Statement of Need for future Health provision in Thetford.

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1 Statement of Need for future Health provision in Thetford. 1. Background and Purpose Under current legislation planning authorities are required to ensure that adequate infrastructure is provided in order to ensure communities have access to appropriate key facilities and services. (Planning Policy Statement 12) The purpose of this paper therefore is to specify the required infrastructure, location and cost, for health care necessary to support the whole town and surrounding area in the light of the major expansion planned up to 2026 and to indicate when it will be required. 2. Thetford: Growth Point Status and planned urban extension. The housing aspirations for Breckland as a whole are set out in the Core Strategy adopted in Thetford is expected to contribute a significant proportion of that number, approximately 5000 new homes by 2026 as recently set out in the Thetford Area Action Plan (2011). Reflecting this challenging outcome Thetford was designated as a Growth Point in This builds on the current Thetford population of approximately 26,000 and therefore represents an increase of 46% Whilst it is understood that the actual number and occupancy of new homes is subject to variation for the purposes of the modelling in this paper a mid range approach based on 5000 new homes with average occupancy of 2.4 people per unit has been adopted throughout. This gives a total increase in relation to the new development of 12,000; NHS Norfolk is treating any remaining growth in population to be the usual growth levels which NHS funding should absorb. These assumptions can easily be modified in the light of further information from the Planning Authorities. The majority of the new homes, approximately 5000, are to be built in a Sustainable Urban Extension (SUE) to the north of the current town which will take the border of the built up area close to the A Current Health Provision in Thetford GP Services The town is currently served by a range of local Primary Care Services covering General medical (GP) services, dentistry and pharmacy. There are 2 large General Practices in the town centre (School Lane and Grove Lane Surgeries) with School Lane also operating from the relatively new Thetford Healthy Living Centre located on Croxton Road in the north of the town. The latter building also houses a wide range of other health services for local people including diagnostics, physiotherapy, mental health, Children s and other community services.

2 Dental services Thetford currently has one existing large dental practice situated in the centre of Thetford. This practice is running at capacity with the current population and has no spare capacity to absorb any additional population from the development. There is also a specialist surgery in the Healthy Living centre which is used for provision of dental services to patients with special needs. This set up is unsuitable to be used as a general practice facility. Pharmacy There are 4 pharmacies currently (Boots/Lloyds in the town centre, and others located within Tesco s and Sainsbury s supermarkets) with a fifth potentially due to open at the Healthy Living Centre in the near future. Patients needing to access acute hospital care are predominately referred to the West Suffolk Hospital at Bury St Edmunds, or to the Norfolk and Norwich University Hospital. Thetford is recognised within the Norfolk Joint Strategic Needs Assessment as being an area of relatively poor health in relation to county and national norms. The area demonstrates higher incidences of illnesses such as diabetes, coronary heart disease and mental health problems which are commonly associated with higher levels of social deprivation. Accordingly NHS Norfolk and Breckland Council made a successful bid to the Department of Health for Thetford s inclusion within the national Healthy Towns programme: a 1.8m programme aimed at tackling high levels of obesity through improvements to the planned environment, as well as services aimed at promoting physical activity and improving diet. It is well established that more deprived populations, such as Thetford s, are less likely to travel to access health services and thereby provision of locally accessible care, particularly primary care, is essential. 4. The likely Impact of Forecast Growth on Current Capacity With regard to the assessment of current provision against the planned growth there are 2 dimensions which require consideration: Physical infrastructure such as buildings Workforce and other consumable resources A review recently undertaken by NHS Norfolk has highlighted the following requirements in Thetford in relation to the planned expansion: Physical Infrastructure GP Services: Currently can physically accommodate up to a further 7500 patients, principally within the Thetford Healthy Living Centre with additional GP and community health capacity to be put in place. Additional physical capacity for approximately 4500 patients is required. It is estimated this would require an additional 2-3 GPs working with other health professionals in a multi disciplinary team. Dental services: As current provision is at capacity there is a requirement to provide some additional dental facilities (one additional dentist) early in the development (2012/13). From the

3 projected population figures it is projected that a 5-6 chair facility will be required by completion of the development in Pharmacy Services: The expected increase in population will require an additional pharmacy Community/Mental Health services: Sufficient physical capacity exists within the Thetford Healthy Living Centre. Acute Hospital Care: Some additional outpatient services will be relocated to the Thetford Healthy Living Centre but otherwise the West Suffolk Hospital, and Norfolk and Norwich Hospital have sufficient physical capacity to accommodate additional activity. Capital Costs GP Services: One additional GP surgery capable of supporting up to 4500 new patients by The building is required to be of the order of 860m 2, at an estimated cost of 1.55m (excluding VAT and fees). This facility will need to be in place to provide services by no later than The building capacity indicated could provide for up to a total of 6000 patients to allow for the potential to meet health care needs if there is further population growth in future. Dental Services: A new Dental practice capable of supporting clinical capacity equivalent to 6 Dental Chairs. The building required to be of the order of 152m 2, at an estimated cost of 274k (+VAT and fees). It would be advantageous for the Dental and Medical Practices to be co located within a single building. The areas quoted above do not include space for the requisite car parking capacity. The building could be a 2 storey structure with clinical services on the ground floor and administrative support on the first floor. The design would be such that future expansion beyond 2026 could be facilitated by an extension to the new facility. The location and space for this building would need to be identified at the earliest phase of the development. Pharmacy: There is also a requirement for additional pharmacy capacity. This would be a room/building of some 100 m 2, co-located with the other planned health facilities and would cost in the order of 90k (excluding VAT and fees) to provide a basic shell ready for fit-out by the pharmacist. Workforce and other resources The full costs (i.e. workforce, consumables such as drugs, and the revenue costs associated with infrastructure) of meeting the health care needs of the expanded population have been modelled using NHS Norfolk s Locality Budgeting Tool for Thetford which accurately calculates the current population s health cost and costs, and from which the costs for the expanded population can be accurately calculated. Estimated additional revenue costs to the NHS of Thetford Expansion Primary Care Current Cost per Total Additional Cost capita GP Services 118 1,417,657 Prescribing 164 1,968,034

4 Dental ,811 Mental Health 121 1,446,702 Learning Difficulty ,605 Community Health Services 176 2,111,777 Acute Hospital Activity 689 8,263,939 Total 1,351 16,206,526 Based on new residents Source: NHS Norfolk Practice Based Commissioning Budgets 2010/11 NHS Norfolk are funded by Central Government which allocates revenue funding on the basis of a weighted capitation formula based on PCT populations adjusted for their age distribution, need over and above that relating to age and geographical variations in the cost of providing services. This funding is resource and cash limited and PCT s have a statutory duty not to exceed these limits. PCT population numbers are derived from census information and projections made by the Office of National Statistics (ONS). Population projections cover 3 year periods and the funding settlement is therefore based on the stage at which new census data is introduced into the formula and the accuracy of the ONS projections. This leads to a 3 year lag in the funding stream as new population numbers, housing stock increases are not addressed until each 3 year anniversary, with consequent shortfalls arising for the health budget. The formula is therefore insensitive to the type of rapid step growth planned for Thetford and therefore NHS Norfolk and its successor commissioning bodies will not receive full funding for the projected population growth until up to 3 years after the end of the growth period. The table below sets out the additional revenue costs associated with the Thetford expansion based on this 3 year cycle. Model Showing Lag effect of 3 year Funding Cycle for NHS Norfolk Pop n Total Increase Cost per Capita Total Year , , ,134,840 1,134, ,188,620 2,188,620 years 3,647, ,323,460 1,134, ,539,360 2,350, ,836,320 3,647,700 years 7,133, ,214,340 1,378,020

5 ,673,420 2,837, ,051,440 4,215,120 years 8,430, ,348,400 1,296, ,564,300 2,512, ,699,140 3,647,700 years 7,457, ,752,920 1,053, ,725,640 2,026, ,212,000 2,512,860 years 5,593,140 Total funding requirement to cover lag effect 3,647,700 7,133,280 8,430,240 7,457,520 5,593,140 32,261,880 Based on Population increase of 12,000 Pay & prices 2010/11 With regard to the balance of revenue and capital costs NHS Primary care facilities are normally funded by third party capital, the cost of which is passed onto the provider, e.g. the GP, who in turn recovers the cost through a contract for service paid for by the PCT as a revenue stream. Therefore the net revenue shortfalls set out above will meet the cost of servicing the capital associated with the construction of the new facilities. 5. Location The Developers and their representatives asked NHS Norfolk for advice on the optimum location for the building of new health facilities within the town, i.e. the new General Practice, new Dental facility and pharmacy. In doing this NHS Norfolk is minded that: It is responsible as is the Moving Thetford Forward Board for enhancing the whole of the town s facilities, not just that relating to the new development. The location and accessibility of current health facilities for the whole town including the expansion. NHS Norfolk propose that a new multi purpose health facility comprising of a GP Surgery, with additional space for a commercial pharmacy, and a linked dental surgery be sited in the SUE to the East of the railway line. The proposed Primary Local centre shown on the Draft Masterplan would be a suitable location for such. Residents on the Western side of the SUE would also have the option of registering at the Thetford Healthy Living Centre Practice NHS Norfolk has modelled accessibility to the proposed health facilities for a variety of locations (using modelling software from Norfolk County Council) and is happy to share these as required.

6 6. Developer contributions to the proposed new facility As noted above, spatial plans are required to demonstrate how, where and when new infrastructure required to support growth will be provided. Policy CP4 of the Breckland Core Strategy requires that appropriate infrastructure is provided with special reference to Thetford and policy CP5 states that this will be secured through developer obligations. To be valid, a requirement for developer contribution must meet the standard tests for Section 106 as set out in current planning guidance. These include, proportionality, a planning purpose and a direct relationship with the development. As has been clearly demonstrated the increase in population arising from the SUE cannot be met within existing capacity and will require new facilities. Based on these factors the additional cost of the Thetford expansion will generate total additional revenue costs of 32.3m over and above the resources allocated by the Department of Health during the period These costs include the costs of servicing the capital costs relating to the provision of the proposed new General Practice, and Dental facility. NHS Norfolk is fully committed to working with the developers and Planning Authorities to ensure that there is a timely and cost effective expansion in health facilities such to ensure that the health needs of Thetford are successfully met in the future. NHS Norfolk believe that this is best achieved by way of staged payments linked to population growth as outlined above and the allocation of sufficient space for the GP and Dental facilities within the new development. Mark Taylor Director of Locality Development NHS Norfolk