the population of
Bexley, in line with the TSA
recommendations.
There are opportunities across the public
All estates partners are working together to
ensure that any sites that are valuable to
sector for organisations to co-locate and
share sites to meet the growing pressures of partners are utilised rather than disposed of.
The One Public Estate programme involves
more housing and school places.
Bexley public sector bodies working
collaboratively to look more strategically at
the use of assets to drive a shared ambition
to provide modern, effective and efficient
39
London Pressure
Ensuring that all GP practices are fit for
purpose in line with CQC requirements and
are DDA compliant, energy efficient and
comply with infection control standards.
services, in the right locations, and release
surplus capacity. This will include the review
of existing and new estate to house
healthcare facilities, e.g. the Belvedere
Family Centre.
Bexley Relevance
Bexley has a number of branch sites and
converted residential and retail property that
may need reconfiguration and remedial work
to be fit for purpose to accommodate service
expansion. Opportunities for site
reconfiguration, practice mergers and branch
rationalisation will also be considered to
improve the efficiency of practices’
operations, economies of scale and services
to their patients.
In addition to the areas identified above there are other Bexley specific estate drivers:

Although we are one of the London boroughs with the fewest number of practices
(27), there are seven practices that have at least one branch site and one practice
that has two branch sites and one that has three branch sites. In total there are 40
sites that practices operate from. There may be scope for these to be rationalised
bringing about more fit for purpose and efficient use of the estate and the staff
resource working within whilst ensuring that the right capacity and services are
available to Bexley’s residents. With practice staff spending less time travelling
between sites, access to appointments will increase.

From the 1st April 2016, all NHS organisations will pay market rent for buildings that
they occupy and are owned by NHSPS or CHP. This will drive the need for
organisations to reconsider whether the current buildings occupied are the best value
for money. This will hold true for the CCG headquarters where rent is projected to
more than double in 2016/17. As part of One Public Estate the CCG will conduct an
options appraisal on the location of its headquarters to ascertain the most cost
effective and fit for purpose base within Bexley.

There is no acute hospital in the borough; the CCG therefore works with many
providers for provision of acute services. The Queen Mary’s Hospital site, located
within the Frognal LCN, which is owned by Oxleas NHS Foundation Trust, is the
main community services hub for the borough. Erith & District Hospital (also owned
by Oxleas), within the North Bexley LCN, is the borough’s spoke. A utilisation study is
currently underway to determine the potential to re-locate the x-ray department from
the current site in the World War 2 bunker to the main building. A third location within
the Clocktower LCN could to be considered.
One Public Estate
The One Public Estate programme is an initiative delivered by the Local Government
Association (LGA) and the Cabinet Office to fund councils to work in partnership to jointly
40
explore using their assets more effectively to deliver service transformation and local
economic growth. The following three work streams were submitted as areas that the council
and health partners are working on:
1. Planning for Growth through the Public Estate
This involves mapping existing public landholdings within the high growth opportunity
areas to consider the needs and requirement that these ‘new’ communities will have
over the coming years. A key element will be aligning with health infrastructure and
seeking to identify and test opportunities for better and more integrated forms of
service provision, including shared front doors and integrated service models,
building on the many workstreams seeking to better embed service delivery at a local
level.
2. Scope to better deliver depots and heavy vehicle land uses across a range of
users
Bexley has two ageing depots, both located at or close to boundaries with
neighbouring boroughs, so intends to jointly explore potential for consolidation or
shared depot use. In addition there are several other heavy-use vehicle users
operating within the borough where there is potential to relocate from residential
areas to a more suitable shared location. Service efficiencies and releasing sites for
residential or commercial development would be added benefits.
3. Maximising the potential of shared head office and support services
This study will include the scope for further rationalising the Council’s estate into their
headquarters and the potential for consolidation with partners such as the CCG.
Bexley was successful in receiving a proportion of the funding requested to progress this
work, and the London Borough of Bexley is working with partners to take this forward.
41
4. Bexley’s Vision for the Estate Infrastructure
4.1 Future Model of Care and Service Priorities
As part of the CCG’s aim of bringing care closer to home and the broader South East
London strategy, primary, community and social care services need to be more accessible
and better integrated, supporting a preventative and holistic approach to patient care over
time. There is a commitment to strengthen joint commissioning arrangements with the
council to ensure that the full complement of services is joined up around the patient along
pathways of care.
Primary care plays an integral role in delivering our strategic priorities, whether as a provider
within the care pathway, or by ensuring that there are good processes in place for referral
and management of patients following their interaction with more specialist acute or
community services. This community based care model will empower people to manage
their own health positively to prevent deterioration where possible. Following an episode of ill
health the LCN will take a rehabilitative / reablement approach to return patients to their
previous capabilities, resuming self-care if appropriate.
The development of LCNs will be the mechanism by which this service model will be
delivered across south east London, although each LCN in Bexley will be driven from the
bottom-up with provider organisations leading the development of service change to best
meet the needs of their populations and Commissioning Intentions. The services available
will be proactive, accessible, coordinated and provide continuity; with a flexible, holistic
approach to ensure every contact counts. This will be primary care delivered to
geographically coherent populations, at scale, whilst still encouraging self-reliance. This will
be a universal service covering the whole population ‘cradle to grave’.
A LCN will involve primary, community and social care colleagues working together and
drawing on others from across the health, social care and voluntary sector to provide
proactive patient centred care. Services within LCNs will be delivered in ways that respond
to the varied needs and characteristics of the community it serves.
The Transforming Primary Care Strategy expects General Medical Services to be provided
from 8am to 8pm 7 days per week. The service model and timescales for this are yet to be
determined but a federated model is likely whereby the extended access is operated from a
hub(s). This will likely require changes to IT infrastructure and associated support, including
facilitation of a central booking system and possibly central telephone hub.
In Bexley there are three LCNs that align with the existing locality networks of practices
shown in figure 9.
42
Figure 9: Bexley’s three LCNs
The three LCNs include the following practices and populations:
Table 4: LCN Practices & Populations
Locality
Total
population
Practice
Population
10,330
11,529
Clocktower
80,386
4,691
8,722
4,400
5,108
14,146
8,532
12,928
Practice Name
BELLEGROVE SURGERY
BEXLEY GROUP PRACTICE
MAYFAIR MEDICAL CENTRE
STATION ROAD SURGERY
NUXLEY ROAD
WELLING ADMIN OFFICE
BURSTED WOOD SURGERY
CROOK LOG SURGERY
DR THAVAPALAN AND PARTNERS
INGLETON AVENUE SURGERY
THE ALBION SURGERY
THE WESTWOOD SURGERY
PICKFORD LANE SURGERY
WELLING MEDICAL PRACTICE
HOLLY HOUSE SURGERY
43
Locality
Frognal
Total
population
53,784
Practice
Population
15,316
7,339
8,448
10,168
2,337
10,176
8,524
16,313
3,484
9,620
North Bexley
100,191
7,371
6,099
16,192
8,334
2,450
9,688
7,185
4,931
Practice Name
BARNARD MEDICAL GROUP
MARLBOROUGH PARK AVENUE
PLAS MEDDYG SURGERY
SIDCUP MEDICAL CENTRE
231 BURNT OAK LANE
STATION ROAD SURGERY
THANET ROAD SURGERY
WOODLANDS SURGERY
BELVEDERE MEDICAL CENTRE
BEXLEY MEDICAL GROUP
HURST PLACE SURGERY
ERITH HEALTH CENTRE
BULBANKS MEDICAL CENTRE
CAIRNGALL MEDICAL PRACTICE
CUMBERLAND DRIVE SURGERY
CRAYFORD TOWN SURGERY
GOOD HEALTH PMS
BARNEHURST ROAD
LAKESIDE MEDICAL
LYNDHURST ROAD MEDICAL CENTRE
MILL ROAD SURGERY
NORTHUMBERLAND HEATH MED.CTR.
SLADE GREEN MEDICAL CTR.
COLYERS LANE MEDICAL CENTRE
THE PARKSIDE
Figure 10 shows the location of GP practices and how this maps to where patients live at a
lower super output area (LSOA).
44
Figure 10: Location of Bexley GP practices
Due to a number of practices having branch sites (which are not labelled on the above map),
there is not complete geographical alignment between the locality that the practice is a
member of compared to the geographical locality where their patients live. One practice has
a branch in Greenwich and two other practices have significant populations that sit outside of
their own localities. The LCN Programme Board is yet to agree the approach to how these
populations are treated in terms of LCN alignment and priorities for each LCN.
There is a single GP federation, Bexley Neighbourhood Care Community Interest Company
(CIC), where all practices are members. Working through the LCN programme board, the
CCG with the London Borough of Bexley and provider partners seeks to expand and
enhance the service offering around populations.
4.2 Our vision
It is critical that public sector organisations locally make the most efficient and effective use
of their estate so that over the long-term, there is the required infrastructure in place to
support the delivery of services in the locations that best respond to the need. In terms of
primary care, it is vital that the technological and estate infrastructure reflects new models of
service delivery which form part of the primary care transformation agenda and the
development of LCNs. In order to do this, there needs to be fit-for-purpose, well utilised,
sustainable, affordable estate located to best meet the health needs of the population.
45
The development of primary and community care infrastructure in the borough needs to help
facilitate delivery of the following priorities:

Aligns with the London Borough of Bexley’s Growth Strategy and addresses any
service and infrastructure needs that result, across Bexley, including ensuring
sufficient GP provision across Bexley e.g. in Belvedere, Slade Green, Thamesmead
and Erith.

Ensures there is sufficient capacity for primary and community care services to be
provided in out of hospital settings.

Advance technological solutions that reduce the need for face-to-face consultations,
better equip patients to self-manage, enable more preventative care and strengthen
communication and collaboration between organisations. This will include utilising
web conferencing facilities, and other web based solutions, between practices,
practices / branches and practices / patients. This will enable practice education to
be undertaken virtually to reduce staff travel time, increasing time available for
patients and reduce patient travel time as patients can be seen remotely. In addition,
the GP systems of choice need to be fit for purpose both now and in the future.

Reduces reliance on clinical and office space through use of remote and mobile
working.

Improve seven day access to effective care.

Seeks to rationalise branch sites where this enables more efficient ways of working,
without hindering patient access, ensuring remaining practices, across the borough,
are fit for purpose and have the required capacity to meet the needs of Bexley’s
population. The CCG is already looking at premises rationalisation within Welling and
Belvedere jointly with specific GP partners. There are also two other mergers within
the borough that are currently underway, which the CCG and NHS England are
supporting.

Ensures that all practices in the borough are CQC compliant, meet DDA regulations
and that premises are fit for purpose and meet the CQC requirements.

Ensures that there is sufficient training and workforce development capacity and
improved accessibility across practices, and LCNs; improving the learning culture
across Bexley. This will also facilitate an increase in the number of practices able to
offer placements for all student healthcare professionals.

Greater partnership working across providers through co-location of services.

Delivers the emerging LCN strategy including the consideration of hub sites.

Maximises the use of purpose built, high quality estate for clinical purposes through
exploring the potential for the relocation of administrative and storage functions off
site at a lower cost, or through digitalisation.
46

Identifies where buildings are surplus to requirement for all partners and investigating
there potential for use across the borough before disposing of assets.

Ensure any changes are beneficial to patient access and do not exacerbate health
inequalities. This will include reviewing recommendations within CQC reports and
instigating improvements to ensure that premises are fit for purpose.

Maximise the use of space through exploring with partner organisations how space
can be reconfigured to deliver maximum value to the public sector and improved
facilities for patients.

Ensures the maximisation of digital technology to facilitate patient care.
4.3 Hub sites
To help implement new commissioning arrangements such as the integrated MSK service,
cardiology service, urgent and unscheduled care service and ophthalmology service the
CCG has been working with its partners to develop and transform both Queen Mary’s and
Erith & District Hospital sites as ‘smaller viable hospitals’ / community sites.
Oxleas NHS Foundation Trust owns both sites, and there are a range of providers operating
from the sites to deliver the services shown in figure 11 (the diagram reflects the vision for
Queen Mary’s Hospital that was agreed by all partners in 2014). Bexley CCG and partner
organisations are committed to the continued development of the Queen Mary’s site as a
multi-provider health “hub” with Erith & District Hospital as a “spoke”. There is a new Kidney
Treatment Centre and a new Cancer Centre under construction and being developed upon
the Queen Mary’s site.
47
Figure 11: Queen Mary’s Hospital vision
Queen Mary’s Hospital is well placed to serve the Frognal LCN and Erith & District Hospital
is well placed to serve North Bexley LCN but the potential for a third hub will be explored that
would serve the Clocktower LCN. This would not necessarily need to house the range of
services located at Queen Mary’s and Erith hospitals but could be a site, or multiple sites, for
providing the extended primary care service that is likely to be commissioned by NHS
England from April 2016. However, it is recognised that LCNs are about service provision
and healthcare wrapped around the patient, as well as how services connect with each other
rather than the physical locations of services; and with the direction of travel being towards
more self-care options, it is anticipated that investment in technology will replace investment
in physical assets.
48
5. The Current Estate
5.1 Overview
This section describes the current health and local authority estate and the buildings that are
delivering services across Bexley. It focuses on key sites reviewing the cost, size, utilisation,
condition and ability of these sites to absorb population growth and increases in services
demanded within the borough. It also analyses the estate held by service providers in the
Borough.
Across Bexley there are the following health service providers, who occupy buildings across
the borough:

General Practice

Oxleas NHS Foundation Trust (Oxleas)

King’s College Hospital NHS Foundation Trust (KCH)

Guy’s & St Thomas’ NHS Foundation Trust (GSTT)

South London and Maudsley NHS Foundation Trust (SLaM)

Lewisham & Greenwich NHS Trust (LGT)

Dartford & Gravesham NHS Trust (DGT)

The Hurley Group
Additionally, the two Department of Health property companies, NHS PS and CHP, have
interests in the following sites; the two health centres are multi-occupied and Erith Road is
the CCG’s headquarters office building.
Organisation
Tenure
Building
NHS PS
Freehold
221 Erith Road
NHS PS
Freehold
Erith Health Centre
CHP
Head Lease
Agreement
Plus Lakeside Health Centre
In line with the One Public Estate, Department of Health and NHS England initiatives, the
Local Estate Strategy should also include relevant Local Authority estate where services
might be integrated and co-located and these are shown as Appendix L.
49
Estate Summary
The map (figure 12) graphically depicts the number of GP and community health buildings
by LCN.
Figure 12: GP and Community Estate in Bexley
Lower
Belvedere
Clocktower Locality
Northumberland
 13 GP Centres
 8 Community and
Mental Health Centres
East
Wickham
Barnehurst
North Bexley Locality
 17 GP Centres
 8 Community and Mental
Blackfen
Bexley
Health Centres
North
Cray
Frognal Locality
Foots Cray
 11 GP Centres
 6 Community and Mental
Health Centres
A brief summary of the key facts about organisations that operate within Bexley have been
displayed in Table 5. The GP estate is detailed in Appendix J. The majority of the community
and mental health centres are part of the Oxleas estate detailed in Appendix I. The
exceptions are Lakeside and Erith Health Centres, held by CHP and NHS PS respectively.
Maps of each estate occupier or owner have been included in the Appendices G and I.
50
Table 5: Provider accommodation key facts
Organisation
No.
of
sites
GP
40
Oxleas
27
% of total
Total
health
Sqm
estate
Occupied
occupied
9,921*
67,112
12.74%
86.19%
TBC
KCH*
5
TBC
1.07%
SLaM
1
833
GSTT
1
TBC
LGT
2
TBC
DGT
2
TBC
The Hurley
Group
2
TBC
81
77,866
Sub-Total
Other Property
TBC
TBC
TBC
43*
Pharmacies
Dentists
45
29
TBC
TBC
Opticians
14
TBC
TBC
TBC
TBC
Care Homes
35
TBC
TBC
247
97,886
Comments
LPA = Lease Plus
25 x Freeholds, Agreement
14
x
Leaseholds,
1 x LIFT LPA
10 x Freeholds, Total sqm includes
5 x Leaseholds, 47,300 sqm at Queen
1 x LIFT LPA,
Mary Hospital (QMH)
5 x
PFI, and 6,742 sqm at
2 x 3rd party and Bracton Centre (MSU)
4 x sessional
At Barnard Health
Centre, QMH, Erith &
3 x Licences
District Hospital,
2 x Leasehold
Lakeside Health
Centre and Erith
Health Centre
Provides outpatient
services at Erith
TBC
Health Centre
1 x Leasehold
1 x Leasehold
1 x TBC
At QMH Hospital
At Erith and District
Hospital and QMH
TBC
At QMH and Erith &
District Hospital
TBC
At QMH and Erith &
District Hospital
100%
Council
Properties
Total
20,000
TBC
Ownership
Status
TBC
36 x Freehold
and 7 x
Leasehold
TBC
TBC
*Sites of possible colocation with council
and health care
TBC
TBC
Multi occupied
properties have not
been double counted
* Missing data
51
5.2 GP Estate
The GP estate has been summarised in Table 6 and is detailed in a spreadsheet at
Appendices F and J.
Table 6: GP Estate summary
No. of
Practice
converted Single
Practices Premises buildings/ handers
purpose
built
premises
27
40
30/11
5
Branch
sites
(incl.
admin
building)
13
No.
No. of
Average Average
of
Patients list size Patient
WTE
per GP
GPs
WTE
114
234,361
8,680
2,055
In summary, there are 27 Practices (including 5 single handers) operating from 40 sites of
which 29 are converted residential or retail premises. As a result surgeries may not be DDA
compliant and rooms may not meet current health facility design standards. The remaining
sites are purpose built.
Included in the 40 sites are 13 branch sites, which means staff have to spend time travelling
to sites to see patients and to manage the branch activities.
A number of the premises are quite small with limited ability to expand to meet the
healthcare needs of a growing population.
The cost of the GP estate is c£2.64m + per annum (data on seven sites has not been
supplied).
Bexley has a higher patient per GP ratio (2,055) than the Department of Health average ratio
of one GP per 1,800. However, Bexley is the joint highest in London for Nurse WTE at 0.27
per 1,000 patients. Bexley is 24th out of 32 areas in London for combined GP/Nurses with
0.67 per 1,000 patients. The average list size in Bexley is 8,680, which is above the 7,575
average for the other five South East London Boroughs. This occurs because Bexley has a
significantly higher number of branch sites compared to the other South East London CCGs.
Out of hours service provision is provided by the Hurley Group, who also provides the CCG’s
two Urgent Care Centres and currently support the 111 service with GP dispositions. This
service is provided for all patients registered with a Bexley surgery. The out of hours service
is provided from of Queen Mary’s Hospital. Bexley’s two Urgent Care Centres (UCC) are
based at Queen Mary’s Hospital, Sidcup, which is open 365 days a year and 24 hours a day
and Erith District hospital which is open from 8am to 10pm 7 days a week. There are no
Walk-in Centres in Bexley.
52
Figure 13: GP Practices across the borough
Key: The above map has been generated from the SHAPE database. Because of the scale,
where GP premises are closely located, they are depicted by a number on the map, i.e. 4
denotes 4 GPs in that location. A larger map is located at Appendix 6.
53
Size (NIA in Sq M) of GP Practices against patients list size
800
700
600
Sq M
500
400
300
200
100
0
2,000 - 4,999
5,000 - 7,999
8,000 - 10,999
11,000 - 13,999 14,000 and above
Patient List Size
Mean
Maximum
Minimum
Figure 14: The size of GP practices compared to patient list size
This graph shows the difference between the patient list size and the square metres of the
estate. The Practices have been grouped according to their list size. The graph plots the
mean, maximum and minimum size in sqm. for each list size grouping. The data indicates
that the larger the distance between the minimum and the maximum size value within a
single list size group, the more potential for finding cost and space efficiencies. For example
the graph indicates that the patient list size of 5,000 – 7,999 and 14,000 and above should
be focused on as areas in which cost efficiencies could be found. As an aggregate there is
not a clear upward trend in the maximum value (per square metre) compared to patient list
size.
5.2.1 GP Utilisation
In September 2015, a self-assessment questionnaire was sent to all practices for
completion. The questionnaire asked a number estate questions to gather data to inform this
Local Estates Strategy.
54
To date, 38 out of 40 responses have been received for practices’ premises in the borough
and the utilisation data shown in figure 15 was returned.
Figure 15: GP Utilisation Survey
Excellent >80%
High 60 - 80%
Average 50 - 60%
Poor 40 -50%
Very Poor <40%
0
10
20
30
40
The recent survey provided a simple understanding of the utilisation of GP practices
premises across Bexley. A common theme to come out of the survey was:

the need for additional clinical and non-clinical space,

storage for patient records,

further administrative space and

a limitation to the number of patients that can be seen and the range of services
offered.
Further, Bexley CCG commissioned desk top utilisation reviews of 6 of the larger GP
practices and two health centres in the borough.
Practice
Sqm/patients
The Albion Surgery (Bexleyheath)
approx. 473 sqm/14,000 patients
Crayford Town Surgery
approx. 532 sqm/7370 patients
Belvedere Medical Centre
approx. 346 sqm/8520 patients
Cairngall Medical Practice (Belvedere)
approx. 353 sqm/9620 patients
Lyndhurst Medical Centre (Barnehurst)
approx. 355 sqm/ 8330 patients
Northumberland Medical Centre ( Erith)
approx. 334 sqm/9690 patients
55
Within the two health centres were the following practices:


Erith Health Centre (1,480 sqm):
o
Good Health Practice – approx. 6100 patients
o
Bexley Medical Group – approx. 4350 patients
Barnard Health Centre (800 sqm):
o
Barnard Medical Group – approx. 15,230 patients
These practices were chosen as they are sited in areas of expected high population growth
and were commissioned to understand their current capacity and occupancy. Key findings
included:

The average overall occupancy of clinical rooms in GP practices is between 54% to
81% however, when looking at how the rooms were used during the audits the
occupancy of the rooms where clinicians are seeing patients drops to between 39%
and 67%,

The schedules provided by the practices suggest there is currently unused capacity
in the clinical rooms scheduling totalling 240 sessions each week available in the
area.
A summary of the findings is included at Appendix G.
Clearly, this study was just a sampling of the GP estate, and on certain day / times of the
week, and there will be variance across the Practices however, the under-utilisation
identified in this report reflects similar findings elsewhere in the country. The key finding is
therefore that GP practices need to be encouraged to better utilise their accommodation
before new investment is sought for extensions to or new buildings.
5.2.2 GP Asset Condition
Compliance Surveys for GP surgeries were undertaken by an independent building
surveying consultancy between 2011 and 2012.
As mentioned, the majority of the GP occupations are in converted residential or retail
properties. Only 11 premises are located within purpose built facilities. Figure 17 shows the
age and type of the GP estate.
Criteria for assessing the suitability of premises needs to be agreed with stakeholders in
order to inform future business cases and investment decisions. More is said about this in
section 6.3.
56
Figure 16: Type and Age of GP estate
Age of GP Estate
GP Building Type
2000 2009
10%
Purpose
built
26%
1990 1999
13%
Convert
ed
74%
1900 1929
20%
1980 1989
14%
1930 1949
23%
1950 1979
20%
The Compliance Surveys conducted on the Bexley PCT GP estate in 2011/2012 by NIFES
Consulting Group have been reviewed and the findings are shown in the pie chart below.
GP Compliance Surveys
Amber
45%
Green
55%
Figure 17: GP Compliance Surveys
Note: The associated risk matrix has been included in Appendix 8.
As the Compliance Surveys are 4 years old, some improvement works may have been
undertaken which would improve their individual score. Several bids have been submitted
and 66% grants approved for the 2015/16 Primary Care Infrastructure Funding (PCIF) to
undertake various works across a number of practices. These works were rated red, amber
or not approved.

Red rated works – included fire safety compliance and infection control works

Amber rated works – included DDA plus infection control works
57

Whilst undertaking improvement works and moving from amber to green is a positive
step, it does not necessarily mean the GP accommodation is fully fit for purpose and
the CCG would envisage practices moving over time to larger, better buildings, fit for
the delivery of 21st century healthcare. However, this would be dependent on the
available investment.
5.3 Community & Mental Health Estate
Oxleas is the main community and mental health provider in Bexley.
Other providers of services include KCH, GSTT, LGT, SLAM and the Hurley Group.
Figure 18 shows the size (sqm) of the community and mental health estate across Bexley.
Figure 18: The size of Community & Mental Health estate across Bexley
Size of Community & Mental Health Estate (sqm)
25000
20000
15000
10000
5000
0
Oxleas
SLaM
KCH
Note: the sqm for GSTT, LGT and the Hurley occupations is to be confirmed.
Oxleas has 27 occupations and owns or leases the majority of the community and mental
health estate in the borough. It also owns Queen Mary’s Hospital, Sidcup and Erith & District
Hospital, two significant community healthcare sites and the healthcare “hub” and “spoke” for
the borough. Generally community services are provided from a mix of purpose built health
centres ranging in size, age and condition.
Details of the Oxleas estate is included at Appendix H and site fact sheets of key buildings
are located in Appendix I.
Additionally, Oxleas owns;

The Bracton Centre, a medium secure mental health facility, just over the border in
Dartford, which provides a range of specialist forensic mental health services for
58

people aged 18 - 65 living in the boroughs of Bromley, Bexley, Greenwich and
Lewisham and other boroughs when requested.
Goldie Leigh Hospital provides multiple community health services. It is located just
over the border in Royal Borough of Greenwich and also provides health services
Bexley residents.
The approximate cost of the Oxleas estate is £11.58 million per annum.
NHS Property Services owns the freehold interest in the modern, Erith Health Centre (1,480
sqm) and has a lease on the associated car park. Also, it owns the freehold of the Bexley
CCG HQ building at 221 Erith Road. A site fact sheet for Erith Health Centre is included in
Appendix I.
Community Health Partnership holds the head leaseplus agreement for the Lakeside Health
Centre. Completed in 2007, it is a new, multi-use health centre (2,033 sqm) that was built
under the Local Improvement Finance Trust (LIFT) initiative. A site fact sheet for Lakeside is
located in Appendix I.
There are a number of other sites that will be central to the gap analysis in section 7. These
buildings are key to the estate strategy moving forward and are purpose built health centres
that are ranging in size, age, and condition and include Erith Health Centre. Figure 20
shows all of the community estate in Bexley. Figure 20 shows the cost of the estate for each
provider:
Figure 19: Community Estate £ per sq
£1,000
Costs £ per sqm of the community and mental health
estate
£900
Cost £ per sq m
£800
£700
£600
£500
£400
£300
£200
£100
£0
Oxleas
SLaM
KCH
Average
This graph shows the average, range and upper and lower quartiles of data for the
community estate. The Oxleas element shows £ per sqm ranging between £153 and £984
59
per sqm. With the average circa £314.56 per sqm. There is a large disparity of costs within
the Oxleas estate because of the high cost per sqm of Lakeside Health Centre. SLaM cost
data has not been supplied, so no assessment is possible. The KCH element shows a £ per
sqm ranging between £377 and £685 per sqm with an average cost per sqm for £531.
5.3.1
Utilisation studies of the Community and Mental Health Estates
A key finding within the CCG’s commissioned desk top utilisation review of Erith Health
Centre was that the utilisation of Oxleas’ clinical rooms at Erith Health Centre was poor with
an average occupancy of 24%. However, this does not take into account Oxleas’ plans to
move health visitors and district nurses into Erith Health centre from Colyers Lane in May /
June 2016. To accommodate future growth, there is an expectation that current rooms used
for admin will need to be converted for clinical use. This is being discussed with NHS
Property Services.
Additionally, in July 2015, CHP commissioned a study of its Lakeside Health Centre,
Thamesmead.
The purpose of the study was to understand the utilisation and capacity at the health centre
including the GP space and its waiting area. The report concluded that:

The GP practice is at 100% utilisation, with high occupancy levels throughout the day
and over-crowding in the waiting area.

The first floor and second floors leased to Oxleas were under-utilised.
The report highlights that there is an opportunity to locate other services into this building
and adapting the 2nd floor for clinical use. Following the study, further work is being carried
out by CHP to develop the reception area and a feasibility study is underway in
Thamesmead & Belvedere, this is expected to include proposals to improve the utilisation of
the upper floors. Oxleas is also intending to relocate some of the existing admin services
from this site, which would allow the space vacated to be converted for clinical use.
Lakeside Health Centre is a key site for the Bexley, Local Estates Strategy. It is a modern,
purpose built health facility in the Thamesmead East ward with potentially high population
growth. It is located very close to the borough border with Greenwich, which is similarly
anticipating high population growth in its adjoining wards of Thamesmead Moorings and
Abbey Wood. Lakeside Medical Practice is located within the health centre and is already
one of the largest practices in the borough with 16,300 plus registered patients. It is the only
Bexley GP in Thamesmead East ward.
60
5.3.2
Oxleas Community & Mental Health Estate Utilisation
Oxleas has an estates strategy to regularly review its community and mental health estate. It
currently has plans to rationalise elements of its estate, as reported later in this strategy
document. Oxleas has not shared any formal utilisation studies but, has provided a view
about the utilisation of its estate, which is shown in Figure 20.
Figure 20: Utilisation of Oxleas Estate
Excellent >80%
High 60 - 80%
Average 50 - 60%
Poor 40 -50%
Very Poor <40%
0
5
10
15
Where the estate is poorly utilised, Oxleas have plans for its future use or disposal.
Oxleas are undertaking different ways of working by the provision of multi-disciplinary sites
where all clinic rooms are shared between the different services. This ensures full utilisation
of clinic rooms, group rooms etc.
5.3.3
CHP Pilot Utilisation Scheme
The evidence of the utilisation studies suggests that some of the expected population growth
can be absorbed by the existing estate through better utilisation.
To try and tackle this difficult issue, CHP has proposed undertaking a pilot scheme in
Lambeth to better manage some of the LIFT buildings, where poor utilisation has been
identified. If this pilot project proves to be successful then the learning could be rolled out
across other boroughs, LIFT buildings and potentially shared with other building owners
such as Oxleas and NHS PS.
5.3.4
Oxleas Asset Condition
Oxleas has provided data which indicates the current condition of its estate is generally
good.
The results are illustrated in Figure 21.
61
Figure 21: Condition of Oxleas Estate
Condition of Oxleas Estate
Amber
30%
Sessional
33%
Green
37%
The key community buildings in the Borough are predominately purpose built sites that
range in age from the 1980’s to 2007.
Queen Mary Hospital is the largest health site in the borough. It is part owned freehold by
Oxleas and part held under a PFI contract. The Trust has indicated the freehold areas have
an amber rating and the PFI elements, green. However, Oxleas are undertaking a multimillion pound redevelopment of the Queen Mary’s Hospital site to bring the condition of all
areas to a green rating.
5.4 Bexley CCG HQ
The CCG HQ building is located at 221 Erith Road, Bexleyheath. The building is owned
freehold by NHS PS, who is introducing market rents across its whole portfolio from 01 April
2016. As a result the CCG has undertaken an options appraisal to review its HQ base and
the most cost effective solution. Options will include co-location with the Local Authority. The
results of the options appraisal will be reported in a future iteration of this Local Estates
Strategy.
5.5 Financial Summary
Financial information about premises costs has been captured from various sources but, is
not complete. GP reimbursement information has been provided by NHS England and some
high level financial data has been received from Oxleas, and KCH. Some finance data has
also been received from the Local Authority, which is incomplete - see Table 7. Financial
data is awaited from DGT, GSTT & LGT.
62
Table 7: Financial summary
Provider
Occupation Cost per annum
GPs
£2.64m
Oxleas
£11.58m*
KCH
£0.22m
SLaM
TBC
Council Properties
Total
£1.48m
£15.92m
* These costs include QMH
5.6 Current Disposals
The current disposal list identifies a number of opportunities to reduce the estate. Further
opportunities for rationalisation could potentially occur where leases have expired or break
clauses exercised, subject to the relocation of the health services to alternative premises.
Also GP retirements may facilitate practice mergers and or relocation to alternative locations.
As these mergers are proposed and agreed, there are likely to be cost implications in terms
of re-configuration of services around fewer sites.
Oxleas has provided details of its plans for the implementation of its estates strategy. It
currently has a good understanding of sites that are core to the services it provides, sites
that will need further review before a decision can be made and sites that will be disposed of
over the next 5 years. They also have plans in place for the re-investment of the proceeds
from the planned property disposals.
Table 8 sets out the Oxleas site disposals.
63
Table 8: Oxleas Site disposals
Sites
Type of
disposal
Date
Running
costs
Existing
use value
Number of
residential
units
Upton Day
Hospital
F/H
2015
N/A
£600,000
6/7
Colyers
Lane
F/H
2016
N/A
£175,000
7/8
Murchison
Clinic
F/H
2016
N/A
£350,000
8/9
Stuart House
L/H
Oct
2016
£150,000
N/A
N/A
Woodside
L/H
2016
£35,000
N/A
N/A
Bedonwell
Clinic
L/H
Oct
2015
£35,000
N/A
N/A
£210,000
£1,125,000
21/24
Total
NHS Property Services has provided a disposal list for South East London but, has not
identified any assets for disposal in Bexley. However, dependant on the outcome of the
options appraisal for the CCG’s HQ site, this could lead to the disposal of 221 Erith Road.
LB Bexley has supplied a data sheet of properties but, none are identified for disposal.
5.7 Challenges and Opportunities
The NHS and in turn the CCGs are under financial pressure to ensure that the health estate
is rationalised and that assets are maximised to their full potential. This will present a
number of challenges as well as opportunities to improve the functionality of the estate in
line with the service strategy.
Engagement with the key stakeholders in the borough has led to identification of the
challenges and opportunities that Bexley faces. Identification of these will enable the chance
to address these issues and act on the opportunities that arise.
Estate Challenges
There are a number of challenges that stakeholders will have to address in order to create
an efficient health estate within Bexley. The estates challenges should be able to be
mitigated to create opportunities.
64
Table 9: Challenges & Mitigations
Challenges
Mitigation
Growth scenarios still being developed for
the LBB growth strategy but will cover the
next 20 years
Maintaining a constant dialogue about long
term housing development and population
growth through the Local Estates Forum with
relevant stakeholders
Monitoring the proposed housing
developments over the next 20 years and
ensuring CIL opportunities are captured
Maintaining dialogue with Bexley Council’s
planning and development department.
Not knowing what accommodation
(particularly clinical) is available.
Development of shared estates database
that can be accessed by all stakeholders.
How to create an effective system that allows
different organisations to share flexible
space and facilities effectively.
CHP currently piloting room booking system,
which potentially can be rolled out across SE
London.
Oxleas are undertaking different ways of
working by the provision of multi-disciplinary
sites where all clinic rooms are shared
between the different services.
Lack of capital investment for
development/reconfiguration
Local Estate Strategy will set out
improvement that can be applied for though
the Estates & Technology Transformation
Fund and other available funding.
Large number of stakeholders
Maintain the Local Estates Forum and
ensure all stakeholders, particularly Oxleas,
LB Bexley, NHSE and the GPs remain fully
engaged.
Constraints of leases and budgets
Working with the NHS property companies
and NHSE, creating a flexible lease
framework for service providers.
Population distribution and health
inequalities
Ensuring Health hubs are accessible for all
Lack of transparency within each agency
Creating local estates meeting with key
stakeholders on a regular basis to encourage
engagement.
65
Challenges
Mitigation
Availability of transport to certain key hubs
Engagement with the Council to ensure that
key hubs are well serviced by public
transport.
Better utilisation of expensive clinical
buildings
Relocation of admin and storage facilities to
cheaper accommodation / digitalisation of
records; conversion to clinical where
appropriate.
GP Freehold and retiring partners
Early engagement with practices over
succession planning
Impact of large scale housing development
in adjoining CCG areas
Consideration of the balance between Local
Care Network hubs and more locally
provided care.
Early cross border discussions and
agreements with other CCGs.
Working with community providers and GPs
to plan for local care to be available where
appropriate within LCNs / localities.
Estate & Technological Opportunities
The Local Estate Strategy presents an opportunity for all stakeholders in Bexley to create an
estate for the future that will be able to provide integrated care to all patients. It also presents
an opportunity to:

Queen Mary’s Hospital and Erith & District Hospital - Continue to secure Queen
Mary’s Hospital and Erith & District Hospital - as the main health hub and spoke for
Bexley’s population in recognition that Bexley has no acute site.

Lakeside Health Centre - Improve the utilisation of Lakeside Health Centre, which
has capacity for additional expanded GP and other services in the North of the
borough.

Thamesmead East & Belvedere - Undertake a feasibility study in Thamesmead East
& Belvedere, with Greenwich CCG, to ascertain whether Lakeside Health Centre can
be better utilised to absorb the population growth arising from the regeneration of the
area. If the emerging growth plans are realised in Belvedere then the population of
this area of the borough will increase dramatically to become Bexley’s most
populated ward. No sites have been formally re-allocated as part of the Local Plan
process but close liaison between the CCG and the Council needs to occur as part of
the development plan process following the adoption of the Growth Strategy.

Erith - The Erith Western Gateway Development Framework (January 2012)
identifies a potential for at least 500 new homes. Redevelopment of Erith Quarry site,
in Fraser Road will provide up to 600 residential units, a primary school and 530 m2
of non-residential floorspace. There have been discussions regarding the possibility
of a health centre as part of the proposals but, better utilisation and reconfiguring
66
services at Erith Health Centre might meet some of the demand. A utilisation review
is also being carried out at Erith Hospital which includes looking at the potential to relocate the existing x-ray department into the main building.

Crayford – a number of new homes have been built or are proposed. Crayford Town
Surgery relocated into the refurbished Town Hall building in December 2014 and has
the capacity to meet this new demand.

Maximising the use, and realising the benefits, of digital technology which will
include data sharing across and within the health economy, digitalising records and
enabling practices to work in different ways to maximise the available estate, allowing
absorption of growth, and improving patients’ experience and outcomes. The Local
estate strategy will set out to create meaningful forums to discuss needs and match
with capacity.

Improve the use of clinical rooms in all key estate.

Engage in cross boundary discussions to ensure that the need for health services is
met in the borough.

Create a hierarchy of services – decide what we want, how we provide it and where.

Creating one voice for the estate.

Look at other boroughs where success is evident, in terms of technology, estate
strategy and patient care.

Co-locate services where possible and sensible.

Create a system for all health estate and wider public estate so that organisations
have the opportunities to share, swap and borrow buildings. Although Electronic
Property information management systems (EPIMS) exist currently, it is regarded to
not be fit-for-purpose and it is therefore not used.

Dispose of single service sites over time and where sensible.

Identify any existing leases where there is poor value for money.

Rationalise branch sites where possible and it is in the best interests of the
population and value for money.

Maximise the use of Bexley’s health facilities and ensuring all sites are fit for
purpose, DDA and CQC compliant.

Map, collect and maintain real estate information across the estate.
There are a number of opportunities that can be implemented through the transparency of
estate information between providers. These opportunities would be regarded as effective
and requiring little capital development.
67
6. Planning for Growth
6.1 Planning for Growth
This section focuses on regeneration and population growth and change. The future estate
will need to accommodate an increasing demand for services resulting from population
growth and demographic change. The development and regeneration of areas provides site
opportunities to modernise and rationalise the estate. The planning system can help identify
future health infrastructure requirements and secure financial contributions from developers
in the form of Community Infrastructure Levy (CIL) to mitigate the impact of development.
6.2 Population growth and demographic change
In 2011, the resident population of Bexley stood at 233,000. According to the 2014 round of
GLA population projections (SHLAA-based, capped household size, short-term migration
scenario), the population of the borough has increased to 240,600 in 2015 and will increase
further by a further11,000 between 2015 and 2025, or 4.6% over the decade (although
Bexley’s GP registered population is lower than this). By ranking population growth between
2015 and 2025 across London boroughs, historically Bexley has been considered to be a
‘low growth’ borough (ranked 30th out of 33 boroughs). However, this is likely to change
through the development of the Borough’s ambitious Growth Strategy.
Population growth is uneven and concentrated in different parts of the borough. This
presents different challenges for service and estates planning. Population growth is currently
concentrated in Erith ward with a GLA projected increase of 29% between 2015 and 2025.
The next highest growth ward is Christchurch ward with 10% growth over the next decade.
However, the GLA population projections above do not take into account the Council's
emerging Growth Strategy, which would transform Bexley from a low growth to a high growth
borough with significant infrastructure implications. These high growth areas include
Belvedere, Erith, Thamesmead, Crayford and Slade Green.
As an outer London borough, Bexley currently has the sixth lowest population density in
London (at 3,972 persons per sq. km). It is one of the greenest boroughs in London with
over 100 parks and open spaces. With rapid housing growth, the population density and
character of areas will change placing pressure on local services and infrastructure. There is
also evidence that in some areas increasing household size has increased population
density.
68
Figure 22: Bexley Population growth 2015-2025
Demographic change
The population age profile of the borough shows that the proportions of young people aged
19 and under and older people aged 65 and over are higher than both the London and
national averages. The GLA projections suggest that the number of 0-4 year olds will fall
between 2015 and 2025, whereas the number of 5-19 year olds will increase by 11.6%.
69
Compared to London there are fewer working age residents aged 20-64 and the proportion
in this age group will remain static over the next decade. Whereas the proportion of older
people aged 65 and over will remain relatively high (17.9% compared to 12.7% in London),
the GLA projections suggest a relatively lower increase in this age group compared to
London as a whole. However, the GLA projections may not fully reflect local demographic
factors and therefore should be treated with caution.
The wards of Thamesmead East and North End have the highest numbers of children aged
less than 15 years. The highest numbers of older residents aged 65 and over are found in
Longlands, Brampton, St Mary’s and Sidcup.
Bexley is becoming increasingly diverse. The number of White residents continues to fall,
but the proportion at 2015 remains significantly higher than the London average (79.0%
compared to 57.9%). The Black, Asian and Minority Ethnic (BAME) population is projected to
grow by 27.1% between 2015 and 2025 but will still remain proportionately smaller than
London as a whole. The largest BAME group is Black African which is projected to increase
by 5,440 over the decade.
Thamesmead East is the most diverse ward in Bexley and shares characteristics with many
inner London areas. It is the only ward in the Borough where, in 2011, the majority of
residents were from BAME groups (52.7%) compared to 40.2% in London as a whole.
The 2010 Indices of Multiple Deprivation indicates that Bexley was ranked 180 out of 326
local authorities in England (by rank of average rank). However, according to the 2015
Index, Bexley is less deprived as it is now ranked 195 in England and ranked 26th amongst
London boroughs.
There are pockets of high deprivation in the north and south east of the borough with the
wards of Thamesmead East, North End, Lesnes Abbey, Crayford and Cray Meadows
containing areas (Lower Super Output Areas) within the most 20% deprived in England.
North End has the greatest concentration of deprived areas.
Life expectancy for both men and women is higher than the England average. However, life
expectancy is 6.8 years lower for men and 5.2 years lower for women in the most deprived
areas of Bexley than in the least deprived areas.
70
Figure 23: Map of Bexley GP practices against index of multiple deprivation
Housing supply and Opportunity Areas
The Mayor of London’s Further Alterations to the London Plan (March 2015) established a
new minimum target for Bexley of 446 net additional homes per annum between 2015 and
2025, which would provide 4,460 new homes over the decade. This crudely equates to a
population growth of 11,195 between 2015 and 2025 (based on an average household size
71
of 2.51 from the 2011 Census), which aligns with the GLA population projection over the
decade.
According to the Council, there is a five year supply of 2,370 new homes (April 2015 - March
2020) which is in line with the housing target. 681 units are currently under construction as of
April 2015.
Opportunity Areas are designated in the London Plan and are large areas of brownfield land
which have significant capacity for housing and employment growth. Housing and population
growth is concentrated in Opportunity Areas. The London Plan identifies Bexley Riverside
Opportunity Area and Thamesmead and Abbey Wood Opportunity Area as having the
potential combined capacity to accommodate a minimum of 7,000 new homes and 11,000
new jobs.
It is expected that the minimum new homes figures will be exceeded. The Mayor of London’s
‘City in the East’ report (2015) provides a higher housing estimate of 21,500 new homes for
the Bexley Riverside and Thamesmead and Abbey Wood (Opportunity Areas).
Abbey Wood and South Thamesmead (part of the Opportunity Area in Bexley) has been
designated as a Housing Zone by the Mayor of London (October 2015), where funding will
be available to support infrastructure and unlock individual schemes. Bexley Council and
Peabody Trust have identified a potential for over 1,300 new homes, capitalising on the new
Crossrail at Abbey Wood from 2018.
It should also be noted that the emerging LBB Growth Strategy shall include higher levels of
growth than the current GLA projections.
Regeneration and site opportunities
The Bexley Growth Strategy (Direction of Travel, June 2015) proposes 24,500 new homes
by 2030 in the borough, known as scenario PH3, and a revised scenario is currently under
development which looks to 2036 as part of a master planning exercise looking at higher
densities at new and enhanced town centres / transport hubs and growth in the rest of the
borough.
The high level of growth is partly dependent on major transport improvements, such as the
extension of Crossrail to Gravesend via Belvedere, Erith and Slade Green stations, new river
crossings and other highway and transport infrastructure.
The current high growth scenario (PH3) is focused in five locations:

Thamesmead / Abbey Wood, more than 5,000 new homes and 1,000 new jobs

Belvedere, approximately 11,000 new homes and 5,000 new jobs

Erith, approximately 2,500 new homes and 1,000 new jobs

Slade Green, approximately 2,500 new homes and 1,000 new jobs

Crayford, approximately 1,000 new homes and 500 new jobs
72
In considering future health service and infrastructure needs the latest available growth
projections will need to be considered.
Figure 24: London Borough of Bexley’s emerging growth vision
Thamesmead/Abbey Wood
Currently, over 1,300 new homes are proposed in the Abbey Wood and South Thamesmead
Housing Zone. A South Thamesmead Regeneration Framework was adopted in 2012 which
covers the three housing estates of Parkview, Lesnes and Southmere. The regeneration of
Southmere Village is underway comprising 800 new homes, plus new community facilities,
including a health centre and a community hall. Phase 2 comprising 81 net residential units
and library and retail space is complete.
Belvedere
The Belvedere Park development in Picardy Manor Way provides 400 residential units and
is close to completion. If the emerging growth plans are realised, then the population of
Belvedere will increase dramatically to become Bexley’s most populated ward and possibly
anther town centre. No sites have been formally re-allocated as part of the Local Plan
process. This will occur as part of the development plan process following the adoption of
the Growth Strategy.
73
Erith
The area contains large development sites at Erith Quarry and in the Erith Western Gateway
area. The Erith Western Gateway Development Framework (January 2012) identifies a
potential for at least 500 new homes. The new Bexley College campus opened in September
2014. There is a current planning application on the former Riverside Swimming Centre to
provide 71 homes and commercial floor space.
Redevelopment of Erith Quarry site, in Fraser Road will provide up to 600 residential units, a
primary school and 530 m2 of non-residential floorspace. There have been discussions
regarding the possibility of a health centre as part of the proposals.
Slade Green
The area currently contains three large development sites. Up to 622 residential units are
under construction at Erith Park (the former Larner Road estate). The development will be
completed in 2017.
372 new homes are under construction at the Howbury Centre, Slade Green Road and
nearby 336 residential units and 500 m2 of retail / community floorspace has been approved
on the former LINPAC site in Richmer Road.
Crayford
Crayford Town hall and library has been redeveloped to provide 188 new homes, a library,
health centre and shops. Crayford Town Surgery relocated into the refurbished building in
December 2014.
Currently up to 1,000 new homes are proposed in the area. 359 residential units are
proposed on the Electrobase / Wheatsheaf Works site, Maxim Road. 247 dwellings are
under construction at the former Samas Roneo Site in Maiden Lane. The Cray Waterside
Village site has potential for 130 homes.
Cross boundary demand and opportunities
There are two areas of the borough where significant housing and population growth crosses
borough boundaries. In the following areas, a coordinated approach to service and estate
strategy and investment is required:

Thamesmead and Abbey Wood (with Greenwich CCG)

Bexley Riverside and the proposed Ebbsfleet Garden City, Kent (with Dartford,
Gravesham & Swanley CCG).
74
Figure 25: South East London population growth 2015-2025
Local Plan and Infrastructure Planning
Local Authorities are required to keep their local plans up to date with evidence on physical
and social infrastructure required to support housing and commercial development. An
infrastructure study based on the latest housing and population growth projections can help
identify social infrastructure requirements, including healthcare and future site opportunities
and better use of public sector assets. The infrastructure study will also help allocate
Community Infrastructure Levy receipts.
A report ‘Testing the Service Requirement Impacts of Future Housing Growth in Bexley’ was
prepared by ERM consultants in June 2007 to inform the LBB Core Strategy. However, the
Council is currently reviewing the growth and service planning assumptions used and will
produce a revised Development Infrastructure Funding Study early in 2016. This local estate
strategy should be developed in parallel with the Infrastructure Study.
In December 2015, LBB in partnership with the London Borough of Lewisham and Bexley
CCG joined phase 3 of the One Public Estate programme. The programme brings public
sector bodies in an area to together to develop a joined up approach to managing their land
and property, enabling partners to release assets and share land and property information.
75
6.3 Sources of Investment
The Local Estates Strategy seeks to coordinate and make best use of all available funding
for premises development. This includes the Estates and Technology Transformation Fund
(ETTF) (previously Primary Care Infrastructure Fund (PCIF) and Primary Care
Transformation Fund (PCTF)), NHSPS customer and landlord capital, CHP investment, NHS
Trust capital investment, and developer contributions in the form of Section 106 contributions
or CIL.
To some extent additional demand can be accommodated within the existing estate by using
the estate more effectively, but there will be demand hotspots where new investment may be
needed, particularly in the Opportunity Areas.
Section 106 contributions / Community Infrastructure Levy (CIL)
Prior to the introduction of the borough Community Infrastructure Levy (CIL), s106 health
contributions were routinely secured from planning applications. It is estimated that
approximately £722,000 of s106 health contributions have been secured; however, very little
of this remains. Future CIL contributions may be received as developments commence and
are completed.
The borough introduced its CIL in April 2015. The CIL Regulation 123 List identifies
infrastructure projects and themes which CIL could contribute towards. The list includes
‘health’, but no specific projects are mentioned. The list will be reviewed and updated
regularly as required.
The Estates and Technology Transformation Fund
The Estates and Technology Fund (ETTF) is a multi-year £1billion investment programme to
help general practice make improvements, including in premises and technology. It is part of
the additional NHS funding, announced by the Government in December 2014, to enable the
direction of travel set out in the NHS Five Year Forward View.
Stronger GP services are the cornerstone of delivering a new deal for primary care and this
fund is designed to accelerate investment in infrastructure to enable the improvement and
expansion of joined-up out of hospital care for patients. Alongside programmes like the GP
access Fund, it will support new ways of working that are needed to deliver a wider range of
services and a new deal for primary care.
GPs were invited to submit bids for investment in 2015/16. The majority of bids have focused
on helping GP practices make much needed improvements in access to clinical services by
extending or improving existing GP premises. In March 2015, following a process of
assessment, it was announced that the first GP practices had bids supported in principle and
they would move to the next stage to seek formal approval. These investments in principle
were subject to formal approval against technical, financial and governance criteria. NHS
England continues to work with GP practices that already submitted bids.
76
PCIF Underspend for 2015/2016
Some underspend was identified in the financial year 15/16 and this was targeted for use by
CCGs for condition surveys, utilisation studies and feasibility studies. Bexley CCG submitted
a number of bids and was successful with the following:
Table 10: 2015/16 PCIF Underspend bids
Chosen Support
Core Reasoning
Utilisation studies
Estimated costs, to be confirmed. Full
utilisation review of Bulbanks Health Centre
which is on the border of Belvedere, which is
a major planned development / growth area
in Bexley.
Utilisation studies
Estimated costs, to be confirmed. Full
utilisation review of Bursted Woods
surgery which is in North Bexley, which is a
major planned development / growth area in
Bexley.
Utilisation studies
Estimated costs, to be confirmed. Utilisation
review of Erith Hospital outpatients and x-ray
departments, and subsequent feasibility
review and led by Oxleas which is the
borough’s healthcare spoke and located in
North Bexley.
Feasibility study
Estimated costs, to be confirmed. Joint
review with Greenwich CCG to review the
health needs in Thamesmead and
Belvedere, which are major planned
development / growth areas in Bexley.
Feasibility study
£18,684. Study conducted within Slade
Green to establish the future health needs
and the opportunity to develop a mixed use
development on the site of the council owned
former Slade Green Community Centre. This
has reported that the current health centre
has sufficient space to accommodate
planned future growth.
On 28 October NHS England sent a letter to CCGs to confirm the approach for funding
primary care infrastructure for 2016/17 to 2018/19. Key points are:
77

Total funds available from 2015 to 2019 is £1bn

The bulk of the fund will be deployed to improve estates and accelerate digital and
technological developments in general practice, and will be subject to an initial
bidding process, the initial deadline of which was 28th February 2016. Bids are now
expected in June 2016.

Emerging criteria for funding recommendations for 2016/17 are:

o
increased capacity for primary care services out of hospital;
o
commitment to a wider range of services as set out in commissioning
intentions to reduce unplanned admissions to hospital;
o
improving 7 day access to effective care;
o
increased training capacity.
Other criteria to potentially include:
o
Evidence of patient involvement
o
Consistency with the local estates strategy
o
Clear identified need,
o
Deliverable between April 2016 – March 2019
o
Sustainable in the long term,
o
Flexible design
Since October, there have been some changes in the guidance, with final guidance still
awaited. The CCG is currently preparing ETTF submissions based on the criteria recently
received and their local estates strategies and digital roadmaps. Submissions will request
financial support for investment in premises or technology which will increase the capacity of
general practice and out-of-hospital care and are expected to be submitted in June 2016,
using an online portal that will be published in due course.
78
7. Gap Analysis
The strategy can divide existing estate into three broad categories:

Suitable for long term use and able to meet future requirements with only routine
adaption. These are the core sites, part of the ‘estate of the future’.

Suitable for long term use but only likely to meet future requirements with major
investment and change.

Unlikely to be suitable long term. These buildings could, potentially, be disposed of,
or disinvested from.
In addition, the strategy should clarify where there are gaps with no current estate capability
to meet future service requirements. At this point, the plan has established the overall
strategic direction of the estate: what needs to change over time, and the relative urgency, to
meet future service requirements.
Overview
The Borough is divided into the three designated Local Care Networks for gap analysis on a
more local scale. This division of the Borough enables a more accurate application of the
Local Care Network model, which focuses on population-based care within specific
geographic locations; 50,000-130,000 people per LCN has been proposed as a guide by
OHSEL. The Local Care Networks within Bexley are:

North Bexley

Clocktower

Frognal
79
Lower
Belvedere
Northumberland
North Bexley Locality
East
Wickham
Clocktower Locality
Barnehurst
Blackfen
Bexley
Frognal Locality
North
Cray
Foots Cray
Figure 26: Map showing the 3 LCNs within Bexley
Dividing the estate for analysis to match the location of the LCNs in Bexley is deliberate. To
encourage effective set-up and operation of LCNs, analysis of the local needs must be
consistent with the desired service delivery model.
The GP Federation is playing a key role within the LCN model in helping patients to access
the necessary services provided in both the community and in hospitals, co-ordinating care
so that it is received in the appropriate settings. However, other partners are equally
important and the local pharmacist representation.
In order to determine its suitability for major investment and long term use. Bexley CCG will
ultimately take responsibility for the direction of investment, however it is important that its
stakeholders all have an input throughout the process as it is recognised that collectively
they hold the majority stake in healthcare properties across the borough, therefore acting as
key decision makers and enablers of change.
80
Each of the key stakeholders operating within Bexley has their own estates programmes,
and will work collaboratively to ensure future decisions reflect the needs of all organisations.
The Estates Working Group will continue to meet regularly with attendance by key
stakeholders to further develop this strategy and take forward the workstreams.
Bexley Clinical Commissioning Group Locality Analysis
The vision for estate, as set out in section 2, describes the changes in service delivery driven
by a number of different factors, and addressed in estates terms through the coordination of
LCNs. The current estate will need to accommodate these changes towards the LCN target
model of care whilst also accommodating for a growing population.
Section 5 gave an overview of the current estate in Bexley and provides analysis of several
facets including utilisation, condition, and cost. Section 6 then identified population growth
across the Borough over the next ten+ years.
What is clear is that growth will be incremental in parts of the borough but additionally there
will be large scale housing developments in Bexley and adjoining boroughs (e.g. crossborder with Greenwich and Dartford, Gravesham and Swanley) that will result in opportunity
areas where there will be proportionately higher population growth. The two opportunity
areas within the borough are Bexley Riverside, and Thamesmead & Abbey Wood.
Introduction
This section provides an analysis by local care network (LCN) and ward of current and
projected population and the implications for future capacity requirements (quantified in
terms of primary care consult/exam suites (CE rooms) and treatment rooms.
Bexley CCG serves a population of around 240,000 and the area is divided into three Local
Care Networks (LCNs): North Bexley, Clocktower and Frognal as illustrated in Figures 27
and 28. The population by LCN is outlined in Table 11.
81
Figure 27: Bexley borough map with LCN areas. The insert shows Bexley borough in
the larger South East London area
Table 11: Bexley Population by LCN; Source 2016 Population Bexley Council
Population density – Mid 2014
LCN Name
North Bexley
Clocktower
Frognal
Total
Population
95,279
76,526
66,009
237,814
Analysis of ONS data suggests that whilst Bexley overall does not have a particularly high
population density (Bexley CCG mean population density circa 3,100 per sq. km versus an
England wide LSOA mean of around 3,300 per sq. km), there are some higher population
density pockets as illustrated by the population density by wards in Figure 29. Areas of
higher density include: the western border and central wards in North Bexley, much of
Clocktower and western wards of Frognal.
82
Figure 28: Bexley ward population density map
Population Growth projections - GLA
Figures 30 to 35 outline the GLA growth projections 2025 and 2035 by Ward for the North
Bexley, Clocktower and Frognal LCNs.
83
Figure 29: North Bexley LCN growth projections 2025
Figure 30: North Bexley LCN growth projections 2035
84
Figure 31: Clocktower LCN growth projections 2025
Figure 32: Clocktower LCN growth projections 2035
85
Figure 33: Frognal LCN growth projections 2025
Figure 34: Frognal LCN growth projections 2035
86
Demand and Capacity Analysis
Growth Projections: GLA and Bexley Council
Figures 31 to 35 highlight the GLA growth by LCN. This analysis of future demand
requirement is based on the above GLA population growth projections and also Bexley
Council population growth projections. Tables 12 and 13 indicate the respective 2025 and
2035 population growth by LCN and Ward for the GLA and Bexley Council.
Table 12: Growth Projections: 2025 GLA and Bexley Council
LCN
North Bexley
Clocktower
Frognal
Growth Projections 2025
Ward
GLA
Bexley Council
Barnehurst
4.2%
1.9%
Belvedere
1.8%
155.6%
Colyers
-0.1%
-0.8%
Crayford
7.7%
14.8%
Erith
29.2%
46.5%
North End
8.0%
11.4%
Northumberland Heath
0.0%
-0.8%
Thamesmead East
5.2%
54.2%
Brampton
1.2%
-1.1%
Christchurch
9.6%
5.4%
Danson Park
2.5%
1.6%
East Wickham
2.4%
0.8%
Falconwood and Welling
0.8%
-0.4%
Lesnes Abbey
1.1%
12.1%
St Michael's
1.0%
-1.1%
Blackfen and Lamorbey
0.4%
-1.0%
Blendon and Penhill
0.5%
-1.0%
Cray Meadows
6.3%
-1.0%
Longlands
1.0%
3.3%
Sidcup
3.9%
0.9%
St Mary's
5.0%
1.1%
87
Table 13: Growth Projections: 2035 GLA and Bexley Council
LCN
North Bexley
Clocktower
Frognal
Growth Projections 2035
Ward
GLA
Bexley Council
Barnehurst
8.8%
4.0%
Belvedere
2.8%
196.2%
Colyers
-0.3%
-1.4%
Crayford
11.3%
18.3%
Erith
33.2%
73.8%
North End
8.5%
94.4%
Northumberland Heath
3.8%
0.2%
Thamesmead East
11.4%
89.9%
Brampton
2.1%
-2.4%
Christchurch
26.6%
18.6%
Danson Park
4.7%
2.3%
East Wickham
4.8%
0.7%
Falconwood and Welling
2.9%
-0.7%
Lesnes Abbey
2.3%
10.5%
St Michael's
1.5%
-2.3%
Blackfen and Lamorbey
1.4%
-2.5%
Blendon and Penhill
3.0%
-2.0%
Cray Meadows
8.4%
-2.6%
Longlands
4.7%
7.2%
Sidcup
8.2%
1.0%
St Mary's
9.4%
1.2%
These tables show that in the North Bexley LCN there are some significant differences
between the GLA and Bexley Council Growth projection. Differences between the two
growth sources were used to model high and low population projections for the subsequent
demand and capacity modelling. Further analysis by LCN and ward is shown in Appendix A
and B.
Demand and Capacity Modelling: Measure of Demand
Demand (the number of CE and treatment rooms) was modelled using HBN 11 parameters
and assumptions including:

Access rate: 5,260 per 1,000 population CE rooms; with 20% of patients requiring
Treatment rooms

Availability: 50 weeks per year

Appointment time: CE rooms 15 minutes; Treatment rooms 20 minutes

Building operational: 60 hours per week

Room utilisation: 60%.
88
It should be noted that these are initial assumptions are for review and, as appropriate,
revision in the implementation of any projects to address capacity requirements.
GP list sizes for 2015 were used in conjunction with the HBN 11 parameters to model CE
and treatment rooms for a 2015 baseline. Where list sizes were grouped by practice rather
that specific GP site, a proxy GP site list size was determined either by proportioning current
CE rooms per site or NIA per site. The GLA and Bexley Council growth factors were applied
to the 2015 modelled CE and treatment rooms to project CE and treatment room
requirements for 2025 and 2035. Graphs illustrating the current (actual), current modelled
and projected CE and treatment rooms, by both GLA and Bexley Council, LCNs and wards
are shown in Appendix C and D.
Modelled CE and Treatment Room Requirements 2025 and 2035
For the modelled room requirements, the higher of the GLA or Bexley growth projections
defined the high range and the lower of GLA or Bexley growth projections defined the low
range. Tables 14 to 17 provide a summary of current CE and treatment rooms by LCN and
low and high range of additional rooms required to meet the modelled projection growth.
Note, for the generation of these tables modelled 2015 CE rooms was used in the absence
of current CE room data.
Table 14: Current and Additional CE Room Demand 2025
LCN
Current
North Bexley
Clocktower
Frognal
Total
77
50
45
172
Additional CE Rooms 2025
Low
High
15
13
5
33
43
14
5
62
Table 15: Current and Additional CE Room Demand 2035
LCN
North Bexley
Clocktower
Frognal
Total
Current
77
50
45
172
Additional CE Rooms 2035
Low
High
16
15
5
36
59
16
6
81
89
Table 16: Current and Additional Treatment Room Demand 2025
LCN
Current
North Bexley
Clocktower
Frognal
Total
27
29
14
70
Additional CE Rooms 2025
Low
High
5
1
1
7
11
1
2
14
Table 17: Current and Additional Treatment Room Demand 2035
LCN
North Bexley
Clocktower
Frognal
Total
Current
27
29
14
70
Additional CE Rooms 2035
Low
High
5
1
1
7
17
4
3
24
Tables 14 to 17 suggest a potential significant increase in CE and treatment rooms in the
North Bexley LCN and more modest increases in both Clocktower and Frognal. A more
detailed breakdown of room requirements, by LCN, ward and practice is shown in Appendix
E (CE rooms) and Appendix F (treatment rooms). The growth by site shown here and in the
appendices is indicative only – the actual location of GP service provision is dependent on
many factors such as estate and service strategies, GP profiles etc., and to be decided at a
future date.
Note that this does not include any additional provision that might be required within
practices for mental health or community health services,
LCN Six Facet Analysis
Figures 36 to 38 outline the results of a Six Facet survey by LCN. The analyses suggest, in
2011 at least, the condition of the buildings was amber or green - with North Bexley around
60% green, Clocktower around 50% green, and Frognal around 30% green. See Appendix J
for breakdown of Six Facet risk matrix.
90
Figure 35: North Bexley Six Facet Summary
Figure 36: Clocktower Six Facet Summary
91
Figure 37: Frognal Six Facet Summary
92
8. Estates Options for Change
8.1 Summary of estates options
In the earlier sections we have identified the key drivers for change, the CCG’s vision of the
emerging Local Care Networks, the current estate and we have undertaken demand
modelling and gap analysis.
The GLA data informs us that historically Bexley has been regarded as a low growth
borough. However, the London Borough of Bexley is developing its Growth Strategy which
includes much higher levels of projected growth with at least 24,500 new homes by 2030
(PH3). Much of this development would be in the North of the borough in Thamesmead East,
Belvedere, Erith and Crayford and North End (Slade Green), along with the provision of
major transport infrastructure improvements, potentially including an extension of Crossrail
and new river crossings.
We have undertaken a number of utilisation studies that suggest assets are not being used
to their full potential. Therefore, we have assumed that with improved utilisation much of the
exiting estate can be used to meet the increased demand in the wards where there are small
population increases. This is a very general view and may not apply to small or all premises,
so to make more informed decisions, further work needs to be undertaken with the
Practices.
Where we are aware of opportunity areas and likely or known development plans, including
their timescales, and where investment is going to be required, feasibility studies have been
or need to be commissioned and subsequently project teams need to be formed. Project
Initiation Documents (PIDs) need to be approved and the business case process should be
commenced with a view to providing facilities on time to meet the increased population’s
needs. This will form part of ETTF bids.
The business case process is set out in the NHS England, Business Case Approval Process
– capital, investment, property & ICT guidance. It will require early engagement with NHSE,
Projects Appraisal Unit PAU), who assure property and ICT investment business cases for
the NHS England Board, prior to approval.
All cases at each key stage (e.g. strategic outline case (SOC), outline business case (OBC),
full business case (FBC), as appropriate are required to adhere to the principles of best
practice set out in the HM Treasury Green Book, the Capital Investment Manual and the (DH
1994) and NHS Estates Code (DH 2007).
As this process can be lengthy, the CCG and its partners need to plan ahead and engage
with key stakeholders. Essential to this process is early knowledge of development
proposals and an assessment of their likely impact on health services in that ward. Horizon
scanning and placing of markers with the Local Authority that additional facilities may need
to be provided is essential. Also, markers should be placed in estates strategies and with
NHSE PAU to highlight future funding requirements.
93
The local estates strategy and the demand modelling are suggesting the following
programme of related projects and workstreams to take forward. These may translate into
ETTF bids. Table 18 details these areas.
Table 18: Estates strategy projects and workstreams
Projects/Workstreams
Comments
Governance
This will be a complex programme of
projects that needs to be properly resourced
and accountable to the CCG Governing
Body.
Finance/ETTF
Develop bids for submission during June
2016.
Belvedere
Current under-provision and potential
significant new provision identified in LB
Bexley Growth Strategy. Feasibility study as
part of Thamesmead brief from 2015/16
PCIF funding. Potential to re-locate two
Belvedere practices into one site.
Queen Mary’s Hospital
Development plans being progressed for
Bexley Hub.
Erith Hospital
Future utilisation being discussed by
CCG/Oxleas for Bexley Spoke. Utilisation
review commissioned to look at space and
the possibility of re-locating the x-ray
department within the main building.
Erith Health Centre
Better utilisation and assess potential for
expanded GP provision and other services
within Erith Health Centre.
Thamesmead East
Better utilisation and assess potential for
expanded GP provision and other services
within Lakeside Health Centre. Potential
under provision and cross-border issues with
Greenwich CCG around Thamesmead.
Feasibility study with Greenwich agreed from
2015/16 PCIF funding.
North End (Slade Green)
Potential under provision with expected
growth. Feasibility study has reported that
current site has sufficient space for projected
growth.
94
Projects/Workstreams
Comments
Clocktower locality
Consideration of the most appropriate
location(s) for services within the Clocktower
locality.
Practice mergers, premises and workforce
Supporting practice mergers where known,
looking at practice branches and practice
locations including rationalisation where
appropriate (1 underway), GP succession
planning and ensuring better premises
utilisation. Also, ensuring practices are fit for
purpose, DDA and CQC compliant.
Dartford Housing Impact
Taking into account any cross-border issues
with Dartford, Gravesham & Swale CCG and
the possible impact on Bexley health
provision.
Taking forward digital improvements for
patient records, e.g. digitalisation, and other
technological innovations that will have a
positive impact on estate utilisation and
patient wellbeing. This includes the proposal
for the Bexley training hub, data sharing and
telehealth.
IM&T
CCG headquarters / One Public Estate
Working with the council to progress the One
Public estate agenda including undertaking
an options appraisal on the most cost
effective location for the CCG’s
headquarters, which could include colocation with the Local Authority.
Acute, community, mental health and social
services provision
Ensuring that the impact of the borough’s
housing growth is considered in respect of
acute, community, mental health and social
services provision, in addition to that within
primary care.
It is hoped that these new projects will allow, over time, the development and rationalisation
of practice sites. Additionally, GP retirements and practice merger opportunities will further
facilitate the reduction in the estate and the development of larger practices working at scale
and supporting the LCNs.
95
It is vital that the impact of growth within the borough is also viewed in respect of the impact
on the acute, community, mental health and social services provision and this will also be
taken forward by the estates group.
8.2 Evaluation process and criteria for Investment
All sites should be initially assessed for investment on the basis of the emerging NHS
England, ETTF criteria as follows:

Increased capacity for primary care services out of hospital,

Commitment to a wider range of services as set out in commissioning intentions to
reduce unplanned admissions to hospital,

Improving 7 day access to effective care,

Increased training capacity.
Other investment criteria to include are:

Evidence of patient involvement,

Consistency with the local estates strategy,

Clear identified need,

Deliverable between April 2016 – March 2019,

Sustainable in the long term,

Flexible design.
Additionally consideration could be given to the following complementary criteria for
analysing premises for investment.

Good geographic location to support growth areas,

Good public transport accessibility,

Statutory compliance – including access to and around buildings,

Fit for purpose and capable of being ICT enabled,

Capacity to co-locate integrated services into multi-use accommodation,

Functionally suitable, good quality, flexible accommodation,

Sustainable premises capable of working at scale,

A minimum patient list size.
96
Consideration could then be given to exit those sites that do not meet the above criteria if
and when alternative facilities are available. However, QMH and Erith Hospitals are
considered fixed points and must be secured for the Bexley population. Therefore, if any
review shows under-utilisation, on these sites, the services will be expanded to maximise
use.
97
9. Delivering the Strategy
9.1 Short term work actions
These are the actions that should be undertaken April to June 2016, to inform the ETTF
applications in June. However, a number of these require investment and is therefore
dependant on external resources being available.

Incorporate the latest LBB growth data, PH5, in assessing future health service and
infrastructure needs

Procure estates/project management expertise to take the Local Estates Strategy
forward post April 2016

Test the interim gap analysis at locality level with stakeholders

Procure further utilisation studies to key estate to better understand capacity to
inform future ETTF bids

Procure joint feasibility study for Thamesmead

Continue involvement in SEL estates strategy meetings to ensure awareness of
cross border issues and sharing of best practice

Agree the criteria for investment and then consider which sites/projects might need
funding

Link estates, IT and workforce strategies

Identify and start planning pilot projects and quick wins
9.2 On-going medium and long term work actions
We believe the following medium and long term actions will need to be progressed:

Greater clarity of stakeholders estates strategies

Greater clarity around LCNs in terms of specific services to be housed and where to
be located

Investigate voluntary and community use of buildings

Identify best practice and knowledge sharing across SEL

Options appraisal and business case development for core sites and where
investment is required, following ETTF approval

Develop communications plan for engaging with stakeholders as projects emerge

Continue to understand ICT and workforce implications on the estate
98

Continual review of the estates strategy and individual project governance for new
schemes, with a formal review every 12 months

Ensure robust communications between the SEL estates, ICT and workforce
workstreams

CHP to roll out Procurement of project managers, health planners and design team
for working up refurbishment projects or new schemes

Ongoing development and maintenance of the SHAPE database

Further engagement with Local Planning Authority to ensure CCG and stakeholders
have early warning of development proposals and to give them time to consider the
health impact and to apply for developer contributions.

Develop a timeline for the proposed new housing developments.
99
10.Financials
Disposals
Information relating to Oxleas’ proposed disposals is shown in table 19.
Table 19: Oxleas potential capital receipts
Sites
Type of Date
disposal
Running
costs
Existing
use
value
Number
of
residential
units
Upton Day
Hospital
F/H
2015
N/A
£600,000
6/7
Colyers
Lane
F/H
2016
N/A
£175,000
7/8
Murchison
Clinic
F/H
2016
N/A
£350,000
8/9
Stuart House
L/H
Oct 2016
£150,000
N/A
N/A
Woodside
L/H
2016
£35,000
N/A
N/A
Bedonwell
L/H
Oct 2015
£35,000
N/A
N/A
Oxleas have plans in place for reinvestment of all proceeds from their planned property
disposals.
No pipeline disposals have been provided by NHS PS, LB Bexley or other providers at this
stage but it is hoped more detail will be forthcoming once their estates strategies are further
developed.
Void Costs
Void cost data has been supplied by CHP. NHSPS advises that there are no void costs
within Bexley. The projected void costs in 2016/17 are £139,000. This is subject to change
and is expected to increase.
Savings
Possible revenue savings are in the process of being calculated, and will be dependent on
agreement of estate utilisation. However, any savings are likely to be incurred only by
significant investment in the reconfiguration of estate or investment in e.g. digitalisation.
100
11.Outline Implementation Plan
11.1 Programme plan and milestones
A Key milestone is the submission of ETTF applications in June 2016.
There will be numerous other milestones to add which will continue to be developed jointly
with stakeholders.
11.2 Enablers of change and managing constraints
With so many parties involved and so many potentially competing views, it is easy for the
process to stall.
The plan identifies the following enablers of change:

National SEP Steering Committee

London SEP Lead

SE London SEP Lead

Local Strategic Estates Adviser

Senior Managers and stakeholders in the estates strategy

QMH (& Erith) Programme Board

LCN Programme Board
11.3 Risks and mitigations
Table 20: Risks and Mitigations
Risks
Mitigations
Lack of capacity and estates expertise to Work with strategic estates advisors;
further the agenda
Procurement
of
estates
and
management expertise
project
National economy and housing market
No mitigation currently identified
NHS funding – changes in priorities
No mitigation currently identified
Inadequate and/or poor data
Work with providers of data to make it as
reliable as possible
S106/CIL contributions
Ensure good engagement with LB Bexley to
ensure health requirements are built into local
101
development plans
Poor engagement from Providers
Ensure strong leadership and buy-in from all
parties to the value of working together
Lack of funding / running costs available Bid for ETTF funding where possible and
to invest in necessary work to enable the continue to investigate other sources of
strategy
funding
Lack of funding available to reconfigure Bid for ETTF funding
GP estate to increase utilisation of
digitalisation
12.Summary
The Bexley local estates strategy outlines the borough’s proposal in respect of its estate
over the coming years. At this stage, the strategy is primarily focussed on primary care to
inform the ETTF bids.
It is recognised that further development and on-going review will need to take place,
especially with respect to the impact of growth on areas outside of primary care, including
acute, mental health, community and social services provision. This should also be picked
up through the south east London estates strategy and ‘Our Healthier South East London’
programmes.
Table 21 summaries the initial areas that the CCG and its partners are prioritising through
this strategy and will be submitting as ETTF bids in June 2016 or future years. However, as
the strategy develops, some of these may be withdrawn but equally additional schemes may
be added over the operation of the ETTF funding.
Table 21: Summary of initial ETTF bids
No
Scheme Name
Brief Description
1
Relocation and
consolidation of Bexley
Group Practice - Welling
Bexley Group 0Practice in Welling aims to consolidate
three sites and re-locate services to a single building
located within close proximity to the existing main branch
premises on Upper Wickham Lane. This would enable the
practice to extend the range of services they provide,
extend opening hours and encourage integration of
primary, community and voluntary organisations.
102
No
Scheme Name
Brief Description
2
Infrastructure to support
virtual consultations,
communication, remote
access and virtual
training
This scheme will provide improved technology
infrastructure that will enable practices and Bexley
Community Education Provider Network (CEPN) to use
Web EX/video conferencing technology to link virtually
with colleagues, other health and social care
professionals and patients. The scheme proposes the
inclusion of Smart TV technology in three large training
practices (one per locality) and main training and
education sites across the borough. It also includes
equipping all practices with web cams and the Omnijoin
software that will enable them to set up virtual meetings
and consultations. This technology is already in use by
Bexley CCG and seven practices have recently started a
pilot of Omnijoin. Practice staff and the CEPN have
expressed their intention to use the technology in the
following ways: delivery various models of training and
activities with virtual attendance, holding virtual MDT
meetings aimed at avoiding admissions by inviting District
Nurses and Social Workers remotely, using it to
strengthen communication links with care homes without
the GP physically needing to attend, video consultations
with patients, virtual team meetings where practices
operate across a number of sites.
3
Digitalisation of Patient
Records
Bexley CCG currently holds approximately 250,000 Lloyd
George envelopes within GP practices. By digitalising
patient records, this scheme releases prime space within
GP practices. This will result in space being freed up that
could be used for clinical and admin purposes. This
scheme will increase the efficiency of GP practices whilst
providing much needed capacity.
4
Lakeside Health Centre
Re-configuration of Lakeside Health Centre to enable the
expansion of GP services (Lakeside Medical Practice)
currently in the building. This will result in better utilisation
of space and would provide additional primary care
capacity in Thamesmead, an area where healthcare
services are already under strain.
This would enable the practice to extend the range of
services they provide, extend opening hours and
encourage integration of primary, community and
voluntary organisations.
103
No
Scheme Name
Brief Description
5
Integration and
Interoperability – data
sharing
The CCG is actively pursuing the integration and
interoperability agenda for data sharing. Whilst having
an established programme for sharing information
between practices, out of hours and the emergency care
setting, the next phase is to pursue the ability for health
and care professionals in other settings such as the
acute, community and mental health and social care to be
integrated into the overall vision.
On this basis, the CCG is fully engaged with the LGT
Connect Care programme and the Darenth Valley
Integrated Care Record Programme. Going forwards, the
CCG envisages participation of the King’s Health Online
portal to provide information sharing for those patients
who are seen by GSTT, Kings College, Princess Royal
and Maudsley hospitals.
Longer term, it is anticipated that the CCG will utilise the
Digital London tools to support the full interoperability of
the portals mentioned above.
In the meantime, it is anticipated that the CCG will need
to harness the ability to contextualise information into the
GP systems for each of the portals.
6
Hub (8-8) site
infrastructure
The CCG envisages top up 8-8 services being provided
from the 2 existing hubs, currently housing the Urgent
Care Centres, at Queen Mary’s Hospital and Erith
Hospital. Infrastructure, including IT, to support the
addition of bookable appointments and extra facilities and
appropriate space will be required.
This will improve patient experience and facilitate both
working at scale and extended opening hours.
7
Relocation and
consolidation of Bexley
Group Practice Belvedere
Bexley Group Practice in Belvedere aims to consolidate
two branch sites and re-locate services to a single
building located within close proximity to the Station Road
surgery premises. This would enable the practice to
extend the range of services they provide, extend opening
hours and encourage integration of primary, community
and voluntary organisations.
This will enable the practice to provide the additional
capacity that is currently needed within Lower Belvedere.
This should also release capacity in Thamesmead,
another area of significant growth. A feasibility study in
Belvedere is currently underway and a site search will be
required.
104
No
Scheme Name
Brief Description
8
Erith Health Centre
Re-configuration of Erith Health Centre to enable the
expansion of GP services (Good Health & Bexley Medical
Group) currently in the building. This will result in better
utilisation of space and would provide additional primary
care capacity in Erith, an area of significant growth.
This would also enable the practice to extend the range of
services they provide, extend opening hours and
encourage integration of primary, community and
voluntary organisations.
9
Integration and
Interoperability – GP
systems of choice
The CCG is reviewing the clinical systems used within GP
practices to ensure that current systems are fit for
purpose now and in the future.
The majority of the CCG GP estate is based on INPS
Vision. Historically this has not been an issue and both
system suppliers (Vision and EMIS) in the borough have
been able to provide the necessary core capabilities for
our practices.
Recently, the services received from Vision have been
subject to performance issues and delayed service
functionality issues. We are aware that this may in the
future have a detrimental effect, particularly as we are
keen to ensure that we meet the 2020 paper free at the
point of care ambition. To this end, the CCG envisages
support for capital hardware and implementation costs
would be required if a strategy to migrate to a single
system solution is implemented Bexley wide.
10
Practice mergers and
DDA/CQC compliance
The CCG is aware of potential mergers within Bexley
where financial support may be required. These mergers
will support extension of a range of services, extended
opening hours and encourage integration of primary,
community and voluntary organisations. Furthermore,
mergers will likely support rationalisation of branch sites
supporting internal operations of practices within Bexley.
Estate improvements to raise standards of healthcare
buildings, ensuring that they are compliant with DDA and
CQC standards may also be required during the funding
period.
105
No
Scheme Name
Brief Description
11
Integration and
Interoperability – Telehealth
The CCG would want to explore out of hospital care and
the continuity of care provision using tele-healthcare
service developments. Discussions are on-going as to
how this could be implemented to improve the care
provided to patients whilst releasing travelling time for
clinicians and patients creating additional clinical capacity.
12
Erith Hospital
This is a scheme to fund the development of a business
case that sets out the feasibility and costs associated with
consolidating clinical space and re-locating the x-ray
department from the ‘bunker’ to the outpatients building,
following the utilisation review currently being carried out.
The CCG would also be requesting funds for the
development of the scheme stemming from the business
case. This will improve seven day access for effective
care and would support one of the CCG’s proposed 8-8
hubs.
106