Agenda item - What Happens when a GP Surgery Closes or Merges or There is Other Serious Patient Disruption

Report of Director of Partnerships, Clinical Commissioning Group (copy attached)

            RESOLVED – That the content of the report be noted.

49.1    The Board considered a report of the Clinical Commissioning Group (CCG), Director of Partnerships, detailing the arrangements put into place when a GP surgery closed or merged with another surgery or when there was other serious patient disruption.

49.2    It was noted that the report had been requested by Board Members at their meeting on 10 September 2019, following the announcement that the Matlock Road surgery would be merging with the one in Beaconsfield Road. At that time the CCG had been asked to provide background information regarding the processes which the CCG had in place and undertook at a time of GP change. The paper provided for the Board that day detailed those steps and also sought to set them into the context of the wider CCG programme aimed at increasing practice resilience. A more detailed paper setting out the information in this report but also including details in relation to the development of PCNs, had been received by the Health Overview and Scrutiny Committee (HOSC). Brighton General Practices experienced pressures in common with the rest of the country in respect of practice closures, on-going cross workforce shortage and the increasing number of GP retirements. The Director of Partnerships at the CCG, Ashley Scarff, was accompanied by the Deputy Director of Primary Care at the CCG, Hugo Luck who was in attendance to answer Board Members questions.

49.3    The following addition/amendment to the recommendations had been received from the Green Group proposed by Councillor Nield and seconded by Councillor Shanks.

            “To add the recommendation 1.2:

            That the Board requests a further report which maps the geographical spread of GP practices in Brighton and Hove, shows where surgeries have been lost through closure or merger since 2015, and where surgeries may be in danger of closure or merger (for example through GP retirement) by 2030. This report is to explain the forward plan for ensuring that residents in all areas of Brighton and Hove are provided with primary care which is both local and accessible to them.”

49.4    Councillors Nield and Shanks stated that their amendment had been put forward to seek to ensure that Board Members were fully informed in respect of this matter, if however, they considered information in response to questions by Board Members in addition to that set out in the report support was sufficient, they would withdraw their amendment.

49.5    The Director of Partnerships, Ashley Scarff, referred to the flow–diagrams which had been circulated to Board Members which were intended to set out in simple terms how the process worked. Although GP surgeries operated independently of the NHS it was recognised that upheaval could be experienced by some patients when a practice was closed or merged with another and it was important therefore to mitigate upheaval as far as practicable, to try and reduce pressures and to provide opportunities to create new skills. As some aspects of this service linked into primary care, it was important to address gaps and to look at how services could be provided most appropriately. There were circumstances in which a patients needs could be better addressed by other services than by attending a GP practice.

49.6    Councillor Nield explained that she wished to understand how the process worked and how patients were made aware of changes in advance of them occurring. Often gaps occurred and in the case of the Matlock surgery closure some elderly residents had found the process bewildering and that their concerns had not been considered. In the case of the Matlock Road surgery closure the greatest concern had been that the nearest surgery was not located on a direct bus route.

49.7    The Deputy Director of Primary Care, Hugo Luck, explained that it was important to recognise that the structure of GP practices had changed little since 1948 when the NHS had been set up. In consequence this element of the service had not kept part and it was important to provide the right care in the right place. Whilst all that had been said in respect of the Matlock surgery were noted, the changes there and in respect of other closed/merged surgeries had been welcomed by some patients. When small surgeries closed it provided the opportunity a have access to a broader range of services and facilities than could be provided at a smaller surgery, for example access to nursing services and the ability to have an annual health review. The downside was that the nearest surgery might be some distance further away from the patient’s home Details had been provided to those registered at the surgery and the options available to them had been detailed. As far as practicable, patients were notified of changes in order to enable them to digest that information and to decide the option most appropriate to their needs.

49.8    It was a fact of life that closures and mergers would happening as GP’s would retire or move on. Patients had differing needs and it was not possible to map every bus route to in view of the surgeries across the city, however, patients were advised regarding other surgeries in closest proximity to their home. Information was also provided on the surgery website.

49.9    Councillor Shanks asked for clarification as she understood it, a patient was compelled to sign up to the surgery located nearest to their home address and that if they requested to sign up to one further away that they would not be accepted onto the register for that surgery. She wished to understand how the commissioning arrangements in place worked and what degree of flexibility existed. It was explained that a range of contracting and commissioning arrangements were in place. GP services were contracted nationally with additional services commissioned at local level by individual CCG’s. As the city was compact and densely populated there was a considerable overlap of/between surgery boundaries so in reality this did not generally represent a problem.

49.10  Councillor Nield enquired regarding the facility for patients who were unable to attend a surgery to be visited in their own homes and asked how easy it was for a patient to receive a home visit if they needed one. The Co Deputy Chair, Dr Hodson, CCG, responded that this was resource driven, patients were visited in their own homes where that was required in response to a reasonable request. Generally, it was better for the patient and there was less delay if they visited the surgery directly, it was more efficient time wise for all.

49.11  The Chief Executive of Brighton and Hove Healthwatch, David Liley stated that feedback they had received indicated that GP mergers across the city had been well organised. A recent review of GP practices across the city had indicated that when mergers had occurred the majority of patients did not consider that they had been disadvantaged as a result and that the general level of service provided was very high. Research carried out two years ago had identified a small group who did have problems accessing a local surgery and had sought to find more effective means of reaching those individuals. Overall however, this did not appear to represent a significant problem.

49.12  Councillor Appich referred to the level of GP support via the Primary Care Network, in particular the support given to care homes. In some instances, residents had needed to be admitted to A & E due to lack of more suitable care. It was noted that the measures were in place to address such issues and that the CCG could and did work with NHS and voluntary sector organisations to encourage them to work with GPs to address any potential problems for which they could provide assistance.

49.13  Councillor Bagaeen stated that having considered the data provided he was of the view that details of the percentage of locum GPs compared with salaried and partner GPs would have been useful. Also, details in relation to anticipated reduction in capacity and maps indicating surgery boundaries. It was explained that although detailed data was available, there were caveats when seeking to draw conclusions in that although it provided raw data as to numbers it did not indicate “what” services/advice they were qualified to provide for patients. In larger surgeries nurses were able to assist by taking appointments which freed up the GP to deal with more complex patient needs. The boundaries between the different surgery areas were fairly fluid given the concentration of the city’s population.

49.14  As no further matters were raised in respect of this item the Chair moved to the vote. Councillor Nield stated she wished to withdraw her proposed amendment in view of the update/information which had been given.

49.15  RESOLVED – That the content of the report be noted.