Carry out an option appraisal

This section describes undertaking an option appraisal in order to establish the optimal configuration of services across a local area (often a locality within a PCT area) and hence inform the development of new and existing premises.

The option appraisal should be a collaborative exercise involving local stakeholders, including GPs, community, voluntary sector and social services staff, PCT/local government managers and patients. It should take account of the objectives within the local SSDP.

The development of new and existing premises should be driven by local needs and gaps in the provision of local services. This information should be documented in your PCT's SSDP, which should be your first point of reference when considering the development of services and premises.

If the SSDP does not suggest additional facilities are needed in your locality, it is unlikely that you will secure funding for any new project. An SSDP is unlikely to define exactly what services should be delivered from individual premises. This decision can only be taken after undertaking an option appraisal. Before doing this, it is important to be aware of the typical pattern for delivery of primary care services (see attachment - to be added). Undertake an option appraisal
An option appraisal is a complex and iterative process. It may be undertaken as a series of workshops involving all stakeholders. First, it is necessary to consider all the options available in terms of service delivery and premises developments. These may include:

• Ensure compliance with statutory legislation
Deliver the same services from the same premises and just carry premises alterations to ensure compliance with statutory legislation e.g. DDA.
• Improve the standard of premises
As above but also carry out minor improvements to bring premises up to an acceptable standard where technically feasible and economically viable.
• Develop a local network for delivery of services
Develop a good network of service provision in each natural locality, by replacing or improving GP practices and other primary care premises, with limited consolidation of surgeries and clinics where geography/patient access allows.
• Develop a 'hub and spoke' model for delivery of services
Rationalise the number of primary care premises by developing a limited number of primary care centres or one-stop shops (hubs) whilst reducing the number of existing GP practices (spokes) in the locality.
• Centralise services
Rationalise the existing portfolio of primary and social care premises in the locality into a small number of larger, purpose-built hubs.
• Decentralise services
Continue to operate out of existing premises where technically feasible and economically viable. Bring all premises up to an acceptable standard. Provide additional purpose-built facilities in locations where there is currently lack of provision.

At this stage stakeholders should start to think about the possible configuration of the different options in terms of the number, size and location of new and existing premises. Each option should then be considered in the context of the objectives in your SSDP. Typical objectives are listed below together with the questions that may be asked in order to ascertain whether the option is appropriate.

• Improve the range and quality of services offered in primary care
Will the option: Facilitate the development of existing and/or new primary care services? Enable a shift of services from secondary to primary care? Improve the quality of primary care services? Maintain or improve waiting times for services?
• Improve the environment for patients and staff
Will the option: Lead to a better environment for patients? Enable practices to address health, safety and access issues (e.g. DDA compliance)? Facilitate improved clinical care and address governance issues related to facilities?
• Provide greater integration of health, social care and voluntary/community sector services
Will the option: Enable more primary care and community health staff to be co-located? Facilitate closer working between health and social services? Create opportunities for primary care and voluntary/community sector services to be co-located?
• Increase recruitment and training opportunities for healthcare staff
Will the option: Help encourage GPs and other healthcare staff to stay in or take up posts in your locality? Allow more practices to offer undergraduate and postgraduate training places? Increase training opportunities for primary healthcare staff?
• Create flexibility for the future
Will the option: Ensure that localities and individual practices have the scope to adapt and change as needs change? Accommodate expected changes in the IT infrastructure?
• Be acceptable, deliverable, and value for money
Will the option: Be supported by local stakeholders? Be acceptable to patients and communities? Be acceptable to the PCT and other authorities? Will the option be deliverable within the resources and timescales available? Is the option realistic? Will land be available? Are there likely to be serious planning or other constraints? Is the option affordable?
• Improve access, particular for those with greatest need
Will the option: Improve access to treatment and diagnosis for patients? Complement other access initiatives such as improvements to rural bus services? Improve car-parking facilities for patients and staff? Improve disabled access constraints?

The options may be ranked using a scoring system such as:

1. Apply a relative score (weighting) to each of the strategic objectives (e.g. to total 100 points)
2. Score each service delivery option against each strategic objective (e.g. out of 10).
3. Multiply this score with the agreed weighting of the objective.
4. Combine the scores for each strategic objective to produce a total score for each option.

The options may be risk assessed using a similar scoring system (measuring each option against a series of risk factors rather than strategic objectives). These scores should indicate the preferred option(s). Preliminary costings may then be produced for projects that fit with the preferred option (where sufficient data is available). For example, in the case of implementing a hub and spoke service delivery model this may be the cost to extend and refurbish two health centres and close two branch surgeries. For details on how to produce preliminary costings for a new building see the section on 'Prepare an initial financial model'. This provides a benchmark figure for a typical primary care building. For most refurbishments a cost of £950 per square metre is an appropriate estimate (to cover the cost of decorating and changing internal layouts). For small extensions (of up to 150 m²), where adjacent land is available for extending a property, a cost of up to £2000 per square metre should be allowed. Having identified the likely configuration of the preferred option(s) (i.e. in terms of new and existing premises), stakeholders need to list the services that they feel should be delivered from each building. The final decision on the reconfiguration of services and facilities should balance the demands and needs of all stakeholders with the need to achieve cost efficiency at manageable levels of risk.