The report of the NHS Associate Director Keeping Well and Chief Finance Officer (Document “G”) is presented in two parts and is intended to brief Members on the commitment of Bradford District and Craven CCG and the former AWC CCG to deliver fit for purpose primary and community estate in central Keighley, it also provides a briefing in relation to a contract for general practice services which has an end date of November 2021.

Members are asked to consider the proposal for public engagement and it is -  Recommended

1.    That progress made on the Keighley estate development, and the NHSE/I letter of support be noted.

2.    That the need to secure service provision for the 6.5k patients registered at the North Street Surgery post November 2021, informed by the outcome of market testing be noted.

3.    That the engagement activities with the registered population of the North Street Surgery be noted.

(Lynne Scutton – 07855832612 /

Robert Maden – robert.maden@bradford.nhs.uk)

The joint report of the NHS Associate Director Keeping Well and Chief Finance Officer (Document “G”) was presented in two parts and intended to brief Members on the commitment of Bradford District and Craven Clinical Commissioning Group (CCG) and the former Airedale, Wharfedale and Craven (AWC CCG) to deliver fit for purpose primary and community estate in central Keighley, it also provided a briefing in relation to a contract for general practice services which has an end date of November 2021.

The first part of the report updated Members on progress made since the formation of Bradford District and Craven CCG on the Keighley estates development; it set out the high level timeline of planned activities; confirmed the financial ‘affordability’; outlined the three potential estate options and the intended approach to public engagement.

Secondly the report set out an interdependency as the estate development was also likely to be required to make provision for 6.5k patients currently registered at North Street practice which has a contract of a time limited nature known as Alternative Personal Medical Services (APMS) with an end date of November 2021.

The background to the report clarified the Keighley Health and Wellbeing Estate Solution and explained that the need for healthcare estate development in Keighley had been recognised for many years. Former NHS bodies had proceeded to the public consultation stage; however, the development and delivery of an estate solution for integrated services did not proceed due to a range of reasons including financial constraints and NHS reorganisation.

The case for change had not diminished and was, in fact, stronger due to the growing population need; increasing health inequalities; and the deteriorating nature of the estate; namely Keighley Health Centre, Holycroft Surgery and North Street Surgery which were becoming increasingly expensive to maintain. The case was strengthened through the intent of the NHS Long Term Plan; national policy direction and local strategy and vision.

The report revealed that in central Keighley there were five practices within 1.5 miles of each other. The delivery of an estate solution for Keighley would address the CCG estate priorities and the needs of the Holycroft Surgery (10k patients); North Street Surgery (6.5k patients) and community services, including community diagnostics for the Airedale locality (circa 54k population). The NHSE commissioned dental services for vulnerable people and those who had difficulty accessing a ‘high street’ dentist.  The community dental service was delivered by BDCFT which was also located within the health centre and plans for future estate provision were included in the report.  The overall model was for re-provision of current services whilst recognising that there were opportunities for integrated working and shared space and to create and realise benefits and efficiencies.

Plans for the North Street Surgery were explained in detail and included that the Holycroft Surgery team, as well as the current providers of the North Street contract, had engaged in stakeholder activities and affirmed their willingness to work together and share space in order to create an environment which was flexible and multi-functional thereby.   It was reported that should the outcome of market testing indicate that there was no market interest in the contract then managed patient allocation/list dispersal would be a likely outcome and the estate requirements may change.

The report detailed a range of options for the Keighley Health and Wellbeing Estate and it was reported that these had been refined to three viable options:

a)    Re-provision on the existing Keighley Health Centre site on Oakworth Road Keighley at which the Holycroft Surgery is co-located.  A feasibility study had been undertaken which confirmed that there was the ability to refurbish and expand on the current site and accommodate the expected space requirements. This was likely to be through a phased approach to minimise disruption to service provision, otherwise a decant solution may be required.

b)    New build on one of two potential sites in central Keighley. Both were cleared land and would reduce disruption to services and negate the need for a decant solution.

In response to query as to the third option it was clarified that options two and three were the potential new build sites.

With regard to public consultation/engagement it was explained that NHSE/I’sindicative assurance position suggested that a robust and meaningful public engagement process may be the correct approach rather than formal consultation on the proposals.  That was, however, subject to the views of Members and the CCG Primary Care Commissioning Committee (PCCC).  Members were, therefore, being asked for views on the plans contained in Document “G”.

Following a very detailed presentation and in response to views on the engagement / consultation process to be developed Members raised a number of issues.

Concerns were raised that due to the distance between the two practices which could be merged there would be some impact on one set of practices’ users.

It was also believed that as there were a number of practices which used the Keighley Heath Centre consultation on proposals for that facility should include the wider population and not only the users of the North Street practice.  The availability of radiology services at Keighley Health Centre was also felt to be an important aspect to be considered and that the current site was difficult to access by car.

In response Members were assured that a feasibility study had been conducted on the current health centre site; the proposals were viable and as a viable option must be included in the consultation but may not be the final outcome.  Assurances were provided that consultation would include the wider Airedale community.

A Member believed that the impact of the proposals on a disadvantaged community must be considered and those residents must be involved in shaping the outcome of plans for their health care.  Concern was expressed that the patients at the North Street surgery could be marginalised during the engagement process if account was not taken of the digital divide.

Members acknowledged that the proposals had not been predetermined but neither were residents being given the right to determine what will be, but they were involved in shaping the outcome.

It was questioned if there were voluntary service resources available to sit side by side with residents to enable them to become engaged.  It was acknowledged that it was known who lived in the area and what their characteristics would be so there ought to be some understanding of the threshold of what a viable consultation should be.   Whilst their involvement may not necessarily shape the outcome people should feel they have been fully engaged in the process.

In response it was agreed that assistance could not be fully provided by the voluntary sector and that it would need to be resourced and given the time and skills required.  Assurances were provided that there were existing structures where voluntary sector organisations were funded to carry out engagement on behalf of the CCG and that they would be closely involved in the work.  There was also the opportunity to involve more grass roots and smaller organisations in the process.  It was explained that, in partnership with the voluntary sector, work to develop skills to tackle digital exclusion had been developed.

Members acknowledged that, in the event of there being no interest in a new APMS provider for the North Street practice, patients would be dispersed.  The impact on practices, which could potentially be asked to take 1,000 additional new patients, was discussed and it was questioned if contingencies had been developed for that occurrence.  In response it was confirmed that NHS were aware of that impact and that there was additional estate capacity in the area.  It was explained that the model of general practice was changing and that there was the opportunity to look at back office functions.

The timeline for the proposals was questioned and it was explained that if an engagement process was preferred the timeline would be run concurrently with the timeline for the development of the estate.  This would be developed in key phases and take approximately two to three months’ dependant on commencement. 

A Member with a community engagement background confirmed that she favoured the engagement process reported. She believed it would provide a wider understanding of the communities rather than a consultation process. 

The distinction between engagement and consultation and questioned was discussed and it was questioned if there was an advantage to the population of undertaking formal consultation or a prolonged engagement process.

In response a personal view that engagement could be more meaningful was provided. Members were advised that there was a statutory duty to involve the population and take due consideration of their feedback and both process would be weighted identically.

Resolved –

(1)       That progress made on the Keighley estate development, and the NHSE/I letter of support, be noted.

(2)       That the need to secure service provision for the 6.5k patients registered at the North Street Surgery post November 2021, informed by the outcome of market testing be noted.

(3)       That an engagement approach and activities with the registered population on proposals to secure provision for patients registered at the North Street Surgery be supported.

(4)       That an engagement approach and activities with the wider population of Airedale, and the registered populations of North Street and Holycroft Surgeries, on the Keighley estate developments, be supported.

 (5)      That the comments of the Committee stressing the importance of engaging with those without access to digital resources, and the wider need for accessible information, be taken into account.

(6)       That the issue be added to pending items on the Committee’s Work Programme for consideration at an appropriate time.

ACTION: Overview and Scrutiny Lead