Decisions

The Committee received a report from Dr Anil Doshi, Dr Stella Jacobs, Nurse Practitioner Janet Thomas and Partners of Crawcrook Medical Centre in order to take Committee through the proposal/rationale for the proposed closure of the branch surgery at Greenside and the engagement work carried out so far with patients and stakeholders.

Crawcrook Medical Centre currently deliver primary care services through a GMS contract from the purpose built main surgery premises on Pattinson Drive Crawcrook and a limited service to patients within the Greenside Community Centre Premises. The medical centre are proposing to close the branch surgery at Greenside due to the fact that by January 2017 they will have lost 50% of the GP capacity, and despite the best efforts they have been unable to recruit more GPs.

Background

Up until July 2016 Crawcrook Medical Centre has provided a clinical session at Greenside Community Centre. A GP from Crawcrook has attended the site 5 mornings a week, providing each morning allocated slots to see up to 12 patients face to face and one as a telephone appointment slot. Any patients who need to attend to see a nurse of health care assistant need to be given an appointment at the main surgery at Crawcrook, because the rooms at Greenside don’t meet the national standards to see patients beyond anything other than a face to face consultation with a GP.

As the GP resource has reduced by 33% from January 2016, due to two of the salaried GPs leaving, the practice felt they had no choice but to ask permission from NHS England in July 2016 to reduce the service at Greenside from 5 mornings a week to 3 mornings a week, as it became impossible to sustain GP cover for 5 days.

From mid January 2017 another GP will be leaving, reducing the GP resource by a total of 50% and making it impossible to sustain continued delivery of services over 2 sites.  The practice are therefore having to review their structure and ways of working to accommodate this reduction.

External Audit

An external audit was carried out to help the practice understand how many patients attend Greenside surgery. The audit was carried out by an external auditor to look at the demographics and attendance of patients, resident with a Greenside address, during the 12 month period 26.09.15 to 26.09.16. The results demonstrated that out of a potential 1500 Greenside residents 743 Greenside patients had attended in that year and there were only 58 patients identified who have only ever attended Greenside and have never attended the Crawcrook site, which is 3.8% of the 1500 Greenside residents. The remainder of those 743 patients have attended both Greenside and Crawcrook with 651 of those patients attending Crawcrook more than Greenside. The 58 patients represent 0.8% of the total population of the 7268 patients registered for both Crawcrook and Greenside and this confirms the practice decision for the services to be consolidated to the Crawcrook site.

The practice has looked at the demographics of those 58 patients which only attended Greenside and these are set out below:-

In the age group 61-90 there were 8 attendances of more elderly patients and the practice has confirmed they will look at way to be able to mitigate the consequences for these patients. The practice has also confirmed that they have contacted the local bus company to ask which bus services are available for residents of Greenside and Greenside patients.

NHS England and CCG

The Practice has had discussions with both NHS England and the CCG informing them of the increasing vulnerability of the practice and NHS England have given guidance to the practice of the process required to make a proposal toc lose the branch site. The CCG are also aware of the proposal and Jane Mulholland, Director of Operations and Delivery was also in attendance at the OSC.

CQC Inspection

Following a recent CQC inspection, in March 2016, of both premises, the CQC report rated the practice “Good for being well led” and “Good for Caring” however there were areas that gave the rating for “Requiring Improvement” due to 2 issues:-

·         Not having a Defibrillator and oxygen at the Greenside site

·         Staff appraisals not having been all completed for that year at the time of the inspection

Not meeting these 2 areas brought the overall rating down to “Requires Improvement”.

Both areas have now been satisfactorily met and the reports submitted to the CQC informing them that the Oxygen and Defibrillator have been purchased and are in place at Greenside and all the staff appraisals have now been completed. There is not a requirement for any remedial action plan as Crawcrook Medical Centre has addressed and corrected the CQC requirements.

One of the areas that CQC also highlighted during the inspection was patient concerns over access to appointments. The decision to close the branch surgery will hopefully make it possible to improve access for all patients.

Justification for Proposed Closure

Having a 50% reduced capacity of GP resource by January 2017 will make it impossible to sustain services over 2 sites. The Practice has found it impossible to recruit GPs to replace the 2 salaried GPs, despite having advertised twice in the last year. This resulted in no applications whatsoever to the adverts. This is currently in line with the national situation due to a lack of GPs generally and exacerbated by the facts that GPs do not necessarily choose to work in the South-East area of the UK. In addition, the pool of available GPs in the system has been greatly reduced due to dwindling interest in applications to become a GP and a lot of GPs choosing to emigrate to places like Australia where they are offered a better work life balance, along with better remuneration than can be offered within the UK. This picture is unlikely to change until the mid 2020’s.

Actions taken to reinforce our services when consolidated to Crawcrook site

The Gateshead GP Federation known as CBC has been successful in securing funding through the Primary Care “Five Year Forward View” funding initiatives allowing them to support Crawcrook Medical Centre along with other local vulnerable practices.

Regular meetings are taking place with CBC to review and support Crawcrook moving forward.

One of the primary aims of these meetings is improving access for all out patients and consolidating all service delivery from one site to improve the current appointment system by better utilisation of the skill mix across the primary care clinical team. This will be done by reviewing our access and increasing our available appointments at Crawcrook along with additional training for the practice staff in signposting patients to the correct clinician. To prepare for this, the practice have been strengthening the resources amongst the other clinicians and have appointed a second full time Nurse Practitioner and an additional part time nurse and are in the process to recruit an additional Health Care Assistant. CBC have also supplied the resource of a Pharmacist and Pharmacy Technicians at Crawcrook Surgery, who can manage a substantial amount of the medicines management work, which will free up time for the GPs to be able to see more patients at Crawcrook.

To safely supervise the clinical skill mix, it is a necessary that there are GPs present on site to safety support and supervise the clinical skill mix of the team. Being on one site will also ensure that GPs have full access to all of the EMIS clinical resources (some of which are not available for the GPs when working from the Greenside site).  This would be impossible to manage with the level of reduced GP capacity in January 2017 unless all of the remaining GPs see patients from one site.

The Committee were advised that the practice is not a dispensing practice and the proposal does not impact in any way on the GMS contract that is in place.

Crawcrook is a training practice and to maintain accreditation for the Training Status with a reduction in our overall GP resource, the consolidation to one site will allow the clinical team to be more effective, reduce the dilution of resource and maintain a clinically supportive environment conductive to training.

Members of the staff at Greenside are lone workers once the GP has finished surgery and whilst safety factors have been put in place to minimise risk, the situation of lone working is not ideal.

Car Parking

Concerns have been raised relating to Parking Issues at Crawcrook Medical Practice and in advance of the OSC meeting an independent survey of the site in relation was carried out the previous week.

Andrew McGarvie from Communities and Environment attended the OSC and provided aerial shots of the car parks in the vicinity of the GP practice and concluded that there was generally sufficient parking in the area available overall to meet local needs and the needs of patients accessing the main GP practice at Crawcrook. Key points to note are there are approx. 11 to 12 staff at the Crawcrook Practice parking in the adjacent care park (which has been designated for staff only and has parking capacity for 16) and arriving before 9am.

However the other nearby car park is only operating at between 60% to 70% capacity throughout the day and there are other time restricted parking bays in the vicinity of the practice.

If the OSC has concerns about car parking resulting from the additional patients who will have to attend the site as a result of the proposed closure of the Branch Surgery at Greenside, the option may be to request that the GP Practice/Assura (who manage the car park) act on the concerns of the Committee and allocate some of the parking provision at the adjacent site to public parking and ask that the CCG and NHS England encourage this course of action (however it does not appear that there is anything requiring them to do so)

The Committee discussed at length the situation facing the practices but noted that it has been coming for a while and was not an isolated incident. The Committee suggested that Government be lobbied and the Department of Health be informed about the situation and the serious problems that now exist with the lack of GPs and failure to recruit.

Committee suggested joint working arrangements being developed with other practices in the vicinity, and although discussions have taken place and practices are willing to work together the situation regarding the lack of or retention of GPs is a borough wide and regional issue.

Ward Councillors, Jack Graham and Kathleen McCartney attended the OSC and raised the following concerns; Cllr Graham expressed concern that some of his constituents are not convinced that closure is a good idea and a petition from the residents is currently being developed. Cllr Graham asked if a locum had been considered? Jane Mulholland reported that no one had come forward albeit this had been explored but the issue of lone working at the Greenside site was putting a lot of people off.

Cllr Graham also expressed concern with the current telephone appointment system not being fit for purpose. The Practice Manager replied that there is a new telephone system in place with additional lines and once all the staff have completed training (which is ongoing) things should improve.

Cllr McCartney asked if any additional provision had been made to transport Greenside residents to the Crawcrook site as the bus service is very poor. The Practice Manager reported that the bus companies had been made aware of the proposed closure and had provided information about bus timetables and timings.

Cllr McCartney asked if the public car park can be returned to public use as it is currently being used by medical centre staff.

Cllr McCartney asked if the practice were aware of the high level of upset and bad feeling amongst the residents? The Practice Manager reported that they were

aware and were arranging an open day and had also held a public meeting recently to try and alleviate as many concerns as possible.

RESOLVED -

i)

That the information contained in the report be noted.

ii)

That the disappointment of the Committee be conveyed to the Government and the Department of Health in order to express concern at the shortage of GPs and lack of retention of GPs within Gateshead borough and the north east region

iii)

That further consultations be undertaken with the community to ease the transition should the proposed closure of Greenside go ahead.