PART 1 Primary Care Commissioning Committee 2019/20 Date of Meeting: 14 February 2020 Agenda Item: 2.4 Subject: Application to close the York House Surgery (YHS) site Reporting Officer: Sarah Crossley (Author: Sarah Hickman) Aim of Paper: To provide the Primary Care Assurance Sub-committee with the necessary information to enable them to make a decision regarding the application from Heywood Health to close the YHS site Governance route prior to Primary Care Meeting Date Objective/Outcome Commissioning Committee Primary Care Commissioning Committee Select date of meeting. Click to Select Primary Care Assurance Sub - Committee Select date of meeting. Click to Select Primary Care Innovation and Transformation Select date of meeting. Click to Select Sub-Committee Primary Care Assurance and Transformation Select date of meeting. Click to Select Sub - Committee IM&T Group Select date of meeting. Click to Select Other Click here to enter text. Primary Care Commissioning Committee Approval/Decision Resolution Required: Recommendation The Primary Care Assurance Sub-committee are requested to review the attached paper regarding the application to close the YHS site and make a recommendation to the Primary Care Commissioning Committee as to whether this is supported by members Link to Strategic Objectives Contributes to: (Select Yes or No) SO1: To be a high performing CCG, deliver our statutory duties and use Yes our available resources innovatively to deliver the best outcomes for our population. SO2: To deliver on the outcomes of the Locality Plan in respect of Yes Prevention and Access (Prevention and Self Care) SO3: To deliver on the outcomes of the Locality Plan in respect of Yes Neighbourhoods & Primary Care (Getting help in the Community) SO4: To deliver on the outcomes of the Locality Plan in respect of No In Hospital - Planned (Getting more help) SO5: To deliver on the outcomes of the Locality Plan in respect of No In Hospital - Urgent Care (Getting more help) SO6: To deliver on the outcomes of the Locality Plan in respect of Children, Yes young people and families SO7: To deliver on the outcomes of the Locality Plan in respect of Yes Mental Health Risk Level: (To be reviewed in line with Risk Policy) Red 1 Comments If the closure of the York House Surgery site is not approved, there is a risk (Document should detail that the practice continues to struggle to successfully operate two sites how the risk will be mitigated) which may ultimately impact on their ability to fulfil their contractual obligations and continue to deliver General Medical Services. Content Approval/Sign Off: The contents of this paper have been Head of Primary Care, Sarah Crossley reviewed and approved by: Clinical Content signed off by: Not applicable Financial content signed off by: Not Applicable Completed: Clinical Engagement taken place Not Applicable Patient and Public Involvement Not Applicable Patient Data Impact Assessment Not Applicable Equality Analysis / Human Rights Assessment completed Not Applicable Executive Summary Aim The purpose of this paper is to provide information to the Primary Care Assurance sub-committee for consideration of the application received from Heywood Health to permanently close the York House Surgery Site and consolidate all services onto the Argyle Street Medical Centre site. A number of options and a recommendation are included in the paper for the committee to consider and determine next steps. Background In October, the Primary Care Commissioning Committee (PCCC) approved a temporary reduction in services at Heywood Health’s York House Surgery site. Due to exceptional circumstances, the following changes the opening times at York House Surgery were implemented with immediate effect: • Mondays: 08:00-15:00 • Tuesdays: 08:00-15:00 • Wednesdays: 08:00-15:00 • Thursdays: closed • Fridays: closed (previously the site was open 08:00-18:30 Monday to Friday) The changes were originally put in place up to Monday 6th January 2020 or until such time as the practice is stable enough to resume full service, whichever was sooner. Full services remain available to all patients via the Argyle Street Medical Centre site. The practice has reviewed its situation and has now submitted an application for a permanent closure of the YHS site. Under delegated co-commissioning responsibility with NHS England, the CCG must consider this application. 2 Since the submission of the above request, the practice experienced further staffing issues and approached the CCG to request a further reduction of services at the YHS site as follows: • Mondays: 08:00-13:00 • Tuesdays: 08:00-13:00 • Wednesdays: 08:00-13:00 • Thursdays: closed • Fridays: closed This was requested to be put in place until such time as a decision is made regarding the future of this site, so therefore covering the months of January and February 2020. This was approved by the PCCC under chairs actions on 24th December 2019. This paper highlights the background and rationale to the closure request from the practice and includes elements the CCG has considered, and information is included regarding the following points for consideration by the committee: • Staffing Issues • Partnership Changes • Practice Finances • Patient Usage of Sites • Stakeholder Consultation • Equality Impact Assessment • Travel Analysis • Patient Choice • Surrounding Practice Capacity • Consideration of Local Health Needs • Housing Developments • Strategic Direction • Financial Implications Recommendation The Primary Care Commissioning Committee is asked to review the application and supporting information and make a recommendation to the Primary Care Commissioning Committee as to whether the proposal is to be approved. 3 1.0 Introduction The CCG has received an application from Heywood Health to close one of its two sites. The practice is not applying to close its list or to amend its existing practice boundary, this is simply an application to run its General Medical Services from one site. This means there will be no change in the amount of capacity available at this practice, all services currently provided at the York House Surgery (YHS) site will be made available at the Argyle Street Medical Centre (ASMC) site. The application is shown in Appendix A. 2.0 Background In December 2016, Argyle Street Medical Centre (ASMC), 141 Argyle St, Heywood OL10 3SD and York House Surgery (YHS), 19 York St, Heywood OL10 4NN merged to become Heywood Health with one contract covering two sites. On 20th September 2019 Heywood Health approached the CCG to explain that the practice was in “crisis” in terms of clinical staff which meant that they were no longer able to support full staffing at two sites and felt that continuing to manage this would be unsafe for patients. The practice had reached this point due to a combination of clinicians being away from work due to bereavements and sickness with clinical sessions having dropped from 62 to 42 per week. They had tried alternative ways to manage this pressure but finally approached the CCG to ask for support. This support came in the form of a temporary reduction in services at the York House Surgery site. The paper that was approved by the Primary Care Commissioning Committee via chairs actions can be found in Appendix B. The approved opening hours were as follows: • Mondays: 08:00-15:00 • Tuesdays: 08:00-15:00 • Wednesdays: 08:00-15:00 • Thursdays: closed • Fridays: closed This change was originally put in place up to Monday 6th January 2020 or until such time as the practice is stable enough to resume full service, whichever was sooner, with full services remaining available to all patients via the ASMC site. This was further reduced for January and February, again a paper was approved by the Primary Care Commissioning Committee via chairs actions, This was because after the original request to reduce the hours at YHS, a further GP partner went on sick leave with no fixed return to work date reducing their available sessions even further and making it more difficult to flex their workforce to cover two sites. The paper approved by PCCC is shown in Appendix C. The subsequent approved opening hours, which are currently in operation are: • Mondays: 08:00-13:00 • Tuesdays: 08:00-13:00 • Wednesdays: 08:00-13:00 • Thursdays: closed • Fridays: closed This was requested to be put in place until such time as a decision is made regarding the future of this site, so therefore covering the months of January and February 2020. This was approved by the PCCC under chairs actions on 24th December 2019. 4 The practice, having reviewed its current situation, has approached the CCG to request a full closure of the YHS site from 1st March 2020. The application from the practice is a request to close the YHS site and to continue to provide primary medical services to all their registered patients from the ASMC site. This is not an application to close the list or to reduce the contractual boundary. Under delegated co-commissioning responsibility with NHS England, the CCG must consider this application. The application has been considered in accordance with the NHS England policy ‘Primary Medical Care Policy and Guidance Manual’: https://www.england.nhs.uk/publication/primary-medical-care-policy-and-guidance-manual- pgm/. Part B 7.15.10 – 7.15.29 is relevant and is shown in appendix D for ease of reference. We liaised with our contacts at the Greater Manchester Health and Social Care Partnership initially to understand some of the contractual implications, however they were happy for the CCG lead the process. 3.0 Staffing The catalyst for the change has been the reduced staffing model the practice has been operating with. Due to a combination of sick leave and bereavement leave the practice are finding it increasingly difficult to clinically staff this site.