Agenda item

11:30

CCG will update the Committee on key issues for the CCG and will outline current and upcoming areas of work. This includes an update on Cogges GP Practice, Witney (JHO8).

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

Cllr Brenda Churchill, speaking as a Cogges GP Surgery patient, a member of Cogges Patient Participation Group (PPG) and Mayor of Witney, stated that the closure of the surgery came as a shock and had caused the Town great concern. Whilst they were aware that the circumstances of this closure differed from the Deer Park Surgery closure, the fact remained that there were only two doctors’ surgeries remaining in Witney. These struggled to take on an extra 4,500 patients, with the additional problem of shortness of space. With the extra 7,749 additional patients, she asked how they would cope. Moreover, extra doctors would be required at a time when surgeries were struggling to recruit and in circumstances where a large number of houses were being built. She also pointed out that many of the patients at Cogges lived outside of Witney in South Leigh and in several more of the villages to the east of Witney; asking how would patients travel into Witney to see a doctor when there was no bus service serving those areas.

Cllr Churchill also pointed out that, in her view, if some of the IRP ,recommendations regarding Deer Park patients had been taken on board by the CCG then this situation would not have happened. The recommendation to not preclude opening the Surgery again had not been looked at seriously, and, in her view should have been. As a consequence, she urged the Committee not to allow another surgery to close until such time as fully workable business plans could be seen, to ensure that other practices had the capability of taking the 7,749 patients, plus the new patients. She concluded that, in her view, the CCG’s Locality Plan was not workable and Witney town now needed the OCCG et al to begin to look at what needed to be done to give the people of Witney the patient care they deserved.

Cllr Rosa Bolger, speaking to save Cogges Surgery, stated that Cogges Surgery was essential to Witney and its surrounding villages. She pointed out that this repetition of the Deer Park Surgery closure was no different to the picture emerging nationwide which, to date, had seen the closure or merger of 200 GP practices. She informed the Committee that a community workshop had been convened to ensure that all voices were heard. The community wanted the GPs to remain at Cogges. Cllr Bolger told the Committee that a positive meeting had taken place with the OCCG, who appeared to understand the importance of keeping the surgeries open in the Town. She asked that the Committee continue to scrutinise this matter and to commit to working with the OCCG to retain the surgery, as a steer towards a better solution. In addition to apply pressure to ensure that the highest bidder was intending to retain services at Cogges, to ensure it thrived, rather than be closed. She also appealed to the Committee not to allow any further closures of practices in the town, pointing out that vulnerable patients needed to be seen in their own community.

Louise Patten assured the residents of Witney that the CCG had worked with the practice before it had made the decision to give notice on its contract. She reminded the Committee that GP practices were independent businesses that contracted with the NHS. She told the Committee that the OCCG continued to learn from the Deer Park experience and was ensuring that it was covering its statutory responsibility to ensure that Cogges patients received ongoing GP services. Furthermore, the OCCG was able to demonstrate that it had talked together with the community and was working with the constituent systems to ensure that all were working together for the residents. She pointed out that the OCCG could have made the decision to disperse the list, or for a local merger, but, by going out to limited invitation to tender throughout, it had demonstrated its ultimate wish for services to continue on the Cogges site. Louise Patten explained that, by contract law when going out to limited application, local GP providers were to be asked if they wished to continue. If this proved not to be so, then the next step was to ask for wider interest. She assured the Committee that the CCG would strive to work with other PPG’s with the same open and transparent approach. She thanked the PPG for their work in communicating information out to patients, adding that there would be continuous updates provided as the process continued.

Questions from the Committee and responses received were as follows:

-       When asked if there would be a need to negotiate with the leaseholders, Louise Patten responded that the CCG could not mandate that services were provided from that specific building because it was privately owned. Talks had taken place with the leaseholders of the premises. The CCG had stipulated the weighting was high on the list when making a decision relating to a local provider.

-       In response to a view expressed by a member of the Committee, who was also a local member for Witney, that an important part of the local engagement process with the community was one of understanding the specifics of the model and how it fitted in with the legalities of the tendering process (which was a factor of tension with regard to Deer Park), Louise Patten agreed that it would be reasonable to publish a high level evaluation and then the OCCG could afterwards summarise some of the specifics relating to those from other providers. This Councillor also expressed her view that the experience with Cogges had differed greatly from that of Deer Park, with the OCCG going to greater efforts to conduct early dialogue with the community;

-       Another local member for Witney thanked the speakers for their clear and concise statements and also re-affirmed his colleague’s view in relation to the improved attitude of the CCG towards the Witney population. He asked if the West Oxfordshire District Council’s local plan had picked out any provision for new medical centres in and around Witney, to accommodate the 15k new homes being built, a third, if not more of which were in Witney and its surrounds. He asked the OCCG to be aware of this and to speak to local planners. Another member pointed out that county and district council’s timeframes were far larger than the OCCG’s and this ten year gap needed to be addressed. Louise Patten agreed that future NHS planning had not previously been done well, however, there was a growing understanding that planning could not take place unless there was also sufficient infrastructure. The OCCG had conducted two meetings with West Oxfordshire planners and was also working with other councils across Oxfordshire - and was beginning to increase its involvement. It had been agreed that there was a need for proper infrastructure governance and there needed to be an improved response in the longer term;

-       A member pointed out that one of the concerns with regard to the Deer Park closure was the unstable effect on other practices when GP’s either decided to retire early or were approaching their retirement in the longer term, asking what the OCCG was thinking about doing about workforce issues. Dr Collison agreed that there were very real pressures on the workforce both in the local area and nationally. On this basis GP practitioners had been promised 5k extra GPs, which had not yet materialised. In the meantime, it was necessary to make the best use of resources, including that of the workforce. The OCCG was trying to work out which parts of the workforce could take on the less complex cases such as administration, nursing and therapist staff. In addition, how the OCCG could show support for busy practices, who were, she pointed out, independent businesses, if practices began to creak at the seams. A member suggested that a possible difference could be made by looking at childhood vaccine data;

-       Dr Collison responded to a question about what was taking place locally in the short term to acquire more doctors, stating that workforce strategies were being developed across a few centres. In addition, a significant amount of work was being done to encourage trainees to stay in the county. She added that the high cost of living was a very real issue and there was a need to make jobs attractive to entice them to stay. She added that the GPs job was very stressful and people were retiring early with ‘burn out’. The situation at Cogges was a real - life example of where this was happening;

-       With regard to flu vaccinations, Dr Collison stated that this was going well and work was underway to decide how to work with other eligible adults and children in schools in order to provide then earlier than last year.

With regard to Oxfordshire vasectomy services, Louise Patten was asked how the OCCG could justify removing the NHS service when need for it could be demonstrated, pointing out that it went against health inequality principles and ‘breaking the cycle’ as demonstrated in the Director of Public Health’s Annual report. She responded that the current service had been provisionally flagged up as a real issue concerning staffing. When the contracts were originally set this was based on historic activity and set against the amount of money which was available. Each year providers were having to switch their priorities. Furthermore, it was not unusual for GPs to let people know of the routes that were available to them. Many CCGs had ceased funding these services. In some cases, an Independent Review Panel would make exceptions to the rule. Generally speaking, however, the OCCG would have to look at whether to fund this service. Elsewhere, people had gone to private practitioners.

The Committee AGREED to;

(a)   keep the above issues under review;

(b)   note the report as a whole; and

(c)   Thank the QCCG for the report and for their attendance.