Leeds West CCG Primary Care Commissioning Committee Meeting Date of Meeting: 9 February 2017
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Agenda Item: 6 FOI Exempt: N Leeds West CCG Primary Care Commissioning Committee Meeting Date of meeting: 9 February 2017 Title: Application for Branch Surgery Closure Lead Governing Body Member: Dr Simon Stockill, Tick as Medical Director Category of Paper appropriate () Report Author: Joanne Evans, Primary Care Decision and Approval Locality Manager Reviewed by SMT: N/A Information Reviewed by Primary Care Improvement Group: Discussion 25 January 2017 Checked by Finance: N/A Approved by Lead Governing Body member (Y/N): Y Strategic Objectives – that this report relates to Tick as appropriate 1. To tackle the biggest health challenges in West Leeds, reducing health inequalities 2. To transform care and drive continuous improvement in quality and safety 3. To use commissioning resources effectively 4. To work with members to meet their obligations as clinical commissioners at practice level and to have the best developed workforce we possibly can Joint Health & Wellbeing Strategy Outcomes – that this report relates to Tick as appropriate 1. People will live longer and have healthier lives 2. People will live full, active and independent lives 3. People’s quality of life will be improved by access to quality services 4. People will be actively involved in their health and their care 5. People will live in healthy, safe and sustainable communities Assurance Framework - to which risks on the GBAF does this report Tick as relate? appropriate 1. Failure to improve health outcomes and reduce health inequalities through improving the health of the poorest the fastest. 2. Providers fail to meet quality standards, leading to poor quality and unsafe care. 3. The cessation of the YHCSU will create a great deal of instability for CCGs which could in turn impact on the CCG’s ability to deliver on its responsibilities. 4. The governance arrangements for collaboration, partnership working, risk sharing and commissioning across the Leeds CCG network, Local Authority, NHSE and other partner agencies are not robust. 5. System resilience shortfalls leading to a failure to meet patient needs. 6. Failure to achieve financial stability and sustainability. 7. Lack of member engagement and primary care capacity will impact on the development and implementation of the CCG strategy. 1 EXECUTIVE SUMMARY: Abbey Grange Medical Practice has formally applied to the CCG to close their branch surgery at Holt Park Health Centre. In August 2016 permission was granted from the CCG, after discussion at the Primary Care Improvement Group (PCIG) on 18th August 2016, to commence stakeholder engagement after the practice had completed some pre-engagement with local practices, MP Greg Mulholland, Local Councillors and their patient participation group (PPG), this was to gauge the level of support for the closure of the branch. The practice has now completed their stakeholder engagement which ran from the 5th October to the 30th November 2016. The practice would like to formally request the closure and should approval be granted that a date for closure be agreed but the practice has acknowledged this would not be before 1 April 2017. NEXT STEPS: Subject to discussion and agreement at Primary Care Commissioning Committee, the primary care and communication and engagement teams will work with the practice to agree an action plan to further engage and involve patients in the next steps. The action plan should be managed by Primary Care Improvement Group with update on progress reported to Primary Care Commissioning Committee. RECOMMENDATION: Primary Care Commissioning Committee is asked to: a) NOTE the engagement report and supplementary documents; b) NOTE the objections against the proposal to close the branch surgery; c) ACCEPT recommendation in this paper from Primary Care Improvement Group; and d) APPROVE the recommendation for Abbey Grange Medical Practice to close the branch surgery at Holt Park Health Centre. 2 1. Background 1.1 Abbey Medical Centre and Moor Grange Surgery successfully merged their two practices in April 2015. At the same time they applied to NHS England to close the branch surgery at Holt Park Health Centre. 1.2 NHS England refused the application to close the branch surgery as the patient feedback and public consultation events showed that the strength of opposition to the proposals was significant. They were also not assured that the current level of alternative capacity locally was sufficient to ensure that if existing patients at Holt Park wished to register elsewhere that they would be able to do so without causing undue pressure on other local practices. 1.3 Since the successful merger of Abbey Medical Centre and Moor Grange Surgery in April 2015, the practice has continued to review the service provision of core general medical services (GMS) across the three practice sites and have now concluded that it does not have sustainable capacity to continue over the three sites. 1.4 Abbey Grange Medical Practice is therefore seeking permission to close the branch surgery at Holt Park Health Centre Holt Road, Leeds, LS16 7QD. 1.5 The practice undertook some pre-consultation engagement with the Patient Participation Group (PPG), local practices, local councillors and the local MP who have all been supportive of the proposal. 1.6 A request to commence a period of formal consultation with stakeholders and patients was taken to the Primary Care Improvement Group (PCIG) where it was agreed that the consultation could progress to close the branch surgery. 1.7 Abbey Grange Medical Practice has now completed their consultation and has now submitted an engagement report to formally request the closure of the branch. The full application and associated can be found at the end of this report. 2.0 Details of Branch proposed for closure 2.1 The branch surgery is located in Holt Park Health Centre, Holt Road, LS16 7QD, which is a Leeds Community Healthcare (LCH) owned building. The practice has two other sites 1) Moor Grange Surgery, 60 Moor Grange View, Leeds, LS16 5BJ 2) Abbey Medical Practice, Norman Street, Leeds, LS5 3JN 2.2 The application to close the branch does not affect the provision of other services at the location. 3.0 Alternative provision of medical care 3.1 There are two alternative GP practices, High Field Surgery and Ireland Wood Surgery, within 1 mile of Holt Park Health Centre in line with NHS England 3 policy. They are both within the Leeds West CCG area. Both practices have open lists and both practices have a pharmacy located within or adjacent to their premises. (Please see map below.) 3.2 As part of the pre engagement work Abbey Grange Medical Centre met with both practices to ascertain if they had capacity to take on any extra patients. Both practices confirmed that they did have extra capacity. Since the consultation began in October, approximately 50 patients have already re- registered with local practices. This is in addition to the 500 patients that registered when the two practices merged. 3.3 The CCG has since written to both practices and has had confirmation that their lists are open and that they still have capacity to take any further patients who may wish to register with a local practice, including any future growth. 4.0 Reasons for practice wanting to close the branch 4.1 Since the merger of the two practices in April 2015, the practice has continued to provide general medical services from all three sites. Continuity of care has proved difficult as clinicians are spread across three sites with the use of locums to assist in adequately covering all three sites. If the branch surgery was approved to close the practice would be able to be more efficient in the use of the practice workforce and communication would be better for all clinicians as they would be able to engage more. 4 4.2 Operating across two sites instead of three sites would mean that the practice would not need to use as many locum GPs, which would improve continuity of care and improve the patient experience. 4.3 In 2015, when the practice initially merged and consulted on closing the branch, 500 patients left the practice and registered with neighbouring practices, this has meant that there are fewer patients using the branch surgery and more patients are choosing to attend one of the other sites to see a GP of their choice and for continuity of care. 4.4 The practice has also experienced difficulties in GP recruitment and has struggled to employ administration staff and locums as they do not want to work over three sites or be on their own at the branch surgery. 5.0 Practice Statistics 5.1 The practice has a population of 8,787 patients. The practice is a GMS practice with 6 GPs - four partners and two salaried with a total of 4.06 WTE (whole time equivalent), 2 practice nurses with a total of 1.8 WTE. 5 5.2 The patient survey shows that the practice does really well in some areas of the survey, but shows that only 53% of patients got to see or speak to their preferred GP. This is an area that could be improved if the clinicians were not stretched over 3 sites. CQC 5.3 The practice has not yet been inspected by CQC. We anticipate that this will be in the final quarter of 2016/17. Alternatives to branch closure 5.4 When the two practices merged in 2015, they also put in an application to close the branch surgery at that time; as a consequence of that proposal over 500 patients chose to register at two of the local practices. This has meant that the practice has had a drop in the number of patients using the branch surgery.