Primary Care Commissioning Committee August 2019 - Responses to Public Questions
1. Why are patients and their representatives not allowed to address this meeting given that you are spending public money?
The Primary Care Commissioning Meeting is a meeting held in public rather than a public meeting. This is the same as our Governing Body and meets the NHS England requirements for CCGs. Members of the public are able to ask questions in advance and the process is covered in Section 5 of our ‘Meeting in Public Guidance’ published on our website at this link.
Responses to questions will formally be made in writing to the questioner within 10 working days, summarised verbally at the meeting and the summary included in the meeting minutes. Paper copies of the questions raised for the Primary Care Commissioning Committee on Wednesday, 7 August, 2019 will be available at the meeting together with responses.
2. What were the reasons for rejecting the options considered alongside closure?
The preferred option was to find a new provider to continue services at Whitehall Medical Practice, however due to the lack of any interest by any potential provider this was not possible. Other potential solutions considered included:
- To extend the tender deadline
- To offer a single tender award to the incumbent provider, or alternative provider, to either take on the contract or to step in as a caretaker
- To close the practice and support patients to find a new GP Practice
After debating the risks and benefits of each option and taking into consideration past experience and the reducing timeline, regrettably it was decided that there was no alternative option but to close the Practice and support patients to find a new GP Practice.
3. Was the second option considered by the PCCC explored and discussed between January 2019 and June 2019? If not, why not?
No discussion was held during the procurement process as this could have been seen to be prejudicing the outcome of that process.
4. Why did the PCCC not consider whether the following organisations could manage the Whitehall Medical Practice?
a. Another practice by means of a merger or takeover
This is not possible because of the type of contract that was held by Whitehall Medical Practice. However, an individual practice could have bid for the contract but did not choose to do so.
b. The Shrewsbury and Telford Hospital NHS Trust - in Birmingham a Trust has taken over a practice
SaTH have shown no interest in putting forward a bid for the contract.
c. The CCG itself
The CCG is not able to hold provider contracts.
d. The Primary Care Network
Primary Care Networks were not in place until 1 July, 2019 and therefore not able to bid for the service. A federation could have bid for the contract, however no bid was forthcoming.
5. The PCCC seems to have missed a stage in the consultation process. Understandably when discussing a possible commercial tendering process, discussions were held in private. But when it was decided that there was not a commercial solution why were the discussions about future options not held in public? The CCG spends public money and their actions should at the very least be open.
PCCC was keen to secure a provider for services, however no bidder came forward and this restricted the options available. Patients were advised in the letter sent in March that should a provider not be secured, then patient dispersal was a likely option.
As stated in the question there was a live procurement in progress and the discussion could not take place in public. In order to provide patients with sufficient time to find a new Practice, it was agreed that the decision to disperse the patient list should proceed without delay.
6. The report states that 500 responses were received to the initial consultation. Why therefore, was I told on 6 December 2018 that nearer 1000 responses had been received with 250 coming back in the first week?
The numbers stated in the report are correct.
7. What support is being given to the Belvidere Practice? They made clear their opposition to the closure of the Whitehall Medical Practice stating that “Belvidere would not be able to provide safe and effective medical care in the short and long term were it to have a sudden large increase in list size above that which is already expected from local building developments.”
The CCG has offered support to all Practices that are expected to receive large numbers of patients. The immediate request from Belvidere was support around premises, which is ongoing. Discussions with the practice are ongoing to ensure that any concerns are addressed.
8. All Surgeries have not been given enough time to cope with an influx of new patients between June 2019 and September 2019 when Whitehall closes. Did the PCCC consider closing Whitehall at a later date?
Unfortunately due to the CCG already rolling the contract forward several times, procurement rules restricted any further extension. When the procurement attracted no bids and in discussion with NHS England, it was considered that three months was sufficient time for patients to register with new Practices.
All Practices in Shropshire CCG have been informed of the position and all have open lists, and are therefore able to register new patients living within their Practice boundary. Any Practice experiencing difficulties are able to contact the CCG directly to discuss concerns. To date only two practices have contacted the CCG for support around future premises development.
9. The report does not mention that there was a delay in informing patients of the decision to close Whitehall with the result that many first heard about it from local media. Why has the PCCC not been formally notified of this delay and a public apology announced?
The CCG does not hold patient data and therefore was reliant on another part of the NHS to send the letters on our behalf. Despite our efforts to ensure timings of patient and stakeholders with the press release, patient letters were received after the press statement. We apologise that the letters did not arrive in the expected time and this will be taken into account in future.
10. Why is there no acknowledgement by the PCCC of the problems that many Whitehall patients have been experiencing in registering with new practices? I have raised this issue as have others and I am sure that some of the PALS contacts will have been about this, but their report does not include enough detail. Some patients moved to Whitehall after being deregistered by their original Practice and are now faced with another move.
The paper to PCCC in August provides a summary of the 26 issues raised via our PALS team or directly with Primary Care. Of these, 11 have been about difficulties registering, all of which have been resolved to the patients’ satisfaction. Five have been expressing disappointment with the decision and the rest have been around more specific issues.
In addition to this, members of the PCCC have the questions originally asked by Cllr Vasmer together with the answers. Nine questions have been raised by the Health and Adult Social Care Overview and Scrutiny Committee and these have also been shared with Committee members.
If patients are experiencing difficulties registering with an alternative GP Practice, please telephone our PALS Team (Patient Advice Liaison Service) on telephone: 01743 277586 or email: SHRCCG.CustomerCare@nhs.net.
11. What is your contingency plan if it is not possible to transfer all Whitehall’s patients before it closes given that between June and July only 614 of nearly 4,000 had transferred? Nearly half Whitehall’s patient list may not have transferred before the practice closes.
The numbers of patients registered with an alternative practice as of 2 August is around 700 and we would encourage all patients currently registered at Whitehall Medical Practice to register with a new Practice.
The CCG will begin the process of allocating patients to another GP Practice early in September 2019 and therefore all patients registered at Whitehall will be allocated a new GP before the Practice closes.
12. Has there been any discussions with the Hospital Trust about the possible impact on A&E services if large numbers of patients are unable to register with a doctor before the end of September?
All patients registered at Whitehall will be allocated a new GP before the Practice closes and therefore we would not expect any negative impact on A&E services.
13. Why were vulnerable patients not contacted when the closure of Whitehall was announced? They should have been given support from day one and not left until now.
The CCG is working with NHS England on ensuring that the process followed is in line with guidance. The CCG has written to all patients to provide an opportunity for them to secure a new GP.
Any patient identified as 'vulnerable' who has not already secured a new GP will be contacted in the coming weeks, to ensure that they are aware of their nearest GP Practice. This process will be repeated in early September if patients have not registered at a new Practice.
14. Why has the PCCC only recently commissioned a review into the increasing demand that new housing estates will and are creating? The plans for extra housing in Shrewsbury have been known for some time so why is this only now been considered?
We are currently undertaking a full review of our Primary Care Estates Strategy, which was last updated in 2016, to map the future need of Primary Care estate through to 2041. There is also a programme of work around retention and recruitment of GPs and other clinical staff (nurses, clinical pharmacists, advanced practitioners etc.) to ensure that our workforce remains fit for the future sustainability of General Practice.
15. Has there been any discussions with the Hospital Trust about the possible impact on A&E services if large numbers of patients are unable to register with a doctor before the end of September?
See the answer to question 12 above.