Primary Care Commissioning Committee Report. 26 September Cross Plain Surgery and Bourne Valley Practice

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1 PCCC/17/09/06f Primary Care Commissioning Committee Report 26 September 2017 Cross Plain Surgery and Bourne Valley Practice Merger Application, Boundary Change Application, and Closure of Branch Surgery Application

2 Cross Plain Surgery and Bourne Valley Practice Purpose of Paper Wiltshire CCG has received applications, as attached, for the following: 1 Merger of the following practices: Cross Plain Surgery (J83632), Bulford Road, Durrington Bourne Valley Practice (J83643), Station Road, Tidworth This merger was approved at the Primary Care Commissioning Committee held on 27 June 2017with effect from 1 October Transitional funding has been agreed continuation of the pace of change agreement for PMS premium removal applicable to Bourne Valley ( 6, per annum ). 2 Change of practice boundary Cross Plain surgery proposal to increase practice boundary to include a proportion of the area covered by Bourne Valley Practice. The remaining area is serviced by other neighbouring practices (The Castle Practice and Hampshire practices). Existing patients will not be affected. 3 Closure of branch surgery On approval of merger, Bourne Valley Practice would become a branch surgery of Cross Plain Surgery. To improve practice resilience and reduce travel implications for staff, the practice have requested closure of this site. Reduced staffing levels were implemented in May due to workforce constraints. Supporting Information Background The national shortage of GPs has been evident for some time across the UK and has only relatively recently impacted Wiltshire. With planned retirements, resignations and maternity leave, the practices were anticipating a loss of 50% of their GP workforce by October A temporary Crisis Plan was agreed following meetings with the CCG in April 2017 which included temporary closure of the Ludgershall site. There were 3 clinics per week being held at the site, including the Elderly Care Clinic (which has continued). All patients were notified of this change. The staffing issues have been addressed with successful recruitment of GPs and nurses and the decision of one partner to return to full-time NHS General Practice. Cross Plain Surgery and Bourne Valley Practice have been operational as one entity for 3 2

3 years as Salisbury Plain Health Partnership. The practices feel the time has now come to fully merge under one GMS contract. This will improve the resilience of the practice and, in conjunction with the proposed branch surgery closure, reduce the current workforce constraints. The financial impact of the change to a GMS contract for Bourne Valley Practice would be avoided by the CCG continuing to apply the PMS Premium pace of change agreement to the merged practice. LMC and NHSE advice is that this is usual practice. Permanent closure of the Ludgershall premises will allow the practice workforce to operate over a smaller geographical area and reduce travel between sites. The branch surgery is contracted for 2 clinics a week, and one elderly care clinic. There are 751 patients registered as living in Ludgershall. There are good public transport services between Ludgershall and Tidworth and in addition there is another surgery (The Castle Practice) in the town. The proposed boundary change will enable Cross Plain Surgery to include a proportion of the area covered by Bourne Valley practice. It is proposed that the new Cross Plain area should not include those villages to the north of Ludgershall or those east of Ludgershall and Thruxton. Patients in these villages will be able to access other surgeries in Ludgershall, Tidworth or Andover. There are 259 registered patients living in this area but they will not be affected and will only be removed by their choice. Aim of change Resilient services delivered over the whole practice area. Economies of scale to enable provision of specialist treatment by skilled clinicians. The merged practice boundary will incorporate the majority of the area covered by the two surgeries. The remaining area is within the boundary of other practices. Current patients will remain in the practice. Reduction in time lost to travel by clinicians. Underutilised clinical space can be made available for other purposes. Capacity within neighbouring practice to take on patients who cannot or will not travel to other sites. Consultation Salisbury Plain Health Partnership have engaged with the public in relation to closure of the Ludgershall branch surgery and practice boundary amendment in numerous ways. o All patients have been written to explaining the proposals, no responses have been received from patients in relation to this. o A random selection of 180 patients from each age group were ed the proposals and asked for their opinions. A total of 12 responses were received. The responses were mixed between no comment, supportive and concerned. The topics of concern were having to travel between surgeries, appointment waiting times, shortage of GP s and the triage system. After due consideration the practice believes this will be improved by the proposals. o Two public consultation meetings have been held on different days at different times of day; eight and nine patients attended respectively. The main patient concerns and practice responses were as follows: 3

4 Concern Closure of the surgery at a time of increasing housing development Would patient records transfer if patients move surgeries? Will remaining patients have to travel even further for appointments? Would patients be able to choose the surgery they attend Practice Response The remaining practice in Ludgershall (Castle) is aware of the issue and have been involved in the consultation process Yes and whilst this would be unfortunate to lose patients, it would be understandable Through staff training, the practice will take into account patient location when allocating appointments. The practice have also informed Wiltshire Community Transport of the changes. Yes The practice will be monitoring the length of waiting times for patients, ensuring this has no detrimental effect. Wiltshire CCG neighbouring practices have been contacted for feedback and locality meetings were arranged to discuss all three applications. Concern has been noted from one practice regarding the boundary change for patients residing in Collingbourne Kingston, The Chutes, Clanville and Weyhill, whom following the proposed change may not have a choice of GP practice as a result. Concern has also been noted for patients in the north of the area covered by Burbage surgery. West Hampshire CCG were contacted in June 2017 and their initial response was they did not support any boundary changes. They requested consultation with their practices to inform further comments. Neighbouring cross boundary practices were contacted in July 2017, however no responses were received. Next Steps It is proposed to counter-propose to the practice that their proposed boundary is increased to include Collingbourne Kingston, Upper Chute and Lower Chute as these are within the Wiltshire boundary. Executive Summary Merger The date of completion of the merger is 1 October

5 Closure of Branch Surgery Following approval, the date of closure of branch surgery is 29 September Boundary Change If the practice agree to the revised boundary, the date of change is 1 October If the practice do not agree to the counter proposal, further consultation on the proposed boundary change will be conducted with surrounding stakeholder practices. Recommendation The Committee is asked to consider the applications to: Close Ludgershall branch surgery Change the practice boundary It is recommended that the applications for the branch surgery closure and boundary change from Cross Plain Surgery are approved by PCCC subject to the change to the boundary outlined above. 5

6 Blue line current edge of Cross Plain J83632 Outer boundary Blue and Red Line - NEW Cross Plain Area to incorporate some of Bourne Valley J83643 area Area enclosed red / orange lines is currently Bourne Valley area but will not be included in the new J83632 Cross Plain area MRF June 2017