Agenda item

The issue has been raised by Councillor Stamp and will be considered by the Committee as a Member item.

 

This report advises the Committee of a proposal under consideration by Medway Clinical Commissioning Group to close the Sunlight GP Surgery in Gillingham. In the view of Medway Clinical Commissioning Group this is not a substantial service reconfiguration.

Discussion

 

Councillor Stamp introduced his Member item, the key points of which were as follows:

 

·      A petition against the proposed closure of the Sunlight Centre Surgery had been signed by nearly 1,000 people. A separate petition was against the closure of the DMC branch surgery in Twydall.

·      Pubic engagement by the CCG had been completely inadequate. Councillor Stamp had received the letter sent to patients of the affected practices on 3 August 2018 which had given just six working days for a response. This was not long enough, particularly during the summer when many people would be away and many students would have returned to their parents’ house. This short engagement period was completely unacceptable.

·      The CCG had stated that it did not consider the proposals amounted to a substantial variation in health services and that, therefore, a full consultation process was not required. A proposal to close two GP surgeries that would affect almost 26,000 should definitely be considered to be substantial.

·      The CCG should have worked with the Committee and referred the issue as matter of course rather than it having had to be brought to the Committee as a last minute Member item. Alternative options should have been presented and a full options appraisal undertaken. This referral should have taken place several months previously and the Committee and the public should have been provided with full details and the rationale for the proposals.

·      There had been no assessment of how the proposals would impact on mental health, social isolation, accessibility or patient care and there should have been an assessment of how well each location was served by public transport. There had been little consideration of the needs of patients.

·      The decision about whether or not to close two GP surgeries was due to be taken on 29 August 2018. It was not clear that those making the decision would have sufficient information available to enable them to make an informed decision. It was concerning that the decision would be made in  private with no transparency or accountability.

·      There were already GP vacancies at the Balmoral Healthy Living Centre with patient lists being oversubscribed. It was therefore not clear how the surgery would cope with additional demand. The issue of GP shortages was a national issue which should not be used as justification locally to close surgeries.

·      Poor patient feedback had been cited as one of the reasons for the proposed closures but this was not borne out by the feedback at the public meeting, at which patients had talked of their positive experiences as patients of the Sunlight Centre. The CCG had not shared patient feedback to substantiate its claim.

·      There was a significant lack of detail in the Committee report with no supporting evidence to substantiate the claims made. It had been claimed that the proposals would reduce health inequalities but no evidence had been provided in relation to how this would be achieved.

·      There were more than 7,000 patients registered at the Sunlight Centre Surgery. The local population was forecast to increase by 10% over the next 17 years with significant development planned in the vicinity of the Sunlight Centre. There were high levels of deprivation in this area and in Gillingham North ward as a whole, with the ward being the 3^rd most deprived in Medway, having the 3^rd highest rate of people with long term health problems and being amongst the 5% most deprived wards in the country. The ward was in the top 20% for adult social care needs and life expectancy was 6-7 years lower than in the wealthiest parts of Medway.

·      Given the poor health of many of the Sunlight Centre surgery patients, it was unreasonable for them to be expected to walk the extra distance to other surgeries. Public transport provision was not always adequate and taxis were too expensive for many people. The claim that public transport links to St Mary’s Island were good was questionable.

·      Any financial  savings resulting from the proposals would be outweighed by human cost. It was requested that the CCG undertake a full consultation with a full range of options to be provided.

 

Councillor Cooper addressed the Committee as follows:

 

·      The Sunlight Centre Development Trust had been set up with local residents, Councillors and prominent members who could bring expertise to the trust. The Centre and the variety of community provision within it had been an integral part of the local community for many years. The closure of the GP surgery would have a significant impact on patients and the local community and the pharmacy would also need to close.

·      The proposal was being put forward due to younger GPs only wishing to work in multi-disciplinary practices.

·      St Mary’s Island was very difficult to get to by public transport and taxi costs were prohibitive. There was a hill between the Sunlight Centre and Balmoral Gardens, which made it unsuitable for many people to walk.

·      Local people were angry at the proposals and scared they might lose their GP surgery.

·      The proposals should be recognised as a substantial variation, the Sunlight Centre should be kept open and the consultation period extended.

 

Ms Zi Fincham (patient) addressed the Committee as follows:

·      The Sunlight Centre GP surgery was important to the wellbeing of the local community and the proposal to close it made her upset and angry. The 1,000 signature petition against the closure demonstrated the strength of local feeling.

·      Closure of the GP surgery would also result in the closure of the pharmacy and other services at the Centre, which would be devastating for the local community.

·      The proposal did not support the aim of the Medway Model to deliver joined up local health and care services closer to people’s homes and the proposals were being driven by the wish to save money.

·      The public had not been adequately consulted and had not had enough time to respond. Furthermore, no details of the proposed hubs had been provided for public scrutiny.

·      There had been no engagement undertaken at the Sunlight Centre, the letter sent to patients about the proposals had not been clear and many patients had not received it.

·      There had been no regard to the impact of increasing the number of patients attending the surgeries that would remain open.

·      GP surgery closures would cause unnecessary stress to local people to the extent that the local mortality rates could increase if people felt unable to obtain healthcare.

 

Rachel Turpin (Sunlight Development Trust), addressed the Committee:

 

·      Local people were anxious about the proposals, particularly as the Sunlight Centre was well regarded locally.

·      The impact of the closure would be devastating. The Centre would be an ideal facilitator of social prescribing with people being able to see their GP and then being able to be immediately referred to other services.

·      GPs were attracted to the Sunlight Centre by the wide range of organisations it hosted, with a wide variety of community groups also using the centre.

·      Air quality on St Mary’s Island was poor meaning a GP located there would be unsuitable for people with respiratory problems.

·      It was requested that the consultation period be extended and that the consultation be fully transparent.

·      The CCG had only just agreed to meet with the voluntary groups based at Sunlight Centre in order to discuss their concerns.

 

The Director of Primary Care Transformation at the CCG said that no decision had yet been made about whether to close any GP surgeries. The five surgeries affected by the proposal had four GP contracts between them. These were time limited APMS contracts that had to be reprocured every three years. The providers at the Sunlight Centre and at Chatham Boots had both handed back the contracts to the CCG. This had provided the opportunity to combine contracts. However, there would be no GP provision at either surgery if a new contract was not awarded by December. The CCG considered the practices contained in the proposals to be in close proximity.

 

The pooling of resources over three sites would enable better use of resources, both clinical and non-clinical. Engagement with potential providers had indicated that they would prefer to run services at three sites rather than five. The three sites would also be able to provide enhanced services and were considered to have sufficient capacity. Only 57% of total capacity and 51% of clinical capacity was currently utilised at Balmoral Gardens. Service specifications for the three sites would be further considered in terms of improved access. There were no financial savings associated with the proposal as any savings would be reinvested to provide extended access in evenings and at weekends.

 

The CCG had written to all patients of the five affected surgeries, as listed in the patient database. They were aware that there had been an issue in Twydall which had been discussed with the surgery. Significant feedback had been received as a result and the impact that any closure of the GP surgery at the Sunlight Centre would have on other services provided at the Sunlight would be taken into account as part of the decision making process.

 

The proposals were due to be discussed at the Primary Care Commissioning Committee meeting on 29 August 2018. This meeting was private due to it including the discussion of contracts. The CCG would publish all patient feedback and details of the decision making process within a week of the meeting. The process was considered to be in line with the Medway Model for the development of health and social care provision across Medway and with NHS England Best Practice. External procurement advice was also being sought.

 

Members of the Committee raised a number of concerns, a summary of which is as follows:

 

·      The Committee should have been consulted long before the commencement of public engagement and more detailed information should have been provided, including details of the impact of the closures.  The Committee had not been informed that the implementation of the Medway Model would result in GP surgeries closing.

·      The letter sent to patients in relation to the proposals lacked clarity and it was also not clear how comments received would be taken into account or what the other options were.

·      A lack of public transport and parking difficulties made reducing the number of surgery locations a particular concern. In Twydall there were many elderly people with mobility issues or young people who did not own a car.

·      River ward, Gillingham South and Watling wards would also be affected by the proposals.

·      The CCG had not provided sufficient evidence to substantiate its view that the proposals did not amount to a substantial variation. This included a lack of evidence that four tests, set out in the NHS Operating Framework had been met. The four tests were Strong public and patient engagement; Consistency with current and prospective need for patient choice; A clear clinical evidence base and; Evidence of support for proposals from clinical commissioners.

·      Patients had not been involved in developing the proposals and the health profiles that had been produced for each ward in Medway should be used to base service provision on the need in a particular locations.

·      The claim that patients would have greater choice was not correct as patients of the Sunlight Centre or the branch surgery in Twydall would have to attend a different surgery.

·      There was no evidence that the proposals would provide better outcomes and it was not acceptable for the CCG to state that it was unable to find a provider prepared to operate all existing locations. It was also not the case that no patients would be less well off.

·      The four tests set out in the NHS Operating Framework had not been met by either the proposal or the consultation undertaken. It was noted that the Council was currently undertaking in depth work looking at how to tackle social isolation, but that in order for the concept of social prescribing to be effective there needed to be local GPs and support services available.

·      No evidence had been provided to support the view that services could be provided more effectively in larger surgeries and practices and it was concerning that many patients would be expected to attend the Balmoral Healthy Living Centre instead of the Sunlight Centre in view of relatively low public satisfaction with the former.

·      A Committee Member said that they supported the proposals put forward as part of the Member item but that the Committee should not be in this situation as it should have been fully consulted much earlier.

 

In response to a question asking whether he had been aware of the proposals, the Director of Children and Adults Services said that the Council worked closely with the CCG in relation to joint commissioning and the development of the Medway Model in the context of the STP. Meetings had taken place in relation to the broader local care proposals but there had not been a specific discussion in relation to the proposal. It was also noted that the duty under the health scrutiny regulations was for consultation to take place specifically with the Health Overview and Scrutiny Committee rather than with other parts of the Council.

 

In summary of his Member item, Councillor Stamp said that clear procedures on protocol should be put in place to ensure that the Committee would be properly consulted in the future. There was a need for clarity about why the CCG considered that the proposals did not amount to a substantial variation. This needed a robust justification that considered all impacts on patients. The CCG had been aware that the contracts needed to be retendered and should therefore have started making arrangements to re-tender sooner. It was requested that full details and options associated with the proposals be provided and that the public consultation period be extended.

 

The Chief Operating Officer said that the CCG had been put in a difficult position as two of the providers had handed back contracts unexpectedly. The CCG had been notified of this in March. It was emphasised that no decision had yet been taken. In relation to the transport concerns raised, Twydall was on a bus route to Balmoral Gardens with there being regular buses. There were two other practices near to the Twydall surgery, with one of these being particularly keen to take new patients. The distance between the Sunlight Centre and Balmoral Gardens was 0.7 miles. It was acknowledged that more notice should have been given of the proposals. The CCG would need to ensure continuity of service should there be a delay to the procurement process.

 

A Committee Member emphasised that it should have been obvious that the matter would need to be brought to the Committee and that it was the responsibility of the CCG to inform the Committee.

 

In response to a Member question asking what the next steps and response of the CCG would be, the Chief Operating Officer was unable to say at this stage what would happen but could confirm that the issues raised would be discussed at the Primary Care Commissioning Committee on 29 August 2018.

 

It was confirmed that a letter would be sent to the CCG setting out the requests made by the Committee and that the matter would be provisionally added to the Committee’s work programme for the October meeting, subject to the decision made by the CCG on 29 August 2018.

 

Decision

 

The Committee:

 

i)     Resolves that the CCG proposals to merge four AMPS contracts into one and reduce operating sites from five to three do constitute a substantial variation of provision and therefore merits a formal delay of the decision due to be made by the Primary Care Commissioning Committee on 29th August 2018.

 

ii)    Further requests an extended consultation period which takes proper account of the alternatives and issues presented by stakeholders during the new consultation period.