Agenda item

15:30

There will be an update on activity since the last meeting on the decision by the OCCG to close the Deer Park Medical Centre, Witney. Attached is a record of the outcome of a confidential Toolkit meeting held with OCCG representatives on 12 December 2016 (JHO11).

In light of recent legal proceedings for judicial review against the closure, advice has been sought from the County Council’s legal team on the implications of this in terms of HOSC’s consideration of this issue. A report from the Director of Law & Governance  is attached at JHO11.

Prior to consideration of this item the Committee heard addresses from the following members of the public:

Cllr James Mills urged the Committee to support the closure of Deer Park Medical Centre as a substantial change of service. He expressed his concern that the informal meeting comprising some members of the Committee and representatives from the OCCG had not invited local representatives to attend, particularly when local issues around workforce and the local planning authority were to be aired. He pointed out that thousands of houses were to be planned which would cause major problems if there was insufficient provision of primary care.

Cllr Toby Morris stated that currently Witney was experiencing a 25% vacancy rate for GPs which caused concern particularly as 2,000 houses were due to be built in the Witney area. For this reason it was the Town Council’s view that the closure of Deer Park Surgery constituted a substantial change in service as it was an important satellite for patients living in the West Witney, Cogges and central Witney which amounted to half the size of Witney. He pointed out that Witney Town Council had not been consulted on the proposed change by the OCCG and expressed concern that the OCCG had sent letters to the dispersing patients that morning, which was immediately prior to discussion by this Committee.

Brenda Churchill referred to the Court decision, from the previous day, not to continue with the application for judicial review on the grounds that the application had not been made early enough.  It was the view of the Patient Participation Group that the OCCG should have discussed the procurement issues with them earlier. Furthermore, they believed that the OCCG should have conducted a broader and more meaningful exchange on the impact of the closure with the local public. She also expressed her concern that there had been too many meetings in private. She urged the Committee to take the view that it was a substantial variation in service, as requested by the district council, the local MP and others. She asserted that very few patients had left the surgery to go to other surgeries because they wanted to remain at the practice.

The Chairman assured Mrs Churchill that no conversation had taken place behind closed doors with the CEO of the OCCG at any time.

David Bailey stated that the decision to close Deer Park Medical Centre made even less sense after listening to the previous item relating to future changes in primary care in Oxfordshire.  He told the meeting that in 1993 he had suffered a heart attack and, since that time, the Deer Park Surgery, which had been rated as a ‘good’ surgery, had taken great care of him. He expressed his concern that the Ambulance Service and the OUH might struggle to respond to emergencies leading to patients not receiving the same level of care. He asserted that GPs were leaving other surgeries, yet the OCCG were planning to remove three GPs from Deer Park who would not be transferring to another surgery. He concluded by urging the Committee to refer the closure to the Secretary of State.

The Chairman then asked the County Council’s Director of Law & Governance & Monitoring Officer, to give an update on events since he wrote the paper (attached at JHO11) in relation to the Deer Park Surgery. He reported that events had overtaken the content of the report since the Court hearing had occurred the previous day. His view was that it was not helpful to speculate on what the Judge had said at the hearing. A primary aspect on which the judgement had been made was the delay from the claimants (the Patient Participation Group) to make the submission and that there was no reason why the application could not have been brought earlier. He emphasised that there had been no delay on the part of the Committee, or criticism in the way that it had approached the matter. Committee members had given consideration as to whether the closure would be considered a substantial variation of service by the Committee on 12 December 2016 in an informal, further fact finding meeting to which OCCG representatives had been invited. The meeting today was the first meeting for it to be considered formally and in public by the Committee, subsequent to 12 December. He pointed out that the law did not assist in that there was no legal definition of what constituted ‘substantial’. It was the OCCG’s view that it was not a substantial change. He advised that if members of the Committee were in agreement with the OCCG, then it would constitute the end of the discussion, but if there was disagreement, then consideration would need to be given about how to go forward ie. consultation on the closure, or referral to the Secretary of State. He confirmed that it was the OCCG’s decision about what action they wished to take in the future.

David Smith pointed out that a two hour discussion had taken place with HOSC members on 12 December; that a procurement process had been carried out and the current operator had been the sole bidder. The bid was too high and in the absence of an alternative suitable provider, the OCCG had to take a decision to close the practice at the end of March 2017. He added that the OCCG had previously extended the provider’s contract by 1 year. He stated that the OCCG had to inform the patients as soon as the judicial review process had been completed, as it was getting very close to the closure date and patients had to be dispersed to other practices. Mr Smith stated that the OCCG were happy to accept that public consultation would take place, but asked the Committee when this should happen given the timescale.

Questions asked by members of the Committee were in the following areas:

·         At the 12 December meeting, members of the Committee had asked for information on financial savings for analysis;

·         The Committee ought to have been informed earlier so that different solutions could have been considered;

·         On 11 August 2016 Virgin Care, the provider, had confirmed that they were prepared to continue providing services at Deer Park and this had been shared with the local MP;

·         The OCCG’s consultation process on the closure and their willingness to make it feasible;

·         If there was any community-led initiative for the surgery to continue;

·         Why letters to patients regarding their dispersal had been sent out that morning, despite an informal steer from Committee members on 12 December that they considered the closure to be a substantial change.

·         Would there be patients who were ‘orphans’ who would not be able to find a surgery in Witney to register with?

·         What about patients who were, prior to closure, part of a screening programme and, after closure to which their notes could be transferred? Relying on the Cardhill Formula that only 20% of patients were active on a GP list at any one time, could put patients at risk. The outcome of this would be to skew a receiving surgery’s workload, without the funding that followed it.

Answers received from the questions posed by members were:

·         The OCCG would make no savings from the closure of the Surgery;

·         Virgin Care had confirmed that their original tender bid still stood as it was. Therefore Virgin Care’s bid was not affordable within the contract. A consequence of paying more money to Virgin Care would be that more money would have to be paid to other practices and funding was not available for this;

·         A ‘toolkit’ had been considered with HOSC on whether it was a substantial change. As of now, the practice was closing and patients had been written to. Practices were already taking on further staff to accommodate the rise in numbers of patients and some patients had already registered with other practices. It was reiterated that the OCCG had wanted to begin to inform patients much earlier and advise them on registering with other practices. The judicial review process had put a halt to the letters being sent out earlier. They then went out at the earliest opportunity on notice of the result of the hearing;

·         It would be very difficult at this late stage to accommodate a community-led initiative to keep the surgery open. The contract had already been extended;

·         The patients would have a choice of who to register with;

·         The process of transfer of patients was worked out in conjunction with Virgin Care. Text messages were to be sent to patients reminding them to re-register and Virgin Care would be telephoning some. This would be the subject of ongoing reviews.

On the conclusion of the discussion, Cllr Bulmer put forward a motion, seconded by Cllr Dhesi, and carried by 12 votes to 0, that this was a substantial change in service.

In light of the above agreement that it was a substantial change in service, the Committee then considered what action it wished to take. David Smith stated that there was no time for the OCCG to undertake a consultation. Julie Dandridge reiterated that the OCCG could not leave the despatch of letters to patients any longer and confirmed that other practices were able to take the patients being dispersed. Moreover, it was unsafe for the patients not to have a service. Normally there needed to be three and a half months for the dispersal of patients.

Nick Graham advised that as the Committee was in disagreement with the OCCG about whether it was a substantial change in service, if any further action proposed by the Committee was not acceptable to the OCCG, then the only course of action left to the Committee was to refer the matter to the Secretary of State.

Cllr Bulmer then put forward a motion, seconded by Cllr Dhesi, to refer the change in service to the Secretary of State on the basis that consultation with the public and patients at Deer Park Medical Centre was inadequate and the closure of the surgery would not be in the interests of residents and patients in the Witney area. This was carried by 12 votes to 0.