Agenda item

The Committee received a report of the Director of Transformation and Partnerships (for copy see file of Minutes) and verbal update by representatives of Skerne Medical Group further to the end of the engagement period regarding the future of the practice.

 

Dr Hearmon reported that the process started with a meeting with key stakeholders including the local MP, County Councillors and Town and Parish Council Representatives. During the six week period which ended on 3 December 2018, there were six separate public engagement events around the practice area were the dramatic shortage of GP’s was outlined and the difficulties this was causing.  By February 2019 there would be 40% fewer doctors than 2 ½ years ago.  It was therefore felt that the group were unable to safely man four separate sites. More than 400 people took the trouble to attend these events and asked many questions and offered opinions on how to should proceed.  A variety of feedback via the practice website, as well as written feedback left at the meetings or handed in at the surgery was also received.  Patients of all ages who attended the surgery over this time were spoken to, and local providers of mental and physical health care and our local pharmacies were visited to explain the situation.

 

Referring to the engagement process Dr Hearmon said that they were pleased with the turnout of more than 70 people per event.  Over 70 comments were received via the practice website and further written comments were also received.  Verbal feedback during consultancies also took place and many questions were raised at each event.  In addition, although the practice did not use social media, there was considerable discussion on social media.

 

Dr Hearmon reported that feedback from patients had some common themes, as well as some specific issues from particular sites and that in general patients recognised the significant issues faced by Skerne Medical Group due to shortage of GP’s and that changes were necessary.  They expressed concern about appointment availability worsening, given the lack of GP’s and also the current and future housebuilding.  At all sites there was concern about accessing surgeries, both from a public transport availability angle and also the lack of adequate car parking.  Particular groups of patients were mentioned, for example, those with limited mobility and also mums with small children. 

There was significant interest expressed in looking towards relocating the practices given the situation.  Sedgefield Community Hospital was favoured by many patients and a new build surgery on the old school site in Trimdon Village was clearly preferred by the people who lived there.

There were suggestions about financial inducements to attract GP’s, for example, “Golden Hello’s”, provision of a vehicle, and removal expenses.  It was explained, along with the CCG about such schemes elsewhere but that this would not attract GP’s to a multiple site practice.

The subject of section 106 money was raised at all meetings both on what has happened with available funds from the numerous building sites currently being constructed and sites with planning permission where work had not as yet commenced.

 

 

Dr Hearmon summarised themes for each site:-

SEDGEFIELD

•              Shortage of appointments

•              The concern of an increased patient list due to house building

•              Practice boundary change to limit new registrations

•              Lack of significant car parking

•              Interest in Sedgefield Community Hospital 

•              Concern over DNA’s

•              Transport

 

FISHBURN

•              Would prefer to maintain Fishburn site, but felt preservation of whole practice was the greater need and would support this.

•              Interest in Sedgefield Community Hospital

•              Car Parking Issues – not sufficient parking facilities with no room to expand

•              DNA’s

•              Impact on local pharmacy

•              Transport – more centrally located and the challenges of transport links and travel for patients was less.

 

TRIMDON COLLIERY

•              Transport concerns to alternative sites

•              Cost of transport

•              Appointment Availability

•              GP to travel rather than patients

 

TRIMDON VILLAGE

·         Strong feeling of lack of fairness in suggesting closing their site

·         Concern over immediacy of changes verses four year implementation

·         Access to other sites especially the elderly/young mums.  Social demographics a big concern.

·         Poorest facilities deserved development

·         Recruitment issues note understood as nearby practice has full complement of GP’s

·         Social

·         Smallest surgery offering only one GP consulting room and one treatment room. Inability to mentor trainees and other clinicians.

·         Only1500 registered patients which represents approximately 10% of the practice list.

·         A section of Trimdon Village patients have been accessing services at other branches for many years without any formal complaints and since September 2017 only morning appointments had been offered.

 

The existing rented premises are inadequate for modern general practice

 

With reference to the proposed changes, Dr Hearmon said that the practice would provide wider education about practice services, would anticipate increased use and use digital technology in the future.  Keeping Trimdon Colliery open ensures that clinical services were being offered at both the south and north of the current boundary.  With regards to the two major care homes in the area there were more natural links with Willowdene to Sedgefield and Craigarron to Trimdon Colliery.

 

Dr Hearmon added that at the start of the engagement process there had been five partners, one has since retired and another partner had confirmed their resignation and had commenced sick leave.  This left the group with three partners, down from eight.

 

She added that the engagement exercise was a positive interaction with practice and patients to consider options to move forward, that patients recognised the need to change, and that as well as sharing challenges they had learnt clearly about those faced by our patients.  She believed that some future technology based changes would help patients in the future and patients were interested in progressing these.  She reiterated her point that the practice had limited options in the short term to provide safe primary care to all patients and that reduced sites would engage the small pool of experienced GP’s to provide support and supervision to more junior GP’s, GP’s in training and Nurse Practitioners who see patients, in order to maintain the service and ultimately would enable Skerne Medical Group to attract/retain staff both GP’s and Nurse Practitioners in the future.

 

Dr Hearmon advised that in the short term the closure of two of our sites was needed at Fishburn and Trimdon Village leaving clinical services to be provided for patients from Sedgefield and Trimdon Colliery sites. This would have financial consequences to the practice who own the Fishburn site and the site would be utilised to accommodate those AHP’s who provided services from the building for the whole area, for example,  midwives, health visitors, counsellors, mental health workers and podiatrist, as the two clinical sites would be unable to accommodate these services.  Also some practice admin functions would be Fishburn based.

 

In the longer term members were advised that the practice would continue to explore the options available to establish alternative sites for the practice, or development of existing premises.  Medical services had not benefited to any significant degree from Section 106 monies resulting from the widespread development in our area to date and this would be vital for future developments.  The practice would continue to work closely with DDES CCG to achieve a sustainable future once viable options had been fully investigated, there would be an implementation plan developed to remodel the practice sites, taking into account the opportunities from both Trimdon and Sedgefield Community Hospital as well as the two current sites.  Alongside this, strenuous ongoing efforts to recruit GP’s for the future would take place.

 

In summary, Dr Hearmon advised that the change in delivery of service was not about people losing access to their GP but about ensuring all the patents could get quality medical services for the longer term. She was not prepared to see this practice fail due to issues over buildings.  She added that any changes would not reduce the number of appointments and would provide a more efficient operation. She referred to this weekend’s online Sunday Times that showed more GPs heading to conurbations, at the expense of rural areas. By creating a larger, full service, surgery structure would be attractive to this new generation. Two of the recently recruited salaried GPs were leaving for single site practices. The practice area is wonderful countryside, but it’s not Jesmond (Newcastle), Hyde Park (Leeds) or Fallowfield (Manchester). Unless that kind of working environment could be provided, that recent graduates expect, we would only have third rate medical services in ten years’ time.  Dr Hearmon had talked to recently qualified GPs who have said that should be have less sites that the practice would be really attractive, hence the need to change.   She concluded that change always hurt, but if people work together to consolidate the sites this could be really positive for the future. She was sure that we all wanted quality medical services across the practice area, as she did, as when retired she would also be a patient.

 

The Chairman thanked Dr Hearmon for attending the meeting to provide an update.  He had invited Alan Foster to attend and had also notified Hartlepool and Stockton Borough Councils that the meeting was taking place as this decision could also affect some of their residents.  He invited the CCG to comment.

 

The Chief Clinical Officer, DDES CCG supported everything the practice had said and commented that it had provided a very high level of service for a number of years.  As we lived in an ever changing environment, this practice, along with many others, were struggling to attract GPs.  He felt that if the practice did not make these changes then there was a real danger that it would collapse and could potentially have a domino effect that would be catastrophic.  He felt that the CCG had no alternative but to support the practice.

 

The Chairman asked for information on when this decision would be implemented and asked when the meeting would be taking place for the CCG to determine this. The Director of Primary Care and Engagement, DDES CCG informed the Committee that it would be up to the practice to propose an implementation plan with a date of implementation.  He advised that an extra ordinary meeting had bene called of the Primary Care Committee on 18 December at 12.30 p.m. with information available on the website the week beforehand.

 

The Chair of the Patient Focus Group for Skerne Medical Practice although not able to offer an opinion on the decision itself as he was not qualified to do so, commented that the process from the beginning had seen sincere efforts to reach these decisions.  He added that this was not a new issue as the practice had found it difficult to recruit for a number of years.  This and the fact that the partners were working with ever changing policies had made it very difficult but he supported the practice, its manager and partners in reaching this very difficult decision.

 

Councillor Grant was very disappointed with the decision and understood that it had been a very difficult one to make.  However she said that the Trimdon Village site had been left to rot for a number of years and did not feel that this was an emergency situation but a decision that had been coming for the last three years and she believed that something could have been done within this time period.  She appreciated that GPs did have a difficult job to do and had admiration for them.  She felt however that the decision to close Trimdon Village and Fishburn were being made as these were the cheapest options and was not about the safe care of patients, and was a decision that had already been made before the consultation process had taken place.  She pointed out that the consultation meetings had been chaired by what the practice had classed as an independent person, however she informed members that this person was paid to carry out this role by the practice.  Councillor Grant asked who had been spoken to before the consultation as she was not aware of any town or parish councillors being contacted.  She was concerned about the people of these villages especially the vulnerable residents.

 

Dr Hearmon responded that the Overview and Scrutiny had advised the practice who to contact and they had followed that advice by approaching town and parish councils, local county councillors and the local MP.  She confirmed that the decision was not about money but about trying to maintain a service across the practice.  She advised that the independent person chaired the consultation meetings and had been helping the practice with media as they had no expertise to do this and no ability to find the time to find out how to do this due to a shortage of staff.

 

Referring to the buildings not being fit for purpose, car parking and transport, Councillor Patterson asked what other options had been explored.  Dr Hearmon explained that the buildings were not fit for purpose and none of the current buildings would support holding the whole practice on one site.  The Trimdon Village practice was in a converted house which was not up to current standards.  She advised with regards to transport there were bus services running across the area and people had fed back through the consultation that they were happy to use the service to access the other sites.  Dr Hearmon reported that all sites had operated closures over the last 12 months and patients therefore were used to travelling to another site when their practice was closed.  She also reminded members that there was a volunteer driver scheme available.

 

Councillor Patterson said that bus services were not appropriate for all and asked what alternative care provisions had been put in place.  In response, Dr Hearmon reported that the practice had recruited an additional nurse practitioner and a paramedic.

 

The Chairman pointed out that any S106 funding for the GP service went directly to the CCG and advised that the practice speak to them regarding lack of this funding.  He added that as a representative for Fishburn he was shocked at the announcement of the closure and asked when implementation would be.  The Director of Primary Care and Engagement, DDES CCG explained that the practice would present to the Primary Care Committee and from that the practice would determine implementation dates.

 

Referring to the number of patients, Councillor Darkes asked for breakdown for each practice area and was advised that Trimdon Village had 1500, Fishburn had 4079, Trimdon Colliery had 2049 and Sedgefield had 7200.

 

Councillor Brookes said that this was a disgraceful decision and was bad enough that 1500 patients from Trimdon Village were losing their service but that others who were used to travelling to Fishburn would now have to travel to Trimdon Colliery or Sedgefield. He asked how this decision could be justified on business grounds.  He commented that the poorest people would have to travel the furthest for their primary care needs and urged Skerne Medical Group to rethink this decision.  He added that more than 100 people had attended the public meeting in Trimdon Village showing their concern about the proposals.  Councillor Brookes went on to say that this decision would have an impact on appointments in other surgeries and the request for home visits would increase.  He was concerned that 300 people would have to now travel to see a GP and especially during the winter months when there was a poor transport service between the villages.  He asked the CCG to intervene and continue to provide primary care from all four practices.

 

Councillor Bell said that this was a very concerning situation that had deteriorated since the practice were last at committee a couple of weeks prior.  He asked if there was a formula or rational for assessing needs that had been used to inform the decision.  He did accept that the practice did not have the staff to cover all areas.  The Director of Primary Care and Engagement, DDES CCG advised that the GPs contract was not written to cover needs but was about coverage and giving people the ability to register with a GP.

 

Making reference to the car parking problems at Fishburn, the Chairman pointed out that if this facility was going to still be used it would still have the same car parking problems.  He reminded members that this decision could be called in to the Secretary of State but that strict criteria applied.

 

The Principal Overview and Scrutiny Officer referred members attention to the Local Authority Health Scrutiny Guidance published by the Department for Health which set out specific requirements for specific circumstances for referral to the Secretary of State.  The section pertinent to this debate was part c – proposal is not in the interest of health in its area.  Should the committee decide to call in this decision it would need to be reported to full Council where it could be debated.

 

Councillor Grant moved to call in the decision as this was a substantial change that affected services in County Durham and she wanted to support the local residents.

 

Councillor Darkes seconded the call in as felt that the decision was a poor one for the area.

 

Councillor Smith said that she fully understood the concerns of councillors from these areas and should this be called in it would prolong any decision making.  She recognised that the Skerne Medical Group were in deep crisis and should this committee call this in the group would not be able to implement the decision.  She added that the service had demonstrated that they were struggling to provide a service across all four sites due to a lack of personnel, not buildings and therefore she would not support the proposal to call in.

 

The Principal Overview and Scrutiny Officer advised that the committee did agree a recommendation asking for Trimdon Village to be considered as part of the Practice’s longer term review process.

 

The Chief Clinical Officer assured the committee that the people of Fishburn and Trimdon Village were not being left without medical care as this would be provided from different sites.  The Primary Care Committee would look at the contract from Skerne Medical Group which stated that care would be provided across four sites and should the practice not take the advice from the CCG they could issue a breach notice, which was the only power afforded to them.

 

Councillor Crute was concerned about the process and asked where the committee were in terms of the decision making process.  The Principal Overview and Scrutiny Officer explained that the representations made at the meeting on 15 November to Skerne Medical Group could be communicated to the Primary Care Committee for their meeting in December.

 

The Chief Clinical Officer said that the CCG would take note of the recommendation from this committee but their primary concern was that if they did not support the practice there may be a collapse and no practice in the area at all.

 

Councillor Temple understood the real issues facing the surgery in being able to recruit and retain staff and understood that it would be easier for them to recruit to two sites rather than four.  He picked up on Councillor Darkes point about the size of the surgeries and that they would be closing one of the biggest surgeries.  Notwithstanding the geography of the area and where one site was to the other and the transport flow through the villages he felt that there was a real threat to health care for the local people.  He asked the CCG to re-examine the position as there seemed to be no logic in closing the second largest site and keeping one of the smaller sites operational.

 

Councillor Crute was keen that the committee followed due process and asked did not obstruct the decision of the Primary Care Committee.  He asked that the committee make representations to the Primary Care Committee and reserve the right to make a decision about call in until that decision had been made.  He asked that feedback from the meeting on 18 December was shared with the committee.

 

In light of this, Councillor Grant supported this course of action.

 

Following on from his earlier comments and questions Councillor Bell asked that the CCG look at including a needs assessment in future contracts as patient interactions and transport links to surgeries were more important than the buildings and car parking problems.

 

 

Resolved:

(i)            That representations be made to the Primary Care Committee for their meeting on 18 December 2018;

(ii)          That feedback from the Primary Care Committee meeting be received; and

(iii)         That the Committee reserve the right to make a decision on referral to the Secretary of State for Health and Social Care until a final decision had been made.