PROBITY COMMITTEE
28 NOVEMBER 2017 3:00PM, BOARDROOM, WHITE ROSE HOUSE
AGENDA
No. Agenda Item Lead officer
1. Apologies for Absence – Richard Hindley
2. Declarations of Interest Richard Hindley
3. i) Minutes of the meeting held on 24 October 2017 Richard Hindley ii) Action sheet from the meeting held on 24 October 2017
4. Matters Arising Richard Hindley
5. Outwood Park – Wrenthorpe Branch closure application Chris Skelton
6. Station Lane application to change practice boundary Chris Skelton
7. Crofton list closure application Chris Skelton
8. Improvement in Prescribing Plan (ImPP) 2016/17 Annual Report Carly Day
9. Co Commissioning Update (Verbal) Chris Skelton
10. Practice Resilience and Virtual Practice – Strategic update (Verbal) Dr Greg Connor
11. Any Other Business
The Committee is recommended to make the following resolution: “That representatives of the press and other members of the public be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest” (Section 1 (2) Public Bodies (Admission to Meetings) Act 1970)”.
12. Date and Time of Next Meeting 23 January 2018, 3:00pm, The Boardroom, White Rose House 1
Agenda item: 3i
NHS Wakefield Clinical Commissioning Group
PROBITY COMMITTEE
Minutes of the Meeting held on 24 October 2017
Present: Melanie Brown Programme Commissioning Director Integrated Care Sandra Cheseldine Lay Member Dr Greg Connor Executive Clinical Advisor Stephen Hardy Lay Member Richard Hindley Lay Member (Chair) Dr Hany Lotfallah Secondary Care Consultant Andrew Pepper Chief Finance Officer
In Attendance: Liz Blythe Network Development Manager Cllr Pat Garbutt Health and Wellbeing Board Representative Anna Ladd NHS England Representative Ruth Unwin Associate Director of Corporate Affairs Pam Vaines Minute Taker
17/073 Apologies
Apologies were received from Nichola Esmond, Diane Hampshire, Pat Keane, Jo Pollard and Jo Webster.
17/074 Declarations of Interest
There were no declarations of interest made.
17/075 (a) Minutes of the meeting held on 28 September 2017
The minutes from the meeting held on 28 September 2017 were agreed as an accurate record, subject to a correction that the non-quorate agenda item was item 17/060, not item 17/054.
(b) Action sheet from the meeting held on 28 September 2017
The action sheet was noted.
17/076 Matters Arising
There were no matters arising.
17/077 Wakefield Practice Premium Contract – Performance Update.
Liz Blythe presented the Committee with an overview of the Wakefield Practice
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Premium Contract (WPPC) during Quarter 2.
Action plans have been updated following submissions by practices. Practices which fall below the expected trajectory are being monitored. The submissions show that all practices are currently compliant with the Access Domain.
Phlebotomy activity has decreased, possibly due to some practices reducing the number of requests.
Liz Blythe highlighted an increase in Spirometry requests and noted that all practices continue to provide ear irrigation.
Sandra Cheseldine asked for future reports to contain more detail relating to the outcome of verification visits and funding variations made as a result.
Dr Greg Connor agreed to provide details of all payments made to practices. He is confident that all practices will achieve the targets. Liz Blythe confirmed that the six month targets within WPPC are benchmark figures and not a contractual condition.
It was RESOLVED that:
(i) Probity Committee noted the update of the Wakefield Practice Premium Contract (WPPC) for Quarter 1 and 2 (ii) Receive a further WPPC performance report for Quarter 3 2017/18
17/078 Additional Patient Access Contract Quarter 2 Performance Report
Liz Blythe informed the Committee that Patience Lane Practice had corrected the 44 contact shortfall that they had reported in Quarter 1.
All other practices, except Stuart Road, had achieved target and are eligible for payment. The Practice Manager at Stuart Road had misinterpreted the target for Quarter 2, which resulted in a shortfall in Quarter 2. The practice has plans in place to rectify the shortfall in Quarter 3.
Andrew Pepper commented that nationally the work carried out in Wakefield is highly valued and suggested the CCG should look for opportunities for publicise this work.
It was RESOLVED that:
i) Probity Committee approved the report of the APAC Scrutiny Panel including the proposals for payments to 35 practices.
17/079 Virtual Practice Update – Verbal
Dr Greg Connor informed Committee members that a verbal update on the Virtual Practice will be given at the November meeting. 2
17/080 Outwood Park Branch closure consolation – Verbal Update
Liz Blythe informed Committee members that a verbal update on the proposed closure of the Outwood Park Branch would be given at the November meeting.
Mel Brown confirmed that consultation would finish at the end of October. The findings will be presented at the Overview and Scrutiny Committee which will inform the CCG’s decision. Two petitions have been received and the Morley MP, Andrea Jenkins, is involved in this matter and has met with CCG representatives.
17/081 Premises Re-imbursement
Andrew Pepper suggested that Premises Re-imbursement does not need to be a standard agenda item and should only be included in future when required. He confirmed that details of GP rents will be presented to Audit Committee.
It was RESOLVED that:
i) The Probity Committee accepts that Premises Re-imbursement will no longer be a standing agenda item.
17/082 Probity Committee Terms of Reference
Ruth Unwin presented revised Terms of Reference to the Committee for consideration. The members were advised that it had been proposed that the committee should take responsibility for seeking assurance on implementation of plans that had been approved by the Committee.
Following proposed changes to the Terms of Reference of Clinical Cabinet, additional responsibilities regarding Medicines Optimisation will pass to the Probity Committee.
Changes to the membership of the Committee are being proposed together with quoracy requirements
The revised Terms of Reference will be presented at Governing Body for approval.
It was RESOLVED that:
i) The Probity Committee noted the update.
17/083 Any Other Business
No items were identified for discussion.
17/084 Date and Time of Next Meeting
Tuesday 28 November 2017, 15:00pm, The Board Room, White Rose House
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Agenda item: 3ii NHS Wakefield Clinical Commissioning Group
ACTION POINTS FROM PROBITY COMMITTEE HELD ON 24 OCTOBER 2017
Minute Topic Action required Who Date for Progress No completion 17/034 Late Visiting Provide pilot evaluation to Probity Katie Roebuck 23 January Specification Committee once completed and 2018 or April incorporate all costs at evaluation stage 2018 Outwood Park Branch To bring back proposed closure to Chris Skelton 23 January 17/035 Closure Consultation Probity once Patient Engagement 2018 Complete Co-commissioning A new constituent needs a GP Melanie Brown 28 Sept 2017 Completed 28 September 17/037 Update allocation. Melanie to arrange on behalf 2017 of Cllr Garbutt. Delegated Guidance is requested for financial Melanie Brown Awaiting NHS NHS England’s Response; 17/047 Commissioning support England Our finance teams have responsibility for Primary always worked with CCGs Medical Care Services around what level of MOU support is needed by each CCG. Completed September 2017. Understanding schemes Training regarding the names and Ruth Unwin 1 December and organisations which relationships of the developing 2017 17/054 CCG is involved with. organisations and schemes at a Board Development Session Wakefield Practice Quarter 3 performance report will Dr Greg 23 January 17/077 Premium Contract include details of the outcome of Connor 2018 monitoring and of payments made to practices 17/079 Virtual Practice Verbal update Dr Greg 28 November Connor 2017
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Title of Probity Committee Agenda 5 meeting: Item:
Date of 28 November 2017 Public/Private Section: Meeting: Public Private Paper Title: Outwood Park (B87013) – Wrenthorpe N/A Branch Closure Request If private, insert here reason for
inclusion as a private paper Purpose (this paper is for): Decision Discussion Assurance Information
Report Author and Job Chris Skelton, Head of Primary Care Co-Commissioning Title: Responsible Clinical Dr Greg Connor, Executive Clinical Advisor Lead: Responsible Mel Brown, Director for Integrated Care Governing Board Executive Lead: Recommendation (s):
Is it recommended that Probity Committee;
a) Formally receives the request by Outwood Park Medical Centre to close the branch surgery at Wrenthorpe, Wakefield b) Notes the content of the documents produced by the practice c) Notes opposition to the closure and concerns raised by the local community d) Accepts or rejects the request
Executive Summary:
Probity Committee previously agreed to the commencement of a period of patient and stakeholder engagement and has received regular progress updates throughout the process. At the Probity Committee meeting in July 2017, the Outwood Park Medical Centre presented an interim Engagement Report and permission was agreed for the engagement with patients to commence before a formal application was submitted for a decision.
Following the consultation, the practice has now submitted a formal application for a branch closure.
Link to overarching principles from the Reduction in hospital admissions where appropriate strategic plan: leading to reinvesting in prevention New Accountable Care Systems to deliver new models of care
Collective prevention resource across the health and social care sector and wider social determinant partners Expanded Health and Wellbeing board membership to represent wider determinants A strong ambitious co-owned strategy for ensuring safe and healthy futures for children A shift towards allocation of resources based upon primary and secondary prevention and social determinants of ill health Transforming to become a sustainable financial economy
Organising ourselves to deliver for our patients
Outcome of Integrated Included within the Paper Impact Assessment completed (IIA) Outline public Included within the Paper engagement – clinical, stakeholder and public/patient: Management of Conflicts Not applicable of Interest:
Assurance departments/ Ruth Unwin, Associate Director for Corporate Affairs, WCCG organisations who will Dasa Farmer, Engagement Manager, WCCG be affected have been consulted: Previously presented at 25 July 2017 committee / governing body:
Reference document(s) / Practice Application enclosures:
Risk Assessment: Not applicable
Finance/ resource Not applicable implications:
NHS WAKEFIELD CCG
Application to Close Branch Surgery at Wrenthorpe Outwood Park Medical Centre (B87013)
1. Purpose The purpose of this report is to:
a) Consider the application made by Outwood Park Medical Centre to close the branch surgery at Wrenthorpe.
2. Background
Outwood Park Medical Centre (B87013) is seeking permission to close the branch surgery at Wrenthorpe Lane, Wakefield WF2 0NL.
The practice has been reviewing service provision of core Personal Medical Services (PMS) and has concluded that it does not have sustainable capacity to make a commitment across both sites. The application received from the practice can be found at Appendix 1.
Probity Committee previously agreed to the commencement of a period of patient and stakeholder engagement and has received regular progress updates throughout the process. At the Probity Committee meeting in July 2017, the Outwood Park Medical Centre presented an interim Engagement Report and permission was agreed for the engagement with patients to commence before a formal application was submitted for a decision.
3. Alternative provision of primary medical care
There are three alternative GP practices within 2 miles of the branch surgery however none of these is within 1 mile of the branch in line with NHS England policy. These practices have open lists and are registering new patients.
These practices are;
New Southgate Surgery 1.3 Miles Alverthorpe Surgery 1.8 Miles Homestead Medical Centre 2.0 Miles
From the consultation undertaken by the practice, the practice does not expect that many patients will register with alternative providers.
4. Reasons for the practice wanting to close the branch.
The practice has reluctantly decided to propose the closure on the grounds of:
• The practice has been reviewing the provision of core services and has concluded that it does not have the sustainable capacity to make commitments of an equitable service across both sites. • The branch surgery at Wrenthorpe falls short of service standards and compliance. • Due to physical access constraints the building is not fit for the purpose of accessing same day urgent care.
• Despite the work undertaken by the Patient Reference Group who in partnership with the Wrenthorpe Village Hall provide parking spaces for patients with poor mobility there is still insufficient parking availability. • The practices strategy for centralisation of services at Outwood is a clinical case for change. Wrenthorpe does not have access to the extended services that are provided at Outwood. In the number of patients who use the branch surgery, the vast majority of these patients may have to make another visit to the main practice to see a GP, nurse or health care assistant for physical examinations, review of a long term condition, blood testing etc. This could ultimately cause a delay in diagnosis.
5. Utilisation of the branch
As part of the application, the practice has reported the utilisation of the branch surgery. The practice states that on average 15 patient consultations take place each week, equivalent to one GP session.
6. Financial Impact of Potential Closure
In the event of closure a) The practice would save on heating, lighting and other utility bills. b) The practice would no longer receive notional rent, rates or reimbursement for clinical waste which are funded via the CCG through the GMS contract (Statement of Financial Entitlements) c) There would be no financial impact on staffing as all staff currently work across both sites and duties would be absorbed back to the main site.
If a significant number of patients were to re-register with another practice, this would impact on payments to the practice which are based on the number of registered patients (capitation payments).
There is a financial implication to the CCG that if the Branch closure is approved the CCG will continue to pay for the vacant space created. Therefore the CCG would continue to be liable for £20,000 on revenue costs.
7. Patient and Stakeholder Engagement
The engagement process is led and owned by the practice supported by the CCG.
Outwood Park Medical Centre has provided the following documents for consideration by Probity Committee to support their branch closure request and they describe their patient and stakeholder engagement.
The Engagement Report has been prepared by the practice and sets out the scale and scope of the patient and stakeholder engagement process and with the key themes of the responses. This also includes representations made by MP, Councillors, patients and the Overview and Scrutiny Committee.
The report was presented to the Adult Services, Public Health and the NHS Overview and Scrutiny Committee on November 16th and the committees concluded:
‘The OSC requests that the Probity Committee carefully consider the proposal for closure prior to making a decision and that sufficient weight is given to the views of local people as expressed through the engagement and consultation process and these are taken fully into account.
The Committee will then carefully scrutinise the decision of the Probity Committee and the reasons for that decision both in relation to potential closure but also any proposed future provision of primary care in Wrenthorpe.’
8. Opposition to closure
Patients, local councillors, the Local Authority and the local MP have expressed views directly to Outwood Park Medical Centre and these have been reflected in the practice’s report.
A number of representations to oppose the closure have also been made directly to the CCG. For ease of reference, these have been included as appendices with this report.
Dr Adam Sheppard formally received a petition on behalf of the CCG from Andrea Jenkyns, the MP for Morley and Outwood, whose constituency also includes Wrenthorpe. A copy of the letter is attached as Appendix 3. The petition has been signed by 141 people.
An on-line petition headed Stop the Closure of Wrenthorpe Local Surgery (SCOWLS) containing 441 signatures was also received by the CCG.
9. Quality Impact Assessment and Equality Impact Assessment
The engagement process is led and owned by the practice supported by NHS Wakefield CCG. It has assessed what the impact would be on quality of service provision (Quality Impact Assessment) and an Equality Impact Assessment has been completed as part of the engagement work.
Key themes to emerge were concerns about accessibility and patient transport, particularly for elderly patients, those less mobile and those with young children. These themes are strongly reflected in the patient feedback in the practice’s engagement report and in the feedback addressed directly to the CCG.
10. Conclusion
NHS Wakefield CCG has followed the national process for dealing with requests for branch closures as directed in NHS England’s Primary Care Policy Book (Jan 2016) https://www.england.nhs.uk/commissioning/wp- content/uploads/sites/12/2016/01/policy-book-pms.pdf Included as Appendix 2.
The GP Forward View, published in April 2016, acknowledges that General Practice is under unprecedented pressure and needs to transform to ensure that services are fit for the future.
“Almost every practice is struggling to balance rising workload within tighter financial constraints. Add to this the strain of recruitment issues and it becomes easy to see why morale is so challenged. Clinicians increasingly feel unable to provide the care they want to give, and understandable resentment of working under this pressure is growing.”
NHS Wakefield CCG is at the forefront of developing new models of care and the strategic plans for General Practice in Wakefield seek to ensure provision of high quality innovative primary care. This will also involve practices thinking and working differently.
Outwood Park Medical Centre reports that they find that most of their patients attend the main site with very few elderly patients without transport of their own. Due to the
demands that the practice is experiencing, the practice states they are finding it more difficult to manage the branch site.
In concentrating services at the main Outwood site, the practice feels it would provide • Greater Range of clinical expertise • Increased access to same day urgent care • Enhanced patient safety due to continuity of care • Larger team with the ability to provide responsive essential medical services • More continuity at one site rather than waiting several days to see the same GP at the branch • Better facilities, better disabled access and child friendly compliance • 100+ parking spaces as opposed to 3 at the branch site • Reduced clinical risk at the main surgery due to the ability to conduct all necessary tests with a Nurse, Health Care Assistant, Phlebotomist and GP being on site together.
11. Recommendations and Next Steps
It is recommended that Probity Committee a) Formally receives the request by Outwood Park Medical Centre to close the branch surgery at Wrenthorpe, Wakefield b) Notes the content of the documents produced by the practice c) Notes opposition to the closure and concerns raised by the local community d) Accepts or rejects the request*
Where the Commissioner refuses the branch closure through its internal assessment procedure, the contractor shall be notified in writing within 28 days following the internal assessment and the contractor may then follow the relevant resolution process as referenced in the GMS contract.
Chris Skelton Head of Primary Care Co-Commissioning 13th November 2017
Appendix 1 – Practice Application for Branch Closure
Image (10).tif
Dr Putman & Partners Proposal to Close Wrenthorpe Branch Surgery
Engagement Report October 2017
1.1
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Contents Introduction ...... 8 Background ...... 8 The Proposal ...... 8 As a practice we feel ...... 9 Engagement Process ...... 9 Methods of Communication and Engagement ...... 9 Equality impact Assessment ...... 12 Feedback ...... 13 Public Meeting Wrenthorpe Village Hall 30.08.17 ...... 14 Patient Survey results ...... 16 Reason for disagreeing with the proposal to close Wrenthorpe surgery were categorised as ...... 20 Additional Comments – patient survey ...... 21 Appendix 1 – Patient Survey ...... 40 Appendix 2 Poster ...... 45 Appendix 3 Frequently Asked Questions (FAQs) ...... 46 Appendix 4 Letter to Patients ...... 48 Appendix 5 – Communications and Engagement plan ...... 50 Appendix 6 Summary ...... 74 Background ...... 74 Methods of Communication and Engagement ...... 76 Feedback ...... 77
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Introduction
Dr Putman & Partners continuously strives to provide high quality healthcare and are very keen to maintain the best possible service to our patients. The nature of care provided in General Practice has been rapidly changing with more extensive management of chronic disease, treatment of more complex cases, an increase in demand for same day appointments and provision of a wider range of services. The practice operates over two sites Outwood Pak Medical Centre (main site) and Wrenthorpe Branch Surgery On review of our current core services the practice concluded that it does not have the sustainable capacity to make commitments of an equitable service across both sites. And as such the most efficient way to improve services would be to offer them from just one site. On consideration of the above is what brought the partners to their decision in April 2017 to put forward an application to NHS Wakefield Clinical Commissioning Group (CCG) to close the branch surgery in Wrenthorpe.
2. Background
For a number of years there have been concerns within the practice about the accessibility and provision of services that could be safety delivered at the branch surgery in Wrenthorpe. There were concerns that: 1. the branch surgery at Wrenthorpe was falling short of service standards and compliance. 2. Due to physical access constraints the building was not fit for the purpose of accessing same day urgent care. 3. Insufficient parking availability made it difficult for patients with poor mobility to physically access the surgery safely. 4. Wrenthorpe does not have access to the extended services that are provided at Outwood. 5. In the number of patients who use the branch surgery, the vast majority of these patients may have to make another visit to the main practice to see a GP, nurse or health care assistant for physical examinations, review of a long term condition, blood testing etc. This could ultimately cause a delay in diagnosis
6. Wrenthorpe Surgery operates on a different telephone number from the main site but both sites have access to the same appointment and clinical system. Other than the receptionist there are no clerical or administration staff based at Wrenthorpe.
These concerns and the practices strategy for centralisation of services at Outwood was the basis of the decision to put forward a proposal to close the branch surgery.
3. The Proposal
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The practice is proposing to close the branch surgery at Wrenthorpe. An application was made to Wakefield CCG to commence engagement with the registered patients of Dr Putman & Partners to seek their views on this in order to provide the Probity Committee of the CCG (who will be making the decision on this) an overview of patient feedback.
4. As a practice we feel
If the branch surgery was to close, this would free up more clinical time at Outwood. By concentrating services at the main site the practice would be able to provide - • Greater range of clinical expertise under one roof. • Increased access to same day urgent care • Enhanced patient safety due to continuity of care – More chance of seeing a preferred GP • Larger team with the ability to provide responsive essential medical services • More continuity at one site rather than waiting several days to see the same GP at the branch • Improved telephone access at main site – designated line to administration. Four phone lines instead of one at branch surgery • Better facilities, better disabled access and child friendly compliance. • 100+ parking spaces as opposed to 3 at branch surgery • Reduced clinical risk at main surgery due to the ability to conduct all necessary tests with a nurse, Health Care Assistants, Phlebotomist and GP being on site together
5. Engagement Process
In 15 June 2017 the practice met with the CCG to go through the application process. In 17 July 2017 the proposal was shared with the Patient Participation Group (PPG) at the six weekly meeting. The rationale was discussed with the group and having listened and participated in the discussions the group gave their 100% backing to the proposal. The draft communication and engagement plan was shared with the group for their comment and suggestions. They were incorporated in the final version of the document. In July 2017 the application was formally submitted to the CCG and the practice was invited to attend the Probity meeting 25 July 2017. Permission was granted to enter in to a 12 week period of public engagement. The practice was mindful that the engagement process would run over the summer holidays hence the decision to run for a period of 12 weeks.
6. Methods of Communication and Engagement
• Met with CCG • Met with Practice team and the wider PHCT ( Community Nurses & Midwife) • Met with PPG Chair
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• Presented to PPG
Staff Staff were informed in May 2017 of the proposal. They were assured there would be no redundancies. The staff have been informed at every stage of the process and were actively involved with preparing for the engagement period. Patient Participation Group The practice has a well establish and actively involved patient group. The proposal was discussed with the group chair and a further meeting with all members was arranged. In July 2017 the proposal was shared with the Patient Participation Group (PPG) at the six weekly meeting. The rationale was discussed with the group and having listened and participated in the discussions the group gave their 100% backing to the proposal. The communication document was shared with the group and members put forward suggestions and offers of support to advertise the proposal. Members requested that they be informed and involved in the development of this plan and the engagement process Throughout the period of engagement the practice has kept in close contact with PRG members. The PRG members have close links with the Wrenthorpe community and the members acted as conduits between the patients and practice in the aim to provide a consistent and accurate response to patients concerns and to feedback to the practice – they also encouraged patients to contact the practice directly if they were worried. Our members have attended community events and coffee mornings where the proposal has been discussed. – The PRG members have ensured that Posters/leaflets and FAQ have been available in a number of community venues where they have a personal involvement. The PRG have been in regularly updated on the progress of the engagement and are in receipt of the outcomes. Letter to patients – the practice wrote to the 2,000 registered households in Wrenthorpe and those households that could be deemed to be closer to Wrenthorpe than Outwood. To ensure that the practice had identified the correct postcode search criteria we enlisted the help of a member of the CCG Data Quality team to verify the searches. Local Practices 10 August 2017 the practice met with the Federation /Network member practices. The practices are geographically aligned and as such three of the practice areas overlap the Outwood Park Medical Centre boundary Pharmacist in Wrenthorpe Communications between both parties have been based on reassuring patients that the service will continue and how the service could be improved. Patient surveys A paper version was available from both Outwood and Wrenthorpe reception areas, online on the surgery website and in Wrenthorpe Village community venue FAQ and information leaflets were available from both sites and on the website. Comments & Suggestion box. Patients were encouraged to post their comments and suggestion in a feedback box at both sites . Local Media The practice has written an article for both the Outwood & Wrenthorpe newsletter which is distributed all local households – The PRG Chair has been instrumental in pulling this together There has been a local media presence – article in the Wakefield Express
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Website A section on the website was created to provide information and links to surveys, FAQ and a method to leave feedback. Petition The practice are aware that a petition was presented to the CCG
Drop in Sessions These were held at various times and days of the week in the hope that as many stakeholders as possible would have an opportunity to attend. The practice held four Drop in Sessions 10.08.17 Outwood Park Medical Centre 5:00pm -7:00pm In attendance • Glennis Rhodes Practice Manager • PRG Chair • 2 patients attend the drop in session
14.08.17 Wrenthorpe Health Centre 3:00pm 6:00pm In attendance • Glennis Rhodes Practice Manager • 2 Members from PRG • 35 patients
16.08.17 Wrenthorpe Health Centre 10:00am -12noon In attendance • Glennis Rhodes Practice Manager • Kay Allon Senior Practice Nurse • PRG chair • 50 Patients
31.08.17 Outwood Park Medical Centre 9:30 – 11:30pm In attendance • Glennis Rhodes Practice Manager • 1 member of PRG • Dasa Farmer CCG Comms & Engagement • 2 Patients
Meeting with local Councillor Charles Keith 11 August 2017 (2hr) In attendance from the Practice • Glennis Rhodes Practice Manager
Key areas of concern: • Travel and transport options • Service provision • Impact on local services • Impact on village status
Councillor Keith made recommendations and agreed to arrange and chair a public meeting. Representatives from the practice were invited to attend.
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Councillor Keith took an active role in promoting the event and provided a leaflet drop to the Wrenthorpe community to ensure that the event was widely publicised. Councillor Johnson was also key to the process being a successful event. Public Meeting Wrenthorpe Village Hall 30 August 2017 Feedback on the night was submitted to the practice by the organisers Attendance from the practice • Glennis Rhodes Practice Manager
And all available partners • Dr Helen Putman Senior Partner • Dr Stephen O’Boyle • Dr Anwar Al-Khaili • Dr Anoushka Capewell
Members of the Public • Estimated at 85 for the whole duration of the meeting
MPs office • A representative of Andrea Jenkyns office was in attendance
CCG Representatives • Two member of the engagement team from the CCG
7. Equality impact Assessment
The Equality Act 2010 protects people against discrimination, harassment and victimisation in relation to housing, education, clubs, the provision of services and work. It unifies and extends previous equality legislation. The groups the Act specifically covers are called ‘protected characteristics’ these are: • Age
• Disability
• Gender reassignment
• Marriage and civil partnership (with some restrictions)
• Pregnancy and Maternity
• Race
• Religion or belief
• Sex
• Sexual orientation
The CCG also incorporates consideration of carers within this work.
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The public sector equality duty section 149 of the Equality Act requires public bodies, to pay regard to the need to; • Eliminate discrimination, harassment and victimisation
• Advance equality of opportunity
• Foster good relations
A quality impact assessment has been carried out and this will be submitted to the Probity Committee of the CCG as part the overall documentation for Probity committee consideration
8. Feedback
Feedback has been received in a number of ways o Verbal o Email o Written o Surveys both hard copy and online o PRG Feedback Feedback Summary We received o 287 individual written responses to the patient survey. o Feedback from the organisers of the public meeting where shared with the practice after the event. o 3 letters o Standard letters for and against the proposal that were issued at the public event o 3 emails o Verbal – drop in sessions and public meeting attendances The Key themes arising from all of the feedback can be grouped into the following themes. In order of ranking o Transport - Ranked highest of the key areas with 98 survey respondents having concerns with how they would travel to the main surgery given the lack of public transport between the two sites. o Housing - Noted throughout verbal discussions was the concerns that were raised regarding the number of new housing developments that were taking place across the area and their impact on local public services. o Access – the third ranked area of concern was of the impact on appointment availability. Some patients thought that the closing of Wrenthorpe branch would lead to a reduction in actual appointments. As part of the verbal discussions patients were reassured that there were no plans to cut back on appointments. It was explained that the same number of appointments would be available just at a different location.
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o Rationale for the proposal – some respondents questioned this, feeling that the true reason for the proposal was financial savings for the practice. o Impact on local pharmacist – Patients were worried that should the closure impact on the chemist to the point whereby it would no longer be financially viable to remain open what the knock on effect of this would have on the village status. At verbal discussion the practice was able to offer assurances that it would continue to maintain the close, successful relationship it holds with the pharmacist and did not foresee any reason why this should not continue.
o Pollution – linked to concerns in the over development of the area. Patients felt that the closure would mean the need for more cars. The practice responded that whilst this was an area which was out of our control we envisaged that as a maximum this would mean an extra 32 cars a day would be travelling to Outwood rather than Wrenthorpe. I was felt that this would cause little if any significance to the environment.
9. Public Meeting Wrenthorpe Village Hall 30.08.17
7:00 – 8:30pm • Introduction- Councillor Keith highlighted the local councillors’ 3 areas of concern o The impact on the pharmacy o Connectivity between the villages of the ward (buses) o Access to improved health care • Chair – Martyn Johnson introduced the rules of the meeting • Practice presentation from Glennis Rhodes, Practice Manager • Questions open to the floor • Future plans of the practice • Meeting closed
The meeting provided everyone with an opportunity to write down their questions and comments and for these to be submitted to the Chair. All of these were addressed at the meeting. 85 people were in attendance. Minutes of the meeting submitted by the organisers note the following questions and answers: Q1 – Transport – How do people with mobility problems get to Outwood surgery? Observation also raised on the same subject– I don’t drive and it takes ½ hour to walk to Outwood surgery from Wrenthorpe, and ½ hour to walk back. That is a lot of time out of my working day. ANSWER – The surgery and the Councillors are looking at ways in which the bus services between Wrenthorpe and Outwood could be improved. A preliminary
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meeting has been held with Kim Purcell from Arriva as currently there is only one bus which goes to the Outwood surgery. There have also been discussions with local taxi firms to explore ideas for potential reduced fares for patients. Whilst the surgery management will do all it can to improve access, there are still limitations on what they can actually do.
Q2 – Why is it proposed to close the Wrenthorpe surgery? ANSWER – The proposal has been put forward because we cannot provide the same high level and quality of services that we want to do, across both sites. There is a limitation on the facility at Wrenthorpe and not the same access on site to other parts of our medical services. Wrenthorpe does not have as many professional medical staff present on site – such as nurses – that could assist with emergency medical care of any of the patients if they suddenly became very ill. These reasons mean that the facilities available are could be detrimental to patients seen at the Wrenthorpe surgery. We want to develop and progress higher standards and enhanced services, moving towards what is needed and desired for our patients. Focusing these efforts on one site will future –proof the surgery to the standard which patients need and deserve.
Q3 – Has the NHS been approached to make the Wrenthorpe surgery building fit for purpose? ANSWER - We have no control over some of the issues concerning the building. The partners offered to buy the building some 10 years ago but due to insurmountable issues concerning caveats and land ownership, it became impossible to make the purchase viable. The NHS property department which owns the site only has a finite amount of money available across all the properties it owns, and therefore, with the CCG, has to categorise these in order of important for financial investment. This site is not a high priority to them. One of the Doctors cited the issue of problems with access into the surgery. There have been accidents on the site and a connected concern with this is the difficult of access for the emergency services (ambulance and equipment for paramedics). This means the patients there are more vulnerable should an emergency with their health and treatment arise. Q3 – Why wasn’t it mentioned in the survey that there was a financial implication involved in the decision to close the surgery? ANSWER – There isn’t a financial implication to the proposed closure. Rental for the property is not directly involved with the partners. There is only the lighting and heating to fund so finance is not part of the decision.
Q4 – Building of new houses in the area might result in up to 500 new homes being established, along with their residents. Will they be able to see a GP or join the practice? ANSWER – The patient list is constantly rising and the number of GP’s increasing to meet the demand. The surgery and other public providers (like schools) are not consulted about local growth in housing and population. Many of the new houses proposed, or actually built, are not necessarily within our practice area. We can only take patients from within our area.
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Q5 – I asked for an appointment at Wrenthorpe and was told there weren’t any available immediately, have you started closing it? ANSWER – No we haven’t started closing the surgery. We only book ‘same day’ appointments for people who are acutely poorly at the Outwood site because of the higher number of clinical staff and access to the other services there. This is one of the reasons why we feel we cannot offer the same high level of service there. Q6 – Could you put all the routine appointments at Wrenthorpe, and the same day appointments at Outwood for the Wrenthorpe based patients? ANSWER – This would not be practical as all appointments are dealt with on a first come first served basis for patients across the whole practice area. It isn’t just a case of separating out different types of appointments, because the underlying issue of the building not being fully suitable for our purposes is still there. Q7 – Will you still do home visits? ANSWER – Home visits will always be undertaken for very ill or house-bound patients. There is no change to the practices policy on this matter. We have previously trialled a patient transportation system for people too poorly to travel to the surgery on their own. We had a car available to collect them. Some patients accepted the offer to be collected, whilst others declined. The trial finished due to low up-take. Q8 – Is any additional funding available to be able to spend on the Wrenthorpe surgery to bring it up to a better standard? ANSWER – The funding structure in simple terms is that we are given an amount of money, per annum, per patient. There are some variations to this to take account of different cohorts or for deprived areas. We do not have pockets of deprived areas, so don’t receive extra funding. This funding is for open access for patients to the facilities of the surgery.
10. Patient Survey results The following section outlines the results received via the survey. The questions can be found in Appendix 1. Are you, or someone you care for, registered with Dr Putman & Partner’s?
o Yes – I am 139 o Yes – Someone I care for is 0 o No 0
Are you completing this survey as a patient or a carer of someone who is a patient at Dr Putman & Partners?
o On my own behalf 148 o On behalf of someone I care for 1 o Both 10
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Where do you normally go for your appointments? o Outwood Park Medical Centre 61 o Wrenthorpe Health Centre 12 o Both 86
When did you last visit one of the surgeries? ( if you visited the practice today do not count this in your response)
o In the last month 84 o 1-3 months ago 44 o 4-6 months ago 16 o 7-12 months ago 6 o More than 12 months ago 6
Thinking about the last 12 months, how often have you visited the surgery at Outwood Park Medical Centre? o Not visited 5 o 1-3 times 77 o 4-6 times 46 o 7-12 times 20 o More than 12 times 9
If you attended Outwood Park Medical Centre, how did you get there?
o On foot 29 o Drove myself 88 o Got a lift from a friend/ relative 28 o Bicycle 3 o Public transport 3 o Taxi 5
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Thinking about the last 12 months, how often have you visited the surgery in Wrenthorpe?
o Not visited 67 o 1-3 times 75 o 4-6 times 8 o 7-12 times 4 o More than 12 times 0
If you attended Wrenthorpe, how did you get there?
o On foot 94 o Drove myself 34 o Got a lift from a friend/ relative 10 o Bicycle 2 o Public transport 0 o Taxi 1
Do you agree with the proposal to close Wrenthorpe Branch Surgery?
o Yes 9 o No 143 Undecided 3
If Wrenthorpe Branch Surgery Closes, how will you access GP services
o Go to Outwood Park Medical Centre 125 o Register with another practice 17
What is the first part of your postcode?
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The figures below show that the majority of the respondents live in Wrenthorpe area. WF1 30
WF2 116
WF3 2
What sex are you?
Male 8 Female 14
Prefer not to say 0
How old are you 20 -30 3 31-40 6 41-50 11 51-60 15 61-70 34 71-100 45
Which country were you born in United Kingdom 18 South Africa 1
Ethnic group? Indian Pakistani Bangladeshi Chinese Other Asian background (please specify) Caribbean African
Other Black background (please specify) White and Black Caribbean White and Black African White and Asian Other mixed background (please specify)
19
English/Welsh/Scottish/Northern Irish/British Irish Gypsy or Irish Traveller Other White background (please specify) Arab Not answered 20
Do you consider yourself to be disabled Yes No 12
Do you look after, or give any help or support to a family member, related to age? friend or neighbour because of a long term physical disability, mental ill- health or problems
Yes 6 No 9
Are you pregnant or have you given birth in the last 6 months? Yes 0 No 12
11. Reason for disagreeing with the proposal to close Wrenthorpe surgery were categorised as
Concerns over transport or mobility problems 98
Concerns over increasing pollution/new housing 21
Concerns over chemist 4
Concern over lack of appointments 10
20
Concerns over pollution 2
Money/Financial 2
12. Additional Comments – patient survey
The following table features all of the open ended comments received via the survey. The key themes from this were: o Transport and physical access to practice o Housing developments in the area and their impact on public services. o Access to appointments – this was both in respect of the impact of new developments but also what impact there would be should the branch surgery not be open. o Home visits – proportion of respondents queried as to whether the practice would be able to sustain any potential increase in home visits such a change could result in. Based on previous home visit work and current population requirements, the practice feels confident to be able to manage this. o Rationale for the proposal – some respondents questioned this, feeling that the true reason for the proposal was financial savings for the practice.
o Outwood from Wrenthorpe?? This is a stupid idea if you want to save money look at other ways and start thinking about the actual repercussions that will occur on YOUR PATIENTS
o Wrenthorpe means I not need to travel by car and is very useful for my elderly parents and teenage daughter. It already takes too long to get an appointment at Outwood
o It is becoming increasingly difficult to get an appointment at Outwood. If the surgery could guarantee more doctors to cater for the expanding area then i would not have an issue with Wrenthorpe closing, as i would not be personally affected.
o Despite reassurances that doctors and nurses will move to Outwood it is already difficult to get an appointment, and I believe this closure will make it even harder. People - and especially the elderly, disabled, and those with young children will have to travel much further to get to a surgery, and the chemist near Wrenthorpe will likely lose business, and be unsustainable. This means people in Wrenthorpe will have to travel further for their appointments and their medicines. With the entire new house building it seems crazy to close surgeries. We need to expand capacity, not consolidate it.
o Because there are enough pts already at Outwood and Wrenthorpe will be too far to travel for me and my mum. And for numerous other ppl too I can image each village should have their own gp practice after all there are enough houses being built. This all boils down to money and is not fair if it closes! 21
o As I grow older and may no longer have use of a car I believe we will become more dependent on a local surgery in the heart of the village. Add to that the huge increase in traffic and people living in and around Wrenthorpe we should be considering expanding the Wrenthorpe local practice. Returning it to its traditional home at the heart of the community. o It appears as though the practice itself has run down the Wrenthorpe Branch In the past there has been 2 Doctors on duty and appointments have always been full. o I would use the Wrenthorpe branch more but the waiting list for an appointment is so much longer. o I see no reason for the closure and think that it is important for the Wrenthorpe Community o Facilities within the village should be maintained or improved because:- The village has a large population and we can expect more people to live longer, requiring frequent and regular medical attention. Services to maintain mobility such as chiropody etc. and other services to maintain health (not just treat the sick) are valuable and should be increased locally. Travel to a more remote surgery becomes increasingly difficult for non- drivers.Bus services are infrequent. The degree of difficulty in accessing services may lead to self-neglect. Perhaps more home visits would be required - will Outwood Surgery offer this? The adjacent Pharmacy in Wrenthorpe is a good service - what is its future if the Surgery closes? Planning policies should take health facilities into account. Housing developments are in progress, and more are to come. It would be irresponsible to continue development without relevant support to meet the needs of residents. Planning departments consider that we should be using sustainable transport links, fewer cars etc. - removing local facilities does not enhance compliance. Family services should be available within this village. o The reasons for the proposed closure are not valid in my opinion. If the premises really are inadequate then a local venue should be found to replace it with. o Value for money - as a resident I feel that we should receive a good service locally, not remotely. o It is essential part of the options especially for young parents and older people tone able to access a doctor close to where they live. When I'll it is not always possible to drive
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o I've not visited Wrenthorpe because never any appointments there so instead of being able to walk to Wrenthorpe, I have to drive to Outwood. My daughter of 13 years has Type 1 Diabetes so use Wrenthorpe chemist regularly for her supplies. I used to order her prescription on line but now she is 12, your practice won't allow me to do this! It's such an inconvenience having to post the prescription at Wrenthorpe surgery instead of being able to do it on line. I work full time so ringing up is impossible and when I've tried, the line is always busy. It will be even more of an inconvenience if I have to drive up to Outwood to drop it off and then go back for the supplies 2 days later if Wrenthorpe closes. It will be such a shame for the elderly people who will struggle travelling to Outwood. It's a struggle getting an appointment as it is, waiting a month sometimes. Waiting lists will only get longer if Wrenthorpe shut. o No it could be used more. Whenever I try to get an appointment am told it is full. Been down there and found it closed when supposed to be open. Out wood surgery is difficult to get to if don’t drive. I have to rely on my husband which is not always convenient. Expensive to have to go by taxi. If it closes it also means taking repeat prescriptions to Outwood as not everyone has computer or wants to use it and it will probably mean the chemist will also close. o I believe the access problems quoted by the practice are overstated in order to achieve their objectives. o It's ridiculous to use the example of someone falling down the stairs and breaking a joint, when the stairs are not regularly used by patients: they all use the main door. The access to the main door is also stated to be a problem - but the practice hasn't attempted to improve disabled access. If you look at what other NHS bodies have done to improve access, e.g. Pinderfields Ashton Centre with disability-friendly handrails, it's clear that by spending money they could do a lot. o I live in Wrenthorpe close to the surgery. I can easily get there and I can receive the same service as Outwood. If I have to go to got to go to Outwood I need to drive to the surgery. o Concerned for elderly in Wrenthorpe. Elderly mum used to live in Wrenthorpe and used to go by herself for appointments in Wrenthorpe. If surgery closed in Wrenthorpe she would have needed a lift either by taxi or being picked up by family. o Outwood currently struggle to book me in regular appointments which i assume will only be worse with Wrenthorpe closing. It's hard enough to get Outwood Drs to answer the phone so that would get worse & also those at Wrenthorpe would have a lot further to travel to an appointment. o Wrenthorpe Surgery is a lifeline to many residents in the village who may have trouble getting to Outwood either through infirmity or lack of transport. The ease of access and parking for the surgery make it less trouble for able bodied and disabled rather than trailing up to Outwood. 23
o Unfortunately the process of getting an appointment at Wrenthorpe has been made more difficult in the last few years due to the unavailability of appointments issued by Outwood. At one time you were asked Outwood or Wrenthorpe, now you are allocated Outwood unless you specifically ask for Wrenthorpe. o I feel that this is a deliberate attempt to make Wrenthorpe redundant. o If Wrenthorpe closes then the waiting times at Outwood surgery AND chemist will get longer o It would be a sad loss for Wrenthorpe village. We will probably lose the chemist.
o A lot of new houses are being built and a surgery is essential, o Not everyone has a car; public transport to Outwood is very poor. o Wrenthorpe surly is in need of its own surgery, especially for the elderly population and the mothers of young children who may not have access to transport. By closing their surgery you will be increasing greatly the footfall at Outwood Park and making the whole experience for patients so much worse by extending already long waiting times to see a chosen doctor. I also think your home visits will increase greatly for those elderly patients who cannot afford a taxi or are unable to walk up the hill into Outwood. Primarily because there are a lot of patients who will find it harder to access the GP. I have had to wait over 4 weeks to see the GP at Outwood. I had to 'call back in a week' because there were no appointments. The car park is badly designed; the entrance to the car park is narrow. The waiting room has only one screen displaying parents when called so half the seating is unused. The seating is awful, terribly uncomfortable the seats are the wrong height and wrong depth and when you are 20 minutes late going into your appointment and you have the FIRST appointment of the day this is unacceptable. Now imagine that I don't live around the corner and I'm not a fit and healthy woman in her 30s needing a contraception appointment but an elderly person from Wrenthorpe needing a referral for something complex. What if the elderly person decides it is too hard, too painful and too risky so they just don't go anymore? Also, I have answered bicycle to the question regarding getting to Wrenthorpe surgery as it would not allow me to submit without answering and your ethnic group boxes don't work below. They are prefilled as all ethnicities. o Wrenthorpe/Outwood park population is expanding rapidly yet the medical services are being cut back we are already waiting 4 weeks for an appointment shouldn’t Wrenthorpe be used for excess capacity we all pay our taxes for a reduced service i don’t think so do you i will contact our local MP o I much prefer to go to Wrenthorpe surgery, but very rarely am offered an appointment there.
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o Closing the surgery at Wrenthorpe, is not to the benefit of the elderly or people without their own transport
o I have been forced to book appointments at Outwood in recent years for both myself and children as there have never been any appointments available at Wrenthorpe to actually book. As I have an eye condition, I am unable to drive and the length of time to walk up for appointments at Outwood is unacceptable for me. I am a busy mum who works at home and having to go for appointments at Outwood now adds unnecessary time onto my already busy day. I know that the Wrenthorpe facilities are certainly adequate for the majority of people and this was evidenced by the fact that the surgery was always busy. I also have concerns about the elderly population. Thankfully I am fit and healthy, but my concerns are with the elderly who won't find the journey up to Outwood as easy as nipping to Wrenthorpe. I believe this is a cost cutting exercise and I am speaking for a large number of the Wrenthorpe population. The reasons for closure are not strong enough in my opinion and many elderly people are seen at Wrenthorpe, followed by appropriate medication from the local chemist. Also, if the surgery is to close I am guessing that the popular Wrenthorpe chemist will also be forced to close, which will bring extra burden to those finding it difficult to get to Outwood. I will remain with Outwood as I don't see I have an option - other practices are even further away. Closing Wrenthorpe surgery is not an answer to many people's health needs. Thanks
o The surgery should be kept open as it is frequently visited by elderly patients who may not be able to get transport to Outwood; it is also part of the local community. The only reason I have not visited Wrenthorpe surgery as the times it opens are not convenient due to work commitments. o I am fortunate in not having to visit either surgery very often, and i certainly have no wish to waste any doctor’s valuable time. But on occasions when i or my wife have needed to visits a Doctor the appointments that are available are atrocious. You can be expected to wait from 2-3 weeks which is absolutely appaling, and in most cases we find it easier although more expensive to see someone private. We are fortunate to be able to do this, but we really feel it should not be something we have to do. Why can't the surgery offer more availability for appointments like a many number of other surgeries throughout Wakefield. If the Wrenthorpe surgery is closed this will surely only add even greater waiting times for appointments at Outwood. My family members who are looked after by other Wakefield surgeries can get an appointment most days and certainly within the week if it’s not urgent. o I know the appointment problem is a serious issue by speaking with other Outwood patients, who all say it needs resolving. I look forward to seeing if there will be any response to ours or others concerns on this matter, and any proposals about rectifying the problem’s o It is the local surgery for all people living in Wrenthorpe, it is served by a 25
reasonable bus service whereas the bus from here to Outwood Park Centre is hourly, and in addition people in the village could walk. It forms part of the Village centre together with the pubs, Community Centre, local shop[s including the chemist. There are too many local services that are being scrapped in favour of centralised services which unfortunately, experience tells us, do not mean greater efficiency. I do not doubt the practice partners good intentions but I very much doubt that the improved service that is promised will come to pass. This is evidenced by the fact that the Wrenthorpe surgery has been running at a greatly reduced rate for some time yet there has been no matching improvement at Outwood. o I would always prefer to have an appointment at Wrenthorpe surgery but appointments there do not seem to be available. It is a very long walk from the far side of Wrenthorpe to Outwood surgery: about 50 minutes at a moderate to fast pace. Not something easily undertaken if one is unwell or ageing (I'm 65 now). o I will certainly consider registering with another practice.
o I would visit Wrenthorpe surgery more if there were appointments available there. It is difficult enough getting appointments at Outwood surgery within an acceptable timescale. As I get older it will become more and more difficult to access Outwood surgery. It seems to be the height of folly to shut any medical facility at a time when there is considerable housing expansion in the area. If Wrenthorpe surgery closes then so will the chemist in the village which is an important resource. I always collect my repeat prescriptions from the chemist in Wrenthorpe and would not take kindly to having to use Outwood Park chemist and would avoid doing so.
o Clearly, Wakefield MDC have failed to ensure that there are adequate facilities and services to serve developments for which they grant planning consent. There is a clear shortage of GP services in the area, only to become worse with the current and proposed new housing developments.
o Whilst that is not Outwood PMC's responsibility, this seems to be an unfortunate loss of what could be a useful local facility. Outwood PMC, NHS Property and the CCG need to get together to facilitate this. o You should provide more services, blood test, nurse appointments, flu vaccinations and more services. When you try to book appointments at Wrenthorpe there are none. o Longer opening times more doctors.
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o Wrenthorpe has as old population which rely on the Wrenthorpe surgery, and Outwood is out of the way if you do not drive.
o Not as convenient, will have to drive rather than walk. It has become very difficult to get an appointment at Wrenthorpe Surgery so it’s been closing by stealth anyway. Its closure may also threaten the viability of Rowlands Pharmacy.
o More convenient to walk to Wrenthorpe surgery. Pleasant and welcoming surgery. Concerned that with new developing/ proposed housing developments in the area it will become even more difficult to get a GP appointment. It is already extremely frustrating when you ring Wrenthorpe surgery only to hear automated message stating surgery is closed and it should be open and then ring Outwood to be told there are no available appointments and that they are waiting for management to release some more and you need to keep ringing every day until they are available!
o I feel the practice is now unable to deal with the number of patients on the books and maybe it is time that Wrenthorpe had a separate practice. I feel having being registered with Outwood for over forty years that the service now is no longer good enough in terms of waiting times for appointments and the lack of continuity in being able to see the same GP on more than one occasion where necessary. I am now extremely frustrated and disillusioned with the service being offered to the people of Wrenthorpe and I will seriously consider changing to another practice if the proposed closure goes ahead.
o This is a local surgery which is within walking distance of my house. If it closes I will have difficulty accessing a doctor as there is poor public transport from Wrenthorpe to Outwood - if I am ill I am not able to drive!
o Closing the Wrenthorpe surgery will possibly also lead to the closure of the pharmacy and having memories of not having this facility when I first came to the village I would not like to be in this position again when I am old as again access will be very difficult.
o I shall, myself most likely find difficulty in getting to Outwood Pk in the coming years; others already experience this problem. In recent years it has been difficult, if not impossible to obtain a Wrenthorpe appt. within a reasonable period, & so I have tended to visit Outwood Pk. Like many people I just want to consult a doctor-without any on-site "theoretically immediately necessary services" ( in any case X ray and laboratory testing, etc. are not available at Outwood - but I don't expect such). Wrenthorpe needs MORE GP and general nurse time - this was realised 35 or more years ago when a surgery was introduced; this requirement cannot have 27
reduced!
o For many who live in Wrenthorpe, the branch surgery is only a short hop away – the main practice is not
o Concerning acutely unwell patients not being treated at Wrenthorpe because it isn’t equipped to the same standard as the main site. Being re-directed elsewhere because the surgery is not equipped to deal with your particular medical complaint is regrettable but not unavoidable. On one occasion, I drove my acutely unwell husband to the main practice at Outwood and he had to be referred to Pinderfields in any case. Do you know how many acutely unwell patients have needed equipment not available at Wrenthorpe, but that was available at Outwood? The argument that some patients who visit the branch then have to make another visit the main practice, as a reason to close the branch, is flawed. Attending Outwood in the first place doesn’t preclude the possibility that you need to make another visit to schedule in a blood test or physical examination. The one time I saw my GP at Outwood and was referred to a nurse, I still had make another appointment and make a second visit to Outwood to see the nurse. Do you know how many patients attending appointments at Wrenthorpe have had to make a subsequent appointment at Outwood for treatments that would definitely have been handled in a single visit to Outwood? With the surge of housing development in Wrenthorpe village resulting in an ever-burgeoning number of patients, placing demand on the medical centre, the question should be how to make the branch surgery a better extension of the main practice. Staff shortages is not a reason to close the branch surgery; recruitment is the answer. Regarding accessibility, for the residents of Wrenthorpe who have problems with walking, or who are parents with prams and young children, there exists the opportunity for those patients to make their appointment at Outwood instead. If you succeed with your proposal to close the branch, patients who require a routine appointment, who live in Wrenthorpe and who don’t have problems with walking will be forced to travel further to Outwood. o If the main practice at Outwood was all our community had ever had available and along came an opportunity to open a branch in Wrenthorpe that could handle routine appointments that would take the pressure off the main practice and offer greater convenience for those patients who reside in Wrenthorpe, there would be a case in favour of doing so. o In general, the arguments in your proposal feel as if they have been constructed merely to fit the desire to close the branch – it would be good to see the statistics, if there are any, which support them.
o Wrenthorpe surgery is so convenient I can walk there. Outwood I have to rely on someone to give me a lift there. Wrenthorpe is in the heart of the village so 28
is very good for most residents. o Wrenthorpe is in the heart of the community. It is easy to get to by a large number of residents. Outwood Park Medical Centre is not convenient to get to by foot or public transport you have to travel by car.
o I think it would be very bad for most patients for the Wrenthorpe surgery to close.
o Closing Wrenthorpe practice would force patients to go to Outwood surgery. Outwood surgery is already extremely busy and always difficult to get an appointment. o Outwood and Wrenthorpe are growing areas and we need more surgeries to accommodate the growing population. Closing Wrenthorpe would have a completely detrimental effect on Outwood surgery o It is extremely difficult to get an appointment at Outwood surgery as it is. . I had to wait 5 weeks for my last routine appointment. This is not acceptable!! o New houses are constantly being built in the Outwood and Wrenthorpe areas and this would greatly add to the strain on Outwood surgery. WE NEED MORE SURGERIES NOT. LESS!! o As it is sometime difficult to book appointments at the Outwood Surgery, it is nice to have the option of another surgery. Wrenthorpe is accessible for me to get there by bus or walking if I have no access to a car. I do find that there is ample parking in Wrenthorpe Village close by to the surgery. o I live in Wrenthorpe and used to see the doctor in Wrenthorpe. Over the last few years the services have been reduced and the possibility of an appointment at Wrenthorpe have decreased to less than no chance. Personally, now that I have retired, I can walk up to Outwood, a distance of just over a mile, when and if I need to see a doctor. This distance, however, is becoming an obstacle as I have a bad knee and the walk is troublesome. If I travel by car the walk from the car park at Outwood is further than the walk from car park at Wrenthorpe as the doctors and others have protected parking outside the surgery while the patients have to walk from the other side of the car park.
o I was unable to submit the survey unless I responded to the last 2 questions about Wrenthorpe surgery even though I have not visited it. Your survey was set up wrong and did not allow me to omit these 2 questions considering my earlier response. o Outwood surgery is too far for people with mobility problems or who do not have a car. Also it would severely affect the viability of Wrenthorpe pharmacy. 29
o The reason why I sometimes drive to Outwood is only because you have reduced the services available at Wrenthorpe over the past few years, I can only assume deliberately, in order to give yourselves the opportunity to close the Wrenthorpe surgery, thus making the practice partners richer but the Wrenthorpe patients poorer.
o It should be Wrenthorpe’ s main surgery NOT Outwood's satellite - Outwood doesn't have the monopoly of elderly people and the population of both villages are roughly the same. It will be so difficult for a huge section of the collective community to get to Outwood. Many services could be done at Wrenthorpe - i.e. shared - with Outwood. Imagine the outcry if Outwood surgery was going to close in favour of Wrenthorpe! As for the argument that Wrenthorpe is difficult to get to for both drivers and non-drivers - NO it's not difficult - a little inconvenient, maybe, but nothing that would compare to getting up to Outwood on a regular basis for many of our friends and relatives. In regard to the question below, "If Wrenthorpe was to close how you will access GP services" - well it would have to be Outwood but my preference would always be Wrenthorpe.
o I don't really have enough information to answer this but I do feel that there must be many people who would find it difficult to get to the Outwood Surgery and for whom the facilities at Wrenthorpe are adequate for most situations. Occasionally I have found that an appointment was available at Wrenthorpe when no available appointments were shown for Outwood.
o Find it quite difficult to get to the Outwood surgery by public transport and collecting any medication from the pharmacy there, as I have a feeling that if the surgery closes in Wrenthorpe, so will the pharmacy!
o Wrenthorpe is nearer to me and I can walk to the surgery. I would miss it if it closed.
o As a lifelong patient I was very sad and disappointed when I read your letter, at what seems to be a done deal, which you are quite simply going through the motions on consultation for. I live locally and every time I try to get an appointment in Wrenthorpe I am told there are none or the hours are restricted. Therefore, I feel it’s unfair of you to survey people about how often they visit it, when you are in fact restricting attendance at it in a bid to wind down services. This undoubtedly provides you with data which supports your case, but which is fundamentally flawed. The tone and position of your questions is unfair and will provide data which suggests people choose to visit Outwood, but that's because they are not provided with any other choice. 30
The surgery was in its heyday, the hub of the village and having lived here for 36 years I remember it as being a bustling little surgery with a large take up for services. I truly believe that you have chosen to change the services offered there and have intentionally wound down services to a point where it makes sense to close it.
I must re iterate, I believe these have been conscious choices on your part to actively manage the facility to closure. All the reasons stated to me in your letter as reasons for closure are aspects which are in your complete and total control as a leadership team.
You choose which services you offer at the surgery and having seen it in its heyday, they were all provided there, in fact for those of you who recall it was seen as the more equipped branch in comparison to the old Outwood branch.
Accessibility, it’s no more or less accessible than any other branch, with car parking at the rear and side, on a bus route, next to a pharmacy and local shops. In fact it sits more at the heart of the village than the current Outwood surgery does.
Unwell patients, you choose to staff the surgery with the number of GP's - that's a scheduling choice you make and is entirely in your control.
Chaperones, again a choice, and a choice you make every day in terms of which you staff the clinic with.
None of these outlined issues are beyond a capable management team to resolve; in fact they are the kind of issues I am sure many other practices manage sufficiently on a daily basis.
The fact that you choose to use them as reasons to justify your opt out decision is weak. As a management team you have a choice, if you want the surgery to work then make it, you are empowered to do that and to suggest that these reasons stop it being efficient are unconvincing. If once you've provided options to patients, staffed it to its capacity and you still have low footfall or it doesn't stack up financially, then demonstrate that and be honest with people.
If it’s about cost to run, then just be honest about that. We all run or work in businesses, if it's not financial viable anymore, then say so, don't try and hide behind issues that are solely in your control. o Having lived here since I was born, the last 10 years have seen unprecedented growth in the village footprint, multiple housing developments and as a result a steep rise in its population. Any strong management team would be embracing this opportunity and using the services to full capacity, let’s be clear the fact that you are not is a choice you have made, not as a consequence of patients opting out of services.
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o o Demand for local services is increasing, and to close a branch surgery, and no doubt the only pharmacy in the village with such a backdrop seems counterintuitive. I rest assured I won't be the only patient with this view and hope that you will re consider your decision, and instead invest your efforts in making the branch work.
o I do not agree with the reasons for closure as stated in the letter. Patients are forced to travel to Outwood mainly because services at Wrenthorpe have been allowed to run down over the past few years. I do not believe it is by choice. I always request a Wrenthorpe appointment if available. This argument is circular and seems to be used to support a decision about closure that has already been made. It is not always easy to get timely appointments at Outwood. The parking issue is spurious as there is parking in the community centre accessed by an off road passage. I am also concerned that this closure will have a knock on effect on the local pharmacy and that will also close. There is so much bandied about regarding patient choice but this closure goes totally against that. Non mobile patients will have to rely on family etc. to take them to Outwood as there is no direct public transport link. In summary, there is nothing in the letter that provides a convincing patient quality argument for closure and one is forced to think that yet again it is a decision based on finances. If only some effort could be put in to think about sharing services across the two sites, so that Outwood based patients also needed to travel, to allow the Wrenthorpe site to be preserved for non-mobile and vulnerable residents. I think the question below regarding where I would go in future does not allow for the fact that many patients are loyal to their practice, and would stay with it. It would not mean that one was happy with the decision to close.
If there were doctor(s) based there then it is more convenient and I'm less likely to get caught in school traffic making me either late for the appointment or even more time out of work (unpaid) if that is the only appointment I can get. I am diabetic and Wrenthorpe is in walking distance (especially if I can do school run at same time) but walking up to Outwood is not always possible and the public transport from Wrenthorpe up to the surgery is hourly. To make an appointment around public transport is virtually impossible so I would not like to think my mother in law needed to get there as it could take all day on public transport or use up a large proportion of her state pension if her family (son or me) couldn't take her there in taxi fares. There is a large proportion of older patients who are not computer savvy and so will their voices be heard, Appointments at both surgeries are like hen's teeth at the best of times and to see my named GP can take multiple telephone calls and the receptionists are not qualified doctors but seem to think they are at times and want to know why you need to see the doctor. I have a lifelong condition and continuation of care is preferable and saves the practise money/time as I don't have to go through the side effects/condition each appointment. Accessibility issues are minor BUT there is plenty of parking at Wrenthorpe using the village hall car park or on Wrenthorpe Road outside the chemist and if the surgery closes then the work load of the doctors may also increase as the those in
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Wrenthorpe may not be able to access pharmacy advise as this may also close. There seems plenty of scope of extending services in Wrenthorpe space wise with maybe the nurses running clinics down there or offering other services such as podiatry or physiotherapy (which could be a semi privately funded) or maybe midwifery/mother and baby clinics once a fortnight/monthly. I know it is a long walk up to Outwood when pushing a pushchair to see the health visitors. The closure proposal seems to be mainly for monetary reasons and not for the well fare of the patients.
o More houses built in Wrenthorpe that to close a surgery is ridiculous, we need more doctors and appointments, local o It is convenient for my children and elderly relatives living round the corner as most do not drive. I also have teenage/young adult nephews & nieces in the village and think at their ages it is important they have easy access. I do ask for appointments in the village when booking but find it hard to get them. I have lived in Wrenthorpe over 20 years and access to appointments at the surgery and the service provided from there has definitely deteriorated.
o There have been a lot of houses built in and around Wrenthorpe recently and the village needs basic services more than ever. Should the NHS allow for another practice to open in the village then I am sure many people living in the village will register with them.
o It is very difficult to get an appointment as it is so closing Wrenthorpe means even less appointments are available
o I feel that there are still many people living in Wrenthorpe who do not have convenient vehicular access to Outwood Surgery. If the branch surgery closes I fear we may lose the Chemist in the village which would then require a visit to Outwood or a trip into town. I have tried unsuccessfully to ring Wrenthorpe on a number of occasions over the past year but have always had to contact Outwood so although I object I am sure closure will take place. o There are many elderly people living within walking distance to the surgery
o People are forced to use Outwood surgery because there is limited appointment
o The transport links are extremely poor o That surgery Wes part of the planning infrastructure when new homes were built
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o The chemists may lose business and jobs o The arguments for closure set out in the letter to patients are in general spurious. In our view the main reason is money - lack of funds. We have lived in Wrenthorpe since 1979. There was a small surgery in a property on Wrenthorpe Road prior to the Wrenthorpe Branch surgery being built and opened. In the early days of the surgery there were at times two GP's on duty and some extended services. The waiting room was often full of patients waiting to be seen. Gradually since the economic crisis approx. 8 years ago services seem to have been run down. E.g. one GP instead of two and hardly any and now no extended services. The argument that hardly anyone uses it now is because services have been withdrawn not because people don't want to use it. The argument that many patients have to attend Outwood for extended services is because they are not provided at Wrenthorpe and anyway an initial visit to Wrenthorpe and then one to Outwood is better than both to Outwood. The argument that there is limited parking for patients is not really valid as, as well as the parking at the rear, people can park in the parking places in front of the Village Hall where there is reasonable access to the surgery. The Wrenthorpe Community Association own most of the car park and are happy for people to use it when visiting the surgery. There is also street parking in front of the Chemist. Acutely unwell patients are able to ask for a home visit from a GP and usually do not attend the surgery themselves in my experience. We are aware that Outwood are having difficulty in getting GP's in post when vacancies occur and this is another reason why GPs are often not present at the Wrenthorpe surgery. The service as a whole is underfunded which to be fair is the fault of central government and not the CCG. For the sake of the substantial number of elderly. Disabled and vulnerable people who live near the surgery I urge you to reconsider the closure of Wrenthorpe Surgery. It provides a valuable service which it would be a shame to lose. There is no mention in your documentation about the extent to which the proposed closure is a cost-cutting exercise.
Wrenthorpe population has and shall continue to increase due to the continual housing developments which are being built. I think that now more than ever this Wrenthorpe surgery should be playing a vital part in alleviating what is already a lot of pressure on Outwood Medical Park. In addition the ageing population and the many people who don't have the privilege of transport will suffer significantly as a result of the closure. Utilise this surgery more - not less! It is a hugely important asset to our village, also and including the chemist! Regards Mrs Thompson. o It is very difficult to get a routine appointment now at Outwood Medical Centre. It took me three weeks last time I booked one. This will surely only get worse if everyone who was previously going to appointments at Wrenthorpe also has to come to Outwood. Also what about those people who haven't got a car and find it difficult to either access (disability, severe illness) or afford public transport to get them there? You are obliged to do this public consultation, but ultimately and pretty transparently this isn't about patient- centred care it is about saving money. 34
o Wrenthorpe is an expanding village with hundreds of extra houses. We need a full time Doctor's Surgery and Chemists to service the growing community. Outwood is not far away for those with transport, but access is extremely difficult for everyone else o Lack of health care facilities massive increase in the local community demanding more facilities not less with the demise of the surgery so we will use the pharmacy which I use constantly to collect prescriptions there is adequate parking facilities at the surgery and being local a lot of patients could walk o Outwood surgery patently cannot cope with demand as an ordinary appointment. Is taking in excess of one month and patients being triaged prior to an appointment being offered which is demeaning because we are expected to describe often very personal details to a receptionist who is not qualified nor bound by the same creed as a GP, leading to reluctance to contact the surgery, preferring to wait until conditions progress to such a degree that people are treated in A&E, increasing demand on hospitals. For what reason? Simply put, Greed! I am disappointed with Outwood surgery and every GP who supports this travesty, to such a degree that if this goes ahead then although it will cause not inconsiderable inconvenience, I will not hesitate to change surgeries due to a total loss of respect for a group of people who puts finance before patients.
o Shocking and unacceptable.
o I feel that because of the number of new homes being built in the area and the potential for more people wanting to register with the practice the time it already takes to get an appointment will further increase, and people who actually live in the Wrenthorpe area are being deprived of a facility of an already over- stretched service.
o I remember when there wasn't a surgery in Wrenthorpe and it was hard work walking to Outwood from Wrenthorpe, 8 months pregnant and with a two year old! o Wrenthorpe is a large village and needs its own GP practice. The only reason I have to go to Outwood is because no appointments in Wrenthorpe. If more GP's were available there it would be easier for pts'. It is a large building and can surely accommodate at least one other Doctor. The opening hours are too short as well. Ask the CCG for money to be spent to improve the available services and accessibility, do not close it. I am fit enough to go to Outwood but another few years and I will not be, there are a lot of elderly in Wrenthorpe. We need that GP practice. I would for another practice to take it over.
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o We have an ever increasing population in the Wrenthorpe / Outwood area and the current patients are struggling to see a Doctor, we are now triaged and ailments are left to self-diagnosis or the alternative is to wait for four weeks for a regular appointment. o We have a huge amount of new properties being built with no consideration for the needs of the community o And the answer is to close a perfectly good surgery absolutely ridiculous. o This decision is obviously financial and not about patient care. Why not staff the surgery properly cut down waiting times. give Doctors a chance to do what they have trained to do and give patients the care that they deserve. Patients particularly older ones do not like to make a fuss and if they cannot secure an appointment within a reasonable time they will just not bother resulting in potentially serious illnesses going undiagnosed. Please let common sense prevail and keep this surgery open for the good of the community. o As a matter of interest. the question how often have you visited Wrenthorpe surgery is unfair and biased because although many would like to, very few are given the opportunity.
`The answer to the next question is also biased because it forces you to answer in a particular way purely because registering with another practice is for most, not an option. I attempted not to answer that question but was forced to do so making the entire survey manipulative o Wrenthorpe Branch Surgery is extremely convenient for patients living in Wrenthorpe and Kirkhamgate districts. Unfortunately when making an appointment to see a doctor or a nurse Wrenthorpe is never given as an option, you have to ask for an appointment there. I take my repeat prescriptions there regularly and 9 times out of 10 it is closed. Surely if there was a couple of doctors and a practice nurse (there are plenty of rooms available) patients would use the practice rather than, (unless you have your own transport) the difficult job of getting to Outwood on limited public services. o I disagree with the concerns listed, extended services could be provided if the surgery was run properly. Regarding parking, there is no parking at the rear as mentioned but there is to the side and although the substantial parking at the from is shared by a public house and the Community Centre do believe that neither would object to patient parking for the limited time they would be there. There is also on-street parking very close and a chemist shop almost adjoining which is very useful. The surgery has the capability to be upgraded to deal with acutely unwell patients. Regarding chaperones surely this is not a reason to consider closing down the surgery. If as suggested patients were able to visit on a regular basis i.e. they started opening the practice at regular hours, there would be sufficient staff available to provide such a service. It’s a crying shame that this is even being considered. Again I would say get a couple of doctors there, a nurse for taking blood etc., an asthma clinic on 36
specific days and cardiology clinic also on specific days. Finally if you go against the wish to close down the surgery please gets reception staff to give patients making appointments the option that Wrenthorpe is available. It’s a big catchment area and moving everyone to Outwood would make the sometimes difficult task of getting an appointment in a reasonable time, much worse. o Have to rely on someone to drive me to Outwood or pay to use public transport/ taxi Find using Wrenthorpe surgery much more convenient and hope it does not close. o Another part of vital infrastructure will be lost. Impact on the local environment as more people have to travel by car to attend appointments at Outwood. Increased level of pollution & road safety implications. Wrenthorpe surgery is very useful for many people who do not have access to their own transport. Local public transport is very limited and so getting to Outwood would have pressure to people who are unwell. Environmentally there must be more people who walk to Wrenthorpe who would need to use some form of transport to get to Outwood. o I attend Outwood surgery because I can never get an appointment in Wrenthorpe because it's never open, in fact when I want an appointment Wrenthorpe is never even an option. When I drop my repeat prescription off I have to put it through the letter box and hope it gets to the right place as it's never open. 500 + houses have been built in Wrenthorpe over the last few years and there's more being built yet in your wisdom you want to close the surgery. That makes absolutely no sense what so ever. I am able bodied yet it's still a hike from Wrenthorpe to Outwood, what about the elderly and disabled residents? How do they get up there? You can't assume they have access to a car or a friendly neighbour. Factor in the great British weather, especially winter time and it would be a horrible and dangerous hike up to Outwood for the elderly and disabled. You really haven't thought about this have you? But of course it's all about the money not the patients isn't it? o I do not agree as if there were available appointments I would always go to Wrenthorpe but there are never any appointments available. I still use Wrenthorpe for my repeat prescriptions and use the nearby chemist. I cannot understand why it appears always closed these days and why there are hardly ever any appointments available. I do not drive therefore rely on lifts or a very slow long walk. Wrenthorpe is a growing village and is imperative to have its own doctor’s surgery. o When we moved to Wrenthorpe in 2015 we were unable to register at our own surgery as it was so full and therefore had to register at Outwood. Wrenthorpe we could walk to, or if required catch a bus. Outwood has no direct bus service and therefore the only option for patients to get there is to walk or get a taxi/drive themselves. In my 20s, I am able to drive/walk cycle but for those living in Wrenthorpe that struggle to do these things over long distances the closure will be devastating. I know from experience with Outwood surgery that 37
it is extremely difficult to pre-book an appointment for less than a month’s waiting time, and getting one on the day is equally difficult. Closing Wrenthorpe will only make this issue worse. I am strongly in favour of not closing the surgery without ample investment in Outwood being made. There are many new homes currently being built in the area that will also require signing up to Outwood and with Wrenthorpe residents needing to go there too surely it is unsustainable. Patients can't be expected to use a taxi every time they need an appointment and as mentioned there is no direct public transport, therefore I don't think it is even an option to close Wrenthorpe. o I have lived in Wrenthorpe for almost 40 years. I used to always visit the Wrenthorpe surgery until I could no longer see my preferred GP there. I am fortunate in that I can still get to Outwood by driving myself but this may not always be the case. There are many elderly people in Wrenthorpe who no longer drive. I may be one of them one day. The bus service to Outwood is infrequent.
o I have no complaints with Outwood surgery. I have always been able to get an appointment there when I've asked for one - even same day. o If more appointments were available at Wrenthorpe, I would much prefer to go there as it's much closer to me, meaning I could walk there. Plus it's an excellent facility to have in a village - especially one that's growing at a huge rate with all the housing developments. I live in the village of Wrenthorpe and use the Wrenthorpe surgery when a doctor is in attendance, but otherwise I have to travel to Outwood. Also when I enquire about an appointment at Wrenthorpe the answer is that no doctor is available in the village. o As my wife and I are retired and along with lots of our friends we feel that this facility is needed and it is a step in the wrong direction to close it, we should be adding to the needs of the village and not trying to take them away. This village and the surrounding area have experienced an explosion in the number of new houses and so the number of new patients who need a doctor will be greater, so why would anyone want to close a doctor’s surgery when the need is greater in this area. I and a lot of people who use the doctor’s surgery are getting older and the need for doctors in the village is important. As I have indicated I would have to travel to the Outwood surgery as there are no other doctors available near my home. o If I could not get a lift I would NOT be able to get to Outwood. If Wrenthorpe surgery closed it is almost certain that the chemist would not last very long and we would lose that too. The people who need this surgery most are the disabled and elderly and in the case of the elderly many will have no access to this survey as they do not or cannot use the internet. o If my lifts are no longer available I do not know how I would get to Outwood or any other surgery. 38
o I think older people and people with small children and no transport will really struggle to get up to Outwood. Also they are building more houses in Wrenthorpe so more people will need a local surgery. o From my own personal experience of last year, I had been self-medicating to save having to go to the Drs, or so I thought, I needed to make an appointment so I phoned Wrenthorpe to be told no available appointment, the earliest appointment between both surgeries was another month, so with that I went to the walk in centre, how disappointing. So in that case, how on earth is anyone going to be able to access an appointment once all these extra homes are built and filled with families? Crazy system, it used to be a very welcoming surgery but sadly it's being allowed to be run down as far as the patients are concerned, another uncaring part of our society.Also,various authorities are continually bringing 'air pollution' to our attention, well having to get a lift to Outwood is only making this area of concern even worse. o All these new homes in Wrenthorpe and no gp services how can the elderly get to Outwood if they are not car owners o It is very difficult to get an appointment to see a GP. I think that the Wrenthorpe surgery should be available for appointments daily and if more GPs needed be appointed to provide this much needed service. As more houses are built in the area it will only get more and more difficult to see a GP. With an ageing population it is essential that this service be provided locally without the need to travel to Outwood and wait weeks before appointments are available Patients in Wrenthorpe need access to a local surgery. Not everyone can drive or afford taxis o This is a vital service in our village especially to the elderly or those like me who don't drive. This surgery has been run down over the past few years and not because it wasn't well used! At one time there were two surgeries every day with two GPs on a Monday morning as well as access to the nurse, family planning clinics and blood tests. It has become a seldom open branch, so how can the local population use it? The move to only having surgeries at Outwood would entail extra expense, in using taxis etc., causing unnecessary hardship to people already perhaps on a limited income. In view of all the new housing being built in the Wrenthorpe area it is hard to believe that this is even being considered. I understand that there is a shortage of GPs but strongly feel that if this surgery was properly staffed again it may help alleviate the long wait at present for routine appointments. I do not feel that this is being done in the best interest of the local patients and if it goes ahead my family and I would seriously consider moving practices o I am within easy walking distance of Wrenthorpe surgery (2minutes) and it takes me half an hour to walk to Outwood Park as I don't drive. I am never offered appointments at Wrenthorpe or am told they're 'not available' when I have requested one. Whilst I'm reasonably fit and can do the walk to Outwood Park it does take at least an hour out of my working day as opposed to a short 39
walk and the wait for my appointment slot at Wrenthorpe. For those older or more infirm the loss of Wrenthorpe satellite surgery will be significant especially when there is so much housing for the elderly in Wrenthorpe and, therefore many pensioners, buses are infrequent and can't be relied upon to be on time and taxis are an expensive luxury for many older people.
o As I get older or have to stop driving I Will find it either expensive or very difficult to attend out wood surgery for all!!! My medical needs
o As there are no other surgery's on the area I shall have to accept your reasons for the closer of Wrenthorpe.
o Where will everyone in Wrenthorpe go? Outwood barely has enough doctors to see to Outwood residents as it is you will be putting more of a strain on the surgery and causing more issues. What about also the patients that will struggle to come to
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14. Appendix 1 – Patient Survey
Patient Survey Dr Putman & Partners Outwood Park Medical Centre Are you, or someone you care for, registered with Dr Putman & Partner’s? o Yes – I am o Yes – Someone I care for is o No Are you completing this survey as a patient or a carer of someone who is a patient at Dr Putman & Partners? • On my own behalf 40
• On behalf of someone I care for • Both
Where do you normally go for your appointments? • Outwood Park Medical Centre • Wrenthorpe Health Centre • Both
When did you last visit one of the surgeries? ( if you visited the practice today do not count this in your response) • In the last month • 1-3 months ago • 4-6 months ago • 7-12 months ago • More than 12 months ago
Thinking about the last 12 months, how often have you visited the surgery at Outwood Park Medical Centre? • Not visited • 1-3 times • 4-6 times • 7-12 times • More than 12 times
If you attended Outwood Park Medical Centre, how did you get there? • On foot • Drove myself • Got a lift from a friend/ relative • Bicycle • Public transport • Taxi
Thinking about the last 12 months, how often have you visited the surgery in Wrenthorpe? • Not visited • 1-3 times • 4-6 times • 7-12 times • More than 12 times
If you attended Wrenthorpe, how did you get there? • On foot • Drove myself • Got a lift from a friend/ relative • Bicycle 41
• Public transport • Taxi
Do you agree with the proposal to close Wrenthorpe Branch Surgery? • Yes • No
If no, please tell us why
If Wrenthorpe Branch Surgery Closes, how will you access GP services • Go to Outwood Park Medical Centre • Register with another practice
Year you were born (optional) First part of your postcode e.g WF1, WF2, WF 3 If you would like to receive a copy of our feedback report by post, please print your address clearly here.
Equality Monitoring Form In order to ensure that we provide the right services and to ensure that we avoid discriminating against any section of our community, it is important for us to gather the following information. No personal information will be released when reporting statistical data and data will be protected and stored securely in line with data protection rules. This information will be kept confidential.
Please try to answer all the questions. If you would like help to complete this form or would like a form in a different format (such as large print) please ring the practice. 42
1. What is the first part of your postcode? Example WF1 Yours Prefer not to say
2. What sex are you? Male Female Prefer not to say
3. How old are you? Example 42 Yours Prefer not to say
4. Which country were you born in?
Prefer not to say
5. What is your ethnic group? Asian or Asian British: Indian Pakistani Bangladeshi Chinese Other Asian background (please specify)
Black or Black British: Caribbean African Other Black background (please specify)
Mixed or multiple ethnic groups: White and Black Caribbean White and Black African
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White and Asian Other mixed background (please specify)
White: English/Welsh/Scottish/Northern Irish/British Irish Gypsy or Irish Traveller Other White background (please specify)
Other ethnic groups: Arab Any other ethnic group (please specify)
Prefer not to say
6. Do you consider yourself to be disabled? Yes No Prefer not to say
Type of impairment: Please tick all that apply
1. Physical or mobility impairment (such as using a wheelchair to get around and / or difficulty using their arms) 2. Sensory impairment (such as being blind / having a serious visual impairment or being deaf / having a serious hearing impairment) 3. Mental health condition (such as depression or schizophrenia) 4. Learning disability (such as Downs syndrome or dyslexia) or cognitive impairment (such as autism or head-injury) 5. Long term condition (such as cancer, HIV, diabetes, chronic heart disease, or epilepsy)
Prefer not to say
7. Are you a carer?
Do you look after, or give any help or support to a family member, friend or neighbour because of a long term physical disability, mental ill-health or problems related to age? Yes No Prefer not to say
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Thank You
15. Appendix 2 Poster Proposal to Close Wrenthorpe Branch Surgery
Patient information DROP IN Session Monday 14 August 2017 3:00pm – 5:00pm
Wrenthorpe Health Centre
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Please come and meet us We want to hear your views
16. Appendix 3 Frequently Asked Questions (FAQs)
Proposed Closure of Wrenthorpe Branch Surgery Frequently Asked Questions (FAQs)
Dr Putman & Partners have sought approval from Wakefield Clinical Commissioning Group (CCG) to undertake patient engagement and consultation on the proposal to close Wrenthorpe Branch Surgery.
Below are some FAQs, which we hope will answer any questions you may have. How are you engaging with people about the proposal? The practice will make sure people know about the proposed closure. We are doing this by contacting patients directly, putting notices in places like the surgery, shops, meeting halls and pharmacies. We are using a survey to ask what patients and local residents think. These can be found on the surgery website or available at both Outwood and Wrenthorpe surgeries. The results will be collected, analysed and a report written. The report will go to the Probity Committee of NHS Wakefield CCG to make the decision on whether to close the Wrenthorpe Branch Surgery. The committee will look at other information to help make the decision. Why have you proposed to close Wrenthorpe? This was not an easy decision. We feel that Wrenthorpe Branch Surgery is soon going to be unsuitable to provide the services our patients need and deserve. We have looked at the branch in Wrenthorpe and found: o We cannot provide enough of the health services patients want at both practices to make sure patients get the same high quality health service. o It is not meeting service standards and compliance. o The way into the building and the building itself are not meeting the needs of all patients. Will the opening times at Outwood Surgery change? No, our opening times will remain the same Will there be changes to the way I book appointments? No, you can continue to book appointments either online, face to face or by telephone. We will contact patients that need vaccinations, reviews or for routine screening appointments like smears.
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We want to make our appointment booking and administrative systems better as there will be more reception and administrative staff on one site.
Will I still be able to see my usual doctor or nurse? Yes, you will. All the staff and doctors will continue to work at the Outwood Surgery. Will the same number of appointments be available? Yes, we will be increasing the number of appointments at Outwood Surgery to cover those that were at Wrenthorpe. What will happen to vulnerable patients? The doctors will continue to provide home visits to our vulnerable or housebound patients. Will the practice boundaries change? No - we will continue to register and provide services for patients that fall into the catchment area. All our patients currently registered with the practice can stay on our practice list. Will the services currently offered at Wrenthorpe surgery be offered at Outwood? Yes - All services that we currently offer will be transferred to Outwood. Will any new services be introduced? One of the main reasons for the proposed closure is for us to be able to grow and expand the services that we are able to provide. We want to see what else we could provide and will work with local commissioners to provide access to additional services when they become available. Will I need to re-register to remain on the Practice list? No, all patients will remain registered with Dr Putman & Partners Outwood Park Medical Centre. If you want to move to another Practice or if you move from your current address outside the practice catchment area you can register somewhere else. 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 not be affected by the closure. How do I order my repeat medication? There is a designated telephone prescription line at Outwood (01924 786 202) which is operated by trained staff Monday – Friday 9:00am – 12:00noon. Alternatively you can order your medication online or in writing at the practice. Our prescription clerks will assist you in selecting the system you prefer. We will be notifying the local pharmacists so that they will be able to help patients with their repeat medications. When will we know what the decision is? When we have got all the surveys back and have heard what people think, the feedback will be analysed and included in a report for the Probity Committee at NHS Wakefield CCG to make an informed decision. We hope that this will be by October 2017. If the CCG agrees with the proposal, when would Wrenthorpe Practice close? There is a lot that would need to be done if the proposal is approved, so there would be no changes before January 2018. The practice will provide regular updates via the surgery website www.outwoodpark.gpsurgery.net
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17. Appendix 4 Letter to Patients
Dear Patient Re: Proposal by Outwood Park Medical Centre to close branch surgery at Wrenthorpe We are writing to inform you that Dr Putman & Partners are proposing the closure of the branch surgery at Wrenthorpe, Wakefield. The medical centre has recently undertaken a review of the Wrenthorpe premises which identified a number of concerns, in particular: • Access to services - Wrenthorpe does not have access to the extended services that are provided at Outwood. In terms of the small number of patients who use the branch surgery, the vast majority of these patients may have to make another visit to the main practice to see a GP, nurse or health care assistant for physical examinations, review of a long term condition, blood testing etc. • Accessibility - The building is difficult to access for some patients. There is limited parking available which is as the rear of the premises. Patients that park in the car park have to walk back out on to pavement and walk around the front of building to the main entrance. This is very difficult for patients that have problems with walking and parents with prams and young children. • Acutely unwell patients - As Wrenthorpe is not equipped to the same standard as the main site we are concerned about the ability for a lone clinician to manage an acutely unwell patient. • Availability of chaperone – Due to staff shortages, a chaperone may not be unavailable if requested during a consultation. We want to know what all our patients think of this proposal so we understand what impact it may have on them, so we want to engage with you. Developing our plans
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To develop our plans to engage with patients we will work with our Patient Participation Group (PPG) to ensure that we get the process right and get views from as many of our patients as possible. We will meet with patients and their representatives at both practices to understand what people think, we will ask people to complete a questionnaire to gather views. This will take us 12 weeks and we will keep you updated via our website www.outwoodpark.gpsurgery.net.
We will be actively engaging with patients and the community to seek their response. This will take the form of a questionnaire available on the website www.outwoodpark.gpsurgery.net and a paper version available at both Outwood & Wrenthorpe Surgery. We will be holding drop in sessions at Wrenthorpe on TBC and Outwood TBC where staff and representatives from the Patient Participation Group will be on hand to answer your questions. Posters will be displayed on surgery and community notice boards. Information will be available on the practice website. We will be writing individually to all households of patients that are registered with Dr Putman & Partners. Proposal process We have applied to NHS Wakefield CCG to propose the closure of our branch surgery; it is they who will have the final decision. We have outlined our concerns to the CCG and they are supportive of us starting the engagement process. We are asking for your views and we will report what we find to Wakefield Clinical Commissioning Group (CCG). They are responsible for making the decision. Before they make a decision on our proposal to close Wrenthorpe branch surgery, the CCG will consider the report we write on your feedback and other evidence on the impact of the change to patients. If you have any concerns about the proposal please get in touch with the Practice Manager Mrs Glennis Rhodes at the above address. If you need this document in another language or another format, such as large print or audio tape, please contact us on 01924 822626 or email [email protected] Potřebujete-li tento dokument v jiném jazyce nebo v jiném formátu, jako je například velký tisk nebo audio, zavolejte nám na 01924 822626 nebo [email protected]
Yours sincerely Dr Helen Putman, Dr Shakeel Sarwar, Dr Stephen O’Boyle Dr Anwar Al-Khaili Dr Anoushka Capewell
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18. Appendix 5 – Communications and Engagement plan
Dr Putman & Partners Outwood Park Medical Centre / Wrenthorpe Health Centre Communication and Engagement Plan Background
Dr Putman & Partners Outwood Park Medical Centre (OPMC) is proposing to close its branch surgery in Wrenthorpe. The practice has reluctantly decided to propose the closure on the grounds of: • The practice has been reviewing the provision of core services and has concluded that it does not have the sustainable capacity to make commitments of an equitable service across both sites. • The branch surgery at Wrenthorpe falls short of service standards and compliance. • Due to physical access constraints the building is not fit for the purpose of accessing same day urgent care. • Despite the work undertaken by the Patient Reference Group who in partnership with the Wrenthorpe Village Hall provide parking spaces for patients with poor mobility there is still insufficient parking availability. • The practices strategy for centralisation of services at Outwood is a clinical case for change. Wrenthorpe does not have access to the extended services that are provided at Outwood. In the number of patients who use the branch surgery, the vast majority of these patients may have to make another visit to the main practice to see a GP, nurse or health care assistant for physical examinations, review of a long term condition, blood testing etc. This could ultimately cause a delay in diagnosis.
Practice population is approx. 13,300 (May 2017) 1. OPMC registers patients living in Outwood, Wrenthorpe, & Stanley. These are predominately residential areas of little deprivation 2. The practice has 4.375 Whole Time Equivalent (WTE) partners and 4.625 (WTE) salaried GPs = total 9 WTE doctors 3. The practice is not a dispensing practice
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The Practice Patient Participation Group (PPG) has been involved in the proposal but no engagement has taken place prior to NHS Wakefield Clinical Commissioning Group agreeing that the public engagement exercise should begin. The PPG will be fully involved in planning for the engagement and follow up work. All patients are registered under one practice list with Dr Putman & Partners. There is no separate list for Wrenthorpe Surgery Wrenthorpe Surgery operates on a different telephone number from the main site but both sites have access to the same appointment and clinical system. Other than the receptionist there are no clerical or administration staff based at Wrenthorpe. Patients ringing for results or to speak to the secretaries do so by ringing Outwood Park telephone number where they are given a number of extension options. Repeat prescriptions can be ordered over the phone, face to face or in writing at both sites. An audit of patients requesting repeat prescriptions have found that there are on average 60 repeat prescription requests per week which are processed by the receptionist at Wrenthorpe. Of the registered population there are over six thousand patients who have a repeat prescription. For this purpose there is a designated phone line at Outwood which is open between 9am and 12:00pm. Trained prescription clerks at Outwood process prescriptions from 8:00am – 6:00pm. The aim is to meet the 24hr turn around target. It is not anticipated that opening times or man power would be affected by an additional 10 prescription requests a day should the Wrenthorpe service cease to exist. As with other local pharmacist, Wrenthorpe pharmacy has individual arrangements with patients for collection and delivery.
Wrenthorpe Health Centre (B) bottom left of the map is approximately 1.4 miles away by road from the main surgery Outwood Park Medical Centre (A) top of the map.
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Conditions, accessibility and compliance The branch surgery at Wrenthorpe is a purpose built health centre erected in the early 1980s and subsequently extended at a lower floor level to form an additional dental consulting room. This is operated separately from the GP practice Brick built and under a concrete tile roof with painted aluminium single glazed windows. Due to the nature of the site the majority of the accommodation is at upper ground floor level with additional accommodation below. Car parking is situated at rear lower level. The premises are not served by a lift.
Externally The access to the car park is via a private access road which leads down from Wrenthorpe Lane and is bounded on one side by a stream. There are two access points into the practice. Access to the surgery from the car park is via a steep narrow staircase with a turn mid- way. Access to the front of the building is from a public footpath and is made up of concrete paving The premises do not provide ease of access to patients with poor mobility
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Rear lower level and parking
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Front entrance via pavement
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Ariel view
Patients are registered in clusters of WF1, WF2 and WF3. – The data map has plotted12, 900 of the resident population of 13,300
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There are 3982 patients resident in the Wrenthorpe WF2 area code. As seen from the above data map over 1000 of these households are closer to the Outwood WF1 area.
Practice Demographics Data as of May 2017
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Increase in list size Outwood Park Medical Centre from Jan 11 – Jan 2017
Jan-11 Jan-12 Jan-13 Jan-14 Jan-15 Jan-16 Jan-17 12783 13046 13070 13108 13204 13253 13296
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13400
13300
13200
13100
13000
12900
12800
12700
12600
12500 Jan-11 Jan-12 Jan-13 Jan-14 Jan-15 Jan-16 Jan-17
Utilisation of Wrenthorpe Branch Surgery
Audit Date: 13.07.17
Audit period:13.07.16 -12.07.17
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Target Population: Number of patients with a registered post code of WF2 3984
Total number of patients seen at Wrenthorpe Branch Surgery in the audit period 1266
Of the 1266 – the number of patients with a registered post code 546 of WF2 seen at Wrenthorpe Branch Surgery
Of the 546 – the number of patients seen at both Outwood & Wrenthorpe Branch Surgery in the same time period 519
Author: Chris Jackson – Data Quality Wakefield CCG
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http://www.cqc.org.uk/sites/default/files/1-549106379_GP_Insight_r1.pdf Proposal
The practice is proposing to close the branch surgery at Wrenthorpe By road the distance between the Main Surgery at Outwood Park is approximately 1.4 miles
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• Car = 5min • Foot = 1.2 mile (35 min) – most of which is on an incline • Public Transport
Alternatively there are 3 practices within 2 mile radius of the Wrenthorpe Health Centre which have open list and are registering patients.
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New Southgate Surgery Buxton Place Wakefield WF1 3JQ 1.3 miles away
Alverthorpe Surgery Balne Lane Wakefield WF2 0DP 1.8 miles away
Homestead Medical Centre Homestead Drive Wakefield WF2 9PE 2.0 miles away
Benefits and Improved outcomes for patients If the branch surgery was to close, this would free up more clinical time at Outwood. By concentrating services at the main site the practice would be able to provide - • Greater range of clinical expertise under one roof.
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• Increased access to same day urgent care • Enhanced patient safety due to continuity of care – More chance of seeing a preferred GP • Larger team with the ability to provide responsive essential medical services • More continuity at one site rather than waiting several days to see the same GP at the branch • Improved telephone access at main site – designated line to administration. Four phone lines instead of one at branch surgery • Better facilities, better disabled access and child friendly compliance. • 100+ parking spaces as opposed to 3 at branch surgery • Reduced clinical risk at main surgery due to the ability to conduct all necessary tests with a nurse, Health Care Assistants, Phlebotomist and GP being on site together
Risk of retaining the branch premises with reduced resources would include • Wrenthorpe does not have access to the extended services that are provided at Outwood. In terms of the small number of patients who use the branch surgery, the vast majority of these patients may have to make another visit to the main practice to see a GP, nurse or health care assistant for physical examinations, review of a long term condition, blood testing etc. This could potentially result in a delay in diagnosis
• The building is difficult to access for some patients. There is limited parking available which is at the rear of the premises. Patients that park in the car park have to walk back out on to the pavement and walk around the front of building to the main entrance. This is very difficult for patients that have problems with walking and parents with prams and young children.
• As Wrenthorpe is not equipped to the same standard as the main site we are concerned about the ability for a lone clinician to manage an acutely unwell patient.
• Due to staff shortages, a chaperone may not be available if requested during a consultation.
1. Inability to provide high calibre services from branch surgery due to the level of staffing skill mix required to deliver services at the main site.
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2. Operating across two sites presents problems around communication and efficiencies of scale. Patients often need to speak to staff both clinical and non- clinical which often lead to more than one contact being made. This could potentially result in delay in the processing of information.
3. Due to difficulties in sustaining two sites, opening times and telephone access is currently very limited
Seeking the views of patients using Wrenthorpe Surgery and other Key stakeholders
Through a twelve week communication and engagement process the practice will be seeking the views of the patients and stakeholders who use Wrenthorpe and Outwood surgery. Legislation Equality Act 2010 We will be asking for views on whether there are other options we should consider and how best to ensure that the patient’s needs are not overlooked. The Equality Act 2010 protects people against discrimination, harassment and victimisation in relation to housing, education, clubs, the provision of services and work. It unifies and extends previous equality legislation. The groups the Act specifically covers are called ‘protected characteristics’ these are: • Age
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• Disability • Gender reassignment • Marriage and civil partnership (with some restrictions) • Pregnancy and Maternity • Race • Religion or belief • Sex • Sexual orientation
The CCG also incorporates consideration of carers within this work. The public sector equality duty section 149 of the Equality Act requires public bodies, to pat regard to the need to; • Eliminate discrimination, harassment and victimisation • Advance equality of opportunity • Foster good relations
Obligations under section 242 of the 2006 NHS Act amended in the Health and Social care Act 2012 This states that Each relevant English body must make arrangements, as respects health and services for which it is responsible, which secure that users of those services, whether directly or through representation, are involved (whether by being consulted or provided with information, or in other ways) In- 1. The planning of the provision of those services 2. The development and consideration of proposals for changes in the way those services are provided, and 3. Decisions to made by that body affecting the operations of those services
With regards to GP branch closures, the Practice has a responsibility for undertaking initial public engagement prior to a decision to being taken by the CCG (NHS England Policy for Branch Closure of Primary Medical Services) Dr Putman and Partners will uphold their statutory duty to engage with patients and stakeholders.
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We will conduct a 12 week engagement process to ensure that service users and carers are informed of the change. We will canvas opinions of stakeholders, carers and patient advocates so not to overlook the needs of the vulnerable groups who may be affected. We will undertake a robust communication exercise to ensure our patients and stakeholders are informed of the engagement as well as the decision taken on the future of the branch. We will listen to all points of view and will answer queries and concerns which may arise during the engagement period. Our hope it to maintain the strong relationship within the Wrenthorpe community and seek to assure our patients that their health and wellbeing is at the heart of the decisions we make. The public consultation will broadly test two things. 1. As a practice we can only see one workable option – but we are open to suggestions and learning from your experiences 2. How can we make this option work to make the service at Outwood Park Medical Centre meet your needs
Objectives to the communication and engagement plan
1. To hear the views of patients currently using Wrenthorpe Surgery 2. To hear the views of patients who occasionally use the services of Wrenthorpe and Outwood 3. To ensure key stakeholders know how to contribute to discussion about the future services 4. To support patients to better understand where to access the appropriate care. 5. To listen to the views of our staff and the extended primary healthcare team 6. To share information with local pharmacies
Key messages
1. The branch surgery at Wrenthorpe falls short of service standards and compliance. 2. Wrenthorpe is not equipped to the same standard as the main site which limits the ability for a lone clinician to manage an acutely unwell patient 3. Due to physical access constraints the building is not fit for the purpose of accessing same day urgent care.
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4. There are a broader range of services available at Outwood Park. 5. Access to on-site staff resources reduce possible risk 6. Equitable quality service for all patients with improved continuity of care 7. Staffing levels will not be reduced
We believe that this will provide long term sustainability for our patients, reduce risk and offer wider choice of clinical input
Target audience
1. Patients currently registered at Outwood Park Medical Centre and their carers 2. Patients who currently use Wrenthorpe Surgery and their carers 3. Staff at Outwood park Medical Centre 4. Local GP Practices and Pharmacies 5. Other local stakeholders: MPs, local councillors, Local Medical Committee, NHS Wakefield Clinical Commissioning Group, voluntary and community sector groups.
Budget
The engagement and communications will be delivered within existing resources by existing staff Options for analysis/verification of feedback results will be explored further. One option is external verification of data to be undertaken with the help of the Patient Participation Group (PPG) Approximate Postage, Stationary costs = £6,000 Drop in sessions Interpreter fee Data analysis Patient Survey Communication/ Media cost will be funded by the Partners
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Method of Engagement and Communication
Method of engagement/communication to include: • Meet with the CCG • Meet with the PRG chair • Present to the PRG. • Keep the members informed and involved in the development of this plan and the engagement process • Write to all registered households inviting their views to complete the enclosed paper questionnaire or the online version • Posters in local meeting places, church hall, supermarkets and both surgery sites • Information leaflets and frequently asked questions sheets available in both surgery sites with feedback post box on both sites for comments and responses • Information stand, drop in sessions • Media release – article for Wakefield Express • Online questionnaire – sharing this widely and including email cascade and posting on surgery website • Written briefing for Wakefield Overview and Scrutiny Committee, Local councillors, MP and Healthwatch • Attendance at local community meetings where possible
Timescales
1. Planning and communication activity – June – July 2017 2. Engagement 1 August - 31 October 3. Analysis of views – report available early November 2017 4. Feedback November onwards
Risk and Mitigating Actions
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Risk Mitigating Action Challenge to accessibility to alternative surgeries Travel & transport options to be explored and readily available through engagement period Availability of clinical / managerial spokespeople Identify key people in practice & CCG
Partnership working
NHS Wakefield CCG is responsible for co-commissioning primary care for the local population of Wakefield and Outwood Park Medical Centre holds a contract to provide Primary Medical Services to the local population. The CCG and OPMC are therefore working together to seek local peoples views about the future of these services and the best way to ensure that local people have access to the high quality services they need.
Planning
Planning Detail By whom Date Date Date Date Date Practice, PPG rep & CCG meet to discuss engagement Fact finding re travel information to be made available Inform PRG of Proposal request to CCG Share Draft E&C with PRG and seek advice on when/ how to liaise with
Page | 69 Glennis Rhodes Draft E&C plan 31.03.17 community groups Planning for questionnaire for patients in Wrenthorpe Surgery to add to information about who uses the service and why Brief Healthwatch Agree plans timings for information sessions Plan date to meet with staff at OPMC Identify CCG Contacts Draft Letter to registered list patients Letter to stakeholders Press statement Posters Online Survey Communication links OSC MP Healthwatch Raising awareness campaign Interested parties Identify analyst
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Activity
Activity Detail By whom Date Date Date Date Date INFORMATION & ENGAGEMENT Letter/email to all patients on registered list advising time /dates of information sessions and offering feedback route liaise with primary care team over mailing date Letter to key stakeholders Press release Information stands Websites: Poster for local distribution Drop in sessions
Activity
Activity Detail By whom Date Date Date Date Date
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FEEDBACK Inform partners and stakeholders, patients and public of progress Inform PRG Update poster and website of progress to date Media update
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19.
20. Appendix 6 Summary
Dr Putman & Partners continuously strives to provide high quality healthcare and are very keen to maintain the best possible service to our patients. The nature of care provided in General Practice has been rapidly changing with more extensive management of chronic disease, treatment of more complex cases, an increase in demand for same day appointments and provision of a wider range of services. The practice operates over two sites Outwood Pak Medical Centre (main site) and Wrenthorpe Branch Surgery On review of our current core services the practice concluded that it does not have the sustainable capacity to make commitments of an equitable service across both sites. And as such the most efficient way to improve services would be to offer them from just one site. On consideration of the above is what brought the partners to their decision in April 2017 to put forward an application to NHS Wakefield Clinical Commissioning Group (CCG) to close the branch surgery in Wrenthorpe.
21. Background
For a number of years there have been concerns within the practice about the accessibility and provision of services that could be safety delivered at the branch surgery in Wrenthorpe.
There were concerns that:
7. the branch surgery at Wrenthorpe was falling short of service standards and compliance. 8. Due to physical access constraints the building was not fit for the purpose of accessing same day urgent care. 9. Insufficient parking availability made it difficult for patients with poor mobility to physically access the surgery safely. 10. Wrenthorpe does not have access to the extended services that are provided at Outwood. 11. In the number of patients who use the branch surgery, the vast majority of these patients may have to make another visit to the main practice to see a GP, nurse or health care assistant for physical examinations, review of a long term condition, blood testing etc. This could ultimately cause a delay in diagnosis
12. Wrenthorpe Surgery operates on a different telephone number from the main site but both sites have access to the same appointment and clinical system. Other than the receptionist there are no clerical or administration staff based at Wrenthorpe.
These concerns and the practices strategy for centralisation of services at Outwood was the basis of the decision to put forward a proposal to close the branch surgery. Economies for rationalising services onto one site: Benefits and Improved outcomes for patients Page | 74 Glennis Rhodes Draft E&C plan 31.03.17
If the branch surgery was to close, this would free up more clinical time at Outwood. By concentrating services at the main site the practice would be able to provide – • Greater range of clinical expertise under one roof. • Increased access to same day urgent care • Enhanced patient safety due to continuity of care – More chance of seeing a preferred GP • Larger team with the ability to provide responsive essential medical services • More continuity at one site rather than waiting several days to see the same GP at the branch • Improved telephone access at main site – designated line to administration. Four phone lines instead of one at branch surgery • Better facilities, better disabled access and child friendly compliance. • 100+ parking spaces as opposed to 3 at branch surgery • Reduced clinical risk at main surgery due to the ability to conduct all necessary tests with a nurse, Health Care Assistants, Phlebotomist and GP being on site together
Case for Change: The closure of the branch surgery will help the practice to address greater productivity gains and better access by offering the patients a wider choice of clinicians that they can see as opposed to just the one at the branch surgery.
Having all available GPs, nurse, HCA & phlebotomist on site everyday will help in the management of long term conditions such as those supported by the QOF and local enhanced services. The practice wants and needs to transform the way it provides services to the benefit all our patients. We want to be best placed to meet the growing challenges facing primary care • An ageing population • Growing co-morbidities • Increasing patient expectations. • Growing dissatisfaction with access to services. • Continuity of care.
The closure of the branch surgery means that the clinicians can solely concentrate on all of their patients from one site. When working from just one site, they can cut out wasted travelling time between the two practices. This then frees up more time for them to create an environment that enables the practice to play a much stronger role, as part of a more integrated service that provides: • Pro-active coordination of care, particularly for people with long term conditions and more complex health and care problems. • Holistic care: addressing people’s physical needs, mental health needs and social care needs. • Fast, responsive access to care and preventing avoidable emergency admissions and A & E attendances. • Prevention of ill health, ensuring a more timely diagnosis of ill- health, and supporting wider action to improve community health and wellbeing. • Involving patients and carers more fully in managing their own health and care. • Consistently high quality of care: effectiveness, safety and patient experience. Page | 75 Glennis Rhodes Draft E&C plan 31.03.17
Consultation In 15 June 2017 the practice met with the CCG to go through the application process. In 17 July 2017 the proposal was shared with the Patient Participation Group (PPG) at the six weekly meeting. The rationale was discussed with the group and having listened and participated in the discussions the group gave their 100% backing to the proposal. The draft communication and engagement plan was shared with the group for their comment and suggestions. They were incorporated in the final version of the document.
In July 2017 the application was formally submitted to the CCG and the practice was invited to attend the Probity meeting 25 July 2017. Permission was granted to enter in to a 12 week period of public engagement. The practice was mindful that the engagement process would run over the summer holidays hence the decision to run for a period of 12 weeks.
22. Methods of Communication and Engagement
• Met with CCG • Met with Practice team and the wider PHCT ( Community Nurses & Midwife) • Met with PPG Chair • Presented to PPG
Staff - Staff were informed in May 2017 of the proposal. They were assured there would be no redundancies. The staff have been informed at every stage of the process and were actively involved with preparing for the engagement period. Patient Participation Group -The practice has a well establish and actively involved patient group. The proposal was discussed with the group chair and a further meeting with all members was arranged. In July 2017 the proposal was shared with the Patient Participation Group (PPG) at the six weekly meeting. The rationale was discussed with the group and having listened and participated in the discussions the group gave their 100% backing to the proposal. The communication document was shared with the group and members put forward suggestions and offers of support to advertise the proposal. Members requested that they be informed and involved in the development of this plan and the engagement process Throughout the period of engagement the practice has kept in close contact with PRG members. The PRG members have close links with the Wrenthorpe community and the members acted as conduits between the patients and practice in the aim to provide a consistent and accurate response to patients concerns and to feedback to the practice – they also encouraged patients to contact the practice directly if they were worried. Our members have attended community events and coffee mornings where the proposal has been discussed. – The PRG members have ensured that Posters/leaflets and FAQ have been available in a number of community venues where they have a personal involvement. The PRG have been in regularly updated on the progress of the engagement and are in receipt of the outcomes. Letter to patients – the practice wrote to the 2,000 registered households in Wrenthorpe and those households that could be deemed to be closer to Wrenthorpe than Outwood. To ensure that the practice had identified the correct postcode search criteria we enlisted the help of a member of the CCG Data Quality team to verify the searches. Page | 76 Glennis Rhodes Draft E&C plan 31.03.17
Local Practices -10 August 2017 the practice met with the Federation /Network member practices. The practices are geographically aligned and as such three of the practice areas overlap the Outwood Park Medical Centre boundary Pharmacist in Wrenthorpe - Communications between both parties have been based on reassuring patients that the service will continue and how the service could be improved. Patient surveys - A paper version was available from both Outwood and Wrenthorpe reception areas, online on the surgery website and in Wrenthorpe Village community venue FAQ and information leaflets were available from both sites and on the website. Comments & Suggestion box. - Patients were encouraged to post their comments and suggestion in a feedback box at both sites . Local Media -The practice has written an article for both the Outwood & Wrenthorpe newsletter which is distributed all local households – The PRG Chair has been instrumental in pulling this together There has been a local media presence – article in the Wakefield Express Website - A section on the website was created to provide information and links to surveys, FAQ and a method to leave feedback. Petition - The practice are aware that a petition was presented to the CCG Drop in Sessions These were held at various times and days of the week in the hope that as many stakeholders as possible would have an opportunity to attend. • 10.08.17 Outwood Park Medical Centre 5:00pm -7:00pm • 14.08.17 Wrenthorpe Health Centre 3:00pm 6:00pm • 16.08.17 Wrenthorpe Health Centre 10:00am -12noon • 31.08.17 Outwood Park Medical Centre 9:30 – 11:30pm
Meeting with local Councillor Charles Keith 11 August 2017 • 30.08.17 Public Meeting Wrenthorpe Village Hall
23. Feedback
Feedback has been received in a number of ways • Verbal • Email • Written • Surveys both hard copy and online • PRG Feedback
Feedback Summary We received • 287 individual written responses to the patient survey. • Feedback from the organisers of the public meeting where shared with the practice after the event. • 3 letters • Standard letters for and against the proposal that were issued at the public event • 3 emails • Verbal – drop in sessions and public meeting attendances
The Key themes • Transport
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• Housing • Access • Rationale for the proposal • Impact on local pharmacist • Pollution • Increase in Home Visit requests
Mitigating actions Taking account of views expressed by the patients, and particularly concerns expressed by elderly patients, it is proposed that the GPs in the practice will be asked to ensure that any negative impact on these patient groups is mitigated. Transport -The patient views highlighted an impact on elderly patients who indicated they had or in the future would have difficulties in accessing services at Outwood. The partners acknowledge that the branch surgery provides ease of access to a GP for a number of patients who live close to Wrenthorpe Surgery than the main surgery in Outwood. From the survey responses it was noted that a significant proportion of those who have used Wrenthorpe practice had walked there. Although this would indicate the branch surgery being primarily used by those living close to it, the practice have also carried out analysis of the use of each site and findings show Of the total number of patients registered as living in area code closest to Wrenthorpe surgery (3,008) between 01.04.16.-31.03.17 there were • 284 Home Visits • 807 face to face routine appointments with a GP
Within the same time frame The total number of face to face routine / pre -bookable consultations at Wrenthorpe with patients that live in the Outwood area code • 326 face to face routine appointment with a GP
98 survey respondents had concerns with how they would travel to the main surgery given the lack of public transport between the two sites.
Mitigating actions • Local Councillors are taking action around the provision of bus services in the local area.
• The practice recognises that patients using public transport will need to be able to plan and appointments will be made close to bus times wherever possible.
• The practice has started to look how surgeries can be staggered across the day by looking at times when there is less foot fall through the door. This would ease the burden of queues building up at reception, in the pharmacy and more available seating.
• By providing appointments at mid–day would help patients to travel at times when the bus fares are subsidised and in day light (particularly in the winter months.)
• If patients require an appointment with a GP and Nurse we always try to synchronise appointments so that patients do not need to make a further visit.
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• Home visits are and would remain to be available to those who need these.
Housing - Noted throughout verbal discussions was the concerns that were raised regarding the number of new housing developments that were taking place across the area and their impact on local public services. Mitigating actions • This is a wider commissioning issue which the CCG are working on together with partners, however, the practice retains an open list in order to provide care for patients within our catchment area who need it. • Housing developments are happening both in Wrenthorpe and Outwood areas and consideration would be given to the situation on both sides of the catchment area.
Access – the third ranked area of concern was of the impact on appointment availability. Some patients thought that the closing of Wrenthorpe branch would lead to a reduction in actual appointments. As part of the verbal discussions patients were reassured that there were no plans to cut back on appointments. It was explained that the same number of appointments would be available just at a different location. Mitigating actions We fully recognise and appreciate the concerns about appointment availability. • Clear communication will be shared with our patients and our patient participation group to make sure that a consistent message is shared with all our patients, both Wrenthorpe as well as Outwood. We recognise that it is important for all of our patients to feel reassured about there not being any reduction to the appointments available to our registered patients.
• The practice is making every effort to manage increasing demand and improve access. One major change in the management of same day demand has been the introduction of a GP triage service. Patients that feel that they need a same day contact or who feel that their problem will not wait until the next routine appointment are offered a call back from a GP. The GP and patient agree what/if further intervention is needed and are directed to the most appropriate clinician
• Appointments would continue to be available to all our patients and we aim to use any staff time efficiencies to improve and increase our service, e.g. by making our prescription ordering line open for longer so that patients can have better access to a trained member of staff.
• The practice has one of the highest GP to patient ratio in the Wakefield District. This enables the practice flexibility in responding to peaks in demand. An example of this is if there is a rise in home visit requests a GP would take on all of the home visits whilst the other GPs remained in the practice.
Rationale for the proposal – some respondents questioned this, feeling that the true reason for the proposal was financial savings for the practice. Mitigating actions • We appreciate that the efficiencies that can be gained both clinical and administratively by delivering services from one location will not be obvious to all our patients. We will continue to reiterate that the rationale for the proposal has been based on clinical need and the aim to improve services for all our patients.
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We will do this by maintaining and promoting the PRG and encourage feedback and suggestion in the forms of patient survey, newsletters and website.
• The practice is keen to retain ongoing dialogue with our patients, stakeholders and local councillors.
Impact on local pharmacist – Patients were worried that should the closure impact on the chemist to the point whereby it would no longer be financially viable to remain open what the knock on effect of this would have on the village status. At verbal discussion the practice was able to offer assurances that it would continue to maintain the close, successful relationship it holds with the pharmacist and did not foresee any reason why this should not continue. Mitigating actions • The pharmacy has direct links to the practice prescribing clerks through the designated prescription line at the surgery.
• An audit of patients requesting repeat prescriptions have found that there are on average 60 repeat prescription requests per week which are processed by the receptionist at Wrenthorpe. Of the registered population there are over six thousand patients who have a repeat prescription. For this purpose there is a designated phone line at Outwood which is open between 9am and 12:00pm. Trained prescription clerks at Outwood process prescriptions from 8:00am – 6:00pm. The aim is to meet the 24hr turn around target. It is not anticipated that opening times or man power would be affected by an additional 10 prescription requests a day should the Wrenthorpe service cease to exist. As with other local pharmacist, Wrenthorpe pharmacy has individual arrangements with patients for collection and delivery.
• We will continue to promote the use of electronic prescribing to make sure that patients are able to name pharmacies and collect prescriptions in their preferred locations, be it near home or work.
Pollution – linked to concerns in the over development of the area. Patients felt that the closure would mean the need for more cars. The practice responded that whilst this was an area which was out of our control we envisaged that as a maximum this would mean an extra 32 cars a day would be travelling to Outwood rather than Wrenthorpe. It was felt that this would cause little if any significance to the environment. Increase in Home Visits • Assurance will be provided to patients that home visits would be available based on clinical need but regardless of the home address of the patient.
• All requests for home visits would continue to be triaged as they are currently.
Conclusion As previously stated in earlier parts of the document, the current premises of the branch surgery is no longer fit for purpose. The proposal is for approval for the closure of the branch surgery and to provide services from the main surgery only. The branch surgery carries many underlying problems, such as inadequate parking facilities and due to the restriction of the size of the site, it is unable to expand any further to allow for disabled access, furthermore the landlord may not give permission for structural changes. Page | 80 Glennis Rhodes Draft E&C plan 31.03.17
The location of the main premises provides better access to the surgery. The location also allows for ample car parking space which is in contrast to the current provisions at the Wrenthorpe site. The population of the area is growing and the needs of the patients are also increasing. With an ageing population, the main premise is proofed to be fit for purpose to continue to provide a sustainable service to all the patients. The main surgery premises will not only allow the practice to expand the provision of PMS services it currently provides, but also allow the practice to be able to help develop enhanced primary and community services. Constraints in the current branch surgery premises do not enable the practice to increase or make changes to services. The space allowance at the main surgery will promote the ability for multi-disciplinary working and enable the introduction of new services. As a result of the closure of the branch surgery, the clinicians will be able to focus on all their patients from one site.
This will help address the strategic needs for primary care as:
• Patients will be helped in their goal to remain healthy and independent.
• Far more services will be delivered safely and effectively from the main surgery.
• Services will be integrated, built around the needs to patients, promoting independence and choice.
• Long standing inequalities in access and care will be tackled.
• Patient communication and the use of IT etc. will improve following the proposed closure of the branch surgery through a range of contact systems such as telephone clinical triage, planned and urgent appointments, and home visits.
• The Wrenthorpe patients who do want to stay with the practice in Outwood do not need to come to the surgery to pick up their repeat scripts. The surgery has been set up for Electronic Prescribing Service- meaning the scripts are sent electronically to the patient’s choice of nominated pharmacy.
Page | 81 Glennis Rhodes Draft E&C plan 31.03.17
Commissioning intention: Proposal Name: Request to close the branch surgery at Wrenthorpe Health Centre Summary of main changes being proposed: Dr Putman & Partners continuously strives to provide high quality healthcare and are very keen to maintain the best possible service to our patients. The nature of care provided in General Practice has been rapidly changing with more extensive management of chronic disease, treatment of more complex cases, an increase in demand for same day appointments and provision of a wider range of services. The practice operates over two sites Outwood Pak Medical Centre (main site) and Wrenthorpe Branch Surgery On review of our current core services the practice concluded that it does not have the sustainable capacity to make commitments of an equitable service across both sites. And as such the most efficient way to improve services would be to offer them from just one site. On consideration of the above is what brought the partners to their decision in April 2017 to put forward an application to NHS Wakefield Clinical Commissioning Group (CCG) to close the branch surgery in Wrenthorpe. or a number of years there have been concerns within the practice about the accessibility and provision of services that could be safety delivered at the branch surgery in Wrenthorpe. There were concerns that: 13. the branch surgery at Wrenthorpe was falling short of service standards and compliance. 14. Due to physical access constraints the building was not fit for the purpose of accessing same day urgent care. 15. Insufficient parking availability made it difficult for patients with poor mobility to physically access the surgery safely. 16. Wrenthorpe does not have access to the extended services that are provided at Outwood. 17. In the number of patients who use the branch surgery, the vast majority of these Page | 82 patients may have to make another visit to the main practice to see a GP, nurse Glennis Rhodes Draft E&C plan 31.03.17 or health care assistant for physical examinations, review of a long term condition, blood testing etc. This could ultimately cause a delay in diagnosis
18. Wrenthorpe Surgery operates on a different telephone number from the main site but both sites have access to the same appointment and clinical system. Other than the receptionist there are no clerical or administration staff based at Wrenthorpe. These concerns and the practices strategy for centralisation of services at Outwood was the basis of the decision to put forward a proposal to close the branch surgery.
Project Lead: Glennis Rhodes Practice Manager Date EIA Started:
Page | 83 Glennis Rhodes Draft E&C plan 31.03.17
Evidence Base: What evidence has been used to inform this assessment? Please provide details of all the evidence that has been used to inform this assessment, e.g. service user equality monitoring data, patient experience intelligence, national and local research, engagement and consultation with patients, service users and the wider community, information from partner agencies, staff and any other interested groups.
• Met with CCG • Met with Practice team and the wider PHCT ( Community Nurses & Midwife) • Met with PPG Chair • Presented to PPG • Met with local practices
National and local research Local demographics / Census Total practice population data
Wakefield
Page | 84 Glennis Rhodes Draft E&C plan 31.03.17
Under 65 10475 65-74: 1668 Over 75: 1137
Total: 13280
Leeds – there is a small number of patients that are registered on the Leeds border
Service user equality monitoring Total number of patients registered as living in area code closest to Wrenthorpe surgery = 3,008 data Analyse service user data by protected groups Audit Period 01.04.16.-31.03.17 Within this timeframe there were 15,680 patient contacts by this registered population • 8275 were recorded as a contact with a GP • 284 contacts were for Home Visits • 6,583 were recorded as face to face contacts at surgery • 807 of the 6,583 were recorded as face to face consultations at Wrenthorpe • On average -from the audit population (3,008) – 15 patients per week had a face to face consultation at Wrenthorpe • Of the 807 consultations 153 were with patients 75yrs – a average of 2 patients per week • 334 patients of the 807 were aged between 60 – 74yrs.an average of 7 patients a week
Patient experience data e.g. Complaints/Compliments/PALS, national and local patient surveys, Friends and Family test Engagement and consultation A survey and other engagement activity was carried out with patients on the proposed change activity What between 15.07.17and 17.10.17. are the key findings relating to the protected
Page | 85 Glennis Rhodes Draft E&C plan 31.03.17 groups? Drop in Sessions
These were held at various times and days of the week in the hope that as many stakeholders as possible would have an opportunity to attend.
• 10.08.17 Outwood Park Medical Centre 5:00pm -7:00pm
• 14.08.17 Wrenthorpe Health Centre 3:00pm 6:00pm
• 16.08.17 Wrenthorpe Health Centre 10:00am -12noon
• 31.08.17 Outwood Park Medical Centre 9:30 – 11:30pm
Meeting with local Councillor Charles Keith 11 August 2017
• 30.08.17 Public Meeting Wrenthorpe Village Hall
Patient Survey
Feedback Summary
We received
• 287 individual written responses to the patient survey. • Feedback from the organisers of the public meeting where shared with the practice after the event. • 3 letters • Standard letters for and against the proposal that were issued at the public event • 3 emails • Verbal – drop in sessions and public meeting attendances
Page | 86 Glennis Rhodes Draft E&C plan 31.03.17
Patients completed the survey and chose to disclose
Male 8 Female 14 Prefer not to say 0
20-30 3 31-40 6 41-50 11 51-60 15 61-70 34 71-100 45
The engagement found;
o Transport - Ranked highest of the key areas with 98 survey respondents having concerns with how they would travel to the main surgery given the lack of public transport between the two sites. o Housing - Noted throughout verbal discussions were the concerns that were raised regarding the number of new housing developments that were taking place across the area and their impact on local public services. o Access – the third ranked area of concern was of the impact on appointment availability. Some patients thought that the closing of Wrenthorpe branch would lead to a reduction in actual appointments. As part of the verbal discussions patients were reassured that there were no plans to cut back on appointments. It was explained that the same number of appointments would be available just at a different location.
Information from other agencies, e.g. Healthwatch, Community groups and other
Page | 87 Glennis Rhodes Draft E&C plan 31.03.17 stakeholders
Any other evidence?
Equality Impact Assessment Describe the actual or potential impact (positive and negative) of any proposed changes on the following groups: Group Impact (Positive / Description of impact and evidence used Actions / Mitigation Negative / Neutral)
General Issues Positive The building at Wrenthorpe is not very accessible, limited Outwood is a recently purpose built practice disabled parking, distance from parking to practice, steep with a range of services and level access. stairs (at rear) and a large incline to practice. This would have an impact on older, disabled and pregnant people and of course people who are ill. Other practices are available within 1 .5 miles CHECK THE ABOVE – MAY HAVE EXAGGERATED!!! of Wrenthorpe) The practice has met with local councillors to Negative Lack of public transport between residents currently using ask their support in putting forward a plan to improve transport connectivity between Wrenthorpe and Outwood Practice. Wrenthorpe & Outwood Patients who cannot travel, or leave their homes concerned about the additional burden of travel. Patients unable to Where necessary a Dr would visit patients who attend Outwood could not leave their homes. We have a clear communication plan to meet Change may have a distressing/confusing impact on some patient needs patients Should this happen to the extreme. The practice has a process in place to manage demand. 1, a GP will triage all visits and 2, The practice has enough flexibility in the system to respond to the peaks in demand. This could be by increasing the number of visiting doctors
Page | 88 Glennis Rhodes Draft E&C plan 31.03.17
Age Capitation Report Age Range Male Female Total 0 - 10 744 746 1490 11 - 20 694 651 1345 21 - 30 724 721 1445 31 - 40 791 800 1591 41 - 50 916 951 1867 51 - 60 951 1026 1977 61 - 70 880 897 1777 71 - 80 525 609 1134 81 - 90 195 292 487 91 - 100 26 69 95 101+ 0 1 1 Total 6446 6763 13209
Some patient have expressed concerns regarding the lack of public transport and the cost of private hire taxi services
Patients said that we would see an increase in home visit request
Page | 89 Glennis Rhodes Draft E&C plan 31.03.17
Disability Some disabled patients may struggle to travel to Outwood, From the survey returns the number of patients We do not have the data of the patients consultations at that considered themselves to be disabled was Wrenthorpe were with disabled people. a zero return
Gender neutral 1 patient reassignment We do not predict any issues for trans patients as the practice staff would not change, unless there were other issues such as disability/age which affected travel. Marriage and neutral None predicted civil partnership (Employment only) Pregnancy and Pregnant people and those with very young babies may maternity struggle to attend appointments at Outwood But have all the ante/post natal checks been done at Outwood Ethnicity % of Ethnicity Total British or mixed British 90.00% Irish - 0.10% Other White 1.30% White and Black Caribbean 0.20% White and Black African 0.30% White and Asian 0.40% Other Mixed background 0.40% Indian or British Indian 0.70% Pakistani or British Pakistani 0.60%
Page | 90 Glennis Rhodes Draft E&C plan 31.03.17
Other Asian background 0.30% There are no predicted Caribbean - ethnic category 0.10% impacts to patients of different ethnicities as the African - ethnic category 0.60% practice staff will not Other Black background 0.10% change, nor will the Chinese - ethnic category 0.60% systems in place to Other - ethnic category s 0.20% support patients with Ethnic category not stated 4.10% language or other needs. Religion or belief Religion % the total Where recorded Religious affiliation 0.1 % Roman Catholic 0.1 % Atheist 0.0 % Jehovah's Witness 0.1 % Hindu 0.0 % Christian 0.5 % Not religious 0.3 % Methodist 0.0 % Agnostic 0.0 % Religion NOS 0.2 % Nonconformist 0.0 % Muslim 0.0 % Religion not given - 0.1 % patient refused Patient religion 0.1 % unknown Orthodox Christian 0.0 % church of England, 0.1 % follower of religion
Religion (Other) 0.1 % Sex No impacts predicted above those already mentioned. Sexual This information is not recorded, we do not predict an orientation impact on this community Carers 112 registered carers Any other NO groups (e.g. people from low income backgrounds, rural communities, homeless people,
Page | 91 Glennis Rhodes Draft E&C plan 31.03.17 asylum seekers and refugees) Human Rights Health no Inequalities (refer to Public Health Information such as JSNA)
Action Plan (Impacts on proposal/implementation plans) Impact Actions Timescale Lead Poor public transport links from Wrenthorpe locality we will continue to to Outwood influence public transport etc Change is complex and confusing for some patients We will ensure a with additional needs communications plan which specifically targets equality groups and is accessible and designed to meet the needs of different groups if the agreement is made to close
Implementation Name of individual, Role Frequency group or committee How will the impact and effectiveness of the actions be monitored and reviewed? How will these actions be embedded into mainstream activity? Who will review the outcome of the proposed changes and when?
Page | 92 Glennis Rhodes Draft E&C plan 31.03.17
Equality Lead sign off: ☐ Yes ☐ No ☐ Other Date:
Clinical Lead sign off: ☐ Yes ☐ No ☐ Other Date:
☐ Yes ☐ No ☐ Other SRO sign off: Date:
Page | 93 Glennis Rhodes Draft E&C plan 31.03.17
Appendix 2 – NHS England Primary Care Policy Book for Branch Closure Branch Closure
23.1 The closure of a branch surgery may be as a result of an application made by the contractor to the Commissioner or due to the Commissioner instigating the closure following full consideration of the impact of such a closure.
23.2 In the circumstances that the Commissioner is instigating a branch closure, the Commissioner must be able to clearly demonstrate the grounds for such a closure and have fully considered any impact on the contractors registered population and any financial impact on the actual contractor. The Commissioner will be expected to demonstrate that they have considered any other options available prior to instigating a branch closure and entering into a dialogue with the contractor as to how the closure is to be managed. The Commissioner will need to have complied with the duty (under section 13Q of the NHS Act) to involve patients in decision- making before any final decision to close a branch is made.
23.3 Where a contractor wishes to close a branch surgery, the contractor should have preliminary discussions with the Commissioner to determine appropriate and proportionate patient involvement requirements prior to the consideration of such a service provision change. Even though the closure is being instigated by the contractor, the Commissioner will still need to comply with the section 13Q duty to involve patients in decision-making before any final decision is made.
23.4 The closure of a branch surgery would be a significant change to services for the registered population and as such the Commissioner and the contractor should engage in open dialogue in the first instance to consider the consequences and implications of the proposed change and discuss any possible alternatives that may be agreed between them. At this stage the duty to involve the public in proposals for change is triggered and the Commissioner and contractor should work together on fair and proportionate ways to achieve this. The Commissioner should ensure clarity on what involvement activities are required by the contractor.
23.5 Contractor and Commissioner discussions resulting ultimately in a decision about a branch closure will often include consideration of (but not be limited to):
23.5.1 financial viability;
23.5.2 registered list size and patient demographics;
23.5.3 condition, accessibility and compliance to required standards of the premises;
23.5.4 accessibility of the main surgery premises including transport implications;
23.5.5 the Commissioner’s strategic plans for the area;
23.5.6 other primary health care provision within the locality (including other providers and their current list provision, accessibility, dispensaries and rural issues);
Page | 94 Glennis Rhodes Draft E&C plan 31.03.17
23.5.7 dispensing implications (if a dispensing practice);
23.5.8 whether the contractor is currently in receipt of premises costs for the relevant premises;
23.5.9 other payment amendments;
23.5.10 possible co-location of services;
23.5.11 rurality issues;
23.5.12 patient feedback;
23.5.13 any impact on groups protected by the Equality Act 2010 (for further detail see chapter 4 (General duties of NHS England);
23.5.14 the impact on health and health inequalities; and
23.5.15 any other relevant duties under Part 2 of the NHS Act (for further detail see chapter 4 (General duties of NHS England).
23.6 The Commissioner and contractor, through their dialogue, may establish that there is a need to retain medical service provision in the locality and must find a solution, which could include tendering for a new provider within that locality though not necessarily within the same premises. Note that most changes in premises will trigger the Commissioner's duties to involve patients in decision-making.
23.7 The Commissioner should confirm any such arrangements and agreements in writing to the contractor as soon as is practicably possible after the agreement is reached.
23.8 If the Commissioner and the contractor are unable to reach an agreement to keep the branch surgery open, then the contractor, based upon their previous discussions with the Commissioner regarding appropriate and proportionate involvement, will continue to involve patients in the proposed changes.
23.9 The contractor is required to follow the patient and public participation Patient and Public Participation Policy and Statement of Arrangements & Guidance on Patient and Public Participation in Commissioning process as appropriate to the arrangements agreed with the Commissioner, with support and advice as appropriate from the Commissioner. Adherence to the PPP involvement process will help ensure that an appropriate involvement exercise is carried out, that meets the legal obligations on the Commissioner.
23.10 Once this involvement exercise has been undertaken and the results provided to the Commissioner, the contractor would then submit a formal application to close the branch surgery to the Commissioner for consideration (Annex 14A).
23.11 The Commissioner will then assess the application regarding the closure and the outcome of the patient involvement exercise with a view to either accepting or refusing the proposal. These assessments will need to again consider all the relevant factors, including those listed at paragraph 15.11. The Commissioner should document how it has taken the various factors into account. Page | 95 Glennis Rhodes Draft E&C plan 31.03.17
23.12 Either the contractor or the Commissioner may invite the LMC to be party to these discussions at any time.
23.13 Where the Commissioner refuses the branch closure through its internal assessment procedure, the contractor shall be notified in writing within 28 days following the internal assessment and the contractor may then follow the relevant resolution process as referenced in the contract. Please refer to Annex 14B.
23.14 Where the Commissioner approves the branch closure, the Commissioner will need to ensure that it retrieves all NHS owned assets from the premises.
23.15 The contractor remains responsible for ensuring the transfer of patient records (electronic and paper Lloyd George notes) and confidential information to the main surgery, having full regard to confidentiality and data protection requirements, Records Management: NHS Code of Practice guidance and any relevant guidance from the Health & Social Care Information Centre or the Information Commissioner's Office. Where a third party contractor is being used to handle records, they must be vetted and appropriate contractual arrangements put in place. Further information is contained in Annex 15.
23.16 The contractor remains responsible for carrying out public involvement in accordance with the instructions given by the Commissioner and informing the registered patients of the proposed changes. However, ultimately it is the Commissioner's responsibility to ensure that involvement activities have met legal requirements, even if carried out by the contractor. Further guidance can be found in the NHS England document Patient and Public Participation Policy and Statement of Arrangements & Guidance on Patient and Public Participation in Commissioning
23.17 Once the final date for closure is confirmed the Commissioner will issue a standard variation notice to remove the registered address of the branch surgery from the contract, including the amended sections of the contract for completeness.
23.18 Where the contractor has previously been granted premises consent to dispense, and these rights are only associated with the closing premises in question (that is listed on the relevant dispensing contractor list), the contractor’s consent to dispense will cease.
23.19 The Commissioner shall update its records and ensure that the relevant dispensing contractor list is updated appropriately to reflect the removal of the premises.
23.20 It is possible that a PMS or APMS contract will reflect the terms as set out above. It is however essential that the Commissioner reviews the individual contract for these or any other relevant provisions to allow a variation to effectively remove the closing premises and any rights associated with that premises alone.
Page | 96 Glennis Rhodes Draft E&C plan 31.03.17
Appendix 3 – Letter from MP
Page | 97 Glennis Rhodes Draft E&C plan 31.03.17
A – letters from Next Door Neighbours website
Letters from Next door Neighbours website concerning Proposed closure of Wrethorpe Surgery
This colour highlights names which are assigned to more than one comment / response.
This colour highlights any comments relating to NHS Wakefield CCG.
Margaret Mitchell, Wrenthorpe
Wrenthorpe Surgery ccproposed closure
There is a proposal to shut Wrenthorpe Surgery. The reasons why can be found on the website. ALL patients from the surgery will be informed by post shortly. A survey is to be carried out to find out peoples opinions.This will be over 12 weeks. Drop in sessions will be advertised .
Carole McLeod, Wrenthorpe·28 Jul
Facebook page set up to fight the closure with petition details to follow. https://www.facebook.com/wrenthorpesurgery/
Dan Budd, Wrenthorpe·28 Jul
What a shocker. It's never open and when it is you can't get an appointment. Hundreds of houses built and being built in the village and they want to close the surgery. You can't make this S*** up!
Bridget Sykes, St John's·28 Jul
Such a shame, I have used this Surgery for years and also the Chemist, if there is no Surgery then perhaps there will be no Chemist - great shame they are a great bunch of people who do a fantastic job.
Susan Carthew, Wrenthorpe·28 Jul
This shouldn't be allowed to happen, last year when I needed an appt after self medicating and not clearing the problem up myself, between the two surgeries I would have had to wait one month for the next available appointment so I ended up going to the walk in centre instead. So with all the new houses being built obviously the waiting problem is going to get longer and if they close the walk in centre it's only going to get worse, so where will they want us to go next, Pinderfields? It will only make matters worse all round.
Wrenthorpe Surgery
My husband has set up a Facebook page to fight the proposed closure of Wrenthorpe Surgery with an on-line petition to follow shortly. Please let your feelings be known on the page. https://www.facebook.com/wrenthorpesurgery/
Tracey Haworth, Wrenthorpe·28 Jul
You can never get an appointment at out wood never mind wrenthorpe surgery. I thought it was shut already.
Stuart Asquith
1
A – letters from Next Door Neighbours website
I believe this has been a long time ploy to ease the shutting down of Wrenthorpe surgery. It is still the same amount of Drs and patients shared between 2 surgeries Much better than all crammed into one surgery. What about the elderly and disabled who do not have a car ? How are they expected to climb that steep hill ? What is going to happen when all the new houses are complete and all these families need medical care,? What a nightmare and to think that they are even considering shutting a surgery down.
Stuart Asquith
Great idea isn't it. Build more houses and then shut the surgery. Another bright idea by wakefield council
Glynnis Blackwell, Outwood·28 Jul
Wrenthorpe surgery is never open but it should be,why they can't have one doctor one nurse permanently based here I have no idea, this village is growing, and we should keep it open. There are lots of rooms that could be rented out to physiotherapists chiropodists etc pensioners like myself would be happy to only use this surgery more convenient, it's so difficult to get appointments now doctors have to call you back now to see if your sick enough to see hem , a general appointment is now three weeks, how things have changed. I would sign the petition.
Paul Bennett, Wrenthorpe·29 Jul
Just received the letter this morning stating what the intentions are. Getting an appointment (without having to answer several questions to a receptionist) is nigh on impossible within a month. The number of houses in Wrenthorpe is increasing which surely warrants a more substancive service in the village. The letter recieved this morning is inciting that accessibility for patients is a big issued, surely not as big as having to travel to Outwood. I do hope that more consideration is taken and more use is made of the facilities that Wrenthorpe surgery offers to local residents that are unable to travel to Outwood.
Carole McLeod, Wrenthorpe·29 Jul
Have you signed the petition Paul?
Marguerite Hogg, Outwood·29 Jul
Signed the petition. It's ridiculous to close the satellite surgery at Wrenthorpe for lots of reason. It's much easier for those of us in Wrenthorpe and it's already difficult to get appointments at Outwood Park. If they also close the pharmacy in Wrenthorpe it will be terrible.
Paul Bennett, Wrenthorpe·29 Jul
Yes signed the petition Carole
Carole McLeod, Wrenthorpe
Closure of Wrenthorpe Surgery
2
A – letters from Next Door Neighbours website
Thank you to the 282 people who have already signed the petition to keep Wrenthorpe Surgery open. It has come to my notice that two Labour councillors are mistakenly telling people not to bother signing the petition as it only counts for one vote. I have spoken with the communications officer at Wakefield CCG and he has assured me that the the petition (with as many signatures as possible) will count as one aspect of the inquiry as will the surveys which are being sent out from the Drs Surgery. It's only common sense anyway because otherwise why would anyone ever sign a petition.
So good neighbours please sign the petition and give your reasons for wanting to keep the surgery open. If you complete the survey please also give your reply at the bottom of the page. I have published my reply previously.
Go on the FB Page SCOWL https://www.facebook.com/wrenthorpesurgery and find links to petition and leave as many comments as you wish.
We have a common goal...to get the best facilities for our lovely village
Scowls
Scowls. 26 likes · 43 talking about this. Outwood surgery are going to put out a consultation document in reference to closing Wrenthorpe Surgery. I believe they have already decided to close it
Pete Shaw, Wrenthorpe·1 Aug
Hi Carol,
Do you know the names of the councillors involved because I believe that they need taking to task over what appears to be an attempt to sabotage the petition
David Weaver, Alverthorpe·1 Aug
I suspect it may be Charlie Keith and Martyn Johnson
Marguerite Hogg, Outwood·1 Aug
We haven't received a letter from the surgery yet. Wouldn't they have been sent out at the same time?
Carole McLeod, Wrenthorpe·1 Aug
Hi Peter and David, I don't think it was a deliberate attempt to do that as we are all on the same side I hope .Just misguided and unaware of the power of social media, so I would rather not give their names.Just hope people in the village are aware that the petition is very important.and that we all united in our efforts, not only to keep Wrenthorpe Surgery open, but also to have a comprehensive service from it. Not as it has been for the last few years. Thank you for your support..
Pete Shaw, Wrenthorpe·1 Aug
And thank you Carole and your husband for being the driving force behind this campaign.
David McLeod, Wrenthorpe
3
A – letters from Next Door Neighbours website
Wrenthorpe Surgery
I have filled out the survey on Outwood Park website ref "Closure of Wrenthorpe Surgery" https://outwoodpark.gpsurgery.net/patient-info/patient-survey/
Here is what I have put in the reasons I am against the closure section.
Dave McLeod
If Wrenthorpe surgery closes the sick,disabled and the elderly will be put at the most inconvenience, hardly good practice for a caring health service.
A lot of the elderly also do not have access to the internet to fill in this survey.
Even this survey is weighted towards closing Wrenthorpe surgery as it asks how often you attended this surgery. How can many people attend when you have been running it down for the last two years. I would always have prefered to go to Wrenthorpe but could never get an appointment for my wife or myself.
The last question is also another loaded question. It implies the threat that the only choice I have is to go to Outwood or change my doctors.
I sincerely believe that the closure of Wrenthorpe surgery has already been decided for monetary reasons and NOT the good of the health of community.
Dan Budd, Wrenthorpe·30 Jul
Hi Carole, were you sent a link to the survey or is it accessible on the website?
Carole McLeod, Wrenthorpe·30 Jul
Hi Dan, Here is the link to the survey https://outwoodpark.gpsurgery.net/patient-info/patient- survey/
David McLeod, Wrenthorpe·31 Jul
Just received my letter from Outwood Park this morning and these are their main points and my response...
Access to services...
There are no extended services at Wrenthorpe because they have not provided them.
The reason there is a small number of patients using Wrenthorpe is that they have been running it down and closing it on regular occasions for the last two years and not making appointments available at Wrenthorpe. It would be called "constructive dismissal" if it was in the workplace.
Accessibility...
They seem to be omitting the fact that there is perfectly adequate parking outside the community centre adjacent to the surgery car park. (An omission that might help their case to Wakefield CCG)
4
A – letters from Next Door Neighbours website
Acutely unwell patients..
It was their duty to ensure that Wrenthorpe was brought up to the appropriate standard. For many, many years before Outwood took over Wrenthorpe the local Doctor ran things on his own as many local doctors do. Are the doctors at Outwood less trained than the old GP's then?
Availability of chaperone...
There is always a receptionist present when the surgery is open and I'm sure they would not be missed at the desk in short time allocated to an appointment.
Please do not forget to sign the petition and please leave a comment if you wish. The petition will be sent to Wakefield CCG to counteract the proposal to close the branch.
Petition link..
https://you.38degrees.org.uk/petitions/stop-closure-of-wrenthorpe-local-surgery
Carole McLeod, Wrenthorpe·31 Jul
When you fill in the survey don't forget that a visit to drop in your prescription is counted as a visit.
Dan Budd, Wrenthorpe·31 Jul
My response on the Patient Survey
I attend Outwood surgery because I can never get an appointment in Wrenthorpe because it's never open, in fact when I want an appointment Wrenthorpe is never even an option. When I drop my repeat prescription off I have to put it through the letter box and hope it gets to the right place as it's never open. 500 + houses have been built in Wrenthorpe over the last few years and there's more being built yet in your wisdom you want to close the surgery. That makes absolutely no sense what so ever. I am able bodied yet it's still a hike from Wrenthorpe to Outwood, what about the elderly and disabled residents? How do they get up there? You can't assume they have access to a car or a friendly neighbour. Factor in the great British weather, especially Winter time and it would be a horrible and dangerous hike up to Outwood for the elderly and disabled. You really haven't thought about this have you? But of course it's all about the money not the patients isn't it?
Marguerite Hogg, Outwood·31 Jul
Completely agree. Sorry I didn't save my response but it was along the same lines as yours. The time of the survey is that it's almost a 'done deal'. When I moved to Wrenthorpe from Balne Lane I was really pleased to see a surgery that was almost on my doorstep after the original local surgery to Balne Lane was closed and I then had to trek across town to Warrengate in order to keep the same GP. Thought I'd seen the last of having to do similar. Seems not. I really hope they take note of local residents/patients and that plenty of patients make their voices heard.
Pete Shaw, Wrenthorpe·31 Jul
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Well said. Your words have almost echoed exactly my comments in the ridiculously biased survey that we have been allowed to complete.
As you so rightly say it's a done deal and all for financial reasons and nothing at all to do with patient care
Carole McLeod, Wrenthorpe·31 Jul
I believe that the GPs think that we are stupid. It's very disappointing to think that they are willing to put financial gain before the patients. They should be honing their medical skills rather than business skills. They are now extremely well paid and ought to be able to organize their practices better. Should not take a month to get an appointment. It used to be such a good surgery at both Wrenthorpe and Outwood. Shame !
Susan Carthew, Wrenthorpe·1 Aug
I've also put about creating more air pollution by more cars travelling what is a relatively short distance by car, when it is local you can walk to the surgery, we've surely enough air pollution going on by being near the motorway.
Diane Norton, Stanley·1 Aug
I have been going to Wrenthorpe and outwood surgery for 10+ years I have also noticed that there is hardly any appointments at Wrenthorpe, if they do close it down dose that mean that the money saved will go into the outwood surgery??
Carole McLeod, Wrenthorpe·2 Aug
A good point raised by Susan.
Thank
Carole McLeod
Carole McLeod, Wrenthorpe·2 Aug
The money will just disappear into thin air Diane, doubt if it will go on patient care, Diane
Carole McLeod, Wrenthorpe
Drop-in Session Wrenthorpe Closure
I went to the first drop in session at Outwood Health Centre tonight and met the Centre Manager Glennis and Margaret from the Patient Participation Group
I was the only one who turned up for the first 1/2 hour and was joined by a chap called Peter who brought up the same points as I had.
We were both under the impression that the reasons given in the proposal to close Wrenthorpe Surgery were purely financial and at the end of the session after 1hr 15 minutes I was not convinced by their argument that it was purely for the sake of the patients.
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I also mentioned that the chemist would most likely close and got the impression that they were not concerned about that aspect.
I was a bit disturbed by the fact that the Patient Participation Group representative and the centre management were singing from the same hymn sheet as I am sure that no patient approached them and suggested that Wrenthorpe should be closed.
All the more reason that as many people as possible fill out the survey and do the on-line petition leave a comment on both as to why they are against this proposal.
The CCG will read your comments.
David McLeod
Margaret Mitchell, Wrenthorpe·6d ago
I have seen all the work that has been done over the last few years. The Practice has been helped by the WCA to try and improve the access to help to keep Wrenthorpe surgery going. I am most concerned about the ACCIDENTS outside the surgery , broken limbs etc.!!!! That is what I have based my personal views on.
Where were the concerned people last night ?
Carole McLeod, Wrenthorpe·6d ago
I appreciate your concern Margaret but if someone has an accident outside Debenhams or Asda etc. they don't close the store down.
As you say you have based your personal views on this issue but in this matter you should be representing the views of the majority of the patients.
I agree that I expected more people to turn up but if you think about it most people would be returning from work and having their evening meal at that time and the people who have trouble getting to Outwood will attend the Wrenthorpe drop-in on Monday 14th August 3.00pm- 5.00pm or Wednesday 16th August 10.am-12.00 noon
Please encourage your friends and neighbours to sign the petition. The more signatures we get the the better. Thank you for your participation in this petition. https://you.38degrees.org.uk/petitions/stop-closure-of-wrenthorpe-local-surgery
Please don't forget to do the survey too https://outwoodpark.gpsurgery.net/patient-info/patient-survey/
David McLeod
Marguerite Hogg, Outwood·6d ago
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I was away from Wakefield last night so couldn't attend but will attend one of the sessions at Wrenthorpe next week if I can get back in time for them
David Sherborne, Altofts·6d ago
I'm from Altofts and hence have no real knowledge or opinion of the Wrenthorpe closure; however we have just gone through a similar situation whereby the Park View Surgery in Normanton Common was supposedly "merged" with the Queen St surgery in Normanton. We were consulted and the case seemed fine. However once the Park View surgery closed we are finding problems. It seems the the Wakefield CCG are not aware of what happens and do not seem to be able to enforce promises given at the consultation. I am now in a middle of a complaint to NHS England to try to get the surgery to conform to some of their promises. Therefore my advice would be to try your hardest to get firm guarantees that no patients will suffer in any way. Whether you can get anyone from the NHS to sign up to this is another matter.
Carole McLeod, Wrenthorpe·5d ago
Thank you David, I am not sure how independent the CCG is from the doctors, it has been said to me that the Wakefield CCG is also called the "Doctors Union" in some circles.
If I suspect that there has been a "cosy" agreement then I will also make this a national issue and we could join forces.
Marguerite Hogg, Outwood·5d ago
My husband said he would have attended one of the drop in sessions but as he works in Bradford he's not back until after 6pm. Lots of working people are not going to get to these sessions. He has signed the petition and we've completed the online survey. I agree that the PALS group should be consulting with all or more patients rather than basing it on personal views. That is one personal view against a majority of views.
Marguerite Hogg, Outwood·5d ago
In fact, the more I think about this the angrier I get. There are huge amounts of elderly people in sheltered housing in Wrenthorpe probably with limited mobility and closing a local surgery is going to make things so much harder for them. Also there will be added pressure on Outwood surgery. Really not happy about this. It is socially exclusive.
Carole McLeod, Wrenthorpe·4d ago
Thank you for all the replies and get your friends, families and neighbours to get involved. Many thanks.
Carole McLeod, Wrenthorpe1
Drop -in Wrenthorpe Surgery
Did anybody attend the drop-in session at Wrenthorpe this morning (Wednesday) If so, what did you think?
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David McLeod
Cath Nicholson, Outwood·58m ago
Can you remind us when these drop in sessions are please. I didn't know/forgot there was one yesterday. Thank you.
Carole McLeod, Wrenthorpe·44m ago
Hi Cath,
The next drop-in session is at Outwood Park Medical Centre on Thursday 31st August 9.30-11.30am
Please encourage your friends and neighbours to sign the petition. The more signatures we get the the better. Thank you for your participation in this petition. https://you.38degrees.org.uk/petitions/stop-closure-of-wrenthorpe-local-surgery
Please don't forget to do the survey too https://outwoodpark.gpsurgery.net/patient-info/patient-survey/
Carole McLeod, Wrenthorpe
Drop-in session Wrenthorpe
Don't forget today's drop-in session at Wrenthorpe Surgery 3.00pm-5.00pm regarding closure of Wrenthorpe Surgery.
Please attend if you can and let me know what you got from it.
Please encourage your friends and neighbours to sign the petition. The more signatures we get the the better. Thank you for your participation in this petition. https://you.38degrees.org.uk/petitions/stop-closure-of-wrenthorpe-local-surgery
Please don't forget to do the survey too https://outwoodpark.gpsurgery.net/patient-info/patient-survey/
David McLeod
See more…
Stop Closure Of Wrenthorpe Local Surgery
Outwood surgery are going to put out a consultation document in reference to closing Wrenthorpe Surgery. I believe they have already decided to close the surgery as they have been running it down for at least the last two years, a worry that I have expressed to my local councillor on regular occasions. The reasons for closing the surgery are purely monetary, no matter what they say. I believe that it is part of the "privatisation of the NHS" policy by selling off NHS properties. Make no...
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Richard Lister, Wrenthorpe·2d ago
Dropped in last night. All we got was it was to enable us to get "better access to services" in case someone was taken ill while visiting the surgery. The doctors seem to be covering their backs in case someone is taken ill during a visit but that is why we go to the doctors, when we are ill.
Some figures were thrown at us which I am going to ring up about as they do not seem to gel right.
Bus company are been approached to put on an extra service to make 2 an hour going to Outwood, I don't think so as they are in the business of making money and our Councillor and MP are supposed to be getting involved.
It was pushed too much that it is not a money saving exercise but to give us a better "service" if we fall ill while visiting,
Apparently there are 32 appointments a day at Wrenthorpe which are all filled so it is obviously needed but the Doctor's do not seem to see that, just "access to services" mantra was rolled out again and again but they do not want to continue giving us a "service" by keeping the surgery open.
There was a lady there who was from some patients group who kept backing the Manager up so they have obviously got to that Group to support the closure.
Unfortunately it is all down to money and the fact that they cannot afford a nurse to be down there with the Doctor in case someone is taken ill during a visit. Question, how many have been taken seriously ill at Wrenthorpe during a visit?
They do not seem to appreciate how far it is to Outwood surgery for someone without transport and that anyone with transport is already able to go to Outwood. It is those without transport who should be looked after by keeping this surgery open.
Carole McLeod, Wrenthorpe·2d ago
Hi Richard,
Exactly the same conclusions as I had.
As I have said before, if someone has an accident outside Debenhams, Asda etc they don't close down the store.
The lady from the patient group has also replied on a previous post of mine that her views were HER personal views and therefore I suggest she is not representative of the patients at these drop-in sessions.
The patient safety access is just to please the CCG
It is purely a case of saving money at the expense of the elderly, infirm and most in need who happen to be in a minority.
Thank you for posting,
Don't forget tomorrows drop-in session (Wednesday)at Wrenthorpe Surgery 10.00am-12.00noon
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Please attend if you can and let me know what you got from it.
Please encourage your friends and neighbours to sign the petition. The more signatures we get the the better. Thank you for your participation in this petition. https://you.38degrees.org.uk/petitions/stop-closure-of-wrenthorpe-local-surgery
Please don't forget to do the survey too https://outwoodpark.gpsurgery.net/patient-info/patient-survey/
David McLeod
Elaine Mann, Kirkhamgate·22h ago
Is it worth at the next meeting asking how many additional home visits have been budgeted for patients in the Wrenthorpe area following the closure of the Wrenthorpe surgery
Carole McLeod, Wrenthorpe·10h ago
Hi Elaine,
I asked that at the first session and basically the answer was that it had not been budgeted for.
I also asked what their contingency plan is if they don't get permission to close Wrenthorpe surgery and got a shrug of the shoulders which I took to mean that they fully expected to be granted the permission.
If this whole survey is just a cosmetic action on something the practice and Wakefield CCG have already decided then it warrants further journalistic investigation from outside the Wakefield area.
Dan Budd, Wrenthorpe·1h ago
Sounds to me like it's a done deal and has been for a while. They are just going through the motions. I wonder what will happen to the land and where the money from said sale will go? mmmmm!
Carole McLeod, Wrenthorpe·56m ago
Apparently they don't own the building just rent 25% of it. I believe it is owned by NHS Property Services so no doubt that it will end up in private hands of some medical company with a politician on their board of directors.
Don't give up on this though, I won't, if there is some skulduggery afoot I know just the people who would like to investigate it.
David McLeod
Dan Budd, Wrenthorpe·37m ago
That's interesting to know David. I'm in here for the long haul don't you worry, no retreat, NO SURRENDER!!!
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Ian Carthew, Wrenthorpe·14h ago
Got the flyer delivered this morning,so I presume every house in Wrenthorpe has got the message.But I do know that some folk are in favour of it closing because they think they can get the community association to it Where they think the finance will come I do not know.
Marguerite Hogg, Outwood·14h ago
I don't think everyone has received one yet. We haven't. I just saw this on Wrenthorpe Community Association's Facebook page so thought I'd post it here too. You mean WCA use the site? How can they afford that?
Carole McLeod, Wrenthorpe·13h ago
Thank you Marguerite. We have not received a flier so are grateful for this information. We have not yet , during the course of running the petition, met anyone in favour of the close down apart from Margaret Mitchell who is part of the patient Liaison group.She has been in discussions with Outwood practice for quite a while. I am not aware of any patients being consulted until now. I would hate to think that the WCA would put their own interest before the welfare of the villagers . It is vitally important that as many people as possible attend this meeting and put their views forward.
Please continue signing the petition and giving your reasons for doing so. Keep informing friends and family of the petition which is extremely important
Marguerite Hogg, Outwood·13h ago
I've emailed both councillors and said I'll be happy to distribute leaflets for them.
Ian Carthew, Wrenthorpe·13h ago
Well exactly,I think some folk think the council has a pot of gold to give away.We already have a village hall,the church hall,the chapel hall,valley drive centre I can,t see that any more of those type of facilities are needed.My own view is that health is worth more than wealth and as the government says we are becoming an older society we shall need more not less health centres.These surgeries take pressure off our hospitals.Lets keep what Wrenthorpe needs and deserves.
Glynnis Blackwell, Outwood·13h ago
Everyone who can go should go to this meeting ,our Wrenthorpe surgery is worth fighting for. Not everyone as a car busses are one every hour to Outwood, that means you have to call a taxi. Our pharmacy will end up closing. These are just some reasons why it should stay. If the nurses and doctors can go to Homstead medical centre why can't they be permanent in Wrenthorpe.?
Susan Carthew, Wrenthorpe·12h ago
Where's Homstead medical centre please?
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Marguerite Hogg, Outwood·12h ago
I don't drive. I had to take my son up to Outwood Park last week. The 103 wasn't due for a while and it was an 'on the day' appointment so we ended up having to get a taxi up there. We were then due to go into town from there to a summer holiday sport activity and would have had to wait 40 mins for the next bus so, again had to get a taxi. If it's a challenge for me then imagine how it is for the elderly or infirm to get up to Outwood from Wrenthorpe.
When I have an appointment myself I usually walk up but it takes half an hour there and half an hour back plus the time you often have to wait and then the appointment. That's often 1.5 hours out of the working day which isn't great for what should be a local service.
David Weaver, Alverthorpe·12h ago
Homestead Medical Centre is tucked away on a side street halfway down Alverthorpe Road
Susan Carthew, Wrenthorpe·12h ago
I would also like to add that whatever reasons various people come up with for the closure of our surgery ,from the NHS point of view, must surely be for financial reasons on their part.I can remember when the surgery use to be held opposite the chemist, where the beauty parlour is,in very cramped conditions,which we were all willing to put up with until the new centre was built, so now, a few years down the line and they want to now shut that.Everyone who agrees it should be shut should hang their heads in shame, very much an I'm alright Jack society proven.What about the elderly, the infirm, no private transport,mum's with young children and pushchairs.
Ian Carthew, Wrenthorpe·12h ago
On the flyer from our local labour councillors they state,and I quote they want to improve connectivity between the villages of the ward.Does that mean they want a bus service to get folk from Kirkhamgate,Carrgate,Newton Hill and St Johns to Wrenthorpe!Thought not.
Carole McLeod·Just now
If the WCA want to move into the Wrenthorpe Surgery building there is plenty of room for the doctors and WCA as the doctors only rent 25% of the building so that argument does not even come into the equation.
David McLeod.
Please spread the word and make your voice heard.
Please sign the petition and leave a comment...
https://you.38degrees.org.uk/petitions/stop-closure-of-wrenthorpe-local-surgery
Please also fill in the survey and leave a comment.... https://outwoodpark.gpsurgery.net/patient-info/patient-survey/
Susan Carthew, Wrenthorpe·22 Aug
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Just to add that I've spoken to two members from the WCA and they have no intention of wanting to use any of the space in the surgery and at the end of the day it is a NHS building. Also to add I just hope that when we have this meeting with the two councillors it will be held constructively and not everyone start getting angry,as can happen when we are all annoyed over this issue.Ive listened to various concerns and can understand some pointers but not all,I'm still totally against closing 'our' surgery.I know of one lady that is 94 and got a lift off a neighbour this morning,her neighbour had to leave her but was also having to call back for her,not good.
David McLeod
Dear Friends,
I have been told, although I have not received anything through the door, that Councillors Charlie Keith and Martyn Johnson are holding a public meeting to discuss and gather opinion on the proposed closure of Wrenthorpe surgery.
I will not be interfering in their campaign as I assume we are fighting for the same ends so please give it your fullest support as you have done with the on-line petition and together we can stop this ludicrous proposal.
The meeting will take place at Wrenthorpe village Hall at 7pm on Wednesday 30 August.
Please be aware that this proposal will not only affect the few who live in Wrenthorpe and who are in need of your support but will also impact on ALL patients at Outwood Park in the form of longer waiting times for appointments and prescripions when Wrenthorpe chemist is forced to close.
Please also be aware that the representative from the Patient Laision Group is not there representing the patients but is merely expresing her own opinion
Please spread the word and make your voice heard.
Thank you for signing the petition Stop Closure Of Wrenthorpe Local Surgery, can you help spread the word by forwarding the link below to your friends?
https://you.38degrees.org.uk/petitions/stop-closure-of-wrenthorpe-local-surgery
Don't forget to tell everyone to sign AND comment on the survey available at Outwood and Wrenthorpe surgery or on-line at..... https://outwoodpark.gpsurgery.net/patient-info/patient-survey/
Thanks
David McLeod
Richard Lister, Wrenthorpe·2d ago
Tried to do this on my phone but when I got to the end I could not post it so if it is already somewhere apologies and this may be a little different.
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Following my last post I spoke to the Practice manager and it would appear that THERE ARE NO RECORDS KEPT of how many patients have needed to have an ambulance called to the surgery which seems strange since this seems to be the main concern for closing Wrenthorpe.
Also when they prepare the doctors rotas they fill up Outwood first then if there are any doctors spare allocate them to Wrenthorpe so we get the last look in for services at Wrenthorpe.
If we had 2 sessions a day, 5 days a week for 50 weeks they could see 8000 patients there. ( check my calcs Murdoch, I assume you are the MM from Carr Gate not Kirkhamgate) based on her figures of 16 patients a session.
The Practice Manager also came up with figures saying that out of 1300 patients who used the surgery only 500 were from Wrenthorpe addresses. No indication could be given for the period covered but just that it seemed only 500 Wrenthorpe people used the surgery. More could have if the surgery had been open, again an example of figures been quoted to justify closure as more would have gone there if they had been give the chance instead of been forced to go to Outwood because they had allocated all the Doctors to Outwood
As to physical access to the surgery this has not deteriorated but improved over the 33 years since my late wife took our 3 boys there, same with car parking, same car parks and roads. Are they taking us for idiots?
The main argument comes down to lack of funding for Doctors and nurses by the NHS which is compounded by WMDC allowing houses to be built on green belt land ( Rhubarb fields off Bradford Road and Wrenthorpe bypass by Rhubarb Triangle etc) without giving ANY consideration to the provision of health services/schools etc which has been compounded by successive Governments lifting planning restrictions and not using brown sites because it is sometimes too expensive to clean them up and so not make as much profit.
Apparently one of our Councillors is going to try and get two 103 buses to run through the village, highly unlikely unless subsidised by the Council from the extra rates they will collect from all the new houses.
The building is not owned by the Doctors but they lease their part. There is a covenant that the building can only be used for Health services. Question, what happens if the building and land are sold and pulled down, does the covenant cover the land as well? My thoughts are that they will get the covenant removed and sell for building land, could get a tidy few houses and hence profit from it, can our Councillors give us an assurance that this will not happen, bet you they can't.
Marguerite Hogg, Outwood·2d ago
I emailed Councillor Johnson last weekend to say that we had not had leaflets about the meeting (to be held on Wed) through our door. He replied to say that they went through the doors of people living on Jerry Clay Lane as these were most likely to be affected. I said my family (on Silcoates Lane) were just as affected and he said he understood that 'not many' people living in Silcoates Lane are patients of Outwood/Wrenthorpe surgery. Is that really the case? Councillor Johnson dropped some leaflets off at my house last week, at my request so that I could hand deliver them on our street but I only received 25 so didn't get to as many houses as I'd have liked.
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Murdoch Mann, Kirkhamgate·2d ago
Agree your figures above, Richard. From what you say, surely the allocation of staff should be 5 sessions at Wrenthorpe for every 8 at Outwood. Such an allocation would match supply with patient numbers (as an indicator of demand). I do not expect that the demand for medical services will be significantly different between Wrenthorpe and Outwood because the two areas are similar socially.
It would not surprise me to find that information which would support the retention of the Wrenthorpe surgery is not being collected so that it does not exist.
Richard Lister, Wrenthorpe·2d ago
This sounds suspiciously as if they are trying to keep the Wednesday meeting as quiet as possible
It is not for them to assume who is and is not a patient at a particular surgery
Makes it sound even more like a done deal and our councillors are in on it
Pete Shaw, Wrenthorpe·2d ago
Of course it's a done deal and of course our councillors are a part of it
They gave already indicated that their chief concern is to keep the pharmacy open, there was no mention of the surgery, now it transpires that they are selecting who they want at their meeting it was also rumoured that they were advising people not to sign the petition. Why are they concerned about a bus service if they believe in this campaign and intend to oppose the closure? I will let you draw your own conclusions.
Dan Budd, Wrenthorpe·2d ago
Running Wrenthorpe Surgery down has been going on for years. In the last 2 years I have needed their services and not once have I been able to get an appointment at Wrenthorpe, it's not even an option. I have to drop my repeat off once a month and the place has never been open, I have to stick it through the letter box and hope it gets picked up.
As I have said on previous posts and many others have, this is purely about money! Nothing more.
David McLeod, Wrenthorpe·2d ago
I agree that this whole thing gives the impression of a cosy arrangement between the Doctors and the CCG or why would they pretend it is about patient safety and access.
If anyone who has been to Southgate Surgery will know the access there is far worse than Wrenthorpe, especially in icy conditions. Then again, maybe Outwood and Southgate are part of the next phase of closure to make way for another financially crippling PFI scheme on the new Sunnyhill complex? Just a thought.
Since the NHS own the building what is wrong with another doctors practice setting up on the Wrenthorpe site and utilising the rest of the building by sub letting to say a chiropodist or
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Carole McLeod, Wrenthorpe·1d ago
Reminder... Wrenthorpe village hall. Public meeting 7.00 pm Wednesday
Susan Carthew, Wrenthorpe·19h ago
I've just got caught up with replies regarding closure of 'our' surgery and would like to say thanks to those who have worked out figures and come up with appropriate questions ,hope you will be there on Wednesday to put these forward.To say I don't trust any form of political figure and always feel these gestures they come up with is for their own needs and neck.It has also been suggested that they are hoping to get a telephone line put in at the surgery to connect to a taxi service for those who need to get back to Wrenthorpe,also to hopefully also get a reduced rate for patients!So that beggars the question is it an already done deal?I have seen accidents myself but outside the chemist, on the level, so whether you are on the level or not accidents can happen.As I have said before regarding air pollution, Wakefield was mentioned on a programme I was listening to as a 'hot spot' for air pollution, there were two or three towns mentioned and our was one of them.As for just putting these leaflets along Jerry Clay Lane is unbelievable, that does involve where we live but did expect these leaflets to be distributed through EVERY door in Wrenthorpe.Hopefully there will be many there at the meeting.
Shelagh Wigglesworth, Stanley·16h ago
Just been on news Surgeries in London can now be accessed 7 days a week morning until night North/ South divide?
Public meeting on this issue 7.00pm Tonight (Wednesday 30th August) at Wrenthorpe Village Hall.
Susan Carthew, Wrenthorpe·
I've attended the meeting in the village hall tonight regarding closure of our surgery and it seemed the first part of the meeting was all about Outwood more than Wrenthorpe.There was questions and answers but obviously not enough time to be able to ask everything,as everyone one would like to have done.I felt the meeting was very one sided and pre-loaded with rhetoric that didn't really mean anything, decision seems to have been made despite continual denials.The Practise Manager did slip up in one of her sentences by saying "when Wrenthorpe closes" , to which there were jeers! So not impressed but will still be attending the drop in session at Outwood tomorrow.I think they are coming up with various reasons to try to justify the closure.When is the lease up on the building,that's what I would like to know?
David McLeod, Wrenthorpe·
I agree Susan, certainly was not enough time to get all the questions in and the long-winded replies from the panel just reiterated that the heavily weighted survey is NOT a consultation but a document of intention.
Susan Carthew, Wrenthorpe·
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We've been to the 'walk-in session' at Outwood,the first thing that struck me was the box where you put you're questionnaires in,is not a sealed box, has a loose fitted lid,so anything can happen there.We again put our points forward and did push on the 'pollution front', especially for schools near by, as much as others may not dwell on this, we have a family member that works for the environment agency on air pollution and out of the two schools near them, the one they chose was because the air was a better quality at that school than the other.Also Wakefield came out top in air pollution along with Bradford,so worth pointing out.We listened to everything but at the end of it we said we were still against the closure.It seems they want to centralise it all,so we will have to await the outcome.
Murdoch Mann, Kirkhamgate·
I was at the public meeting on Wednesday evening but not at the Thursday AM session. I realised that one question which has not been asked was whether, if other suitable premises could be found, would they consider moving the Wrenthorpe surgery to such premises. For logistical reasons this needs to be fairly close to the existing premises, so that it is readily accessible from all of Wrenthorpe, and the first thought that I had was that the wheel Inn on Bradford Road has been closed, again, and with the difficulties that Sam Smiths are having in attracting staff, it does not seem likely to be re-opening. Could that building and land be purchased, the building demolished and a purpose-built surgery be built there for Wrenthorpe, but that defeats the intent of having a surgery as near to the centre of the village as possible. It also does not resolve the problems that people would have getting to Outwood. The next two alternatives I considered was a replacement surgery built on what is currently the Rec and moving the childrens play area to Wrenthope Park, and temporarily closing the Wrenthorpe surgery and the dentists, and having NHS Properties demolish the existing building and build a replacement, to meet the standards of best practice for both a medical practice and a dental practice. As an aside, I wonder how NHS Properties can be letting a property for use as a medical surgery when the building fails to meet the standards required for such premises under an NHS contract.
Marguerite Hogg, Outwood·
I think the issue is that NHS Properties do not want to spend money to bring the current branch surgery up to current health and safety standards (or it appears were much lower down their list of priorities) which would be much cheaper than demolishing the building and building a new one.
Dan Budd, Wrenthorpe·
There's nothing wrong with the current building, parking or access! They just don't want to fund,maintain or staff it! Cheaper to centralise all the services in one place it would seem. Regardless of the ever increasing demand.
The building has never been fully staffed since it was built, and I remember it being built, as I'm sure most people on here do. At it's peak, when it was first built there was maybe 2 (at a streach 3) doctors there, a chiropodist and baby clinic. A shadow of it's former self.
Those services were needed then and they are more so then ever before need now!
18
A – letters from Next Door Neighbours website
Susan Carthew, Wrenthorpe·
Also to add to this, it is known that Sam Smiths very rarely, if ever, sell off property or land, they own a building in town,it was a club,which they took over and closed down and is still left empty, they would rather leave the building empty and sell to no-one.Also, they have said that whatever pot of money the NHS have towards such repairs, it seems would go to a poorer area above our needs, I think the powers that be regard Wrenthorpe as an 'affluent area'.I also think someone's head should roll for allowing for the building to become so unusable, if that's truly the case, maybe they should have an open day to prove it?It use to be a well run surgery, as said it use to have 2 Drs., nurse, reception,a well used baby clinic and chiropody.No, none of this comes into it, they want to centralise everything!
David McLeod, Wrenthorpe·
I agree Susan, the only reason that they deem Wrenthorpe Surgery as "Not fit for purpose" is that they have made it that way.
As for losing ANOTHER pub in Wrenthorpe I disagree with that idea too. Eventually Humphrey Smith will be ousted by his sons and that will re-open as a better facility.
We know that NHS has been instructed to sell off land and buildings but Wrenthorpe Surgery would be an asset to this expanding community if it was properly run by either Outwood or some other practice.
What if the private landlord who owns Outwood surgery was made an offer they could not refuse by say, Sainsbury's or some other business?
Mike Spinney, Wrenthorpe·
Interesting ideas Murdoch.
Murdoch Mann, Kirkhamgate·
@ Marguerite Hogg
The question is "Have they been asked to make improvements to bring it into line with current and proposed best practice?" I would wager that the answer is emphaticly "No!!!"
Marguerite Hogg, Outwood·
Murdoch - that's what many were getting at during the meeting? The surgery should be lobbying the NHS Buildings team that if improvements aren't made then the surgery will close. It still seems like this is a case of 'going through the motions' and procedures and that Wrenthorpe surgery will close.
David McLeod, Wrenthorpe·
Don't give up hope Marguerite, after speaking to CCG I do not think the doctors will have the easy ride they thought they would have, especially with their claims over the parking issue.
David McLeod, Wrenthorpe·
19
A – letters from Next Door Neighbours website
Please note, on-line petition closes midnight tonight. Thank you, David McLeod
David McLeod, Wrenthorpe·21 Aug
Please remember that a comment on the survey and the petition as to why you oppose the closure will help our case with Wakefield CCG
David McLeod, Wrenthorpe·1d ago
Please note, on-line petition closes midnight tonight. Thank you, David McLeod
Glynnis Blackwell, Outwood·21h ago
Glad to hear Andrea Jenkyns office have got in touch, she should be getting involved , she's our MP. And this is a very important matter for Wrenthorpe.
David McLeod, Wrenthorpe·14h ago
Hi Glynnis, Hope she is and not just trying to jump on my bandwagon.
20
B - Comments from SWPWLS webpage and petition
Stop Closure Of Wrenthorpe Local Surgery (SCOWLS)
Comments from SCOWLS webpage..
This colour highlights names which feature on this document and document A.
Marguerite Hogg When you don't drive it's a hassle to get up to Outwood Park.
Scowls Yes Marguerite..and for the elderly and or disabled..there is no public transport up the steep hill.
Scowls Thanks for the like Catherine. If you haven't already will you please sign the petition.TIA.
Shelley Thompson I'm shocked and appauled that despite Wrenthorpe's population continuing to increase significantly due to the many new housing developments, that our local doctors surgery is under threat of closure. Surely it would make sense to utilise this more?! ...See more
Scowls Well said and very true Shelley. Thank you.
Nic Stansby The decision to close Wrenthorpe is entirely down to the GP partners at Outwood Medical Park Surgery, they dictate their opening hours, how much money they pay themselves and their staff. It might be better to write to the partners and threaten to move to another surgery if they decide to close Wrenthorpe, unfortunately GPs are more money orientated than patient care these days.
Scowls So true Nic. That is why we need the strength of numbers on the petition.They need to know the strength of feeling and to realise there may be a mass abondenment.
Nic Stansby As per my other post, GPs are not fond of home visits as they are costly, so might be worth mentioning that more patients will request a home visit if they can't get to Outwood ☺�
Nic Stansby I don't think they will pay much attention to petition, they will just start the blame game about non existent NHS cuts (funding has actually increased by £35,000,000,000,000 in 10 years but immigration has increased demand)
Scowls Good idea about the home visits Nic. Regarding the petition..we have to inform people and get them interested before it is too late. There are other roads we are going down as well but all local people need to be aware and come on board. Thank you for your input 😊😊
Scowls Thanks for the like Cassie. I trust that you and Joe have both signed..:-)
1
B - Comments from SWPWLS webpage and petition
Marguerite Hogg Have you thought of putting flyers through local people's doors? Not everyone uses the internet or Facebook and many of the older population probably don't.
Scowls Yes we have and we are setting this up today. Thanks for the suggestion Marguerite
Ginny Hammond signed but not sure if it will make any difference to the people running the surgery. Waiting times for doctors will be even worse now...
Scowls Thank you for signing Ginny. We have other irons in the fire too but need to get as many peeps as possible on board
Paul Bennett From what I have heard Outwood has one of the longest waiting times for appointments in the area. Lupset and New Southgate have the shortest and are better organised.
Scowls Thank you Rachel and Joanne
Scowls Thank you Jill and Kevin.
Helen Kirsty Antcliff Signed and shared.
Scowls Thank you Helen
Scowls Thank you Tim
Heather Angel I believe that this will happen throughout the UK. Local surgeries will merge, close down and move into large premises to form a primary care unit. Possibly open 8am to 8pm. A&E depts will close down and local hospitals will become cottage hospitals. There will be far fewer, but, centres of excellence. I believe that people over a certain age or with an unhopeful prognosis wlii be shipped to the cottage hospitals and put on an end of life plan.
So far looking good for younger people..but you too will become old and still wish for correct treatment.
All a means to privatise our NHS
Comments from petition….
Dennis S. a day ago
The statement that the Wrenthorpe Surgery is “not fit for purpose” is misleading and surely not unsurmountable. More worrying is the lack of willingness of some Doctors and Nurses to come down to staff the surgery. With new residential development taking place in Wrenthorpe it would make more sense for another practice to take over to accommodate them. As this would mean the potential loss of around 5000
2
B - Comments from SWPWLS webpage and petition
Wrenthorpe patients it would not be in the interests of Outwood to allow this to happen.
Caroline S. 6 days ago
Because waiting 5 weeks for a routine appointment is unacceptable and will only get worse if everyone is coming to one place.
Jon R. 14 days ago
My wife is unable to drive and access up to outwood would be difficult if she were to be poorly. Also outwood is too far for elderly people who are unable to drive
Margaret D. 22 days ago
Wrenthorpe surgery is at the heart of the village and should be adapted to suit the needs of the community who need it. Making people drive or get a taxi (there is one bus an hour for a few hours a day) to Outwood when there is a facility nearer is not environmentally friendly and is not patient centred care, nor putting care out to the community.
Stuart P. about a month ago
This closure is about NOTHING ELSE other than money. The reasons given for them making this decision are a nonsense. All of a sudden they decide access isn't good for older/infirm folk. I've live in this area for over 25 years and the surgery had been well established for many years then, and it has taken all this time to realise there might be a problem with access? Please doctors, don't treat us like idiots.
Jane N. about a month ago
Wrenthorpe needs a surgery plus all those new houses we should be getting more doctors not less
Karen S. 26 days ago
How can they close wrenthorpe surgery when all it will do is put pressure on surrounding surgeries making appointment times even longer. Maybe it should be looked into to see if local G.P's. are working more part time than full time. Surely this would ease the crisis.
Gillian R. 29 days ago
Services at this surgery have been run down over the past 25+ years. I took both my babies there for weighing when I could not drive. My elderly mother now is able to walk there. Parking is a false issue. I am concerned about the future of the pharmacy .I would prefer to see the Practice think about sharing services across the two sites
3
B - Comments from SWPWLS webpage and petition rather than always defaulting to centralisation. Services here that folk have to travel to could preserve the site for those who can't travel.
Jovan T. about a month ago
We need to save services and develope them not close them down why not let another GP surgery take over the service if they feel unable to provide an adequate service that the people of wrenthorpe deserve.
Paul O. about a month ago
Because people need a local doctors surgery due to lack of mobility, old age, convenience etc etc
Trevor H. about a month ago
Outwood Surgery is already over-stretched, how does this make sense at all?
4
Integrated Impact Assessment Tool: Guidance notes Title of scheme: Closure of Wrenthorpe branch Surgery Lead Manager: Karen McNally GP Clinical Lead: Name: Dr Sarwar Signature: Date: Executive Lead: Name: Signature: Date: Brief description of scheme: To close the branch surgery at Wrenthorpe due to the concerns within the practice about the accessibility and provision of services that are delivered there. The practice does not have a sustainable capacity to make commitments of an equitable service across both sites.
Executive summary of findings: Please ensure all key negative impacts are highlighted below Overall significantly more positive points to support the case. A number of public engagement events were held and all concerns considered and mitigating actions taken wherever posible . A number of private meetings were arranged with local councillors. We considered telephone access/distance to travel and Outwood waiting room capacity. We feel these impacts were outweighed by improved parking/ease of access and increased clinical effectiveness as well as improved patient safety for patients. We considered whether patient safety was at risk by Wrenthorpe patients being discouraged to attend Outwood because of the closure. We dont believe this to be the case when we audited Wrenthorpe patients the audit showed that two thirds of the patients seen at Wrenthorpe over a 6 month period were Outwood residents and elderly Wrenthorpe patients regularly attend routine appointments at Outwood. We considered the impact on other local practices and discussed this with them but have their full support in this case. We also considered the impact on the Wrenthorpe pharmacy but feel we have mitigated against that.
Page 1 Closure of Wrenthorpe branch surgery_IIA_v1_24 11 17 Guidance notes Equality Impact Assessment Demographics What is the impact on EQUALITY Describe potential impact and evidence to support decision Actions/ Mitigation Monitoring Lead
(Positive and/or negative)
Positive Negative knownNot Consequence(1- 5) Likelihood(1-5) Score Human Rights Done on a separate document 0 Health inequalities 0 General issues 0 Age 0 Older people 0 Children and young people 0 Specific age range (describe) 0 Disability 0 Physical impairment 0 Mental health 0 Learning disability 0 Sensory impairment 0 Long term conditions 0 Other 0 Pregnancy and Maternity 0 Ethnicity 0 Asian/Asian British 0 Black/Black British 0 Mixed/multiple ethnic groups 0 White 0 Other groups - e.g. asylum seekers/refugees, 0 Eastern Europeans/travellers
Religion and Belief 0 Sex 0 Women 0 Men 0 Sexual Orientation 0 lesbian, gay and bisexual 0 Carers 0 Gender Reassignment 0 Any other Groups, rural communities, 0 homeless, substance misuse etc.
0 0 Privacy Impact Assessment Guidance Notes Please note: if you need assistance in completing the PIA Screening Questions please contact the Governance Team.
Screening Questions Yes / Additional comments Will the project involve the collection of new information about individuals? No Will the project compel individuals to provide information about themselves? No Will information about individuals be disclosed to organisations or people who have not previously had routine access to the information? No Are you using information about individuals for a purpose it is not currently used for, or in a way it is not currently used? No Does the project involve you using new technology which might be perceived as being privacy intrusive? For example, the use of biometrics, facial No recognition or automated decision making. Will the project result in you making decisions or taking action against individuals in ways which can have a significant impact on them? No Is the information about individuals of a kind particularly likely to raise privacy concerns or expectations? For example, health records, criminal No records or other information that people would consider to be particularly private. Will the project require you to contact individuals in ways which they may find intrusive? No Outcome / Next Steps The screening questions are not an exhaustive list, therefore in the event of any uncertainty please discuss with the Answering ‘yes’ to any of the screening questions is an indication that a PIA is required. Did you answer yes to any of the screening questions? Yes/No CCG's Information Governance Team or for General Practice contact [email protected] If yes, a copy of CCGs Privacy Impact Assessment (PIA) process is held on Skyline. The PIA template is within Annex B of the document. Click on http://skyline.wakefieldccg.nhs.uk/Interact/Pages/Content/Document.aspx?id=1071 the link here to access the PIA process: Screening questionnaire completed by Name: Job Title: Work Area: Date: Quality Impact Assessment Guidance Notes
What is the impact on Description of impact Mitigation Monitoring Lead
(Positive or negative)
Positive Negative Consequence (1-5) Likelihood(1-5) OverallScore PATIENT EXPERIENCE Consider •Patient experience (i.e. response to national/local surveys, √ 1, greater range of clinical services under one roof. 0 OPMC complaints/PALS/incidents etc) 2. Avoids multiple attendances to various MDT members. •Patient choice (informed, provider, location etc.) 3,Greater availability of free parking (3 spaces at Wrenthorpe). •Patient access (physical, systems, communications etc.) 4, Improved physical access into and within Outwood building (Wrenthorpe access is •Compassionate and personalised care agenda (dignity, poor - involves stairs and previous accident with patient falling down stairs.) empathy, control of care, involvement) 5, No admin/clerical staff to assist patient at the same visit •Family & Friends Test, FFT 6, Outwood open all day for scripts etc. (Wrenthorpe surgery closed during middle •Learning from incidents and SIs part of the day,) •Responsiveness •Support for people to stay well •Promotion of self-care for people with long term conditions
√ 1. Telephone access - all patients will have to phone Outwood so potentially more 2 1 2 Four telephone lines at Outwood and Wrenthorpe receptionists will be at Outwood so Observe the patient survey section that looks at ease of telephone access difficult to contact the surgery more people to answer the phone √ 2. Distance to travel increased - 2 surgeries are just over a mile apart 1 2 2 In transition period observe and tag notes of vunerable patients. Outwood surgery Staff to be aware and record any S.I's and perform SEA regularly has a wheelchair and lots of staff to assist patients √ 3. Potentially more people in the waiting room at Outwood at certain times 1 1 1 Waiting room is very large at Outwood and the practice manages well on busy flu Reception staff will monitor - especially during peak times and report any adverse open days. Always a number of receptionists available to help patients. incidents.
0
•Meeting the NHS Constitution Rights & Pledges 0
PATIENT SAFETY Consider •The CCG's duty to protect vulnerable groups √ 1,Full MDT on Outwood site (Only one Doctor and one receptionist at Wrenthorpe - 0 •Patient safety eg no nurses/HCA's/pharmacist/physio etc.) •Preventable harm 2,Comprehensive range of equipment at Outwood (No access to equipment like ECG •Reliability of Systems & processes e.g.to prevent healthcare machine to aid diagnosis.) acquired infections, safeguarding incidents 3, Same day appointments available on Outwood site (Only 1 Doctor and no MDT so •Providers meeting CQC essential standards including Equality no same day urgent appointments.) and Diversity 4, Access and parking much safer at Outwood - previous Significant Events at •Staffing levels Wrenthorpe. •Staff morale (TUPE, terms of service change) 5, Outwood is a much newer building so much easier to ensure infection control •Clinical workforce capability and appropriate skills standards are good. •Environment (cleanliness, suitability, PEAT) 6, Outwood does all the chronic disease management and NHS health checks because they are done by nurses/HCA's - i.e keep people well. 7, Wrenthorpe surgery beginning to fall short of safety standards. •The CCG's duty to protect vulnerable groups •Patient safety •Preventable harm •Reliability of Systems & processes e.g.to prevent healthcare acquired infections, safeguarding incidents •Providers meeting CQC essential standards including Equality and Diversity •Staffing levels •Staff morale (TUPE, terms of service change) •Clinical workforce capability and appropriate skills •Environment (cleanliness, suitability, PEAT)
√ Potential for extra travelling distance (approx 1 mile) to discourage some Wrenthorpe 1 2 2 Observe and tag notes of vunerable patients. Very good Doctor : patient ratio enables In the transition period, observe vulnerable patients who need to attend routine OPMC patients from attending/making appointments at Outwood. quite a lot of capacity for visiting patients at home. Outwood has previosuly used as appointments. self funded patient transport service which is still available if needed. We audited Wrenthorpe patients attending Outwood for routine appointents in a 6 month period prior to this process.
CLINICAL EFFECTIVENESS Consider •The CCG's duty to excerise its functions with a view to securing √ 1, MDT available at Outwood 8am to 6:30pm (no closure period) with significant 0 continuous improvement in the quality of services and the amount of same day urgent capacity. outcomes that are achieved from the provision of services. 2, Ability to discuss patients with colleagues whilst the patient is still in the consulting •The CCG’s ability to deliver against the strategic objectives, room. commissioning principles and quality premium. 3, Enables more uptake by Wrenthorpe patients of the significant amounts of •Clinical leadership preventative medicine available at Outwood eg care planning/Chronic Disease •Clinical engagement (buy in) Management/NHS health checks •Development & improvement of and locally agreed care pathways •Implentation of evidence based practice (NICE, pathways, royal colleges etc) •Variations in care (pathways, between areas, protected characteristics groups) •Care delivered in most cost effective way (LEAN, Productive series) •Accelerating adoption and diffusion of service innovation •The quality of information collected and the systems for monitoring clinical quality Other Impact Assessments
What is the impact on Description of impact Mitigation Monitoring Lead
(Positive or negative)
Positive Negative Consequence (1-5) Likelihood(1-5) OverallScore LOCAL HEALTH AND SOCIAL CARE SYSTEM Guidance notes • Health Services (MYHT, SWYPFT, YAS, GP) √ 1, All staff in the same building so easier access for external health/social care workers 0 OPMC • Social Care to contact specific staff members. • Voluntary Care Sector 2, Encourages more Wrenthorpe patients to become part of the Patient Participation • Local Authority Group. • Private Sector 3, All patients have equal access to non-practice staff eg District • Governance arrangements Nurses/physio/dietician/chiropodist. • Contractual (TUPE etc) • Strategic partnerships and shared risk (Local authority, Public Health, Public Health England, Voluntary care and social enterprise, Health & Wellbeing Board, other commissioners) • Sustainability of service due to workforce issues (resilience & skills, recruitment, retention, career pathways)
√ Potential for patients to register at another surgery and increase their workload. 1 2 2 Discussion been had with all local practices who agree to support Wrenthorpe closure. Observe the list size closely for Wrenthorpe patients over the next 12 months. Worked closely for years with local practice as a Network so good relationships exist.
√ Potential for reduced activity of local pharmacy in Wrenthorpe 1 2 2 Discussions already been had with the pharmacy at Wrenthorpe and systems in place Stay in close touch with Wrenthorpe pharmacy to observe activity there. to avoid that. Electronic prescribing means patients can opt for prescription to go to Wrenthorpe pharmacy electronically and patients will still collect their medications from Wrenthorpe. • Social Value (Social Value Act 2012) WORKFORCE Guidance Notes • Effective prioritisation & management of workload √ 1, Improves practice resilience as all clinical and non-clinical staff are in the same 0 • Staff experience as a result of workforce changes building - eases future planning and staff sickness management. • Contractual (TUPE, terms and conditions) 2, Much easier to implement Lone Worker Policy. • Workforce diversity 3, Increases the number of staff in the building at any one time so improves working • The organisation's commitment to high quality workplaces, aiming to conditions and staff satisfaction. be employers of choice Demographics and Data Overview of Wakefield by protected characteristics Equality Impact Assessment
Date: February 2016 The current size of the registered patient population with Wakefield CCG is 361,651. (Public Health England)
Human Rights The Human Rights Act 1998 sets universal standards to ensure that a person’s basic needs as a human being are recognised and met. Public authorities should have arrangements in place to ensure that they comply with the Human Rights Act 1998, and it is unlawful for a healthcare organisation to act in a way that is incompatible with the Act. Age Wakefield has an aging population. Wakefield is expected to encounter a large population structure change within the next five years, with the older persons grouping growing by over 11% by 2016 (73,000 persons). Sex In 2013 there were 161,920 male and 167,788 female residents in the Wakefield district. The difference in the numbers is more pronounced among the older age groups. For example, there are 5,395 males aged 80 and above and 9,336 females. Males and Females are in approximately equal proportions however disparities occur in service usage across several services. There are also variations in health outcomes; life expectancy is 9.9 years lower for men and 7.2 years lower for women in the most deprived areas of Wakefield than in the least deprived areas (Wakefield JSNA) Disability 2011 census reported Long-term health problem or disability Day-to-day activities limited a lot - 11.3% Day-to-day activities limited a little - 10.7% The Public Health England data states that 57.5% of patients have a long term condition. Currently around one in six adults in the district are subject to some degree of low or depressive feelings at any time - this equates to around 40,000 people. (Wakefield State of the District Report Summer 2014). In Wakefield the number of people with a learning disability known to services is around 1,476 the likely true number is 6,522. (Public Health England) Carers Provision of care - 1-19 hours of unpaid care 6.5%, 20-49 hours 1.7%, 50 hours + 3.1%
LGB (Lesbian, Gay, Bisexual) Sexual orientation data at local level remains limited. Regional and national figures vary e.g. 5.8% is the figure currently used by the lesbian, gay and bisexual charity Stonewall. Pregnancy and Maternity In 2013 there were 4,033 live births to mothers usually resident in the Wakefield district. 13.4% of live births (542 out of 4,033) in 2013 were to mothers born outside the UK. Ethnicity Wakefield has a relatively small but growing ethnic minority population. In the 2001 Census, 96.7% of people identified themselves as White British; at the 2011 Census this had fallen to 92.8%. Conversely, the size of the district’s ethnic population has grown from 3.3% to 7.2%. The two largest ethnic minority groups are: ‘Asian’/’Asian British’ – up from 1.4% in 2001 to 2.7% in 2011; and ‘White Other’ – up from 0.7% to 2.3%. The expansion of the European Union in 2004 produced an increase in economic migrants coming to Wakefield. The 2011 Census identifies 2.4% of the Wakefield population as being born in the European Union States (EU) – equating to around 7,800 residents. The majority of these have come from Poland (up from 173 in 2001 to 4,288 in 2011), with smaller numbers from Slovakia and Latvia and the other new EU countries. The migrants have tended to be young, single people planning to stay for a relatively short time and the majority have found low-skilled, low-paid employment in warehouses and distribution centres. The size of the asylum seeker population being supported has fallen in recent years, to 34 people in September 2014, down from 565 people at the beginning of 2003. As a consequence of increasing ethnic diversity there are now many languages spoken within the district. For just over 11,000 residents, English is not the main language spoken. The most common non-English main languages are Polish (4,194 people); Punjabi (889 people); Urdu (809 people); Latvian (409 people); Lithuanian (344 people); and Kurdish (268 people). There are just over 100 different languages spoken among the district’s school children. Arrivals in Wakefield in 2014 from Poland were concentrated in Wakefield North and East Wards The 2011 Census found 5000 residents of Polish nationality/origin. In contrast around 6,500 Wakefield residents identifying as being of South Asian origin. Given migration trends the Polish community is likely to have become Wakefield’s largest ethnic and national minority population. Engagement with the Polish community has identified a number of service issues including on street drinking, as well as lifestyle issues that may be detrimental to future health. Cultural issues around accessing health services, including the community being unlikely access the NHS unless absolutely needed due to perceived poor treatment and the NHS being deemed as not up to standard by many Polish migrants therefore they are likely to present themselves at A&E as their first choice to secure immediate treatment.
Religion and belief According to the 2011 Census, the majority of the district’s population (around 66% or 216,000 people) class themselves as Christian. This figure fell from 78% in 2001 in line with national trends. There has also been a corresponding increase in the number of people who describe themselves as having no religion. In 2011, around 24% (over 79,000 people) described themselves as having no religion - more than double the amount compared to ten years earlier. In addition, in 2011 around 6% did not state their religion. There was also an increase in the number of Muslims, up from 1.1% (3,600 people) in 2001 to 2% (6,500 people) in 2011. All other religious groups combined continue to make up less than 1% of the districts population.
Other groups - links provide some information - but specific research may be needed to understand the impact for your service/change/policy. These are the groups idenitified by NHS England you may be aware of other groups relevant to your work. Data sources for information and Alcohol and / or drug misusers intelligence to support decision making Asylum seekers and /or refugees Ex-service personnel / veterans Those who have experienced Female Genital Mutilation (FGM) Gypsies, Roma and travellers Homeless people and rough sleepers Those who have experienced human trafficking or modern slavery Those living with mental health issues Sex workers Rural residents Complaints PALS Data Voluntary Care Sector data/reports Equality and Human Rights Commission NHS England Equality Impact Assessments Health Service Ombudsman Health Inequalities; Health and Wellbeing Plan health profile Human rights health inequality CCG duty Advice is available from; Equality Service, Complaints, Public health, HR if any of the links above are out of date or fail - please inform the quality team How to score risk
A total score is achieved by assessing the potential consequences and the likelihood of this occurring and assigning a risk score to each. These scores are multiplied to reach a total score.
The following tables define the consequence and likelihood scoring options and the resulting score;
Risk CONSEQUENCE Category LIKELIHOOD CONSEQUENCE score 1 2 3 4 5 1-3 Low risk (green) 1 1 2 3 4 5 1 RARE 1 INSIGNIFICANT 4-6 Moderate risk (yellow) 2 2 4 6 8 10 2 UNLIKELY 2 MINOR 8-12 High risk (orange) 3 3 6 9 12 15 3 POSSIBLE 3 MODERATE 15-16 Serious risk (red) 4 4 8 12 16 20 4 LIKELY 4 MAJOR 20-25 Critical risk (black) LIKELIHOOD 5 5 10 15 20 25 5 ALMOST CERTAIN 5 CATASTROPHIC
Financial Loss or Impact Patient & Public Experience Legal / Regulatory
Insignificant Unsatisfactory patient experience not directly related to patient care. Minor non-compliance with standards. £1k to £5k (1) Locally resolved complaint Minor recommendations e.g. clinical audit, internal audit, external audit etc
Unsatisfactory patient experience - readily resolvable. Justified complaint peripheral to Possible minor out of court settlement or civil small claims court. Moderate (2) Up to £50k clinical care. Isolated failure to meet local standards. Adverse local media report – short term Coroners Court Inquest
Mismanagement of patient care Defensible civil action. Serious Justified complaint involving lack of Improvement notice. Up to £250k appropriate care. Persistent failure to meet local standards. (3) Ongoing adverse local media reports Intermittent failure to meet national performance standards. Coroners Court – narrative verdict
Major Serious mismanagement of patient care. Criminal prosecution. Up to £500k Destabilises provider market. Several justified complaints (of a Ombudsman 2nd stage complaint). Persistent failure to meet national performance targets. (4) Adverse national press interest (<3 days) Coroners Court – neglect verdict
Totally unsatisfactory patient experience. Multiple justified complaints. Corporate Manslaughter or Corporate manslaughter prosecution. Over £1m. Significantly destabilises provider market Catastrophic (5) On-going adverse national press interest (>3 days), Persistent failure to meet national, professional and statutory requirements. MP questions.
Safety / Injury / Harm Health/ Clinical Outcome Impact on Services (patients or staff)
Short term verbal abuse. Less than 3 days absence. Patients required extra observation Minor adverse clinical outcome, e.g. slight delay in referral or treatment with low impact Short term capacity issue (staff/facilities) reducing service quality (< 1 day) Insignificant (1) or minor treatment
One off failure to meet minimum clinical outcomes. Physical encounter (scratches / bruising). Significant inconvenience or cost in maintaining activity. Minor increase in health inequalities (in only 1 area/group) RIDDOR reportable injury with absence of 3 days to 1 week. Moderate (2) Capacity issue (staff/facilities) reducing service quality (<1 week) Patients require minor increase in treatment, did not lead to permanent harm
RIDDOR reportable injury with absence of more than 1 week. Ongoing unsafe staffing level. Serious Persistent failure to meet minimum clinical outcomes in one clinical area. Patients require moderate or major increase in treatment, did not lead to permanent Significant ongoing capacity issue (staff/facilities) preventing service delivery (> 1 Significant increase in health inequalities (across 2 or more area/groups) (3) harm week)
Major Significant increase in health inequalities RIDDOR reportable major injury or dangerous occurrence. Significant ongoing capacity issue (staff/facilities) preventing service delivery for (> 1 (4) (across 2 or more area/groups) Patient experienced permanent harm month)
RIDDOR reportable death. Persistent failure to meet minimum clinical outcomes in a range of services. NRLS reportable death - Interruption of all or significant range of Trust activities (> 1 week) Catastrophic (5) Extreme impact on health inequalities across Trust Patient died as a direct result of incident.
Title of Probity Committee Agenda 6 meeting: Item:
Date of 28 November 2017 Public/Private Section: Meeting: Public Private Paper Title: Station Lane (B87032) – Application to N/A Change Practice Boundary (Extended) If private, insert here reason for
inclusion as a private paper Purpose (this paper is for): Decision Discussion Assurance Information
Report Author and Job Chris Skelton, Head of Primary Care Co-Commissioning Title: Responsible Clinical Dr Greg Connor, Executive Clinical Advisor Lead: Responsible Mel Brown, Director for Integrated Care Governing Board Executive Lead: Recommendation (s):
Is it recommended to Probity Committee that;
• Accepts or rejects the proposed change to the practice’s boundary.
Executive Summary:
Station Lane GP Practice approached the CCG with an application to extend its current inner boundary. The practice currently has capacity to register additional patients therefore wishes to extend its boundary to take on additional patients. The revised practice area covers Streethouse & Sharlston and is detailed within the practices application attached.
Link to overarching principles from the Reduction in hospital admissions where appropriate strategic plan: leading to reinvesting in prevention New Accountable Care Systems to deliver new models of care
Collective prevention resource across the health and social care sector and wider social determinant partners Expanded Health and Wellbeing board membership to represent wider determinants A strong ambitious co-owned strategy for ensuring safe and healthy futures for children A shift towards allocation of resources based upon primary and secondary prevention and social determinants of ill health Transforming to become a sustainable financial economy
Organising ourselves to deliver for our patients
Outcome of Integrated Not applicable Impact Assessment completed (IIA) Outline public Not applicable engagement – clinical, stakeholder and public/patient: Management of Conflicts Not applicable of Interest:
Assurance departments/ Not applicable organisations who will be affected have been consulted: Previously presented at Not applicable committee / governing body:
Reference document(s) / Practice Application to extend practice boundary. enclosures:
Risk Assessment: Not applicable
Finance/ resource Not applicable implications:
STATION LANE – CHANGE TO PRACTICE BOUNDARY
Orange denotes proposed new inner boundary.
Title of Probity Committee Agenda 7 meeting: Item:
Date of 28 November 2017 Public/Private Section: Meeting: Public Private Paper Title: Formal List Closure Application – Crofton N/A and Sharlston Health Centre If private, insert here reason for
inclusion as a private paper Purpose (this paper is for): Decision Discussion Assurance Information
Report Author and Job Chris Skelton, Head of Primary Care Co-Commissioning Title: Responsible Clinical Dr Greg Connor, Executive Clinical Advisor Lead: Responsible Mel Brown, Director for Integrated Care Governing Board Executive Lead: Recommendation (s):
Is it recommended to Probity Committee that;
• Accepts or rejects the proposed list closure application
Executive Summary:
Following Probity Committee in 13th June 2017 Crofton and Sharlston Health Centre have temporarily closed their practice list. The practice has now formally applied to close its practice list for a period of 12 months.
This paper sets out the application received from the practice and the reasons why the closure has been requested. In addition, the context for the CCG is also provided with the considerations of the commissioner.
Link to overarching principles from the Reduction in hospital admissions where appropriate strategic plan: leading to reinvesting in prevention New Accountable Care Systems to deliver new models of care
Collective prevention resource across the health and social care sector and wider social determinant partners Expanded Health and Wellbeing board membership to represent wider determinants A strong ambitious co-owned strategy for ensuring safe and healthy futures for children A shift towards allocation of resources based upon primary and secondary prevention and social determinants of ill health Transforming to become a sustainable financial economy
Organising ourselves to deliver for our patients
Outcome of Integrated Not applicable Impact Assessment completed (IIA) Outline public Practice has engaged with its own PPG. engagement – clinical, stakeholder and public/patient: Management of Conflicts Not applicable of Interest:
Assurance departments/ Not applicable organisations who will be affected have been consulted: Previously presented at Probity Committee 13 June 2017 committee / governing body:
Reference document(s) / Not applicable enclosures:
Risk Assessment: Not applicable
Finance/ resource Not applicable implications:
NHS WAKEFIELD CCG
CROFTON & SHARLSTON APPLICATION FOR LIST CLOSURE
1. Purpose
The purpose of this paper is to:
• Seek a decision from the Probity Committee for Crofton & Sharlston Surgery to formally close their practice list for a period of 12 months.
2. Background
The GMS and PMS contracts allow for a Practice to request permission from its commissioner to close its list to new patients (Paragraph 29 of Schedule 6, Part 2 of the NHS (GMS contracts) Regulations (as amended).
As stated in the ‘Policy Book for Primary Care Services’;
The Commissioner must make a decision, within a period of 21 days starting on the date of receipt of the Application (or within a longer period as parties may agree); To approve the application and determine the date of closure is to take effect and the date the list of patients is to reopen or; to Reject the Application
The practice has agreed for this paper to be presented on the 28th November 2017 to the Probity Committee.
Formal closures are typically for a period of no less than 3 months and no more than 12 months. An area map of Croft and Sharlston Surgery is enclosed in Appendix 1.
3. List Closure Application
Over the last 12 months the practices has lost a number of GPs who were providing services at the practice. In addition to this, one GP partner is currently on sick leave the practice is unsure if/when this GP will be returning to work. Whilst the practice has been able to recruit one GP, the practice is still unable to provide the number of GP sessions that it had previously.
As a result of this, the practice presented to Probity Committee a Temporary List Closure on the 13th June 2017 for a period of four months.
Since that time, CCG Officers met with the practice on the 3rd October 2017 to discuss the temporary closure and to discuss the next steps in terms of whether the practice was in a position to re-open its practice list or to request a formal closure from the Probity Committee. The practice submitted an application for List closure on the 10th November 2017 which is included as Appendix 2.
4. Implications and Considerations for the Commissioner
It is worth noting that the practice is in the rural south of the district. The current practice boundary encompasses a number of areas that otherwise may be left without GP practice coverage. Although these areas are minimal, it may result in the CCG being exposed to negative publicity if unable to secure patient registration for patients residing in these areas. Please see Appendix 3 for a comparative map of practice boundaries in the area. Appendix 4 contained the detail of the areas that, should the CCG agree to the List Closure would be left without immediate GP Provision.
The practice list size has not changed significantly from the period prior to the informal list closure compared to other practices across Wakefield which have grown considerably. In October 2016 the list size was10,481 and in October 2017 they now have 10,474 registered patients.
The CCG, in line with the NHS England Policy Book, does have the ability to allocate patients to a practice with a closed list (Appendix 5) however this would have an administrative burden onto the CCG to administer this for a small number of patients. The CCG in conjunction with the practice could discuss with neighbouring practices to change their boundaries to ensure that patients have a choice in GP Providers.
Further to this, the practice has indicated that they would consider applying to close their branch surgery in Sharlston, current used by c.4000 patients, in an attempt to manage workflow and expectations. Any such request would need to be approved by the Probity Committee; however it is worth noting in this context.
5. Recommendations & Next Steps
Is it recommended to Probity Committee that;
• Accepts or rejects the proposed list closure application Appendix 1 – Practice Area Map
Appendix 2 – Practice Application
Application to close practice list of patients from
Crofton and Sharlston Medical Practice
Drs Hall, Sykes, Taylor and Ferdinandus
Crofton Health Centre Slack Lane, Crofton, Wakefield West Yorkshire WF4 1HJ
Sharlston Medical Practice Clifton Road, Sharlston, Near Wakefield WF4 1AR
Telephone 01924 862621 Practice Manager Ann Batty 01924 866915
Briefly describe your main reasons for applying to close your practice’s list of patients to new registrations:
Prior to December 2016, we had 4 full time partners, and 2 salaried GPs which made up 1.5 whole time equivalents (WTE) of salaried GP sessions.
Our current patient list size is 10431, giving a ratio divided by 4 partners of 2608 patients each, which is far higher than the national recommended number.
Dr Katie Shaw who was a full time salaried GP, resigned in October 2016. She has a young family and commuted from Huddersfield daily. She was looking for a similar position or partnership closer to home and found such a position, leaving us after a 3 month notice period in December 2016
Unfortunately our second salaried GP, Dr Uzma Aziz left the Practice at the end of July 2017 for personal family reasons. Dr Uzma Aziz worked 5 sessions per week for the practice.
Despite advertising, this left us down by 14 GP sessions, additional duties, extra on call periods and sharing the 2 salaried GPs areas of clinical ownership between remaining partners.
What options have you considered, rejected or implemented to relieve the difficulties you have encountered about your open list and, if any were implemented, what was your success in reducing or erasing such difficulties?
• Advertised for additional clinical staff covering a variety of roles which included a full time / part time or job share replacement salaried GP positions, Advanced Nurse Practitioner / Prescriber, Pharmacist or Pharmacy Technician. We tried to attract someone from one or more of the above roles, rather than just restrict it to a like for like replacement / replacements.
• Considered applying to close our branch surgery in Sharlston
• Reviewed all areas of existing working, both clinical and non clinical to allow everyone to work smarter and where possible train existing individuals in-house to do jobs which could safely be passed down releasing clinicians to pick up other GP workload and tasks
• Partners reviewed holidays booked and cancelled dates were able to do so.
• Informed the CCG and asked for support. Together we produced an action plan to apply for resilient funding of £5,000 from NHSE, to help find a salaried GP replacement (or other clinical role) to ease the pressure of patient demand – a copy of the action plan can be provided on request.
• Applied to the CCG /NHSE for temporary list closure. We attended a meeting and presented our case to a panel including NHSE, CCG, Non executive committee members giving reasons why we felt the need to temporarily close our practice list to patients – a copy of this plan can also be provided on request. We were successful in our application and it was agreed we could temporarily close our list for 4 months.
Have you had any discussions with your registered patients about your difficulties maintaining an open list of patients and if so, please summarise them, including whether registered patients thought the list of patients should or should not be closed?
Prior to applying to temporarily close our patient list, we have had several discussions with registered patient groups and individuals, These have included our Patient Participation Group (PPG), posters in the waiting areas, handouts to patient collecting repeat medication and / or making appointments, along with articles in both local village magazines.
We have also added information on our practice website, giving our explanation of why we have had to do this along with details of how to find other practices to register with or who to speak with if they have any issues or concerns.
Our PPG group members were very sympathetic and understanding of our decision and made it very clear they were happy to support our request and share this information with other registered patients.
Have you spoken with other contractors in the practice area about your difficulties maintaining an open list of patients and if so, please summarise your discussions including whether other contractors thought the list of patients should or should not be closed?
We did not take our decisions lightly and did spend time talking to our peers and colleagues within both our current network (Trinity, Network 5) and our previous network (Network 7). We discussed and asked if any practice or group of clinicians (ie practice nurses, phlebotomists, nurse prescribers etc) within either network were able to work extra hours for us, but all practices and individuals hard their own heavy workloads and whilst very supportive and showed empathy, they were unable to offer any tangible services or extra hours to help us.
How long do you wish your practice list of patients to be closed? (This period must be more than 3 months and less than 12 months)
After discussing this at a practice meeting, we would like to apply to close our list for 12 months.
What reasonable support do you consider the Commissioner would be able to offer, which would enable your list of patients to remain open or the period of proposed closure to be minimised?
The Partners and practice manager have recently met with Dr Greg Connor and Mr Chris Skelton from NHS Wakefield and District Primary Care to discuss our options and the practice suggested several things which we believe may help and ease the pressure on current remaining clinical and non clinical staff, but none were identified as being able to enable the practice to confidently feel they could continue without applying to close the list.
The closest option, was one of closing the branch surgery at Sharlston, but as this location has approx. 4000 patients registered here, this is not something the practice would do lightly. However, if the practice is not successful in its application to close its current list, we may have to revisit this option, but this could just exacerbate the current problems as the practice would also have to apply to do this which comes with a long formal process and would affect thousands of patients and other local practices.
Do you have any plans to alleviate the difficulties you are experiencing in maintaining an open list, which you could implement when the list of patients is closed, so that list could reopen at the end of the proposed closure period?
Yes, the practice has been successful in attracting clinicians for some of the clinical sessions and continues to advertise and search for addition resources.
We are working with the CCG in their bid to attract GPs via the International Recruitment Scheme and would be happy to pursue any interest shown by new or existing clinicians moving to the UK.
We believe in looking at other options and having been involved in working with attached pharmacists and pharmacy technicians, via the network vanguard pilot, we are keen to pursue these type of roles within the practice, as we feel they could play an active role in meeting the needs of our patients, as not all patient contact has to be seen by a GP. Do you have any other information to bring to the attention of the Commissioner about this application?
Added to all of the above and previous action plans, which we would continue to work with, one of our fulltime partners has been diagnosed with cancer and is currently off long term sick. He has been off since August 2017 and is currently under going monthly chemotherapy. It is unclear at this stage whether /when he will return to work.
As the partner worked on a 2 week cycle of working 8 session one week and 9 sessions the second week, this has further reduced our available access to GP appointments. It also affects the already higher than average ratio of patients to GP - giving a ratio divided by 3 partners of 3477 patients each.
We welcome the opportunity in discussing this with you further and hope for a favourable response. Thank you Appendix 3 – Practice Boundaries Map
Appendix 4 – Area covered by Crofton Medical Centre only
Most of the area not covered by other practices is open countryside and does not include residential properties.
The area around Weeland Road and Birkwood to the north west of Sharlston however do not appear to fall into the catchment area of other practices.
This is also the case for the houses on West Lane, Doncaster Road and Towers Lane to the west and South of Sharlston
For completeness the next page indicates the entire area covered only by Crofton on an aerial view with the boundaries of neighbouring practices shown in red.
Appendix 5 – NHS England Policy Book – Assignment to a Closed List Assignment to a closed list
1.1 The Commissioner may not assign a new patient to a practice that has closed its list of patients except in the following circumstances:
1.1.1 most or all of the providers of essential services (or their equivalent) whose practice premises are within the Commissioner's area have closed their lists of patients;
1.1.2 the assessment panel, as will be detailed in paragraph 6 below, has determined that patients may be assigned to the practice in question, and that determination has not been overturned either by a determination of the Secretary of State or (where applicable) by a court; and
1.1.3 the Commissioner has entered into discussions with the practice in question regarding the assignment of a patient, whereby additional support that the Commissioner can offer to the practice may be required. The Commissioner shall use its best endeavours to provide appropriate support and should discuss support in respect of the first assignment of a patient and any subsequent assignments made to that contractor during their list closure. 2. Assignment Based on the Determination of a Commissioner Assessment Panel
2.1 Where the Commissioner has the need to assign a patient to a practice that has a closed list and most or all of the providers of essential services (or their equivalent) whose practice premises are within the locality of the Commissioner have closed their lists of patients, the Commissioner must:
2.1.1 prepare a proposal to be considered by the assessment panel which must include details of those practices to which the Commissioner wishes to assign patients;
2.1.2 ensure that the assessment panel is appointed to consider and determine its proposal and the members of the assessment panel must include:
2.1.2.1 a Commissioner director;
2.1.2.2 a patient representative who is a member of the local HWB or Local Healthwatch organisation; and 2.1.2.3 a member of an LMC but not a member of the LMC formed for the area in which the contractors who may be assigned patients as a consequence of the panel's determination provide services.
2.1.3 Notify in writing that it has referred the matter of patient assignment to the assessment panel to the following:
2.1.3.1 the LMC for the area of the Commissioner; and
2.1.3.2 any contractors whose practice premises are within the Commissioner's jurisdiction that have closed their list of patients and may, in the opinion of the Commissioner be affected by the determination of the assessment panel.
2.2 In reaching its determination, the assessment panel shall have regard to relevant factors including:
2.2.1 whether the Commissioner has attempted to secure the provision of essential services (or their equivalent) for new patients other than by means of their assignment to contractors with closed lists of patients; and
2.2.2 the workload of those contractors likely to be affected by any decision to assign such patients to their list of patients.
2.3 The assessment panel shall reach a determination within the period of 28 days beginning with the date on which the panel was appointed.
2.4 The assessment panel shall determine whether the Commissioner may assign patients to practices which have closed their lists of patients. If it determines that the Commissioner may make such assignments, it shall also determine those practices to which patients may be assigned.
2.5 The assessment panel may determine that the Commissioner may assign patients to practices other than those practices specified by the Commissioner in its proposal, as long as the practices were notified during the preparation stages of the assessment panel being held.
2.6 The assessment panel’s determination must include the factors considered by the panel and be made in writing to:
2.6.1 the LMC for the area of the Commissioner; and
2.6.2 any contractors whose practice premises are within the Commissioner's jurisdiction that have closed their list of patients and may, in the opinion of the Commissioner be affected by the determination of the assessment panel. 3. NHS Dispute Resolution Procedure Relating to Determinations of the Commissioner Assessment Panel
3.1 Where an assessment panel makes a determination that the Commissioner may assign new patients to contractors which have closed their lists of patients, any contractor specified in that determination may refer the matter to the Secretary of State to review the determination of the assessment panel. Please refer to the policy on managing disputes (chapter 11). 4. Removal by a Contractor of Patients Assigned to the Practice
4.1 Historically, practices have often applied an unwritten agreement to the retention period of assigned patients. However, there are no formal arrangements in respect of timescales for patient retention in these circumstances. While the significant majority of practices continue to manage assigned patients in the same manner as an ordinarily registered patient, others may commence a formal removal process immediately following assignment. The Commissioner has a responsibility to ensure that all requests to remove a patient at the request of the contractor must be managed in line with the relevant Regulations/Directions.
Title of Probity Committee Agenda 8 meeting: Item:
Date of 28 November 2017 Public/Private Section: Meeting: Public Private Paper Title: Improvement in Prescribing Plan (ImPP) N/A 2016/17 Annual Report
Purpose (this paper is for): Decision Discussion Assurance Information
Report Author and Job Carly Day, Primary Care Medicines Optimisation Lead; Title: Lyndsey Clayton, Medicines Safety Officer Responsible Clinical Dr Chris Barraclough Lead: Responsible Jo Pollard, Chief of Service Delivery & Quality Governing Board Executive Lead: Recommendation (s): It is recommended that the Committee notes the outcomes of the 2016/17 ImPP scheme Executive Summary: • Scheme for 2016/17 included the new eligibility criterion of reporting medicines safety incidences so that lessons learnt could be shared across the district to help mitigate happening again thus reducing further risk • As part of the second level of eligibility, the Probity Committee increased the number of indicators practices were required to achieve from 5 to 6. 15 practices did not achieve this, although the majority of these did achieve 5 • The Medicines Optimisation Team provided practices with support materials to help them achieve the productivity indicators • Disappointing that only 6 practices achieved the ‘antacid and alginate’ indicator as this is a relatively straight-forward review • Encouraging that high number of practices achieved the two antibiotic targets, although work continues around this area and prescribing needs to tighten further • All practices demonstrated positive engagement and change in relation to the dosulepin (tricyclic antidepressant) – a drug subject to safety in terms of cardiovascular toxicity. 3 practices achieved 100% reduction and a further 10 reduced prescribing by more than 75% • Prescribing budget and cost growth - 15 practices were underspent on their allocated budget by year end and 16 practices achieved their allocated cost growth target of either 0% or reduction in growth of 2% based on previous year • No federations achieved the collective achievement award • Overall achievement lower than in previous years and this is mainly due to the increased scrutiny in achieving 6 out of 10 indicators • Some practices did not engage with the scheme until the last few months of the year and as such cost-effective prescribing changes were not recognised fully during the financial year • 17/18 ImPP format will mitigate this issue as practices are required to engage from the start
Link to overarching principles from the Reduction in hospital admissions where appropriate strategic plan: leading to reinvesting in prevention New Accountable Care Systems to deliver new models of care
Collective prevention resource across the health and social care sector and wider social determinant partners Expanded Health and Wellbeing board membership to represent wider determinants A strong ambitious co-owned strategy for ensuring safe and healthy futures for children A shift towards allocation of resources based upon primary and secondary prevention and social determinants of ill health Transforming to become a sustainable financial economy Organising ourselves to deliver for our patients
Outcome of Integrated Not Applicable Impact Assessment completed (IIA) Outline public Not applicable engagement – clinical, stakeholder and public/patient: Management of Conflicts None of Interest:
Assurance departments/ Not applicable organisations who will be affected have been consulted: Previously presented at Not applicable (original ImPP 2016/17 proposal presented to committee / governing Probity Committee 22 March 2016) body:
Reference document(s) / None enclosures:
Risk Assessment: Not applicable
Finance/ resource Not applicable implications:
Improvement in Prescribing Plan (ImPP) 2016/17 Annual Report
Introduction
The ImPP is a voluntary scheme that rewards high-quality and cost-effective prescribing in Wakefield.
The scheme for 2016/17 saw the introduction of a new eligibility criterion which promotes the sharing of and learning from medicines related incidents. To achieve this, practices were required to nominate a practice-based Medicines Safety Champion and report a minimum of 1 incident per 1,000 of their practice population. A further change enforced by Probity Committee as second level eligibility criteria was for practices to achieve 6 out of 10 indicators (previously 5 out of 10).
Further information on the 1617 scheme can be found on Skyline: http://skyline.wakefieldccg.nhs.uk/Interact/Pages/Content/Document.aspx?id=3486& SearchId=
Outcomes breakdown
Eligibility criterion:
Although all practices nominated a MSC, 6 did not achieve the target of medicines safety incidences reported. The CCG Medicines Safety Officer offered all practices support in attending practice meetings to discuss and learn more about medicines incidents as well as one to one training for the nominated MSC. Interestingly, the 6 practices that did not achieve this criteria, did not take advantage of this opportunity at the time.
15 practices did not achieve the second level eligibility criteria of a minimum of 6 out of 10 indicators (this includes 3 practices that did not achieve level one criteria). This compares with just 3 practices in 15/16 that did not achieve 5 out of 10 indicators.
12 11
10 8 8 6 6 6
4 3
No of Practices of No 2 2 1 1 1 0 0 1 2 3 4 5 6 7 8 9 10 No of indicators achieved
Just one practice (Warrengate) achieved all 10 indicators and awarded an extra 10% of their total award.
Practices that did not achieve eligibility criteria
Practice Medicines Safety < 6 out of 10 indicators Incident Reporting achieved Almshouse Ash Grove Crofton & Sharlston Eastmoor Elizabeth Court King Street Kings MP Lupset Maybush New Southgate Orchard Croft Outwood St Thomas Road Stanley Stuart Road The Grange Tieve Tara White Rose
Indicator achievement:
Practices were provided with materials produced by the Medicines Optimisation Team and/or PrescQIPP to support them in implementing the required changes to achieve the indicators.
The table below shows the number of practices achieving each indicator.
No of practices Indicator achieved Low Dose Proton Pump Inhibitors (PPIs) 11 Antacids & Alginates 6 Number of Antibacterial Items Prescribed 29 Cephalosporins, quinolones & co-amoxiclav 32 Dosulepin 33 Steroid/Long Acting Beta Agonists (LABA) combination inhalers 32 Number of items prescribed from the DROP list 32 DROP list- OTC hay fever products 21 Emollients 18 Oral phosphodiesterase inhibitors 28
PPIs Feedback from prescribers is that this is a challenging indicator, especially when high dose PPIs are started in hospital with correspondence stipulating that patients are to stay on a high dose life-long. Such patients should still be reviewed regularly in primary care and doses decreased based on symptom control and reiteration of life-style advice.
Antacids & Alginates This indicator achievement was considerably lower than expected. A few practices proactively switched prescribing to the locally preferred product without problems. Practices had also been identified as prescribing more expensive OTC (over the counter) product descriptions, which could have been switched to the more cost- effective NHS pack description without changing patients’ treatment. Some practices did not act on this advice. Furthermore, a guideline for the management of Laryngopharyngeal Reflux/’Silent Reflux’ in Primary Care was released in December 2016, which offered the month of January for prescribers to review their prescribing and make some straight-forward changes that could be recognised in February and March data.
Antibacterials / Cephalosporins, quinolones & co-amoxiclav Achievement of these indicators reflects good engagement by the majority of practices. In conjunction with Data Quality, the MOT developed a Fever Pain template integrated into the GP clinical systems to support consultations and the appropriate prescribing of antibiotics. Read-coding on the clinical systems indicates that prescribers do not issue many delayed prescriptions for antibiotics, although this may be a coding issue rather than actual practise.
Emollients The achievement of this indicator was disappointing, as many of the higher costing brands have cost-effective equivalents which would be a straight-forward switch. The emollient prescribing guideline has also been available throughout the 1617 ImPP duration for prescribers to reference when reviewing existing prescribing.
Dosulepin This indicator was primarily one of safety due to long term risks of cardiovascular toxicity. The aim was to review patients to determine if treatment could be changed to a safer, suitable alternative or stopping this medication altogether. This indicator was not a quick win, much time and resources required to review patients face to face and if necessary steadily titrating dosulepin dosing down, whilst cross tapering the introduction of another antidepressant drug.
It was an indicator that showed positive engagement and change. We have seen a 49% reduction in the number of dosulepin prescription items (Quarter 1 2016/17 Vs Quarter 1 2017/18).
All practices managed a reduction in dosulepin, but we would like to commend the following practices;
The practices that achieved 100% reduction: Drs Diggle and Phillips, Tieve Tara and Station Lane.
The practices that achieved >75% reduction: Northgate, Castleford Medical practice, Alverthorpe, Maybush, Riverside. Crofton and Sharlston, Friarwood, Newland Surgery, Elizabeth Court and Dr Singh and Partners.
Prescribing Budget and Cost Growth:
15 practices were awarded an extra payment of 10% of their total award for having underspent at year end against their allocated prescribing budget. 16 practices achieved a cost growth (Q4 16/17 vs Q4 15/16) of either 0% or less or a reduction in growth by 2 percentage points.
Federation achievement:
In addition to the above, there was an award available for collective achievement of indicators across a federation. If every practice in the federation achieved the same indicator an additional payment to each individual practice was payable. This year, no federations achieved this compared with 1516, when 3 out of the 7 Networks were recognised for this achievement.
Summary:
The overall achievement for 1617 is lower than in previous years. In the main, this is attributable to the increased scrutiny imposed by the Probity Committee in achieving 6 out of 10 indicators to be eligible for any award. Anecdotally, some practices have left addressing the indicators until the last few months of the scheme and as such, the prescribing changes implemented have not been recognised during the financial year 1617.
The changes to the ImPP 1718 will help address this latter issue as practices are required to be engaged from the start in carrying out the quality audit and implementing the electronic optimisation element of the scheme.
Prepared by: Carly Day, Primary Care Medicines Optimisation Lead & Lyndsey Clayton, Medicines Safety Officer On behalf of the Medicines Optimisation Team
July 2017