Agenda item

11:25

Information is sought by the Committee from the Oxfordshire Clinical Commissioning Group (OCCG) on its plans for future changes and consultation for Banbury Health Centre. In particular information on the challenges, priorities and approach will be sought, including the proposed new model of care in Banbury. The Committee will seek information on how the changes in Banbury relate to the broader context for primary care in the North Locality and on the areas of focus for the OCCG’s consultation plan.

The following reports from the OCCG are attached:

-        Delivering Primary Care at scale in Banbury (JHO8)

-        Consultation Plan – Banbury Health Centre (JHO8)

Information was sought by the Committee from the OCCG on its plans for future changes and consultation for Banbury Health Centre. The following reports from the OCCG were considered:

-       Delivering primary Care at scale in Banbury (JHO8)

-       Consultation Plan – Banbury Health Centre (JHO8)

The meeting was attending by the following representatives:

-       Julie Dandridge, Ally Green and Dr Paul Park – OCCG

-       Paul Roblin – Local Medical Council

A powerpoint presentation was given by Ally Green and Julie Dandridge on proposals for the practice.

Ally Green stated that the OCCG had learned from experience, had engaged with patients already via the PPG. They had also talked to members of the Community Partnership Network and shared the draft plans to consult online. The OCCG had also listened to feedback and had revised their consultation plans and options accordingly. Ally Greene that the CCG had wanted to engage with HOSC early about the way it intended to consult.

The Chairman thanked Ally Green and Julie Dandridge for the presentations. He pointed out that the 8am – 8pm offered by the Centre was the result of a unique contract set up in 2009 as a Darzi Health Centre and it was a facility which was very much welcomed by patients. He began the discussion by asking why was it necessary to move away from these compelling characteristics when it had served the community so well?

Dr Park stated that he was one of the founding GPs of the Centre and had judged it to be a good place to work and gave good primary care service to patients. The question to be considered now was how the opening hours could be retained alongside the expansion of services in north Oxfordshire giving capacity in Banbury to treat unregistered patients, give coverage by the Neighbourhood Access Hub, plus a GP Out of Hours service. In addition, how to take north Oxfordshire forward in terms of health inequality issues with the catchment area containing two clusters with deprivation of illness, disease, cancer and stroke.

Responses to questions from the Committee were as follows:

-       Would Windrush and the drop-in centre at Bradley Arcade shops be included in the consultation? – Julie Dandridge responded that Woodlands and West Bar surgeries would be integrated in an innovative piece of work creating a pathway for other practices to join in. She added that each practice was the GPs own business and each must agree the right way for their practice. However, proposals would allow individuals to join together to decide how to provide services. Dr Park pointed out that Bradley Arcade was a branch surgery of Windrush Surgery.

-       In response to a report about a certain amount of scepticism amongst the public that the Banbury Health Centre would be closed and the need for new GPs and trainees in the area, Dr Park agreed that there was a need for training practices and larger practices could encompass this;

-       A local member of the Committee declared himself in support of the assimilation of smaller practices into larger practices which would offer the best IT services and deliver the best benefits for patients. However, his view was that he would like to see the retention of Banbury Health Centre where they were registered. He recognised that there were cost implications for retaining the centre as set out in the report, but did not feel that these were much higher than those for West Bar. He asked if there had been any discussion with Cherwell District Council (CDC). Ian Davies, Director of Operational Delivery, CDC, who was invited up to the table to respond, stated that CDC did not have any specific plans for the future of Banbury Health Centre building if it was to be closed. The Council regarded it as a local asset and would seek another tenant if it was vacated. Julie Dandridge stated that the OCCG would be willing to work with CDC to understand the costs of the building, adding that NHS premises business tended to b very complex. Dr Paul Park pointed out that the assimilation of the Centre with Woodlands Surgery would also address the health inequality concerns in that it was ideally situated near public transport links and it also accommodated an emergency dentist and a substance misuse service on another floor;

-       A member commented that PML was a crucial factor for future development, asking how responsive it could be and how flexible and transparent was it?  In addition, could it be understood where the drivers for decision making were being made? For example, if tenants were being sought, it would be important to know how secure the tenancies were and if they would cause difficulties regarding use. Paul Roblin responded that the modern scenario required organisations to look for economies of scale where larger units of delivery could also offer satellite working to provide resilience, as against the more vulnerable smaller units. Julie Dandridge added that the GPs now wanted to change from the historic model to one that was salaried. In relation to the issue of transparency, and the need to understand the governance of a larger organisation so that the public could have a meaningful interaction with discussion, Paul Roblin stated that the market would offer different solutions and anybody providing public services needed to provide this transparency. Whilst understanding this concern Dr Roblin stated that he did not agree that PML would have a dominant status and there was no reason why Oxfed GP Federation could not give services to Banbury as well as Oxford;

-       A member asked the OCCG to remember the principles of inequality and, in particular, that extended hours were central to Darzi. He made a plea that this Committee and the OCCG keep the future use of the premises high up on the agenda. Dr McWilliam commented that the principles of Darzi were at the forefront of Health policy at the time, however, things had moved on with a 5 year forward view of the Government. However, he stressed the importance of this Committee keeping a handle on people’s differences and to encourage Health to have sight of this in the local design;

-       A member asked if there could be an emphasis in the consultation document on the availability of appointments at Woodlands and West Bar practices if lists were to be dispersed. It was also vital that transport links be good. Ally Green responded that the OCCG had completed a transport survey of patients who used the Centre, the results of which would be included in the consultation document. This survey had indicated the high cost to patients of the current location due to the fact that there was no free parking for staff or patients. However, it was situated next to the station. The consultation document would also describe the population profile.

-       In response to a comment by a Committee member that, whilst the consultation methodology was good, consultation meetings should be open to all and the premises should be large enough to accommodate all who wished to attend, Ally Green stated that the OCCG was aware of the need to engage the PPGs at the other practices as they were in a position to encourage engagement at those practices. This would be included in the consultation document itself. Furthermore, the OCCG would always arrange open meetings in conducive settings to encourage maximum engagement activity. Transport links and other forms of access would always be considered. It was anticipated that premises situated in the centre of Banbury would be utilised;

-       In response to concerns voiced by a member about the future increase in population in the area and fears about the closure of a fully functioning surgery with access to public transport, Julie Dandridge assured the Committee that the physical estate would be taken into account by the locality planning, ensuring also that buildings had room to expand and were fit for purpose.

-       In response to a question about whether the 8am – 8pm opening hours would be part of the consultation, Julie Dandridge stated that the OCCG would be bringing in extended hours. Currently this facility was only available to six thousand people in Banbury and an extension into the rest of the patch was required. If it was found that a 9am – 5pm was required in a certain area, then an explanation for that would be given. She added that sometimes staff were reluctant to work the additional hours, particularly on a Sunday and it had been found that appointments were currently not being used on a Sunday by patients. In this event, more appointments would be made available on a Saturday;

-       A member of the Committee asked what would be delivered that was not currently delivered, what was the OCCG doing about workforce requirements and how would it manage increasing population needs? Ally Green responded that this information would be included in the consultation document which was currently being worked on. This would include information on gaps around options for extended hours and information on how the OCCG intended to deal with the growing population in the face of practices who currently had no capacity to expand. She added that re-procuring the Banbury Health Centre in its current form would not deliver a solution for a growing population. Dr Park added that a larger model specifying more flexible GP practices would be more attractive to GPs and their staff. The model would contain better facilities for clinicians, pharmacists etc. Moreover, it was hoped that the patients would not notice the changes – they would be receiving their usual GP service. He added that none of the Banbury practices had handed in their notice in the face of the impending changes;

-       A member asked if there was any prospect of, or interest from other Trusts to enter into primary care, in light of the fact that GPs had now entered into the acute care field. Dr Roblin pointed out that the lack of expertise in the primary care field was a problem and that working closely was not the same as integration into, and the running of a premises. Dr Park added that there were advantages and disadvantages to this and agreed that primary and secondary care needed to understand each other better but that it could be something for the future. Oxford Health were already working with GPs, but acute care practitioners would require a detailed knowledge of primary practice;

-       A member asked for assurances that if patients were to be dispersed, they would not be left to drift and would be transferred to another surgery. Julie Dandridge responded that the OCCG were interested to hear from patients if the patient transfer process had denied them their patient choice. Dr Roblin stated that there would be a need to check the regulations in respect to this.

The OCCG was urged by the Committee to ensure engagement with CDC before the consultation began to answer questions on locality, rents, transport, future plans for the building etc. Julie Dandridge stated that this would be part of the consultation. She also confirmed that the final options would be considered by the Primary Care Commissioning Committee at the end of March, early April. The OCCG would be happy to discuss the outcomes of the consultation if time permitted. She confirmed also that the practices would decide what they considered right for their area. Dr Park added that the OCCG would take the opinions of rural practices also in relation to what was appropriate for their areas.

The Chairman thanked all for their attendance, stating that the Committee was looking forward to seeing the draft consultation document and incorporating their comments into it, as part of the decision - making process. He asked that timing be allowed for the draft consultation document to be shared with the Committee at its next meeting at the beginning of February.