Summary of Responses

Agenda Item No. 1 Summary of Responses to the Consultation

SUMMARY OF WRITTEN RESPONSES

 FEEDBACK FROM COMMUNITY AND NHS REPRESENTATIVES  FEEDBACK FROM INDIVIDUAL PEOPLE

1 SUMMARY OF RESPONSES - FEEDBACK FROM COMMUNITY AND NHS REPRESENTATIVES

NAME OF ORGANISATION KEY ISSUES RAISED Hertfordshire-wide 1 Dr Mark Andrews,  Considers the proposal to establish two new GP-led health centres in Hertfordshire to be a Chair, Hertfordshire LMC Sub- complete waste of resources; services are not needed. Committee  May jeopardise PCTs’ fragile financial recovery.  Primary medical care provision good in Herts; above average nos of GPs practising. Bedfordshire & Hertfordshire  Believe that this process is designed to allow large commercial enterprises to establish Local Medical Committee Ltd. themselves with primary care. This will lead to loss of continuity of care, put profit before quality and will drive out the long serving established GPs.  Concern about potential duplication, confusion and delays that could result from GP services being provided, at times simultaneously, at the same site from the out of hours service, urgent care centre as well as the GP led health centre.  Decision to locate the centres at the sites of local general hospitals was based entirely on expediency and the political imperative to make a decision quickly rather than on any analysis of patient needs.  Sub-committee is disappointed that Herts’ PCTs have not been taken a stronger position with the Strategic Health Authority on this issue and have allowed it to dictate how its resources should be spent.  Most decisions have been made before end of consultation; therefore not a true consultation 2 Hertfordshire County Council  Establishment of GP-led Health Centres offers a real opportunity to develop a whole range of Adult Care Services accessible, flexible and complementary services and to develop more integrated and innovative approaches to health and well being.  Need for explanation on how the development of GP-led health centres fits within the overall context and plans for ‘Delivering Quality Healthcare in Hertfordshire’.  The benefits of co-location should be explored further and not just limited to the Health centres but also to hospital sites.  There is a concern that those communities furthest from the Local General Hospital Sites will not be able to access the Health Centres. Even with communities closer to the Health Centres, there may be people who cannot travel to them.  With the move to larger health centres the notion of the ‘family doctor’ might disappear and the continuity of care therefore,lost.  There is a concern about how data will be shared.  It has been recognised that signposting will be a challenge. This needs to be handled efficiently if people are to promptly access the correct services.  The Department of Health model for Health Centres must be adapted to meet the needs of the 2 Hertfordshire population both now and in the future.

3 Katie Leafe  Will there be the opportunity to provide audiology services from these premises? If so who will Business Development be given this opportunity? Manager  Would Specsavers Hearing Centres be given the chance to run their services from these premises complementing the GP services and increasing customer choice? Specsavers Hearing Centres Dacorum 4 Dr Mark Brownfield  Unanimous opposition to PCT’s decision to locate a Darzi Health Centre in Dacorum. Chair of Hemel Hempstead  Why have South Oxhey and Northwood not been considered? There are significant levels of and District Locality Forum deprivation and health need in South Oxhey which have not been identified. Northwood has no general practices within its Hertfordshire boundaries. Hemel Hempstead & District  Proposed location seems entirely for the convenience and financial benefit of the local health Locality Forum economy rather than the patients.  Dacorum has no gaps in primary care provision; there are a sufficient number of GPs to serve the needs of the population; no evidence has been provided to show that cramming another GP practice will improve health.  Profound and damaging impact on two surgeries located close to proposed site.  Issue of premises in Highfield represents a need to invest in the building, not the service  The decision appears to have been made solely on political grounds and is a misguided attempt to console the residents of Dacorum for the down grading of their local secondary facility; the Darzi clinic will not provide any of the secondary care facilities being lost but will severely compromise the stability of the already full provision of local general practice and thereby their continuity of care.  The new Health Centre would represent appalling value for money in Dacorum, ultimately doubling primary care resource allocation jeopardising the fragile financial position of the PCT. 5 Mike Penning, MP  How does the PCT see the relationship between the new clinic which is proposed and the existing facilities and GP surgeries within the town, in particular, the Fernville Surgery? Member of Parliament for  It is imperative that no new facility within the town damages the patient/doctor relationship which Hemel Hempstead already exists in any of the already successful surgeries.

3 6 David Gauke, MP  What are the proposals for polyclinics in Hemel Hempstead?  What impact will such polyclinics have for GP practices in places such as Tring? Member of Parliament for  What view does the PCT have as to the long term future of single doctor GP practices? Hertfordshire South West  To what extent are the above questions determined at a PCT level or nationally?  There is a concern that GP practices may be lost and the doctor-patient relationship broken.

7 Dacorum Patients Group  The Group is unhappy about how the consultation has been managed by the PCT.  There is a strong and consistent message that patients do not want the proposed Darzi centre, but the rushed consultation does not allow these views to be clearly heard and acted upon.

8 Dr Hall Jones,  Resents the move to centralise GP surgeries. This will mean impersonal problems encountered The New Surgery, Tring. by patients being cared for by Doctors who have no loyalty to them or knowledge of their individual medical histories.  A more logical approach would have been to instruct employers to respect the human rights of their employees to be able to attend health appointments if needed during working hours. This is why the small minority of patients find GP hours inconvenient.  This suggests that attempts are being made to privatise the NHS through the backdoor.

9 Zena Bullmore,  Opposes the setting up of a GP-led health centre, wherever it is built. Chairman  There is no justification for the resulting closure of existing GP practices, most of which in this area are large enough to provide a satisfactory range of primary care services. Patients can Dacorum Hospital Action access these more easily and quicker than going to a polyclinic. Group  The number of single practices in West Herts is surely too few to justify building a polyclinic and would create serious problems of access.  Public transport services must be a vital consideration. Local knowledge is needed to satisfy local requirements but sadly decisions appear to have been made by anonymous people unaware and sometimes uncaring of local problems and needs.  Polyclinics will increase dangers of misdiagnosis and treatment as the GP will be unaware of the patient’s background, unlike a local GP who provides continuity of service.  As Hemel Hempstead Hospital is to have an urgent care centre run by GPs and open 24/7 as well as diagnostic equipment, what purpose would be served in building an additional GP-led health centre?

4 10 Daniel Harris, Director  Very interested in the idea of providing a GP-led health centre that can provide a huge range of primary care services under one roof. How would the role of optometry services fit in? Specsavers Opticians  Would the centre provide other types of primary optometric care such as extending current diabetic retinal screening services and current low vision services? Will the centre be involved in establishing glaucoma care share and cataract assessment and direct referral? Will ocular therapeutics be offered?  Would the PCT be looking to equip a clinic room and employ a suitably qualified optometrist or would they be looking to source these services in the community? East Herts 11 Anne Freimanis  Members have concerns regarding the registration process with the Health Centre and the Chief Executive possibility that this could mean GPs losing funds as patients deregister.  It was noted that 6000 people need to register with the health centres for them to be viable. East Herts Council Members were in no doubt that this would have an impact on service provision by local GP surgeries who might be forced to close or cut back on staff.  Members supported the provision of a pharmacy, minor surgery, blood tests, pre natal checks, stitch removal, optician and urgent dentistry.  It is considered important that knowledge of the community, generally, culturally and demographically was essential for the Health Centres to be viable. Preference should be given to those being staffed using local GPs.  The health centres should be able to access a translation service in recognition of the fact the area is continuing to grow.  Health centres are a direct response to a public survey whereby members of the public had complained that they were not able to access GPs for appointments. Members feel consideration should begiven to opening from 7am rather than 8am.  Transport and car parking is of considerable concern, especially as QEII is now the preferred site.  Monitoring profit and investing this back into the system is essential so that provision of services meets community needs and keeps up with continual changing needs. Hertsmere

5 12 Arnold Davey  Members were suspicious that building a new centre in Welwyn Hatfield would be used as an Chairman, excuse to close down the Potters Bar Community Hospital.  If patients had to be seen at the polyclinic they would have to travel further, wasting more time. Potters Bar Society  There was a feeling that only private companies would put up the money, leading to privatisation by the back door, and the undermining of existing GP surgeries.  However, a 7 day a week service would be a great improvement on the current Monday – Friday only set up.  It is felt that only one centre for such an area as sprawling as East & North Herts could only reach a small percentage of the population. Residents of Bishops Stortford, say, would not consider Hatfield a local facility.

North Herts 13 Dr Michael Slattery  No evidence has been produced to show the need for these centres or of their effectiveness for the as yet unidentified unmet need. Orford Lodge Surgery  East & North Herts PCT has shamelessly cut front line services because of financial problems Hitchin and refused to fund the development of existing practice premises.Yet the PCT will now recklessly embark on major spending on buildings and staff for which no use has been identified.  The PCT board should be prepared to put the needs of patients above political expediency.

St Albans 14 Gill Balen, Chairman  Group has concerns regarding the establishment of the new, expensive, superfluous Darzi polyclinic in Hemel Hempstead and the confusion this is going to cause. Red House Patients Group  Setting up these centres is a political imperative rather than one based on need. Radlett  Herts has a high quality service from its GPs and this central imposition is seen as a threat to general practice.  There will shortly be 3 types of medicine on the Hemel site: the UCC, the OOH centre and the polyclinic. How will patients access the one most relevant to them? There will be a triplication of resources and enormous confusion amongst patients.Funds could be better used in developing services in local practices which will be squandered in the rush to meet the Government’s timetable.  Money is being taken away from local GP practices which offer continuity of care.

6 15 Dr Hilary Smith  Are there plans to keep the local Path Labs available and open until 8pm? Similarly routine GP x-ray facilities which we would all have access to? The Maltings Surgery

Welwyn/Hatfield

16 Welwyn Hatfield Borough  A need has not been demonstrated for this development.No ‘needs’ or ‘risk’ assessment has Council Health Panel been undertaken in making this decision.  It will compete directly and unfairly with local surgeries.  It will achieve little that could not already be achieved via the OOH and UCC; health centre should be a walk in GP unit managed as part of the hospital and dovetailing with the UCC and OOH.  It is strongly felt it shouldn’t have patient lists.  What would be the impact on local GP Practices should they be unsuccessful in their bids to run the health centre?  What reassurance is there that the current GP services would not deteriorate as a consequence of the new health centre?  If the health centre is located on the local general hospital site, there would need to be reassurance services wouldn’t be duplicated.  Where would the health centre be located on the current QEII site?  Would the cost of building the health centre be in addition to the sums involved in building the new local general hospital?  Should a private company operate the health centre, what reassurance is there that residents will not suffer as the aim would be to run a profitable health centre.  How will continuity of care for patients be ensured?  How will records of patients be transferred to the new health centre and how will confidentiality be ensured? 17. Dr E I Sherrard  Concepts of Dr Darzi are more relevant to large urban conurbations than semi-rural shire counties; an 8 to 8 GP-led health centre would solve the problem of the percentage of the Friends Of Wrafton House population that have problems accessing a GP in working hours Patient Participation Group  The OOH service in Welwyn Hatfield is very good and should be used to cover the other 12 hour period. Linking these two periods would ensure that patients in this part of the county had 24/7 GP-led care.  The health centre should be made available with suitable diagnostic facilities. It would be advantageous if the health centre had the facility of home visits by GPs. Phone consultations should be more exploited in this context as they have proved very successful at our surgery.  As the patients can walk in or arrange a time as a registered patient, the GP staffing must ensure 7 planned consultations are not delayed by ‘walk-inners’.  The 100 hour a week chemist and polyclinic could then be included at a later date.

18 Dr M Harding  Has very strong objections to the proposal of a health centre on the QEII site.  Choice of location was not based on an assessment of patient need or deprivation. Peartree Lane Surgery  WGC is well provided with good GPs delivering quality care to patients. Does not need another practice right on doorstep of two of the biggest practices in Herts  Proposal comes at the same time as GPs have had to accept significant pay cuts, and forced to accept less pay for opening extended hours. It would make more sense to fund GPs to staff extra hours than to take funds away from them to fund an unnecessary new health centre. Local GPs resent this and feel utterly undervalued.  The health centre will be unable to provide the continuity of care that is currently provided. Patients will not value it as it will operate on a shift system and partly on a walk in basis; we understand it will be staffed by non GP trained doctors in order to operate more cheaply and therefore will not provide the quality of care we strive for. 19 Dr G Pugh  A site should be chosen that is under doctored and where patients have difficulties finding a GP. For and on behalf of An area where substantial new building and expansion is projected and where existing practices Hall Grove Group Practice are set in substandard premises. The patient satisfaction survey should indicate the need for a new practice. The chosen site certainly does not fit any of these criteria.  Given that everybody in WGC is already registered with a practice the patients of this new practice will have to come from our existing patients. This may result in the new practice failing. Most patients will remain loyal to their practices. This will mean no reduction of work load but a substantial loss of revenue. Presumably monies will follow the patient on a capitation basis. Destabilisation of existing practices therefore seems inevitable.  84% of patients are satisfied with their existing practices. It is only the vocal minority that are clamouring for the open all hours clinics; the majority of patients value continuity of care, holistic approach to health care, availability of home visiting and the establishment of a patient-doctor relationship which goes across generations. It is believed patients will not want to see a succession of locums and temporary doctors which it is suspected are all the new clinic will be able to offer.  Changes to the QOF mean that all practices will almost certainly offer extended opening hours, further reducing the need for a new practice. the proposed services being offered by the new practice are no different to those already being offered by existing practices. If the proposal goes ahead patients will be spoilt for choice with the ability to attend three centres within a few yards of each other all offering more or less the same services. This cannot be an efficient use of health resources.

8 SUMMARY OF RESPONSES - FEEDBACK FROM INDIVIDUALS

INITIALS OF INDIVIDUAL KEY ISSUES RAISED Area not known

1 A. L.  Interested to read the different services which will be available and who can access these services. What will the surgeries offer the elderly patients who are housebound or any patient who is too unwell to visit the surgery?

2  A drop in clinic is a good alternative on several levels, e.g. people who work locally but live in E.L. (e-mail) another area, visitors to the area, and workers on short term contracts locally.  However, how is the information going to be communicated between GPs so that treatment is continued, not overlapped or contradicted?

3 E-mail  There are no concrete proposals beyond location and opening hours. There must be some basic plan. It is not clear on how to access information on the proposed new centre.

4 J.L. (e-mail)  Concern about the number of medical staff available at any one time and what area of Hertfordshire each centre is expected to cover.  It is not clear how the walk in part of this arrangement will work. Unless staffs are waiting for work there could be a massive waste of either their time or that of the public who would expect to be seen pretty quickly.  It seems poor compensation for the loss of a proper hospital 5 P.B. (e-mail)  This proposal will increase centralisation of services and result in a reduction in services which are currently provided by GPs near to people’s homes.  These clinics would be manned by Doctors who come and go and take no long term responsibility for the decisions they make.  This is no substitute for a high quality health care GP service where people can have no confidence in the quality of their health care.  What is needed are more high quality GPs and better access to them.

Dacorum

9 6 J.R.  The proposal for a polyclinic at Hemel Hempstead appears unnecessary as there will be a Hemel Hempstead duplication of the GP Group Practice Centres which already provide a very good service.  The hospital already has an A&E centre.  The town is well provided with this form of service, although some specialists not involving GPs may be needed, such as dentists.

7 Mr & Mrs C  Strongly objects to polyclinics. Current GP surgeries are within walking distance and GPs know Hemel Hempstead their patients problems, past and present, and understands their needs.  Pensioners need their primary services close and hospital services easier to reach than Watford Hospital.

8 B.H.  What effect will the polyclinic have on existing GP practices? Hemel Hempstead  In Dacorum the hours between 06.30pm and 08.00am, as well as the weekends are already covered by the OOH.  Many of the services proposed for the new health centre are already provided at the existing GPs. Why would residents want to travel further in order to receive ‘flu’ and pneumococcal vaccinations when there is an excellent service in their own GP practice?  The health centre is considered a waste of resources. The tax payer’s money should be used on a woefully inadequate primary care service for housebound patients. There should be restoration of home visits by chiropodists, carer’s regular arranged visits and more physiotherapists.  Finance should be better used in making vast improvements in what we already have.

9 EG  It is stated that the current provision is above the national average. No clinical need for further GP surgeries has been demonstrated.  Much is needed in Primary Care from more District nurses to Physiotherapists to more intermediate care beds. These all need addressing urgently rather than destroying the network of GPs we have in place.  Patients can already see their Doctors between 8.00am and 6.30pm five days a week. This with the support of the OOH works satisfactorily.  Many surgeries already do minor surgery, ante-natal care, gives flu jabs, takes blood etc. This must not be destroyed by the new polyclinic.  It is only the GPs that are providing a good standard of health care at present. They should be left alone and the NHS should concentrate on other, failing, parts of the healthcare system.  The budget for new health centres will have to come from existing budgets and will require cutting the budget for services currently provided.  Can and will the Healthcare Commission be involved in monitoring? If not they should be, as they

10 are independent, they highlight problems and try to get the situation improved. 10 D.C. (e-mail)  The whole plan for primary and secondary services in Herts needs to be rapidly rethought and the proposed closures halted until the public has been properly consulted.  If Hemel Hempstead is to have an Urgent Care Centre, why is a polyclinic needed on the same site?  Where will all the GPs to run these facilities be found? Most local GPs have large, modern surgeries which already provide a range of services. 11 Z.B.  What services will the polyclinic provide that will be different from the planned Urgent Care Centre Hemel Hempstead services?  If GP practices in the community are to continue where will the additional GPs come from?  Although Hemel Hempstead is easy to access from most parts of Dacorum people still need GP practices even closer and easier to access. Will these be offered?

12 R.C.  A polyclinic, on the contrary, will be a large and impersonal centre that could not offer the same Berkhamsted high, personal care, convenience and commitment that is presently enjoyed. It is not believed that the service would be in any way improved by the creation of a Polyclinic.  It is felt these proposals are not about improving services, but rather an ill-considered cost cutting exercise with the intention of grabbing headlines without any real regard for the patients.

13 K.D.  The move towards a primary care polyclinic for the residents of Hemel Hempstead is not supported. Hemel Hempstead  In Hemel Hempstead there is a selection of GPs to choose from and there is no evidence to suggest the current system doesn’t work for either patients or doctors.  Surgeries are currently open from 8.30 am to 6pm five days a week. It is possible to get an appointment to see a doctor when is needed whether it is for a routine matter or urgent medical need.  If the polyclinic goes ahead the established patient-doctor relationship would go out of the window. Local GP surgeries are just that, local to their patient base. Many can walk there and local pharmacies are in neighbouring shopping areas to dispense prescriptions.  If all this activity was centred at the hospital site, most people would need to drive to get there; parking and traffic congestion would be terrible.  There would be dire implications for the local pharmacies that depend on local surgeries for their trade.  One gets the impression that this is a way of ‘justifying’ the closure of acute services at the Hemel Hospital site. A growing town like Hemel needs extra services including full A&E, obstetric and midwife run maternity and children’s ward to name but a few.  The PCT should leave the successful GPs surgeries alone and instead re-open the award winning 11 Hemel birth centre with immediate effect. They should concentrate on preserving and returning services at Hemel Hospital.

14 R.G.  No rationale or evidence to support the proposals that are being consulted on. Very little detail on Hemel Hempstead what is actually being planned. This is an irrelevant, distracting, experimental and potentially dangerous and expensive pathway which has no convincing evidence to support it.  Different places have different and changing needs. Local needs are best met by local solutions.The population of North-West Hertfordshire can see no need for and do not want a polyclinic.It will threaten the infrastructure of local GP and pharmacy services. Many local pharmacies will face closure.  The GP service in this area is largely working well, and is a jewel in the NHS crown, much appreciated by the population. “If it ain’t broke, why break it?”.  These large surgeries will appear much more impersonal and remote to patients, who will find it harder to see their own GP.  What seems vital, rather than dislocating GP provision, is to stop chipping away at hospital capacity. 15 J.A.  GP-led surgeries are not needed. Hemel Hempstead 16 Mr & Mrs B  Patients are quite happy with the hours their GP surgeries operate and have never been so well Hemel Hempstead cared for.Instead of going to the expense of polyclinics why not put this extra money into keeping Hemel Hempstead Hospital fully open? 17 J.S. (e-mail)  Against the proposals and any interference with services provided by GP surgeries 18 M.B. (e-mail)  Why not use the money to keep open the A&E department in Hemel Hempstead Hospital? There are already good doctors in Hertfordshire, Lincoln House, Boxmoor; Fernville etc.so why open another? 19 R.B.  If there are polyclinics in the area let those who want them register with the service/doctor they Tring wish. Freedom of choice is the essence of any democracy.

12 20 B & P Jones (e-mail)  It is believed the following should be in the health centre:- GPs, Nurse Practitioners, Specialist GPs, Berkhamsted Pharmacy, Physiotherapists, Counselling, Psychiatric services, Maternity services, Health Visitors, Chiropody, Dieticians, Hearing Aid Services, Dentistry, Adult Social Care Services, Children’s care Services, Citizens Advice Bureau, Debt Counselling, Sexual Health Services, Health promotion, Public Health Services and meeting rooms for group and educational meetings.  Where will the staff be recruited from and where will they be housed?  How will the staff be effectively monitored?

21 J.W.  Although superficially a positive idea, these proposals will have a detrimental effect on the delivery Tring of GP services at a local level; a locally based GP is vital to the delivery of a high quality and consistent service to patients.  Local GP services engender trust and enjoy a personal relationship with patients which would not be encouraged by delivery of services on an ‘industrial scale’ by a polyclinic.  This is especially the case as the staffing of the polyclinic at the levels required will almost certainly lack of consistency in the relationship between the patient and practitioner.  It would not be wished to have to travel to Hemel Hempstead to avail of such a service when there is a far superior local GP service already available. 22 N White  The proposed arrangements to dispense with surgeries which would be subcontracted out to new Tring health centres would destroy doctor-patient trust and be detrimental to the local community where the doctor remains a cornerstone.  The older community will suffer. They will be deterred from visiting a GP whom they don’t really know and is further away.Their health will suffer accordingly.  The advantage of adopting subcontracted medical services has not been proved. They may have financial benefits but can never replace the relationship with a GP who has built it over several years. 23 Mrs J. H.  These wonderful polyclinics sound good when you hear the politicians on the TV. There would be Tring clinics that have all the specialists in the same building. Unfortunately it is feared that specialists does not mean consultants.  At the moment patients can walk to see their doctor, many of whom also have nurses. A same day appointment can be guaranteed and most importantly the local GP is a doctor patients feel confident with.  Why would patients want to change something that works so well? Patients do not want to become a number in some multi doctor practice.

13 24 R & J E  This change is being foisted on the public from above without any consideration being given to the Tring feelings or wishes of patients and their existing GPs.  This proposal will inevitably siphon off any surplus funds from existing practices and be to their detriment and threaten them with closure.  For most patients being treated close to home is one of the most important things. When you are ill or frail you do not want to make a twenty mile round journey and wait in a queue at a large impersonal profit making clinic. Patients would rather, as they currently do, make a short half mile trip to an appointment at their convenience with an existing GP who knows the patients background and can give a personal service.

25 R.F.T.  Patients should not be forced to travel to a polyclinic in Hemel Hempstead for repeat scripts and Tring necessary visits to see doctors and nurses. This will involve extra costs for travel, time and parking.  The current GPs currently provide an excellent service which should not be lost.  Polyclinics will inevitably become quite impersonal with patients being treated like just so many numbers and eventually be run by private concerns interested only in profits.  Doctors with little or no UK experience of general practice are quite likely to be the norm at minimal cost to the privateer but at great cost to the patient. Patient choice of general practitioners in Tring should not be reduced. 26 J & J Bax (e-mail)  What effect, long term, will a GP-led health centre have on existing GP surgeries that are, currently, within walking distance for the majority?  The proposed centre will not have access to unregistered patient records. Will diagnosis and prescribing of drugs be hampered?  Most patients prefer the continuity and therefore reassurance of seeing the same doctor.  Current GP surgery opening hours and The Out of Hours Service and A&E are providing adequate cover.  Tring, within Dacorum, is approximately 14 miles from the proposed centre. Public transport is inadequate. The increasing cost of petrol and congestion will compromise the use of the centre for residents of Tring.  The demand for home visits will increase. Patients will expect a better service than they are currently experiencing if a GP-led centre is forced upon them.  Public funding directed towards a GP-led health centre in the area of Dacorum would be an irresponsible, inappropriate use of public funds. 27 S.R.  Some individuals are not able to travel to Hemel Hempstead every time they need to visit a GP. Tring Many of the elderly do not drive and 20 miles is too far to travel when unwell. 28 J.S.  Single handed GP practices should not be denied NHS funding in the future. If this was to happen Tring many of them would have to close. 14  Should this be the case, current patients are likely to have to travel considerable distances to see a GP. This will be difficult for many and impossible for some. 29 R.B.J.  Services delivered locally by a competent family doctor, even if this means having to accept weekdays only with emergency/out of hour’s services more centrally available is favourable over the introduction of polyclinics.  There is no doubt that amongst other things economics and targets sit behind the proposal. 30 B.R.  Families should not lose the services of their local GPs and instead have to attend a polyclinic in Tring Hemel Hempstead.The proposed polyclinic would be in a busy town about ten miles away where parking and traffic can often be a problem. At many current GP surgeries the journey is a short distance with free parking.  The personal attention of a doctor who has known their patients for years is greatly valued.  Patients are not machines or robots needing a service at the main dealers, they want the personal touch of their own GP.It seems both the government and West Herts PCT are completely out of touch with the people’s needs. 31 B.A.M.  Many of the elderly would have to rely on public transport to get to Hemel Hempstead as well as Tring young mothers with babies. They are currently able to walk to the surgery. 32 Mrs D.M.N  Elderly patients would not want to travel to Hemel Hempstead to attend the polyclinics. They do Tring not have their own transport and would feel unable to travel by bus when feeling unwell. 32 M.F.  It is felt patients should not have to travel to a polyclinic in Hemel Hempstead to see a GP. Tring 33 R.J.S.  Patients should not have to travel to a polyclinic in Hemel Hempstead to see a GP. Tring 34 Mrs M.W.  A local GP centre is vital and can be a matter of life and death. Tring  The polyclinic plans have given no thought to the elderly, disabled and young mothers with children, etc. 35 Mrs J.F.  The elderly who no longer drive could not consider a visit to a polyclinic in Hemel Hempstead. Tring 36 Mr & Mrs J. H.  It is believed the government sees no future in single handed GP practices and is seeking for them Tring all to migrate to polyclinics.  GPs should be given the discretion to provide the services that their patients desire, without being financially pressured into a polyclinic or leaving their practice.  It is iniquitous that patients should be expected to register with a practice that is not only out of town but a considerable distance away.  People generally require their GP services when they are unwell and not up to travelling 20 miles.  The distance patients will be expected to travel will be costly in financial, time and convenience terms. It will also be extremely difficult for people without their own means of transport.

15 East Herts 37 J.A  Patients want to be known as people rather than an NHS number. Ware  It is important that individuals have a good rapport with their GP as their GPs are then aware of their medical records and can provide the best service which is currently the norm.  Most GPs have served their patients well and should be allowed to in the future.  Most doctors surgeries are near to where people live and it would seem evident that any such larger sites would be far fewer in number and would mean that virtually everybody would have to travel further to access the nearest. Hertsmere 38 Mr & Mrs D. D.  The polyclinics will jeopardise local surgeries and GPs. Aldenham  It is essential that local practices and GPs are retained.  The probability of being seen by a completely unknown doctor would be equally useless for the patient as well as the doctor on duty.

North Herts 39 J.S.  The government should not interfere with the running of GP surgeries. They are not qualified for Letchworth the job.  GPs should not become salaried employees of the state.  Polyclinics are one step away from privatising the NHS.  International evidence shows that patients have the best outcomes, even in hospital, when there is a strong general practice. For patients seeing doctors at a polyclinic there will be no continuity of care which it was believed was the founding principle of the NHS. 40 D.H.  BIG does not mean better. There is deep suspicion of the possibility that such clinics might be run, Hitchin for profit, by large commercial organisations.  The problem of travel to and from increase with old age and the feeling that one is just a hospital number is intensified in very large organisations.  “If it ain’t broke, don’t fix it.” 41 Mr & Mrs A.Z.H  Extreme concern that the GP doctor service and close personal relationship that patients have with Hitchin their GP will be undermined by the Government proposals.  It is the personal relationship and trust with a GP, the knowledge that they will refer you to a specialist, monitor your progress, reassess you and advise you and be responsible patients when they are ill and vulnerable that is wanted.  Any walk in polyclinic must gradually take away from the personal GP service and reduce services. 42 Mr J.H.  No changes are necessary.The present system works well and has done for 60yrs Baldock

16 43 Mr C.T.V.  Polyclinics will cause parking problems and other down to earth issues. Hitchin  Patients feel more at ease at a decent size but not too large GP surgery.  Certain medical conditions mean it is vital that a patient see’s a doctor who truly knows them, knows all their medical history, rather than forming a rapport in 5-10 minutes with a total stranger. Patients rely on the continuity of GPs and their partners. St Albans 44 Mr & Mrs P.K & M.J. D.  Patients wish for GP surgeries to continue to be run independently by local GPs. Should Harpenden commercial companies run GP surgeries they would be primarily accountable to shareholders, not patients, which is wrong.  Polyclinics will be expensive to develop and run.  NHS funds would be better invested in expanding high quality local GP services, i.e. making full use of the Harpenden Memorial Hospital.  GPs have known their patients over a number of years and have built up personal relationships with their families. Welwyn/Hatfield 45 Mr & Mrs C. H. H.  The idea of starting a health centre at the QEII seems to be a good idea but with the following Welwyn Garden City reservations.  Medical records will need to be electronically transferred which is not currently available. When a patient with a fairly complicated medical history is feeling ill, they are unlikely to be able to provide a concise and accurate summary of this history to a new doctor.  There must be an efficient and rapid system of relaying the information about the patient’s visit back to their own GP.  All samples and blood taken must be dealt with quickly and efficiently, and the results passed on to their ‘home’ surgeries as urgently as possible.

Out of Area 46 Mr G. E.  Polyclinics may end up under estimating patients precise requirements. Aylesbury  Location is an extremely important factor. The elderly do not want to be trotting off to Hemel Hempstead, for example, to wait for attention at a polyclinic. This is a ‘Bridge too far’.  Polyclinics are another indication that Big Brothers influence is increasing, hiding behind an NHS camouflage net.