Enc 00
Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Governing Body Meeting in Public
to be held on Thursday 24th May 2018 at The Aquarius Ballroom Suite, Victoria Shopping Park, Hednesford WS12 1BT
AGENDA 4.00pm to 4.30pm
A=Approval R=Ratification S=Assurance D=Discussion I=Information Enc Lead A/R/S/D/I 1. Welcome Verbal Chair I 2. Apologies Verbal Chair I 3. Conflicts of Interests Enc. 01 Chair I 4. Quoracy Verbal SY I
Items for Discussion 5. CCG Practice Transfer from SES-SP Enc. 02 LM I/D
Items for Information
6. Any Other Business/Close ALL I 7. Questions from the Public
SOUTH EAST STAFFORDSHIRE AND SEISDON PENINSULA CLINICAL COMMISSIONING GROUP CONFLICTS OF INTEREST REGISTER 2018/19 GOVERNING BODY MEETING IN PUBLIC 18-May-18
Employing Forename Surname Role in the CCG Directorships held in Ownership of private Shareholdings in health Positions of Connection with Research Any other role or relationship which the CCG private companies, PLCs companies, businesses, & social care authority in field of voluntary,other funding/grants public could perceive would impair or (CC/SAS/ consultancies health and social organisation otherwise influence the individual's SES) care judgement or actions in their CCG role
CC CCG Paul Gallagher Lay Member - Patient None None None None None None Chair of Quality Committee for the Southern Public Interest / Vice CCGs (Cannock Chase CCG, East Chair of Governing Body Staffordshire CCG, South East Staffordshire for Cannock Chase and Seisdon Peninsula CCG and Stafford Lay Member - Quality for and Surrounds CCG) South East Staffordshire Chair of the Individual Funding Requests and Seisdon Peninsula Panel CCG Chair of the Performance List Decision Panel (NHS England) SAS CCG Gillian Hackett* Executive Assistant None None None None None None None
NS CCG Cheryl Hardisty* Director of Strategic None None None None None None Role works across the 6 Staffordshire CCGs Commissioining & since 11/12/2017 Operations
SES CCG Anne Heckels Lay Member - Patient None None None None None None Member of Patient Participation Group at and Public Interest (PPI) Spires Practice / Finance and Member of South Staffordshire and Performance/Vice Chair Shropshire Healthcare NHS Foundation Trust of Governing Body for (SSSFT) South East Staffordshire Family Member is an employee shareholder - and Seisdon Peninsula NORR Consulting, providing architectural CCG services to public service
SAS CCG Allison Heseltine* Deputy Director of Director/Company Secretary None None None None None Role works across the 6 Staffordshire CCGs Nursing, Quality and of Net Technology UK Safety Limited (Spouse's company) (01.08.2001 to present)
SES CCG Heather Johnstone* Director of Nursing and None None None None None None Role works across the 6 Staffordshire CCGs Quality since 11/12/2017 Spouse is employed by HEFT. Sibling working as a nurse for SSOTP Brother-in law works as an Occupational Health Nurse for Team Prevent at UHNM, providing occupational health across the health economy NS CCG Zara Jones* Director of Strategy, None None None None None None Role works across the 6 Staffordshire CCGs Planning & Performance since 11/12/2017
SAS CCG Lynn Millar* Director of Primary Care None None None None None None Role works across the 6 Staffordshire CCGs since 11/12/2017 Employing Forename Surname Role in the CCG Directorships held in Ownership of private Shareholdings in health Positions of Connection with Research Any other role or relationship which the CCG private companies, PLCs companies, businesses, & social care authority in field of voluntary,other funding/grants public could perceive would impair or (CC/SAS/ consultancies health and social organisation otherwise influence the individual's SES) care judgement or actions in their CCG role
NS/Stoke Alistair Mulvey* Chief Finance Officer None None None None None None Director of Finance for: CCG Cannock Chase Clinical Commissioning Group North Staffordshire Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group Stoke on Trent Clinical Commissioning Group
SES CCG Ehtesham Noor Chair of Govenring Body, None Partner at Darwin Medical Darwin Medical Practice is None Currently Clinical Co- None Darwin Medical Practice is a member and SES&SP CCG Practice a member and shareholder Chair at the SE shareholder in Alexin Locality Director - in Alexin Alliance Board - I Membership of South East Staffordshire Lichfield and Burntwood represent the CCG on Alliance Board this board
SES CCG Douglas Robertson Secondary Care Associate Medical Director None None None None Received Role works across the 3 CCGs and North Consultant for: and consultant physician at Educational Grants Staffordshire CCG Cannock Chase CCG Leighton Hospital Crewe from, taken part in Clinical Lead for Planned Care in South East Staffordshire (Mid Cheshire Hospitals FT) clinical research for, Staffordshire Transformation programme and Seisdon Peninsula and have consulted Honorary Lecturer in Education at Warwick CCG for, the Medical School Stafford and Surrounds pharmaceutical CCG companies Takeda, Sanofi and NovoNordisk SES CCG Sekhar Singu Locality Director - None None Alexin Healthcare None None None General Practitioner at Tri Links Medical Tamworth Practice
SES CCG Lynne Smith Lay Member, None None None None None None Lay Member for Quality at East Staffordshire Governance, South East CCG since June 2013 Staffordshire & Sesidon Peninsula CCG NS CCG Marcus Warnes* Accountable Officer None None None None None None Accountable Officer for: Cannock Chase Clinical Commissioning Group North Staffordshire Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group Stoke on Trent Clinical Commissioning Group
SAS CCG Sally Young* Director of Corporate None None None None None None Role works across the 6 Staffordshire CCGs Services, Governance since 11/12/2017 and Communication
* Individual/role works across Cannock Chase CCG, North Staffs CCG, South East Staffordshire & Seisdon Peninsual CCG, Stafford & Surrounds CCG and Stoke on Trent CCG. Item: 05 Enc: 02
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
The healthiest place to live and work, by 2025
REPORT TO: South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Governing Body Meeting in Public
TO BE HELD ON: Thursday 24th May 2018
Subject: Moss Grove Kinver – Transfer Application Board Lead: Director of Primary Care - Lynn Millar Officer Lead: Senior Primary Care Development Manager – Ian Saberton Approval/ Recommendation: Assurance Discussion Information Ratification
PURPOSE OF THE REPORT:
The Governing Body are asked to review the available information presented in this paper and decide if the CCG should support the transfer of Moss Grove Kinver Practice to Dudley CCG. Should this be supported an application to change the constitution of the CCG would need to be submitted to NHS England.
KEY POINTS: Moss Grove Surgery Kinver is a GP practice within the South East Staffordshire and Seisdon Peninsula (SESSP) CCG. The current practice population is 5,480 patients, the practice are part of the Seisdon locality, working closely with the other eight practices with a total population in the locality of 53,000
Moss Grove Surgery has requested to transfer from SESSP CCG to Dudley CCG which would ultimately enable them to merge with their practice in Kingswinford.
The paper details the impact of the transfer on patients as well as primary care and community services, it details the financial implications, and summarises the patient consultation as well as the stakeholder consultation which includes feedback from CCG member practices.
Enclosures:- Enc. 2-1 Kinver Paper Enc. 2-2 Appendix 1 – Patient consultation report (includes all stakeholder feedback) Enc. 2-3 Appendix 2 – Letter sent to Stakeholders Enc. 2-4 Appendix 3 – South Staffordshire Council Response Enc. 2-5 Appendix 4 – Response from Dudley and Walsall Mental Health Partnership Enc. 2-6 Appendix 5 – Reply to Dudley and Walsall Mental Health Partnership from Dudley CCG Enc. 2-7 Appendix 6 – Response from Dudley Group NHS Foundation Trust Enc. 2-8 Appendix 7 – Response from SSOTP/SSSFT Enc. 2-9 Appendix 8 – Reply to SSOTP/SSSFT from Dudley CCG We are honest, accessible Quality is our day job We innovate and deliver Care and respect for all and we listen Page | 1 Item: 05 Enc: 02
Enc. 2-10 Appendix 9 – Response from Black Country Partnership
CCG GOALS: Change the culture: • Hospital to home • Professional to patient More focus on prevention Involving everyone for improved health and N/A care Empower and support patients to take control of their own health Services supporting people to make informed decisions
IMPLICATIONS: If the application is supported there will be a legal requirement to apply to Legal and/or Risk change the constitution of SESSP CCG. CQC N/A Patient Safety N/A Patients and stakeholders have been consulted as part of the practice’s Patient Engagement proposal Financial There is a financial implication for the CCG The practice have identified issues with sustainability which they say can Sustainability be eased with the transfer to Dudley CCG Workforce/Training N/A
RECOMMENDATIONS/ACTION REQUIRED: The Governing Body are asked to review the available information presented in this paper and decide if the CCG should support the transfer of Moss Grove Kinver Practice to Dudley CCG. Should this be supported an application to change the constitution of the CCG would need to be submitted to NHS England.
We are honest, accessible Quality is our day job We innovate and deliver Care and respect for all and we listen Page | 2 Item: 05 Enc: 02
Not KEY REQUIREMENTS Yes No Applicable Has a quality impact assessment been undertaken? Has an equality impact assessment been undertaken? Has a privacy impact assessment been completed? Has a comms & engagement impact assessment been completed? Have partners/public been involved in design? Are partners/public involved in implementation? Are partners/public involved in evaluation?
Equality Impact Assessments Governing Body members need to execute good leadership by appropriately challenging decisions that have not considered the equality and inclusion risks…… 3 key Equality questions CCG Board members should be asking Q1 What are the equality and inclusion implications of your decision to reconfigure services/ commission a particular service/decommission a service? Q2 What in essence did any feedback received from local protected group reps say (about any negative impacts arising / recommendations for service improvements)? Q3 What has been done to mitigate any potential risks for local protected groups? (re-shaping services for inclusion) NOTE: Board / Senior Committee Chairs should request this to be recorded in minutes to provide EDS evidence in Board minutes.
CCG VALUES We are honest, accessible and listen Care and respect for all Quality is our day job We innovate and deliver
We are honest, accessible Quality is our day job We innovate and deliver Care and respect for all and we listen Page | 3 Enc: 02-1 Kinver Transfer
1. Background
Moss Grove Surgery in Kinver is a GP practice within the South East Staffordshire and Seisdon Peninsula (SESSP) CCG. It has a current practice population of 5,480 patients. The practice is part of the Seisdon locality which includes eight other practices and a combined locality population of 53,000.
Moss Grove surgery partners also have a practice in Kingswinford which is part of Dudley CCG, this practice has a population of 14,500. The Kingswinford practice operates under a separate GMS contract with an identical partnership.
The senior partners have highlighted concerns regarding staffing and recruitment at the Kinver practice. Several discussions with both the CCG and NHS England around the support available to help the practice have been held. The practice has been offered access to NHS England’s GP supporting general practice team and had discussions about potentially subcontracting some of their GMS contract delivery to the Kingswinford practice.
Moss Grove would like to complete a formal application to transfer the Kinver practice to Dudley CCG with a view to merging the two Moss Grove practices. To do so an application to change the constitution of SESSP CCG would need to be made. An equivalent matched application would need to be made by Dudley CCG to change their constitution as well.
2. Impact of Transfer
2.1 Practice Sustainability
The merger would result in a number of benefits for the practice:
• Supports workforce recruitment and retention • Supports the practice with delivery of services such as extended access • Reduction in workload due to holding one contract with one CCG • Maximises efficiency by doing everything once rather than twice under two contracts • There is a risk to the practice around sustainability in the medium to long term if they are unable to transfer to Dudley CCG
2.2 Access to GP services
The practice has suggested during their consultation with patients that the registered population of Kinver will benefit in the following ways:
• Access to both sites increasing the continuity of care such as being able to access preferred GP • Access to services currently only available to Dudley patients at Kingswinford such as minor surgery • Larger practice population enabling more services to be delivered by the practice
2.3 Community Services
• Any services currently delivered as part of Staffordshire CCG contracts such as Primary Care enhanced services will no longer be available to the patients (there may be equivalent schemes in Dudley) • Local schemes such as extended access will no longer be available as part of Staffordshire programmes (there may be equivalent schemes in Dudley) • Fragmented care provision:
1
Enc: 02-1 o Community and mental health service providers will change to Dudley as the commissioning allocation will transfer o Current health and social care services are delivered by one organisation (SSOTP). This will no longer be the case as the responsibility for social care will still be with Staffordshire County Council. The health element will transfer to Dudley o Community health and mental health providers in Staffordshire are merging for a more integrated model including mental health, community and social care. Kinver practice patients would not have access to this combined service.
2.4 Finance
There is a financial risk to the CCG associated with this transfer and the potential application has been discussed at length with NHS England.
Representatives from NHS England have stated that the financial position of a CCG is the responsibility of that CCG and that any transfer does not affect that overall position. Therefore if a practice were to transfer from the CCG membership the share of the debt held by that CCG would not transfer.
The debt associated with the practice is calculated below
Debt CCG Calculation Practice
Cumulative debt up to and £51,885,000 Using the average £1,494,288 including 2017/18 practice list size Kinver practice has 2.88% of the population
Updated May 2018 to reflect year end position
2.5 Locality working
• The locality of Seisdon losing 10% of its population affects its stability and opportunities for locality development • The change reduces the opportunities for the locality to deliver primary care at scale • It reduces the ability of the locality to deliver locality programmes from the GP Forward View such as active signposting or workflow optimisation • A move affects the ability of the locality to deliver extended access to general practice • It also sets a precedent for other border practices to request a transfer to neighbouring CCGs, however, it is important to note the practice is unique in that they have a sister practice in an adjacent CCG • A proportion of the Kinver population are already registered with practices outside of Staffordshire CCG. The population of Kinver is estimated at 7,500.
2.6 Future Decision Making
The Staffordshire CCGs would no longer have any responsibility for the commissioning of the practice and the performance management under the terms of the GMS contract. Any future application by the practice in relation to changes in opening times, service delivery or surgery closure would be the responsibility of Dudley CCG not the Staffordshire CCGs. A change in delivery or opening times could then have an effect on neighbouring practices in Staffordshire.
2.7 Local Services
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Enc: 02-1 The proposed merger between the current community health and social care provider (SSOTP) and current community mental health care provider (SSSFT) aims to deliver a fully integrated healthcare, social care and mental health service. This fully integrated service would not be available for the Kinver practice population due to the separation of health and social care commissioning.
2.8 Community Health Services
• The funding allocation for community services will transfer to Dudley CCG • Dudley CCG would then take the decision around the future of community services • Commissioning from an existing Dudley provider means a complex contractual unpicking process and potential Transfer of Undertakings Protection of Employment (TUPE) implications for staff currently working in those services for organisations such as SSOTP.
2.9 Social Care
• The social care commissioning budget sits with Staffordshire County Council • The social care budget would not transfer to Dudley Council and responsibility for social care would remain with Staffordshire County Council • The current health and social care services are jointly delivered by one provider and would need to be separated and commissioned independently requiring both complex contractual negotiations and a fragmented service with social care and health commissioned separately.
2.10 Mental Health Services
• The funding allocation for mental health services will transfer to Dudley CCG • Dudley CCG would then take the decision around the future of mental health services • Commissioning from an existing Dudley provider means a complex contractual unpicking process and potential Transfer of Undertakings Protection of Employment (TUPE) implications for staff currently working in those services for organisations such as SSSFT.
2.11 Children’s Services
• The budget for children’s services such as the 0-19 service sits with Staffordshire County Council • Responsibility for children’s services would remain with Staffordshire County Council and the current provider of the 0-19 service (SSOTP). • Separating this service from the adult community services would create complex challenges, referral and transfer risks currently delivered by one provider.
2.12 Prevention Services
• The budget for preventative services such as sexual health, weight management, stop smoking, falls prevention and health checks sits with Staffordshire County Council • Staffordshire County Council commission services for its resident population • The responsibility for preventative services would remain with Staffordshire County Council and the current providers including SSSFT and Everyone Health.
3. Consultation and Feedback
3.1 Patient Feedback
• The patient and key stakeholder engagement started on 26 March and finished on 11 May. Engagement took place through a variety of ways including online surveys, public meetings, face to face meetings and letters. Over 500 people including members of the public and wider stakeholders took the opportunity to feed back on the proposals with the majority of responses being positive or neutral. Concerns were raised around appointment availability and
3
Enc: 02-1 accessibility at both practices and around the impact on community and social care provision should the boundary change go ahead. The report is available in full as (Appendix 1)
3.2 Public Events
• Two public meetings held, one in Kinver one in Kingswinford • The events were attended by a total of 150 people • Question and answer summary produced from each event which is also included in Appendix 1
The practice state they have the support of the Patient Participation Groups at both Kinver and Kingswinford, the Local Medical Council, the local Member of Parliament and Healthwatch. It should be noted that this feedback has come directly from the practice and was based on the summary of the potential merger given by the practice.
4. Stakeholder Feedback
Stakeholders have been consulted with through a joint communication sent from Dudley CCG and Staffordshire CCGs (Appendix 2). It should be noted that during the consultation period a number of further questions have been raised and responded to, to date the CCG has received no further feedback or comments.
The following responses have been received;
4.1 Staffordshire County Council
No formal response from SCC
4.2 South Staffordshire Council
• Discussed at Wellbeing Select Committee 24th April 2018 (Appendix 3) • Whilst understanding of the practice reasons for moving a number of concerns were raised and have been formally fed back; o Retaining a surgery in Kinver o Financially destabilising the locality with the potential to lead to further applications o Separate commissioners for health and social care and a lack of clarity about the future o Setting a precedent for other local practices
4.3 Dudley and Walsall Mental Health Partnership NHS Trust
The response from the Dudley mental health provider (Appendix 4) raised questions and comments;
• Mental health assessments provided by the local authority poses a challenge, would the boundary change or would any commissioning changes be made. • Changes to commissioned services requesting more clarity • Need an agreed plan around out of hours and liaison with Staffordshire County Council and Staffordshire Police • Query concerning whether the Kinver practice would require the same primary care mental health development taking place at other Dudley practices • Geographical spread and whether there would be an impact on services such as home treatment • Financial implications on the trust and ensuring the allocation moved to Dudley
The Director of Commissioning at Dudley CCG has responded to the letter to say that;
• Staffordshire County Council will still be responsible for social care • More work would need to be done to fully understand the implications of the effect on services, contracts and funding (Appendix 5)
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Enc: 02-1 4.4 The Dudley Group NHS Foundation Trust
• Broadly supportive of the transfer and understand their block contract will be enhanced to incorporate the Kinver population (Appendix 6)
4.5 Staffordshire and Stoke on Trent Partnership NHS Trust
• Expressed concerns about service commissioning, care delivery, transfer of services and travel and geography of new service providers (Appendix 7) • Reply to the response from the Director of Commissioning at Dudley CCG (Appendix 8)
4.6 South Staffordshire and Shropshire Foundation NHS Trust
• As above as response from SSSFT was on behalf of both organisations.
4.7 Black Country Partnership NHS Trust
• Acknowledged it was difficult to quantify the impact • Concerned at an increased waiting time for learning disability services • Geographical boundaries would be challenging • Commissioning of the young people’s services would need reviewing as it is local authority commissioned (Appendix 9)
4.8 Internal Governance CCG
The proposed transfer application and supporting information has been presented to the following CCG committees.
4.8.1 Finance and Performance Committee
• The application was discussed at the Finance and Performance Committee February 2018, due to the financial risk associated with the debt remaining with the CCGs the application was not supported
4.8.2 Primary Care Commissioning Committee
• The application was discussed at the Primary Care Commissioning Committee April 2018, • Members agreed that the transfer and merger reflects the direction of primary care whilst acknowledging the financial challenges posed by the potential transfer and expressed concerns about boundary changes as a result of the practice transfer effecting other practices in the area. (These minutes are not finalised until PCCC 30th May)
4.8.3 Membership Board – May 2018
There was a discussion at the Seisdon Locality Board 9th May 2018 where locality practices were represented and shared views and differing opinions on the potential transfer.
• There was support for the application citing the number of Kinver residents currently already receiving services from Dudley, although the numbers are estimated the population of Kinver is 7,500 with 5,500 of those registered at the practice meaning around 26% are receiving primary care services from Dudley or elsewhere. • Members expressed concerns about destabilising the locality and that the transfer sets a precedent for other practices to transfer to neighbouring CCGs • There was an understanding of the sustainability issues at the Kinver surgery • There was a concern that a reduction in budget would lead to a reduced service and that patients would suffer as a result
5
Enc: 02-1 • It was suggested it could be proposed that a transfer where debt was also transferred be put forward • It was agreed that a request would be made to all SESSP practices to respond individually and anonymously if they wished
The members of the Seisdon locality have been asked for comments and feedback as have the wider member practices of SESSP CCG. The responses received are summarised below;
• Five practices have responded to the request for their views on the proposed transfer • One has stated that their partners support the application • One has presented a balanced view saying they would not support if there were CCG issues • Three have said they do not support the transfer for the following reasons; o Negative financial implications for the CCG o Damage to existing community services as contracts are unpicked and reviewed o Longer term damage to services in the locality as a result of reduced income o Destabilising the locality as other practices request to transfer
5.0 Summary
This paper is intended to provide a factual summary of the known information regarding the request by Moss Grove Kinver to transfer from SESSP CCG to Dudley CCG. It summarises the perceived benefits to the practice the patients and the CCGs as well as the potential risks to the practice, the patients and the CCGs.
It is clear that there is an understanding from stakeholders as to the reasons for the application and that this fits with the direction of travel in primary care as a whole but that there are also significant risks to the financial position of the CCGs, to the stability of the Seisdon locality and to the community, social care and mental health services.
If the governing bodies in common do not support the proposal to transfer, no application to NHS England will be made by the CCG to change its constitution meaning the practice will not transfer. If the governing bodies in common do support the practice in applying to transfer an application will be made by the CCG to change its constitution and the decision will be taken by NHS England.
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Enc: 02-2
Application to merge Kinver and
Kingswinford practices and to transfer Kinver practice into Dudley CCG from
South East Staffordshire & Seisdon Peninsula CCG:
Report of Involvement findings
May 2018
Contents 1 Background ...... 2 2 Engagement methodology and feedback ...... 4 3 Involvement feedback ...... 6 3.1 Online survey feedback ...... 6 3.1.1 Participant profiling ...... 6 3.1.2 Survey findings ...... 9 3.2 Public meeting feedback ...... 23 3.2.1 Public meeting feedback ...... 23 3.2.2 Feedback from the GP locality meetings ...... 25 3.2.3 Views from Dudley CCG Member Practices ...... 25 3.2.4 Scrutiny Committee views ...... 26 3.2.5 Dudley CCG Healthcare Forum ...... 26 3.3 Correspondence feedback ...... 27 3.3.1 Participant profiling ...... 27 3.3.2 Key findings from the correspondence ...... 27 4 Conclusion and recommendations ...... 36 4.1 Engagement strategy and response ...... 36 4.2 Summary and recommendations ...... 36 Appendix ...... 38 Appendix A – Engagement plan ...... 38 Appendix B – Online survey data tables ...... 40 Appendix C – Feedback from the public events ...... 56
1 Background
The Partners at Moss Grove Surgery have expressed their wish to merge the two practices (Kinver and Kingswinford). It is not possible to consider this proposal without also considering and making an application for the Kinver based practice to transfer from South East Staffordshire and Seisdon Peninsula CCG (SES SP CCG), to Dudley CCG. The proposal from the practice is therefore to simultaneously merge the practices and transfer Moss Grove Surgery, Kinver into Dudley CCG. The timescale for this proposal is April 2019.
The surgery has expressed their intent in a letter to Dudley CCG highlighting the case for change, this includes;
• Transferring and merging the Kinver Moss Grove practice to Dudley CCG would improve access and choice to Kinver/Kingswinford patients • Kinver patients currently have no choice of extended hours or extended access appointments at their practice. Combining both surgeries will give greater ability to manage variations in ‘on the day demand’ • Improved continuity of care, as patients are sometimes unable to see their preferred doctor as they are working across two surgeries • Merging would mean that patients in Kinver could access nurse services for five days of the week. • Clinics available now to Kingswinford patients (e.g. minor operations, IUCD clinics, injection clinics, etc.) would be available to all patients • Currently the partnership works and supports two CCG's, two NHS England (NHSE) area teams. This increases workload on an already stretched partnership, management team • Economy of scales across both clinical and administration areas • Hope that this will improve recruitment and retention of staff to both practices
Critically, the proposal is not suggesting the scaling back of service provision at either site as a result of this.
To merge the practices, two processes needed to be followed; • An application to make a CCG Constitutional change. This application should come from the CCG, be agreed with member practices, and evidence views around the following: o Any unitary local authority and/or upper tier county council whose area covers the whole or any part of the CCG’s area o Any other CCG which would be affected o Any other person or body which in the CCG’s view might be affected by the variation requested o The extent to which the CCG is assured that patient and public views have been sought • An application to merge practices (subject to the above) - this application should come to the CCG from the practice; be agreed by Dudley Primary Care Commissioning Committee and evidence how the practice has involved patients and the public in the decision
The constitutional boundary change (transfer CCG) requires an application to NHSE by the CCG and the merger application can only be agreed by the CCG after any application to change CCG has been agreed. However, given the importance of the merger rationale to the practice and given that it is this element which resonates more with patients, we have conducted a combined conversation with stakeholders, patients and the public. This report of findings
summarises the feedback provided by patients and the public around this proposal, and ensures their views are being considered in the decision-making process.
Report authors
Dudley CCG commissioned NHS Midlands and Lancashire Commissioning Support Unit (MLCSU) to collate and analyse all the feedback received by the practice and the CCG from this involvement exercise to produce this report. The report has been produced by the Communications and Engagement team at MLCSU and verified by the Director of Communications at Dudley CCG.
2 Engagement methodology and feedback
Dudley CCG and SES SP CCG embarked on an extensive programme of planned communications and engagement, ensuring that all activities were coordinated and that the messages delivered were consistent. The plan helped to:
• Ensure high levels of awareness • Encourage participation in the public meetings • Encourage feedback, through the online survey as well as receive additional correspondence commenting on the proposal
The engagement plan included sending a stakeholder letter detailing the proposal and consultation to all statutory organisations in the area asking them to share their thoughts. A detailed overview of the pre-consultation and post- consultation engagement plan can be found in Appendix A.
The consultation results will be taken to the Primary Care Commissioning Committee in May, when the merger application will be considered in principle. The report will also be taken to the governing body of the CCG in June 2018, to inform the decision on whether to submit an application to transfer the Kinver Practice to the CCG.
Below is an overview of the methodologies used to collect feedback from residents and organisations in the area and how they will be analysed and summarised in this report of findings:
• Online survey comprising six closed and three open questions - both the closed and open questions are tabulated by practice, respondent type, gender, age, ethnicity and religion. Open responses were read and coded before being tabulated, and key quotes identified • Public meetings: th o Two public meetings were held at Kinver High School on 25 April 2018 and Dudley/Kingswinford Rugby Football Club on 1st May 2018. Discussion points at the meetings were captured and have been summarised in this document th o A further public meeting of the CCG Healthcare Forum on the 17 May 2018 o The proposed merger was also discussed with member practices at the five locality meetings below; . Dudley, Netherton (24th April 2018) . Stourbridge, Wollescote and Lye (25th April 2018) . Sedgley, Coseley, Gornal (27th April 2018) . Kingswinford, Amblecote and Brierley Hill (1st May 2018) . Halesowen and Quarry Bank (3rd May 2018) th o The proposal was also presented at the Dudley GP Members event on 19 April 2018 • Submission of correspondence from the public, member practices and stakeholders – each piece of correspondence has been read, coded and a summary of the key findings outlined in this report
The following table shows how many responses have been received through the different channels. The table also shows a breakdown of the responses between Dudley (Kingswinford) and South Staffordshire (Kinver).
Table 1. Breakdown of response by practice/ region Responses from Kinver Responses from Feedback method Overall total (South Staffordshire) Kingswinford (Dudley) 388 186 198 Online survey Open responses: 807 Open responses: 382 Open responses: 413 Written correspondence 22 11 11 84 66 Public meetings 150 (Dudley/Kingswinford (Kinver High School) Rugby Football Club)
A further opportunity for the public to express views was presented at the Dudley CCG Healthcare Forum with around 55 members of the public in attendance.
3 Involvement feedback
3.1 Online survey feedback
The following section reports on the findings from the online survey which was accessible through the surgery websites. Hard copy versions of the survey were also made available for those who requested.
This section provides a summary of who participated in the online survey as well as the key findings from their responses.
Please note: • Significance testing has been carried out amongst sub-groups (e.g. male/female) with a base of at least 50 responses. Where key significant differences between sub-groups are apparent, these have been included within the commentary throughout the section • The ‘open’, free text responses submitted in the survey have all been read and ‘coded’ into themes. These are presented in this section • As part of the analysis of the ‘open’, free text questions, ‘verbatims tables’ have been included which contain a small selection of quotes to bring each ‘coded’ theme to life • Percentages are shown to 0 decimal places, and where figures do not total to 100%, this is due to rounding • The base/ total figure on the tables and charts show the number of participants providing an answer to each question. This number varies as participants were able to skip questions they did not want to answer • A full breakdown of the data by sub-group can be found in Appendix B
3.1.1 Participant profiling
Overall, 388 individuals participated in the online survey, the table below shows the different respondents types completing the survey.
Table 2. Demographic profiling - respondent type
Number Percent Patient at Moss Grove Surgery – Kingswinford 175 45% Patient at Moss Grove Surgery – Kinver 172 44% Carer/ Relative of a patient at Moss Grove Surgery – Kingswinford 1 0.3% Carer/ Relative of a patient at Moss Grove Surgery – Kinver 0 0% Staff Member at Moss Grove Surgery – Kingswinford 22 6% Staff Member at Moss Grove Surgery – Kinver 14 4% Other 4 1% Total 388 100%
The majority of those participating in the online survey are patients, with similar numbers based at Kingswinford (175) and Kinver (172) practices. The remaining sample consists of staff based at the two practices. Only one respondent identified themselves as a carer or relative of a patient.
Almost two thirds of those participating in the survey are female, with around four in ten, male. A small proportion chose to not disclose their gender.
Figure 1. Demographic profiling – gender. Base - 388
61%
37%
2%
Female Male Prefer not to say
The figure below shows the age profile of respondents, with the majority aged over 45, specifically 50% of the participating sample is aged over 65. There is also some representation from the younger age cohort (17 and under to 44).
Figure 2. Demographic profiling – age. Base - 388
31%
24%
19%
13%
5% 4% 3% 1% 2%
17 and 18 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 and over Prefer not to under say
When considering the ethnicity of participants, the majority state they are ‘White/Caucasian/White British’. Additionally, some state they are ‘Asian/Asian British’, ‘Mixed/Multiple ethnic Groups’ and ‘Black/African/Caribbean/Black British’.
Figure 3. Demographic profiling – ethnicity. Base – 388
White/ Caucasian/ White British 94%
Asian/ Asian British 1%
Mixed/ Multiple Ethnic Groups 1%
Black/ African/ Caribbean/ Black British 0.3%
Other 1%
Prefer not to say 4%
Participants were also asked to state their religion, here over two thirds stated they are Christian, whilst around a quarter state they do not have a religion. A small minority state they are; Buddhist, Hindu and Muslim.
Figure 4. Demographic profiling – religion. Base - 388
69%
24%
5% 0.3% 0.3% 0.3% 1%
Christian Buddhist Hindu Muslim Other No Religion Prefer not to say
3.1.2 Survey findings
In response to the information outlined on the Moss Grove Surgery website, around two thirds state they feel positive towards the proposals, with around a quarter feeling neither positive or negative. However, around one in eight feel negatively towards the proposals.
Figure 5. Referring to the information available on www.mossgrovesurgery.co.uk, what are your feelings about the proposals? Base – 388
Negative, 13%
Neither Positive or Negative, 24% Positive, 63%
When considering the age of participants, a significantly greater proportion of those aged over 65 feel positive towards the proposal (68%) compared to those aged 35 to 54 (55%). No other significant differences between sub-groups are apparent.
To obtain further insight around the reasons behind participants’ reactions to the proposals, the survey asked participants: • What positives of your current practice would you want to see maintained after the proposals? • What are your concerns about the proposals? • What ways could we help to alleviate your concerns?
The responses to these questions have been outlined below.
3.1.2.1 What positives of your current practice would you want to see maintained after the proposal?
The figure below shows the elements participants would like maintained after the proposals.
Figure 6. What positives of your current practice would you want to see maintained after the proposals? Base – 313
Good appointment availability (quick to see 22% GP/nurses, good/long open hours) All, everything, maintenance of current standards 20% (facilities, services)
Good staff retention, job security 14%
Personal, nominated, chosen GP (continuity of 11% care)
Good appointment system (e.g. online booking) 10%
Good location, accessibility (Local, good transport 9% links, “keep Kinver practice”)
Specific services, clinics 9%
Current standards of care (good/great/excellent) 8%
Availability of doctors, nurses (easy to see them) 5%
Prescriptions, repeat prescriptions service 3%
Communication, good response 1%
Other 10%
Suggested improvements around appointments 4%
Suggests improvements around services 3%
The aspects mentioned most by survey participants are; ‘good appointment availability’, ‘maintenance of current standards (facilities, services)’, ‘staff retention and job security’, ‘greater continuity of care’ and ‘a good appointment system (e.g. online booking)’.
A very small proportion also took the opportunity to suggest improvements around appointments (4%) and services (3%) here.
Further sub-group analysis shows a significantly greater proportion of those responding from the Kinver practice state they would like the ‘maintenance of current standards’ and ‘good location, accessibility’ when compared to those responding from the Kingswinford practice. Whereas, a significantly greater proportion of those responding from the Kingswinford practice state they would like the ‘maintenance of the current standards of care’ and the ‘availability of doctors and nurses’ following the proposals.
Focussing specifically on patients and their carers, significantly more of this cohort using the Kinver practice state they would like to see the ‘maintenance of current standards’ and ‘a good location, accessibility’ when compared to those using the Kingswinford Practice. However, significantly more of those using the Kingswinford practice state they would like to see the ‘availability of doctors and nurses’ maintained.
Focussing on the gender of participants, a greater proportion of male participants state they would like the ‘maintenance of current standards’, whilst a greater proportion of female participants state they would like to see ‘staff retention and job security’ and the ‘availability of doctors and nurses’ maintained.
The table below shows how views differ by the different age bands.
Table 3. What positives of your current Practice would you want to see maintained after the proposals? – by age Age
34 54 64 65+ 18 - 35 - 55 - 17 under and
Good appointment availability (quick to see GP/nurses, good/long open 0% 19% 31% 30% 15% hours) All, everything, maintenance of current standards (facilities, services) 0% 5% 15% 14% 28% Good staff retention, job security 0% 5% 22% 22% 9% Personal, nominated, chosen GP (continuity of care) 0% 10% 11% 14% 10% Good appointment system (e.g. online booking) 0% 19% 9% 11% 8% Good location, accessibility (Local, good transport links, “keep Kinver 0% 14% 9% 9% 9% practice”) Specific services, clinics 0% 0% 5% 14% 10% Current standards of care (good, great, excellent) 0% 5% 4% 6% 11% Availability of doctors or nurses (easy to see them) 0% 10% 4% 10% 3% Prescriptions or repeat prescriptions service 0% 0% 4% 1% 3% Communication, good response 0% 0% 2% 2% 1% Other 0% 10% 7% 9% 11% Suggested improvements around appointments 0% 0% 11% 2% 3% Suggests improvements around services 0% 5% 5% 0% 3% Base 2* 21 55 81 147 *Both responses were invalid and hence have not been included in the analysis
A full breakdown of the data by the demographic sub-groups can be found in Appendix B.
The ‘verbatim table’ below contains a selection of responses provided by participants in response to this question in the survey.
Table 4. What positives of your current Practice would you want to see maintained after the proposals? – verbatim table ‘Coded‘ theme Verbatim “Being able to see a doctor “Amount of late appointments and without having to wait days Good minor surgery options etc available “Access for patients to to get in. Currently I have no appointment to current moss grove patients appointments. Kinver issues with Kinver surgery availability (quick maintained and not being used up patients better access to but having previously been a to see GP, nurses, by kinver patients coming to the Dudley services” patient at Kingswinford good, long open surgery as that surgery not offering Staff Member – some years ago, it was a very hours) them.” Kingswinford busy practice.” Patient – Kingswinford Patient - Kinver “Reduction in administrative costs if the merged practice is in Dudley CCG Ability of patients to see “I feel negative about the Clinical staff in its two sites, i.e. proposals and would rather All, everything, “To maintain the care and Kingswinford or kinver Retention of things remained as they maintenance of feel of a VILLAGE practice - current services Economies of scale, are.” current standards not a larger practice.” greater flexibility Kinver patients Staff Member - (facilities, services) Patient - Kinver will benefit from the MCP (from a Kingswinford Dudley perspective) Could offer greater continuity of care” Patient - Kingswinford “To ensure surrent staff contracts are retained & not affected for current “A good range of availability “The standard of care by both staff. Take in to account Good staff of appointments and the medical & ancillary staff is excellent. that there may be changes retention, job same staff continuing in their Keep up the good work.” to some job descriptions to security current job roles.” Patient - Kingswinford ensure efficiency across Patient - Kinver both.” Staff Member - Kingswinford “Kinver is the best surgery for appointment waiting “Try to maintain contact with same “Being able to get an Personal, times, 3 weeks max is the GP who knows who I am, and will appointment, and with my nominated, most I’ve ever had to wait, have a shrewd idea of what's wrong chosen doctor would be chosen GP most surgery’s is at least 5 this time!” good.” (continuity of weeks to see your chosen Patient - Kingswinford Patient - Kingswinford care) doctor, so definitely keep
limited waiting times.” Patient - Kinver “Ability to book emergency “That the practice remains in Kinver “Ability to book Good appointment on the day and village. Use of online app for appointments online with a appointment advance appointments with prescription requests and general specific GP, but also to get system (e.g. online chosen GP.” appointments.” emergency appointments.” booking) Patient - Kinver Patient – Kinver Patient - Kingswinford Good location, “Closeness of services better “Location, can be reached easily “Evening surgery for people accessibility (Local, for patients & more without need to travel either by who work. Location of good transport accessible services. Good public transport or car.” surgery crucial for me, links, “keep Kinver supportive teamwork Patient - Kinver being local allows me to practice”) Patient satisfaction - make evening
appreciate continuit of GP's appointments. Location of and staff.” chemist, doctor can sumbit Patient - Kinver prescription directly to chemist when required. An efficient and helpful service from reception.” Patient - Kinver “Ease of appointments. “Being able to access physiotherapy, “Friendly approachable Availability of clinics i.e. blood tests, flexible appointments, Specific services, staff and atmosphere, cervical smear, vaccinations reasonable time spent with doctor clinics female 'health' sessions” Personal service.” for an appointment.” Patient - Kingswinford Patient - Kinver Patient – Kingswinford. “That the surgery is not stretched to the detriment of patients within the Kingswinford area due to doctors “Maintain the level of care being diverted to Kinver, which “High quality of care from Current standards from the reception/booking appears to be the case now as the clinical staff. Fairly well of care (good, staff and the care from doctors that have usually been on integrated systems.” great, excellent) medical staff.” hand at Kingswinford always seem Staff Member – Patient - Kinver to be at the Kinver surgery. Bigger Kingwinsford and Kinver is not better whatever the Health Service tries to imply.” Patient - Kingwinsford “If you can see doctors at either practice and the number of appointments remains the same at each “Everything about Kingswinford practice the time between Moss Grove surgery is excellent. The “Access to appointments booking an appointment Dr's are always available when within reasonable and seeing a doctor could myself or my family need them. The Availability of timescales. Access to a increase. How is that a nursing staff are experienced and doctors, nurses range of doctors and benefit to patients at each ubderstanding. The availability of (easy to see them) services.” surgery. Surely to offer this appointments is most acceptable Patient - Kinver increased choice the and I would be very disappointed if number of appointments at this was to change in any way.” both practices should Patient – Kingwinsford increase to prevent longer delays.” Patient - Kingwinsford
“Online booking system. “Booking appointments on line at Prescriptions, “Repeat prescriptions. Collecting repeat either surgery to see regular GP and repeat Good service at present.” prescriptions from village on line ordering of prescriptions for prescriptions Patient - Kingwinsford pharmacy.” local pharmacy in kinver.” service Patient - Kinver Patient – Kinver “Availability of specific “Speedy response and signposting “Good team with excellent Communication, doctors. Text reminders where necessary” communication” good response about appointments” Patient – Kingswinford Staff Member – Kinver Patient - Kinver “We need to be given more “Reduced administration can only “All staff have same work Other information than is being help everyone & free up time for load at Moss Grove Kinver”
offered here. Kinver surgery what doctors and support staff are Staff Member - Kinver is in dire need of an upgrade. trained to do, treat patients” When we were encouraged Patient - Kingswinford to move from the High Street to the Clinic we were promised by SCCG that the building would become a state of the arts surgery with facilities for minor ops with up to date equipment. It was decided to move. Apart from some issues concerning health and safety (i.e. new boiler and removal of ceiling tiles) nothing else was carried out. My fear is that if we are taken over by Dudley CCG again nothing will change.” Patient - Kinver “All of it. Like the patient access “Better patient care, more “Shorten waiting time for appointment system. Wish you Suggested appointments across both appointments with could get more information on it so improvements sites due to reduced nominated doctor.” you wouldn’t have to bother the around beurocracy” Patient - Kinver surgery thus reducing their work appointments Staff Member - load.” Kingwinsford Patient - Kingwinsford “Patients would benefit from more local Dudley services. “To keep the blood test clinic and if Partners & management possible offer appointments on line “Access to same GP. Access Suggests would only have one CCG to so we don’t have to call the practice. to better Dudley Services improvements meet and work with, saving It would also be of great benefit if for patients” around services valuable time. The Kinver you offer extra sessions?” Staff Member - team to remain at Kinver as Patient - Kingwinsford Kingwinsford work so well together” Patient - Kinver
3.1.2.2 What are your concerns about the proposals?
The main concerns outlined by participants are the prospect of ‘longer waiting times, difficulties getting appointments’, ‘increased pressure of extra patients’, travel issues and fear of a decline in service availability. All the concerns stated by participants are shown in the figure below.
Figure 7. What are you concerns about the proposals? Base – 268
Longer waiting times, difficulty getting 25% appointments Increased pressure of extra patients (increased 21% workload) Hard to travel, location issues (public 12% transport/car park) Decline in, loss of services (incl. cutbacks) 11% Continuity of care (Personal/nominated/chosen 8% GP) Closure of the practice 8%
Job security, stability 6% Logistics of multiple sites (e.g 4% records/paperwork/communication) Having to work at multiple sites 3%
Equality of service provision after merger 3%
Other 7%
No concerns/ concerns were answered 7% Agree with merger, combining services is a good 4% idea Should work if proposal is correct/there's no 3% decline in service It will be beneficial 1%
Positively, when asked to outline concerns some stated; they didn’t have any concerns (7%), they agreed with the merger (4%), there should be no ill-effect if the proposal is correct (3%) and the proposals will be of benefit (1%).
Further sub-group analysis shows a significantly greater proportion of those responding from the Kinver practice state they have concerns around; the ‘decline in, loss of services’ and ‘closure of the practice’. Additionally, significantly more of this cohort also state they don’t have any concerns when compared to those responding from the Kingswinford practice.
The analysis shows significantly more of those responding from the Kingswinford practice state they have concerns around; ‘longer waiting times, difficulties getting appointments’ and ‘increased pressure of extra patients’. Additionally, significantly more of this cohort also state they ‘agree with the merger’ and feel ‘combining the service is a good idea’, compared to those responding from the Kinver practice.
Focussing specifically on the patient and carer cohort, significantly more of those based at Kingswinford highlight ‘longer waiting times, difficulties getting appointments’ and ‘increased pressure of extra patients’ as concerns than those based at the Kinver Practice. Whilst significantly more patients and carers based at the Kinver practice outline the ‘decline in, loss of services’ and ‘closure of the practice’ as concerns compared to those based at the Kingswinford practice.
Focussing on the gender of participants, a greater proportion of males state the idea of ‘having to work at multiple sites’ as a concern, whilst significantly more females state ‘job security, stability’ as a concern. Also, significantly more female participants state they ‘agree with the merger and feel combining services is a good idea’.
The table shows how views differ by the different age bands.
Table 5. What are you concerns about the proposals? – by age Age
under 34 54 64 65+ 18 - 35 - 55 - 17 and
Longer waiting times, difficulty getting appointments 0% 32% 30% 32% 18% Increased pressure of extra patients (increased workload) 0% 37% 22% 22% 18% Hard to travel, location issues (public transport/car park) 0% 21% 2% 11% 14% Decline in, loss of services (incl. cutbacks) 0% 5% 18% 11% 9% Continuity of care (Personal, nominated, chosen GP) 0% 5% 6% 7% 10% Closure of the practice 0% 11% 6% 11% 8% Job security, stability 0% 0% 18% 3% 3% Logistics of multiple sites (e.g. records, paperwork, communication) 0% 11% 2% 8% 3% Having to work at multiple sites 0% 5% 8% 4% 0% Equality of service provision after merger 0% 0% 4% 1% 4% Other 0% 16% 6% 4% 10% No concerns/ concerns were answered 0% 0% 4% 8% 9% Agree with merger, combining services is a good idea 0% 5% 6% 1% 5% Should work if proposal is correct, there's no decline in service 0% 0% 2% 3% 5% It will be beneficial 0% 0% 4% 0% 0% Base 2* 19 50 73 115 *Both responses were invalid and hence have not been included in the analysis
A full breakdown of the data by demographic sub-groups can be found in Appendix B.
The ‘verbatim table’ below contains a selection of responses provided by participants in response to this question in the survey.
Table 6. What positives of your current Practice would you want to see maintained after the proposals? – verbatim table ‘Coded‘ theme Verbatim “1). That patient information “1) Jobs - higher workload “With extra people from could be lost between the two when staff already working to Moss Grove K'ford it would surgeries or not updated in a capacity Longer waiting be more difficult to get an timely manner. 2) When people leave, putting times, difficulty appointment. There is no 2). Even greater waiting times to their workload to other staff getting direct transport link from see a doctor. 3) Longer waiting period for appointments Kinver to K'ford - difficult 3). Even greater inconsistencies in referrals for our patients.” for elderly to get there.” seeing your preferred doctor Staff Member - Kinver Patient - Kinver because of more patients.”
Patient - Kingswinford “My main concern is the limited resources at Kingswinford which may not be able to cope efficiently with the increased activity on this site. Dare we mention the car park! All patients who visit kingswinford from Increased pressure Kinver will need own transport - “To merge would mean “Jobs, workload How does this of extra patients cars, cars, cars!!! 1) Stress can be huge patient numbers.” affect our contract??” (increased added to any illness you have Patient - Kinver Staff Member - Kingswinford workload) after negotiating th car park!! The local post office does not help.2) It appears that taking over kinver practice has been a great clinical challenge. The 'Eastbourne Type' Kinver Patient profile is a challenge in itself.” Patient - Kingswinsford “I am unconvinced that going into a pool with 15000 other “Lack of car parking at people is a positive. There is “Travelling:- How do we Kingswinford Surgery for any no direct public transport get to Kingswinford or additional patients and should you have to go to Wombourne? No buses so professional staff Can see many Kingswinford. The practice has pay for a taxi? No local taxi advantages for Kinver Surgery as limited parking facilities and service. Any parking? I do the smaller practice, but not for Kingswinford itself doesn't not know where Moss Kingswinford Surgery exactly have ample parking. I Hard to travel, Grove K'ford is. Continuity Geographical distance between recently used the mental location issues could be difficult if different the two surgeries will limit the health services provided by (public surgeries. We our South effectiveness of this model of Seisdon and was impressed transport/car park) Staffs - not West Midlands. patient care. No bus services to with the availability of Our choice to live here not link the two surgeries. Concern appointments and also that I West Mid. Kinver money that this proposed change is could see someone in Kinver,. I for them will get absorbed being driven by the threat to the would not like to have to do by Dudley patients, more of future of Kinver Surgery rather this under the banner of them.” than improved patient care at the "Dudley" and would also not Patient - Kinver two surgeries.” be starting from square one in Patient - Kingswinford effect if I had to start seeing someone completely
different.” Staff Member - Kingswinford “The acupuncture I received was “Impact on Choose & Book, second to none and enabled me “A watering down of services Social Care, Care Homes & to walk after suffering great pain i.e. Physio is only available at Decline in, loss of MH Services Will savings and discomfort. Therefore I am the Kinver site (not Moss services (incl. be re-invested? The MCP worried whether this service Grove) and that is on the 3rd cutbacks) could easily and would be available after the Wednesday of the month.” infrequently be fractured.” proposals.” Patient - Kingswinford Patient - Kinver Patient - Kinver “That if I would prefer my care to be with the same GP I may have “I value my regular visits “No direct bus routes from to travel to Kinver. Fine at my age with the diabetic nurses in Kingswinford to Kinver, or vice Continuity of care and with transport but not for Wombourne. I would not versa. Increase in cars on car (Personal, people with young children or be happy visiting an park, difficulty parking at the nominated/chosen disabled or elderly. Appointments already over-loaded moment. Difficulty in being GP) with the same clinician at the Russells Hall Hospital.” seen by same doctor.” same surgery may be spaced out Patient - Kinver Carer -Kingswinford time wise.” Patient - Kingswinford “Required or expected to travel to Kingswinford. That there won't be “That over time this will see sufficient staff to keep Kinver a reduction in service or going and that it will diminish, closure of kinver. The CCG just as village is again expanding. “Precursor to closing one of Closure of the doesn’t have an endless pot Sounds like the proposal is for the the practices.” practice of money. Also that the benefit of the practice not the Patient - Kingswinford MCP will affect the services patients. I can see how it will be offered from 2019.” cost saving to the practice but Patient - Kinver fear it will be at the out of services.” Patient – Kinver “None - should not make a lot “Happy with the proposals “More incoming phone calls to of difference to us in our but worried about closure Kinver, not enough staff, both working environment but ?job sometime due to lack of Job security, scanner & coder have to answer security ?contract of recruitment everywhere stability phonecalls as no telephone staff employment will continue and Kinver area being here at 8am” from original start date not small.” Staff Member - Kinver merger.” Patient - Kinver Staff Member - Kingswinford “Considering the cost of achieving and operating this amalgamation I “Distribution of hospital “How will paperwork be dealt consider the money would letters from hospitals, would Logistics of multiple with? Need to make sure be better sent aquiring they be sent to the wrong sites (e.g. records, appointments are booked under larger and better premises. practice? Would we have to paperwork, the correct surgery to save any perhaps on one of the keep forwarding letters on to communication) mistakes”. industrial estates, keeping K'ford?” Staff Member - Kinver the traffic away from the Staff Member - Kinver congested village centre.” Patient - Kingswinford
“Personally happy to work at both sites but some staff “Job merge 1 person to do job “That I'd have to keep working at Having to work at may find it difficult if across both sites resulting in different places.” multiple sites required.” job losses.” Staff Member - Kinver Staff Member - Staff Member - Kingswinford Kingswinford “That the more experienced staff members will be located mainly in “Proposed move to dudley Kinver. Moss Grove has taken on “Kingswinford doctors Equality of service Group - i.e. Preferential too many new patients and spending more time at provision after treatment for Dudley appointments / services have Kinver.” merger residents.” been stretched in recent years Staff Member - Kingswinford Patient - Kinver resulting in overworked staff.” Patient - Kingswinford “Funds that should be for Kingswinford patients “I am a resident of Staffordshire and want being used by patients from a different borough. Other my services to remain in the county.” Patients from kinver taking appointments and Patient - Kinver resources from an already very busy practice.” Patient - Kingswinford “None - I welcome the “I don't have any concerns. I merger so that there is would welcome all under 1 more chance of getting authority. At the moment:- 1) emergency appointments, Medical/Dudley 2) Mental Health “I have no concerns. Your No concerns, when required. If I need to Dementia/Staffordshire no local website info and FAQ seems concerns were see a GP, I don't care where support 3) Speech, physio, O.T. to have covered everything.” answered they are. In fact, why can't Wolverhampton Rehab Centre Patient - Kingswinford I as a UK citizen book an They do not speak with one appointment at ANY GP another - different computer surgery in England?!?” systems.” Patient - Kinver Patient - Kinver “I am happy to join “If everything stated is correct, Kingswinford - we were Agree with merger, both surgeries are already “No concerns, I think it will patients there for 25 years, combining services working along side one another work well!” and if things remain the is a good idea so should be no problems.” Staff Member - Kingswinford same, I have no concerns.” Patient - Kingswinford Patient - Kinver “None from what I've “None about Stage 1; Kinver “Initially seems ik - concerns heard/read so far. If the being bought in to Dudley. about longer term aspects e.g. Should work if improved service across the Concern about further merging with other proposal is correct, two sites is as stated we developments incorporating other Kingswinford practices or there's no decline in should be able to enjoy a services in stage 2. Space for being taken over by a service more streamlined service other agencies attached to the 'management company'.” hopefully.” practice is at premium.” Patient - Kingswinford Patient - Kinver Patient - Kingswinford “All seem very positive.” “None - it's positive.” It will be beneficial Patient - Kinver Staff Member - Kingswinford
3.1.2.3 What ways could we help to alleviate your concerns?
Participants outline a number of ways in which concerns can be alleviated, including; ‘communication, information about the changes’, ‘ensuring, improving appointment availability’ and ‘seeking more resource to cope’. All the methods outlined have been included in the figure below.
Figure 8. What ways could we help to alleviate your concerns? Base – 226
Communication/information about the changes 20%
Ensure/improve appointment availability 14%
Seek more resources to cope (budget/staff) 10%
Improve/guarantee services 8%
Stay the same, abandon plans/changes 8%
Don't merge, close or move the local practice 6%
More discussion/open to questions 5%
Job security/stability, no changes to terms 3% (working hours/location/pay grade)
Other 12%
Don't know 5%
Sub-group analysis shows a significantly greater proportion of those responding from the Kinver practice state concerns could be alleviated by;
• ‘Staying the same, abandoning the plans, changes’ • ‘Don’t merge, close or move the local practice’
Whereas, significantly more of those responding from the Kingswinford practice state concerns could be alleviated by seeking more resource. This significant difference is also present amongst the Kingswinford patient, carer cohort when compared with the Kinver patient, carer cohort.
However, significantly more patients and carers based in Kinver state concerns could be alleviated by; ‘improving, guaranteeing services’ and not ‘merging, closing or moving the practice’ than those responding from the Kingswinford. practice
Additionally, a significantly greater proportion of male participants state concerns could be alleviated by; ‘seeking more resource’, ‘improving, guaranteeing services’ and by ‘staying the same and abandoning the changes’. Whereas, significantly more female participants state ‘more discussion’ would alleviate concerns. A significantly greater proportion of 55 to 64-year olds also feel more discussion would alleviate concerns compared with those aged 65 and over.
A full breakdown of the data by demographic sub-groups can be found in Appendix B.
The ‘verbatim table’ below contains a selection of responses provided by participants in response to this question in the survey.
Table 7. What ways could we help to alleviate your concerns? – verbatim table ‘Coded‘ theme Verbatim “We need to know in advance “Good communication what proposals you have put in using social media and place to maintain the services “Clarification of the plan other means eg we have at the moment and also regarding EMIS & Docman Newsletter Meeting how you propose to better these (i.e. Seperate EMIS codes commitment given that services i.e. by not having a two to remain/Kinver as a Communication, care of patients in week wait to see a doctor (other 'Branch site' in EMIS, information about the Kingswinford will not than in an emergency) What are possible implementation of changes change Ensure the your plans with regard to the Docman 10 for 'web' Patient Panel is kept proposed development of a access of documents)” informed/consulted on further 144 houses in the village Staff Member – Kinver and developments - will you be able to cope any Kingswinford including MCP.” better by joining Dudley.” Patient - Kingswinford Patient - Kinver “1). I would like to see a “We need to know in advance doctor when I need to what proposals you have put in rather than have to place to maintain the services “Keep the emergency waiting weeks before we have at the moment and also appointments being able to book an how you propose to better these Changing from South appointment. 2). Being services i.e. by not having a two Staffs CCG to Dudley - able to see the same Ensure, improve week wait to see a doctor (other will this mean if you doctor for consistency appointment availability than in an emergency) What are are referred you will be within reasonable time your plans with regard to the able to see/access frames. 3). Not having to proposed development of a Dudley serviices (i.e. wait on the telephone or further 144 houses in the village CAMHS)?” keep trying to get through - will you be able to cope any Patient - Kinver to actually book an urgent better by joining Dudley.” appointment.” Patient - Kinver Patient - Kingswinford “Probably not within the gift of “Don't increase “More staff to answer the practices - but the expansion services at phone We are told when of appointment/consultation Kingswinford without Seek more resources to cope scanning & coding not to opportunities seems to me to be increasing resources. (budget, staff) answer phone calls, but if fundamental. Whether this can It's often very difficult we don't do it - who will?” be achieved via more staff to get an appointment Staff Member - Kinver recruitment and retention may now and patients have
not be within the gift of the to "run the gauntlet" of practise - so probably worth getting agreement exploring on-line/telephone from the Receptionist access to consultation.” that their need is Patient - Kinver urgent.” Patient –Kingswinford “There are many services at Moss Grove that could be streamlined to free up “Good communication appointments. There is using social media and supposedly a system other means eg whereby emails can be Newsletter Meeting sent to request commitment given that prescriptions where a “More care in the community. care of patients in doctors appointment isn't Improve, guarantee services Homes, visits, etc.” Kingswinford will not required. I have emailed Patient - Kinver change Ensure the this twice in the past and Patient Panel is kept received no response. A informed/consulted on triage system should also developments be managed by including MCP.” receptionists (like many Patient - Kingswinford other GP surgeries) to filter out unnecessary appointments.” Patient - Kingswinford “Not to go ahead; the proposal is non- workable for both surgeries. Our impression is that NHS England is pushing for “Don't change the current changes nationally and “Maintain current practice Stay the same, abandon system which is great.” these proposed local working environment.” plans/ changes Patient - Kinver changes are merely a Staff Member - Kinver response to this national agenda and will not ultimately benefit the two surgeries.” Patient - Kingswinford “Keep Kinver as an active surgery. We will be swamped by “Ensure that Kinver the numbers in K'ford. In Dudley patients can always be we'll be 2nd class citizens. Even “Advise that location is not Don't merge, close or move seen in Kinver, even if if we "stay as we are now" soon changing.” the local practice they might have to be pushed out by numbers. Not Patient - Kingswinford wait a bit longer.” convinced by speaker of our Patient - Kinver security as individuals.” Patient - Kinver More discussion, open to “To be open and transparent “Keep consultation, “Be honest and upfront. questions regarding the proposals and information and Better to hear from
how this will impact on patients decisions open and partners than the and staff.” accessible to all patients/media. Please Patient - Kinver patients.” treat us a people with Patient - Kingswinford mortgages, families & bills to pay - not just bums on seats. Please take this as being honest answers NOT critical.” Staff Member - Kinver “Guarantee our jobs are Job security, stability, no “Recruit extra doctors so doctors “Keep same hours & safe.” changes to terms (working stay at one practice.” place of work.” Staff Member - hours, location, pay grade) Patient - Kingswinford Staff Member - Kinver Kingswinford “We need to be able to talk to Drs if choice more easily if consultations aren’t available as they fully understand your very personal “Push for a shared database for conditions where another Dr often has no idea clinical records Ops in one hospital about you and what is right. Often not even are not known at a hospital in reading notes properly and you having to Other another area (i.e. 3 ops at QE in 2012 explain your condition(s) yourself. That is very were not known at Kiddie minor ops hard especially with mental health conditions whose records related to 1983 op)” where the research shows undoubtedly better Patient - Kinver to have a consistent medical practitioner; especially your GP!!!” Patient - Kingswinford
3.2 Public meeting feedback
3.2.1 Public meeting feedback
During this involvement activity, two public events were held where 150 members of the public attended. These events took place on;
• Wednesday 25th April at Kinver High School, where 66 people attended • Tuesday 1st May at Kingswinford Rugby Football Club, where 84 people attended
During the events, many people expressed their support for the proposals as outlined in the feedback and verbatims below.
It is felt that the merger will enable both practices to remain/become sustainable now and in the future, and therefore this merger would be a positive move in the interests of all involved. To ensure access to a ‘wider’ service/clinic facility this merger would be beneficial. However, the merger needs to reflect the needs of all patients at both surgeries and it is appreciated the lengths gone to invite patients to the meetings.
“I hope that public views are considered in this process rather than the usual NHS financially driven decisions.” Public event attendee
“I’m grateful for the doctors taking time to talk us through these changes, giving me a chance to ask questions. I support the plans.”
Public event attendee
“Based upon the recent public meeting, given the outline information regarding the direction of the Moss Grove surgery, I am more positive than negative about the merger.” Public event attendee
“Given the outline information regarding the direction of the Moss Grove Surgery, and response to my Questions I am very satisfied that these changes will be positive for the practice and us as patients.” Public event attendee
Other feedback captured at the events was around how the proposals appear to improve the services available at the Kinver Surgery or to ‘save’ the Kinver Surgery. However, there is a feeling that even with a more ‘connected’ community service that gets to know patients and each other working and visiting around Kingswinford are unlikely to travel to Kinver residents was also mentioned. There is acceptance that ‘footfall’ will not increase but the availability of appointments at the Kingswinford practice, for Kinver patients will reduce the amount or reduce the chance of Kingswinford practice patients getting an appointment at the Kingswinford practice.
Event attendees also raised several questions, which were answered fully by representatives managing the involvement activity. The questions raised by attendees during the events, are grouped into themes below.
Those attending the events were also signposted to the online survey, therefore their feedback will be reflected in section 3.1 above.
Impact on the practices • “Will the Kingswinford surgery get busier?” • “If unsuccessful what does it mean for Kingswinford patients?” • “If we become a Dudley practice will the other people who live in Kinver, currently registered with Dudley practices, want to move to Kinver surgery?”
Provision of services • “You mentioned more services coming out into the community but there is no room at Kingswinford so where will they be based?” • “How do you balance the statements, ‘no service change’ with ‘improved opportunities for innovative service changes’?” • “I have been involved in the NHS for 35 years and I have never seen services so stretched, demand so high and staff so wanting. What can be done to help that?” • “If merger does go ahead will telephone access get worse?” • “My relative had dementia and we didn’t receive great help from Staffs services. Could we have used the dementia services in Dudley if this transfer/ merger had already happened? Services such as the memory assessment service?”
Contracts and financials • “What is the financial situation?” • “I’m worried about the implication that the practice is operating as a business?”
• “If the ideal scale of general practice is 35,000 registered patients, then if this merger is successful then Moss Grove would have around 20,000 patients so who else would ultimately be in the grouping?” • “Can you explain the areas where you would find economies of scale?” • “Can we get more money for the building?”
Appointment availability • “If doctors work across both sites could I get an appointment in Kinver in the future if this goes ahead?” • “Will it be harder to get an appointment in Kinver and could I go to Kingswinford if I can’t?” • “There are longer waits for physiotherapy in Dudley than Staffs, will that be corrected?” • “Appointments work well at Kinver, but we hear they are worse at Kingswinford will all those patients travel here and take our appointments?” • “Will the transfer affect patient choice and options on Choose and Book?”
The application process • “What happens if South Staffs or Dudley CCG don’t support the application?”
Accessibility • “People in Kinver can’t drive and there are no buses to Kingswinford
The Multi-speciality Community Provider (MCP) • “The future MCP that you talk about, can you explain what it is in more detail and can it go bust?” • Following both events, members from the CCG and the practice stayed behind to answer questions around the MCP as residents were particularly interested to learn more about it and its role with regards to keeping people out of hospital.
Appendix C provides a summary of the responses that were given to the questions posed at the events.
3.2.2 Feedback from the GP locality meetings
All five of the Dudley GP localities discussed the proposed merger and supported the Kinver/Moss Grove merger application. The proposal to accept the Kinver practice were endorsed on the basis that the transfer did not incur additional costs for the CCG in terms of providing commissioned services to the merged practices.
3.2.3 Views from Dudley CCG Member Practices
The proposal was presented at the Dudley GP Members event on 19th April 2018 where the following questions were raised and addressed;
• Will this reduce the level of community services provided to other practices? • Will this reduce practice share of the PMS premium that is available through the DQOFH?
In response, the CCG advised the GP Membership that patients registered with the practice currently access community services such as district nursing, therapies, mental health services and community midwifery through contracts set by
SES SP CCG. These contracts will be transferred to Dudley CCG with the appropriate level of funding and access maintained without any effect on other Dudley practices.
Adult social care and public health services including health visiting, sexual health and substance misuse are the responsibility of Staffordshire County Council. These arrangements will remain in place without any effect on other Dudley practices.
The resources associated with the services commissioned by the CCG will become the responsibility of the Dudley Multi- speciality Community Provider (MCP) when it is established. It will then be the responsibility of the MCP to determine how best to provide community health services for the practice’s patients in a manner consistent with the service model that the MCP will be contracted to deliver. As far as adult social care and public health services are concerned, any change to existing funding arrangements will require a separate agreement to be made between Staffordshire County Council and Dudley Metropolitan Borough Council.
Considering the question around the possible reduction in the share of the PMS premium, in response, the Kinver practice will contribute to the PMS premium which will be used to invest in the Dudley Quality Outcomes for Health Framework (DQOFH) in the same way as has occurred with existing Dudley practices. Kinver’s disease register sizes are being looked at, but the expectation is there will not be any positive or negative net effect on the DQOFH values for other practices.
A GP of a membership practice subsequently commented;
“As a GP of a membership practice I would support this merger and bringing Kinver into Dudley CCG. My reasons are: The GP surgery is a resource for patients in a small village and will not only be a hub for health but also a source of health promotion. I hear arguments that this will be cost neutral to the CCG, but even if there is a small cost, this would be acceptable to me as the majority of any financial risk would be with the Practice who clearly feel they are able to manage this. The CCG will benefit from the changed administration process, hopefully easing that burden. I suspect that the current status quo is un sustainable and consequently, if this merger did not proceed then it wouldn't be long before Moss Grove were unable to continue to support Kinver as a Branch Surgery and would be looking at closing it.” 3.2.4 Scrutiny Committee views
The proposals were offered to Dudley Health and Adult Social Care Scrutiny Committee; however, the chair didn’t feel there was time at the April Committee to consider the proposal. No further comments had been received.
3.2.5 Dudley CCG Healthcare Forum
The Dudley CCG Healthcare forum also received the proposals at the meeting on the 17th May. This presented an opportunity for questions to be raised and for people to express an opinion directly to the CCG. There were no objections raised to the proposals.
3.3 Correspondence feedback
3.3.1 Participant profiling
Overall, in response to this involvement activity 23 pieces of correspondence were received. The format of these correspondence were emails, letters and meeting minutes. The table below provides an overview of the organisations sending correspondence during the involvement period.
Table 8. Those sending correspondence through by location Correspondence received from those based in the Correspondence received from those based in the Dudley CCG area South East Staffordshire and Seisdon Peninsula CCG area Dudley Local Medical Committee South Staffordshire Council The Dudley Group NHS Foundation Trust - Russells Hall South Staffordshire Member of Parliament Hospital Dudley & Walsall Mental Health Partnership NHS Trust Healthwatch - Engaging Communities (2 responses) Lower Gornal Medical Practice Staffordshire Local Medical Committee MCP Bidding Partnership South Staffordshire Council Dudley Metropolitan Borough Council County Councillor for South Staffordshire Patient Opportunity Panel feedback Gravel Hill Surgery Lion Health Surgery Moss Grove Kinver Patient Panel AGM Member of staff at the Dudley Group NHS Foundation Kinver Parish Council Trust Staffordshire and Stoke on Trent Partnership NHS Three Villages Medical Practice Trust South Dudley Member of Parliament Black Country Partnership NHS Foundation Trust
3.3.2 Key findings from the correspondence
As shown in the figure below, there is great support towards the proposal with 15 of the 23 organisations stating they ‘support the proposal to merge the two practices’. Other key themes to emerge from the correspondence focus on the positive impacts on the sustainability and accessibility of services available to patients, greater continuity of care and the consolidation of CCG workload.
However, some question how the merger will affect the provision of community and social care services.
Figure 9. Emerging themes from the correspondence received. Base - 23
Support the proposal to merge the two practices 15
Merger will mean patients will have greater access to services 8
Merger will mean stability, sustainability of services 5 The proposal should consider implications on community, council 5 services (e.g. home treatment) The proposal should consider the impact on social care 5 If merger were to go ahead, would expect contracts, financials to 4 reflect this Hope the merger is able to secure important services for Kinver 3
Merger will potentially offer greater continuity of care 3
Merger will streamline CCG workload, pressures 3
Consultation document is clear and concise 2 Decision to move the practice between CCGs is the responsibility of 2 NHSE Don't mind who provides services in South Staffordshire as long as 2 they are high quality Merger could offer greater out of hours access 2 Reassurance required around how long a surgery will remain in 2 Kinver Concerns around the potential impact on Dudley CCG population as 2 a result of Kinver's inclusion Requirement to agree a plan for out of hours services 1
Need to allocate resource to ensure transfer and minimise impact 1 The financial risk involved in the merger of the two practices is at 1 an acceptable level Need to consider how Kinver residents can access services at 1 Kingswinford Concern there is a risk that Dudley health services will be provided 1 to residents from neighbouring councils Concern the merger may lead to the surgery being removed from 1 Kinver Would not support the whole practice moving to Kingswinford 1 Concerns around the outstanding deficit of the Staffordshire health 1 economy transferring with the practice Assurance that removal of one practice will not affect other 1 practices within South Staffordshire Reassurance the public have been engaged/consulted with 1 sufficiently Confirmation that there will be no change to the opening times of 1 either practice Confirmation that there will be no change to the number of 1 appointments available at either practice
Focussing on the Dudley and South East Staffordshire and Seisdon Peninsula areas, the table below shows how the emerging themes are split between organisations in the two areas.
Table 9. Emerging themes from the correspondence received by area. Base - 23 Total Dudley South Staffordshire Support the proposal to merge the two practices 15 9 6 Merger will mean Patients will have greater access to services 8 3 5 Merger will mean stability, sustainability of services 5 3 2 The proposal should consider implications on community, council services 5 3 2 (e.g. home treatment) The proposal should consider the impact on social care 5 3 2 If merger were to go ahead, would expect contracts, financials to reflect this 4 3 1 Hope the merger is able to secure important services for Kinver 3 2 1 Merger will potentially offer greater continuity of care 3 1 2 Merger will streamline CCG workload, pressures 3 1 2 Consultation document is clear and concise 2 0 2 Decision to move the practice between CCGs is the responsibility of NHSE 2 0 2 Don't mind who provides services in South Staffordshire as long as they are high quality 2 0 2 Merger could offer greater out of hours access 2 0 2 Reassurance required around how long a surgery will remain in Kinver 2 0 2 Concerns around the potential impact on Dudley CCG population as a result of 2 2 0 Kinver's inclusion Requirement to agree a plan for out of hours services 1 1 0 Need to allocate resource to ensure transfer and minimise impact 1 1 0 The financial risk involved in the merger of the two practices is at an acceptable level 1 1 0 Need to consider how Kinver residents can access services at Kingswinford 1 1 0 Concern there is a risk that Dudley health services will be provided to 1 1 0 residents from neighbouring councils Concern the merger may lead to the surgery being removed from Kinver 1 0 1 Would not support the whole practice moving to Kingswinford 1 0 1 Concerns around the outstanding deficit of the Staffordshire health economy 1 0 1 transferring with the practice Assurance that removal of one practice will not affect other practices within 1 0 1 South Staffordshire (e.g. more practices wanting to move) Reassurance the public have been engaged, consulted with sufficiently 1 0 1 Confirmation that there will be no change to the opening times of either practice 1 1 0 Confirmation that there will be no change to the number of appointments 1 1 0 available at either practice
The individual responses provided by organisations have been outlined below;
3.3.2.1 Responses from the Dudley CCG area
Dudley Local Medical Committee - “We discussed your attached application at the LMC on Friday (6/3/18) and fully support the application for both the necessary CCG boundary changes, by constitutional variation, and the subsequent merge of the Moss Grove and Kinver practices.”
The Dudley Group NHS Foundation Trust - Russells Hall Hospital – “The Trust recognises the reasons for merger set out in your letter and is broadly supportive of the transfer. Your letter advises that patient flows will largely continue on the same basis as currently happens. Our expectation is that contract financial values, including block contracts, will be enhanced to reflect the transfer and we look forward to discussing this with you. Unless advised otherwise, we assume the MCP modelling and bid will continue on the basis of the current CCG population and that the future MCP contract will also reflect the impact of the transfer.”
Dudley & Walsall Mental Health Partnership NHS Trust – “We have reviewed this proposal with our operational teams and would comments as follows • Have the CCGs considered the impact on Local Authority boundaries. Social care staff do not work across Local Authority boundaries. Any Mental Health Assessment services need to be provided by the neighbouring boroughs • Are you able to identify what percentage of the practice list is currently open to other Mental Health Services (e.g. South Staffordshire and Shropshire Healthcare NHS Foundation Trust) and how these will transfer to Dudley provision so a more detailed assessment of the risk to operational capacity (Community teams, Beds, OP Clinics) can be made • For out of hours services a plan for operational liaison with those services relevant to Staffordshire would need to be agreed (e.g. Police, Social Care) • Will there be a requirement for MH Primary Care provision at Kinver Surgery and the development of the MDT approach in line with other Dudley Practices? • Implications for community services including Home Treatment will need to be considered if the geographical spread of services grows • There would need to be appropriate resource transfer to the Health Economy and onward to the Trust for the impact of this change.”
MCP Bidding Partnership – “The MCP Bidding Partnership have given consideration to the union of Moss Grove Kinver Surgery with Moss Grove Kingswinford Surgery. This would involve the addition of approximately 6000 patients from the Kinver practice to Dudley CCG. It was felt that provided that there was a proportional increase in funding of Community services to cover these patients that there would be no problems incurred by the union of the two practices. There are already a number of practices in the Dudley borough whose patients cross CCG borders (such as Lion Health and Three Villages), and services are already in place for these. Reciprocal social care arrangements would need to be created. Consideration would need to be given to how Kingswinford and Brierley Hill locality based services could be provided to Kinver residents, given the closer proximity of Kinver to Stourbridge. This is however not felt to be insurmountable provided that funding follows the patients.”
Dudley Metropolitan Borough Council – “I met with Dr Hopkins in Kingswinford recently to discuss the merger and was reassured regarding my concerns about potential pressures on car parking at the Kingswinford site. I can see that the merger will provide benefits to both Kinver and Kingswinford patients, in terms of access and quality of services. However, I do have concerns about the significant increase to the CCG population that the inclusion of the Kinver practice will result in. There are already 4,501 people resident in South Staffordshire who are registered with a Dudley GP. I understand that the practice joining the CCG will more than double this number. As you will be aware, the Council is including some of its public health services in the scope of the MCP. These services are funded for residents of the Borough. As the MCP will deliver a primary care led model of care, with a strong emphasis on prevention, I am concerned that there is a risk that Dudley public health services will be provided to a large number of residents of neighbouring councils, diluting the funding for Dudley residents. If this is not the case, the difference in public health services for those resident in Dudley and those resident in South Staffordshire could cause confusion for the GPs and limit the ability for the service model to be integrated in this part of the Borough. Although I can see the benefits of the merger for the practice and for Kinver residents, I am concerned about the potential impact on the CCG population.”
Patient Opportunity Panel feedback (meeting minutes) – The clear majority of this cohort (approximately 75% of the 17 members in attendance) saw no objections and offered constructive feedback and observations that supported the proposal of a change in boundaries, including; • Belief that in the current climate the Kinver practice is too small to survive, therefore the merger is positive as without it there is the possibility that the practice could close in the future • Understanding that the transfer of the Kinver practice will not cause any reductions in services at either site • It will allow the practices to maintain current personnel and members of staff • Some specialist clinics in Kingswinford will benefit all patients • Larger practices will attract services • More capacity and flexibility – Kingswinford patients could accept appointments in Kinver • Enabling improved continuity of care with doctors working in both practices • No concerns were raised around; appointment availability, fewer doctors, less continuity and car parking
Lion Health Surgery – “The Practice is very happy to support your proposal. It certainly seems very sensible in the current climate. We have no doubt that a joint entity working under the umbrella of Dudley CCG will be of benefit to both the patients and staff of Moss Grove Surgery, Kinver. We are therefore very happy to support your application.”
Member of staff at the Dudley Group NHS Foundation Trust – This was a response from a member of staff at the Trust expressing his personal views which are in support of the proposal.”
Three Villages Medical Practice – “Following a practice meeting at Three Villages I can confirm that we do not have any objections for your proposed merger. Inevitably we are sure that some of our registered patients may move practices for logistic reasons, but we would not oppose your merger due to this.”
South Dudley Member of Parliament – “I can confirm that I fully support the application to merge these two practices and to transfer the Kinver practice into Dudley CCG from South Staffordshire & Seisdon Peninsula CCG.
I believe that this merge is necessary to secure the long-term future of both practices and give them the opportunity to develop further services for their patients, whilst Dudley CCG moves forward with its plan for a Multispecialty Community Provider (MCP) model of care. The primary aim of this merge is to maintain and improve services to all patients. The surgery partners have confirmed that there will be no change to any services available at either practice and no change will be seen regarding opening times and the number of appointments available to patients.”
Black Country Partnership NHS Foundation Trust – “In order to provide commissioners with meaningful feedback in regards to the proposed practice merger, the Trust has sought the views of each service that Dudley CCG commissions from BCPFT. These services include: Children, Young People and Families (CYPF), Learning Disabilities, Ault Psychiatry and Old Age Psychiatry. Although we are unable to quantify the impact of the practice merger on our services, the Trust believes that the Learning Disabilities and CYPF services could experience the greatest impact from the proposed practice merger. Therefore, it must be noted by commissioners that any increase in demand on any services commissioned by Dudley CCG will impact on BCPFT’s waiting times. Therefore, further discussion would be required between our respective organisations in regards to the Contract should the merger proceed. Learning Disabilities: Consideration also needs to be given to the Transforming Care Programme (TCP) and the demand and capacity modelling that BCPFT has recently undertaken as part of this programme of work which Moss Grove Surgery was not included in. Whilst it is recognised that patients from Moss Grove Surgery would benefit from access to the Dudley Adult Learning Disabilities Specialised Community Team, the existing team and the new TCP teams would be unable to accommodate a potential increase in referrals at this stage. It is further noted that the extension of geographical area would be difficult for those teams providing a Black Country wide response. Children, Young People and Families (CYPF) – Health Visitor Service: The access criteria the Health Visitor service is based on Dudley residents only. Therefore, the Trust believes the impact of the practice merger to be negligible on this service. However, the health Visitor service is commissioned by the Public health division of Dudley Metropolitan Borough Council; therefore, the effects of the proposed practice merger and changes to the constitutional boundary need to be raised by CCG with DMBC for further discussion with the Council. BCPFT currently has a two-year Contract in place with Dudley CCG, which is due to end on 31st March 2019. We will, therefore soon be entering into the 2019/20 contract negotiations with commissioners. Most of the activity purchased by Dudley CCG under this Contract is agreed under a black contract arrangement with only some cost and volume activity relating to acute Inpatients, Older Adults and Learning Disabilities. Activity plans are agreed with commissioners at the start of each relevant financial year for both types of arrangements. BCPFT, therefore, requests that if the merger proceeds and the change to the constitutional boundary is agreed by NHS England, that the new patients list size is profiled appropriately across the Indicative Activity Plan to reflect the impact of this additional cohort of patients in the Trust’s finance and activity plans.”
3.3.2.2 Responses from the South East Staffordshire and Seisdon Peninsula CCG area
South Staffordshire Council – “The Council received a Joint letter from Lynn Millar and Caroline Brunt on the 3rd April regarding the proposed merger, which stated both CCG’s would be happy to attend any proposed meetings to answer questions from our elected Members on the issue. We have invited both CCG’ to attend the Council Wellbeing Select committee to allow members to put any questions they have to the two CCG’s.
I know you have spoken to the three Kinver Elected Members regarding the merger and answered a number of questions, however based on recent experiences with Pattingham surgery and Perton clinic our elected Members feel decisions on health care are being made with limited consultation and would like the issue discussed formally at the Council’s Wellbeing select committee. From what I understand the Members are happy with the responses from the practice to the questions asked but have questions they want answering which are CCG specific such a deficit, impact on other local practices and Community Services. The Council fully appreciates the final decision on GP practices moving between CCG’s is the responsibility of NHS England and we are firm believers that those partners who are best placed to deliver services do so, as we are not precious about who delivers services in South Staffordshire providing they are high quality. However, at this point in time what we would like to ensure is Members have the whole picture to enable them to make an informed decision on the consultation.”
South Staffordshire Member of Parliament – “This does sound a very positive move and hope this is able to secure important medical services in Kinver for the future and make sure they are sustainable.”
Healthwatch - Engaging Communities – “I have read your documentation and from a Healthwatch perspective your reasons are set out clearly and objectively and make a lot of sense from a sustainability of the service point of view and of offering a quality service to patients in the longer term. It is also a positive benefit to patients to have access to the services offered at the Kingswinford practice and to the potential for better continuity of care and extended access hours. It is clear that working with 2 CCG and 2 NHS England areas causes you additional workload and by streamlining this through the merger should free up time to focus on patient care. You have set this out clearly and concisely for patients so that they have the information on which to make a decision. I have however looked at your websites for both practices which and find that Kinver is quite out of date. The last patient survey was 2015 so it is hard to get a feel of what patients think about the proposed merger. Also, there are no minutes or indication of when the Patient Participation Group last met or what their view on the merger is. I note however that you have arranged 2 patient engagement events to talk to patients about the merger and I would be interested to know how you will record and take account of the views expressed by patients. In Principal, Healthwatch can see the benefits of the merger for patients but would be interested to know how concerns of patients are going to be recorded and addressed and reassurance given if this is possible that the merger will not adversely affect patient care but will in fact enhance it.”
“Thank you for the opportunity to respond to the application by Moss Grove Surgery to merge with Kingswinford and become part of Dudley CCG. We have looked at the documents and also information we have received from the practice and feel that upon balance there are strong reasons for the merger and that the practice have set out their reason clearly and objectively. There seems to be a strong case for the merger in terms of the sustainability of the practice and the ability to offer a good quality service to patients in the long term. There seems to be evident benefits to patients to have access to the services offered at Kingswinford that they don’t currently have access to and also the potential for better continuity of care and extended hours. It is hoped that the freeing up of time of having to work with 2 CCG’s and 2 NHS England organisations will enable them to better focus on patient care. I have asked the practice about their patient engagement about the merger and am pleased to see that the PPG is 100% supportive or the merger. Patients have been consulted in a number of ways; By survey and 141 written responses were received of which 86 are positive about the changes and 33 do not feel it will affect them.
There were 2 public meetings planned and the consultation will be completed by the 11th May, I have seen the notes with the preliminary findings of the meetings and there is a clear sense from them that the questions raised by the public were comprehensively answered and all attempts to allay patients concerns made. Both meetings had good attendance from patients and with the paper survey that were completed I am satisfied that the practice has made every effort to engage and consult with patients and involve them in this process. For this reason, Healthwatch Staffordshire is happy to add its support to the merger as being in the long-term interests of patients and sustainability of the Practice.”
South Staffordshire Council – “The Council’s primary consideration on this issue is to ensure residents can access good quality health care locally, not necessarily who provides the service. Whist we understand and support why the practice wants to merge and move CCG areas, South Staffordshire Council has a number of concerns we would like to raise as part of the consultation process. The first concern for the Council is the longevity of a surgery remaining in Kinver. Although nothing in the current climate is certain we would like some assurance on how long a surgery will remain in Kinver. As a Council what we would not support is the whole practice moving to Kingswinford either now or in the future, as currently 5,480 residents access the Moss Grove Practice in Kinver. The overall catchment area is closer to 10,000 and as our population ages the likelihood is more residents who choose to access their healthcare out of Staffordshire may decrease and the need to access services locally intensifies due to reduced mobility and a lack of public transport options. The second and critical issue concerning Members is the outstanding deficit of the Staffordshire health economy and this transferring with the Practice. Confirmation that the deficit will not move with the practice could put additional financial burden on other Seisdon Practices which Members do not feel is equitable. In addition, whilst we see the logic for Moss Grove practice wanting to merge and move CCGs, what we want to avoid is other practices taking this approach. Other than Claverly Medical Practice we do not currently see any reasoning for another practice being able to move CCG areas, and we would like assurance that the removal of one GP practice will not affect the viability of other local GP practices within South Staffordshire. The final observation is regarding the following statement “Although there will be a single Health Commissioner, arrangements for the commissioning of Social Care and other Council services will remain the same”. By definition this means there will be two separate Commissioner’s one commissioning health care and one commissioning social care. Although this is the arrangement now, what we don’t have is a clear picture of how this will work across borders under the proposed transfer arrangements. We would like to understand how logistically this will work and how the patient journey will be unaffected as what we want to avoid is the scenario of a postcode lottery for health care particularly within one District. South Staffordshire Council fully appreciates that the final decision on GP practices moving between CCG’s is the responsibility of NHS England, and we are firm believers that those partners who are best placed to deliver services do so. However, we would like to ensure the concerns put forward by the Wellbeing Select Committee are considered as part of the consultation process.”
County Councillor for South Staffordshire – “I feel the that, in general, the audience understood why this merger should take place, and that there was no real opposition to it. And you even had a round of applause – unheard of in Kinver on such subjects! I can confirm that from the information I have heard to date, I fully support this proposal, and send you my best wishes for a smooth transition.”
Gravel Hill Surgery – “The Partners at Gravel Hill Surgery, Wombourne support the application by Moss Grove Surgery, Kinver to merge with Moss Grove Kingswinford and move to Dudley CCG. Kinver lies at the furthest edge of the Seisdon Penninsula. The patients at Kinver have all of their hospital services from the Dudley Group NHS Trust. Over 2500 residents from Kinver are registered with Dudley based practices. It makes sound geographical and financial sense that Moss Grove Surgery, Kinver is part of Dudley CCG and both practices are allowed to merge.”
Moss Grove Kinver Patient Panel AGM (meeting minutes) – Following a presentation by Dr Hopkin, all 25 patients attending the meeting voted unanimously in support for both proposals. Some questions were raised by patients around giving assurance that Kinver will remain in Kinver.
Kinver Parish Council – “The Parish Council is in full support for the proposals and the case put forward for the merger makes good practical sense for both the practice owners and its patients. We appreciate the geographical location of Kinver means the services provided now could be improved for the parishioners of Kinver Parish (your patients); as they would be able to access services that are closer to Kinver and more easily accessible both in distance and with public transport should this merger succeed.”
Staffordshire and Stoke on Trent Partnership NHS Trust – “I am pleased to see that the proposal would seek to improve patient care and access to services. Although these improvements are clearly articulated in reference to Primary care, there may be unintended consequence of this transfer in relation to the provision of community services and from my organisational perspective. As such, I feel that the consultation needs to include consideration of the following, and apologies if these factors have already been considered: 1. Contractual plans for the community services. Currently both SSOTP and SSSFT provide community services for these registered patients. What are the expected Provider contractual changes, including consideration of subcontracting arrangement? If there is a planned transfer of Provider contract, then as part of our formal decommissioning process I would appreciate early dialogue to understand the expected timeframes and financial implications. 2. Operational service delivery. Currently the local teams provide the local services for the patients registered to this practice. These cover domiciliary and clinic based services such as District Nursing, Out of Hours nursing, Allied Health Professionals, and Long Term Condition services. I am keen to understand the plans to maintain continuity for safe and effective patient care (and this relates directly to the outcome of my first point above). In the current climate of maximising efficiencies, I would be concerned if a change in contractual arrangements concluded community staff from Dudley commuting further distances in order to provide the community services to residents of SES and Seisdon Peninsula.”
Where stakeholders have asked questions, Dudley CCG has ensured a response has been issued.
4 Conclusion and recommendations
4.1 Engagement strategy and response
To obtain as much feedback as possible, the practice, and both CCGs have ensured the implementation of an extensive, multi-pronged communication and engagement strategy throughout the involvement period. This concerted effort had a positive effect on the level of response to the proposals with over 500 patients and staff sharing their feedback through the online survey and CCG organised public meetings.
With regards to the survey, paper versions of the survey were offered to allow individuals an additional option to participate.
As well as obtaining feedback through the public meetings and online survey, the proposals were discussed at numerous locality meetings, GP member events and CCG Healthcare Forum. Thus, giving key healthcare professionals and stakeholders the opportunity to share their thoughts on the proposals.
To ensure further participation and feedback, key stakeholders were actively contacted as statutory consultees, to obtain their feedback through written correspondence. This form of engagement resulted in stakeholders such as; members of parliament, Councils, Local Medical Committee, GP surgeries, Patient Opportunity Panels, Healthwatch and NHS Trusts submitting their views.
4.2 Summary and recommendations
Overall, there is a strong degree of positivity and agreement towards the proposals with; 63% of the online survey sample stating they felt positive towards the proposals and 24% ‘neither positive or negative’; high levels of positivity towards the proposals at the CCG organised public events and stakeholder meetings; and the majority of organisations either expressing support for the proposals or outlining the potential benefits of the transfer in their correspondence.
The benefits outlined include; • The merger will make both practices more sustainable now and, in the future • Patients will have the ability to access a greater range of services • Potential greater availability of appointments as patients will be able to access appointments at both practices • Potential decrease in the burden placed on the CCG due to a more streamlined administration process
Although there is a large degree of positivity towards the proposals amongst patients, staff and key stakeholders, some concerns/queries have been raised around;
• The impact on the two practices around appointment availability and accessibility • The future of the Kinver practice and the impact on the provision of the services it provides • The impact on community and social care service provision following the change in CCG boundary • The contractual and financial implications around the transfer of the practice and CCG boundary change.
Appointment availability across both practices and the future of the Kinver practice were outlined in the proposals. Therefore, to alleviate these queries/ concerns it could be suggested that a concerted communication effort be implemented. To ensure patients and staff at both practices are fully aware of the remit of the proposal and are reassured that impacts are kept minimal.
To reassure patients further, it could also be suggested that if the proposal to transfer the Kinver practice to Dudley CCG were to go ahead, appointment availability and ease of booking be monitored and measured. In the instances where appointment availability and booking are affected, measures are put in place to counter these, thus ensuring patient experience remains the same.
Additionally, it could be suggested that there is a requirement to liaise with and reassure statutory consultees around the provision of social and community care services – showing how the provision of these services will continue following the proposed transfer of the practice.
Finally, any decisions made by NHSE or the CCG should be clearly explained to those interested and affected by these proposals and there should be transparency of decision making on these proposals, which are of public interest.
Overall, the public and stakeholder views should be viewed as positive about the proposals. The level of involvement has been good and ample opportunities have been offered for people, who wish to do so, to express their thoughts.
Appendix
Appendix A – Engagement plan
Plan to involve
Date Stage Activity Dudley Activity Staffordshire Notes Prior to • Patient letter to be drafted • Patient letter to be drafted Letter to state: consultation • Stakeholder letter to be • Stakeholder letter to be • Proposal drafted drafted • Reason for proposal • Website information to be • Website information to be • Brief on merger and drafted drafted practice CCG change • Survey monkey with questions • Survey monkey with • What this means for to be developed questions to be developed patients • Practice to conduct an Equality • Practice to conduct an • How they can get Impact Assessment (both sites) Equality Impact Assessment involved and • Information to be sought on (both sites) express their views health inequalities (both sites) • Information to be sought on • What happens with yo • Conversations with key health inequalities (both feedback stakeholders to check the plan sites) • How/when a for involvement • Conversations with key decision is made stakeholders to check the plan for involvement
26th Consultation • Letters sent out as set out in • Letters sent out as set out in March Go Live section above section above 2018 Practice Led • Note on bottom of • Note on bottom of activity prescriptions across both sites prescriptions across both • Write to local councillors across sites ward directly affected and • Write to local councillors neighbouring wards across ward directly • Write to local MP (Mike Wood) affected and neighbouring • Write to Healthwatch Dudley wards (Jayne Emery) • Write to local MP (Gavin • Write to Chair of HASC (Cllr Williamson) Ruth Buttery) • Write to Healthwatch • Write to secretary of LMC (Dr Staffordshire (Robin Tim Horsburgh) Morrison) • Information on website across • Write to Chair of Healthy both sites Staffordshire Select • Talk to locality GPs Committee (Dr Johnny • Ensure this proposal is McMahon) reference at a GP Members • Write to chair of local event 19th April 2018 scrutiny committee (Cllr • Talk to GP Practices in close Kath Perry) proximity (Lion Health) • Write to Chair of LMC (Dr • Write to local pharmacy Gulshan Kaul) Localities: • Information on website
DN – 24 April – St James’ across both sites SWL – 24 April – Lion • Talk to locality GPs SCG – 27 April – Northway • Ensure this proposal is KAB - 1 May – BHHSCC – T051 reference at a GP Members HQB – 3 May – St Margaret’s Well event • Talk to GP Practices in close proximity (Lion Health) • Write to local pharmacy • Hold a public meeting 29th Consultation • Write to existing service • Write to existing service Letters to go from March go live providers (DGFT, DWMHPT, providers (SSOTP, SSSFT, Caroline Brunt as 2018 CCG Led BCPFT) RWT, Dudley) Director of Primary activity • Write to Chief Executive of the • Write to Chief Executive of Care and Lynn Millar, Local Authority (Sarah Norman) the Local Authority (South Director of Primary • Write to Director of Public Staffordshire District Council Care – joint letters th Health - Dave Heywood) sent on 4 April 2018. • Write to STP leader (Andy • Write to Director of Public Williams) Health – Richard Harling • Write to Chair HWBB (Cllr Peter • Write to STP Chair/ leader Miller) (Simon Whitehouse, Sir Neil • Write to chair of HASC (cllr McKay) Ruth Buttery) • Write to Chair HWBB (Dr • GP Members Event 19th April Johnny McMahon) • Raise awareness about the • Raise awareness about the consultation via CCG channels consultation via CCG i.e. website, patient groups, channels i.e. website, twitter patient groups, twitter • Attend the Practice Public Meetings • Take to Patient Opportunity Panel • Take to HCF ( 17th May)
Appendix B – Online survey data tables
Q1. To help us break down our responses, please select the option below which best fits you: Table 1 Area Respondent type
Total Other Kinver Kinver at Kinver Kingswinford Kingswinford Patient or carer Patient or carer at Kingswinford Staff member at Staff member at Patient at Moss Grove Surgery – 45% 0% 89% 0% 0% 100% 0% 0% Kingswinford Patient at Moss Grove Surgery - Kinver 44% 92% 0% 100% 0% 0% 0% 0% Carer/ Relative of a patient at Moss 0% 0% 0% 0% 0% 0% 0% 0% Grove Surgery - Kingswinford Carer/ Relative of a patient at Moss 0% 0% 0% 0% 0% 0% 0% 0% Grove Surgery - Kinver Staff Member at Moss Grove Surgery – 6% 0% 11% 0% 0% 0% 100% 0% Kingswinford Staff Member at Moss Grove Surgery – 4% 8% 0% 0% 100% 0% 0% 0% Kinver Other 1% 0% 0% 0% 0% 0% 0% 100% Base 387 186 197 172 14 176 22 4
Q1. To help us break down our responses, please select the option below which best fits you: Table 2 Gender Age
34 54 64 65+ Total Male 18 - 35 - 55 - Female 17 under and
Patient at Moss Grove Surgery – 45% 41% 52% 100% 54% 48% 39% 46% Kingswinford Patient at Moss Grove Surgery - Kinver 44% 46% 42% 0% 19% 32% 45% 54% Carer/ Relative of a patient at Moss 0% 0% 0% 0% 0% 0% 0% 0% Grove Surgery – Kingswinford Carer/ Relative of a patient at Moss 0% 0% 0% 0% 0% 0% 0% 0% Grove Surgery – Kinver Staff Member at Moss Grove Surgery – 6% 7% 3% 0% 15% 15% 4% 0% Kingswinford Staff Member at Moss Grove Surgery – 4% 6% 0% 0% 8% 5% 10% 0% Kinver Other 1% 0% 2% 0% 4% 0% 2% 0% Base 387 237 144 2 26 65 92 192
Q1. To help us break down our responses, please select the option below which best fits you: Table 3 Ethnicity Religion
Total None Asian Other Mixed British British Christian Black/Black Black/Black White/white Other religion
Patient at Moss Grove Surgery - Kingswinford 45% 46% 0% 100% 50% 67% 47% 46% 50% Patient at Moss Grove Surgery - Kinver 44% 45% 67% 0% 0% 33% 45% 44% 25% Carer/ Relative of a patient at Moss Grove 0% 0% 0% 0% 0% 0% 0% 0% 0% Surgery – Kingswinford Carer/ Relative of a patient at Moss Grove 0% 0% 0% 0% 0% 0% 0% 0% 0% Surgery – Kinver Staff Member at Moss Grove Surgery – 6% 5% 0% 0% 0% 0% 4% 5% 0% Kingswinford Staff Member at Moss Grove Surgery - Kinver 4% 3% 33% 0% 50% 0% 2% 3% 25% Other 1% 1% 0% 0% 0% 0% 1% 1% 0% Base 387 364 3 1 2 3 93 267 8
Q2. Referring to the information available on www.mossgrovesurgery.co.uk, what are your feelings about the proposals? Table 1 Area Respondent type
Total Other Kinver Kinver at Kinver Kingswinford Kingswinford Patient or carer Patient or carer at Kingswinford Staff member at Staff member at Positive 63% 68% 60% 65% 100% 59% 68% 50% Neither positive or negative 24% 21% 26% 23% 0% 26% 23% 50% Negative 13% 11% 14% 12% 0% 15% 9% 0% Base 388 186 197 172 14 176 22 4
Q2. Referring to the information available on www.mossgrovesurgery.co.uk, what are your feelings about the proposals? Table 2 Gender Age
34 54 64 65+ Total Male 18 - 35 - 55 - Female 17 under and
Positive 63% 66% 60% 50% 58% 55% 65% 68% Neither positive or negative 24% 23% 25% 50% 19% 29% 21% 23% Negative 13% 11% 15% 0% 23% 15% 14% 9% Base 388 238 144 2 26 65 92 193
Q2. Referring to the information available on www.mossgrovesurgery.co.uk, what are your feelings about the proposals? Table 3 Ethnicity Religion
Total None Asian Other Mixed British British Christian Black/Black Black/Black White/white Other religion
Positive 63% 64% 100% 100% 50% 33% 63% 65% 50% Neither positive or negative 24% 24% 0% 0% 50% 0% 24% 23% 38% Negative 13% 12% 0% 0% 0% 67% 13% 12% 13% Base 388 365 3 1 2 3 93 268 8
Q3. What positives of your current Practice would you want to see maintained after the proposals? Table 1 Area Respondent type
Total Other Kinver Kinver at Kinver Kingswinford Kingswinford Patient or carer Patient or carer at Kingswinford Staff member at Staff member at Good appointment availability (quick to 22% 25% 19% 27% 11% 19% 24% 0% see GP/nurses, good/long open hours) All, everything, maintenance of current 20% 25% 16% 25% 9% 16% 12% 0% standards (facilities, services) Good staff retention, job security 14% 17% 12% 15% 0% 9% 29% 0% Personal, nominated, chosen GP 11% 12% 11% 12% 0% 12% 6% 0% (continuity of care) Good appointment system (e.g. online 10% 11% 8% 12% 0% 9% 0% 0% booking) Good location, accessibility (Local, good 9% 15% 4% 14% 44% 4% 0% 0% transport links, “keep Kinver practice”) Specific services, clinics 9% 7% 10% 8% 33% 11% 6% 25% Current standards of care (good, great, 8% 5% 10% 5% 0% 9% 12% 50% excellent) Availability of doctors, nurses (easy to 5% 3% 8% 3% 0% 9% 0% 0% see them) Suggested improvements around 4% 4% 5% 4% 11% 4% 6% 0% appointments Prescriptions, repeat prescriptions 3% 3% 3% 3% 0% 3% 0% 0% service Suggests improvements around services 3% 2% 5% 1% 0% 4% 12% 0% Communication/good response 1% 2% 1% 1% 0% 1% 0% 0% Other 10% 8% 10% 8% 11% 9% 18% 25% Base 313 155 154 146 9 137 17 4
Q3. What positives of your current Practice would you want to see maintained after the proposals? Table 2 Gender Age
34 54 64 65+ Total Male 18 - 35 - 55 - Female 17 under and
Good appointment availability (quick to 22% 25% 17% 0% 19% 31% 30% 15% see GP/nurses, good/long open hours) All, everything, maintenance of current 20% 16% 27% 0% 5% 15% 14% 28% standards (facilities, services) Good staff retention, job security 14% 17% 9% 0% 5% 22% 22% 9% Personal, nominated, chosen GP 11% 10% 12% 0% 10% 11% 14% 10% (continuity of care) Good appointment system (e.g. online 10% 9% 11% 0% 19% 9% 11% 8% booking) Good location, accessibility (Local, good 9% 10% 7% 0% 14% 9% 9% 9% transport links, “keep Kinver practice”) Specific services, clinics 9% 9% 9% 0% 0% 5% 14% 10% Current standards of care (good, great, 8% 8% 8% 0% 5% 4% 6% 11% excellent) Availability of doctors, nurses (easy to 5% 7% 2% 0% 10% 4% 10% 3% see them) Suggested improvements around 4% 4% 5% 0% 0% 11% 2% 3% appointments Prescriptions, repeat prescriptions 3% 3% 2% 0% 0% 4% 1% 3% service Suggests improvements around services 3% 4% 3% 0% 5% 5% 0% 3% Communication/good response 1% 2% 0% 0% 0% 2% 2% 1% Other 10% 8% 14% 0% 10% 7% 9% 11% Base 313 198 111 2 21 55 81 147
Q3. What positives of your current Practice would you want to see maintained after the proposals? Table 3 Ethnicity Religion
Total None Asian Other Mixed British British Christian Black/Black Black/Black White/white Other religion
Good appointment availability (quick to see 22% 22% 0% 0% 0% 0% 26% 20% 33% GP/nurses, good/long open hours) All, everything, maintenance of current 20% 20% 0% 0% 0% 67% 15% 22% 33% standards (facilities, services) Good staff retention, job security 14% 15% 0% 0% 0% 0% 13% 14% 0% Personal, nominated, chosen GP (continuity 11% 11% 33% 0% 0% 0% 10% 11% 0% of care) Good appointment system (e.g. online 10% 10% 0% 0% 0% 33% 14% 9% 0% booking) Good location, accessibility (Local, good 9% 9% 33% 0% 0% 0% 13% 8% 0% transport links, “keep Kinver practice”) Specific services, clinics 9% 9% 33% 0% 0% 0% 3% 12% 0% Current standards of care (good, great, 8% 8% 0% 0% 0% 0% 8% 9% 0% excellent) Availability of doctors, nurses (easy to see 5% 5% 0% 0% 0% 0% 1% 7% 0% them) Suggested improvements around 4% 4% 0% 0% 0% 0% 8% 3% 0% appointments Prescriptions, repeat prescriptions service 3% 3% 0% 0% 0% 0% 3% 3% 0% Suggests improvements around services 3% 3% 0% 0% 0% 0% 4% 3% 0% Communication/good response 1% 1% 0% 0% 0% 0% 0% 2% 0% Other 10% 9% 0% 0% 0% 0% 12% 8% 17% Base 313 296 3 1 1 3 78 215 6
Q4. What are you concerns about the proposals? Table 1 Area Respondent type
Total Other Kinver Kinver at Kinver Kingswinford Kingswinford Patient or carer Patient or carer at Kingswinford Staff member at Staff member at Longer waiting times, difficulty getting 25% 19% 32% 19% 10% 35% 6% 0% appointments Increased pressure of extra patients 21% 10% 32% 11% 0% 34% 12% 0% (increased workload) Hard to travel, location issues (public 12% 14% 10% 15% 0% 9% 12% 0% transport, car park) Decline in, loss of services (incl. cutbacks) 11% 16% 6% 18% 0% 6% 6% 0% Continuity of care (Personal, nominated, 8% 7% 9% 7% 10% 8% 12% 0% chosen GP) Closure of the practice 8% 14% 3% 15% 0% 3% 0% 0% No concerns, concerns were answered 7% 9% 4% 10% 0% 5% 0% 0% Job security, stability 6% 5% 7% 4% 10% 1% 53% 0% Logistics of multiple sites (e.g. records, 4% 5% 3% 2% 50% 3% 0% 25% paperwork, communication) Agree with merger, combining services is 4% 2% 6% 3% 0% 6% 6% 0% a good idea Having to work at multiple sites 3% 2% 4% 0% 20% 2% 24% 0% Should work if proposal is correct/there's 3% 2% 5% 2% 0% 5% 6% 0% no decline in service It will be beneficial 1% 1% 1% 1% 0% 0% 6% 0% Don't know 1% 1% 1% 0% 10% 1% 0% 0% Other 7% 9% 7% 8% 10% 8% 0% 0% Base 268 128 136 118 10 119 17 4
Q4. What are you concerns about the proposals? Table 2 Gender Age
34 54 64 65+ Total Male 18 - 35 - 55 - Female 17 under and
Longer waiting times, difficulty getting 25% 27% 22% 0% 32% 30% 32% 18% appointments Increased pressure of extra patients 21% 21% 22% 0% 37% 22% 22% 18% (increased workload) Hard to travel, location issues (public 12% 11% 11% 0% 21% 2% 11% 14% transport, car park) Decline in, loss of services (incl. cutbacks) 11% 11% 9% 0% 5% 18% 11% 9% Continuity of care (Personal, nominated, 8% 10% 5% 0% 5% 6% 7% 10% chosen GP) Closure of the practice 8% 8% 9% 0% 11% 6% 11% 8% No concerns, concerns were answered 6% 8% 2% 0% 0% 18% 3% 3% Job security, stability 4% 4% 5% 0% 11% 2% 8% 3% Logistics of multiple sites (e.g. records, 4% 2% 7% 0% 5% 6% 1% 5% paperwork, communication) Agree with merger, combining services is 3% 5% 0% 0% 5% 8% 4% 0% a good idea Having to work at multiple sites 3% 4% 1% 0% 0% 4% 1% 4% Should work if proposal is correct/there's 3% 4% 2% 0% 0% 2% 3% 5% no decline in service It will be beneficial 1% 1% 0% 0% 0% 4% 0% 0% Don't know 1% 1% 0% 0% 0% 0% 1% 1% Other 7% 6% 9% 0% 16% 6% 4% 10% Base 268 167 96 2 19 50 73 115
Q4. What are you concerns about the proposals? Table 3 Ethnicity Religion
Total None Asian Other Mixed British British Christian Black/Black Black/Black White/white Other religion
Longer waiting times, difficulty getting 25% 25% 0% 0% 0% 50% 32% 23% 0% appointments Increased pressure of extra patients 21% 21% 0% 0% 0% 0% 32% 18% 25% (increased workload) Hard to travel, location issues (public 12% 12% 0% 0% 0% 0% 16% 11% 0% transport, car park) Decline in, loss of services (incl. cutbacks) 11% 10% 50% 0% 0% 0% 14% 10% 0% Continuity of care (Personal, nominated, 8% 8% 0% 0% 0% 0% 8% 8% 0% chosen GP) Closure of the practice 8% 8% 0% 0% 0% 0% 10% 8% 0% No concerns, concerns were answered 6% 6% 0% 0% 0% 0% 2% 7% 0% Job security, stability 4% 5% 0% 0% 0% 0% 5% 4% 0% Logistics of multiple sites (e.g. records, 4% 4% 0% 0% 0% 0% 3% 5% 0% paperwork, communication) Agree with merger, combining services is a 3% 3% 50% 0% 0% 0% 2% 3% 0% good idea Having to work at multiple sites 3% 4% 0% 0% 0% 0% 2% 4% 0% Should work if proposal is correct/there's no 1% 0.4% 0% 0% 0% 0% 0% 1% 0% decline in service It will be beneficial 1% 1% 0% 0% 0% 0% 0% 1% 0% Don't know 7% 8% 0% 0% 0% 50% 6% 7% 50% Other 268 252 2 0 1 2 63 184 4
Q5. What ways could we help to alleviate your concerns? Table 1 Area Respondent type
Total member at Other Kinver Kinver at Kinver Kingswinford Kingswinford Patient or carer Patient or carer at Kingswinford Staff Staff member at Communication, information about 20% 19% 20% 18% 38% 12% 71% 50% changes (more/better/ongoing) Ensure, improve appointment availability 14% 12% 16% 13% 0% 19% 0% 0% Seek more resources to cope 10% 4% 15% 3% 13% 17% 0% 0% (budget/staff) Improve, guarantee services 8% 7% 10% 8% 0% 11% 0% 0% Stay the same, abandon plans/changes 8% 13% 3% 13% 13% 4% 0% 0% Don't merge, close or move the local 6% 10% 2% 11% 0% 3% 0% 0% practice More discussion, open to questions 5% 6% 5% 2% 50% 3% 18% 0% Don't know 5% 3% 6% 3% 0% 7% 0% 0% Job security, stability, no changes to terms (working hours/location/pay 3% 3% 3% 2% 13% 1% 18% 0% grade) Other 12% 15% 9% 17% 0% 9% 6% 0% Base 226 98 124 90 8 107 17 4
Q5. What ways could we help to alleviate your concerns? Table 2 Gender Age
34 54 64 65+ Total Male 18 - 35 - 55 - Female 17 under and
Communication, information about 20% 20% 22% 0% 5% 28% 17% 21% changes (more/better/ongoing) Ensure, improve appointment availability 14% 17% 10% 0% 11% 9% 17% 17% Seek more resources to cope 10% 7% 15% 0% 16% 4% 16% 8% (budget/staff) Improve, guarantee services 8% 6% 13% 0% 16% 4% 6% 12% Stay the same, abandon plans/changes 8% 5% 11% 0% 0% 0% 11% 10% Don't merge, close or move the local 6% 6% 4% 0% 11% 4% 8% 3% practice More discussion, open to questions 5% 8% 1% 0% 11% 7% 9% 1% Don't know 5% 6% 3% 0% 0% 9% 5% 3% Job security, stability, no changes to terms (working hours/location/pay 3% 4% 1% 0% 5% 4% 5% 1% grade) Other 12% 13% 9% 0% 11% 13% 11% 13% Base 226 142 79 2 19 46 64 86
Q5. What ways could we help to alleviate your concerns? Table 3 Ethnicity Religion
Total None Asian Other Mixed British British Christian Black/Black Black/Black White/white Other religion
Communication, information about changes 20% 20% 0% 0% 0% 0% 20% 19% 0% (more/better/ongoing) Ensure, improve appointment availability 14% 14% 0% 0% 0% 0% 13% 15% 0% Seek more resources to cope (budget/staff) 10% 10% 0% 0% 0% 0% 13% 9% 0% Improve, guarantee services 8% 9% 0% 0% 0% 0% 9% 9% 0% Stay the same, abandon plans/changes 8% 7% 0% 0% 0% 50% 2% 8% 25% Don't merge, close or move the local practice 6% 6% 0% 0% 0% 0% 9% 5% 0% More discussion, open to questions 5% 6% 0% 0% 0% 0% 5% 6% 0% Don't know 5% 5% 0% 0% 0% 0% 5% 4% 0% Job security, stability, no changes to terms 3% 3% 100% 0% 0% 0% 0% 5% 0% (working hours/location/pay grade) Other 12% 12% 0% 0% 0% 50% 7% 13% 50% Base 226 211 1 0 1 2 56 150 4
Q6. What is your gender? Table 1 Area Respondent type
Total Other Kinver Kinver at Kinver Kingswinford Kingswinford Patient or carer Patient or carer at Kingswinford Staff member at Staff member at Female 61% 66% 58% 63% 100% 56% 77% 0% Male 37% 33% 41% 35% 0% 43% 23% 75% Transgender 0% 0% 0% 0% 0% 0% 0% 0% Non-binary 0% 0% 0% 0% 0% 0% 0% 0% Other 0% 0% 0% 0% 0% 0% 0% 0% Prefer not to say 2% 2% 1% 2% 0% 1% 0% 25% Base 388 186 197 172 14 176 22 4
Q6. What is your gender? Table 2 Gender Age
34 54 64 65+ Total Male 18 - 35 - 55 - Female 17 under and
Female 61% 100% 0% 50% 62% 83% 71% 50% Male 37% 0% 100% 50% 38% 15% 29% 49% Transgender 0% 0% 0% 0% 0% 0% 0% 0% Non-binary 0% 0% 0% 0% 0% 0% 0% 0% Other 0% 0% 0% 0% 0% 0% 0% 0% Prefer not to say 2% 0% 0% 0% 0% 2% 0% 1% Base 388 238 144 2 26 65 92 193
Q6. What is your gender? Table 3 Ethnicity Religion
Total None Asian Other Mixed British British Christian Black/Black Black/Black White/white Other religion
Female 61% 62% 67% 0% 50% 0% 59% 62% 63% Male 37% 37% 33% 100 50% 100% 40% 38% 38% Transgender 0% 0% 0% 0% 0% 0% 0% 0% 0% Non-binary 0% 0% 0% 0% 0% 0% 0% 0% 0% Other 0% 0% 0% 0% 0% 0% 0% 0% 0% Prefer not to say 2% 1% 0% 0% 0% 0% 1% 0% 0% Base 388 365 3 1 2 3 93 268 8
Q7. Which of the following age groups do you fit into? Table 1 Area Respondent type
Total Other Kinver Kinver at Kinver Kingswinford Kingswinford Patient or carer Patient or carer at Kingswinford Staff member at Staff member at 17 and under 1% 0% 1% 0% 0% 1% 0% 0% 18 to 24 2% 1% 3% 1% 7% 2% 9% 25% 25 to 34 5% 3% 7% 2% 7% 6% 9% 0% 35 to 44 4% 4% 5% 4% 0% 4% 9% 0% 45 to 54 13% 9% 16% 8% 21% 14% 36% 0% 55 to 64 24% 27% 20% 24% 64% 20% 18% 50% 65 to 74 31% 31% 32% 34% 0% 36% 0% 0% 75 and over 19% 24% 14% 26% 0% 15% 0% 0% Prefer not to say 3% 1% 4% 1% 0% 2% 18% 25% Base 388 186 198 172 14 176 22 4
Q7. Which of the following age groups do you fit into? Table 2 Gender Age
34 54 64 65+ Total Male 18 - 35 - 55 - Female 17 under and
17 and under 1% 0.4% 1% 100% 0% 0% 0% 0% 18 to 24 2% 2% 3% 0% 31% 0% 0% 0% 25 to 34 5% 5% 4% 0% 69% 0% 0% 0% 35 to 44 4% 5% 2% 0% 0% 25% 0% 0% 45 to 54 13% 17% 5% 0% 0% 75% 0% 0% 55 to 64 24% 27% 19% 0% 0% 0% 100% 0% 65 to 74 31% 27% 39% 0% 0% 0% 0% 63% 75 and over 19% 14% 27% 0% 0% 0% 0% 37% Prefer not to say 3% 2% 1% 0% 0% 0% 0% 0% Base 388 238 144 2 26 65 92 193
Q7. Which of the following age groups do you fit into? Table 3 Ethnicity Religion
Total None Asian Other Mixed British British Christian Black/Black Black/Black White/white Other religion
17 and under 1% 0.3% 0% 0% 50% 0% 1% 0% 13% 18 to 24 2% 2% 0% 0% 0% 0% 6% 1% 0% 25 to 34 5% 4% 33% 0% 0% 0% 11% 3% 0% 35 to 44 4% 4% 0% 0% 0% 0% 9% 3% 0% 45 to 54 13% 13% 0% 0% 0% 0% 20% 10% 13% 55 to 64 24% 24% 33% 0% 50% 67% 16% 26% 38% 65 to 74 31% 13% 0% 0% 0% 33% 26% 34% 38% 75 and over 19% 19% 33% 100% 0% 0% 8% 24% 0% Prefer not to say 3% 1% 0% 0% 0% 0% 3% 0.4% 0% Base 388 365 3 1 2 3 93 268 8
Q8. Please choose the option that best describes your ethnic group: Table 1 Area Respondent type
Total Other Kinver Kinver at Kinver Kingswinford Kingswinford Patient or carer Patient or carer at Kingswinford Staff member at Staff member at White/ Caucasian/ White British 94% 95% 94% 95% 86% 96% 77% 75% Asian/ Asian British 1% 1% 1% 0% 7% 1% 0% 0% Black/ African/ Caribbean/ Black British 0.3% 0% 1% 0% 0% 1% 0% 0% Mixed/ Multiple Ethnic Groups 1% 2% 0 1% 7% 0% 0% 0% Other (please specify) 1% 1% 1% 1% 0% 1% 0% 0% Prefer not to say 4% 3% 4% 3% 0% 2% 23% 25% Base 388 186 198 172 14 176 22 4
Q8. Please choose the option that best describes your ethnic group: Table 2 Gender Age
34 54 64 65+ Total Male 18 - 35 - 55 - Female 17 under and
White/ Caucasian/ White British 94% 96% 94% 50% 92% 97% 96% 96% Asian/ Asian British 1% 0.4% 1% 50% 0% 0% 1% 0% Black/ African/ Caribbean/ Black British 0.3% 0% 1% 0% 0% 0% 0% 1% Mixed/ Multiple Ethnic Groups 1% 1% 1% 0% 4% 0% 1% 1% Other (please specify) 1% 0% 2% 0% 0% 0% 2% 1% Prefer not to say 4% 3% 2% 0% 4% 3% 0% 2% Base 388 238 144 2 26 65 92 193
Q8. Please choose the option that best describes your ethnic group: Table 3 Ethnicity Religion
Total None Asian Other Mixed British British Christian Black/Black Black/Black White/white Other religion
White/ Caucasian/ White British 94% 100% 0% 0% 0% 0% 97% 98% 50% Asian/ Asian British 1% 0% 0% 0% 100% 0% 0% 0% 25% Black/ African/ Caribbean/ Black British 0.3% 0% 0% 100% 0% 0% 0% 0.4% 0% Mixed/ Multiple Ethnic Groups 1% 0% 100% 0% 0% 0% 0% 1% 0% Other (please specify) 1% 0% 0% 0% 0% 100% 0% 0.4% 25% Prefer not to say 4% 0% 0% 0% 0% 0% 3% 0% 0% Base 388 365 3 1 2 3 93 268 8
Q9. What is your religion? Table 1 Area Respondent type
Total Other Kinver Kinver at Kinver Kingswinford Kingswinford Patient or carer Patient or carer at Kingswinford Staff member at Staff member at No Religion 24% 24% 24% 24% 14% 25% 18% 25% Christian 69% 68% 70% 69% 64% 71% 64% 50% Buddhist 0.3% 0% 1% 0% 0% 1% 0% 0% Hindu 0.3% 0% 1% 0% 0% 1% 0% 0% Muslim 0.3% 1% 0% 0% 7% 0% 0% 0% Jewish 0% 0% 0% 0% 0% 0% 0% 0% Sikh 0% 0% 0% 0% 0% 0% 0% 0% Other (Please specify) 1% 2% 1% 1% 7% 1% 0% 0% Prefer not to say 5% 6% 4% 6% 7% 2% 18% 25% Base 388 186 198 172 14 176 22 4
Q9. What is your religion? Table 2 Gender Age
34 54 64 65+ Total Male 18 - 35 - 55 - Female 17 under and
No Religion 24% 23% 26% 50% 62% 42% 16% 16% Christian 69% 70% 71% 0% 38% 51% 76% 80% Buddhist 0.3% 0% 1% 0% 0% 0% 0% 1% Hindu 0.3% 0% 1% 50% 0% 0% 0% 0% Muslim 0.3% 0.4% 0% 0% 0% 0% 1% 0% Jewish 0% 0% 0% 0% 0% 0% 0% 0% Sikh 0% 0% 0% 0% 0% 0% 0% 0% Other (Please specify) 1% 2% 1% 0% 0% 2% 2% 1% Prefer not to say 5% 5% 1% 0% 0% 6% 4% 3% Base 388 238 144 2 26 65 92 193
Q9. What is your religion? Table 3 Ethnicity Religion
Total None Asian Other Mixed British British Christian Black/Black Black/Black White/white Other religion
No Religion 24% 25% 0% 0% 0% 0% 100% 0% 0% Christian 69% 72% 100% 100% 0% 33% 0% 100% 0% Buddhist 0.3% 0% 0% 0% 0% 33% 0% 0% 13% Hindu 0.3% 0% 0% 0% 50% 0% 0% 0% 13% Muslim 0.3% 0% 0% 0% 50% 0% 0% 0% 13% Jewish 0% 0% 0% 0% 0% 0% 0% 0% 0% Sikh 0% 0% 0% 0% 0% 0% 0% 0% 0% Other (Please specify) 1% 1% 0% 0% 0% 33% 0% 0% 63% Prefer not to say 5% 2% 0% 0% 0% 0% 0% 0% 0% Base 388 365 3 1 2 3 93 268 8
Appendix C – Feedback from the public events
Public event 1
Event name: public meeting on proposed changes to moss grove surgeries Kinver/ Kingswindford- 25th April 2018 7.30pm Event location: Kinver high school Number of people attending the event: 66 ______Questions raised by participants at the event: Please outline the questions raised by participants, the response (if one was provided) and the attendees reaction to the response Presentations from Dr Mark Hopkin and presence from wider partnership Inc. the practice manager
Questions included
1. If the ideal scale of general practice is 35,000 registered patients, then if this merger is successful then moss grove would have around 20,000 patients so who else would ultimately be in the grouping? A. It would be most likely with the other Kingswinford practices as it would make sense for community teams to serve the area a whole but that will be determined by the future Dudley MCP.
2. Will it be harder to get an apt in Kinver and could I go to Kingswinford if I can’t? A. It will be the same the number of apts will remain the same at each site so access should continue as is. We do expect there to be improvements for patients with regard to continuity of care though as you may (if you wish) be able to follow a GP to the different site.
3. People in Kinver can’t drive and there are no buses to Kingswinford A. You are correct, there is no intention to remove services from Kinver though and if successful the change may mean Kinver benefits from improved access to community services with them closer in Kingswinford than Codsall or other south staffs areas.
4. There are longer waits for physio in Dudley than staffs will that be corrected A. Dudley MCP has a vision for physio that would see direct referral so there will be improvements in this area. It’s really important that you express any areas you are concerned about through so that we can work to influence those improvements for you.
5. Apts work well at Kinver but we hear they are worse at Kingswindford will all those patients travel here and take our apts? A. Good point and I expect we will hear similar concerns from the patients at Kingswinford. We don’t anticipate any problems and will be working to ensure that you get apts at site of choice. If over time there was more demand at certain sites then the practice would need to flex to accommodate hat patient choice.
6. Can you explain the areas where you would find economies of scale? A. In the back office functions really, we would ideally want to have systems and managers across 2 sites for example a HR role, IT, Finance. We would also save in time from attending 2 meets for each CCG. We think this would save time of at least 1 clinical and 1 management session per week that would be reinvested back into the practice.
7. My relative had dementia and we didn’t receive great help from staffs services. Could we have used the dementia services in Dudley if this transfer/ merger had already happened? Services such as the memory assessment service? A. Yes, Dudley does have a good range of Dementia services.
8. Will the transfer affect pat choice and options on Choose and book? A. No
9. The future MCP that you talk about, can you explain what it is in more detail and can it go bust? A. MCP is a Multi-speciality Community Provider, it will be a new organisation (likely to be an FT) and will hold a contract for 10—15 years., services will include GP, Community nursing, wider community services such as physio, outpatient clinics, mental health, the option for social care and some voluntary sector services. These will wrap around the GP practice to support people to stay healthy and provide care closer to home. If it is a Foundation Trust it will be guaranteed by the treasury so will not ‘go bust’ in the sense that the private sector could. The current procurement is live and the bidders are existing NHS organisations working with local GPs.
10. Can we get more money for the building A- The CCG is not responsible for this so this is unlikely to be affected by the merge/ transfer. However, we continue to work hard to secure funding for any build improvements at both our sites.
11. If we become a Dudley practice will the other people who live in Kinver, currently registered with Dudley practices, want to move to Kinver surgery? A. Maybe, but when people move surgeries the money for their care follows them so if this were to happen we would increase services and resources here to accommodate the patient numbers.
Meeting closed at 8.45pm
Members from CCG and practice stayed behind to answer any further Qs, in particular to provide more details of the Dudley MCP which people were interested in and positive about.
Public Event 2
Event name: public meeting on proposed changes to moss grove surgeries Kinver/ Kingswinford- 1st May 2018 7.30pm Event location: Dudley/ Kingswinford Rugby Football Club Number of people attending the event: 84 (including one lady with hearing impairment and her sign language interpreter) ______Questions raised by participants at the event: Please outline the questions raised by participants, the response (if one was provided) and the attendees reaction to the response
Q1- will the Kingswinford surgery get busier A1. We don’t anticipate the number of regular appointments to change at either site so no, we don’t expect the footfall at each surgery to differ from the current position.
Q2- you mentioned more services coming out into the community but there is no room at Kingswinford so where will they be based?
A2 The new model of care for Dudley will see community services wrapping around the care that you receive from General Practice, what we mean by that is a shared community and primary care team for a shared population of around 30,000 patients. If this merger were to happen it would make it easier for those teams to work around a shared practice population. We also hope that some services run from the hospital will be able to operate from community buildings like the practice, but this will be dependent on the space we identify.
Q3. What is the financial situation? A3. The money follows the patient, so if 500 patients move from one CCG to another or from one practice to another then the money for their care follows them. In the case of funding for the Kinver patients, Dudley CCG and South Staffs CCG will be conducting an assessment of the financial implications and this will factor in their decision making before submitting an application to NHS ENGLAND. It is important to note that the practice itself does not present any financial risk to the system, so by that we mean the Kinver practice operates within the resource available.
Q4. If unsuccessful what does it mean for Kingswinford patients? A4. It means that the status quo remains, as you are already covered by Dudley CCG you will benefit from the MCP services when they go live in April 2019. For Kinver patients if unsuccessful then this would not be the case and as a practice we would need to revisit to plans.
Q5. What happens if Souths Staffs or Dudley CCG don’t support the application? A5. We hope that the CCGs and NHS ENGLAND will take into account the views of patients on this matter, we have received lots of feedback so far and will be presenting it all to those making the decision. If it is what our patients support and we are then unsuccessful we will try to appeal the decision.
Q6. If doctor’s work across both sites could I get an apt in Kinver in the future if this goes ahead? A6. Yes, in principle this should make it easier to follow your preferred doctor for continuity reasons if you wish to do so. We don’t anticipate many people choosing to travel between sites regularly though.
Q7. How do you balance the statements, ‘no service change’ with ‘improved opportunities for innovative service changes’? A7. Apologies, I recognise that is confusing but I can explain. We don’t see any service changes affecting the way that primary care operates from our 2 existing sites in Kinver and Kingswinford, no change to opening hours or apts. However, if Kinver patients do join Dudley CCG then there is the opportunity for them to benefit from the innovative service changes that the MCP will bring about. For Kingswinford patients this is a given anyway.
Q8. I’m worried about the implication that the practice is operating as a business? A8. I won’t apologise for that, we employ staff, we manage money, we strive to provide high quality service in that respect we are a business and we need to ensure that business operates efficiently and effectively so that we can maximise the time spent delivering high quality care. GP practices up and down the country are finding themselves unsustainable and doors are closing, we need to make this area one which is an attractive place to work for GPs and new GPs want bigger practices where they can benefit from flexible working and opportunities to do different things like minor surgery, teaching sessions and other work. We hope these changes, if accepted will help both our sites to thrive.
Q9. I have been involved in the NHS for 35 years and I have never seen services so stretched, demand so high and staff so wanting. What can be done to help that?
A9. You are quite right and we feel the same in primary care, we have to find ways of making the right thing to do the easiest, for staff to start enjoying their roles again, feel supported to do the best for the people they care for. We have to stop the revolving door to hospital services and prevent people from getting so ill that they require hospital intervention. Dudley MCP will help all of those things and at Moss grove we are committed to making it work for you, our patients.
Q10- if merger does go ahead will telephone access get worse? A10. We have heard your fears about access in general and with regard to telephone access in particular, we don’t have it all worked out just yet but we are committed to listening continually to your feedback and making the necessary adjustments to improve access in general. We don’t think the changes will have a detrimental effect on access but we are aware of the issue you raise and are looking into how best to resolve them, regardless of the outcome of this proposal.,
Other comments/ notes: Please note any other comments/ notes raised by participants that you feel are relevant to this consultation Lots of subsequent questions on the MCP and the role it will play with regard to keeping people out of hospital. Laura Broster from the CCG and Simon Hughes from the MCP Steering group responded to these where necessary and directed people on where they could access more information.
Enc: 02-3
2nd Floor, Marmion House, Lichfield Street, Tamworth, Staffordshire, Via email to : B79 7BZ
rd Date: 3 April 2018
Dear
We at South East Staffordshire and Seisdon Peninsula (SES&SP) Clinical Commissioning Group (CCG) and Dudley CCG are writing to you collectively to seek your views on a proposed CCG Constitutional Change. Moss Grove Surgery in Kinver has indicated that they wish to transfer from SES&SP CCG to Dudley CCG.
Many of the GP partners at the Kinver practice also manage a practice in Kingswinford and they have started to seek the views of patients on the proposal so that they may put in an application to merge the two surgeries. They have articulated their reasons for the proposed merger of the two practices as follows:
• Merging and transferring Kinver under the commissioning structure of Dudley CCG would improve access and choice to our Kinver/Kingswinford patients. As patients would be able to use services at both sites. • It is currently harder to offer patients of both practices extended hours or extended access appointments in our Kinver surgery. Combining both surgeries will give a greater ability to manage variations in ‘on the day’ demand • There will be improved continuity of care. Currently, patients are sometimes unable to see their preferred doctor as they are working across 2 surgeries; if the transfer and merger were accepted then patients could see doctors at either site. • Merging would mean that it is easier to offer patients in Kinver access to nurse services for five days of the week. • Clinics available now to Kingswinford patients (minor operations, IUCD clinics, injection clinics to name a few) would be available to all patients • Currently the partnership works and supports two CCGs and two NHS England area teams. This increases workload on an already stretched partnership management team. • Economy of scale across both clinical and administration areas in Dudley would be realised. • It is hoped that the merger will improve recruitment and retention of staff to both practices.
It is not possible for the CCG to consider a merger application from practices in two separate CCGs so any proposal to merge is subject to a decision by NHS England on whether they support an application to amend the CCG Constitutional Boundary. This application is made by each of our CCG Governing Bodies to NHS England articulating whether we support the proposal or not.
We are seeking your views on this matter to help our Governing Bodies reach a decision. We will of course also be taking into account the views expressed by patients at the two practices (as sought by the practice) and through our own involvement mechanisms.
South East Staffordshire and Seisdon Peninsula CCG Chair: Dr Shammy Noor Accountable Officer: Marcus Warnes
Enc: 02-3
Please find below a number of key points which may help you to reach an opinion on this matter:
• Kinver Practice has a list size of approximately 5480 patients. • A vast proportion of these patients are resident in South East Staffordshire and Seisdon Peninsula. • The majority of patients currently choose to use the hospital services in Dudley. These arrangements and patient choice would continue regardless of the host CCG.
In the event of a CCG transfer the responsibility for existing contracts for health services would transfer to Dudley CCG, the intention being to maintain access to services for patients as exists at present.
• Although there will be a single health commissioner, arrangements for the commissioning of social care and other Council services will remain the same • In the event of a CCG transfer, the funding associated with patients registered at Kinver would transfer from South East Staffordshire and Seisdon Peninsula (SES&SP) CCG to Dudley CCG • In the Event of a CCG transfer NHS England have indicated that the practice would not transfer with any proportion of South East Staffordshire and Seisdon Peninsula (SES&SP) CCG financial deficit, this may create a challenge within that health economy. The application to NHS England is required by the 1st June 2018 with any agreed change happening the following April (2019).
We expect that you may have further questions on these proposals, we would be happy to assist in attending any suggested meetings to ensure we are able to gather your organisations views. Please do contact us via [email protected] and [email protected] for further information.
We welcome your feedback on this matter before our Board considers the application. Please respond by the 17th May 2018 so we may ensure your views are taken into account.
We look forward to hearing your thoughts on this matter.
With best wishes
Yours sincerely
Lynn Millar Caroline Brunt Director of Primary Care Chief Nurse Stafford & Surrounds CCG Dudley CCG
South East Staffordshire and Seisdon Peninsula CCG Chair: Dr Shammy Noor Accountable Officer: Marcus Warnes
Enc: 02-4
Lynn Millar Director of Primary Care Staffordshire CCG
Caroline Brunt Chief Nurse Dudley CCG
Dear Lynn / Caroline
Transfer of Moss Grove GP Practice
Thank you for seeking the views of South Staffordshire Council on this matter and attending the Councils Wellbeing Select Committee on Tuesday 24 April. Whilst this issue has been discussed on an informal basis by our elected Members, your attendance allowed the Committee a formal opportunity to respond to consultation which is very much welcomed, particularly on decisions that impact on the residents of South Staffordshire.
The Council’s primary consideration on this issue is to ensure residents can access good quality health care locally, not necessarily who provides the service. Whist we understand and support why the practice wants to merge and move CCG areas, South Staffordshire Council has a number of concerns we would like to raise as part of the consultation process.
The first concern for the Council is the longevity of a surgery remaining in Kinver. Although nothing in the current climate is certain we would like some assurance on how long a surgery will remain in Kinver. As a Council what we would not support is the whole practice moving to Kingswinford either now or in the future, as currently 5,480 residents access the Moss Grove Practice in Kinver.
Continued…../
Enc: 02-4
Page 2
The overall catchment area is closer to 10,000 and as our population ages the likelihood is more residents who choose to access their healthcare out of Staffordshire may decrease and the need to access services locally intensifies due to reduced mobility and a lack of public transport options.
The second and critical issue concerning Members is the outstanding deficit of the Staffordshire health economy and this transferring with the Practice. Confirmation that the deficit will not move with the practice could put additional financial burden on other Seisdon Practices which Members do not feel is equitable. In addition, whilst we see the logic for Moss Grove practice wanting to merge and move CCGs, what we want to avoid is other practices taking this approach. Other than Claverly Medical Practice we do not currently see any reasoning for another practice being able to move CCG areas, and we would like assurance that the removal of one GP practice will not affect the viability of other local GP practices within South Staffordshire.
The final observation is regarding the following statement “Although there will be a single Health Commissioner, arrangements for the commissioning of Social Care and other Council services will remain the same”. By definition this means there will be two separate Commissioner’s one commissioning health care and one commissioning social care. Although this is the arrangement now, what we don’t have is a clear picture of how this will work across borders under the proposed transfer arrangements. We would like to understand how logistically this will work and how the patient journey will be unaffected as what we want to avoid is the scenario of a postcode lottery for health care particularly within one District.
South Staffordshire Council fully appreciates that the final decision on GP practices moving between CCG’s is the responsibility of NHS England, and we are firm believers that those partners who are best placed to deliver services do so. However we would like to ensure the concerns put forward by the Wellbeing Select Committee are considered as part of the consultation process.
Yours sincerely Councillor Janet Johnson Chair South Staffordshire Wellbeing Select Committee
Cc Caroline Brunt
Enc. 02-5
Our Ref 190418/MA/ND Trust Headquarters Date 19 April 2018 2nd Floor, Trafalgar House 47-49 King Street Telephone 01384 324510 Dudley E-mail [email protected] DY2 8PS
Caroline Brunt Lynn Millar Chief Nurse Director of Primary Care Dudley CCG Stafford and Surrounds CCG Brierley Hill Health Number 2, Staffordshire Place and Social Care Centre, Stafford Venture Way, Brierley Hill, ST16 2LP West Midlands, DY5 1RU
Dear Caroline and Lynn,
Further to your letter dated 3rd April 2018 regarding proposed CCG constitutional change and a transfer of Moss Grove Surgery to Dudley CCG. We have reviewed this proposal with our operational teams and would comments as follows
Have the CCGs considered the impact on Local Authority boundaries. Social care staff do not work across Local Authority boundaries. Any Mental Health Assessment services need to be provided by the neighbouring boroughs Are you able to identify what percentage of the practice list is currently open to other Mental Health Services (eg South Staffordshire and Shropshire Healthcare NHS Foundation Trust) and how these will transfer to Dudley provision so a more detailed assessment of the risk to operational capacity (Community teams, Beds, OP Clinics) can be made For out of hours services a plan for operational liaison with those services relevant to Staffordshire would need to be agreed (e.g. Police, Social Care) Will there be a requirement for MH Primary Care provision at Kinver Surgery and the development of the MDT approach in line with other Dudley Practices? Implications for community services including Home Treatment will need to be considered if the geographical spread of services grows There would need to be appropriate resource transfer to the Health Economy and onward to the Trust for the impact of this change
Your letter offers the opportunity to meet and discuss these implications. In providing responses to the above Jacky O’Sullivan is happy to meet to discuss these operational implications and can be contacted on Jacky.O’[email protected]
Yours sincerely,
Mark Axcell Chief Executive Dudley and Walsall Mental Health Partnership NHS Trust Chair: Harry Turner Chief Executive: Mark Axcell Enc: 02-6
Dudley CCG 2nd Floor, Brierley Hill Health and Social Care Centre 25 April 2018 Venture Way Brierley Hill
DY5 1RU Tel: 01384 322777 Email: [email protected] Mr M Axcell Chief Executive Dudley and Walsall Mental Health Partnership NHS Trust Trust Headquarters 2nd Floor Trafalgar House Dudley DY2 8PS
Dear Mark
Proposed Transfer of Moss Grove Practice to Dudley CCG
I refer to your letter dated 19 April 2018 addressed to Caroline Brunt and Lynn Miller. I have responded to the specific points you raise below:- 1. Yes. Existing local authority arrangements will continue. In due course, it may be appropriate to review a potential transfer of resource from Staffordshire County Council to Dudley MBC for adult social care, children’s social care and public health services, as a means of facilitating greater alignment. 2. We are obtaining contractual information for all services, including mental health, from the existing CCG so further discussions can take place. This will also deal with the issue identified at 6 below. 3. Yes. 4. Yes. 5. Yes. 6. Yes – See 2 above. Resources transferred will be included within the Whole Population Budget of the proposed Dudley MCP. The MCP will then be able to determine whether to provide services directly or sub-contract.
Chair: Dr David Hegarty MBE Chief Officer: Mr Paul Maubach
In terms of meeting with Jacky, can I suggest we do this once we have the information referred to at 2 above?
Yours sincerely
Neill Bucktin Director of Commissioning
cc Caroline Brunt Lynn Miller Trish Taylor Laura Broster Jacky O’Sullivan
Chair: Dr David Hegarty MBE Chief Officer: Mr Paul Maubach
Enc: 02-7
Finance Department 2nd Floor, South Block Russells Hall Hospital TJ/AJF/3949TJ Dudley West Midlands 18 April 2018 DY1 2HQ Tel: 01384 321059 C Brunt Fax: 01384 321051 Chief Nurse E-mail: [email protected] Dudley CCG
L Millar Director of Primary Care Stafford & Surrounds CCG
Dear Caroline and Lynn
Re: Proposed CCG Constitutional Change
Thank you for your letter of 3rd April 2018 seeking feedback regarding the proposed constitutional change and transfer of Moss Grove Surgery in Kinver to become a member of Dudley CCG. The Trust recognises the reasons for merger set out in your letter and is broadly supportive of the transfer.
Your letter advises that patient flows will largely continue on the same basis as currently happens. Our expectation is that contract financial values, including block contracts, will be enhanced to reflect the transfer and we look forward to discussing this with you. Unless advised otherwise, we assume the MCP modelling and bid will continue on the basis of the current CCG population and that the future MCP contract will also reflect the impact of the transfer.
Best wishes
Tom Jackson Director of Finance
c.c. D Wake, Chief Executive Enc: 02-8
Enc: 02-9
Dudley CCG 2nd Floor, Brierley Hill Health and Social Care Centre 16 May 2018 Venture Way Brierley Hill
DY5 1RU Tel: 01384 322777 Email: [email protected] Mr N Carr Chief Executive Staffordshire and Stoke on Trent Partnership NHS Trust Morston House The Midway Newcastle-under-Lyme Staffordshire ST5 1QG
Dear Mr Carr
Transfer of Moss Grove Kinver Surgery to Dudley CCG
I refer to your letter regarding this issue forwarded by Lynn Miller to Caroline Brunt on 11 May 2018.
I am in the process of obtaining from colleagues at SES and Seisdon Peninsula CCG information regarding the contracts that the patients of the practice are currently covered by. I recognise the need to ensure continuity of care and subject to my comments below, it would be my intention to enter into a suitable contract with your Trust from the date at which the practice and the commissioning responsibility transfers to this CCG.
As you may be aware, the CCG is in the process of procuring the services of a multi- specialty community provider (MCP) which will provide a range of community based services. Subject to the necessary regulatory approvals, the contract is likely to be in place by 1 October 2019. From a date to be confirmed, the resources associated with the Kinver patients would be allocated to the MCP’s “Whole Population Budget” and the MCP will need to consider whether it delivers the services directly or sub-contracts with your Trust.
Chair: Dr David Hegarty MBE Chief Officer: Mr Paul Maubach
I hope this provides some degree of clarity and would be happy to meet to discuss the matter further. My PA, Fiona Jolly, manages my diary and her email address is [email protected].
Yours sincerely
Neill Bucktin Director of Commissioning
CC Caroline Brunt – Chief Nurse - Dudley CCG Lynn Miller – SES and Seisdon Peninsula CCG Laura Broster – Director of Communications and Public Insight – Dudley CCG
Chair: Dr David Hegarty MBE Chief Officer: Mr Paul Maubach
Enc: 02-10