Agenda item

Joint report of Chief Executive and Strategic Director Corporate Services and Governance.

Committee received a presentation on the possible future of the Blaydon GP led practice. Members were advised that a consultation was held on future options for the GP led practice as the existing emergency contract expires on 30 June 2018. It was noted that the current contract has already been extended and can’t be extended further. An updated patient list size figure of 2,040 was provided.

A period of engagement for phase one was completed in September 2017. This included engaging with members of the public, patients and stakeholders. The results of phase one informed phase two, a period of consultation to consider the options available for the future of the service.

Under phase one, patients reported the service they received to be either very good or good. Based on the feedback two options were identified;

·         Option 1 – Keep a GP Practice in Blaydon Primary Care Centre

·         Option 2 – Close the GP Practice

Option one would mean a procurement exercise would be undertaken for providers to apply to run the GP practice. Patients would automatically transfer to the new provider or would have the choice to register with another practice. Option two would not affect the walk-in centre at the Primary Care Centre and patients would be given advice about registering at another GP surgery in the area.

It was noted that that the practice has previously been subject to procurement exercises which were unsuccessful. This was possibly due to the relatively small patient list size.

The consultation methodology was noted and it was confirmed that the events organised with Healthwatch were well attended. 334 responses have been received to date (a 16% response rate).The closing date for responses was 14 January 2018.  A report will now be written on the information and feedback received. This will be presented to the NHS Newcastle Gateshead CCG’s Primary Care Commissioning Committee for a decision to be made on 27 February 2018.

It was queried what would happen to those patients who currently use Chainbridge Practice and are sent to Blaydon Practice as overspill.  It was confirmed that the consultation only relates to the GP practice and not the walk-in centre or extended access hub. These will continue to support all other practices.

Members wanted reassurance that if the practice were to close there would be enough capacity at other GP practices in the West to take on the additional patients. It was confirmed that NHS officers have contacted the Chainbridge Practice and it is actively looking to increase its patient list and appoint additional GPs (although the difficulties in recruiting GPs was noted). In terms of other practices in the West, members were advised that the report will identify which practices have capacity, including which have a medium or small patient list. It was also pointed out that a number of patients are travelling some distance to practices (including Blaydon) and, therefore, there is a need to widen the net in terms of GP practice areas when identifying potential solutions.

The point was made that there seems to be an issue in the West generally around sustainability, with some practices struggling and, therefore, there are also wider issues linked to the sustainability of the Blaydon site.

It was suggested that public transport is not always conducive to accessing smaller practices and this is something that needs to be looked at in the wider picture. The fact that there is a bus stop outside Blaydon PCC is one of the reasons why the Blaydon practice is valued by patients. It was confirmed that ease of travel is a factor that is looked at when evaluating practices.

It was also noted that when the consultation started all practices in the area were contacted to seek their views on the potential impact on them if Blaydon closed.

It was questioned whether the reality of the situation was that if no GP provider was willing to run a practice from the Blaydon site, it would close anyway. It was confirmed that it could work but it is difficult to attract GP providers with such a small patient list size and, therefore, there is a risk that any further procurement exercise would be unsuccessful. It was requested that every effort be made to identify flexible solutions in order to secure the future of the practice. It was reported that NHS officers are looking at this; however, if there is no appetite amongst providers to take it on, then there may be no alternative but to close the practice. Committee was advised that GP practices are paid per patient on their registered list, therefore the contract income would be small for Blaydon as well as the provider having to pay a service charge for the building. The current provider has stated that there is no real capacity to increase the patient list size unless changes to the use of rooms and layout are made at the primary care centre.

It was pointed out that there are housing developments planned in Crawcrook, Ryton, High Spen, Blaydon, Winlaton and Metro Green and other areas which should help to grow the list size in the future. It would seem short-sighted, therefore, to close the practice given the housing developments that are due to come on stream in future years. However, it was noted that there were some issues around capacity within the practice and that the practice cannot be subsidised in terms of service charges, although rent and rates are reimbursed through the NHS. The service charges set by NHS Property Services were a significant cost for the practice and members felt that representations should be made to have these reduced.

Concerns were raised that if the practice were to close this would impact on meeting patient needs at other practices, for example people waiting longer for appointments.

It was suggested that due to the ongoing and future housing development in the area any decision should be delayed. Committee was advised, however, that the current practice is operating on an emergency contract which has already been extended and no further extension can be made under NHS regulations. It was also noted that this is an expensive way to operate. It was confirmed that the housing developments will be identified in the report to the Primary Care Commissioning Committee.

The point was made that NHS services at Metro Riverside were originally given temporary planning consent which had been extended. It was suggested that these services could be moved to the Blaydon PCC to make it more viable. It was confirmed that conversations are ongoing around the Metro Riverside facility. However, such a move would not impact on the level of service charges incurred by the Blaydon practice. It was also suggested that the Blaydon practice could be used as a satellite base for another practice.

With regard to the scope for extending the existing emergency contract, it was suggested that the Secretary of State could be asked for an exemption to NHS regulations on this issue. Members were advised that this would have to be explored through NHS England.

In addition, it was suggested that the level of service charges imposed by NHS Property Services on the Blaydon GP practice could also be raised with the Secretary of State whereby potential bidders for the contract beyond June 2018 could be asked to identify the maximum level of service charge they could pay, consistent with running a sustainable GP practice at Blaydon PCC going forward. The Committee was informed that service charges are set in accordance with a national framework and they would be difficult to alter; it would also be highly unlikely that an exemption to the application of NHS regulations would be granted in the case of the Blaydon GP practice.

The point was made that the Blaydon GP practice is unique in Gateshead in that it is co-located with a leisure facility and other NHS services at the primary care centre. When the facility was opened, it was seen as a forward looking and innovative approach to the co-location of services – it was felt that it would therefore be a backward step if a GP practice could no longer be provided as part of the ‘offer’ from the centre. It was also suggested that, given the move towards the provision of GP services at scale, wrapped around other complementary services, it would be a missed opportunity not to build upon what is already in place at Blaydon PCC, with the GP practice being seen as integral to existing and future arrangements as a key hub for the West of Gateshead.

A flexible approach should be taken to best ensure the sustainability of the practice (until future housing comes on stream) and to maximise the benefits to local residents.

NHS colleagues were commended for the consultation process that had been undertaken, consistent with NHS guidelines.

RESOLVED    -           (i)         That the Committee’s comments on the options under

consideration be noted and forwarded to NHS Newcastle Gateshead CCG, particularly in relation to the comments on future housing development, the request to pursue flexible options for the future development of the Blaydon practice and the need to re-examine the service charges imposed on the Blaydon practice.

                                    (ii)        That Committee is satisfied with the adequacy of the

consultation by NHS Newcastle Gateshead CCG.

                                    (iii)       That Committee support option one and are satisfied

that this option is in the best interests of the local health service in the area.