Leeds West CCG Primary Care Commissioning Committee Meeting Date of Meeting: 9 February 2017

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.

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.

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

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.

4.2 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.

5.2 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. The decision was made by NHS England at that time that they proposal should not be progressed further. It has therefore meant that the practice has continued over the three sites.

5.5 In order for the practice to be sustainable in the future, the practice does not feel that there are any other alternatives other than the proposal to close the branch surgery.

Accessibility between Holt Park Health Centre, Moor Grange an Abbey Medical Centre

Holt Park to Holt Park to Holt Park to Holt Park to Moor Grange Abbey Medical High Field Ireland Wood Centre Surgery Distance* 2.3 miles 3.1 miles 0.2 miles 1.3 miles By Car 8 minutes 10 minutes 0 minutes 5 minutes Walking 39 minutes 60 minutes 5 minutes 20 minute Bus No 19 No 19 No 19

*distances based on google maps

5.6 It must be noted that the bus does not stop directly outside the practice premises but that the bus stop is a short walk to both surgery sites.

Financial impact of the potential closure

5.7 The practice does not own the branch premises and they have been reimbursed for the notional rent to cover the cost of the rent on the building.

5.8 In the event of closure  The practice would save on the cost of utilities within the building.  The practice would no longer receive notional rent, rates or reimbursement for clinical waste which is funded via the CCG in line with the GMS contract.  There would be no financial impact on staffing as all staff would be absorbed in the two existing sites.  If significant numbers of patient chose to register with other local practices this would affect payments to the practice that are based on the registered patient population.

Patient and stakeholder engagement

5.9 The engagement process was led by the practice and all practice households were written to with the engagement letter, with the opportunity to comment on the proposal and attend the engagement event planned by the practice.

5.10 Abbey Grange Medical Centre has provided:  Formal letter to request the closure of the branch surgery  Appendix 1 – minutes of meeting with High Field Surgery and Ireland Wood Surgery (pre-engagement)  Appendix 2 – minutes of meeting the practice Patient Participation Group (PPG) (pre-engagement)  Appendix 3 – minutes of meeting with local MP & Councillors (Pre engagement) o Councillor Billy Flynn o Councillor Barry Anderson

o Greg Mulholland (MP)  Appendix 4 – engagement report  Appendix 5 – comments received from patients

5.11 The CCG communication and engagement team provided advice and templates for the practice to use to produce their engagement document.

5.12 The engagement report has been prepared by the practice and sets out the scale and scope of the patient and stakeholder engagement and the key themes and responses from patients during the consultation period.

5.13 The CCG sent formal notification to local MP and councillors, the Local Medical Committee (LMC), Pharmacies and Scrutiny Board. The CCG also took the patient engagement to the patient assurance group (PAG).

5.14 The LMC have given their support to the closure of the branch surgery.

5.15 It should be noted that the practice has worked effectively with its Patient Participation Group who have been actively involved in the whole process, from the initial (pre) application to the final submission.

Opposition to the closure

5.16 The CCG has not received any formal opposition to the closure.

5.17 All comments received by the practice and the CCG are enclosed in the engagement report attached. Key themes to emerge are:  Car parking  Difficulty for full time Carers  Accessing other sites via public transport  GP provision  Home visits  Access to another GP locally if not wanting to stay registered with Abbey Grange, if the closure is successful  Repeat prescriptions

5.18 The engagement events were attended by a small number of patients.

New Models of Care

5.19 Abbey Grange Medical Practice is currently part of Woodsley and Holt Park neighbourhoods/networks. As part of extended access they have currently offered patients the opportunity to book extended hours appointment at the Abbey Medical Centre Site during weekdays and as part of the Ireland Wood Hub during weekends. Extended access provision will continue to be provided as part of the hub, plans are still to be agreed as to how this will be provided and what the amount of provision will be.

5.20 They are working closely other local practices to design how new models of care will be implemented in their neighbourhood.

Future demographic growth

5.21 Please note also that there are a number of housing developments in the area with a total of 1,318 houses proposed but not yet completed, in the areas surrounding the branch surgery. Please note that some of these will still be in the catchment area of Abbey Grange, if the branch were to close they would still be able to register with the practice.

Cookridge 1140 Holt Park 42 Lawnswood 136

Conclusion

5.22 NHS Leeds West CCG has followed the national process for dealing with requests for branch closures as directed in NHS England’s Primary Care Policy Book (Jan 2016):

https://www.england.nhs.uk/commissioning/wp- content/uploads/sites/12/2016/01/policy-book-pms.pdf

5.23 We know through the publication of the GP Forward View that the provision of general practice services needs to transform to ensure they are sustainable in the future. We need to support practices in the key areas of workforce, workload, estates and technology and ultimately redesign the way services are provided in conjunction with practices but also with the network to look at how services can be provided innovatively and at scale.

5.24 Since the successful merger of the two practices in 2015, the practice reports that more patients are attending their other sites for continuity of care. Due to the financial constraints and the difficulty in recruiting clinical and administration staff the practice is finding it more difficult to manage all three sites.

5.25 In order to support the sustainability of general practice and in line with the GP Forward View (GPFV), the Primary Care Improvement Group recommends that the application to close the branch at Holt Park Surgery is APPROVED as we are now assured that:  The level of engagement has been appropriate.  Patients are accustomed to accessing services from across the sites.  The current level of alternative capacity is sufficient to ensure that if patients wished to register elsewhere they would be able to do so.  There would be no reduction in capacity with appointments being transferred to the alternative sites.  The proposal supports the resilience of the practice.  The proposal supports the strategic direction of the GPFV in supporting the sustainability of general practice.

Risks

 It is recognised and acknowledged that some patients will be unhappy with the decision and may choose to register with a local practice.  Future estate issues – in the short term this specifically relates to parking issues and in the future will need to be reviewed as part of the estates strategy with respect to future estate needs

6. RECOMMENDATIONS

6.1 The 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.

Appendix 1 Drs. Liu Welch Farrell & Khan ABBEY GRANGE MEDICAL PRACTICE

Abbey Medical Centre Moor Grange Surgery Holt Park Health Centre Norman Street, 60 Moor Grange View Holt Road LEEDS LS5 3JN Leeds LS16 5BJ Leeds LS16 7QD Tel (0113) 295 1844 Tel (0113)2954880 Tel.( 0113) 2951855 Fax (0113) 2951845 Fax. (0113)2954881 Fax. (0113)2951856

12th January 2017

Kirsty Turner Associate Director of Primary Care Transformation NHS Leeds West Clinical Commissioning Group Suites B5 – B9 Wira House Wira Business Park Leeds LS16 6EB

Dear Kirsty,

In July 2016 Abbey Grange Medical Practice made the decision to apply to NHS Leeds West Clinical Commissioning Group (CCG) for permission to engage with patients regarding a proposal to close the branch surgery within Holt Park Health Centre. Permission was granted by the CCG and our patient and stakeholder engagement ran from 5 October 2016 to 30 November 2016. Following on from the engagement process, we would now like to formally apply to close the Holt Park branch surgery.

Background Following the successful merger of Abbey Medical Centre and Moor Grange Surgery in April 2015, Abbey Grange Medical Practice is now operating across three sites with a population of 8,800.

The reasoning behind this application is that since our original application which we submitted to NHS England in March 2015 we have in the region of 550 less patients at the Holt Park Surgery, many of those left straight away as they thought the surgery would close. Our research shows that approximately 150 patients are seen at the Holt Park branch per week in comparison to over 400 at each of the other two sites.

We have seen a change in patient patterns with more Holt Park patients choosing to be seen at Moor Grange and Abbey Medical Centre. This is either because they prefer to see their regular GP and are prepared to “follow” that GP across sites or because they can take advantage of the extended opening hours at the Abbey Medical Centre site. Although the Holt Park reception is open 8.30-6.00 (except Wednesday) we are seeing less patients through the door partly because the electronic prescription service continues to become the most popular way for patients to receive prescriptions.

Our previous application to close the branch surgery in March 2015 was rejected due to negative patient feedback, timing, inaccuracies in public consultation and the commissioners

11 believed that local capacity would not be sufficient for those patients wanting to re-register following the closure. These concerns have been fully considered and addressed.

We met with Dr John Shaw from Highfield Surgery and Dr Kirsten Manock from Ireland Wood Surgery; both practices support the proposal to close the branch surgery and have given assurance that they have capacity to accept any patients wishing to re-register with their respective surgeries. We have their assurance in writing. We consulted the communications and engagement team at NHS Leeds West CCG for advice on delivering a robust patient and stakeholder engagement. In addition we met with our patient participation group, the local MP and local councillors before applying for permission to commence engagement – all of whom gave their support.

Rationale We feel that by consolidating the high quality primary care services that we offer over two sites, rather than three, we can improve effective patient care in many ways.

 Continuity of care would be improved as clinicians would be at each of the two sites for more sessions whereas currently some part time clinicians are consulting at each site for one session per week. This means patients have to travel between sites if they want to see the same GP.  There would be one Neighbourhood Team rather than a separate one for patients registered at Holt Park. This would mean one team of district nurses and one community matron which would improve co-ordination of care for vulnerable and complex patients.  The time saved by clinicians not having to travel between three sites would improve access for patients.  As the practice area would not change there would be no disadvantage to housebound patients as they would still be seen at home.  Operating across two sites rather than three would mean that locum GPs were only needed very occasionally. This would improve continuity of care for patients and improve patient experience as we know from previous surveys that patients do not like seeing locum GPs.  Patients who felt they could not access Abbey Medical Centre or Moor Grange Surgery and had to re-register would still be able to be seen at the weekend hub as both local practices are involved in the Ireland Wood Hub.  Efficient use of the practice workforce would improve patient experience as access would be improved. The service provided would be more efficient for patients.  Communication between clinicians would be improved as they would see more of each other and be able to meet more often to discuss patients, this in turn would give better continuity of care.  Patients who felt that they could not travel to either of our other sites – Moor Grange Surgery 2.2 miles or Abbey Medical Centre 3.2 miles - could re-register locally with surgeries at Highfield Surgery (0.1 miles) or Ireland Wood Surgery (0.9 miles) both having capacity.

In addition to the above we feel that efficiencies in practice would be improved. The telephone system would operate more efficiently across two sites, improving patient experience. IT systems, e.g. Lexacom, which currently struggle to operate efficiently across three sites would be improved and efficiency increased.

The proposed closure would not impact on patients who usually access Abbey Medical Centre or Moor Grange Surgery as all appointments currently provided at Holt Park would be transferred between the two remaining sites. We can confirm that appointment numbers would not be reduced should the closure be approved. Abbey Medical Centre has answered all calls from Holt Park since the merger in April 2015 without problem (a new telephone system was installed at the time). This means patients would not see a longer wait time for calls to be answered following the proposed closure of Holt Park.

We are a training practice for GP specialist trainees, broad based training doctors and foundation year two doctors. Research and feedback has shown that trainees are happier and more confident when based at one location, ideally with their own 'trainees’ consultation room'. With our two GP trainers moving everyday across three sites and the need for the trainees to be under their supervision, our trainees are having to work across three sites. Often the only negative feedback from trainees we receive at the end of their placements, is that continuity of care for their patients is difficult when constantly changing location. This would be much improved if working across only two sites in the future. We would not want our good reputation as a training practice to be compromised by logistics currently out of our control.

Engagement Exercise Prior to requesting permission to begin an engagement with our patients from the CCG we met with GPs from the two neighbouring practices (Highfield & Ireland Wood Surgery) minutes of the meeting can be found at Appendix 1

We also held a meeting with our patient participation group to obtain their thoughts and gauge their support for another application to close the Holt Park branch surgery – the minutes of the meeting can be found at Appendix 2. In addition we arranged meetings with Greg Mulholland, the local elected MP, and two local Councillors to inform them of our proposal to begin an engagement – notes from the meeting can be found at Appendix 3.

Once we had received permission to engage with patients we asked for advice from NHS Leeds West CCG’s communications and engagement team on what a robust engagement should look like, timescales, stakeholder engagement etc. Our engagement report can be found in Appendix 4, it details how we undertook the engagement exercise, the feedback we received both in support of and opposed to the proposal. It also details of how we have, or intend to act on feedback received.

Detailed feedback can be found in Appendix 5 – this has been anonymised but the practice can provide full details if necessary.

Next steps If we were given permission to close the Holt Park branch we would do this no sooner than 1 April 2017. We would continue to engage with our patients and provide all help and assistance needed to any patients who felt they needed to change practice. We would hold drop in sessions at the Holt Park branch to answer any questions/queries/anxieties patients may have about attending the other surgery sites. We would also invite representatives from the local practices to attend to help patients re-register if that is their preference.

We would ensure regular and ongoing engagement with patients to gather feedback and views about the actions we have identified and to ensure that these are acceptable and sufficient.

In summary, we feel there is no doubt that being given permission to close the branch surgery and consolidate services over two sites would sustain the high quality effective care we are proud to provide to our patients.

APPENDIX 1

Meeting to discuss Holt Park Surgery (Drs Farrell and Liu) 6th October 2015

Present – Dr A Farrell, Dr M Liu (Abbey Grange Medical Practice), Dr K Manock (Ireland Wood & Horsforth Medical Practice), Dr J Shaw (High Field Surgery), Joanne Evans, Sally Holmes (NHS Leeds West CCG).

The purpose of the meeting was to discuss the way forward with the proposal to close the GP surgery (Holt Park Surgery) at Holt Park Medical Centre, and gain agreement from High Field Surgery and Ireland Wood & Horsforth Medical Practice that they are happy for Dr’s Farrell & Liu to proceed with their proposal.

Abbey Grange Medical Practice need to assure NHS England that there is capacity in place at High Field Surgery and Ireland Wood & Horsforth Medical Practice to take on any further patients who wish to leave the patient list at Holt Park Surgery.

Abbey Grange Medical Practice are seeking agreement from High Field Surgery and Ireland Wood & Horsforth Medical Practice that they are happy to proceed with the planned proposal to close Holt Park Surgery.

Abbey Grange Medical Practice are looking to propose closure of Holt Park Surgery in around April 2016. Drs Farrell & Liu are currently writing a paper to submit to NHS England.

Currently there are approx. 2000 patients at Holt Park Surgery. Over 500 patients left the patient list at the end of 2014 (approx. 450 transferred to High Field Surgery, approx. 100 transferred to Ireland Wood & Horsforth Medical Practice). They are currently unsure of the number of patients that may still want to leave the list (if the proposed closure goes ahead). The initial surge of leavers (over 500) may well be complete, they have no idea.

Currently Holt Park/Cookridge patients are happy to visit the Moor Grange Surgery site.

Capacity:-

High Field Surgery – Dr Shaw commented that High Field Surgery are currently recruiting for a GP partner/salaried GP as they have a GP leaving them in the next 6 months. They are currently advertising this position but have had very little interest. It is difficult to say at the moment what their capacity will be, but he is happy to support the proposal by Abbey Grange Medical Practice.

Ireland Wood & Horsforth Medical Practice – Dr Manock commented that Ireland Wood & Horsforth Medical Practice currently have 2 new registrars (who are supernumerary) and a 7 session GP, so they currently have plenty of capacity to take on extra patients. Their Nurse Practitioner is due to go on Maternity Leave in early 2016. Dr Manock thinks that they certainly have the capacity to take on another couple of hundred patients, however she points out that this extra capacity is dependent upon continuation of the Enhanced Access scheme beyond March 2016 to continue to fund their 7 session GP.

There are a couple of new housing sites to consider:- - Boddington Hall (120 houses)

- Cookridge Hospital (still in plan)

High Field Surgery advised that their PRG discussed access to GP services at a recent meeting, following the initial transfer of over 400 patients from Holt Park Surgery. They felt that access to GP appointments would suffer if High Field Surgery took on any more patients.

High Field Surgery and Ireland Wood & Horsforth Medical Practice are happy to support Abbey Grange’s proposed process (and they are happy to put this in writing)

Action – LWCCG Comms Team to assist Dr’s Farrell & Liu with template(s) for High Field Surgery and Ireland Wood & Horsforth Medical Practice to complete to support a submission to NHS England by Abbey Grange Medical Practice to move forward with the proposed closure of Holt Park Surgery.

Timescales:-

Drs Farrell & Liu to submit a proposal to NHS England in November 2015, and if agreed in principle they will then proceed with patient engagement in January 2016.

Drs Farrell & Liu assured the meeting that there would be no redundancies of any staff at any of their sites if/when Holt Park Surgery closes. Nothing has been announced to any staff as yet (the only discussions that have taken place are between GP partners). Please be discreet and only discuss this information with fellow GP partners currently.

Action – Dr Farrell will arrange a follow up meeting in early December 2015, prior to patient engagement in early January 2016.

APPENDIX 2

MINUTES OF MEETING OF

PATIENT PARTICIPATION GROUP

HELD ON 09/06/2016

ABBEY MEDICAL CENTRE

Attendance Apologies

Amanda McDermott (Practice Manager) CTV Janine Town (Patient Services Manager) AS Dr S Khan SN Dr M Liu

IT MS DM TP RH LH JT

Agenda Items Patient Survey Any other business

Amanda welcomed everyone to the meeting.

Minutes of the previous meeting

The minutes of the previous meeting on 03/03/2016 were summarised. As these minutes were all distributed by post on this occasion some members reported that they had not received them. Janine to send out further copies with today’s minutes.

1 Patient Survey

Prior to the meeting the group had been sent out some examples of previous patient surveys to review to enable the group to then discuss at the meeting the most affective questions to incorporate into this year’s patient survey to enable us to use the data to evaluate on how we can improve our services to patients.

After discussion the group had evaluated what the most important questions for the survey were 1. Access – ease of getting an appointment, Different ways patients utilised the booking system and the use of online Booking with the additional comments box for further feedback,

And the use of Electronic Prescribing facility

2. Clinical Care – question to be kept with the addition of a comments box 3. Practice Improvements - questions added from the Moor Grange Survey

4. Hub - To find out if patients were fully aware of the weekend hub and their use of it.

It was felt that we should take out the surgery opening times as this was now widely known.

The amended survey is attached for your feedback and finalisation. (Appendix A)

When Finalised the survey will be posted onto our practice website, at reception, text message the survey through a “survey monkey” posters and signs widely distributed around the practice for maximum response.

2. Any other Business

Holt Park Branch Surgery

Amanda informed the group that when the practice applied to merge the 2 practices, we also applied to close the branch surgery at Holt Park as the Practice felt that having three sites was impractical with the number of patients we had. The merge was supported and approved but the closure was declined at that time The practice is now at a stage where we are thinking that we should again think about whether to close the Holt Park site. She expressed that there is a formal process to follow if this was decided and it was not something that we have started at the moment as the practice wanted to engage with the group for your support. As our Patient Group you are not only our patients you also representatives of our wider practice population and the practice would like to give you the opportunity to be involved in this important decision of whether to close the Holt Park branch.

The reasons for a proposed closure were explained and reasons for confidentiality in this matter is paramount as no application had been applied until consultation with the group, the local MP/Councillors and other surgeries had taken place.

The reasoning behind this discussion was that since the original application we have in excess of 500 less patients at HP, many of those left straight away as they thought the surgery would close anyway. Our research has shown that per week, approximately 150 patients are seen at Holt Park branch. This number is gradually reducing as patients patterns change, more HP patients are choosing to be seen at Moor Grange or Abbey MC for continuity of care or to take advantage of extended hours. Although the reception is open 08:30-6:00 (except Wed) we are seeing less patients coming through the door at HP as more patients are choosing to use the electronic service and having their prescriptions sent to the local pharmacy and therefore feel that the practice could offer a more efficient service to our patients by operating on 2 sites rather than 3. Continuity of care would improve drastically. Access to the GP/Nurse of choice is always high on the patient agenda. In doing this she expressed that no appointments would be lost the capacity of appointments would be transferred to the other 2 sites.

Questions raised.

Q: Would there be any financial gain? A: Dr Liu informed the group that the closure would be based on a practical decision and not for financial reasons as the Holt Park Premises were rented.

Concerns re: lack of Parking if more patients attending Moor Grange and Abbey? A: Moor Grange had had no complaints about parking on the street and the only complaints received regarding parking facilities was when the practice had previously applied for a car

18 park at the back of the premises. Staff are provided with car parking space on the drive of the premises (6) spaced to reduce on-street parking.

Abbey did have car parking facilities and had recently taken the decision that none of the staff would park in the car park to facilitate more spaces for patients and that staff would park in the nearby streets. Dr Liu informed the group that many surgeries in the local vacinity do not have any car parking spaces on the premises and rely on street parking.

Dr Liu informed the group that more practices are now merging especially the smaller practices in order for practices to survive NHS pressures. The aim to continue to provide a good service to all our patients and to be able to provide this through consolidating the workload, thus less locum cover would be needed to enable patient continuity of care with their preferred GP.

Q: Travel to the branch sites: There would be some patients who do not have transport and find the journey difficult. Dr Liu said that the practice would not consider closing Holt Park if there were no local GP surgeries in the near vicinity. There are two other surgeries close by one being only approximately 50 metres from Holt Park surgery that patients may wish to register. There is direct transport from Moor Grange to very near Moor Grange Surgery. All housebound patients would be visited for treatment.

In summary The group have agreed to support the proposal to close Holt Park Branch Surgery. Please let us know if you have any feedback following the minutes.

Date of next PPG meeting September 22nd

APPENDIX 3

ABBEY GRANGE MEDICAL PRACTICE

MEETINGS WITH LOCAL MP & COUNCILLORS REGARDING PROPOSED APPLICATION TO CONSULT WITH PATIENTS IN RELATION TO CLOSING HOLT PARK BRANCH SURGERY. 2016

Meetings took place to gauge support for an application by Abbey Grange Medical practice to Leeds West Clinical Commissioning Group to consult with patients regarding closing the branch surgery within Holt Park Health Centre. Dr Angela Farrell ( GP Partner) & Amanda McDermott (Practice Manager) met with:

Councillor Billy Flynn - 1st July 2016

Councillor Barry Anderson - 15th July 2016

Greg Mulholland MP - 2nd September 2016

All meetings began with a summary of the background:-

Following the successful merger of Abbey Medical Centre and Moor Grange Surgery in April 2015, the Practice is now operating across three sites with a population of 8,800.

The reasoning behind the application being that since the original application which we submitted to NHS England in March 2015 we have in the region of 550 less patients at the Holt Park Surgery, many of those left straight away as they thought the surgery would close. Our research shows that approximately 150 patients are seen at the Holt Park branch per week in comparison to over 400 at each of the other two sites.

Our previous application to close the branch surgery in March 2015 was rejected due to negative patient feedback, timing, inaccuracies in public consultation and the commissioners believed that local capacity would not be sufficient for those patients wanting to re-register following the closure. These concerns have been fully considered & addressed. We met with Dr John Shaw from Highfield Surgery and Dr Kirsten Manock from Ireland Wood

Surgery; both practices support the proposal to close the branch surgery and have given assurance that they have capacity to accept any patients wishing to re-register with their respective surgeries. We have their assurance in writing. We consulted the communications and engagement team at NHS Leeds West CCG for advice on delivering a robust patient and stakeholder engagement. In addition we met with our patient participation group who are supportive of our plans.

The response from all the meetings was positive with the main points raised being:

 Would we be reassuring patients that the other health centre services would remain if the surgery received permission to close We gave assurance that this was a priority as there had been so much confusion last time. We agreed that it would be made clear in the patient letter & also in the information leaflet that the Health Centre would not be closing & all services other than the GP surgery would remain.

 Would proposed new housing developments be taken into consideration when making the decision We confirmed that this was something that would be taken into consideration at the decision making stage & also that the CCGs across Leeds were aware of all proposed housing developments & had these in mind when making commissioning decisions involving delivery of primary care services.

 Had we assurance that any patients who wished to re-register would be able to do so at a nearby practice It was explained that a meeting had taken place between the practice & the two local surgeries (with CCG representation also) & assurance had been given & documented in writing that both practices would support an application to close & had capacity to accept new patients.

 Would we be consulting all patients or just the patients who are seen at Holt Park Confirmed that ALL registered patients would be consulted & given opportunity to feed back.

 Would any consultation be robust & stakeholders kept informed of proceedings We gave assurance that if we received permission to engage with patients we would ask for advice from NHS Leeds West CCG’s communications and engagement team on what a robust engagement should look like, timescales, stakeholder engagement etc

APPENDIX 4

Drs. Liu Welch Farrell & Khan ABBEY GRANGE MEDICAL PRACTICE

1) What this document is about This report outlines the engagement process we used to find out what people thought of the proposal to close our branch surgery located within Holt Park Health Centre.

The document also summarises the feedback, identifies some of the key themes, looks at how we will respond to any concerns raised and explains what happens next.

2) The background to the engagement

In July 2016 Abbey Grange Medical Practice made the decision to apply to NHS Leeds West Clinical Commissioning Group for permission to engage with patients regarding a proposal to close the branch surgery within Holt Park Health Centre. We did this after very careful consideration and consultation with our patient participation group, the local MP, local councillors and the two neighbouring GP practices. Our request to the CCG to engage with patients was based on our view that consolidating the practice on two sites rather than three would sustain high quality patient care. We can do this without losing any appointments or services and future proof the practice in the long term.

A previous application to close the branch had been rejected by NHS England (who were sole commissioners for primary care services at that time) in March 2015 with the main reasons being negative feedback, timing, inaccuracies in public consultation and local primary care capacity not being sufficient for those patients needing to re-register following a closure. Abbey Grange Medical Practice felt that some of these issues had been addressed in the original proposal but may not have been made apparent during this initial engagement.

We feel that this engagement process has been comprehensive and involved all key people who would be affected by the proposed closure. The reasons have been fully

22 addressed by the practice including obtaining detailed advice from NHS Leeds West CCG’s communications and engagement team on best practice to follow to ensure we can hear the views of all our patients including those who may be housebound.

In addition we had written confirmation from the two neighbouring practices that they would be able to accommodate any patients who wanted to register with them so that they could attend a GP practice within the Holt Park area. The two practices are Highfield Surgery, which is less than 0.1miles from Holt Park Health Centre (at the opposite side of the Asda car park), and Ireland Wood Surgery which is 0.9 miles from Holt Park Health Centre. We also met with our patient participation group, the local MP and local councillors prior to approaching NHS Leeds West CCG for permission to begin an engagement process. We had a full and frank discussion with the CCG as to why we were considering a new application, welcoming their views, questions and suggestions. We also asked if they felt they could support us in any application we made; they all agreed to support the practice. Following the previous application approximately 500 patients who used our Holt Park branch left our list and registered elsewhere before a decision had been made by NHS England. Following the merger of Abbey Medical Centre and Moor Grange Surgery in April 2015 a small number of patients still chose to attend the Holt Park branch surgery, however these numbers have reduced considerably over the past year. Abbey Grange Medical practice is now operating across three surgery sites with a patient population of approximately 8,800.

3) How did we inform people about the engagement? Abbey Grange Medical Practice operates across three sites – Abbey Grange, Moor Grange and Holt Park – with a patient population of around 8,800.

Our engagement exercise gave all registered patients a chance to share their views. Our previous engagement exercise was restricted to patients who attended the branch surgery at Holt Park. However, the CCG’s communications and engagement team advised us that the engagement should be open to all registered patients as they could all be potentially affected by the proposal.

We wanted to make sure that anyone potentially affected by the proposed change had the opportunity to feedback on how it would affect them, what obstacles it presented to them in accessing primary care and any other feedback they had.

 We developed an engagement document which outlined the proposal and asked people to share their views. The document: o Was sent with a covering letter to every household registered at Abbey Grange Medical Practice (4,680 households) o Was available in the waiting area at all three surgery sites o Was available online on the practice website o Was available in alternative formats on request o A text message was sent to all patients where we have their mobile phone number with a link to the engagement document on our website

 We held three engagement events where patient could find out about the proposal and talk to GPs at the practice about their concerns. The minutes from these events can be found at the end of this document. We held the events at: o St Paul’s Church Hall, Raynel Drive, Leeds LS16 6BS on 20 October 2016 1.00pm – 2.00pm o Mercure Parkway Hotel, Otley Road, Leeds LS16 8AG on 3 November 2016 7.00pm – 8.00pm o Holt Park Health Centre, Holt Road Leeds LS16 7QD on 28 October 2016 12.00pm – 1.00pm. This was a drop-in event.

NHS Leeds West CCG wrote to stakeholders including local pharmacies, the elected MP, local councillors, the chair of the Scrutiny Board (Adult Social Services, Public Health, NHS) and local voluntary organisations.

The engagement started on 5 October 2016 and ended on 30 November 2016.

4) What did people tell us? A total of 142 patients (out of around 8,800 registered patients) took the opportunity to respond to the proposal we put forward. This provides a response rate of around 1.6% of the total practice population.

Engagement events We held three public events which were attended by a total of 32 patients or patient representatives broken down below:  St Paul’s Church Hall – 11 people  Mercure Parkway – 8 people  Holt Park Health Centre – 13 people

Engagement form A further 110 patients shared their thoughts on the proposal by returning the engagement document comments form either to the practice, to NHS Leeds West CCG using the Freepost address provided or completing it online.

Out of the 1.6% of our practice population that returned the comments form:  84 (77%) of those who responded were opposed to the closure  26 (23%) of those who responded supported the proposal or felt the proposal would not affect them.

KEY THEMES IDENTIFIED

We identified a number of key themes from the feedback we received:  MANY PEOPLE ARE VERY HAPPY WITH THE SERVICE THEY RECEIVE FROM ABBEY GRANGE MEDICAL PRACTICE AND FEEL THEY ARE PROVIDED WITH HIGH QUALITY CARE.  Some patients would find it difficult to attend appointments at either Abbey Medical Centre or Moor Grange surgery due to one or more of the following reasons: o It can be difficult to park at the other sites

o Public transport to the other surgery sites, especially for people who live in Cookridge is not an easy option. Public transport to the Abbey Medical Centre site in Kirkstall involves two buses for people living in Cookridge o Some patients, mainly older people, felt that they are not well enough to use public transport to get to Abbey Medical Centre or Moor Grange Surgery  Some patients expressed concern at whether future planned housing developments in the area would impact on primary care access  Some patients wanted to know why Moor Grange could not be closed rather than Holt Park  Some patients were concerned that they would not be able to access a new GP should they choose (or not be able practically) to stay registered with Abbey Grange Medical Practice.

RESPONSE TO FEEDBACK The practice is committed to supporting our patients and ensuring that everyone registered at Abbey Grange Medical Practice receives high quality accessible care. We have reviewed the feedback from the engagement both at a practice level and also with our patient participation group and looked for ways we can support patients with their concerns. The “You said, We did/will” table below highlights the key themes from feedback and any actions the practice will take or has already taken to mitigate some of the concerns raised.

You said We did/We will

It is difficult to park at the other sites Abbey Medical Centre:  We have asked staff not to use the car park at all, leaving all the spaces for patients.  We have spoken with St Stephen’s school and confirmed that patients can use the spaces reserved for the school before and after school, and during school holidays.  We are arranging to have a dedicated disabled parking bay in the car park at Abbey Medical Centre. Moor Grange Surgery:  We have asked staff to use the space available in the two driveways – space for 6-7 staff cars  We will approach Leeds City Council to ask if we can have a designated disabled parking space outside the surgery  We will look at the possibility of staggering clinics to reduce numbers of patients on site at any one time  We have been asked if we would consider looking at

making the back gardens of Moor Grange Surgery into a car park again – a previous application to do this was met with fierce opposition from neighbours. It has been agreed to discuss this again at practice level in the New Year. In addition to the above, we will always try to help any patients on who feel parking would be a problem. The Practice Manager/Patient Services Manager will endeavour to reserve/make space available if contacted in advance by patient/carer It will be more difficult for full time We actively encourage anyone who is a carers as the surgeries are further away carer to let us know so we can record it. Our patient services manager is happy to speak to anyone who is a carer who has concerns about attending the other sites due to distance/time. She discusses individual cases and puts something in place to overcome any difficulties. This includes home visits for carers and pre- booked appointments at convenient times to allow carers to attend/help a patient attend an appointment.

It is not easy to access the other sites We recognise that for some patients, by public transport especially from accessing either Moor Grange Surgery or Cookridge Abbey Medical Centre by public transport will be difficult. We have identified a number of ways that we might be able to improve access issues:  Increase telephone consultation appointments  Introduce skype and e- consultations (hardware has already been installed to enable this)  Encourage patients to sign up for online services (our patient participation group could help with this)  Work with the Patient Empowerment Project which enables patients to be supported either in a group session or one to one to help them develop the skills, knowledge and confidence to self manage their condition.

 We will look at advanced planning for patients with long term conditions – such as providing COPD patients with rescue medication – as well as providing same day telephone advice/consultation with a GP.  We are interested in working with local elderly action/ voluntary groups who have a minibus who may be able to provide a transport solution for some patients. The logistics of this will need to be looked into but this is also something our patient participation group may take forward.  Any patient on the palliative care/end of life register will be visited at home whenever the need arises.

It would be better to close Moor Grange Prior to the merge of the two practices, Surgery as it is “in the middle” Moor Grange had a registered population of approx. 4000, a large proportion of whom live in the immediate vicinity which does not have another GP practice locally where patients could re-register easily. The Holt Park site has two neighbouring practices with confirmed capacity to take on new patients.

Will there be enough GP provision in This is something that is looked at by the the area when the planned housing Clinical Commissioning Groups on a developments are finished? citywide basis. Ensuring capacity is sufficient to meet the demands and requirements of the local population is paramount and something that will be taken into consideration when a decision is being made whether to approve the closure.

What will happen if I do not feel well Any patients who currently receive home enough to use public transport to get to visits due to long term ill health or mobility the other surgeries? problems will continue to do so. Anyone who in the future becomes housebound due to ill health or mobility problems or who is temporarily incapacitated due to ill health will receive a home visit. The practice also offers telephone triage and telephone consultations which may reduce the need to actually attend the surgery in some cases.

The practice has a clinical care co- ordinator who works closely with elderly patients and those with long term conditions, supporting them and reducing the risk of hospital admissions. She visits patients usually at home and liaises between the patient and the GP, reducing the need for attendance at the surgery. We also have a community matron who has a similar role supporting patients with long term conditions.

How can I be sure I will be able to Before approaching the CCG for access another GP in the area if I permission to engage about a closure, the choose not to stay registered at Abbey partners met with the two local practices Grange? Highfield Surgery, which is situated less than 0.1 miles from Holt Park, and Ireland Wood Surgery which is located on Otley Old Road, 0.9 miles from Holt Park. Both practices agreed to support our proposal to close and gave written assurance that they would be able to register any patients who chose or felt they needed to change surgery. If the decision is given to close Holt Park we will hold some drop in sessions at Holt Park Surgery to provide assistance to anyone wishing to re-register and also invite representatives from the local practices to attend with information about their practices/registration forms etc.

I will not be able to drop off & pick up We will promote the use of electronic my repeat prescription without using prescribing whereby prescriptions are sent public transport electronically to a pharmacy of choice, the prescription can then either be collected by the patient or delivered by the pharmacy.

Most pharmacies offer an ordering/collection/delivery service. We will encourage and help patients to sign up for online services which will enable them to order repeat medications without attending the practice (our patient participation group will be involved in this).

5) What happens next? When a GP practice applies to close a branch practice they have to go through a strict process which is overseen by NHS Leeds West Clinical Commissioning Group

The next step in the process is for the practice to share a report including the findings of the engagement with NHS Leeds West Clinical Commissioning Group.

NHS Leeds West Clinical Commissioning Group will then make a decision on the closure taking into account the reasons for the proposal and the impact this might have on patients. We expect a decision in early February 2017. Patients will be informed of the outcome.

6) How do I ask questions about the engagement If you have any questions about this document please contact the Practice Manager, Amanda McDermott on 0113 2954880 or email [email protected]

Alternative formats An electronic version of this document is available on our website www.abbeygrangemedicalpractice or please contact us directly if you would like to receive a printed version.

If you need this information in another language or format please contact us by telephone: 0113 2951844/0113 2954880 or email [email protected]

29 APPENDIX 5 – comments received from patients

Comments – not edited Our preference would be to continue at the Holt Park Surgery. In our view it is the most pleasant of the 3 surgeries, it has easy and ample parking and is near to our home I do not use Holt Park Surgery, so can not comment, although patients there may feel differently so I am not eligible to say

Our own concern is around the increased traffic at Moor Grange Surgery. There is no car park, on street parking is already chocka-block. Residents find it hard to park. The road is often blocked completely by people double parking, meaning residents are trapped in or out. It is also dangerous for children to cross between so many cars. Grass verges are also getting damaged.

I have been on your books for 62 years, we moved to West park, Dr Hawbrooks surgery was nearby. Getting to Moor Grange is easy by bus, I have been once. I was Dr Pai's penultimate patient.

I would prefer to keep Holt Park Surgery open as I would find it very difficult to get to the other 2 surgeries. I don’t drive and Abbey and Moor Grange are not easily reachable by bus. If I am not feeling well I do not want the hassle of a long bus journey. I will have to think about changing Drs if the closure takes place

Taking 2 buses to the drs and 2 buses back when you are feeling ill is not what I want to do, and if in the snow and ice I fall over and can not get back up. It is a shame for a good drs so near to home to close. It is hard enough getting into a drs with 3 surgeries. We are the only country to go backwards in time. But is seems your mind is made up, soon no-one will go to the drs. it will be like the 1700 and 1800s

While I am not directly affected by the closure of this surgery I do not think you have taken into account that elderly people will be unable to get a bus directly to either Butchers Hill or Kirkstall and is rather disgraceful that no effort is being made to look after them

My concern is for patients who can't afford a bus. These patients will end up losing a good drs who they have built up trust and good relationships with. In addition if I found that I couldn’t afford a car, I certainly woulnt want to travel by bus when I am ill, there is nothing worse. There are lots of houses been built in the are. There is no reason why Holt Park should be short of patients, maybe the surgery should try promoting their services more. That would mean even longer waiting times, so when you book an appointment for a certain time, it is because it is the only time you can make it. Do you have to wait over half an hour which has happened to me on numerous occasions. Unfortunate but apparently not enough of us in Cookridge and Holt Park. Will continue with Abbey Grange while ever practical as I rely on public transport. The closure of Holt Park is very bad news. After the threat of closure before I thought it was all resolved. It is too far for me to travel to the other 2 surgeries and rely on taxis or lifts whereas I walk to Holt Park. I think the reason more patients are using the other 2 surgeries is that when ringing for appointments it is almost impossible to get one for Holt Park therefore the number of patients attending the other surgeries is a case of no choice. Providing the changes do impact on the already long waiting times, I do not forsee an issue for me personally. I have not accessed the Holt Park Site, as the other sites are more convienent for me. However I do envisage that this closure could cause difficulties for patients how are local to the site, especially those that do not have access to private transport

I am concerned that it is already difficult to get an appointment ant any of the available practices, even 2 or 3 weeks ahead. Closing one of the practices will make this a lot more difficult.

30 The no 19 bus does not run to Cookridge!!!! Whilst we do not wish to change drs, without transport, we would find it very difficult to always go to Abbey MC. Now I do feel that we are always directed to Abbey and have to request Holt Park. I was told to go to Abbey for my flu injection as Holt Park was full, very strange! Currently I live within a one minute walk of the number 6 bus stop in Green Lane, Cookridge and this bus service teminates at Hotl Park Surgery Door. I can and I do walk to the surgery in 10 minutes when the weather is suitable. I have no direct bus service to either Abbey or Moor grange Medical Practice and I would need to take 2 buses to Moor grange, Abbey would in reality be inaccessible to me by public transport. I have been registered with Holt Park Surgery since it opened and I have no desire to transfer to another practice. I notice that the financial implications of closing Holt Park are not mentioned but I suspect that these would be favourable to the practice. I wan interesting when I booked for my Flu jab at Holt Park I was informed that there was no appointments left so it would appear that there would be considerable demand for this service at least. Also it is difficult to understand why anyone who has routinely found Holt Park convienent in the past would choose not to continue unless they lived at the top of Spen Lane or services are already been curtailed. Whilst ever I am able to drive getting to either 'new' surgery would not be a problem in good weather, but at 78 years of age and consiquently have to anticipate potential difficulties when I can no longer drive. Only 2 weeks ago I was quoted £2270 for my car insurance, I have a small car and a perfectly clean record, even so if I am still fit to drive I could well be priced of the road if this is an indication of things to come. Needless to say I am very much against this proposed closure and shall have no real alternative that to transfer against my will to another practice.

Often it is difficult to get an appointment at either of the 2 larger surgeries within a week because the appointments are not 'open'. We are often limited to ring at 8am the following day but it is not always possible and an appointment can not always be given. Appointments in advance ie bloods can't be made in advance and drs appointments can't be made in advance either. More patients at the larger surgeries will make it even more difficult to get appointments. we are very upset by the proposed closure of Holt Park Surgery. We look after elderly parents who live next door and will be unable to get to any of the other surgeries. It is a short sighted decision especially in the light of increased population in the area. Holt Park is the only surgery with adequate parking. One surgery is down a cobbled road and one in a converted residential property are not the way forward. I hope you consider a purpose built medical centre to your catchment area with adequate parking as soon as possible. Sounds logical to me, I prefer to use Abbey and Moor Grange. This closure will not affect me, but the patients who use the practice should have a say. Thank you for the form, but we are in walking distance to Abbey Medical Centre. So the Holt Park Closure will not make a difference to me. With reference to the proposed closure of Holt Park Practice and your letter I received this morning. I personally would not oppose the closure of Holt Park if you consider its continuation no longer viable. I have never used Holt Park because of its close proximity to a troubled council estate. I have previously encountered anti social behaviour/hate crime in that area which I try to avoid.

31 Although not expected, I am again saddened to hear that you are again proposing to close Holt Park Surgery. My main reason that it is the nearest surgery to where I live. Secondly there is good parking at Holt Park and no adequate parking at Abbey or Moor Grange, and if we go to either of those sites we will have to go by car. Thirdly loosing Holt Park will mean there is no surgery my side of the ring road and the other two are close to each other. you have claimed that the numbers to Holt Park are dropping, may I suggest you have followed a deliberate policy, since your last attempt to close Holt Park, to divert patients away from Holt Park. My evidence is that when I have telephoned for an appointment with a dr or tried to make an appointmentwith other health professionals (other than a flu jab) since the new surgery set up, I have nver been offered an appointment to attend Holt Park. Perhaps this is because would can't contact Holt Park directly until after 8.30am whereas you can contact Abbey from 7am so are more likely to get an appointment especially if it with a dr you wish to particularly wish to see. You have also said you have carried out refurbishments/improvements at Abbey and Moor Grange - these have been minimal and not evident at Moor Grange. Holt park was refurbished to a good standard quite recently. When you read the background section of your proposal it is clear that you have put additional resources in the direction of Abbey and Moor Grange sites.I am sure the proposal to close Holt Park has a lot to do with saving money. this is not necessarily a bad thing but perhaps you could be a bit more honest about it. Since your last failed attempt to close Hotl Park it is clear to me you have arranged for its demise and have not tried to give it a chance to succeed.

I am unsuprised by this propasal and expect a lot of protest to be made. As a patient registered with this practice for the past 16 years. I regret that the services offered have become increasingly difficult to access in the last year or two. The previous attempt to close, was overturned by public pressure, supported by the labour party. Im my opinion however this campaign failed to acknowledge the fact that the practice appeared to be inadeqately resourced to maintain 3 sites and provide the service previously offered. Consequently, the current rationalisation makes sense in the light of the arguments presented. General Practice is presented in the media as struggling to meet demand. The policies of the current governament militate against any improvement and the blame for this lies at its door rather than the practice, which still provides a good service, if you can get an appointment. It is better to rationalise Abbey grange practice to provide a better service on 2 sites than a thinner one across 3. The current arrangements are likely to be cost inefficient as well in the light of migrations away from Holt Park. I would recommend the closure is allowed for the greater good of a better overall service. Campaigns against closure often tend to be based on emotional reactions rather than common sense and I have no doubt this will be taken into account. The governament however should be called into account in terms of its spending priorities and reluctance to raise taxes to pay for what the country needs.

I am disappointed that you are to close the surgery. My wife and I joined the practice in 1962 and have been pleased with Holt Park since it opened. For the elderly, there are insufficent disabled parking spaces at Abbey and Moor grange (if any) Insufficient parking spaces means parking on the road if available on congested streets. It would appear that the NHS is determined to close the smaller surgeries and impersonal megacentres with long waiting lists, with little or no thought for the patient. It will be our intention to join another practice for my wife and I if the Holt Park Surgery closes down. Incedently what will happen to the Warferin patients who attend the surgery.

I am sorry to hear about the possible closure of Holt Park Surgery once again. I have been a patient there for as long as I can remember and find it most convienient to get to from where I live in Cookridge. Therefore I am considering changing to another practice.

32 When proposed last time I suggested transfering older/most vulnerable patients to High Field Surgery and I think that was done but some of us possibly for activistic reasons didn’t transfer. Hence 150 remaining at Holt Park. The other 2 practices see 8,650 per week Question 1 - Can the remaining 150 patients be transferred to High Field? How many patients does High Field see in a week? Queston 2 - Can't the Drs driveto Holt Park 2 mornings/afternoons a week, equivelent to 1 or 2 days and see 8 patients per hour (4 per session x 4 is 160 patients) Some food for though.

This closure does not affect me, I was originally with the practice at Kirstall House. That closure meant I had to travel to Moor Grange until the merger with Abbey. I am pleased for all patients that the services will be retained even if only on two sites. The Holt Park Surgery is much easier for me to attend and parking is no problem. Parking at the other surgeries is limited and if for any reason I am unable to continue driving as I get older it would be difficult as far as public transport is concerned. Clearly, with falling patient numbers at Holt Park it makes sense to rationalise the situation in favour of Abbey and Moor Grange. My only concern is that patients without their own transport, living locally to Holt Park would find visiting their doctors less convenient. Holt Park is served by a 10 minute bus service which drops you at the surgery door. The 19 bus, mentioned by the doctors letter, does not touch coockridge and is every 30 minutes. To go to moor grange would involve two buses and, for cookrdige residents, would certainly take in excess of an hour. Increasingly we are asked if we can go to Abbey Medical Centre, which for cookridge residents, does not appear to be serviced by public transport and is about 4 miles away. Faced with this prospect, it could significantly increase the doctors being asked to make home visits.

People with mental health issues, such as anxiety, would prefer the surgery to stay open. Holt Park surgery serves the Holt Park area very well, particulary the elderly and people with mental health issues. I feel it would be greatly missed by the local community. I for one do not have a car, computor or mobile phone. To get to Abbey is out of the question. To get to Moor Grange buses run half hourly if they turn up so one may have to wait half an hour for a bus back home. At 86 years old this is not acceptable and i do not intend to change surgery so i will not have a doctor you should give a thought to older people not money.

(letter attached and signed) I was dismayed to hear that this suggestion has raised its head again, after the refusal a couple of years ago by NHS England to allow this to go ahead, whats changed since then? All the reasons for non clousure that stood then still apply, the doctors who operate the surgery say that patient numbers have declined, possibly they have but only because when they threated to close previously some people chose to go to a different practice so they could stay in the area, for a large number of the people the other teo sites are just too far away, they cannot be reached easily by bus from the Leeds 16 area.They also state that patients are choosing to attend two sites, from a personal point of view, yes i have gone to one of them on more than one occasion, not because i choose to but becausei could not be offered an appointment at Holt Park, a typical example happened recently, about three weeks ago i received a letter from the practice advising me the annual flu jabs were available, i called to Holt Park to make an appointment two days later, I was informed that not were available and would not be in the forseeable future, probably towards the end of November but i could go to the Abbey medical centre that same afternoon, so i did that. A similar thing happened wih a blood test i required recently. I am 76 years of age and my husband is 80, at the moment we are preferectly capable physically of making the additional journey to one of the alternative sites but this could change over night, getting there by public transport is not a viable option and we certainly could not afford taxis, there must be hundreds of people like us, also people with young families, in a similar situation, we have been attending this practice for almost 40 years and we want to continue to do so, but with a well run service, not what it has become recently.

33 I attended the meeting about the closing of Holt Park surgery. Although the serices at the main surgery sound wonderful, but like many senior patients is to how we get there, for me I would have to take two buses, plus a walk and should the weather be bad underfoot, I couldnt make it. Holt Park healt cetnre still remains open, so why should it close?

Due to the frequency and reliability of the bus service operating from Holt Park I can envisage travel times for a distance of no more than 2/3 miles taking possibly hours. This does not take into accountmy mental health conditions that does not allow me to travel on public transport!! What alternative arrangements are you going to make other than throwing me out of the practice!! I am not happy to go to either the Highfield surgery or the Ireland Wood surgery. Any soloutions would be appriciated....

If you don’t have transport it is difficult to reach Moor Grange and Abbey from cookridge. There are no direct buses. Patients are not going to Abbey or Moor Grange from choice , if you try to book an appointment at Holt Park they always seem to want you to go to one of the other surgeries. Looking to the future how are the other surgeries going to cope with the increase of patients from the housing developments that are iminent in the area.

We are very dissapointmed to hear of a second attempt to close Hot Park Health Centre. Our whole family has used the centre ever since it opened. Two of us are in our 70s now and if we cant drive, there is no public transport to the other two surgeries for us. Even while we can still drive, parking at both surgeries can at times be almost impossible. Also our doctors know us and our histories and therefore we really dont wish to change to another practice in this area. Incidentally your claim that more people are choosing to attend Abbey or Moor Grange is misleading - more people are being forced to attend Abbey and M G because infact they are being given no choice.

We attended the drop In event at Holt Park on Friday. These aer the comments we would like to be considered. 1. car parking facilities at both surgeries especially Abbey (not even enough spaces for the staff!!0 2. no direct bus route from cookridge to either surgery for people who dont drive. 3. many people left holt park initially because of incorrect information given to them before any decision had been made to close the surgery back in April 2015. The majority of them never returned. 4. There are several new building projects being built now and in the very near future, we understand hundreds of new homes, will we then have enough surgeries in cookridge? 5. Pharmacy also very convenient at Holt Park, no pharmacy near Abbey. 6. We understand longer opening hours leads to greater efficiency for patients but the above comments should be considered especially for more elderly prople who cannot drive & no bus route from Cookridge.

I think it is a realistic move to close Holt Park branch surgery. The merger with Moor Grange has worked so well and to have 3 surgeries to cover is overstretching the staff. I am quite happy with the decision. I am personally affected by the closure of the Holt Park Surgery. I attend Moor Grange However I have concerns about increasing numbers at this surgery and the long waits in obtaining non-urgent appointments. Older people without transport may find travelling difficult no convenient bus service from Holt Park to Abbey Medical Centre (50 Bus route)

So we aer held to ransom again, no way at 82 am I able to travel to Abey Grange, what on earth is going on, I have no idea. What I do know is that the finish for me with my great doctor Liu. It is a disgraceful action on your part and I am very annoyed. (SMA)

34 1. I find it hard to believe that the patients of a GP Practice in the middle of one of the biggest council estates in Leeds prefer to take a fiftenn min walk and walk to a bus instead of walking to the surgery on the estate. 2. Moor Grange Surgery is 15 mni and a walk to the 19 bus stop somewhere in Ireland Wood, no details and a five min walk from Spen Lane however ill or disabled you are. 3. Abbey Medical Centre - sorry folks no access to this surgery on public transport from holt park, Ireland Wood, Adel or Cookridge. Perhaps you are not meant to use this oart of the practice any more even if the extend opening hours or increase staff. 4. Will home visits be available for those too ill or disabled or old to get there? 5. Holt park surgery is and has been an excellent practice for over 40 years. I strongly disagree with running down and closing such a good park of the NHS in a time of mch negative comment. Whilst the Holt Park centre has been allowed to deteriorate in a very bad way by our council. The surgery is in good condition, the doctors of the best. The reception staff always helpful and most importantly an appointment available when needed - on the day. 7. I do not support this proposal I am very much against it. 8. I have been attending this practice for 40 years, i will not be moving with it. If getting rid of patients is part of this plan, it has succeeded. signed Oct 17th 2016

We have been [atients with this practice from 1972, but will have to change. There aer no direct bus routes to either Moorgrange or Kirkstall from our area. Ie Tinshill Road. This would mean walking to Ierland Wood for no 19 bus or to Low Lane for no 50 bus. both walks would involve 30 min to a bus route. What about the patients living with a chronic illness that use mobility scooters. Abbey Grange and Moor Grange would be too far. Finding a parking spot at Moor Grange is also a problem. Choosing this surgery would be a disaster for OAP's in Holt Park area as there is no direct bus service. Moor Grange is not an optionfor me, if you close the surgery I will have to change doctors and go to Highfield It is with regret we will have to move to another surgery. We are 85 years old and the thought of having to catch two buses to get to either of your surgeries is frightening and quite out of the question. (extra note) After speaking to Sue Patel and adv of valid points ie appts available, know Dr they said they will not change just yet and will think. signed .

I do not agree with closure as I have no transport. To get to Abbey. I also do not want to change doctors I am happy with Holt Park and always have been. I have been going to Holt Park Surgery since 1977. It is with in walking distance for me and I don’t want to change doctors. Moor Grange is close but I need to catch a bus. The 19 bus is only every half hour and not reliable I do not want the surgery to close because i am happy with the way it is and i have benver had problems making appointments to see the doctor.

My husband and I have been patients at this practice for nearly 30 years (our son and daughter and family both families have moved house recently and were at this practice). We mainly have our appointments at Holt Park to see our doctors if not possiblewe prefer to go to Abbey. At both Abbey and Moor Grange the parking is not very good and as my husband has walking problems we find Holt Park is far better for parking. The comment that is made in the letter saying the majority of Holt Park patients prefer to go to either of the other two surgeries is unbelievable. We do know patients in the Holt Park area that do not have thier own transport and would have to reply on public transport. The practicalities of closing Holt Park practice is important to us as we would not like to move to another practice after many of the doctors we have had over the years have been so good to us. We also think of the nurses and receptionists that are so helpful. PLEASE THINK AGAIN. Yours sincerely,

1. I think this is a tradgedy that Holt Park GPs will close-as those who wish to remail loyal to our practice may find the travelling elswhere difficult. 2. Providing I can remain driving, I can manage, and even have the odd taxi, but 2 buses and a walk will not be a good idea if ill. 3. I will review the situation as and when, but as i have been with the practice many years, I am loathe to change. 4. We are to have a new housing development in cookridge. How near will they be to a surgery?.

35 The closure of Holt Park would be devestating for many patients. It has excellent parking, which is needed for disabled people. Abbey Medical Centre has not got the room for the number of patients arriving by car. Having a disability I need to park reasonably close. It now involves my husband having to drive me to appointments in case there is nowhere for me to park. I need to be able to open the door wide which is very difficult there. If I was on my own and there were no parking spaces, the only other place is down the lane, making it difficult for me to then walk up the hill to the centre. The other surgery at Moor Grange has on road parking, but the waiting room is so small that it is difficult not to catch anything from other patients as we are all crammed in together. If there is a wheelchair or pushchair or children it is not very comfortable especially when you are not feeling very well. Holt Park is in an excellent situation with good parking and a large waiting area.

Dear Doctors Upset and depressed with the thought of the possible closure, personally feel deserted thinking about the possiblity and the alternative proposals. I have been a patient since 1960 and feel very upset with the thought of the proposal. I cannot understand why this move is even been considered as the surgery waiting room always has patients waiting.. The bus is not the answer for someone like me. I dont want to move to another surgery and most of the patientsfeel the same.

As a regular user of the Holt Park Surgery I am against its closure. This surgery is the most convienient for me and my family. I am surprised at its lack of users. The other surgeries at Moor Grange and Kirkstall are further away and more difficult to access (unless you have a car) The Holt Park Surgery is easier to access for people who travel by bus. I am really disappointed that the surgery is closing especially as the other services will still be offered there and will stay open at this site.

As I have lived in the Holt Park and Lawnswood areas for over 30 years and registered as a patient of Holt Park in all that time, Holt Park has always been my first choice of surgery. I feel that the doctors have arrogantly assumed most people drive so the other surgeries are easily accessible. I do not drive and have to get 2 buses or a taxi at great expense to the other surgeries, as opposed to the number 1 bus or a 28 minute walk to Holt Park. What about the elderly and disabled patients who live in the Holt Park area. The no 1 bus is every 10 minutes whereas the no 19 bus is every half hour, meaning if it misses you miss your appointment. Whenever I have visited Holt Park it is always busy with a simliar number patients waiting to be seen as there are at Moor Grange and Holt Park, both of which I have been forced to attend. Yes there is probably a decreasing number of patients attending Holt Park, but that is because the number of clinic have been reduced deliberately. Since the threatened closure when I ring for an appointment I have to be ademant that I want Holt Park. I have never been offered the surgery, and I feel that I am been forced to choose Abbey or Moor Grange. As I have been a patient at Holt Park for so long as well as my husband. I am reluctant to change to another practice - I am deeply opposed to the closure.

My main concern with the closure of Holt Park Surgery, and not having a car. I would need to take 2 bus journeys , no 6 and 19. A walk between each bus and waiting time - at a time when you are not feeling well or in bad weather. The alternative would be a taxi both ways, and I am sure this would take longer than 5 /10 minutes as stated in your information. As a patient at Holt Park for many years and happy with the Drs and happy with the services offered there. I do hope it will not close.

We are totally opposed to the closing of Holt Park Surgery. Having recently moved to the area, the surgery was a plus factor. Moving to other sites if unwell, having to travel on buses, walking, standing and waiting are not acceptable to us OAPs. Please consider the plight which this entails to the older generation. Leave Holt Park Surgery open.

36 The main impact of the closure of this surgery is access to the aternative sites. Abbey Medical Centre has no bus route from this area and Moor Grange has an half hourly service which is not very reliable meaning that any appointment could take several hours. This situation is not good for the ageing population (thats me!)Whilst the services being offered has benefits are most certainly not for older patients. I was forced to go to Moor Grange for Blood Tests as holiday cover was not provided at Holt Park. I stepped back over 50 years when entering the premises, into a waiting room as they were then. Holt Park is a much better enviroment and doesnt make you feel depressed. I am sure if services were provided at the previous level, Holt Park could be a thriving surgery given the amount of new housing that is expected around this area. If the surgery closes I will transfer to another practice, as will many other patients, thus reducing the viability of Abbey Grange Medical Practice.

It is NOT 5/10 minutes to Kirkstall from my home by car - more like 30 when the roads are busy. The number 19 bus is of no use. Parking is extremely difficult, therefore have to allow more time for the jorney. I don’t think there is a chemist at Kirkstall. Holt Park has been refurbished, has adequate parking and a bus terminus for several routes, and two chemists nearby. More than 150 houses are been built - they will need a surgery. In bad weatherit will be a nightmare. As a carer for my wife, I can do without all this extra grief and stress, It is going to be a two day job just to get a prescription. I have not got a computer.

The surgery is convienent for me as I only live a short distance away. I will find it very difficult to get to the other surgeries by public transport as I don’t drive. We have been through all this 2 years ago. I do not wish to travel to Moor Grange or Kirkstall. There are many people who came to the Holt Park Surgery who are older or do not drive. Please keep this surgery open. Your staff are very helpful and pleasant. I was a patient at Holt Park Surgery for many years but changed over to Moor Grange Surgery and find it more convienient and easier to get appointments now. I have been a patient at Abbey medical Centre since 1979. I hate Holt Park Surgery for many reasons. It is unfriendly, dark uncaring, very difficult for me to attend. The lack of warmth, not peaceful at all. It is so difficult to make an appointment to see the dr you need to see. The building is not very nice either., it needs to close.

If Holt Park closes there will be more appointments and flexibility and very happy with the service I have received by the drs for nearly 50 years. Closing any surgery is not good for any community and neighbourhood. Social activities and meeting areas are all vital to social health. I have recently used Kirkstall, Latchmere, Butcher Hill, Spen Lane and Holt Prk. If the GPs running these services feel to improve other surgeries, by closing one, and would improve. then I trust the judgement of the GPs to do a true and honest valuation of the decision in hand. for the good of the patients.

I never use Holt Park so it wont effect me. Better if there are more appointments at Abbey I personally would be in favour of Holt Park closing as been able to see my preferred GP would be easier if they did not have to divide their times between different sites. Living at West Park I would not have visited Holt Park Surgery as I rarely go in that direction. Closure of the surgery will have no impact on me personally. Why is the branch at Holt Park closed.I have been there all my life but now have to change. Would be better to have more drs in one place to be able to communicate with eath other. I would be very unhappy if Holt Park surgery closed. It would have a profound effect on me trying to get to the drs, as I have a chronic illness. I am unable to walk far as a result of a medical error years ago leaving me with nerve damage. I also have depression and going to places is an ordeal for me. I need to go to Holt Park as this is the nearest surgery for me, the others are too far away. Buses are unrelaible and they dont take you close enough to the surgeries, like Holt Park buses do.

37 I feel having visited the practice at Moor Grange that the building and facilities at Holt Park are much more pleasant and accessible. Parking at Moor Grange was severely restricted the day I attended, I was unable to find a spot to park on the same street. I look after my toddler granddaughter and we had to walk some distance to get to the surgery. Also elderly patients from Cookridge with no transportwould not find it so easy as no direct bus from the Moseley Woods or Green Lane, especially if they were feeling particularly unwell. It would be fairer to the residentsof cookridge to close the Moor Grange Site. Perhaps people accept appointments at the other practice because they are not offered the choice of Holt Park.

I have usually gone to Holt Park Branch, but I would be happy to transfer to Moor Grange. Hopefully can keep the Holt Park Surgery open. The Dr at Holt Park Surgery is more professional and serivce is better than others. We hope you can still open the Holt Park Surgery because its more convienent for old people or people who don’t have a car. The surgeries concerned are too close together, tough for patients without a car. Have you tried using a bus. Many more houses are been built in Cookridge and Adel. The reason for closure I'm sure is for money. I am sure this is a forgone conclusion and nothing anyone will say can change it. After 50 years at this practice, who cares what I say!

I personally am for Holt Park closing as there will be more appointments at Abbey medical Centre where I prefer to go for appointments. Would like to see more appointments at Abbey for Dr Farrell. I would be happy if Holt Park closed , it is not near home but the mian point is that I would find it easier to get appointments at the Abbey surgery - this is important & less stressful. The closure of Holt Park will enable improved services at Abbey Grange with more appointments available and reduced waiting times. I am only really able to get to Abbey or Moor Grange so I think it is a positive thing if there will be more appointments avaialble to me at Abbey if the holt park branch closure is approved. I am happy with the proposals for closure of the Holt Park branch. It will mean there are more appointments available for me at my usual surgery. The downside of merging the 3 practices was that instead of seeing the usual receptionists who knew you were not a time waster, you saw a strange face - why wasn't it possible to keep the usual people in the usual palces? It felt impersonal instead of the usual friendly atmosphere.

I live near the Holt Park Surgery and it has made prescription and seeing a Doctor much easier than getting over to the Moor Grange Surgery. However, I had to use the Moor Grange Surgery for over 30 years before the 2 or 3 surgeries were amalgamated, so I will just revert to Moor Grange Surgery again. My main concern though is this, My Chemist is Cohen's Chemist which is situated right next to the Holt Park Surgery. Since I am now finding it very difficult to even leave my flat, my Chemist now simply take my repeat prescription by phone and they do the rest for me. Including: Running across to the Surgery at Holt Park to raise my prescriptions and have them signed by Doctor. (May be done on-line) Go across again to collect finished prescription.(May be done on-line) Make up the prescription in the Chemist Deliver to me. The Chemist may be the ones to suffer most, I don't know if they deal with the Moor Grange Surgery in the same way? I'm very disappointed that this proposal has reared its ugly head again. You state one of the reasons for closing the practice is that it has significantly less patients than the other surgeries which is hardly surprising since many reluctantly moved across to the other surgeries when threatened with closure last time. It is still difficult to get an appointment regardless. I and many of my neighbours do not drive and would find it difficult to get to either of the other surgeries. We would have to rely on taxis. I have been a patient at this surgery for over 30 years and would be very sad to see it close. I sincerely hope this proposal is turned down. I'm in favour of Holt park closing. The two other surgeries are fantastic, I believe Holt Park is now out

38 dated and unneeded! I have just had a heart valve replacement operation and have to have a warfarin test every 3 weeks will this effect it. Also i cannot believe they are closing this surgery especially when a new housing estate with 135 houses are been built on Moseley bottom where are these people supposed to see a doctor I go to one in Horsforth and sometimes it's difficult getting to see a doctor and we have to wait a while to see one this is just going to add pressure to the already busy surgeries in and around this area. I think this is dreadful what we are being offered instead of fairly local surgery is 2 surgerys miles n miles away not on a bus root either of them, if we felt there was a better doctors in the area we would have left. There aren't enough doctors in the COOKRIDGE area for the people of Cookridge and they are building new houses in Cookridge so we will need more doctors. The kirkstall surgery is miles away and you can't get a bus there from Cookridge,the moor grange surgery is dreadful inside and out no parking and no facilities for the disabled. I am disabled and have used moor grange twice and this was a disaster parking wise I was nowhere near to surgery! I believe the old and very ill are being forgotten not catered for. This practice started many years ago auctually in Cookridge. You can understand why people go to A n E instead of gps when this is happening! We have 2 surgerys to choose from now if they have places? Neither I'm very interested or confident in. so the practice is closing one of its surgeries, do you know how hard it is to get an appointment now with out the additional patients from another practice. I can not remember when I last saw my own Dr, I would now assume that this will be impossible. I would urge you to reconsider. if you are going to close a surgery close the smallest one ie abby grange. regards I would find the closing of holt park very inconvenient Ok to close it. Its hard enough to get appointment now without taking on more patients. My concern is that if the number of patients remains the same but the capacity of doctors reduces due closing one practice then I imagine it will take longer to get an appointment. I'm not particularly proactive and I like Dr Harris but it is certainly a consideration to change surgeries. If you think my concerns could be alleviated then please get in touch. Has we do not use the Holt Park Practice. We would have no objection to its closure. We do however hope that this does not cause too much inconvenience to other patients. Regarding the closure of Holt Park Surgery. The closure of Holt Park would be a huge inconvenience for myself and my parents. My father is 70 and can't be travelling to Abbey Grange should Holt Park close. We've gone there for years (since I was born) and would be hugely disappointed if it were to close. I do not wish the practise to close,it's convenient and does not require me to travel far and is therefore easier to make appointments etc. As someone who works full time it's not easy to get a day off to make an appointment so the fact I can go here and then go straight to work is a lot easier and causes less disruption and inconvenience I would be very sad if the Holt Park Surgery closed. I do not drive but can easily get to the Holt Park Surgery via walking or a bus. I cannot easily get to the Abbey Medical Centre and would be reliant on a lift. Should the Holt Park Surgery close, I would have to move to another surgery which I could easily reach by bus. I have been with the surgery 41 years so this would be a shame. But thank you for letting me know. For both myself and my husband, even though we can drive at the moment, we may find it very difficult in the future as we get older to get to the other surgeries without a car, as irrespective of the weather etc we can get to the surgery at Holt Park. You mention that more and more patients are going to the other two practices by choice, but from our own experience we have gone to the other surgeries - not by choice but it was the only option for a reasonably quick appointment. Speaking personally if I need to see a Doctor I want an appointment as soon as is available. otherwise I wouldn't have rung for an appointment anyway; however, when we have attended Spen Lane, the parking was a nightmare. Regarding the

39 prescription process we understand that it is intended for the re-order to be on line in the future, for us it may be fine, however there are other people who are not IT conversant and maybe don't even own a computer, will there be a procedure in place for prescription collection at a local chemist without having to drop the script into the surgery if Holt Park is closed? My husband has ordered his prescriptions on line; once it was never received by the practice, and on the other occasion despite requesting electronic to ASDA Chemist they never received it and he ended up getting a paper script which had to be collected from Abbey Grange as by now the medication was urgent, and the whole process took 5 days not 48 hours as it used to. Dear Sir or Madam, I am very disappointed that you still feel it appropriate to close the GP surgery at Holt Park. Due to my medical condition you are fully aware that i cannot use public transport. This leaves me with no alternative but to travel by taxi should i decide to remain with your practice. Is it your intention to negate those patients with travelling restrictions by offer 'home visits'? Over a year ago you attempted to close the Holt Park Surgery without going through the right procedure. I can only assume this is another effort to do the same. Your original attempt made me transfer to the Highfield Surgery, as i believed incorrectly that you were giving your patients no other alternative. The change has a negative impact on me at the time, and after a lengthy consultation with the surgery, and the fact that you made an u-turn, i was able to transfer back to your surgery. I fear that the closure of your GP surgery will compound my condition, and i will be left with no GP in this area. As last week was set aside for World Mental Health Awareness it seems your practice has not thought about those patients with high levels of anxiety and depression. Any change for patients with Mental Health issues can be very detrimental to their recovery. I have a lot of other reasons why you should not close the surgery, but these do not impact my family, so i will leave them till i attend either a consultation event or drop-in session. This does not really affect me much but I would be interested to know how many patients regularly use the Holt Park surgery and how many would be inconvenienced. the closing of holt park surgery doesn't really make any difference to me as i live round the corner from moor grange surgery and as i drive i can get to any surgery. I have found my visits to Moor Grange just as acceptable as Holt Park but only because I have a car and drive myself. However if this was not the case or if the weather made it impossible to drive then walking to Moor Grange would be a lot more difficult if not impossible. Would home visits be available in this case even if it was not an emergency. There must be quite a few patients who are in this situation. The arrangement that applies on Saturday and Sunday to visit Ireland Wood surgery would be a good alternative if this was possible. Your comments would be appreciated. I was originally registered at Holt Park when moved to Leeds in 1994. However, over the last 5 or so years I nearly always go to Abbey as it has been easier to get appointments for the nurse or doctor. The staff at Abbey are great whether receptionists, doctors or Jacquie the nurse. It is also easy to phone from 7am in the morning which is amazing. And if you can't get an appointment the receptionists suggest a possible telephone appointment. The fact that you have so many hours available and weekend appointments if you need them at Ireland Wood is also fabulous. I am currently seeing Sister Jacquie on a weekly basis and when she was away on holiday she was clear that if I needed to see a nurse then I should arrange to go to Moor Grange. My only comment would be the number of nurses. I had an accident in May and needed my dressings changing every 3 or 4 days for 3 weeks but due to a shortage of staff I ended up going to Otley hospital every time where I went originally after my accident. I then ended up being cared for at LGI plastics but it was only when I saw Jacquie in August that things started improving (some 3 months after my accident). My leg would probably have healed months ago had I seen a nurse back in May and June. So my issue relates to the number of nurses - they are invaluable and have such a depth of knowledge rather than a narrow perspective.

40 If since the last proposed closure holt park has been actively and noticeably been reducing appointments at holt park surgery, only giving patients an option of abbey grange or abbey medical centre. This closure was inevitable the reduced appointments aren't due to patients going to other practices by choice they've been made to go elsewhere so the statistics are accountable to close. No thought or care is given to patients in this plan, it's ok for gps and nurses with cars but have you thought about your elderly patients and young people or even mothers with young children? Abbey medical and moor grange are not easy to get to. I haven't been happy with the way the surgery has operated since the last planned closure and said at the time that they may dismiss the closure now but it will happen AND I WAS RIGHT!!! I as I'm sure many others who have transport issues will no longer use the proposed practices and will be seeking a new practitioner at Ireland wood or the croft All I can say is don't blame reduced patients as an excuse you did this yourselfs. I strongly object to the proposal to close the surgery at Holt Park Health Centre. If there has been a decline in the number of patients attending here, this is due to the fact that it has been made very difficult to get an appointment at Holt Park, as appointments have been offered in the alternative surgeries first. I don't understand why the practise is hell bent on closing the Holt Park Surgery, I can only assume it will benefit financially, but it would be a huge inconvenience to me and, I am sure other patients. Whilst I am able to drive to the other surgeries at present, it is not inconceivable that as I get older I will be unable to use my car. Should Holt Park Surgery close, I may have to examine other options. As Margaret and myself are already patients at Abbey Grange we do not really have cause to go to Holt Park as we have Moor Grange as an alternative. Really the closure will not be likely to have any undue effect on us. 1. I am disappointed but not surprised that this matter has arisen once more. Despite the reprieve in November/December 2012, it has been clear from the outset that the Practice Management were set upon closure of the Holt Park Surgery! 2. The preliminary details of the future re-development of the area previously occupied by the former Swimming pool, Sports Hall and Ralph Thorseby School, indicate the provision of apartments for elderly people. An excellent proposal given that they will be located at the heart of shops, community areas and recreational facilities. There are plans for further new housing to be built on the site presently occupied by the Cookridge Fire Station. There are new houses/flats currently being constructed on the former Pub site adjacent to Otley Old Road and Holt Lane. Given these facts, more and not fewer medical services will be required in the future! 3. I have been well served and satisfied with the surgery and staff at Holt Park. On the occasions of needing specialist attention, this usually incurs going to another NHS facility which one accepts. But for 'normal' doctor consultation, local facilities like Holt Park Surgery are the 'ideal'! 4. It's location is strategic given the bus services to and from the Centre and the generous parking facilities that exist there. At both the Abbey and the Moor Grange sites none of these benefits exist! At one it is solely residential Street parking and at the other it is limited off street parking spaces shared with adjacent School parking spaces! Adjacent street parking is on a steep cobbled street - not ideal in icy conditions! 5. For reasons outlined in '4' above, the increased numbers attending the other practices will not be 'good news' for local residents! 6. Public Transport journeys are not straightforward either. For example, using the Metro Website 'Journey Planning' facility, 'home to destination journey options' for my home to Moor Grange Surgery, range from 30 - 32 minutes, of which walking comprises 13 minutes. That's just getting there! 7. Similarly different 'home to destination' journey options to Abbey Medical Centre, range from 43 - 52 minutes of which an average of 13 minutes is walking. Please check these journey options out for yourselves! 8. At neither site are there good parking facilities - at one it is solely residential street parking and at the other it is limited off street parking spaces shared with adjacent School parking spaces! Adjacent street parking is on a steep cobbled street far from ideal in icy conditions! 9. For reasons outlined in '8' above, the increased numbers attending the practices will not be 'good news' to local residents! 10. At the age of 77 I am physically active and mobile on foot and by car. That will not always be the case! Neither will be the use

41 of public transport. Taxi/minicab will then remain the only option and not an attractive one for someone on a fixed pension. 11. Needless to say, I am disappointed by what is proposed. I will review what action to take, pending the outcome of the Consultation Process. I am, however, anxious not to delay action too long and find myself unable to transfer to another local practice because of ‘over-subscription’. Points for keeping GP service at Holt Park • The reason there are so few GP appointments made on a weekly basis is surely because the first time this change was mooted many patients panicked and either moved to Abbey and Moor Grange or to other practices in the area! Not surprising the number has dropped! • There are plans for many more houses to be built in the area, both in Cookridge and in Adel, many of these being 4 and 5 bedroom properties where one would assume there would be families of a reasonable size. Where are they going to register when possibly other practices will by then be full? Surely the potential is there to build up the number of patients again at the Holt Park Centre. • If the Centre itself is being kept open, why the need not have the GP presence? • I, as a pensioner, at the moment still have the ability to drive and can, if necessary, get to either Moor Grange or Abbey but what about when I am unable to do that. How do I get there? How many buses is it going to need to attend these surgeries?How can I afford taxis? • ..and finally, one assumes that the ‘no longer viable’ comment in the letter refers to financial viability. So, why then, has an expensive to produce, full colour leaflet been sent out to patients? A very unnecessary expense! NB regarding the last point about viability.....having attended the meeting held at the Parkway Hotel this evening, 3rd Nov, I now learn that staffing is the issue and not finance, though I still feel that this leaflet need not have been such an extravagance Thank you In response to the practice's proposal to close the Holt Park surgery we would say currently we are content to use any of the three practice locations but note that (a) parking provision is more favourable at Holt Park than at Abbey or Moor Grange and a frequent bus service is adjacent to the health centre (b) the Holt Park location is likely to be needed by residents of proposed and ongoing major new housing developments in the area (c) naturally, the number of patients using Holt Park will have diminished considerably if additional appointment options and extended hours have been offered (only) at Abbey and Moor Grange (d) patients unable to drive could find it difficult or impossible to access Abbey or Moor Grange surgeries.