Notes from Public Meeting 19 August 2014
Arnside Medical Practice and Ash Trees Surgery Merger
6.30 pm Arnside WI
Prior discussions with staff and the Friends of Arnside Surgery suggested that the WI was the largest venue within Arnside and was therefore booked for this meeting.
The WI was set up with help from the Friends of Arnside Surgery, and by 6.35 all seats were filled and it was standing room only. A number of patients and residents were turned away, for which we apologise and a repeat meeting will be arranged for September.
Speakers: Dr Dave Kew, Arnside Surgery, Dr David Cheung, Ash Trees Surgery, Dr Gill Wickenden, Arnside Surgery, Terry Keefe, Friends of Arnside Surgery and Jo MacDonald, Practice Manager, Ash Trees Surgery.
Terry Keefe introduced the Friends of Arnside Surgery, and said they were always looking for new members and currently have the vacancy of chair to fill.
Dr David Cheung gave a brief history and current situation within General Practice:
The NHS reconfiguration in 2013 has stripped away 2 layers of “management” but bought big changes and new demands on General Practice
Current Royal College of General Practitioner figures suggest that General Practitioners see 90% of consultations with less than 12% of the NHS budget and there is an ongoing recruitment crisis in general practice as being a GP is no longer seen as a good option due to the hours worked and increased Department of Heath demands on General Practice. Some practices are currently running GP vacancies of 20% or more.
Many smaller practices are finding workloads heavier and heavier and it is difficult to keep coping with the pressure and reductions in income.
Dr Dave Kew explained the background to his approaching Ash Trees Surgery to suggest merging. The situation has not come about overnight, he was speaking to NHS England and the CCG in 2013. Dr Dave Kew explained that the government’s policies are not friendly to smaller practices, and a lot of funding is being cut. He explained that the practice has not been profitable and he had asked NHS England and the CCG about closing the practice. They suggested working with other practices, and Dr Dave Kew approached several to find a way forward. Other practices are facing similar pressures to Arnside and the response Dr Dave Kew got from Ash Trees was the most proactive and positive about the possibility. I felt we could work together from my discussions with them.
Dr Dave Kew explained his own time off with stress forced him to make some changes, bringing in new GPs, but this is not financially sustainable.
He explained he cares about his patients, and he has been working and having these discussions because he does not wish to lose the practice.
Dr David Cheung thanked Dr Dave Kew and explained that General Practice has a lot of work going on behind the surface which patients do not see but which adds pressure and workload to Doctors and their staff.
Dr David Cheung then went onto give a little information about Ash Trees Surgery which provides Primary Care Services for 14,900 patients across 4 sites, Ash Trees in Carnforth, Halton, Bolton-Le-Sands and our Silverdale branch. There are 14 GPs working across these sites, only 2 now full time, but the GPs run personalised lists. This has not been the case in many other local practices. Wherever possible, staff will book patients appointments with their own GP – Dr David Cheung has a list of 1800 patients, who he knows many very well.
Ash Trees tries not to swap patients from GP to GP and Dr Sewell who has just retired after 26 years had a patient list of 1800 and knew every patient on that list. Our usual waiting time for “routine” appointments is 3 – 5 working days and we want to embrace the patient care which Arnside currently provides.
Ash Trees deals with request to see a Doctor on the same day slightly differently. A new “telephone triage” system was introduced in December 2013, because we found that our reception staff were being put in the position where they were giving medical advice as non clinicians. The system now is that our staff place every patient who calls requesting an appointment on the same day is entered onto a patient list on the computer and a Doctor or Nurse rings them back within the hour whilst surgeries are running. They will ask some questions and will make a decision with the patient over what care is required, an appointment on the same day, a prescription, some routine tests with the nursing team or other appropriate medical advice. This has been well received by our patients and contributes to care.
Ash Trees believes in local care – which is why we run 3 branch sites and we wish to continue this strength and learn from Arnside.
We hope that the patient facing side of the practice will not see large changes. We hope that we might be able to support with things like cover for annual leave or sickness.
We have asked all the staff to stay on, so there will be the same faces.
We do hope to make the practice more efficient and sustainable as a result of the merge.
The plan is that Ash Trees will join Dr Kew on the Arnside contract on 1st September 2014, and Dr Kew will come off the contract on 1st October 2014.
We also hope that some of the different services currently run at each practice might be widened to offer to the other, for example Ash Trees offers late night opening on a Monday until 8.30 pm which might help those who work in Arnside.
We wish to give better access as time goes on and keep communications open with patients and you contribute to the development of this merged practice.
At Silverdale, we are required to go through due process and facilitate a public consultation before finalising our long term plans. We currently have the Arnside and Ash Trees premises and are paying charges on 2 properties. We would hope that we can make efficiencies bringing these together into one building but we have to fulfil the wider public consultation before we can do this.
Dr Dave Kew and Dr David Cheung then explained that it is usual when these type of contract changes happen that the sole partner will come off the contract, hence Dr Dave Kew coming off the contract.
· Question
The cultures of the practices appear different to us, we like what we have now and know all our GPs
Response
Arnside need to look at how the GP lists should work and work with us to provide a suitable model. We are not saying our model is the right one, just it is different – however sustainability of the practice is key.
Dr Gill Wickenden explained she has only been here a few months but she described her experienced at Coastal Medical Practice and the difficulties of continuity of care for patients. She advised that her view is Ash Trees have done really well to maintain personal lists.
· Question
How will I be seen by a lady GP if you run personalised lists
Nothing is rigid – patients are welcome to ask to see a specific GP for a specific reason, but our aim is to offer patients continuity of care wherever possible.
· Question
How will you protect Silverdale Pharmacy?
Explained that it is patients who need to do this by keeping using it, the change of GP should make no difference.
Patients asked about Ash Trees pharmacy, which was formerly owned by the Partners of Ash Trees Surgery, however, as GPs retire, less current Ash Trees GP Partners are directors of the Pharmacy. There are 4 GPs who are directors, out of 14 Ash Trees GPs.
· Question
Will the 2 premises remain open (Orchard Road and Silverdale)?
We cannot make any decisions on Silverdale until the public consultation is finished, but Orchard Road will remain open and offering similar appointments to patients.
· Question
What are the future benefits of merging?
We cannot discuss in details what this would be as we have to undertake a full consultation with staff under TUPE; as well as the Silverdale Public Consultation. We will endeavour to communicate as we go along some of the changes We do place a caveat on this that we cannot communicate everything as there are so many changes within the NHS that we would be sending hundreds of e-mails out to do this.
We cannot give a 5 year future, because the Government has a major input into General Practice and the goal posts are being changed continually. We can only plan for the areas which are i our control.
Dr Dave Kew described the changes in patient access to their GP over the last 15 – 20 years. He reminded people that Arnside sees far fewer ambulances for patients who have had a stroke now, and there has been a reduction in some deaths due to improved medicine and primary care. Arnside would benefit from Nurse Practitioners or dedicated Health Care Assistants, but they are not affordable to the practice in it’s current format.
· Question
If there is a financial impetus for this change, does Ash Trees have financial capacity to take this on and make a difference?
Jo MacDonald explained that Ash Trees has the capacity to work in different ways, some of which would reduce pressure and make systems more efficient – for example, incoming mail which a computer programme supports staff and GPs, whereas here all post awaits the GP – often at the end of a long day.
There are potentials to streamline services jointly – but this needs to be worked with staff as part of the planning process.
· Question
What extra services might we see?
Dr David Cheung explained that certain services requires specialised training – such as diabetes care and sexual health services, which it is easier to provide within a larger team across a high patient count.
· Question
What about the nursing team?
Dr Gill Wickenden explained that Arnside’s Senior Nurse is very highly trained and experienced at a variety of chronic diseases and practice nursing, but spends some of her time on basic tasks such as blood taking and admin which could easily be done by a Health Care Assistant. Although Lorraine does some of this, we are pushed and the practice would benefit from adding in more Health Care Assistant hours, and ensuring the nurses use their time for the more skilled chronic disease care
Dr Dave Kew explained it has been increasingly difficult to recruit nationally and locally – but that the practice in it’s current format could not afford more staff.
· Question
How will referrals to secondary care work?
There will be no change for now – all the same referral routes to the same clinicians within Morecambe Bay will remain.
Clinical Commissioning Groups information
There is an added complexity in this merge, in that the practices are in different “Clinical Commissioning Group” areas. (Cumbria and Lancashire North). This affects the commissioning of community and secondary care services – such as midwives, health visitors, podiatry and hospitals.
There has already been some dialogue between the two CCGs over this move, but no changes have been agreed in any way. This will require a lot more detailed consideration outside of both practices. However, there are already Cumbrian patients in Lancashire North and Lancashire Patients within Cumbria – so available choices for patients will remain the same.
· Question
Does Ash Trees have a physiotherapist attached to the surgery?
Yes. It is approximately a 2 week wait – one or two sessions a week. We also have a dietician and retinal eye screening at the practice. These are the services which we could not at present refer Arnside patients to due to the commissioning situation.
· Question
What will be the consultation process at Silverdale and how do we get involved?
This meeting can be seen as the start of this process, but we are looking for patient representatives for Silverdale to discuss this in more detail.
We are required to consult with the Health and Well Being Boards, Healthwatch, County Councils, other care providers and representatives of vulnerable patients. We really need help with this and would love some contacts to work with on this and help us.
· Question
We currently have access to on-line prescription and appointment booking. Will this change?
No. Ash Trees is also offering the same Patient Access system and we are committed to keeping as many things in place to improve patient access to their practice including on-line systems.
Can we book to see an Ash Trees GP on-line?
Not at the early stage of the merge. Each practice has it’s own patient database and we have to apply careful processes to data sharing. A careful project will be required as and when we might merge these together. We hope this will be possible in the future though.
· Question
Is this actually going to happen and if so, why continue when there are so many un answered questions such as CCG etc?
There have and still are conversations about sustainability. Ash Trees will continue in it’s current form, that cannot be said for Arnside. Dr Dave Kew holds the contract, and it is his decision as to how the future works for Arnside. He has asked Ash Trees to work with Arnside, and therefore the change will go ahead.
Dr Dave Kew explained he has been speaking to the Local Medical Council (LMC) and NHS England in the interest of patients. It would not be possible to remain as currently, he would have to look at getting rid of one of the recent GPs, then struggling to find locum cover for holidays, and the costs of this are prohibitive. Currently, the three GPs at Arnside cover each other for absence, but this is not sustainable and cannot continue.