How this PCN used a shopping centre to deliver care

Middleton PCN in Rochdale is one of seven networks shortlisted for PCN of the year for its work on finding a solution to its estate problem. By leasing a unit within the local shopping centre, the PCN has saved money, improved collaboration between different partners and created a convenient ‘one-stop-shop’ for patients. PCN clinical director Dr Mohammed Jiva explains more.

Estates is a problem for many, but it has been a particular issue for Middleton PCN, which covers a population of 50,000 across seven practices in Rochdale, Greater Manchester. Our GP-owned premises vary from terraced houses that have been converted into surgeries to practices that were purpose-built in the 1970s and 1980s and now require upgrading.   

Clearly, funding was needed to update our estates. But this was also a problem. 

The current NHS deficit at Greater Manchester ICB (GM ICB) stands at £500m – a figure estimated to rise to £1.9bn over the next five years. To address this, NHS providers were asked to identify £8m of savings this financial year. In 2025/26, it is predicted this target will rise by 3%.

It was clear that we could no longer rely on the capital funding that general practice once had. The increased use of ARRS staff means that pressure on estates will worsen, and accommodating the ARRS workforce was already a problem for us.  

Greater Manchester ICB stipulated a maximum reimbursement for utilising existing GP estates of £7.50 per hour per room for overheads when used by external agencies. It would cost the PCN £532,350 per year to house 26 ARRS staff in rooms during the week. This was unaffordable, so we looked for alternative solutions.

We decided to solve the problem by leasing a unit in the local shopping centre to create a PCN hub. As far as we know, we are the only PCN to have done this and now have a blueprint for a model that is cost-effective and innovative.

What we did

During the pandemic, Middleton shopping centre offered an empty unit free of charge to deliver COVID-19 vaccines. It gave us the idea of exploring a unit as a solution to our estates problem.

The location was perfect in terms of access for the local population. Although the unit was an empty shell and required work to make it a viable venue for healthcare, this gave us flexibility. However, it was more complicated than simply using existing GP practices.

We had to develop plans for the layout of the premises, produce the required plans and documents for the landlord, engage solicitors and sign contracts. We also had to go out to tender for a preferred building firm, supervise the conversion of the unit and ensure amenities complied with health and safety requirements. And before opening our doors, we needed to obtain sign-off from the Care Quality Commission and the local health and safety team.

We also had to enter into discussions with the ICB. And it did not like our idea at first. Local commissioners refused to support the development of the venue in the initial phase. It would not give any funding towards the project and prevented the ICB IT team from engaging with us.

This was a challenge because there was no collaborative innovation network (COIN) in the shopping centre, which made it impossible to access patient medical records. Our solution was to set up a radio link between the nearest GP surgery and the shopping hub, funded by the PCN.

With a lack of hard-wired telephony within the shopping centre, the PCN took out 20 plus mobile phone contracts with EE to allow ARRS staff to have nominated work mobile numbers. This also meant there were dedicated mobile numbers for the public to use to access the hub reception to book/cancel appointments.  

Costs

In the initial stages of this project, we realised that we were not alone in facing estate issues; other local agencies were experiencing similar problems. 

The local public health team needed space for the delivery of sexual health/screening services, and the GP federation was struggling with the provision of enhanced access. In addition, the training arm of the GP federation, the Primary Care Academy, needed estates for student training. The PCN approached all three to explore the possibility of collaborating.

Having ascertained the cost of conversion, each of the four parties contributed £15,000 to turn the unit into seven consultation rooms, a manager’s office, a store room, and a reception area. In addition, the PCN commissioned 14 desks at two GP surgeries for administration so ARRS staff could hot desk at the cost of £80 per desk per month.

The annual lease and service costs for the hub are £25,000, with the hot desks adding another £13,440. The total of £38,440 is shared between the stakeholders, meaning there are significant savings on the £532,350 price tag to use existing GP practices.

As well as financial savings, there were other benefits for both providers and patients.

The multidisciplinary model encourages team working and creates additional capacity within primary care by removing some of the burden from GP surgeries. And the additional space has enabled us to bring in students from local universities to undertake their placements with qualified professionals and helped to promote local services to our future workforce.

For patients, it is literally a ‘one-stop-shop’ in a location that is easily accessible with a bus depot outside.

Services

Middleton PCN hub has adopted a multi-agency service delivery model, providing a range of services. These include a first contact physiotherapist assessing musculoskeletal presentations, mental health services, smoking cessation, blood pressure monitoring and registration for those of no fixed aboard. Social prescribing link workers arrange their face-to-face assessments at the hub and provide a support service to any walk-in shoppers who need guidance. Since the summer, the hub has been home to enhanced access appointments in the evenings and weekends, sexual health clinics and training for nursing students from Manchester, Salford and Bolton Universities.

There is also a pharmacist who, as well as medication reviews, provides support for walk-in patients. The hub has access to the full medical records for GP practices within the PCN. There are an average of 150 patient contacts with the pharmacist each week.

In addition, there is a bespoke phlebotomy room that supports local GP practices and undertakes phlebotomy on behalf of any service providers within the hub or community nursing teams. An average of 282 patients have phlebotomy at the hub each week.

This model is innovative, cost-effective and a blueprint for how others around the country could improve local services and make their limited financial resource go further.

Profiles of the shortlisted PCNs will feature on Pulse PCN in the run up to the awards night on December 6.