Bundle HDdUHB Primary Care Applications Committee 18 November 2019
1 10:00 - Governance 1.1 Welcome and Introductions Presenter: Chair 1.2 Apologies for Absence Presenter: Chair 1.3 Declarations of Interest Presenter: All 2 10:10 - General Medical Services (GMS) Contract changes 2.1 Future of General Medical Services at Mariners Surgery, Ferryside Presenter: Anna Swinfield PCAC Mariners Surgery Ferryside SBAR November 2019 FINAL Appendix 1 FINAL Ferryside public engagement plan ISSUED Appendix 2: Ferryside EqIA Oct 2019 3 11:20 - Any Other Business
2.1 Future of General Medical Services at Mariners Surgery, Ferryside 1 PCAC Mariners Surgery Ferryside SBAR November 2019 FINAL
PWYLLGOR CEISIADAU GOFAL SYLFAENOL PRIMARY CARE APPLICATIONS COMMITTEE
DYDDIAD Y CYFARFOD: 18 November 2019 DATE OF MEETING: TEITL YR ADRODDIAD: Future of General Medical Services at Ferryside Surgery TITLE OF REPORT: CYFARWYDDWR ARWEINIOL: Jill Paterson, Director of Primary Care, Community & LEAD DIRECTOR: Long Term Care SWYDDOG ADRODD: Anna Swinfield, Head of General Medical Services - REPORTING OFFICER: Sustainability
Pwrpas yr Adroddiad (dewiswch fel yn addas) Purpose of the Report (select as appropriate) Ar Gyfer Penderfyniad/For Decision
ADRODDIAD SCAA SBAR REPORT Sefyllfa / Situation
Meddygfa Minafon has been a Health Board Managed Practice since 2015, and currently operates over three sites. In June 2019 the Primary Care Applications Committee made the decision to support a proposal to consider the consolidation of the delivery of General Medical Services to the population of Meddygfa Minafon over two of the three sites, namely Kidwelly and Trimsaran. This paper outlines the work undertaken on patient engagement regarding the future of the third and smallest site, Mariners’ Surgery in Ferryside. This has included working with the Community Health Council (CHC) on a public engagement plan, patient and stakeholder feedback and a public engagement event in Ferryside.
Cefndir / Background
Meddygfa Minafon currently operates over three sites, serving a total population of approximately 8,315 (October 2019):
Meddygfa Minafon, Kidwelly – main site (serving approximately 5333 patients) Derwendeg Surgery, Trimsaran – branch site (serving approximately 2082 patients) Mariners’ Surgery, Ferryside – branch site (serving approximately 900 patients).
All registered patients are eligible to use the General Medical Services provided at all sites and whilst many patients prefer to use the Surgery most convenient to their home address, many already travel to access a particular service at a particular time due to the lack of availability at their closest or preferred location. This is particularly the case with urgent appointments with a GP due to patient demand and appointment availability.
The PCAC paper (June 2019) contained considerable detail relating to the background and history of the Practice and context for review of the future provision of General Medical Services across the three sites.
Page 1 of 12 Figure 1. Map showing Meddgyfa Minafon practice boundary and patient distribution
GP provision at Meddygfa Minafon has stabilised since 2018 with regular locums working at the Practice alongside a WTE Clinical Lead GP, and another salaried GP. However, there are still significant challenges and risks in delivering general medical services safely and effectively over three Practice sites, and in particular at The Mariners Surgery in Ferryside.
Premises
The Mariners Surgery in Ferryside sits within a complex of buildings at Calon Y Fferi at the southern end of the village and is in the ownership of Ferryside Social Enterprise Group (FSEG). The Calon Y Fferi complex includes extensive community facilities including a café/restaurant with Post Office, Men’s Shed, launderette, community centre and community garden.
The premises is occupied under a five year lease which expires imminently on 4 January 2020. The rent is £9, 900 per annum. The Health Board as tenant is responsible for non-domestic rates and utilities. Running costs in addition to rent for 2018/19 were £8,989.77 bringing the total costs associated with the building to £18,889.77 for the year.
The building is a small ground floor area comprising one consulting room, two treatment rooms, small reception and waiting area, a former dispensary now used as storage, and a small staff kitchen area. Toilet facilities are sited in the neighbouring area adjacent to the Surgery and staff have to let patients in and out through the adjoining door to access this area. Disabled facilities are limited.
Page 2 of 12 Services
Since 2015, General Medical Services at Mariners Surgery have been limited by shortages of locum GPs and other clinical staff, and as a result patients have travelled increasingly to Kidwelly or Trimsaran to see a GP or for nurse-led chronic disease monitoring. The services which remain at Mariners Surgery are limited and not fully utilised with unused appointments.
Figure 2: Table of services currently provided at Mariners Surgery, Ferryside
Monday Tuesday Wednesday Thursday Friday AM AM AM AM AM Reception Reception Reception CLOSED CLOSED Phlebotomy clinic PM PM PM PM PM Reception CLOSED CLOSED CLOSED CLOSED Nurse – Treatment Room
Frailty Clinic/ Physiotherapist (alternate weeks)
Mariners Surgery is currently open for a total of 18.5 hours per week, including periods of lone worker cover by a Receptionist. This has been recently been reviewed and risk assessed under the Health Board Lone Worker Policy in response to staff concerns about being alone on the premises after dark (5-6pm) and having to lock-up and secure the building alone in a comparatively remote location. As a result the closing time on Tuesday afternoons has been revised from 6pm to 5pm to allow the sole receptionist to lock-up at the same time as the Practice Nurse leaves. The opening time on Tuesdays has been brought forward from 1pm to midday to maintain the same level of access.
No GP sessions at The Mariners Surgery have been provided since mid-2016 when it was decided to withdraw GP appointments due to a shortage of locum GPs across the three sites in order to provide safe and effective clinical services to the registered population. To maintain clinical input and relationships with the Ferryside community it was agreed to establish a GP-led Frailty Clinic and an Advanced Physiotherapist clinic, running alternate weeks.
An activity analysis carried out in January-March 2018 demonstrated high levels of vacant (not booked) appointment slots, as well as a percentage of patient DNAs for pre-booked appointments:
Clinic % Vacant slots % DNAs Phlebotomy 24.4% 13.39% Practice Nurse – Treatment Room 26.97% 5.57% Physiotherapist 40% 4.17%
The number of vacant slots for Practice Nurse clinics has continued to increase since this audit and these clinics were subsequently reduced from four sessions to one session per week. Data
Page 3 of 12 from October 2019 shows that, even with running a single session per week, vacant slots with Practice Nurse clinics continue at a rate of between 13 - 21%.
Whenever a patient asks for their phlebotomy, treatment room or physio appointment to be at Ferryside, staff will offer this.
In March 2018, dispensary services at Ferryside Surgery were suspended pending a formal decision on their continuation, due to concerns raised about the clinical safety of the service. An interim arrangement was established with a local Community Pharmacy (Kidwelly Pharmacy) to deliver dispensed medication to Mariners Surgery for collection by patients. This temporary collection service was made possible because the Receptionist based in Ferryside had a dispensing qualification; however this Receptionist retired in August 2019 and it was no longer possible to staff this interim arrangement. As a result of this the collection of medication has been suspended until further notice. All patients affected by this were informed in writing and given a number of choices of alternative ways to get their medication including home delivery by Kidwelly Pharmacy, collection direct from any named Community Pharmacy and collection of the prescription from Minafon Surgery to take to any Community Pharmacy.
Public engagement
Considerable public engagement has been undertaken with the patients of Minafon Surgery since 2015, including public meetings and drop-in events in Kidwelly, Trimsaran and Ferryside.
A public engagement plan was agreed with the Hywel Dda Community Health Council (CHC), see Appendix 1, and this engagement is ongoing. Early engagement has taken place internally with Practice staff and meetings have taken place with FSEG, St. Ishmael’s Community Council and the Patient Participation Group (PPG). Letters were sent to all patients in Ferryside and the surrounding area to inform them of the review and proposal to relocate services to Minafon and Trimsaran. Patients were asked to feedback their views to the Health Board and/or the CHC and were invited to attend a public engagement drop-in event in Ferryside on 15 October 2019.
Public engagement drop-in event, 15 October 2019
Approximately 105 people attended the event held at Three Rivers Hotel in Ferryside (2-7pm), representing approximately 7% of those patients who had received a letter. The event was staffed by the GMS team with support from Community Pharmacy and Minafon Practice staff who were also able to take bookings for flu clinics at the event. All feedback was captured via record sheets and feedback has been compiled (along with that received by telephone, email and post) by theme as indicated in Figure 3. All feedback has been shared with the CHC.
Page 4 of 12 Figure 3: All patient feedback by theme (187 responses compiled from telephone, email, post and in person at drop-in event)
Services at Meddygfa Minafon – 29% of responses raised concerns over services at Meddygfa Minafon. These included specific references to delays answering the telephones, lack of disabled parking bays and lack of continuity with locum GPs.
Telephones: during the peak period of 8.30am - 9.30am over 200 calls can be received at Meddygfa Minafon. An audit of the telephone system shows that all incoming calls are answered within five minutes, other than during periods of staff sickness. The telephone system and recorded message are under review in line with the new Access requirements, and it is expected that patient experience will improve in this area with better response times and clearer messaging. In contrast, an audit of telephone contacts at Mariners Surgery showed an average of seven calls per day.
Disabled parking: there are 16 spaces provided for patients and two for Blue Badge holders at Meddygfa Minafon. Practice staff have regularly observed cars with no Blue Badge being parked in disabled bays and better signage has been suggested to deter this. The approach road to the Surgery lies in a 20mph zone in the town and there is ample, safe street parking for the abled-bodied. Facilities for disabled patients at Minafon are better than those in Ferryside but with closer parking, better toilet facilities and more space for wheelchairs within the building.
GP continuity: for the last 18 months Meddygfa Minafon has built and maintained a core group of regular GP locums in addition to the two salaried doctors, and continuity has improved. Staff report that many patients do not ask to see a specific GP in the expectation that this cannot be provided, whereas this is not the case. Staff are now Page 5 of 12 asking patients if they would prefer to see a particular GP or checking records to see which GP they saw last for an ongoing problem to offer continuity. Wherever possible patients are offered a choice of either waiting to be seen by their preferred GP or taking the next available appointment appropriate to their problem. There are two/three female GPs available working mostly in Trimsaran and arrangements are in-hand to provide more sessions by female GPs in Minafon.
Transport – Ferryside lies 3.8 miles from Meddygfa Minafon in Kidwelly by minor roads (9 minutes), and 7.8 miles to Trimsaran (15 minutes). Those Ferryside patients with appointments for any services not provided in Ferryside are already travelling to Minafon. These include GP appointments, nurse appointments for all chronic disease management, baby clinic, well woman clinic, podiatry, physio and the Cluster social prescriber. Ferryside patients are given the choice of travelling to the further surgery at Trimsaran to see a GP if an appointment is available sooner than is available at Minafon and some choose this option on occasion, however it is noted that the preference is to wait and see a GP at Minafon.
Bus services: the First Cymru 197 and 198 services operate a total of five buses per day between the village square at Ferryside and Porth y Castell in Kidwelly (0.7 miles from Meddygfa Minafon). This is a 16 minute bus journey plus three minute walk for the able-bodied. The same five buses extend to Trimsaran which is a 34 minute bus journey from Ferryside (0.2 miles from the bus stop in Trimsaran to the surgery in the leisure centre). There are two buses travelling from Ferryside in the morning (9.12 and 10.33), one at 13.42, 16.32 and the last bus is at 18.22. Return buses from Kidwelly are at 14.49 and 16.49, and from Trimsaran at 14.34 and 16.34. Minafon is able to prioritise appointments for Ferryside residents travelling by bus around these times where appropriate. It is important to note that in 2017 and in response to concerns raised by Ferryside patients about access to GP appointments, specific slots in GP sessions around bus times were protected for Ferryside patients. However this facility was not used with any regularity and was discontinued. All patients using public transport are encouraged to ask when booking for appointment times to work around their needs and this is accommodated wherever possible.
Alternatively, Country Cars a community based car sharing scheme is available in the area and some patients attending the drop-in event raised the possibility of the Ferryside community establishing a car sharing scheme. It is worth noting that a small proportion of the feedback received regarding transport related to the environmental impact of multiple car journeys.
Ferryside sits on the Arriva trains network linking Swansea with Carmarthen and further west. Seven trains per day run each way during Surgery opening hours from 8.11am onwards and the journey is five minutes in length. The walk from Kidwelly railway station to Meddygfa Minafon is another five minutes.
Demographics – 19% of the responses received raised issues around the demographics in Ferryside and specifically the age profile of residents as a need for services in the village to be maintained or enhanced. This concern reflects the age group represented at the drop-in event. Data from the last census in 2011 indicates that the median age of Ferryside residents is 51. Live data from the Minafon clinical system shows that 579 of the 950 residents are now over the age of 50, equivalent to 61%. The age profile in Ferryside is not unique however, and reflects that of many more rural areas in Carmarthenshire. Ferryside does not have the same provision of housing for younger people or families as Kidwelly or Trimsaran.
Medication arrangements – 14% of respondents commented on the suspension of the medication collection service at Mariners Surgery in August 2019. Patients were reminded of the alternatives available to them which include home delivery by Kidwelly Pharmacy. Several
Page 6 of 12 patients who had previously used the collection service at Mariners Surgery commented that they regularly travel into Kidwelly anyway so are happy to collect in person from Kidwelly Pharmacy.
Communication – 15% of patients raised poor communication regarding services at Mariners Surgery and Meddygfa Minafon with several patients stating that they were unaware of the services available at Mariners Surgery. This resonates with comments from patients not knowing that they can ask to see their preferred GP at Minafon or Trimsaran, or request blood tests or treatment room appointments at Ferryside. Staff at the Practice have stated that they would be better able to support Ferryside patients if they declare themselves as such when making appointments. Communication is a consistent theme which needs addressing to empower patients to make more informed choices about the services they use. The Minafon PPG has an important role in this; it was reported during the consultation that currently there is no representative on the PPG from Ferryside.
At the event, a petition (electronic and hard copy) was handed-in containing 344 signatures (some duplicated) saying:
“We feel very strongly that it is essential to maintain a surgery in Ferryside.
We need a doctor, a nurse and a dispensary to provide the vital services required by a village where most residents are over the age of 50.
It is an integral part of Calon y Fferi Community centre which is very accessible. Visiting the centre is an opportunity to meet people and mitigates against loneliness and isolation. It helps to maintain physical and mental health at a local level. Public transport is very infrequent which makes using other medical centres very difficult for people with mobility problems. Most people want to stay in their own homes as they age and this is possible and more sustainable and economical when services and companionship are nearby. It would be a backward step to oblige all residents to leave the village for treatment.”
These comments reflect others at the drop-in event which focussed on the social interaction offered by a visit to Mariners’ Surgery, as opposed to the clinical need of patients.
A total of four written responses from patients were received (all emails) and this feedback is included in the analysis above.
Stakeholder feedback: letters were sent to local stakeholders including neighbouring Practices, Amman Gwendraeth Cluster Lead, local Community Pharmacies, the local AM, the local MP, St. Ishmaels’ Community Council, Ferryside Social Enterprise Group and Meddygfa Minafon Patient Participation Group. No feedback has been received, other than from those individuals associated with local community groups who attended the drop-in event.
All feedback has been shared with the CHC.
Feedback from patients to the CHC: the CHC has shared feedback received at the drop-in event. A total of 46 sets of comments were recorded by the CHC representatives at the event. The feedback received by the CHC directly mirrors that received direct to the Health Board because much of it is based on observation of conversations between patients and Primary Care staff at the drop-in event (so recorded twice). All four of the written responses received by the Health Board were copied to the CHC.
Page 7 of 12 Asesiad / Assessment
The existing General Medical Services at Ferryside are limited, not fully utilised, housed in a sub- standard building and staffed often by lone workers in a remote rural location. The proportion of vacant appointments for the Practice Nurse Treatment Room clinic has continued to increase during October 2019. It has not been possible to allocate a locum GP to Ferryside since mid- 2016 and this picture is not expected to change.
Issues with GP locum provision across the three sites have meant that those reliable and regular locums that have been secured have been priority allocated to Minafon and Trimsaran where the demand is greatest. Workforce is by far the greatest challenge with any Managed Practice and therefore difficult choices have had to be made between serving patient demand in Minafon or Trimsaran and allocating staff to Ferryside at the expense of the larger sites. There is no realistic possibility of a sustainable GP service being reinstated at Ferryside. Moves are underway for the GMS Contract for Meddygfa Minafon to go out to tender in early 2020 seeking to return the Practice back to independent contractor status. Unfortunately, any Independent Contractor bidder is not likely to view a commitment to a practice with multi-site premises which are not fit for purpose as favourable.
The service used most fully is the weekly Phlebotomy Clinic on Mondays. During discussions with the FSEG it had become apparent that alternative accommodation may be available to continue this service alone, although not in a healthcare setting and with safeguards around lone working. This can be explored further. It may also be very possible to operate outreach flu clinics from Calon-y-Fferi if a suitable venue can be found.
The Mariners Surgery premises is costing in the region of £19k per annum to operate. This is a poor return for the services which can be provided during the 18.5 hours per week the Surgery is open, much of it staffed by a Receptionist as a lone worker. While there is no history to date of adverse incidents related to lone working, the Receptionist who now works there regularly and the Receptionist who covers during periods of leave have requested a review of arrangements through the Lone Worker Policy. A risk assessment has been carried out and opening hours have been adjusted as described earlier. While the suspension of the medication collection service has reduced the risk for lone workers at Mariners Surgery, Health & Safety risks for the staff remain. Furthermore, while the Reception staff have undergone Basic Life Support training, the expectation by patients that a medical emergency could be dealt with at Mariners Surgery also brings risks.
Other concerns relating to the building are the fire stopping to the ceiling, damp in some areas, flooring and a security system which requires upgrading.
Some of the feedback received from patients (including the petition) focussed on the opportunity for social interaction for the elderly in particular afforded by a visit to Mariners Surgery. While this is a valid point, where there are concerns about social isolation, this is not an issue that can or should be solely addressed by the continuation of existing general medical services at the Surgery. The Calon Y Fferi complex and the wider Ferryside community have ably demonstrate how an organised and caring community can operate services and projects to combat loneliness and promote social engagement. These include the luncheon club for the elderly, Men’s Shed, events in the community centre/village hall, Calon-y-Fferi café (with Post Office), active fundraising events for local causes, clothes swap events, Christmas market, live music and events with a religious focus. There are many and varied opportunities for social interaction aside from a visit to the Surgery. As part of a transition plan to relocate General Medical Services from Ferryside to Minafon and Trimsaran, the Amman Gwendraeth Cluster Social Prescriber could
Page 8 of 12 operate sessions from other space within Calon-y-Fferi to further promote wellbeing and social welfare.
The transition of the remaining services from Ferryside to Minafon and Trimsaran would require careful planning, clear communication with patients, stakeholders and the community, discussions with staff and work in Minafon to improve patient experience (Access and staff training). A Patient Satisfaction Questionnaire (PSQ) could be undertaken for the whole Practice population to identify common areas for improvement as well as existing good practice. Mitigations can be put in place to improve communication for patients about access, and improve the patient experience with the telephones in line with the new Access requirements. The PPG should be encouraged to improve representation from Ferryside and could be instrumental in assisting with the PSQ, which would also ideally require CHC input. A review should be carried out of car parking provision for Blue Badge holders, including better signage to deter misuse.
It is proposed that a review take place of the Practice website to improve messaging for all patients and promotion of digital services for patients. As part of this the Health Board will explore providing sessions within Ferryside to assist patients in registering for and using My Health Online.
It is apparent that some restricted services of value, existing and new, can be accommodated at Calon-y-Fferi without the need for a dedicated surgery building and the associated costs. These are services identified as meeting highlighted needs within Ferryside, namely phlebotomy provision which is better-used than other services and Cluster social prescriber sessions. It is proposed that work be undertaken with FSEG to source alternative accommodation on a regular room-rental basis for these services to remain for a trial period and subject to review of their usage and effectiveness.
Argymhelliad / Recommendation
The Committee is asked to support the proposal to relocate the remaining services at Mariner’s Surgery to Minafon and Trimsaran from 1 January 2020, subject to the following:
1. There will be no reduction in service provision across the sites. All services to be relocated to protect capacity. Services identified as meeting greater need in Ferryside, namely phlebotomy and social prescriber, should be scoped for alternative accommodation at Calon-y-Fferi. 2. Patient engagement to be continuous: a. a communications exercise be undertaken to make all patients more aware of all services to include a practice newsletter and review of the website, b. specific communication be aimed at Ferryside patients to encourage those with transport difficulties and using public transport to tell Reception staff this when booking appointments in order that the staff have an opportunity to offer times which may be more convenient. c. the PPG should be strongly encouraged to improve representation from Ferryside d. a PSQ should be conducted to capture the views of all patients and support development of an action plan to improve patient experience; 3. Practical support be provided for Ferryside patients to be assisted with registering for and using digital services, including My Health Online; 4. Parking provision at Minafon be reviewed, including measures to deter misuse of disabled bays
Page 9 of 12 Amcanion: (rhaid cwblhau) Objectives: (must be completed) Committee ToR Reference: 5.3 Consider applications made by GMS Contractors Cyfeirnod Cylch Gorchwyl y Pwyllgor: and make decisions on behalf of the Board in accordance with the NHS (General Medical Services Contracts) (Wales) Regulations 2004, including but not limited to: Applications for changes to a GMS practice boundary; Applications for closing a GMS contractor list; Applications to remove registered patients who live outside the agreed practice area; Applications to withdraw from the provision of Additional Services; Applications to close a branch or split site surgery; Applications to merge two or more GMS contracts/partnerships; Consider breaches to the GMS contract; Applications for new GMS contracts; Applications to dispense.
Cyfeirnod Cofrestr Risg Datix a Sgôr N/A Cyfredol: Datix Risk Register Reference and Score: Safon(au) Gofal ac Iechyd: Governance, Leadership and Accountability Health and Care Standard(s): 2.1 Managing Risk and Promoting Health and Safety 6.3 Listening and Learning from Feedback 3.2 Communicating Effectively Amcanion Strategol y BIP: 4. Improve the productivity and quality of our services UHB Strategic Objectives: using the principles of prudent health care and the opportunities to innovate and work with partners. 2. Living and working well. 3. Growing older well. 5. Deliver, as a minimum requirement, outcome and delivery framework work targets and specifically eliminate the need for unnecessary travel & waiting times, as well as return the organisation to a sound financial footing over the lifetime of this plan Amcanion Llesiant BIP: Support people to live active, happy and healthy lives UHB Well-being Objectives: Develop a sustainable skilled workforce Hyperlink to HDdUHB Well-being Improve Population Health through prevention and Statement early intervention Develop a sustainable skilled workforce
Gwybodaeth Ychwanegol: Further Information:
Page 10 of 12 Ar sail tystiolaeth: Meddygfa Minafon Clinical System Evidence Base: Shared Services Partnership Office of National Statistics Stakeholder and patient feedback, including that shared by CHC Rhestr Termau: CHC – Community Health Council Glossary of Terms: LMC – Local Medical Group FSEG – Ferryside Social Enterprise Group PPG – Patient Participation Group PSQ – Patient Satisfaction Questionnaire GMS – General Medical Services GP – General Practitioner WTE – Whole Time Equivalent NHS – National Health Service NWSSP – NHS Wales Shared Services Partnership NWIS – NHS Informatics Service Partïon / Pwyllgorau â ymgynhorwyd PCAC, June 2019 ymlaen llaw y Pwyllgor Ceisiadau CHC Gofal Sylfaenol: FSEG Parties / Committees consulted prior St. Ishmael’s Community Council to Primary Care Applications Committee:
Effaith: (rhaid cwblhau) Impact: (must be completed) Ariannol / Gwerth am Arian: Potential cost savings from costs associated with lease Financial / Service: and running costs of the premises. Ansawdd / Gofal Claf: More sustainable patient care consolidated over two sites. Quality / Patient Care:
Gweithlu: Staff health and safety considerations: Lone Worker Workforce: Policy 170 (Feb 2018)
Risg: Risk of deteriorating relationship with Ferryside Risk: community – see Recommendation for mitigations.
Cyfreithiol: No likelihood of legal challenge Legal:
Page 11 of 12 Enw Da: Risk of deteriorating relationship with Ferryside Reputational: community – see Recommendation for mitigations. No political interest fed back and very little media interest.
Gyfrinachedd: N/A Privacy:
Cydraddoldeb: EqIA completed. Equality:
Page 12 of 12 1 Appendix 1 FINAL Ferryside public engagement plan ISSUED
Ferryside public engagement plan, V3: October 2019
Continuous engagement plan for review of General Medical Services at Mariners Surgery, Ferryside
Background
Meddygfa Minafon has been a Health Board Managed Practice since January 2015. The practice has a list size of circa 8,300 with the main surgery site located in the town of Kidwelly. The Practice has two branch surgeries: Derwendeg Surgery in Trimsaran; and The Mariners Surgery situated in the village of Ferryside. Both Trimsaran and Ferryside were previously independently contracted for the provision of GMS for 2,022 and 978 patients respectively.
In January 2018 the dispensing services at The Mariners Surgery in Ferryside were reviewed by the Medicines Management Team as part of the Dispensary Services Quality Scheme for patient safety and clinical governance reasons. As a result of this review in April 2018, the Health Board made the decision to suspend all dispensing at Ferryside, due to concerns raised about the clinical safety of the service. As an interim measure the local Community Pharmacy successfully implemented a dispensing and home delivery service for patients and delivered dispensed prescriptions to The Mariners for collection by patients (where this was preferable). Collection of dispensed medication has been suspended until further notice from The Mariners Surgery from the end of August 2019 on safety grounds because of the retirement of the only member of staff with the appropriate dispensing qualification. All patients using this service have been informed of the temporary suspension.
No GP sessions at The Mariners Surgery have been provided since mid-2016 when due to a shortage of GP’s it was decided to withdraw GP appointments. To maintain relationships with the population of Ferryside it was agreed to put in a fortnightly GP-led Frailty Clinic and an Advanced Physiotherapist working alongside the nursing team. Practice Nurse sessions, Phlebotomy and a fortnightly Advanced Physiotherapist and Frailty Clinic have been held at the Mariners Surgery. However following a demand and capacity audit which highlighted a significant lack of patient demand for Practice Nurse appointments, these clinics were reduced from four sessions to one session each week. See table below for weekly services available.
In June 2019 a paper went to the Primary Care Applications Committee and the following proposal was approved:
‘Patient consultation: Joint consultation between the CHC and the Health Board with patients who have used Mariners Surgery over the last year to seek their views on future GMS services at these sites.
These patients are asked to provide structured feedback on the quality, timeliness and service to date. 1 Ferryside public engagement plan, V3: October 2019
A transitional plan be developed which will address all clinical quality and safety issues identified as part of this review. This along with the report will be shared for learning at the Primary & Community Services Quality, Safety & Experience Sub Committee.
In the interim The Mariners Surgery continues to provide services at the same level, until a decision has been made on its future and communicated to the community’.
The Mariners Surgery continues to be open as follows:
Monday Tuesday Wednesday Thursday Friday
Open PM Open AM Open AM Open AM Reception Reception Reception Reception Closed Nurse clinic Phlebotomist GP Frailty Clinic / Physio clinic (alternate weeks)
Appointment data shows that many appointments are unfilled (41% nurse appointments unfilled, 13% phlebotomy appointments unfilled, 24% physio appointments unfilled). In addition 12-67% of appointments which are filled are taken by patients from outside the Ferryside area.
Kidwelly and Trimsaran Surgeries both have the capacity to hold an additional nursing session. Ferryside patients already travel to Kidwelly to see a GP and the statistics would suggest that many are doing the same to see a Practice Nurse. An additional or extended Phlebotomy clinic could be accommodated in Kidwelly.
2 Ferryside public engagement plan, V3: October 2019
Proposed approach for continuous engagement activity
Considerable public engagement has been undertaken with the patients of Minafon Surgery since 2015, including drop-in events in Kidwelly, Trimsaran and Ferryside. The approach will focus on services at Ferryside but will encompass patients the wider practice population. All written communication will be bilingual and alternative formats will be available on request.
The focused engagement activity period will be autumn/winter 2019/20 and going forward will be supported through continuous engagement. This will provide those who are interested in the work to have an opportunity to participate through events / email / phone / written comments.
A drop-in public engagement event is being held in Ferryside. A FAQ will be provided for patients at the event and Welsh language support will be provided.
The basis of all engagement is to seek the views of patients and Stakeholders on the future of General Medical Services for the Ferryside area within the context of the current services and usage.
3 Ferryside public engagement plan, V3: October 2019
Engagement Methods Employed and Rationale
Method Rationale
Engagement period A focused period of engagement will take place from August 2019 onwards.
Broad Approach The following activities will be undertaken: - Information will be circulated to Stakeholders, including community council and Ferryside Social Enterprise Group (FSEG) and PPG. Meetings will take place with key Stakeholders prior to the October public engagement event. - Information will be circulated to local primary care contractors, community clinics, local authority customer service centres, Community Pharmacy, GP Out of Hours, A&E departments and minor injury units and community hospitals - Information will be shared with the media - Global email to all staff and on Staff Bulletin - Utilise any existing opportunities identified during the focused engagement period - Drop-in event at venue in Ferryside in October.
People can share their views by email comments via [email protected] , by telephone (0300 0200 159) or send written comments to Hywel Dda University Health Board, FREEPOST, Haverfordwest, Pembrokeshire, SA61 1BR . There will also be signposting to CHC contact information (telephone 01646 697610, Ty Myrddin, Old Station Road, Carmarthen, SA31 1BT).
4 Ferryside public engagement plan, V3: October 2019
ENGAGEMENT PLAN: All written information to be bilingual.
Engagement
Date 2019 Event / Activity Staff / resourcing Comments Achieved required
August Early briefing information to staff of Minafon Practice Manager Practice Manager has spoken to all Completed Surgery staff to brief.
September V2 of Public Engagement Plan shared with Head of GMS 10/09/2019: CHC Exec meeting, Completed CHC and feedback received Sustainability Aberarth September Early information to Stakeholders, including Head of GMS 11/09/2019: meeting with Completed FSEG, community council, PPG, GP Head of Engagement Ferryside Social Enterprise Group practices, CP, other contractor professions, Head of Property (landlords) local politicians, County team, Estates, SSP Performance LDM 19/09/2019: evening meeting with Practice Manager St. Ishmael’s Community Council (supported by CHC)
30/09/2019: meeting with PPG
Letter to Stakeholders
Late Letter # 1 to patients who live in and around Head of GMS All patient feedback received to be Completed September/ Ferryside to inform (bilingual) of review, Sustainability logged centrally and responded to early October services and event: details of how patients LDM individually. Anonymised feedback (exact date can feedback their views and concerns either PC team support will be shared with CHC. TBC) directly to the Health Board or via the CHC. Comms Details of public engagement drop-in event Engagement team included. Draft shared with CHC, circulated Welsh translation to all Stakeholders, posted on practice
5 Ferryside public engagement plan, V3: October 2019
website. Health Board distribution via HB website and social media. Notices displayed in the Mariners’ Surgery, Trimsaran Surgery and Minafon Surgery. With letter #1 Media statement based on Letter #1 Comms All patient feedback received to be Completed Global email logged centrally and responded to individually. Anonymised feedback will be shared with CHC. 15th October Public engagement drop-in event in Ferryside Exec support All patient feedback received to be Completed (afternoon) (Poachers Rest) Other senior HB logged centrally and responded to Head of GMS individually. Anonymised feedback Sustainability will be shared with CHC. LDM/PCSM PC team support Comms Engagement team Welsh language support October (post Post-engagement event activity: collation LDM/PCSM, data All patient feedback received to be Completed 15/10) and analysis of feedback, drafting of paper for analyst, Head of GMS logged centrally and responded to PCAC, review of EqIA Sustainability individually. Anonymised feedback will be shared with CHC. CHC undertaking to share anonymised feedback received by them. 11 November Extraordinary PCAC PCAC Paper with outcome of 2019 Assistant Director of engagement exercise and PC, recommendation Head of GMS Sustainability 12 November CHC Exec Committee Head of GMS As required 2019 Sustainability Letter to patients informing them of outcome Head of GMS TBC
6 Ferryside public engagement plan, V3: October 2019 of engagement exercise and process. Media Sustainability statement and internal comms. Comms Head of Engagement
7 1 Appendix 2: Ferryside EqIA Oct 2019
Appendix 2: Equality Impact Assessment – Mariners’ Surgery, Ferryside
Form 1 : Preparation
The impact on registered patients of the relocation of remaining General Medical Services from Mariners’ Surgery in Ferryside to Meddygfa Minafon, Kidwelly, and 1. What are you equality impact Derwendeg Surgery, Trimsaran (other sites within the same practice). assessing?
Meddygfa Minafon has been a Health Board managed practice since 2015. In June 2019 the Primary Care Applications Committee made the decision to support a proposal to consolidate 2. Policy Aims and Brief Description the delivery of General Medical Services to the population of Meddygfa Minafon over two of the three sites, namely Kidwelly and Trimsaran. This has included working with the Community Health Council (CHC) on a public engagement plan, patient and stakeholder feedback and a public engagement event in Ferryside.
Aim is to embed EqIA into the planning of the Health Board process to ensure ‘a patient-centred approach that values the criteria of fairness and equality and compliance with the existing public sector duties for race, gender and disability equality’. (‘A Toolkit for carrying out EqIAs’, NHS Wales). This policy aims to support the Health Board decision-making around the future provision of General Medical Services for the patients of Mariners’ Surgery in Ferryside.
Anna Swinfield, Assistant Head of GMS
3. Who is responsible for the Rhian Bond, Assistant Director for Primary Care Policy/work?
1 Appendix 2: Equality Impact Assessment – Mariners’ Surgery, Ferryside
Anna Swinfield, Assistant Head of GMS
4. Who is Involved in undertaking Laura Lloyd-Davies Primary Care Services Manager (temporarily covering Amman this EqIA? Gwendraeth)
Pamela Parker – Practice Manager, Meddygfa Minafon
Yes.
5. Is the Policy related to other GMS contract regulations and Health Board management of branch surgery closures Policies/areas of work? (http://howis.wales.nhs.uk/sitesplus/862/page/53477 )
Stakeholders: patient registered with Meddygfa Minafon and specifically those resident in the Ferryside area, neighbouring practices, Amman Gwendraeth Cluster Lead, local Community 6. Stakeholders Pharmacies, the local AM, the local MP, St. Ishmaels’ Community Council, Ferryside Social Enterprise Group and Meddygfa Minafon Patient Participation Group.
Community Health Council (CHC) and Local Medical Committee (LMC).
Help – public engagement process, communication and discussion with key stakeholders, mitigations recognising the challenges that would be experienced by patients 7. What might help/hinder the success of the Policy? Hinder – poor communication, lease agreement expiry in January 2020.
2 Appendix 2: Equality Impact Assessment – Mariners’ Surgery, Ferryside
1.1. Form 2 : Information Gathering Orientation Language Disability Religion Gender Sexual Welsh Belief Race Age
Is the policy relevant to the public specific duties relating to each equality strand? Tick as appropriate (for a definition of Relevance, refer to Page 22)
In other words, should the Policy:
eliminate discrimination and eliminate harassment in relation to:
promote equality of opportunity in relation to:
promote good relationships and positive attitudes in relation to:
encourage participation in public life in relation to: Yes
In relation to disability only, should the Policy take account of difference, even if it involves treating some individuals more favourably?
3 Appendix 2: Equality Impact Assessment – Mariners’ Surgery, Ferryside
4 Appendix 2: Equality Impact Assessment – Mariners’ Surgery, Ferryside
The Human Rights Act contains 15 rights, all of which NHS organisations have a duty to act compatibly with and to respect, protect and fulfil. The 6 rights that are particularly relevant to healthcare are listed below. For a fuller explanation of these rights and other rights in the Human Rights Act please refer to Appendix A: The Legislative Framework.
Depending on the Policy you are considering, you may find the examples below helpful in relation to the Articles.
Yes No
Consider, is the Policy relevant to: all registered patients and service users
Article 2 : The right to life
Examples: The protection and promotion of the safety and welfare of patients and staff; issues of patient restraint and control
Article 3 : The right not be tortured or treated in an inhuman or degrading way
5 Appendix 2: Equality Impact Assessment – Mariners’ Surgery, Ferryside
Examples: Issues of dignity and privacy; the protection and promotion of the safety and welfare of patients and staff; the treatment of vulnerable groups or groups that may experience social exclusion, for example, gypsies and travellers; Issues of patient restraint and control
Article 5 : The right to liberty
Examples: Issues of patient choice, control, empowerment and independence; issues of patient restraint and control
Article 6 : The right to a fair trial
Example: issues of patient choice, control, empowerment and independence
Yes No
Article 8 : The right to respect for private and family life, home and correspondence; Issues of patient restraint and control
Examples: Issues of dignity and privacy; the protection and promotion of the safety and welfare of patients and staff; the treatment of vulnerable groups or groups that may experience social
6 Appendix 2: Equality Impact Assessment – Mariners’ Surgery, Ferryside
exclusion, for example, gypsies and travellers; the right of a patient or employee to enjoy their family and/or private life
Article 11 : The right to freedom of thought, conscience and religion
Examples: The protection and promotion of the safety and welfare of patients and staff; the treatment of vulnerable groups or groups that may experience social exclusion, for example, gypsies and travellers
7 Appendix 2: Equality Impact Assessment – Mariners’ Surgery, Ferryside
Equality Information Gathered Strand
2011 Census data shows that less than 2% of the West Wales population identifies as BME. No more specific information is available Race for the patient population at Mariners’ Surgery.
Disabilit y http://www.wwcp.org.uk/wp-content/uploads/2017/03/West-Wales-Population-Assessment-March-2017.pdf
(includin Within the Practice demography collected in the 2011 census, the majority of the population self reported very good or good health. g mental Approximately 15% of the Practice demography self reported day to day activities limited a lot and 15% reported day to day activities health limited a little. and people Facilities for disabled patients at Mariners’ Surgery are inferior to those at Meddygfa Minafon and Derwendeg Surgery, Trimsaran. diagnose Mariners’ Surgery is a smaller premises for wheelchair users (narrow corridors) with longer approach path/ramp (greater distance d as from car parking area) and no disabled toilet within the premises. This is not to say that Meddygfa Minafon is fully compliant and clinically more work is required to address this. obese)
PHW data (see link above) – shows higher percentage of females in all age categories 0-44 years. From 45 years onwards the data shows a marginally higher percentage of females. At 85 years plus the percentage of females is almost double that of males. This is Gender consistent with the picture across the Health Board.
Sexual Orientatio No data available n
Public Health Wales Observatory Age (http://www2.nphs.wales.nhs.uk:8080/PubHObservatoryProjDocs.nsf/85c50756737f79ac80256f2700534ea3/fcbca03a937b0a6 e80257ba30056d5b1/$FILE/20130426_GPclusterProfile_HywelDda_HC_v2b-Final.pdf PHW data – shows higher percentage of patients than Health Board average in age categories for 45-64, 65-74 and 75-84. The percentage of patients over 85 is the same as Appendix 2: Equality Impact Assessment – Mariners’ Surgery, Ferryside
the Health Board average. The percentage of patients in all groups 0-44 years is lower than the Health Board average. This data reflects an ageing population.
ONS data for Ferryside specifically indicates that the population of the village itself (as opposed to the village and surrounding settlements) is 859 (some of whom will be registered with other practices, for example in Carmarthen). ONS data for the population of Ferryside (settlement, not surgery) is as follows:
Religion No data available. or Belief Appendix 2: Equality Impact Assessment – Mariners’ Surgery, Ferryside
https://statswales.gov.wales/Catalogue/Welsh-Language/Census-Welsh-Language/welshspeakers-by-la-broaderage- Welsh 2001and2011census Languag e Census data shows that the percentage of people who are able to speak Welsh is 43.9% in Ceredigion (2011 data). All letters and media statements to patients have been issued bilingually and Welsh speaking staff were available at the drop-in event.
Equality Information Gathered Strand
Human No data Rights
Gender Reassig nment
(People who are having or have had No data a sex change, transvest ites and transgen der people)
Marriage and Civil No data Partners hip Appendix 2: Equality Impact Assessment – Mariners’ Surgery, Ferryside
Pregnan cy and No data Maternit y Appendix 2: Equality Impact Assessment – Mariners’ Surgery, Ferryside
1.2. Form 3 : Assessment of Relevance and Priority Evidence: Potential Impact: Decision:
Existing Information to suggest Nature, profile, scale, cost, numbers Multiply ‘evidence’ score by ‘potential some groups affected. affected, significance. impact’ score. Equality Strand Gathered from Step 2. Insert one overall score (See Scoring Chart C) (See Scoring Chart A) (See Scoring Chart B)
Race 3 0 0
Disability
(Including mental 3 0 0 health and people diagnosed as clinically obese)
Gender 3 0 0
Sexual Orientation 0 0 1
Age -2 -6 3 Appendix 2: Equality Impact Assessment – Mariners’ Surgery, Ferryside
Religion or 0 0 0 Belief
Welsh Language 3 0 0
Equality Strand Evidence: Potential Impact: Decision:
Existing Information to suggest Nature, profile, scale, cost, numbers Multiply ‘evidence’ score by ‘potential some groups affected. affected, significance. impact’ score. Gathered from Step 2. Insert one overall score (See Scoring Chart C) (See Scoring Chart A) (See Scoring Chart B)
Human Rights
Marriage and Civil Partnership
Pregnancy and Maternity Appendix 2: Equality Impact Assessment – Mariners’ Surgery, Ferryside
Gender Reassignment
(People who are having or have had a sex change, transvestites and transgender people)
Scoring Chart A: Evidence Available Scoring Chart B: Potential Impact Scoring Chart C: Impact Decision
3 Existing data/research -3 High negative -6 to -9 High Impact (H)
2 Anecdotal/awareness data only -2 Medium negative -3 to -5 Medium Impact (M)
1 No evidence or suggestion -1 Low negative -1 to -2 Low Impact (L)
0 No impact 0 No Impact (N)
+1 Low positive 1 to 9 Positive Impact (P)
+2 Medium positive
+3 High positive Appendix 2: Equality Impact Assessment – Mariners’ Surgery, Ferryside
1.3. Form 4 : Examine the Information Gathered So Far
Do you have adequate information?
Refer to Form 2 : Information Gathering for Yes 1. assistance
Yes 2. Can you proceed with the Policy during EqIA?
Does the information collected relate to all equality Yes 3. strands?
4. What additional information (if any) is required? None
How are you going to collect any additional
information needed? N/A 5. State which representative bodies you will be liaising with in order to achieve this Appendix 2: Equality Impact Assessment – Mariners’ Surgery, Ferryside Appendix 2: Equality Impact Assessment – Mariners’ Surgery, Ferryside
Form 5 : Judge/Assess the Potential Impact of the Policy across the Equality Strands Differential Negative Positive
Information gathered on Forms Consider the likely/potential impact of 2 and 4 the evidence
Age
Disability
(Including mental health and people diagnosed as clinically obese)
Gender
Race
Religion or Belief
Sexual Orientation
Welsh Language Appendix 2: Equality Impact Assessment – Mariners’ Surgery, Ferryside Differential Negative Positive
Information gathered on Forms Consider the likely/potential impact of 2 and 4 the evidence
Human Rights
Gender Reassignment (People who are having or have had a sex change, transvestites and transgender people)
Marriage or Civil Partnership
Pregnancy and Maternity Appendix 2: Equality Impact Assessment – Mariners’ Surgery, Ferryside
1.4. Form 6 : Consider Any Alternatives to the Policy which will Reduce or Eliminate any Negative Impact
1. no reduction in service provision across the sites. All services to be relocated to protect capacity and not withdrawn. Services identified as meeting greater need in Ferryside, namely phlebotomy and social prescriber, should be scoped for alternative accommodation at Calon-y-Fferi.
2. patient engagement to be continuous:
a. a communications exercise be undertaken to make all patients more aware of all services to include a practice newsletter and review of the website, Describe any mitigating actions taken to reduce negative impact b. specific communication be aimed at Ferryside patients to encourage those with transport difficulties and using public 1. transport to tell Reception staff this when booking appointments in order that the staff have an opportunity to offer times which may be more convenient.
c. the PPG should be strongly encouraged to improve representation from Ferryside
d. a PSQ should be conducted to capture the views of all patients and support development of an action plan to improve patient experience
3. opportunities be provided for Ferryside patients to be assisted with registering for and using digital services, including My Health Online Appendix 2: Equality Impact Assessment – Mariners’ Surgery, Ferryside
4. parking provision at Minafon be reviewed, including measures to deter misuse of disabled bays
Is there a handling strategy for any unavoidable but not unlawful negative See above (1.). 2. impacts that cannot be mitigated?
Describe any actions taken to maximise the opportunity to promote equality, ie: changes to the Policy, regulation, See above (1.). 3. guidance, communication, monitoring or review
What changes to the Policy have been made as a result of conducting this None. Mitigations relating to elderly population outlined in 1. above. 4. EqIA? Appendix 2: Equality Impact Assessment – Mariners’ Surgery, Ferryside
1.5. Form 7 : Outcome Report Organisation: Hywel Dda University Health Board
Name: Anna Swinfield Proposal Sponsored Title: Head of GMS, Sustainability by: Department: Primary Care
The impact on registered patients of the relocation of remaining General Medical Services from Mariners’ Surgery in Ferryside to Meddygfa
Policy Title: Minafon, Kidwelly, and Derwendeg Surgery, Trimsaran (other sites within the same practice).
Brief Aims and Objectives of Policy: See title page Appendix 2: Equality Impact Assessment – Mariners’ Surgery, Ferryside
Yes No Was the decision reached to proceed to Record Reasons for Decision: full Equality Impact Assessment?:
Yes No If no, are there any issues to be Record Details: continuous patient engagement,, communication, addressed? transport, PPG, PSQ, digital services, disabled parking
Is the Policy Lawful? Yes No
Yes No
If no, please record the reason and any further action required: Will the Policy be adopted? Appendix 2: Equality Impact Assessment – Mariners’ Surgery, Ferryside
Yes No Are monitoring arrangements in place? Refer to Action Plan (Form 8)
Name: Anna Swinfield
Who is the Lead Title: Head of GMS, Sustainability Officer? Department: Primary Care
Monthly or in line with issues raised. Review Date of Policy:
Name Title Signature
Signature of all parties: Appendix 2: Equality Impact Assessment – Mariners’ Surgery, Ferryside