How to answer the estates challenge

Clinical director of Bexhill PCN, Dr Binodh Bhaskaran explains how his network tackled the estates challenge

Estates is a long running issue for general practice but in recent years with PCNs hiring more staff through the additional roles reimbursement scheme the problem has become more acute. At Bexhill PCN we have found a way to address this issue which was holding us back.

PCN background

Bexhill PCN, is made up of three large practices covering a population of just under 50,000. It’s located in an attractive seaside town in East Sussex, between Hastings and Eastbourne, and is home to a lot of retirees.

Although the dominant age group is between 45 and 64 years of age, a large number of over 65s and above live in Bexhill. There are 33 care homes accommodating more than 800 residents and nine homes for people with learning disability. These have been aligned to each practice in an equitable manner.

PCN set up

A lead practice holds the main contract and deals with finances and recruitment and employment of PCN staff. By early 2020, we had recruited a business manager, physio FCP, three care coordinators (two care home and one for cancer related work) and an IT/project manager.

Lack of premises and desk space was hindering our expansion. All the practices were already swelling and bursting for space. When Covid struck, social distancing and remote working from home addressed this issue, but a lack of IT equipment and infrastructure for our PCN created another stumbling block.

This was also an opportunity to look around and procure external premises for our PCN. As I am involved closely with the council, in June 2021, I emailed my main contact and asked if they knew about any free space we could rent.

They suggested the second floor of the council office in the middle of Bexhill town, which is 300 sq/m. Our initial negotiation stated that the landlord would pay for all services and utilities and reimburses a proportion of telecommunications charges that tenant must meet. The tenant pays a mutually agreed rent and keeps and uses the space in order.

Hurdles

We did encounter some hurdles such as – the cost rent reimbursement, legal rights, lease, and the terms agreed in principle about the use of the property, furniture and common areas.

Our federation, Integrated Community Care, which had been ‘dozing’ for few months was awakened. The proposal went through strict CCG governance procedures and two meetings.

As neither the lead practice or the PCN were a legal entity, the federation, being a company, took on the lease. It pays the rent which was finalised by CCG after recommendation from the district valuer.

The district valuer provides independent valuation of property and advises NHSE/ CCG regarding notional rent GP practices get paid for premises, in our case the rent we pay the council.

The lead practice gets the rent reimbursed by the CCG and passes the funds to the federation. In February all deeds were signed, and we commenced a three-year contract.

Our IT team put in laptops, desktops and set up internet with Wi-Fi. Cloud-based telephony is live, and we started our e-hub in April.

Moving in

We got the keys on March 1, by which time we had expanded our team to include an operation and clinical manager, dietitian, podiatrist, clinical pharmacist, another first contact physio, three social prescribing link workers, three health coaches, two pharmacy technicians and 10 care coordinators.

Everybody is so thrilled to get into the office. The staff morale through the roof. The Federation staff have moved into the space, and we have the community nursing team and other staff near us.

All three practices are at walking distance, so the staff are not concerned about travel or parking. It is an exciting time and as a PCN we are ready to take on the challenges of the DES and recovery from Covid related adversities.

I think we are one of the first PCNs to mobilise premises and workforce within such short time frame. I have to say the council, CCG team, solicitors, IT team and even the district valuer worked at record pace to get our place up and running alongside getting the business continuity measures in place.