Agenda item

Richard Armstrong, Interim Director of Commissioning, NHSE, and Dominic Blaydon, Head of Long Term Conditions and Urgent Care, CCG

Richard Armstrong, Interim Director of Commissioning, NHSE, and Dominic Blaydon, Head of Long Term Conditions and Urgent Care, CCG, presented a report on the actions taken to date and those being considered by NHS England in order to ensure adequate, high quality future provision of GP services in the Chantry Bridge area of Rotherham.

Current services were located in the Community Health Centre on Greasbrough Road and were part of the contract with Care UK together with the Out of Hours Service and the Walk-in Centre.

Appendix A of the report provided a detailed account of the context and position regarding future provision as well as:-

·           Introduction and background to the existing service

·           Current position

·           Demographic information

·           Other Primary Care services at Chantry Bridge

·           Engagement

·           Procurement principles

·           Risk management

·           Next steps

Discussion ensued with the following issues raised/clarified:-

-          The service had commenced in 2009, commissioned at that time by the Rotherham Primary Care Trust to provide both a registered practice for patients as well as walk-in patients who chose to visit during the extended opening hours and for convenience due to its central location for people working in Rotherham

-          The contract had been let for 5 years with an expectation that the practice list would grow to 5,000-6,000 people

-          At the time of the contract coming to an end in May, 2014, the practice had a list of approximately 1,700 and Care UK still provided a walk-in service

-          During the 2013 changes to the NHS structure the responsibility for Urgent Care Services (walk-in centre and out of hours) moved to the Clinical Commissioning Group.  NHS England remained responsible for commissioning GP services provided to a registered list of patients

-          Notification had been received that Care UK wished to withdraw from the provision of GP services but were willing to continue with the provision of out of hours services.  Negotiations had resulted in an extension of the contract until September, 2015.  This was timed to coincide with the opening of the new Emergency Centre at Rotherham Hospital but site issues have meant a delay to the opening date

-          Barnsley Clinical Commissioning Group were co-commissioners for the out of hours service and had agreed to end their contract with Care UK in May 2015.  Rotherham CCG would be receiving a paper from Care UK on the costs of continuing alone with out of hours

-          Consultation with the registered patients had commenced to ascertain their preference.  Options to explore would be whether there was a possibility of commissioning another practice in the area or another GP practice willing to take on the full patient list

-          Need to ensure effective engagement with patients who were new arrivals/faced language barriers and patients with learning disabilities or autism. It was noted that not many patient participation groups included disabled people

-          15% of the 1,700 lived more than 1 mile from the practice and travelled past other practices largely due to the convenience of extended opening hours

-          If patients wished to stay registered in the area efforts would be made to re-procure through advertising the practice to any other provider who wished to take on the responsibility.  Due to its small size, it would be expected to become a branch surgery of another practice

-          NHS England felt that there was sufficient GP capacity in the area.  Given the number of patients who actually lived out of the area it was highly likely that the majority would want to register with a GP closer to home

-          The Community Health Services currently located in the building would not be affected by the changes in GP services

-          The practice profile showed that 70% of the registered patients were of working age so would suggest they found the extended opening hours more convenient.  There was a desire to see extended hours across the Borough and work was taking place with the Clinical Commissioning Group in looking at continuing provision for some form of walk-in centre and extending GP availability into the evenings and weekends.   It was an aspiration for the future to commission services for longer periods of GP availability.  GP practices were encouraged to submit a bid to the Prime Minister’s Challenge Fund which was available to help improve access to general practice and stimulate innovative ways of providing primary care services

-          It was not known why the patient list had not expanded.  It could be that even though they may not be totally satisfied with their existing practice they could not be bothered to change.  Also the service provider already provided the walk-in service for a patient whether they were registered or not so there was no incentive for Care UK to register more

-          It was felt that there was still sufficient footfall for the pharmacy to be a viable business.  A model being considered  in terms of commissioning services from practices was looking at pharmacy services to relieve the strains on GP services and the hospital

-          If practices took on more patients they would receive extra income, on average £120 per patient per practice

-          If practices chose to close their patient list they had to apply to the Area Team and report why they had chosen that course of action.  If it was found to be with no good reason, the application could be refused or sanctions imposed in respect of the provision.  Much of the GP practices chose to be open to register patients

-          It was noted that the Friends and Family test would be introduced as from December for GP practices, to be reported monthly. This would be in addition to the national GP Patient Survey.

-          NHS England did not allocate patients to a particular GP practice other than in situations where the patient was unable to choose.

Consideration was also given to a report to the NHS England and Health Scrutiny Overview Committee by Healthwatch Rotherham.

Healthwatch Rotherham had been approached by NHS England to help with the engagement around the future of the medical practice.  13 comments had been received regarding the practice relating to appointments/waiting times and other.  There were some patients who had been signposted to the practice because of there being a “no boundary” approach and the extended opening hours but some were still reporting problems with appointment/waiting times to see a Doctor even though there were only 1,700 registered patients.  Due to the location and layout at the Community Health Centre, many patients perceived the Walk-In Centre and Chantry Bridge GP practice as being one and the same. At the time of presenting the report Healthwatch had not received a response from Care UK who had been given a copy of the report.

Members requested further information from NHS England in order to inform their response to the proposals:-

-        Information that NHSE had requested from Care UK with regard to the patient demographic profile and proximity to Chantry Bridge.

-        Outcomes of the engagement with registered patients and the six GP practices within one mile of Chantry Bridge.

-        An equality impact assessment/equality analysis

Resolved:-  (1)  That the report be noted.

(2)  That a formal response be submitted to NHS England South Yorkshire and Bassetlaw subject to receiving the information above and confirmation of the timescales.

(3)  That the Select Commission’s thanks and best wishes were given to Mel Hall, Chief Executive, Healthwatch Rotherham, who was leaving the position shortly.