PCCC Agenda and Papers July 2017

Agenda

Meeting Name: Primary Care (General Practice) Commissioning Committee (Formal)

Date/Time: Friday 28th July 2017 9.00-11.00 Venue: Boardroom 1 Bevan House AM

Chair: Terry Savage Meeting No: 14 Reporting Period: 2016/17

Quoracy: The Committee Chair (or Vice-Chair, if the Chair has declared a conflict of interest); NHS SCCCG & NHS VRCCG Chief Finance Officer (or nominated deputy); At least one other NHS SCCCG & NHS VRCCG Executive Director (or nominated deputy). Plus one other voting Committee member. Business Subject Topic Topic Name Lead Time Reports/ No. Slot Verbal Page No.

14.1.1 • Welcome Chair Verbal • Apologies for Absence

14.1.2 Declarations and Chair Verbal Conflicts of Interest Committee Management 14.1.3 Confirmation of Chair Verbal Quoracy

14.1.4 Minutes of the last Chair Attached meeting p4

14.1.5 Action Log Chair Attached p9

14.2.1 Application to Close C Leese/C Attached Contracting Rode Heath Branch Harley p10 Performance Surgery submitted

• Application p38 Form completed by Practice • Equality Impact Assessment • Supporting Appendices as detailed in the papers

14.2.2 Update from NHS NHS England Verbal England

NHS Vale Royal Clinical Commissioning Group NHS South Cheshire Clinical Commissioning1 of 78 Group

Agenda

14.2.3 Update from C Leese/C Verbal Operations Group Harley

Finance 14.3.1 Finance Update L Weekes/J Verbal Burchell

AOB Next meeting 29 Sept 2017 All Verbal Future Dates

24th November 2017

Closed Session

Please see separate addendum.

Circulation list Name Organisation Job Title

John Clough NHS SCCCG Lay Member Tracy Parker-Priest NHSSCCCG & NHS VRCCG Chief Operating Officer/Executive Director of Transformation And Commissioning Lynda Risk NHS SCCCG & NHS VRCCG Interim Accountable Officer/Chief Finance Officer Judi Thorley NHS SCCCG & NHS VRCCG Chief Nurse & Director of Quality Amanda Best NHS SCCCG & NHS VRCCG Service Delivery Manager – Primary Care Transformation Dr Mark Dickinson NHS SCCCG & NHS VRCCG Medicines Management Will Greenwood Cheshire Local Medical Chief Executive & Company Committee Secretary Julie Hughes Cheshire Local Medical Head of Business Operations Committee Dr Annabel London NHS SCCCG & NHS VRCCG Clinical Lead for Primary Care

Diane Noble NHS SCCCG Lay Member

Terry Savage NHS VRCCG Lay Member Patient Engagement Suzanne Horrill NHS VRCCG Lay Member

NHS Vale Royal Clinical Commissioning Group NHS South Cheshire Clinical Commissioning2 of 78 Group

Agenda

Carla Sutton NHS England Contracts Manager – Medical Team Tom Knight NHS England Head of Primary Care Commissioning Guy Hayhurst Cheshire East Council Consultant in Public Health

Chris Leese NHS SCCCG & NHS VRCCG Primary Care Operations Manager Helen Bromley Cheshire West & Chester Consultant in Public Health

Gavin Owen Cheshire East Healthwatch

Lorraine Weekes-Bailey NHSSCCCG & NHS VRCCG Primary Care Accountant

Sam Richards NHSSCCCG & NHS VRCCG Primary Care Quality Manager

Diane Sandbach NHSSCCCG & NHS VRCCG Practice Engagement Manager

Sharon Yates NHSSCCCG & NHS VRCCG Practice Engagement Manager

Caroline Harley NHSSCCCG & NHS VRCCG Primary Care Contracts Manager Dr Sinead Clarke NHSSCCCG & NHS VRCCG Clinical Lead

Donna Rowell NHSSCCCG & NHS VRCCG Interim Associate Director of Operations Kevin Highfield NHSSCCCG & NHS VRCCG Service Delivery Manager IT & Information James Burchell NHSSCCCG & NHS VRCCG Senior Primary Care Accountant Ann Gray NHSSCCCG & NHS VRCCG Lay Member

NB: Other directors/managers to be invited to discuss areas of risk or operational issues that they are responsible

NHS Vale Royal Clinical Commissioning Group NHS South Cheshire Clinical Commissioning3 of 78 Group

Minutes

Meeting Name: Formal Primary Care (GP) Commissioning Committee-Part A Date/Time: Friday, 23rd June 2017 Venue: Board room, Bevan House @ 0930-1100 Chair: Terry Savage Meeting No.: 13 Reporting Period:2017/18 Membership Name Organisation Job Title Present John Clough NHS SCCCG Lay Member  Terry Savage NHS VRCCG Lay Member Patient  Engagement Diane Noble NHS SCCCG Lay Member Patient  Engagement Ann Gray NHS SCCCG & NHS VRCCG Lay Member  Lynda Risk NHS SCCCG & NHS VRCCG Chief Finance Officer X Moira Angel NHS SCCCG & NHS VRCCG Director Quality &  Safeguarding Helen Bromley Cheshire West & Chester Consultant in Public health  Fiona Reynolds Cheshire East Council Consultant in Public Health X Carla Sutton NHS England Senior Contracts Manager X Thomas Knight NHS England Head of Primary Care X Commissioning Louise Barry Healthwatch CWAC Interim Chief Executive X Dr Annabel London NHC SCCCG GP  Mark Dickinson Medicines Management Doctor X Lorraine Weekes NHS SCCCG & NHS VRCCG Finance  Chris Leese NHS SCCCG & NHS VRCCG Service Delivery Manager PC 

Sam Richards NHS SCCCG & NHS VRCCG Primary Care Quality & X Performance Manager Amanda Best NHS SCCCG & NHS VRCCG Service Delivery Manager PC X Sharon Yates NHS SCCCG & NHS VRCCG Practice Engagement Manager X Diane Sandbach NHS SCCCG & NHS VRCCG Practice Engagement Manager X Caroline Harley NHS SCCCG & NHS VRCCG P C Contracts Manager  Kevin Highfield NHS SCCCG & NHS VRCCG IT Manager  Linda Elliott MIAA Audit Manager  Lorraine Weekes- NHS SCCCG & NHS VRCCG Finance  Bailey James Burchell NHS SCCCG & NHS VRCCG Finance  Tricia Vickers NHS SCCCG Practice Nurse – Quality X

NHS Vale Royal Clinical Commissioning Group NHS South Cheshire Clinical Commissioning Group 4 of 78

Minutes

Sue Forrester-O’Neil NHS SCCCG & NHS VRCCG Snr Quality & Improvement  Manager Gillian Harwood NHS VRCCG Practice Nurse - Quality X Wendy Jeffries NHS SCCCG & NHS VRCCG PA / Minute taker 

Ref. Discussion and Action Points Action

13.1 Committee Management 13.1.1 Welcome & Introductions Apologies for Absence As Chair, Terry Savage (TS) welcomed everyone to the meeting and introductions were made.

Apologies were accepted from Carla Sutton, Lynda Risk, Louise Barry, Sam Richards and Gillian Harwood.

13.1.2 Declarations and Conflicts of Interest There were no conflicts of interests declared in respect of Part A apart from:

Annabel London: GP at Kiltearn Medical Centre, which is a member of the GP Alliance, lets out rooms to a local audiology private provider; the practice is involved in research and involved with community services. Husband is a Consultant at the Countess of Chester Hospital.

Kevin Highfield: Trustee at St Luke’s Hospice, Winsford

13.1.3 Confirmation of Quoracy

The meeting was deemed Quorate. • The Committee Chair (or Vice-Chair, if the Chair has declared a conflict of interest); • NHS South Cheshire CCG and NHS Vale Royal CCG Chief Finance Officer (or nominated deputy); • At least one other NHS South Cheshire CCG & NHS Vale Royal CCG Executive Director (or nominated deputy) • One other voting Committee member.

NHS Vale Royal Clinical Commissioning Group NHS South Cheshire Clinical Commissioning Group 5 of 78

Minutes

13.1.4 Minutes of the last meeting (31st March 2017) The Committee approved the minutes from the March 2017 meeting as a true and accurate record.

13.1.5 Action Log The action log had been circulated with the Agenda for information – please see separate updated list.

Updates: 11.2.4: CL has had discussions regarding the GP Forward View action plan with the Transformation Team. The overall plan has gone to the Primary Care Operations Group and exceptions will be highlighted to the Committee in due course.

11.3.1: JB updated the Committee saying that the two-part payment will move to a single monthly payment and a finance meeting is being held soon. Superannuation discussions are still on going.

13.2 Contracting Performance 13.2.1 NHS England Update

NHS England was not represented at today’s meeting.

• JB stated that he has asked for a regular copy of the NHSE Network Bulletin – this month’s copy notes a new record transfer service for medical records is due to be rolled out nationally after having been trialed in a specific area. It is hoped that the service will improve.

13.2.2 Draft Revised Delegated Commissioning Risk Register

• Risk 1: Finance is to review this with updated information for 17/18.

• Risk 2: stays as red. Review after August when newly qualified GPs change their status on the Performers List & start work in local practices.

• Risk 3: new guidance on Conflicts of Interest has been received. This is currently being reviewed.

• Risk 12: covers workload with Delegated commissioning.

• New directions and premises costs – update expected imminently and risk can be re-assessed following that. Potentially NHSE may not be continuing with Rent & Rates reviews. These could pass to Delegated CCGs.

• Risk 8 (formally on the Governing Body risk register, thought more

NHS Vale Royal Clinical Commissioning Group NHS South Cheshire Clinical Commissioning Group 6 of 78

Minutes

appropriate to be tracked through this committee) refers to a risk KH regarding sustainability of GP practices.

• KH asked, in view of the recent Malware Cyber-attack, if the IT risks should be added to the Risk Register – the Committee agreed to this. 13.2.3 Update from Operations Group P12 CL highlighted the following: refers • CL highlighted the work to be undertaken in relation to PMS KPIs and historic non-core contract payments

• New housing developments in our areas are adding new pressures to Practices etc; JB is currently looking at financial support for the CCG’s to manage this issue.

Recommendations: Committee received and noted the update.

13.2.4 Primary Care Contracting & Quality Flow Chart P16 CL gave an overview on the CCGs currently deal with Quality and refers Contractual issues in relation to Primary Care as it had been a request from the Committee to produce a visual form of summary to show the flow of issues into the CCG in respect of quality and contractual issues to give assurance.

MA suggested tracking some case studies to see how the current process works further but this would not need to return to the Committee

CL stated that contractual quality issues are sent from NHS England for the CL/SFON CCG’s to manage. He added that complaints can come in from several areas (patients, practices, NHSE), hence a process was needed to deal with these and manage (through appropriate forms etc) to show the whole picture.

Recommendations : Committee received and noted and discussed the process - this item can now be closed on the Action Log 13.2.5 GP IT Report P19 KH reported the following: refers • Budget management and GPIT Bids have been successful with two separate work-streams: GP in general and Estates &Technology Fund (ETTF).

• IT is working closely with the GP Alliance to manage all the changes.

• Some projects have been carried forward from the last Financial Year.

NHS Vale Royal Clinical Commissioning Group NHS South Cheshire Clinical Commissioning Group 7 of 78

Minutes

• KH was asked about the GP’s Cheshire Care record (CCR) to which he confirmed that the majority of GP practices across Cheshire are uploading data to the CCR. Further discussions at NHS SCCCG Membership Council meeting to encourage Practices to sign up for the CCR will be planned.

JB suggested that there may be issues around data security – KH assured the Committee that data will be as secure as any other NHS data. This was also confirmed by L Elliott with respect to Governance.

KH confirmed that a CCR programme board will be set up to oversee programme delivery. 13.3 Finance 13.3.1 Finance & Premises Update P37- Report covers Financial position and overview of Months April 2016 – 39 February 2017. refers JB and LW-B highlighted the following points:

• There has been a1.8% uplift for NHS South Cheshire CCG.

• CL reported that the Quality Outcomes Framework (QOF) had followed the NHSE process and the CCG had signed off the Practice declaration but these require post payment validation for which discussions are underway with Eastern Cheshire CCG in terms of process this would be between Quality and Primary Care Contracting

• AL highlighted a potential issue concerning GP sickness and payments for Locums etc. This was noted.

• Forecasting to budget – a more in-depth picture will be available at the end of Quarter 1 (end of Month 3).

Any Other Business

• HB reported that the Public Health Team has re-issued Public Health Services on the CWAC website showing that there is potential change in footprint and Primary Care implications. CL will read through the CL document and discuss with S Whitehouse to see if a response has been given to Public Health with regards to this.

• HB also reported that Public Health have a new Director called Ian Ashworth.

Next Meeting will be held on Friday, 28th JULY 2017 at 0900 here at Bevan House.

NHS Vale Royal Clinical Commissioning Group NHS South Cheshire Clinical Commissioning Group 8 of 78 Reference in Original Meeting Action By Title Description By Whom Status Comments Minutes Date Requirements When Mtng 25/01/17 10.1.3 Confirmation of Quoracy The Quoracy to be added to future agendas. WJ March Complete Delegated Commissioning Risk Register & Update Risk register to reflect Red rating re budget raised by NHSE annual 10.2.2 JB March Complete Update from Task & Finish Group uplift does not take into account population growth. Paper required to discuss options going forward and to escalate the 10.2.2 as above LR/JB/LW/CL March financial situation with the NHSE allocation to Governing Body. CL to work with the Quality team to provide a visual representation showing CL/ Quality 10.2.3 Primary Care Quality & Contracting - reporting all route available for escalating primary care contractual.Quality issues March Ongoing team etc. To discuss at the Ops Group also. Mtng 31/03/17 11.2.2 Delegated Commissioning Risk Regiser Risk 1: JB to amend for 17/18 to reflect latest information JB May " Risk 5: CL to amend for 17/18 to reflect latest information CL May " Risk 8: JB to amend risk for 17/18 JB May CL to speak to AB regarding the GP Forward View Plan being a future agenda item. UPDATE: CL has had discussions regarding the GP 11.2.4 Transformation update Forward View action plan with the Transformation team. The overall CL May plan has gone to Primary Care Operations Group, exceptions will be highlighted to the Committee in due course. KH to produce a briefing paper to circulate with the minutes of meeting 11.2.7 GP IT Report CH/KH APRIL held 31/3/17/ CCGs and NHS England to look into the single practice contract payment. UPDATE: JB updated the Committee saying that the 2-part payment 11.3.1 Finance & Premises Update LR & CS May will move to a single monthly payment and a finance meeting is being held soon. Superannuation discussions are still on going.

" JB & TK to discuss superannuation payments by GP Practices. JB/TK May Mtng 23/6/17 Draft Revised Delegated Commissioning Risk Risk 8 (formally on GB risk register) - risk regarding sustainability of GP 13.2.2 KH July Register practices Process needed to deal with contractual quality issues sent from NHS 13.2.4 Primary Care Contracting & Quality Flow Chart CL/SFON July England for CCG's to manage CL to read through re-issued Public Health Services document on CWAC Any Other Business website and discuss with Accountable Officer to see if a response has CL July been given to PH with regards to this.

9 of 78

Report - Template amended May 2017

Agenda No.:

Primary Care (General Practice) Commissioning Committee – Part Report To (committee): A Greenmoss Medical Centre - Proposed Closure of Rode Heath Branch Report Title: Surgery Meeting Date: 28 July 2017

Report Author(s) Governing Body Lead Chris Leese Name Name Lynda Risk Caroline Harley Primary Care Operations Manager Interim Accountable Officer/Chief Title Title Primary Care Contracts Manager Finance Officer Clinical Lead / Clinician sign-off Name Dr Annabel London Name Title Clinical Lead – Primary Care Title

CCG Strategic Priorities (5+1) supported by this paper Transforming Primary Care  Transforming Mental Health X Transforming Urgent Care X Integration  Person Centred Care  NHS Constitution Targets X

Outcome Required Approval  Assurance Discussion  Information Recommendations: The Primary Care (General Practice) Commissioning Committee is asked to make a decision to approve or not approve the Application from Greenmoss Medical Centre to close their branch surgery at Rode Heath. In making this decision the Committee should be assured that due process has been completed. The decision will should take into account any pertinent issues raised by the Cheshire East Council Adult Social Care and Health Overview and Scrutiny Committee on the 6 July 2017. If approved the Committee should agree a date from which the closure will be effective from.

10 of 78

Executive Summary (key points, purpose, outcomes) Greenmoss Medical Centre, Scholar Green, have applied to close their Branch Surgery at Rode Heath. A due process under the Policy Book for Primary Medical Services has to be followed to enable this decision to be made. The purpose of this paper is to ;

(1) Provide the Primary Care Commissioning Committee with an overview of the proposal from Greenmoss Medical Centre to close their branch surgery at Rode Heath, together with the Application Form from the Practice and respective Appendices which will include details of the patient Consultation undertaken. All documents should be read and noted as part of the decision making process, mindful that the Application and the relevant appendices have been written by the Practice. (2) To provide assurance that due process has been followed. (3) To provide assurance that commissioners have considered the impact of the cessation of the services at this location. (4) To take into account any issues that arose from the review by the Cheshire East Overview and Scrutiny Committee on the 6 July 2017 and for the Committee to consider this as part of the decision making process.

The Outcomes from the Committee discussion will be that ;

(1) A decision will be made in respect of the closure proposal (2) Any additional issues that the Committee wish to raise with the Practice in respect of either decision and, if agreed, the date from which the Closure will become effective.

Reviewed by (e.g. committee/team/director) Name (Individual or Group) Date

Finance implications Funding required? (Please tick. If yes, please complete section A) Yes No X Section A Service Title Recurrent (£000s) Non-Recurrent (£000s)

Included in 17/18 budget? (Please tick. If no, please complete section B) Yes No X Section B Proposed source of funding N/A

Have the following areas been considered whilst producing this report? Yes N/A

11 of 78 NHS Vale Royal Clinical Commissioning Group NHS South Cheshire Clinical Commissioning Group

Other resource implications (apart from finances covered above)  Equality Impact Assessment (EIA) included with the application  Health Inequalities (JSNA, ISNA)  Risks relating to the paper  Quality & Safeguarding (6 C’s +1, CASE)  Stakeholder engagement/involvement (member practices/GP Federations, patients &  public, providers etc.) included with the application Regulatory, legal, governance & assurance implications  Procurement processes 

Glossary/Acronyms GMS General Medical Services PC (GP) CC Primary Care (General Practice) Commissioning Committee SCCCG South Cheshire Clinical Commissioning Group

1. Purpose of the paper

1.1. This paper provides the details of an Application from Greenmoss Medical Centre, Portland Drive, Scholar Green, Stoke On Trent, ST7 3BT, Scholar Green, to close and therefore cease provision of services from their Rode Heath Branch Surgery, 130 Heath Avenue, Rode Heath, Stoke On Trent, ST7 3TH.

1.2. Branch closures form part of the NHS England Policy Book for Primary Medical Services which CCGs are obliged to follow under their Delegation Agreement with NHS England. The process is laid down within this policy. Practices wishing to close their branch surgery must apply to the CCG using an application template (attached with this application) – The CCG must consider the application alongside the evidence of a patient consultation process, the outcomes of which should be evident within the paper.

1.3. This paper will highlight any further issues and risks in respect of this.

1.4. This paper will also outline the patient Consultation process undertaken including feedback from the Cheshire East Council Adult Social Care and Health Overview and Scrutiny Committee

1.5. The aims and objectives of this paper are to ensure that the Committee is able to make a final informed decision on the proposed closure of the Branch Surgery at Rode Heath ensuring that the members have considered fully the impact of the cessation of services from this location and been assured of the patient consultation process.

12 of 78 NHS Vale Royal Clinical Commissioning Group NHS South Cheshire Clinical Commissioning Group

2. Background

2.1. Greenmoss Medical Centre, Scholar Green is contracted to provide General Medical Services to their practice patient list of 4822 patients. At present the practice is working over two sites and wishes to cease provision at the Rode Heath Branch Surgery site whilst maintaining full patient registration at the main site and the existing Practice boundary.

The practice demographics (above) are taken from the Primary Care Webtool December 2016 noting the full age range of patients across the whole Practice registration, branch and main. Please note within the screenshot the Practice name is given as Cinderhill Practice (the previous practice name/address).

2.2. The current practice boundary and patient catchment area are as follows:

13 of 78 NHS Vale Royal Clinical Commissioning Group NHS South Cheshire Clinical Commissioning Group

This map is taken from the Primary Care Webtool - December 2016.

2.3. Greenmoss Medical Centre is also a dispensing practice. The practice dispenses on both sites. The practice will still continue to dispense from the main site to the dispensing list of patients if the closure is approved. The Committee should note that the Regulations that govern the Dispensing side of General Practice are governed by the Pharmaceutical Regulations by NHS England and are not for consideration by this Committee.

2.4. Greenmoss Medical Centre is located in a purpose built medical facility opened in 2013. The facility has 8 GP consulting rooms, 5 treatment rooms and a minor surgery suite, all on the ground floor. The premises are fully compliant and accessible with a carpark. Rode Heath Branch Surgery is located in a converted detached house in a residential area. There is limited on the road parking. The building is over two floors with a consulting/treatment room on the ground floor and a treatment room on the first floor. Not all patients be seen on the first floor as there is no lift access to the first floor. The building was recently inspected by CQC which resulted in the building receiving a ‘requires improvement’ notification in the Are Services Safe? Section. CQC recorded in their report after their inspection in January 2017 that there needed to be an up to date electrical wiring inspection and a legionella risk assessment undertaken. The CQC Report for the surgery is available within the public domain. Appendix 10 shows outside photographs of the branch surgery. Clinical and non - clinical staff currently work across both sites.

14 of 78 NHS Vale Royal Clinical Commissioning Group NHS South Cheshire Clinical Commissioning Group

2.5. The current opening hours at the two surgeries are as follows:

Greenmoss Medical Centre

Monday 08.30-18.30 Tuesday 08.30-14.00 Wednesday 08.30-18.30 Thursday 08.30-14.00 Friday 08.30-18.30 Saturday Closed Sunday Closed

Rode Heath Branch Surgery

Monday Closed Tuesday 16.00-18.30 Wednesday Closed Thursday 16.00-18.30 Friday Closed Saturday Closed Sunday Closed

*The Committee should note that the Practice is responsible for the provision of essential services however between 8am and 6.30pm Monday to Friday and these times relate to physical opening times at the surgery premises.

The Practice recently reduced the provision at the Branch surgery due to the retirement of the Senior Partner at the Practice reducing the ability to provide a range of full services across both sites. Currently this vacancy remains unfilled.

The current staffing mix at the surgery in addition to the 3 GP Partners are as follows (the second box denoted any change to the Staff should the closure be approved)

Current After change Dispensing 24 24 Reception 20 20 Administration 17 17 Secretarial 7 7 Nursing 14 14 HCA 3 3

2.6. The distance from Rode Heath Branch Surgery to Greenmoss Medical Centre is 2.8 miles. The distance from Rode Heath Surgery to Alsager Health Centre (2 practices work from this site – Merepark Medical Centre and Cedars Medical Centre) is 2.5 miles.

15 of 78 NHS Vale Royal Clinical Commissioning Group NHS South Cheshire Clinical Commissioning Group

2.7. It is important to note that all registered patients who use the Rode Heath Branch Surgery will still remain registered with the Practice if the closure is approved. However Patients still retain the right to register with an alternative local practice if they wish as long as that Practice registration area covers their home address.

3. Consultation Process

The Practice should also make reference to the relevant Appendices and Practice Application Form

A Summary of the timetable followed by the Practice is given below ;

Hold Patient Panel 6th March meeting Agree: w/c 6th FAQs March Survey Questions Plan of engagement for the Patient Panel Launch online 15th March survey/Feedback w/c 13th leaflet March Patient Panel presence Patient Panel at both practices and social group meetings to conduct paper copy surveys Letter to all households 15th March w/c 3rd April Update website with 3rd April (delay re change of website provider) information Close online survey 24th April w/c 24th Collate responses 26th April April w/c 5th June Patient Panel meetings 5th June/12th June to discuss survey results w/c 12th Patient Information 13th June June Session to inform of results of Consultation

3.1. Following an initial meeting with the CCG in February and subsequent letter of intent, the Practice were asked to commence a Consultation Process with patients which would be included as part of the application to close the surgery and is a requirement of the process.

3.2. The Consultation process should be appropriate and proportionate to the individual circumstances of the change being proposed and the Commissioner should be assured of this.

16 of 78 NHS Vale Royal Clinical Commissioning Group NHS South Cheshire Clinical Commissioning Group

3.3. A Patient survey (Appendix 4) was developed with the input of the Patient Participation Group and took the form of a letter (Appendix 2) and survey to every registered household regardless of whether patients were regular users of the branch surgery or not. The survey ran from 15 th March to 24 th April 2017.

3.4. The survey was also available on line and if requested was available in other formats. A Frequently Asked Questions list (Appendix 3) which was updated once questions from the patients started to come into the Practice was made available on-line and in both Practices in hard copy format. All staff were trained and aware of the process to be able to answer questions and concerns.

3.5. Due to NHS Guidance regarding Purdah in relation to the General Election, the original dates of the patient feedback results were amended resulting in further time between the close of the survey and the sharing of the results.

3.6. Following the close of the survey further meetings were held with the Patient Participation Group on 5 June and 12 June 2017 to examine the results of the patient survey and allow the group to make their own comments.

3.7. A patient information meeting was held on the 13 June 2017 to which all patients were invited to inform patients of the outcomes of the survey and to answer any further questions and concerns raised (around 30 patients attended).

3.8. The results (Appendix 1/Raw Data Appendix 9) were made available to patients via the surgery website along with the questions and answers from the meeting held on the 13 June 2017. The results and responses to concerns are also displayed within the Practice. For those patients who could not attend the meeting there was the option on the questionnaire for them to request the outcome of the engagement process to be sent to them by email or their home address.

3.9. The Practice received advice and support from the CCG in respect of the Consultation process required for these changes.

3.10. A Press release was issued in relation to this (Appendix 5)

3.11. Greenmoss Medical Centre at the end of June 2017 submitted a formal Application to Close the Branch Premises – (Appendix 6) as required under the relevant Policy Book.

4. Survey Results Summary

The Committee should also make reference to the relevant Appendices and Practice Application Form.

4.1 The PC (GP) CC Committee should carefully consider the concerns raised from the survey, the Practice response to them as part of the decision making process including the responses from the Cheshire East Adult Social Care and Health Overview and Scrutiny Committee.

4.2 From the survey /Consultation letter that went to every registered household, 582 patients responded. Within households, responses could include numerous individual responses or patients could individually respond on-line.

4.3 Only 1% of those respondents used public transport to travel to their Practice site of choice.

17 of 78 NHS Vale Royal Clinical Commissioning Group NHS South Cheshire Clinical Commissioning Group

4.4 The majority of those who responded had not used the branch surgery more than once a month, with the highest proportion only using the branch surgery once or twice a year.

4.5 According to the survey results the vast majority of patients use the main surgery (Greenmoss). 25% only use the branch surgery (Rode Heath) with 20% using either.

4.6 Respondents who supported the plan in principle to close the surgery and provide services from Greenmoss surgery (the main site) was 72%.

5.0 Considerations

5.1 One of the main concerns raised during the Consultation was Public Transport and further information is provided below to assist the Committee in considering the impact of this with additional information contained within the Application ;

I. The survey results did show that the vast majority of respondents did not travel by public transport. Additional work undertaken by the Practice contained within the application indicated that within a year there were 162 patients living in the Rode Heath area who solely attended Rode Heath Surgery only for appointments as opposed to the main surgery only or either the main or the branch. II. The Practice advised that there is extremely little public transport either way between the sites and this is historic. This doesn’t apply just to Rode Heath but may also apply to surrounding areas. III. In view of this the Practice has signposted patients to the current Consultation process underway in relation to public transport by Cheshire East Council IV. Patients who are vulnerable and housebound who are unable to get to the surgery and assessed as requiring a home visit would still receive one. V. The Practice is able to flag patients who may be reliant on family/carer members and work with them to find a mutually convenient time for appointments. VI. The Practice have advised of their willingness to work with partners and other stakeholders, to look at the issue further and to act on any further feedback from the Overview and Scrutiny Committee.

5.2 As part of Delegated Commissioning responsibilities the CCG has undertaken an Equality Impact Assessment Stage 1 (Appendix 7) to establish if there would be any significant negative impacts risks associated with the proposal. The screening tool identified that there were impacts and risks involved. The CCG therefore completed the Equality Impact and Risk Assessment Stage 2 (Appendix 8).

5.3 In addition the CCG has also contacted the two Practices located in Alsager, NHS North Staffordshire CCG, NHS Eastern Cheshire CCG and the Local Medical Committee (LMC) for any additional information in respect of the potential impact and further comments.

5.4 The Committee should consider the impact on any local practice in respect of if a significant number of patients decide to register with a local Practice that covers their home address, should the application be approved.

5.5 The Practice also had a number of additional comments from Patients (some of which are given in the Application Form) and these will be worked through by the Practice.

18 of 78 NHS Vale Royal Clinical Commissioning Group NHS South Cheshire Clinical Commissioning Group

5.6 Based on further information provided by the Practice (below) the location usage can be broken down in respect of the following which the practices has used to demonstrate potential usage of both sites and therefore any impact on residents close to the branch or the main surgery

*Consultation facts & figures (1.2.2016-7.2.2017)

Rode Heath Scholar Green, Mow Cop Total & etc Alsager Registered patients 1483 (31%) 3339 (69%) 4822 Had an appointment at 1096 (74%) 1503 (45%)* Rode Heath Surgery Had an appointment at 1000 (67%) 2760 (83%) Greenmoss Medical Centre Had an appointment at 162 (11%) Rode Heath Surgery but not at Greenmoss Medical Centre *Taken from the Practice Application

5.8 The Committee may wish to consider some of the highlighted risks and benefits if the closure were to be approved, but these should only be considered in the context of the overall Application and accompanying information ;

• Same level of service for all Patients who previously may not have had this had they attended the Branch Surgery only. • More pro-active co-ordination and continuity of care on one site – for example in respect of patients with patients for long term conditions and more complex health problems • Improved physical environment including access, parking and ground floor services. • No changes are required to the Greenmoss Medical Centre to accommodate the increased number of patients using the site. • Longevity of the Main surgery and room for growth and expansion of services • GP and nursing time currently split on a rota basis between the two sites • The Branch surgery issues picked up via CQC and general building limitations. • Transport Issues as detailed in 5.1 above (noting the actions the Practice have proposed in relation to this) including patients who are unable to access the services at the main Surgery easily • Any issues with regards to due process and Consultation that may result in an issue not being considered adequately • That the needs and considerations of vulnerable patients have been addressed • The Practice’s ability to maintain continued provision at both sites given the GP vacancy.

19 of 78 NHS Vale Royal Clinical Commissioning Group NHS South Cheshire Clinical Commissioning Group

6.0 Feedback from Overview and Scrutiny Committee

On the 6th July 2017 the CCG attended the Health and Adult Social Care and Communities Overview and Scrutiny Committee. Following the debate and discussion the CCG were asked to clarify some additional points and these are given below with the relevant responses from the Practice. The Committee are asked to ensure that these points are fully explored as part of the decision making process.

• Confirmation required as to the extent of the Practice publicised, the Patient Information Meeting 13.6.17

The Practice publicised the Patient Information Meeting in both Practices (Greenmoss and Rode Heath) and on the practice website. The practice also mentioned the details of the meeting as part of correspondence with the Parish Council.

• Confirmation as to how the Practice fed back the Patient Survey Findings at the Patient Information meeting (How were the results disseminated to the Community)

The results are available on request from both Practices, they are displayed on boards in the waiting area and they were published on the practice website a week after the Patient Information Meeting to include the questions raised at the meeting. Patients were also given the option, on the questionnaire, for them to request the outcome of the engagement process to be sent to them by email or their home address. This has been carried out by the Practice.

• Confirmation required of proposals to assist Patients who visit the Surgeries on foot (given the proposed branch closure)

In the survey 25% of the 582 people who responded, walked to their GP practice. The survey results did show that the vast majority of respondents did not travel by public transport. Additional work undertaken by the Practice contained within the application indicated that within a year there were 162 patients living in the Rode Heath area who solely attended Rode Heath Surgery only for appointments as opposed to the main surgery only or either the main or the branch.

The Practice is able to flag patients who may be reliant on family/carer members and work with them to find a mutually convenient time for appointments.

The Practice have advised of their willingness to work with partners and other stakeholders, to look at the issue further and to act on any further feedback from the Overview and Scrutiny Committee.

• There was a query regarding a figure quoted in respect of costs to address the issues at the Branch Surgery.

The Practice have been unable to find this specific quote given at the meeting in any of the related documents

7.0 Recommendations

7.1 The PC (GP) CC is asked to acknowledge that the consultation process followed by the practice has been fair and proportionate and all relevant parties have been involved.

20 of 78 NHS Vale Royal Clinical Commissioning Group NHS South Cheshire Clinical Commissioning Group

7.2 To agree that all relevant information has been included in this paper for an informed decision to be made.

7.3 To consider the proposal to close the Rode Heath Branch Surgery and whether to approve this application

7.4 Any additional points that the Committee wish to raise in respect of the decision that the Practice should be aware of, including, if approved, the date of closure.

7.5 That the Committee has considered the issues raised by the Overview and Scrutiny Committee and is satisfied these have been addressed

Appendices

Appendix 1 – Patient Survey Results Summary Appendix 2 – Patient Letter Appendix 3 – Frequently Asked Questions Appendix 4 – SurveyResults Appendix 5 – Press Release Appendix 6 – Practice Application to Close the Branch Appendix 7 – Equality Impact Assessment Stage 1 Appendix 8 – Equality Impact Assessment Stage 2 Appendix 9- Patient Survey Results Raw Data Appendix 10 – Branch Surgery Photographs outside

21 of 78 NHS Vale Royal Clinical Commissioning Group NHS South Cheshire Clinical Commissioning Group What have we done to maintain services to patients during the consultation period?

• Increased dispensary opening hours at Greenmoss Medical Centre

• Increased reception opening hours

• Employed locums to supplement REGULAR GP time

• Introduced Nurse Practitioner appointments for minor illness

22 of 78 The benefits of working from one purpose built site:

Increased opening hours Increased services

Increased dispensary opening hours Increased team working

Peer support for staff & GPs Full disabled access

Large free car park with disabled bays No duplication of costs

Staff cover easier to arrange

23 of 78 Survey results

From the survey/consultation letter that went to every household, 582 patients responded. This represents 12% of the overall practice population

The postcodes answering the questionnaire were:

24 of 78 Other How do you currently travel to your GP 1% surgery?

Walk 25%

Public Transport 1% Own Transport Relatives 68% Transport 5%

25 of 78 How often do you attend Rode Heath?

Less than once a year 25%

Once or twice a year 31%

Between once a month & twice a year 26%

Between once a week & once a month 18%

Once a week or more 18%

0% 5% 10% 15% 20% 25% 2630% of 78 35% Which location do you currently attend when you need to access GP services? 60%

50%

40%

30%

20%

10%

0% Greenmoss Rode Heath Either/both 27 of 78 Do you support the practices plan in principle to close the surgery and provide services from Greenmoss Medical Centre?

No 28%

Yes 72%

28 of 78 Concerns raised via survey comments 1

Increased home visits for GPs This would continue as the current practice

Lack of public transport to travel to Greenmoss Medical Centre This applies to ALL patients, there is no public transport from Mow Cop etc. Also, it means that if Rode Heath patients can’t get public transport to Scholar Green, the reverse is also true – no transport from Scholar Green to Rode Heath. Also, it must be remembered that the practice is in a semirural area and covers approximately 63 square miles, the majority of which does not have good public transport.

Collecting/ordering medication If we were given permission to close Rode Heath Surgery, one option would be to look at offering a delivery service to the housebound. To help ALL patients, would it be an idea to look at putting collection boxes in key areas ie Rode Heath and Mow Cop to help with this?

29 of 78 Concerns raised via survey comments 2

Increased waiting times for appointments We have not planned any reduction in appointments if we are granted permission to close Rode Heath Surgery. At the moment however, there are less appointments available with a REGULAR GP as we have not been able to fill the vacancy following Dr Patterson’s retirement. We are using locums to supplement this to maintain the service to patients.

Greenmoss Medical Centre needs to be open more If we were given permission to close Rode Heath Surgery, Greenmoss Medical Centre will be open 8.30am-6.30pm Monday to Friday. This means no closure on a Tuesday and Thursday as at present. The dispensary has already increased its opening hours by 5 per week.

30 of 78 Concerns raised via survey comments 3

Need to replace Dr Patterson ie recruit a new GP We continue to try to recruit another GP. We have spent several thousands of pounds in the past 2 years trying to do this, along side the ‘free’ adverts on local networks, GP Post Graduate Centres etc. We continue to actively recruit, but there is a national shortage of GPs and most practices are finding it hard to fill vacancies.

Letter only sent to household, not individual patients The cost of this was £1550 excluding staff costs. The costs would be more than doubled if sent to each individual patient. The letter and basic survey needed to be sent quickly to patients to inform them of what was happening. The practice thought it would be more prudent to spend the ‘saved’ costs on patient care rather than a letter.

Only 12% of patients responded to the survey. This includes numerous individual responses from several households.

31 of 78 Comments from our Patient Panel Group

• If Greenmoss Medical Centre hadn’t been built, the practice would have ceased to exist as the Cinderhill Lane premises were unfit for NHS use. Rode Heath Surgery is now at that stage.

• When Greenmoss Medical Centre was built, the GPs said they would keep Rode Heath Surgery open for as long as they were able despite the former Primary Care Trust recommending its closure. There was never a promise to keep it open forever, this is not feasible in real life.

• Finite resources – the practice has finite resources. We are committed to providing the best service we can within those constraints.

• Extra services are being introduced at Greenmoss Medical Centre. We are working hard to provide services locally to help avoid trips to hospital etc

• We are looking at ways to alleviate the problems caused by the inability to recruit a new GP. We have introduced nurse practitioner appointments and we try to use the same locum GPs as much as possible to provide as much continuity as possible. 32 of 78

Frequently asked questions

• How will you continue to deliver a duty of care at Rode Heath Surgery? • All appointments will be at Greenmoss Medical Centre. There is adequate space, full disabled access and a large carpark. • Transport is going to be an issue for patients - what will the practice do for the patients in Rode Heath Surgery? • Cheshire East Council is currently in consultation with regards to public transport. Perhaps a community group could be formed to liaise with CEC to help them understand the needs of the community. Odd Rode Parish Council also has transport and perhaps they could look at working with the community group. Transport is an issue for all services, not just health. There is very little public transport in Mow Cop, Rode Heath etc. The transport issue affects ALL patients, not just those in the Rode Heath area. If a patient can’t get transport from Rode Heath to Scholar Green, then the reverse is true, a Scholar Green patient can’t get public transport to Rode Heath.

33 of 78 Frequently asked questions • A promise was made to residents in Rode Heath Surgery that it wouldn’t close, what happened? • When Greenmoss Medical Centre was opened, the Primary Care Trust wanted the practice to close Rode Heath Surgery. The GPs chose to keep it open and said they would do so for as long as it was feasible. Unfortunately that time has now come. The building is no longer suitable for NHS services and the cost to correct this is a practice cost. There isn’t the space physically to ensure disability access requirements are met – this is for staff too, not just patients. The CQC inspection in January 2017 rated the premises at Rode Heath as ‘requires improvement’. NHS income has fallen greatly over the last few years and it no longer makes economic sense to keep both surgeries open when so much is required at Rode Heath Surgery to bring it up to standard • You must have known at the time the promise was made that you couldn’t keep it open? • The Rode Heath Surgery has remained open for 4 years after Greenmoss Medical Centre against the PCT wish for it to close. Unfortunately circumstances change and Rode Heath Surgery is no longer suitable as an 34 of 78 NHS surgery Frequently asked questions

35 of 78 Frequently asked questions

• The size of the building is bigger than is needed – what proportion of the Greenmoss building is used? • The building was built for the future and expansion space was included as part of NHS planning. At the moment the building is currently occupied at approximately 85% making it adequate in size to accommodate Rode Heath Surgery appointments.

• Why was the meeting at Greenmoss and not at Rode Heath Surgery? • There was enough space at Greenmoss Medical Centre to hold the meeting. It is also centrally placed in the practice area and as all patients were invited to the meeting, this was deemed the most central location. There was not enough space at Rode Heath Surgery to hold the meeting

36 of 78 What happens next?

The practice application to close Rode Heath Surgery will be submitted to the Clinical Commissioning Group - Primary Care (General Practice) Commissioning Committee on the 28th July 2017 in Bevan House, Barony Court, Nantwich CW5 5RD.

This is a meeting held in public (not a public meeting) where members of the public can observe the meeting.

The practice application will also be heard at Cheshire East Council, Health, Adult Social Care and Communities Overview and Scrutiny Committee on the 6th July.

Therefore a decision will not be made until 28th July where the Primary Care (General Practice) Commissioning Committee will consider the application fully with the Health, Adult Social Care and Communities Overview and Scrutiny Committee comments.

The practice will then announce the decision. 37 of 78

Greenmoss Medical Centre A member of South Cheshire Clinical Commissioning Group

Dr James Patterson Portland Drive Dr Liz Reynolds Tel: 01270 376800 Scholar Green Dr Sarah Bennett Fax: 01782 782403 Stoke on Trent Dr Neil Bailey ST7 3BT

Branch: 130 Heath Avenue, Rode Heath, Stoke on Trent, ST7 3TH Tel: 01270 376790 (All correspondence to Greenmoss Medical Centre please)

15th March 2017

Dear Household

We are sad to announce that we have applied to close Rode Heath Surgery. Unfortunately the premises are increasingly unfit for purpose and a disappointing CQC report has led us to realise that it is not financially viable to bring them up to the required standard.

We understand this will be disappointing to some patients, but hope all will appreciate the benefits of consolidating limited NHS resources into one purpose built medical centre which has full disabled access, plenty of space and parking, and is already providing many additional services. With all services on a single site, we would also be able to offer more opening hours for both the surgery and the dispensary.

Despite our best efforts, we have not been able to recruit a new GP to replace Dr Patterson when he retires at the end of March. We will continue to try, but, in the meantime our priority is to provide a safe service. We have therefore made the decision to reduce opening hours at Rode Heath Surgery from 1st April 2017 to ensure this can be achieved.

As part of the process we are consulting with patients so that we can submit their views about the proposed closure to the CCG. We have printed a survey on the reverse of this letter and would be grateful if you could complete and return it to either Greenmoss Medical Centre or Rode Heath Surgery reception. Alternatively, the survey can be completed on line – see overleaf for details. We are keen to receive the views of all patients and carers. The closing date for the consultation is the 24th April 2017.

If you require further information, please contact either Greenmoss Medical Centre, or NHS South Cheshire CCG and NHS Vale Royal CCG Communications and Engagement Team – 01270 275286, or [email protected]

Yours sincerely

Drs Patterson, Reynolds, Bennett and Bailey

38 of 78 Proposed Closure of Rode Heath Branch Surgery

Patient Frequently Asked Questions (FAQ) The Partners of Greenmoss Medical Centre & Rode Heath Surgery have sought approval from NHS South Cheshire CCG to close Rode Heath Branch Surgery. Patient feedback is required for the application to be considered.

Listed below are a number of FAQs that are provided to answer any potential queries patients may have. Any further queries should be directed to Surgery staff.

1. Why have you proposed to close Rode Heath Surgery? The Care Quality Commission’s (CQC) report and discussions at the inspection in January 2017 highlighted safety issues that required improvement at Rode Heath Surgery. Surveys carried out by the CCG also indicate that the premises are no longer suitable for NHS Services. A Fire Safety audit showed the need for alterations which would be at a considerable cost to the practice and is not financially viable. This together with Dr Patterson’s retirement means the practice does not have the clinical capacity to safely staff the both sites.

2. Will the Greenmoss Medical Centre opening times remain as they are currently? No, our opening times will increase to 8.30am-6.30pm Monday to Friday

3. Will I still be able to see my usual doctor or nurse? Yes, you will. All staff and partners (whether clinical or not) will be based at Greenmoss Medical Centre. We will continue to provide a full GP service from Greenmoss Medical Centre, providing daily appointments to see Doctors, Nurses and Health Care Assistants. Dr Patterson is retiring on 31st March 2017 and we are also trying to recruit to replace him.

4. Will the same number of appointments be available? Yes, we will be increasing the number of appointments at Greenmoss Medical Centre to cover those that were previously available at Rode Heath Surgery. Although this will mean that Rode Heath patients will need to travel to Greenmoss Medical Centre, in the past year over 65% (1000 appointments) of those who have needed an appointment have attended Greenmoss Medical Centre. 45% (1503 appointments) of Greenmoss Medical Centre patients have had to travel to Rode Heath Surgery and will no longer need to do so. All patients already attend Greenmoss Medical Centre for antenatal, child immunisations, dietician, minor surgery, mental health service and now physiotherapy.

5. Will there be changes to the way I book appointments? No, you will continue to be able to book appointments as you do now, either online or by the telephone. We will continue to recall those patients that require scheduled vaccinations, chronic disease reviews or for participation in routine screening programmes (smears, diabetic eye checks etc.) We do however, hope that we will be able to improve our current appointment booking and administrative systems, with a larger pool of administrative and reception staff available on one site.

6. Will there be any changes to the dispensary? Yes, all dispensing will be done at Greenmoss Medical Centre. This will be available to all patients who are eligible for this service. Dispensary opening times will be increased.

7. What will happen to vulnerable patients? All our patients currently registered with the practice will have the option of being able to stay on our practice list, whilst living at their existing address. The doctors will continue to provide home visits, as now, to our vulnerable, housebound patients.

8. Will the practice boundaries change? No - we will continue to register and provide services for patients that fall into the catchment area.

9. Will the services currently offered at Rode Heath Surgery be offered at Greenmoss Medical Centre? Yes - All services that we currently offer under the GP contract will be transferred to Greenmoss Medical Centre. 39 of 78

10. Will any new services be introduced? We certainly hope so. One of the reasons for the proposed closure is for us to be able to grow and expand the services that we are able to provide locally from within the Practice. Since Greenmoss Medical Centre opened in 2013, we have gradually introduced new services and are investigating what additional services could be delivered locally. We are committed to working with local commissioners to provide access to additional services as and when they become available.

11. How would the closure benefit the patients of the practice? There is a large carpark with disabled parking bays, purpose built premises with full disabled access, with ground floor consulting and treatment rooms and spacious waiting area. There will be increased opening hours for both the surgery and dispensary. It will remove the risk of attending the wrong surgery for appointments (not uncommon with the 2 sites at the moment). There are separate main and dispensary receptions with increased privacy and private interview rooms are available.

12. How would the closure benefit the staff at the practice? All staff would be retained. Clinical staff would be able to work more closely together and improve communication with community services. Annual and sick leave would be better covered leading to lower stress levels of the remaining staff. Partners would be able to share the ever increasing administrative work load required of them by government and regulators. All staff would have increased access to the management team.

13. Will there be any changes to how I access the GP out of hour’s service? No, in order to access a GP when the Practice is closed, you will still need to telephone the NHS 111 service and they will either signpost you to the most appropriate service or arrange for you to access a GP. Between 8am and 8.30am phone the surgery as normal and an answer-phone message will direct you to a clinician if you require urgent help before reception is open.

14. Will I need to re-register to remain on the Practice list? Will my health records be transferred? No, all patients will remain registered with Greenmoss Medical Centre and your health records will remain there. The only way your registration will change, will be if you choose to register yourself at a different Practice or if you move from your current address outside the practice catchment area.

15. Will this affect any treatment or medication I am currently receiving either at the GP practice or any Hospital? No – Any patient’s current treatments, medications or any investigations that they are receiving from any hospital or other healthcare provider will be unaffected by the closure.

16. What are the timescales for the decision of whether to close Rode Heath Surgery? Following the consultation period which will end at midnight on Monday 24th April, the feedback will be analysed and included in a report, for NHS South Cheshire CCG to make an informed decision on 26th May 2017.

40 of 78 Your views are important to us about our GP services

Please take a few minutes to fill out this survey. We welcome your feedback and your answers will be kept confidential. Alternatively you can do the survey online via the practice website: www.greenmossmedicalcentre.nhs.uk - The survey will close at midnight on Monday 24th April 2017.

1. What is your postcode? Please tick  2. What is your age bracket? Under 16 16-24 25-49 50-69 70 and over 3. How do you currently travel to your GP Own transport surgery? Relatives transport

Public transport Walk Other 4. How often do you attend Rode Heath Surgery? Once a week or more

Between once a week and once a month Between once a month and twice a year Once or twice a year Less than once a year 5. Which location do you currently attend when Greenmoss Medical Centre you need to access GP services? Rode Heath Surgery Either/both 6. Which services do you currently use at Rode Prescription collection Heath Surgery? Dispensary

Face to Face GP consultations Face to Face Nurse appointments Other 7. Which services do you currently use at Prescription collection Greenmoss Medical Centre? Dispensary

Face to Face GP consultations Face to Face Nurse appointments Other 8. Do you support the practice’s plan in principle Yes to close the branch surgery and provide services from Greenmoss Medical Centre? No

9. Do you have any further comment?

10. If you would like to be informed about the outcome of the engagement process, please include your contact details below: Name: Email: Address: Thank you for taking the time to fill out this survey. Please return to either of the practice receptions

41 of 78 Copy of Press Release - sent on behalf of Greenmoss Medical Centre

Changes to services provided by Greenmoss Medical Centre

Summary: A period of consultation is being launched by Greenmoss Medical Centre to gather the thoughts of local patients on the proposed closure of their Rode Heath Branch Surgery (based in Rode Heath village).

The patients of Greenmoss Medical Centre and Rode Heath will be asked to share their views and thoughts on the proposed closure of the local Rode Heath Branch Surgery. This will be done via a survey which will be sent to every household served by the practice.

Greenmoss Medical Centre practice manager, Heather Grocott, explains the reasons why the closure is being considered ‘Dr Patterson is due to retire shortly after being a GP at the surgery for many years and whilst we are still advertising for a new GP we are not currently in a position to be able to replace him. As well as this we have a responsibility to our local population to ensure the services we offer are of the highest quality in facilities that are safe and fit for purpose. We have fantastic modern facilities in our purpose built Greenmoss Medical Centre but these just are not matched at our Rode Heath branch surgery.

‘The quality of the premises and facilities at Rode Heath surgery was reflected in our recent Care Quality Commission report rating of ‘requires improvement’ and it would require a very large investment to bring them up to standard, at this point, this is simply not available. Greenmoss Medical Centre has adequate parking, full facilities for our disabled patients as well as the flexibility to offer increased opening times for both the GP surgery and the pharmacy’.

Ensuring that patients have access to GPs and healthcare when they need it remains a priority for Greenmoss Medical Centre. GP Dr Liz Reynolds says ‘We need to do all we can to make general practice and primary care services sustainable locally, supporting patients to give them confidence and encourage them to know when they can self-care or visit their pharmacists for general health advice and care. This is really important to support us in our work to increase access to doctors locally.’

The consultation launches today, Friday, 17th March 2017, and will remain open until midnight on Monday, 24th April 2017. Every patient within the local area will receive a letter outlining the proposals and reasons behind them as well as a survey to complete to share their views.

For more information about this, please visit Greenmoss Medical Centre’s website or contact the practice - www.greenmossmedicalcentre.nhs.uk

Further information contact:

NHS South Cheshire CCG and NHS Vale Royal CCG Communications and Engagement Team – 01270 275286 or email: [email protected]

@NHSSCheshireCCG www.southcheshireccg.nhs.uk

@NHSValeRoyalCCG www.valeroyalccg.nhs.uk

42 of 78

43 of 78 Application Notice to Close Branch Premises

CCG NOTE COMMITTEE SHOULD NOTE THAT EMBEDDED DOCUMENTS HERE AS APPENDICES HAVE BEEN SEPARATELY INCLUDED (THE PATIENT CONSULATION PUBLIC TRANSPORT IS NOT INCLUDED BUT WAS MADE AVAILABLE VIA CHESHIRE EAST COUNCIL)

20th June 2017

Dear South Cheshire CCG

Application to Close Branch Premises

Affix practice stamp: Greenmoss Medical Centre Portland Drive Scholar Green Stoke on Trent ST7 3BT

Details of branch surgery Rode Heath Surgery address proposed for 130 Heath Avenue closure: Rode Heath Stoke on Trent ST7 3TH

1. Do you have premises Yes approval to dispense from the branch 1066 (Branch site, 2834 Greenmoss Medical Centre) surgery? If yes, how many patients do you currently dispense to?

2. Do you have premises Yes (Greenmoss Medical Centre) approval to dispense from any other premises? If no, do you intend to give three months’ notice of ceasing to dispense as required by Paragraph 10 of Schedule 6 of the National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations

44 of 78 2013 as amended?

3. How have you Sequence of events: involved patients Hold Patient Panel 6th March regarding this meeting proposal? th Agree: w/c 6 FAQs March Survey Questions Plan of engagement for the Patient Panel Launch online 15th March survey/Feedback leaflet w/c 13th Patient Panel presence at Patient Panel March both practices and social group meetings to conduct paper copy surveys Letter to all households 15th March w/c 3rd April Update website with 3rd April (delay information re change of website provider) Close online survey 24th April w/c 24th April Collate responses 26th April

w/c 5th June Patient Panel meetings 5th June/12th to discuss survey results June w/c 12th June Patient Information 13th June Session to inform of results of Consultation

We met with our Patient Panel on Monday 6th March 2017 to discuss the draft CQC report on Rode Heath Surgery and to talk about the future and options. They had input into the questions asked on the survey and how this was distributed to our patients. Discussions on transport were a priority and one of our members offered services from a social group that is held at Greenmoss Medical Centre. They have a taxi service at reduced costs.

We then wrote to every household on the practice list informing them of the situation and enclosing a survey asking for their views. The survey could be completed on line via our website. There were also paper copies available at each reception. We produced a FAQs document that was available in both receptions and on our website. A press release was circulated to local press. Further meetings with the PPG were held on 5th June and 12th June to look at the survey results and how to ensure

45 of 78 patients’ concerns were answered at the patient information meeting. Despite initial concerns, the PPG are supportive of the application and understand that the viability of the practice as a whole may depend on the outcome of this application. Posters were displayed in both surgeries to inform patients of the date of the meeting. This was also publicised on the practice website.

The patient information meeting was held on the 13th June 2017 to inform patients of the outcomes of the survey and to answer any questions that they had.

A copy of the letter, survey, FAQs and press release :

A copy of the information supplied at the patient information meeting is attached together with a brief summary of questions asked during a Q&A session in Section 5

The main concern raised in the comments on the survey was with regards to lack of public transport.

4. How will you be We will put notices in the windows of both surgeries, communicating the messages on repeat prescriptions, message on the actual change to practice website, letter to each household and a message patients, ensuring that on the ansaphone at Rode Heath Surgery for a period of patient choice is time. Those patients that provided an e mail address on provided throughout, the survey will be notified by this method. Patients will be should the made aware that they can continue to be registered at Commissioner Greenmoss Medical Centre or choose to register at approve this another local surgery. application?

5. Please provide a The survey was sent to every household to enable our summary of the patient patients to comment on the proposed closure of Rode involvement feedback Heath Surgery. In summary the patient involvement and confirm that you feedback was as follows: will supply evidence of this consultation • From the survey/consultation letter that went to should it be requested: every household, 582 patients responded. Within households, responses could include numerous individual responses or patients could individually respond on-line. • Only 1% of those respondents used public transport to travel to their surgery site of choice (this was 4 patients out of 579 who responded to that question in the survey). • The majority of those who responded had not used the branch surgery more than once a month,

46 of 78 with the highest proportion only using the branch site once or twice a year. • According to the survey results, the vast majority of patients use the main surgery (Greenmoss Medical Centre). 25% only use the branch surgery (Rode Heath) with 20% using either. • Respondents who supported the plan in principle to close the surgery and provide services from Greenmoss Medical Centre (main site) was 72%.

The main concern raised in the comments on the survey was with regards to lack of public transport. This was also discussed at length with the Patient Panel and also at the patient information meeting. This is a summary of our response:

This applies to ALL patients, there is very little public transport from Mow Cop etc. Also, it means that if Rode Heath patients can’t get public transport to Scholar Green, the reverse is also true – no transport from Scholar Green to Rode Heath. It must be remembered that the practice is in a semirural area and covers approximately 63 square miles, the majority of which does not have good public transport. Is this the time to work within the community and with Odd Rode Parish Council and look at transport? Cheshire East Council are currently in public consultation about public transport.

A copy of the information supplied at the patient information meeting is attached together with a brief summary of questions asked during a Q&A session:

A patient information meeting was held on the 13th June 2017 and a summary of information supplied and questions & answers from the meeting are shown in appendix 5.

We are aware that Cheshire East Council are currently holding a public consultation re public transport and have encouraged our patients to participate in this at the patient information meeting:

From the survey results, less than 1% of patients currently travel to the surgery by public transport. This was 4 patients out of 579 that responded to the question in the survey.

Further comments were made on the survey and our responses are noted below:

47 of 78

Summary of comments made Practice response Greenmoss needs to be open if the application is successful, longer. Greenmoss Medical Centre will be open 8.30am-6.30pm Monday to Friday. Will there be more services We continue to work towards brought into Greenmoss introducing more services into Medical Centre. Services noted Greenmoss Medical Centre. In as being required are podiatry February physio became and anti coagulant clinics. available twice a week. Will there be delays at There will be no change to the Greenmoss with extra patients, total number of appointments will it be difficult to get an across the practice as a result of appointment? the proposed closure A mailbox is required There is a secure mailbox situated next to the main gate at the entrance to the carpark of Greenmoss Medical Centre. This ensures patients can drop off prescriptions requests etc when the medical centre is closed. Need to replace Dr Patterson We have advertised for 2 years to replace Dr Patterson , spent thousands of pounds on adverts, placed free adverts in GP networks, local GP training schemes etc. However, there is a national shortage of GPs. We will continue to actively recruit. How do we order medication There are several ways to order now? How do we collect it? medication, in person at Greenmoss Medical Centre, by post, online or fax. Help is available to set up an online account and this enables patients to order their repeat medication at a time to suit them. We will continue to stock a wide range of drugs and dispense to eligible patients within 2 working days. We have increased opening hours of the dispensary and reception since 1.4.2017 and if the application to close is permitted, the dispensary opening hours will be increased further. We will also consider providing a medication delivery service to our housebound patients. Why wasn’t Greenmoss Medical Greenmoss Medical Centre is Centre built in a place more situated centrally to the convenient to meet the needs practice area. The practice area of all residents whether in Rode covers an area towards Heath or Scholar Green. Kidsgrove, Alsager, Rode Heath, towards Congleton, Scholar Green, Mow Cop and towards Harriseahead. At the time of

48 of 78 planning, all possibilities were looked at including siting at Rode Heath. The Greenmoss Medical Centre site was the only feasible site at that time. No investment in Rode Heath In December 2013 Rode Heath Surgery was temporarily closed for two weeks to allow extensive refurbishment to take place. Why have you only sent one The survey was sent to each survey to our house? household to ensure all patients were informed quickly of the changes happening and proposed when Dr Patterson retired. The survey was also available on line, paper copies available in both surgery receptions and also at some social groups via Patient Panel members. The money saved by not sending a survey to every patient, has remained available for patient services. Many people entered more than 1 response on the same form. Lack of public transport to This applies to ALL patients, Greenmoss Medical Centre there is very little public from Rode Heath. transport from Mow Cop etc. Also, it means that if Rode Heath patients can’t get public transport to Scholar Green, the reverse is also true – no transport from Scholar Green to Rode Heath. It must be remembered that the practice is in a semirural area and covers approximately 63 square miles, the majority of which does not have good public transport. Is this the time to work within the community and with Odd Rode Parish Council and look at transport? Cheshire East Council are currently in public consultation about public transport.

We intend to continue to work with our Patient Panel to address the comments made on the survey.

6. Please provide as There are 2 main reasons for the application to close Rode much detail as Heath Surgery. possible about how this proposed closure The first is that the cost and actual physical space required to will impact on your bring the premises up to the standard required by CQC and current registered NHS guidelines is prohibitive. Rode Heath Surgery is a dormer patients, including: bungalow on a residential estate. There is 1 consulting room

49 of 78 • access to the main ground floor) and 1 treatment room (first floor, no disabled surgery site i.e. access). The waiting room is small and there is only one public transport, reception area for both patients attending the surgery for an ease of access; appointment or collecting medication from the dispensary. • capacity at main There is no patient parking. It is leased from a private landlord surgery site; unrelated to the practice. The cost would be a practice cost. • booking appointments; The second reason is the failure to appoint a replacement GP • additional and st enhanced services; for our senior partner who retired on 31 March 2017. Despite • opening hours; 2 years of trying to recruit a GP, we have not been successful. • extended hours; This has led to a shortage of regular GP clinical time. We simply and do not have enough clinical staff to work at 2 sites to provide a • dispensing services safe service for patients.

(if applicable) The decision to apply to close Rode Heath Surgery will affect patients, but the majority already attend Greenmoss Medical Centre for appointments. There are benefits to attending Greenmoss Medical Centre. Access is excellent and located centrally for the practice area. All patient areas are on the ground floor in a purpose built medical centre. There are 8 consulting rooms, 5 treatment rooms, 1 minor surgery suite and a multifunction room. There is a large air conditioned waiting room. Private interview rooms are available to increase confidentiality. It is fully accessible and there is a large carpark on site with designated disabled parking bays. The medical centre was built in 2013 to NHS standards after consultation with patients.

The capacity of the main surgery exceeds the current list for both sites of 4800 patients.

Consultation facts & figures (1.2.2016-7.2.2017) Rode Heath Scholar Green, Total & Mow Cop etc Alsager Registered patients 1483 (31%) 3339 (69%) 4822 Had an 1096 (74%) 1503 (45%)* appointment at Rode Heath Surgery Had an 1000 (67%) 2760 (83%) appointment at Greenmoss Medical Centre Had an 162 (11%) appointment at Rode Heath Surgery but not at Greenmoss Medical Centre The figures indicate that in a year, there were 162 patients, living in the Rode Heath area, who solely attended Rode Heath Surgery for appointments. The remaining patients from the area, attended either surgery.

The current opening hours at Rode Heath Surgery (since 1.4.2017) are Tuesday and Thursday 4pm-6.30pm. Before Dr Patterson retired, Rode Heath Surgery was also open

50 of 78 Monday to Friday 8.30am-12.30pm.

We would be able to open Greenmoss Medical Centre from 8.30am-6.30pm Monday to Friday as a result of relocation of staff.

There is a dispensary at the main site. We are currently permitted to dispense to 3900 patients (81%). If we were granted permission to close Rode Heath Surgery, we would look at providing a delivery service to housebound patients for medication. This would benefit all housebound patients, including those residing at Rode Heath. We also would expect to be able to increase the opening hours of the dispensary further.

The main site offers additional services eg minor surgery, antenatal care, dietary advice, Mental Health worker, physiotherapy, phlebotomy, outpatient consultant clinic (lower limb), family planning, travel advice and vaccination etc. We have recently signed a contract to enable ultrasound tests to be carried out at Greenmoss Medical Centre.

Booking appointments can be done by telephone, on line or in person.

We have introduced Nurse Practitioner appointments to increase access for treatment of minor illness.

We have applied via a bid to NHS England for the services of a clinical pharmacist. This will increase access for patients for medication review, medication queries etc.

From a practice perspective, all medical equipment from Rode Heath Surgery will be transferred to Greenmoss Medical Centre. All staff will remain employed at the practice and will be based at Greenmoss Medical Centre. Working from one site, we will have more flexibility to move staff between roles according to demand eg reception, dispensing. There will be improved access to management support and clinical support when all staff are based at one site. Staff can feel isolated working in the very small team at Rode Heath Surgery.

Staff numbers (sessions per week):

Current After change Dispensing 24 24 Reception 20 20

51 of 78 Administration 17 17 Secretarial 7 7 Nursing 14 14 HCA 3 3

If our bid for a clinical pharmacist is successful, this will be in addition to the above. There will be a reduction in costs to both the practice (no duplicated costs of providing equipment, electricity etc), and the NHS (reimbursable costs ie rent, business rates etc). These reductions can be reinvested in patient services.

We have contacted other local practices in Alsager to inform them of the application being made as this may potentially lead to some patients choosing to register with them. Greenmoss Medical Centre is 2.8 miles from Rode Heath Surgery. The Alsager Health Centre (2 practices) is 2.5 miles from Rode Heath.

We have informed the LMC and NHS England of the application to close Rode Heath Surgery.

162 From which date do As soon as possible. you wish the branch closure to take effect?

52 of 78

Signed by Dr E R Reynolds ______

Date ______

Signed by Dr S L Bennett ______

Date ______

Signed by Dr N A Bailey ______

Date ______

Note ; Scanned Copy with Signatures / original CCG has received

Where an application to close premises is granted by the Commissioner, the contractor shall remain fully responsible for cessation or assignment of the lease for any rented premises and any disposal of owner-occupied premises. In both cases, payments under the premises directions will cease from the day of closure. Please note that this application does not impose any obligation on the Commissioner to agree to this application.

53 of 78 EQUALITY IMPACT & RISK ASSESSMENT STAGE 1 SCREENING TOOL

Organisation: Service: NHS South Cheshire CCG Greenmoss Surgery Project Lead: Service Area: Primary Care

Person responsible for this Assessment: Date of Review:

Brief explanation of what is happening / being assessed (MAX 1000 CHARACTERS) Greenmoss Surgery is applying to close a branch surgery

QUESTION type EQUALITY IMPACT Comments (provide example) No. y or n Does this issue plan to withdraw a service, activity or Example (click for examples) 1 Y Greenmoss Surgery is a new name for what was an existing practice in Scholar Green known as Scholar presence? Green Surgery. Greenmoss Surgery has a practice population of @4800. Scholar Green Surgery was Does this issue plan to reduce a service, activity or originally located in Cinderhill Lane, Scholar Green. The original practice has been existance for over 25 2 Y years and was housed in a 3 storey detached house. The surgery rooms were located on the ground floor presence? and part of the first floor with one of the partners and his family located on the first floor and the top floor. Does this issue plan to introduce or increase a charge for The GP Partner did relocate and the practice was able to use the remaining space for office space and 3 N Service? storage. There was limited parking on this site. At some stage Rode Heath, the branch surgery, was set up. @2010-11 it become quite clear that the Scholar Green surgery site was not suitable for the delivery of 4 Does this issue plan to change to a commissioned service? Y general practice services. It was agreed with Central & Eastern Cheshire PCT (former body to the CCG) that a new purpose built medical centre would be constructed in Scholar Green. The intention was for the building to be future proofed i.e. to have enough space for new housing expansion in the local area. Does this issue plan to introduce, review or change a policy, 5 Y However there were significant issues in finding an appropriate plot for the proposed building . Eventually a strategy or procedure? suitable site was found and the practice currently has its main surgery site housed in a purpose built surgery building occupied in 2013. The surgery then changed its name to Greenmoss Medical Centre. The 6 Does this issue plan to introduce a new service or activity? N new building has 9-10 consulting rooms, 4-5 Nurse rooms, a dispensary and a signicant amount of office Is this primarily about improving access to, or delivery of a space. The site has plenty of parking spaces. The practice has a branch surgery curently housed in a 7 N detached chalet style house on a small housing estate in a village 2.5 miles from the main surgery. There service? is limited parking on site at the branch surgery with parking roadside on the housing estate. The practice is Does this affect employees or levels of training for those who applying to close the branch surgery which currently provides GP consultations on the ground floor and 8 Y will be deliivering the service? Nurse consultations on the first floor. There is no lift to the first floor so patients who are unable to access the first floor are accomodated for their nurse appointments on the main site. The size of the rooms does limit the amount of medical equipment for patient examination and clinical interventions. All the remaining 9 Does this issue affect Service users? Y allied health care services are therefore provided at the main surgery site in rooms that are suitable for all patient. By moving all patients onto one site every patient will have access to full services at all times during Can you foresee a negative impact on any Protected core opening times. The main surgery has the capacity to absorb all of the branch surgery staff as well as 10 Characteristic Group(s)? If YES please state what these could N increasing services provided. The majority of the branch surgery patients are using the main surgery to be. access specific services not provided at the branch surgery. However there is a need to ascertain if there are patients who currently use the branch surgery only and may have difficulty accessing the main surgery EQUALITY RISK Comments (provide example)

Consultation process with patients is planned by the Practice. The practice has already met with their staff Have you got any general intelligence (research, and outlined their proposal to consider closing the branch surgery and the advising of the patient 11 N consultation, etc.)? If YES please list any related documents. consultation process. The practice will meet with their PPG and discuss the proposal of closing the branch surgery and the reasons for this proposal. The practice will be advising the PPG that the branch surgery has had an adverse CQC report around its premises and there has also been a CCG premise Have you got any specific intelligence (research, survey report that identifies a significant amount of improvements that need to be undertaken at the branch 12 N consultation, etc.)? If YES please list any related documents. surgery to ensure that it is fit for delivery of primary care services. The cost of this potentially is not viable to the the practice. The practice will then start an engagement process with the patients. This will involve a patient survey, posters notifiying the consultation process & information on the practice website. The Have you taken specialist advice? (Legal, E&I Team, etc). If 13 N practice will prepare some responses for any predicted frequently asked questions to ensure that the YES please state. patients are kept informed. Until the initial consultation is undertaken it is difficult to envisge as to if this should go to full public consultation. This will need to be presented to the Overview and Scrutiny Have you considered your Public Sector Equality Duty? 14 committee. Please provide a rationale. Y

Do you plan to publish your information? Include any 15 "Decision Reports" N

16 Can you minimise any negative effect? Please state how. N

Do you have any supporting evidence? If YES please list the 17 documents. N

Have you/will you engage with affected staff and users on 18 Y these proposals?

IMPACT 550 There will be some impact. You should undertake a Stage 2 assessment

RISK 600 There is a high risk

HUMAN RIGHTS IMPACT Comments (provide example)

Will the policy/decision or refusal to treat result in the death 19 N of a person?

Will the policy/decision lead to degrading or inhuman 20 N treatment?

21 Will the policy/decision limit a person’s liberty? N

Will the policy/decision interfere with a person’s right to 22 N respect for private and family life?

23 Will the policy/decision result in unlawful discrimination? N

24 Will the policy/decision limit a person’s right to security? N

Will the policy/decision breach the positive obligation to 25 N protect human rights?

Will the policy/decision limit a person's right to a fair trial 26 N (assessment, interview or investigation)?

Will the policy/decision interfere with a persons right to 27 N participate in life?

RISK 0 There is little chance of Human Rights breach. There is no requirement to carry out a Stage 2 assessment

PRIVACY IMPACT Comments (provide example)

Will the project involve the collection of new information 28 N about individuals?

Will the project compel individuals to provide information 29 N about themselves? Will information about individuals be disclosed to 30 organisations or people who have not previously had routine N access to the information? Are you using information about individuals for a new 31 purpose or in a new way that is different from any existing N use?

Does the project involve you using new technology which 32 might be perceived as being privacy intrusive? For example, N the use of biometrics or facial recognition.

Will the project result in you making decisions about 33 individuals in ways which may have a significant impact on N them? e.g. service planning, commissioning of new services.

Is the information to be used about individuals’ health and/or 34 N social wellbeing?

Will the project require you to contact individuals in ways 35 N which they may find intrusive?

RISK 0 There is little chance of a Privacy breach. There is no requirement to carry out a Stage 2 assessment

PLEASE SEND YOUR COMPLETED STAGE 1 SCREENING TOOL TO THE EQUALITY & INCLUSION TEAM EMAIL: [email protected] GENERAL GUIDANCE Please use the comments section to explain any 'RED' scores or to further elaborate what is being assessed is necessary

All 'RED' scores will require further action in future planning regardless of the requirement to carry out Stage 2 approaches.

Signature of person completing the screening tool:

Comments (MAX 250 CHARACTERS)

Signature of Equality & Inclusion Business Partner & Date

Comments (MAX 250 CHARACTERS) 54 of 78

Equality Impact and

Risk Assessment

Stage 2

Equality Impact and Risk Assessment Title

Equality & Inclusion Team, Corporate Affairs For enquiries, support or further information contact Email: [email protected]

Equality & Inclusion Page 1 55 of 78 EQUALITY IMPACT AND RISK ASSESSMENT TOOL STAGE 2 ALL SECTIONS – MUST BE COMPLETED

SECTION 1 - DETAILS OF PROJECT Organisation: NHS South Cheshire Clinical Commissioning Group

Assessment Lead: Caroline Harley

Directorate/Team responsible for the assessment: Primary Care part of the Finance Directorate

Responsible Director/CCG Board Member for the assessment Lynda Risk?

Who else will be involved in undertaking the assessment?

Date of commencing the assessment: 23 March 2017 Date for completing the assessment: 30 March 2017

SECTION 2 - EQUALITY IMPACT ASSESSMENT Please tick which group(s) this project will or may impact upon? Yes No Indirectly Patients, service users Y Carers or family Y General Public N Staff N Partner organisations N Background of the project being assessed: Greenmoss Surgery is a new name for what was an existing practice in Scholar Green known as Scholar Green Surgery. Greenmoss Surgery has a practice population of @4800. Scholar Green Surgery was originally located in Cinderhill Lane, Scholar Green. The original practice has been existence for over 25 years and was housed in a 3 storey detached house. The surgery rooms were located on the ground floor and part of the first floor with one of the partners and his family located on the first floor and the top floor. The GP Partner did relocate and the practice was able to use the remaining space for office space and storage. There was limited parking on this site. At some stage Rode Heath, the branch surgery, was set up. @2010-11 it became quite clear that the Scholar Green surgery site was not suitable for the delivery of general practice services. It was agreed with Central & Eastern Cheshire PCT (former body to the CCG) that a new purpose built medical centre would be constructed in Scholar Green. The intention was for the building to be future proofed i.e. to have enough space for new housing expansion in the local area and if possible for the practice to potentially consolidate on one site. Eventually a suitable site was found and the practice currently has its main surgery site housed in a purpose built surgery building occupied in 2013. The surgery then changed its name to Greenmoss Medical Centre. The new building has 9-10 consulting rooms, 4-5 Nurse rooms, a well-equipped dispensary and a significant amount of office space. The site has plenty of parking spaces. The practice therefore still has a branch surgery currently housed in a detached

Equality & Inclusion Page 2 56 of 78 chalet style house on a small housing estate in a village 2.5 miles from the main surgery. There is limited parking on site at the branch surgery with parking roadside on the housing estate. The practice is applying to close the branch surgery which currently provides GP consultations on the ground floor and Nurse consultations on the first floor. There is no lift to the first floor so patients who are unable to access the first floor are accommodated for their nurse appointments on the main site. The size of the rooms does limit the amount of medical equipment for patient examination and clinical interventions. All the remaining allied health care services are therefore provided at the main surgery site in rooms that are suitable for all patients. By moving all patients onto one site every patient will have access to full services at all times during core opening times. This will allow the surgery to provide a safe and effective service to all patients. The main surgery has the capacity to absorb all of the branch surgery staff as well as increasing services provided. The majority of the branch surgery patients are using the main surgery to access specific services not provided at the branch surgery. However there is a need to ascertain if there are patients who currently use the branch surgery only and may have difficulty accessing the main surgery site (i.e. transport etc). The practice will need to establish the number of patients who may soley use the branch surgery and the reasons for this e.g. in walking distance. Both sites currently dispense but should the branch surgery application close be successful there would be no disruption to dispensing as this will continue from the main surgery. The main surgery site has a comprehensive dispensary. Both sites have recently been CQC inspected. Unfortunately the branch surgery CQC report which has just been published notes that it requires improvement in relation to building. The building will need re-wiring fully in order to achieve a new electricity safety certificate. What are the aims and objectives of the project being assessed? Should Greenmoss Medical Centre, after patient consultation, put a formal application to close their branch surgery this will be submitted to NHS South Cheshire CCG. The CCG will hear the formal application at the Primary Care (General Practice) Commissioning Committee the body for making decisions regarding primary care provision. The Committee will need a full picture of what may or may not be an impact of the ultimate decision. Any impact on Patients ability to access services will need to have been considered and where possible migrating solutions identified where possible. The Committee can only make a decision with all relevant factors having been researched.

Services currently provided in relation to the project: General Medical Services at the Rode Heath Branch Surgery. Currently there is a restricted provision of services at present due to the physical constraints of the building. The building is not DDA compliant. It is a house, in the middle of a housing estate, that has been converted to be used for the provision of services and is therefore not a purpose build medical building.

Which equality protected groups (age, disability, sex, sexual orientation, gender reassignment, race, religion and belief, pregnancy and maternity, marriage and civil partnership) and other employees/staff networks do you intend to involve in the equality impact assessment? Please bring forward any issues highlighted in the Stage 1 screening The practice in discussion with their Patient Participation Group (PPG) have agreed to survey patients that are registered with the practice irrespective of which surgery they attend to ascertain their view of the proposed closure. This ensures that every patient has the opportunity of expressing their thoughts and opinions and ensures that no important group is omitted. The survey identifies which premises they use. Patients who have a disability will have the opportunity to make any further

Equality & Inclusion Page 3 57 of 78 comment on the survey with respect to difficulties they experience with the branch surgery as it is not DDA compliant and the nurse, due to space shortage, can only consult on the first floor and there is no space to install a lift and the current stairway will not be able to take a stannah lift. Some patients with a physical disability may not be able to be seen on the first floor of the branch surgery. The main site at Greenmoss Medical Centre is fully DDA compliant and all services are provided on the ground floor. There are dedicated disabled parking car par spaces on this site also.

How will you involve people from equality/protected groups in the decision making related to the project? Yes these patients, as all patients will be able to complete a survey as part of the patient consultation process and on line. After the patient consultation process has been completed (24 April 2017) there will be a patient meeting held in public with the practice to receive the outcome and findings. As part of the NHS South Cheshire’s 13Q Duty to public involvement the proposed closure of the branch surgery will be presented at the CEC Overview & Scrutiny Committee.

EVIDENCE USED FOR ASSESSMENT What evidence have you considered as part of the Equality Impact Assessment?

• All research evidence base references including NICE guidance and publication – please give full reference • Bring over comments from Stage 1 and prior learning (please embed any documents to support this)

- Recent CQC report

This CQC report highlighted that a member of the PPG had set up a patient and carers group that was run every Friday in a room at the Greenmoss Medical Centre. This room is on the ground floor within a fully compliant DDA building with a car park that has dedicated disabled car parking spaces. Patients were able to drop-in for a cup of tea and advice and support around health and social issues. The group had assisted patients to make healthcare appointments, attend hospital visits and access social services. The Patient and Carers group also provided support to socially isolated patients. The group has close links with the Police Community Support Officer who visits the group to provide information on local matter which had been of concern to patients. The group had established a patient transport service due to limited availability of public transport and the rural nature of the community. This was funded by donations and subscriptions and provided transport to the Patient & Carers Group, GP & Hospital appointments. This transport can be utilised by patients at either site. However the group does not have the capacity to run two meetings so patients do have to come to the Greenmoss Medical Centre site. By patients being located on one site all patients will have access to this unique service.

The main surgery, Greenmoss Medical Centre, has 9-10 consulting rooms and 4-5 Practice nurse rooms. There is a fully equipped dispensary on site. The surgery is a purpose built medical centre with expansion capacity, car park, full disabled access, office space and rooms on the first floor that can be accessed by a lift. In comparison the branch surgery has only a small waiting room, toilets including one which is accessible, a small dispensary area & a nurse’s room on the first floor not accessible for disabled. There is no car parking provision on site it is all roadside on the housing estate. The entrance to the branch surgery is virtually on the flat and the entrance hall can

Equality & Inclusion Page 4 58 of 78 accommodate the width of a wheelchair but manoeuvring into the consulting room on the ground floor is not ideal. In conclusion the branch surgery is not DDA compliant and it would be at considerable cost to bring the premise compliant.

The CQC report also highlighted that the branch surgery premises was rated as requires improvement for providing safe services as an up to date electrical wiring inspection had not been carried out and a legionella risk assessment had not been undertaken.

The Senior Partner who works full time is retiring at the end of March 2017 and despite the practice’s best endeavours they have not been able to recruit a replacement GP even a part time one. This will mean that in the future the practice will already have to reduce GP services at the branch surgery as the main surgery site

Although the closure means that Rode Heath surgery users will need to travel to Greenmoss Surgery the surgery has reviewed the appointments for the past 12 months. This demonstrated that 65% (1000 appts) of those who needed an appointment from the Rode Heath area managed to travel to Greenmoss Surgery. The survey also demonstrated that 45% (1503 appointments) were utilised by Greenmoss patients as these were the only ones available meaning they had to travel to Rode Heath.

ENSURING LEGAL COMPLIANCE

Think about what you are planning to change; and what impact that will have upon ‘your’ compliance with the Public Sector Equality Duty (refer to the Guidance Sheet complete with examples where necessary) In what way does your current How might your proposal affect How will your mitigate any service delivery help to: your capacity to: adverse effects? ( You will need to review how effective these measures have been) End Unlawful Discrimination? End Unlawful Discrimination? End Unlawful Discrimination? Enter text here Enter text here Enter text here Promote Equality of Promote Equality of Promote Equality of Opportunity? Opportunity? Opportunity? Enter text here Enter text here Foster Good Relations Foster Good Relations Between Foster Good Relations Between Between People People People Enter text here Enter text here Enter text here WHAT OUTCOMES ARE EXPECTED/DESIRED FROM THIS PROJECT?

Equality & Inclusion Page 5 59 of 78 What are the benefits to patients and staff?

By being located on one site all staff (clinical and non-clinical) will be in one place ensuring maximum usage of the staff hours. By consolidating on one site there will be more usable hours as currently clinical and non-clinical staff spend time going to two sites. This should enable the practice to increase the overall number of appointments. This should reduce the current waiting time for patient appointments.

All patients will also have access to the services that are currently only provided on the Greenmoss Medial Centre site – antenatal, childhood immunisations, dietician, minor surgery, mental health services and the newly introduced physiotherapy. The rooms at Rode Head are not suitable for the provision of these services. As a result of the consolidation the practice hopes to be in a position to grow and expand services.

The main site is a purpose built health centre with full disabled access. The premise is completely DDA compliant. There are ground floor consulting and treatment rooms and a waiting room area. There are separate surgery and dispensary reception areas with increased privacy and private interview rooms are available should a patient require a private conversation. There is a large car park with disabled parking bays.

With administration staff being located on one site the practice will be able to improve their current appointment booking and administrative services.

Dispensing services will continue and the opening hours increase when on one site.

Any patient who is vulnerable and housebound who is unable to get to the surgery will still be entitled to a home visit.

There is a Community Mini bus that is available for a minimum donation for booking that can take patients to the surgery, shopping etc and back. This is already available for patients to use.

How will any outcomes of the project be monitored, reviewed, evaluated and promoted where necessary? Patients will be able to complete a Patient survey as part of the patient consultation process once the deadline of the 24 April has been reached these will be available for collating to establish the outcome. For those who prefer to complete an on-line survey this is an option. After the patient consultation process has been completed there will be a patient meeting held in public with the practice to receive the outcome and findings. This ensures an open and transparent process and the option for further dialogue should there still be any outstanding queries. As part of the NHS South Cheshire’s 13Q Duty to public involvement the proposed closure of the branch surgery will be presented at the CEC Overview & Scrutiny Committee. For those patients who may not be able to attend the meeting there is the option on the questionnaire for them to request the outcome of the engagement process to be sent to them by email or their home address.

“think about how you can evaluate equality of access to, outcomes of and satisfaction with services by different groups”

Equality & Inclusion Page 6 60 of 78

The consolidation of services on one site will provide the opportunity to for patients to access all services available. Currently this is not possible at the branch surgery as there is lack of space, the premises are not fully DDA compliant, and the rooms are equipped with standard equipment only as there is no space for additional equipment.

The survey includes an option for patients to make any further comments that they feel are important. These will be included in the collation of responses

EQUALITY IMPACT AND RISK ASSESSMENT

Does the ‘project’ have the potential to: • Have a positive impact (benefit) on any of the equality groups? • Have a negative impact / exclude / discriminate against any person or equality group? • Explain how this was identified? Evidence/Consultation? • Who is most likely to be affected by the proposal and how (think about barriers, access, effects, outcomes etc.) • Please include all evidence you have considered as part of your assessment e.g. Population statistics, service user data broken down by equality group/protected group

Please request guidance on Equality Groups/Protected Groups and their issues, this document may help and support your thinking around barriers for the equality groups

Equality Group / Positive Negative Neutral Please explain - MUST BE COMPLETED Protected Group effect effect effect √ Some patients may not have transport and may have to rely on friends, family or carers to take them to their appointment. However the current premises do not offer the full range of services due to the limitation of the building. All patients still reserve the right to have a home visit if they are too ill to attend the surgery. Patients can also have a flag on their record that Age advises that the patient may need assistance to get to the surgery and are reliant on a carer or family member. This would alert the receptionist to look at the range of appointments available which could accommodate the carer or family member.

To note : There is also the use of the community bus Disability √ As above

Gender √

Equality & Inclusion Page 7 61 of 78 Reassignment Pregnancy and √ Maternity Race √

Religion or Belief √

Sex (Gender) √

Sexual Orientation √ Marriage and Civil √ Partnership N.B. Marriage & Civil Partnership is only a protected characteristic in terms of work- related activities and NOT service provision √ Some carers may have to travel further. Carers

√ Some patients may not have their own transport and bus routes may not be close by. Deprived Communities To note : However there is the community mini bus available with a minimum donation. (mini bus) √ Some patients may not have their own transport and bus routes may not be close Vulnerable Groups by. e.g. Homeless, Sex Workers, Military To note : However there is the community Veterans mini bus available with a minimum donation. (mini bus) SECTION 3 - COMMUNITY COHESION & FUNDING IMPLICATIONS Does the ‘project’ raise any issues for Community Cohesion?

No – as all patients will automatically to the Greenmoss Medical Centre irrespective of their background. Patients will still retain the choice to register at another practice if they wish. The area resides in the boundary of two practices in Alsager which the patients are entitled to register with if they chose to.

Equality & Inclusion Page 8 62 of 78 What effect will this have on the relationship between these groups? Please state how will you manage this relationship?

None that can be anticipated.

What is the overall cost of implementing the ‘project’?

None

Please state: Cost & Source(s) of funding: None

This is the end of the Equality Impact section, please use the embedded checklist to ensure and reflect that you have included all the relevant information

Stage 1 EIA SCREENING TOOL V3

SECTION 4 - HUMAN RIGHTS ASSESSMENT If the Stage 1 Equality Impact and Risk Assessment highlighted that you are required to complete a Stage 2 Human Rights assessment (please request a stage 2 Human Rights Assessment from the Equality and Inclusion Team), please bring the issues over from the screening into this section and expand further using the Human Rights full assessment toolkit then embed into this section.

SECTION 5 - PRIVACY IMPACT ASSESSMENT If the Stage 1 Equality Impact and Risk Assessment highlighted that you are required to complete a Stage 2 Privacy Impact Assessment, please request a stage 2 Privacy Impact Assessment either from the Equality and Inclusion Team or the Information Governance Team, email your completed stage 2 to your Information Governance Support Officer either at the CCG or CSU.

SECTION 6 – RISK ASSESSMENT Please identity any possible risk for patients and / or the Clinical Commissioning Group if the project is implemented without amendment. All risks will be monitored for trends and provided to the project author when the project is due to be reviewed IMPLEMENTATION RISK: CONSEQUENCE SCORE DOMAIN INSIGNIFICANT MINOR MODERATE MAJOR CATASTROPHIC Impact on the Minimal injury Minor injury or Moderate injury Major Incident leading to death. safety of requiring no / illness, requiring requiring injury patients, staff minimal minor professional leading An event which impacts or public intervention or intervention intervention to long- on a large number of (physical / treatment RIDDOR / agency term patients psychological reportable incident, incapacit harm an event which y / impacts on a small disability. number of patients Mismana gement of patient care with

Equality & Inclusion Page 9 63 of 78 long- term effects Complaints / Informal Formal complaint Formal complaint Multiple Inquest / Ombudsman Audit complaint / (Stage 1) (Stage 2) complaint complain inquiry inquiry Local resolution Local resolution ts / Gross failure to meet Single failure to (with potential to independ national standards meet internal go to independent ent Severely critical report standards review) review Reduced Repeated failure to Low performance meet internal performa rating if standards nce unresolved rating Critical report Statutory Duty No or minimal Breech of Single breech in Multiple Multiple breeches in / Inspections impact or breech statutory statutory duty. breeches statutory duty. of guidance / legislation. Challenging in Prosecution Zero statutory duty Reduced external statutory performance rating performance recommendations / duty. Severely critical report. For example: rating if improvement Enforcem Unsatisfactory unresolved. For notice. ent For example: a patient example: a minor action catastrophic impact on experience which impact on people For example: a Low people with a protected is not directly with a protected moderate impact performa characteristic has been related to patient characteristic has on people with a nce identified that may lead to care. been identified protected rating litigation or impact on that was agreed characteristic has report patient safety. No action to be accepted been identified. required within the scope For The project should be of the project. This can be example: stopped immediately resolved by making a major No action amendments to the impact required. project or providing on an objective people justification for not with a amending the protecte project (This must d be published with character the EIA) istic has been identified . Consider ation should be given to and review the project immediat ely. Q. Can we make amendm ents to the project

Equality & Inclusion Page 10 64 of 78 or provide objective justificati ons? If yes, this must be publishe d the EIA. Adverse Rumours Local media Local media National National media coverage > Publicity / Potential for coverage short- coverage. media 3 days Reputation public concern term reduction in Long-term coverage MP concerned (questions public confidence. reduction in public <3 days in the House) Elements of confidence service Total loss of public public well confidence expectation not below being met reasonab le public expectati on Business Insignificant cost <5 per cent over 5 – 10 per cent Non- Incident leading > 25 per Objectives / increase project budget over project budget complian cent over project budget Projects No impact on Minor impact on ce with Failure of strategic objectives delivery of national objectives impacting on objectives 10 – 25 delivery of business plan per cent over budget Major impact on delivery of strategic objective s Finance Small loss risk of Loss of 0.1 – 0.25 Loss of 0.25 – 0.5 Loss of Loss of >1 per cent of Including claim remote per cent of per cent of budget 0.5 – 1.0 budget Claims budget Claims (s) between per cent Claim(s) > £1 million Claim less than £10,000 and of £10,000 £100,000 budget Claim(s) between £100,000 and £1 million IMPLEMENTATION RISK: LIKELIHOOD SCORE Frequency: Not expected to Expected to occur Expected to occur Expected Expected to occur daily How often occur for years annually monthly to occur might it / does weekly it happen? Probability <1% 1.5% 6-20% 21-50% >50% Will only occur in Unlikely to occur Reasonable chance Likely to More likely to occur than exceptional of occurring occur not occur circumstances RISK MATRIX RARE UNLIKELY POSSIBLE LIKELY ALMOST CERTAIN Insignificant 1 2 3 4 5

Equality & Inclusion Page 11 65 of 78 Minor 2 4 6 8 10 Moderate 3 6 9 12 15 Major 4 8 12 16 20 Catastrophic 5 10 15 20 25 RISK SCORE ON DRAFT PROJECT RISK SCORE ON FINALISED PROJECT

12 – After completing the document it was envisage the risk score was 9-12 but 12 was chosen as there is no information yet available from the consultation process. WHAT ARE THE KEY REASONS FOR THE CHANGE IN THE RISK SCORE?

EQUALITY IMPACT AND RISK ASSESSMENT AND ACTION PLAN

Risk identified Actions required to Resources Who Target completion reduce / eliminate the required* (see will date negative impact guidance below) lead on the action? Adverse publicity Full patient CCG Practic 24 April 2017 survey Consultation survey. Communication e with Patient frequently engagement and support asked questions (FAQ) Primary Care of CCG fact sheet, PPG teams are available available on a Friday to assist the morning at main practice. Comms surgery site for team supporting patients to raise any practice with issues. Practice happy administering the to receive all survey and the FAQ comments. CCG sheet. Communications team will assist the practice with any media enquiries. After survey there will As above – support As abov Post survey result be a patient meeting will continue post e held in public with the survey practice, NHS South Cheshire CCG and the Parish Council to receive the outcome and findings.

‘Resources required’ is asking for a summary of the costs that are needed to implement the changes to mitigate the negative impacts identified

SECTION 7 – ONGOING MONITORING AND REVIEW OF EQUALITY IMPACT ASSESSMENTS AND

Equality & Inclusion Page 12 66 of 78 ACTION PLANS

Please describe briefly, how the equality action plans will be monitored through internal CCG governance processes?

The Equality Action plans will be provided to the Primary Care Medical Operational Group to ensure the group that the correct underpinning assurances are being undertaken. The final application, should the practice continue to proceed with the closure of the Branch Surgery, will be heard in the Primary Care (General Practice) Commissioning Committee Part A (open to public) meeting for decision. The papers for this meeting are available to the public on the CCG website. CEC & CWAC are standing invitees to the meeting.

If the surgery proceeds with the application to close the Branch Surgery this proposal will also be presented to the CEC Overview & Scrutiny Committee.

Date of the next review of the Equality Impact Assessment section and action plan? (Please note: if this is a project or pilot reviews need to be built in to the project/pilot plan)

Date: June 2017 Which CCG Committee will be responsible for monitoring the action plan progress?

Primary Care (General Practice) Commissioning Committee. Primary Care Operational Group will monitor in the interim

Who will be the responsible person in the organisation to ensure the action plan is monitored? Chris Leese CCG Service Delivery Manager – Primary Care Operations & Caroline Harley, CCG Primary Care Contracts Manager.

FINAL SECTION SECTION 8 Date sent to Equality & Inclusion (E&I) Team for quality check: 12-04-2017 Date quality checked by Equality and Inclusion Business Partner: 13-04-2017 Date of final sign off by Equality and Inclusion Business Partner:13-04-2017

Signature Equality and Inclusion Business Partner: Q Hussain CCG Committee Name and sign off date:

This is the end of the Equality Impact and Risk Assessment process: By now you should be able to clearly demonstrate and evidence your thinking and decision(s). To meet publishing requirements this document SHOULD NOW BE PUBLISHED ON YOUR ORGANISATIONS WEBSITE.

• Save this document for your own records

Equality & Inclusion Page 13 67 of 78 • Send this document and copies of your completed Privacy Impact Assessment and Human Rights Screening to [email protected]

Equality & Inclusion Page 14 68 of 78 Proposed closure of Rode Heath Branch Practice

Q1 What is your postcode?

Answered: 525 Skipped: 59

1 / 10 69 of 78 Proposed closure of Rode Heath Branch Practice

Q2 What is your age bracket?

Answered: 582 Skipped: 2

Under 16

16-24

25-49

50-69

70 and over

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Answer Choices Responses

Under 16 0.17% 1

16-24 0.69% 4

25-49 10.31% 60

50-69 42.27% 246

70 and over 46.56% 271

Total 582

2 / 10 70 of 78 Proposed closure of Rode Heath Branch Practice

Q3 How do you currently travel to your GP surgery?

Answered: 579 Skipped: 5

Own transport

Relatives transport

Public transport

Walk

Other

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Answer Choices Responses

Own transport 67.70% 392

Relatives transport 4.84% 28

Public transport 0.69% 4

Walk 25.22% 146

Other 1.55% 9

Total 579

3 / 10 71 of 78 Proposed closure of Rode Heath Branch Practice

Q4 How often do you attend Rode Heath?

Answered: 560 Skipped: 24

Once a week or more

Between once a week & once ...

Between once a month & twic...

Once or twice a year

Less than once a year

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Answer Choices Responses

Once a week or more 0.18% 1

Between once a week & once a month 17.50% 98

Between once a month & twice a year 26.07% 146

Once or twice a year 30.89% 173

Less than once a year 25.36% 142

Total 560

4 / 10 72 of 78 Proposed closure of Rode Heath Branch Practice

Q5 Which location do you currently attend when you need to access GP services?

Answered: 583 Skipped: 1

Green Moss

Rode Heath

Either/both

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Answer Choices Responses

Green Moss 54.20% 316

Rode Heath 25.39% 148

Either/both 20.41% 119

Total 583

5 / 10 73 of 78 Proposed closure of Rode Heath Branch Practice

Q6 What services do you currently use at Rode Heath?

Answered: 432 Skipped: 152

Prescription collection

Dispensary

Face to Face GP...

Face to Face Nurse...

Other

Other (please specify)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Answer Choices Responses

Prescription collection 40.51% 175

Dispensary 26.16% 113

Face to Face GP consultations 86.57% 374

Face to Face Nurse appointments 58.33% 252

Other 11.57% 50

Other (please specify) 0.00% 0

Total Respondents: 432

6 / 10 74 of 78 Proposed closure of Rode Heath Branch Practice

Q7 What services do you currently use at Greenmoss Medical Centre?

Answered: 484 Skipped: 100

Prescription collection

Dispensary

Face to face GP consultation

Face to Face Nurse...

Other

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Answer Choices Responses

Prescription collection 57.02% 276

Dispensary 45.45% 220

Face to face GP consultation 88.84% 430

Face to Face Nurse appointments 82.85% 401

Other 8.26% 40

Total Respondents: 484

7 / 10 75 of 78 Proposed closure of Rode Heath Branch Practice

Q8 Do you support the practices plan in principle to close the surgery and provide services from Greenmoss Medical Centre?

Answered: 562 Skipped: 22

yes

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Answer Choices Responses

yes 67.44% 379

no 32.56% 183

Total 562

8 / 10 76 of 78 Proposed closure of Rode Heath Branch Practice

Q9 Do you have any further comments?

Answered: 267 Skipped: 317

9 / 10 77 of 78 Proposed closure of Rode Heath Branch Practice

Q10 If you would like to be informed about the outcome of the engagement process, please include your contact details below:

Answered: 288 Skipped: 296

Answer Choices Responses

Name 95.83% 276

Address 88.89% 256

Email 63.19% 182

10 / 10 78 of 78