Agenda item

On 20^th August 2020, Unity Health launched a public consultation on the proposed closure of New Chapel Surgery in Long Crendon.  Members will hear from representatives from Unity Health, the Clinical Commissioning Group and a local action group.

The consultation ends on 23^rd November 2020.

Presenters:

Ms L Munro-Faure, Managing Partner, Unity Health

Dr S Logan, Clinical Partner, Unity Health

Dr A Furlonger, Clinical Partner, Unity Health

Ms J Newman, Head of Primary Care, Clinical Commissioning Group

Ms F Cayley, Chairman of the Local Action Group

Ms F Momen, Member of the Local Action Group

Papers:

Consultation briefing issued by Unity Health on 20^th August 2020

Future of Primary Care Services in Long Crendon (Paper prepared by Unity Health)

The Chairman advised that on 20 August 2020, the Clinical Commissioning Group (CCG) Comms team had circulated an email on behalf of Unity Health (the health providers of five GP surgeries in Buckinghamshire and Oxfordshire) to key stakeholders with a consultation paper for patients on the proposed closure of New Chapel Surgery in Long Crendon.  The public consultation would finish on 23 November 2020 and there was a Primary Care Commissioning Committee meeting on 3 December 2020 where it was proposed that the potential closure would be discussed. 

The Chairman welcomed Ms L Munro-Faure, Managing Partner, Unity Health; Dr S Logan, Clinical Partner, Unity Health and Dr A Furlonger, Clinical Partner, Unity Health.

Dr Furlonger explained that Unity Health served 22,000 patients across five sites and was a training practice, training future GPs.  Unity Health had formed in Oct 2017 through the merger of Trinity Health and Wellington House practices.  Wellington House had covered Princes Risborough and Chinnor; Trinity Health had covered Long Crendon, Brill and Thame.  The Long Crendon practice served 3,490 patients of which 2,350 lived in Long Crendon and the remainder travelled from the surrounding villages.  The existing premises in Long Crendon were unfit for purpose; it was an old chapel which was inadequate in terms of space and the clinical rooms did not meet modern regulations.  Training for GPs and healthcare professionals had ceased in this site due to lack of space.  It was a dispensary practice but was on the road with no parking, drop off or safe disabled access.  There were drainage problems at the site and there was no outside space to expand further; also the age of the building did not lend itself to modification.  Other options had been explored and a number of redevelopment/new premises applications had been submitted which had not been successful in obtaining approval for the funding of a new site.  It had also been a struggle to recruit and retain GPs and other healthcare professionals as they were reluctant to work in isolation in the old building.  After a great deal of consideration, Unity Health had started the consultation process about the possible closure  Unity Health prepared a paper for the Select Committee in which it put forward 4 options. The paper made clear this was not a formal options appraisal but a presentation of the position to date.  The preferred option was option four (Register all patients with Brill surgery but continue to provide some services from another facility in Long Crendon to address some of the patient concerns identified through the consultation process and the difficulties in accessing services in rural communities).  Unity Health had held discussions with a village action group and the CCG and proposed continued provision of services from new premises which could be a collaboration in a community building using land provided to the parish council by the developer for this purpose as part of the Section 106 money.

Ms J Newman, Head of Primary Care, Clinical Commissioning Group, added that she had read the paper prepared by Unity Health and that she would support Option 4.

The Chairman welcomed Ms F Cayley, Chairman of the Local Action Group (LAG) and Ms F Momen, a member of the LAG.  Ms Cayley reported that the LAG, with support from a large number of residents in Long Crendon and the surrounding villages, had formed as a result of the consultation on the closure of the surgery.  Long Crendon had had its own health service for years and had put up with the building as there was no alternative; however, the prospect of losing it altogether had emphasised the value to the community.  The LAG was willing to look at all the options in order to keep the asset in the community.  Residents wanted the dispensing service, GP appointments, the nursing service and other healthcare services in a fit for purpose building.  Travel to Brill was difficult; Thame was easier to access via public transport; but it was unknown if it had the capacity to cope with an influx of extra people accessing services.  The LAG had received good engagement with Unity Health and the CCG and had come up with a viable option.

Ms Momen advised the LAG had sought local views on concerns and what they wanted to see as a minimum.  The LAG understood that it had to fit in with the national plan and Buckinghamshire Healthcare NHS Trust (BHT) plans.  The NHS five year plan was to move healthcare out of hospitals and be closer to home.  The LAG had looked at the Buckinghamshire Integrated Care System Operational Plan and found that emphasis was on prevention; for residents to help themselves more; local support in the community to support people for longer at home; care integrated locally to provide better support closer to home; patients being seen in the most appropriate setting; services located where they are needed which provided care in a timely manner and support for people with long-term conditions.   The LAG did not believe the aims could be fulfilled by having healthcare centres a distance away. Covid had emphasised the risk of spreading disease and residents recognised that Zoom calls would play a part but also wanted face to face access to a doctor.  There was concern that vulnerable people would slip through the net; preventative care was essential.  People needed local access to physios, nurses, counsellors and GPs and the LAG   believed there was an opportunity for a new kind of multi-purpose healthcare centre, including a meeting space and a drop-in area for ongoing preventative care, which was flexible with secure IT.   The centre would be a very valuable building for the future and the Section 106 money would provide a massive start with the funding. 

Ms Cayley outlined the next steps. The LAG had looked at the policy documents; however, a lot of the information was not directed towards rural communities, particularly the NHS Greener Plan; the Group felt this should be looked into at a higher level to see how rural areas could be best served.  Option 4 was the option they supported and would need a clear commitment from all parties to that plan.  The land had been granted by the Section 106 agreement; there was already a made up access road and utility services.  A local architect had offered his services and the parish council would provide £10,000 towards the initial fees for drawing up plans.  The issue was the time pressure as the Section 106 agreement expired in December 2021 so work on a new facility would need to commence by then.  Ms Cayley stressed the importance of commitment and working together to look at the funding options; the Group hoped the CCG would fully commit to the plan and welcomed the support of the Select Committee and local councillors. 

The Chairman advised that the Select Committee had a duty to be involved in this substantial service change.

During the discussion, Members asked the following questions:

• A member of the committee commented that the data behind the options was sparse and that he would like to see an in-depth options appraisal to enable a definitive outcome.
• The LAG were commended for their work and all parties were urged to look into funding options in greater depth as there were companies who specialised in assisting with sourcing funding. 
• Option 4 was clearly the option the local community favoured; Mr A Turner agreed to discuss the option further with the LAG.

ACTION:  Mr A Turner/Ms F Cayley/Ms F Momem to discuss Option 4

• Following a query from the Chairman on when the document had been prepared; Ms Munro-Faure stated the document had been prepared for the Select Committee and pulled together the discussions which had taken place; it was not a formal options appraisal.  The Chairman added that she had only seen a two page document which Unity Health had sent out to patients and it would have been logical to have provided an options appraisal as the first step.
• Ms Newman explained that the CCG would make a decision on the proposal.  The timescale/process was for the practice to gather the evidence, including the results from the public consultation, which the CCG would consider at its Primary Care Commissioning Committee on 3 December 2020.  However, Ms Newman stated the date was not ‘set in stone’ and maybe a different proposal should be considered.    Ms Newman added that the CCG was excited about the possibility of developing a community hub and would play their part in the General Practice element of it.  The Chairman stated that this was positive to hear but still expressed concern regarding the possibility of the proposal being discussed at the meeting in December 2020.
• There were a number of organisations/groups involved but it was not clear who was going to take it forward.  The CCG had said they were willing to work with Option 4 and provide some funding even though the population was less than 10,000 if the right proposal came up.  Members asked how the £1.4 million would be raised for a new facility.  Ms Newman provided some clarity on the funding issue and stated that the CCG did not hold capital.  The capital for health projects came from NHS England; it had not happened in the last two years, and due to the recent investment related to Covid-19, it was unlikely to have capital available in the next couple of years.   The CCG could provide the rental revenue which would come from NHS England to support the practice.  The revenue could be put into a new facility; if the revenue increased due to an increased footprint or improved facility it would change the revenue as a consequence.  A population of 10,000 was not set in stone but was part of the CCG strategy as it looked at the context of Buckinghamshire as a whole and the developments that needed prioritising; Aylesbury was a prime example as 20,000-30,000 houses were being built.  However, in terms of providing a solution for a rural community this could be a leader in a model for the future.
• In response to being asked who was responsible for producing an Equality Impact Assessment (EIA) and an options appraisal Ms Newman confirmed that the CCG and the practice would be responsible and were preparing an Equality Impact Assessment which would be presented to the Health Inequalities Group in November.   Ms Newman stated that due to the work of the LAG and the views/information received; the proposal had evolved in a positive way.  Unity Health and the CCG had changed their view of the future of the Long Crendon practice.
• A member of the committee commented that Thame Town Council had refused a planning application to extend a surgery and asked how this would impact on the planned closure of Long Crendon surgery.  If planning permission was granted, how would the Thame surgery cope with new patients during a new build in Long Crendon.  Dr Furlonger explained that Unity Health shared a site in Thame with the Rycote Practice and had been looking to redevelop as a joint venture using a developer.  There was limited space at Thame which was why they were attempting to accommodate patients at Brill and projects were being worked on being mindful that it was a five site practice.  It was acknowledged that it was a challenge to accommodate the growing population across the practice area.  There was a mix; properties were often owned by a company who leased to the practice.  Some were owned properties which were not suitable and jumping that divide from ownership to finding a developer who would build a new facility was difficult.  For smaller practices the capital cost versus the revenue costs was hard to balance and would be a challenge in terms of obtaining funding for Option 4.
• In response to whether analysis had been carried out on the patient base and their access needs and the impact of moving patients to another surgery, Ms Munro-Faure stated that Unity Health ran a triage first system.  There was a lot that could be done over the telephone, and during covid there had been a conversion rate of 20-30% of appointments being held face to face to over the telephone/video call.  Unity Health was considering Option 4 and how to provide services in Long Crendon to solve the access problem, including a dispensing service.  Dr Logan added that there was a paramedic service which could assess housebound people. The Chairman reiterated her concern over the lack and quality of information which had been provided as well as the reach of the consultation; Dr Logan commented that the consultation had been planned and carried out in consultation with the BCC communications team.  Dr Logan clarified that the only option available at the time of publicising the consultation was to close the surgery; the other options arose after Unity Health discovered that the CCG would support a community venture.
• Assurance was requested that vulnerable, elderly residents, those on low incomes, possibly without digital technology and reliant on public transport, would not be left without a surgery in Long Crendon if New Chapel surgery closed and it was not viable to develop a new facility.  Ms Newman was unable to provide a guarantee but stated that if it was proposed that New Chapel surgery closed and a new facility be built then the Primary Care Committee would have to consider the timing of the closure of the current surgery.  The Chairman advised that she had made enquiries as to whether the Section 106 deadline could be extended.  Ms Cayley commented that the surgery was still operating as a dispensing service. A member of the Select Committee emphasised that this was an opportunity to ‘think outside the box’ to accommodate the greater healthcare requirements of the rural community and provide a return on investment.  The Chairman stated that the Select Committee had been looking at the community hub pilots in Marlow and Thame and the concept of developing care closer to home.  Option 4 involved the use of digital appointments, limited face to face appointments and a dispensary; if Thame could not expand there was an opportunity for a discussion on what could be offered for the surrounding area which could make a bigger building more viable.   Dr Logan confirmed it was the direction of travel but would be based around the primary care networks (PCNs). 
• In response to a question on who owned the premises of the New Chapel Surgery and whether there was capital in the building which could be put into a new build; it was confirmed that the Unity Health partners owned the building but it was mortgaged up to the capital value.  Option 4 would help with the recruitment and retention issue since clinicians would be based in Brill with sessions held in Long Crendon.  Healthcare professionals wanted to be able to work as team.
• A Member asked whether there were other potential healthcare services which might be interested in joining together with Unity Health to provide services from a community location – for example, dentists, physiotherapists.
• Dr Furlonger explained that historically GPs would invest into a partnership; however, at the moment, GPs were not being asked to make a large capital investment in a business and it was a big challenge; all the options needed to be explored and considered.
• Ms Cayley stated that all the points raised today had been discussed by the LAG but emphasised that someone needed to take the lead and felt this should be Unity Health with support from the local action group.  Ms Cayley encouraged commitment and support from the CCG and stressed that it would be helpful to take away the threat of closure of the surgery as it was adding to the stress and difficulty in the process.  All parties needed to focus on finding a sustainable solution/ and look at all the different requirements that a community healthcare facility could provide.  Once the Covid-19 restrictions were over, Ms Cayley hoped the surgery would be able to provide the services it did before and to remain open as an interim solution until the new building was in place.  The LAG had done their best to find an alternative solution and requested that the possibility of the closure of New Chapel Surgery be removed.   The Chairman stated that the decision would be made by Unity Health.  Ms Munro-Faure advised that there was a strong steer from the CCG that they would not support a standalone GP facility; it would need to be something more innovative with community involvement.

The Chairman summarised that she and Ms Wheaton, Committee and Governance Advisor, would prepare a draft response to the consultation on behalf of the Committee which would be circulated to the committee members for comment.  The Chairman summarised the key areas of concern: 

• The consultation process and the brevity of the information that was put out in the public domain as part of the briefing consultation paper.
• The lack of data provided and the lack of options appraisals as part of the consultation
• The over-reliance on online channels to promote the consultation.  There were concerns that the majority of users of the surgery were not aware of the consultation until the LAG was set up.

• The unrealistic timeframe between the end of the consultation on 23 November and the Primary Care Commissioning Meeting on 3 December.
• More work was required by Unity Health and the CCG in exploring the other options, particularly the building of a new community facility.

The Chairman thanked everyone for their participation.