Agenda item

10:30

Diane Hedges, Chief Operating Officer and Deputy Chief Executive, OCCG, and Julie Dandridge, Deputy Director and Head of Primary Care and Localities, OCCG will provide an overview of general practice in Oxfordshire; the pressures on primary care; and the work being undertaken to ensure the sustainability of general practice (JHO7).

Prior to consideration of this item, the Committee was addressed by the following members of the public:

Brenda Churchill expressed the concern of the Deer Park Surgery Patient Participation Group that most of the meetings relating to the closure of the Deer Park Surgery, Witney had appeared to have taken place behind closed doors, there being no reference to any discussions in the minutes of this Committee. She added that to close a well-loved surgery that, in their view, served them well and would expand next year did not make sense in the knowledge that other surgeries in the town did not offer the same services. There had been no consultation with patients on the decision to close, no environmental impact study, no risk assessment and no consultation with other doctors in the town who were expected to take 3,700 patients living in Witney. She added that by March 2017 there would be 200 more houses built in the Deer Park Surgery catchment area and an estimated 600 more patients would be seeking a doctor in Witney. She also made reference to the plans to build another 1,500 houses in Witney next year. She asked where they would they all go? She asked also that this Committee scrutinise the decision for closure and that it concludes that it is a substantial change to medical services for all of the 26,000 residents of Witney.

Julian Cooper, speaking on behalf of the West Oxfordshire District Council Working Party, urged the Committee to agree that the decision to close the Deer Park Surgery, Witney, was a substantial change in circumstances for one of the main communities in Oxfordshire. The reasons for this which he put forward were that:

·         The proposals to build an additional 2,000 houses in Minster Lovall, Brize Norton and Witney did not appear to have been taken account of. There was considerable doubt at the District Council that the practices within Witney had the capacity to absorb these 4,000 patients;

·         The Working Party has concluded that the wrong assessment of the age profile had occurred, adding that a considerable number of patients (approximately 60%) on the register at the Surgery exceeded the age of 65;

·         The main form of communication had been advertisements in the local press;

·         This part of Oxfordshire had lost Burford Hospital in the last 20 years and the further loss of this health infrastructure undermines the commitments given by the Health Authority to this part of the County.

·         He concluded by stating that other communities within Oxfordshire could be left defenceless in the future if this is allowed to go through.

The Chairman stated that the Committee was aware that the OCCG had extended the contract for GP services at Deer Park until March 2017. She added that a completed substantial change assessment (the ‘Toolkit’) had been received from the OCCG. This would now require an informal meeting of the Committee to examine the completed toolkit with OCCG representatives and for the full Committee to then take a view as to whether it was a substantial variation of service to merit public consultation.

The following representatives attended for this item:

-       Dr  Joe McManners, Diane Hedges and Julie Dandridge – OCCG

-       Dr Paul Roblin – Local Medical Council

-       Rosalind Pearce, Healthwatch Oxfordshire

Diane Hedges introduced the paper (JHO7) giving some information on where it featured within the context of the Oxfordshire Transformation Plan. Whilst recognising that primary care in Oxfordshire had much to be proud of, she emphasised the major challenge was that more people were living longer and thus more support would be needed for longer. Julie Dandridge added that GP practices were independent contractors and the OCCG commissioned many of them under a national contract. It was recognised that GP practices were under pressure both nationally and locally for a number of reasons, including more patient requiring a same day appointment and GP recruitment and retention. She stated that the OCCG had invested £4m into GP practices to improve their sustainability; and more appointments had been offered as a result of the GP Access Fund. She also highlighted additional funding, available from 1 November 2016, which allowed the OCCG to provide additional support to practices.

Julie Dandridge emphasised that the OCCG would only decide to close practices where there were concerns about quality and patient safety. Deer Park Surgery, Witney was not one of these surgeries – the OCCG had believed that they could find a provider, but this had not been possible. An extension to the contract had been given until 1 April 2017 and OCCG were working with the existing provider to ensure that patients who had not yet transferred to other practices were identified and supported to do so.

Dr Paul Roblin stated the view of the Local Medical Council was that the problems experienced by GPs were national ones, adding that the main reason why practices were closing was because the financial equation did not work. The percentage of NHS funding had fallen from 10.4% to 7.5% in 2014/15 and Simon Stevens had recognised that GPs had been neglected. As a consequence surgeries could not get replacement partners and the alternative was either salaried GPs or locums. He added that GPs opting for the salaried role would come at a cost as they would not be part of a funding stream. He added also that the financial value attached to initiatives to remedy the deprivation of funding for GPs was not forthcoming. As a result, GPs were retiring early. Dr McManners acknowledged the comments made by Dr Roblin and agreed that it was a national issue. He stated that constructive solutions needed to be identified to address this; one of the ways to sustain general practice in the county was to consider forming larger scale practices and sharing staff and overheads.

A member asked Dr Roblin, if in his view, anything could be put in place to prevent the use of locums. He responded that market forces drove this, but Jeremy Hunt MP had asked local primary care services to report on this issue.

A Committee member asked how the OCCG responded to anticipated health needs in respect of new housing developments. It was stated that NHS England was a statutory consultee in planning applications. Dr Roblin agreed that a potential solution to the problem was the involvement of the NHS in a more co-ordinated way as developments were being planned. The Chairman added that this HOSC had raised this question with NHS England Property in the past and had expressed its hope that responses could be made in this way in the future. Julie Dandridge added that the OCCG was currently working with South & Vale District Council on growth in Didcot, but would welcome more links with district councils. Dr McManners referred to the new Community Infrastructure Levy (CIL) which would offer opportunities not seen before.

In response to a question about why a mechanism had not been put in place to help surgeries to avoid closure, Dr Roblin responded that the solution to it lay in the hands of the Government, NHS England and NHS employers. He added his view that the problems should have been seen in advance, but they were not for a number of reasons.

Dr McManners stated that the OCCG was looking at a number of new models of care in practice around the country in the form of multi-disciplinary or super practices. He believed that new roles, such as the Advanced Nurse Practitioners, would improve patient experience. Consideration was being given to how the concept of the GP could be preserved with its maintenance of a comprehensive care of a patient, with the introduction of the new roles.

A Committee member asked for more detail on how quality was measured in general practice, as it was not apparent from the papers. Dr Roblin responded that General Practice had worked under a fairly comprehensive framework called ‘Quality and Outcomes Framework’, which was still in place, but might be superseded.

In response to a question asking if GPs generally would wish to concentrate on their medical role rather than surgery business, Dr Roblin responded that this did divert attention away from the patients as a sizable chunk of the day was spent in dealing with business. The new models of care would enable GPs to spend more time with their patients. Julie Dandridge confirmed that there were different options available to GP practices in terms of dealing with administration.

A member commented that it was difficult for the Committee to scrutinise issues such as the imminent closure of the Deer Park Surgery, Witney, when there was a lack of detail to drill down into. It therefore had to take many factors on trust. It was also pointed out that the Committee did not have a proper understanding of the issues relating to the Deer Park Surgery because details of the clinical model for the surgery were not known. Diane Hedges responded that in relation to Deer Park Surgery, the OCCG was bound by procurement law. She was able to say, however, that the single response received to the tender was not one that the OCCG could support. She undertook to share the tender documents with Committee members, but not the provider’s tender submission.

A member queried why the procurement process for retendering GP services at Deer Park Surgery was so short and questioned whether this had limited the opportunity for potential providers to come forward. Julie Dandridge responded that the OCCG had met the recommended procurement requirements and undertook to share the advice she had received from OCCG’s procurement team.

Diane Hedges highlighted that one problem the OCCG was wrestling with was how to encourage GP practices to change from working as autonomous businesses to working with others. She added that the model for general practice had to change because per capita funding for each year was a problem, and not one that the Government could solve alone. The OCCG was exploring different models and viable solutions and aimed to take ideas to GPs in December.

Members were disappointed that no particular vision for a sustainable primary care system had been demonstrated. Julie Dandridge responded that a paper on the Primary Care Strategy was to be brought to the next meeting of the Committee on 2 February 2017 where this would be shared.

Rosalind Pearce called for patients to be put at the heart of the changes.

All were thanked for their attendance.