2. This also applies to nurses visiting her for the annual flu vaccination?

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1 Questions to PCCC Date of Committee: 16 th February 2018 All questions to be received by: 12 th February 2018 Date: 9 February 2018 Name: Anon 1. My mother is 96 years old and housebound requiring the occasional GP home visit. Will these continue with the new Health Centre? If so, how can this be booked? 2. This also applies to nurses visiting her for the annual flu vaccination? 3. Prescribed medication from the surgery is sent to Oldswinford pharmacy where it is then delivered on a monthly basis to my mother. What arrangements will be in place with the Lion Health centre? 4. Can you confirm if phlebotomy services are provided at the Lion Health Centre? 5. How will my mother s medical notes be successfully and securely transferred to the new practice? 6. Is there an emergency out of hours service, if so please forward the details. 7. Please confirm the date and contact details of the new medical centre. 1. Yes, this will. All patients for which a home-visit is appropriate will be seen at home. This will include those patients with long-term conditions that otherwise may struggle attending an annual-review at the surgery. Call Option 1, before 11am. You will be required to briefly explain the problem to the on-call receptionist, and may get a call-back from a GP in advance of the visit. 2. Correct. Lion Health will contact eligible patients to arrange a visit for your flu vaccination during flu season, but you can also contact us to book as suits (once we have vaccine in stock usually around mid-september). 3. You will need to advise Lion Health and Oldswinford Pharmacy that you wish prescriptions to be send to your nominated pharmacy. The process will remain the same.

2 4. Yes they are. Currently Monday (9-1), Wednesday (2-4) and Thursday (9-1). No under 10-year-olds in these clinics. 5. The two clinical systems will seamlessly merge enabling staff at Lion Health access to the patient records for Norton Medical patients. Paper records will be transported securely. 6. The Out of Hours service for all Dudley practices is commissioned by Dudley CCG. There will be no change to this service you just call Lion Health, 2 Lowndes Road, Stourbridge, West Midlands, DY8 3SS. Appointments General Enquiries Fax Date: 8 February 2018 Name: Stuart J Walters 1. Will the transfer of existing patients from Norton Medical Practice to Lion Health, (up to 5,700?) be carried out en bloc, or by individual application? 2. Will more doctors be recruited at Lion Health, to replace Doctors, Brindley and Watkins when they retire? 3. Is there an upper limit of how many patients a doctor can accept on his or her registration list? 1. Patients will be transferred en bloc there is no application required by the patient, all medical records will be automatically transferred 2. In anticipation of the retirement of Dr Brindley and Dr Watkins, Lion Health has already managed to recruit 2 new salaried GPs and in the process of appointing an additional GP to expand the team. Lion have also been impressed by the standard of the nonmedical workforce and plan to expand the nurse practitioner team in order to support the GPs

3 3. No upper limit however practices need to be satisfied to be able to meet the reasonable needs of their patients. There is no longer a suggested doctor/patient ratio due to the change in skill mix found in general practice where it is becoming more and more common for practices to employ nurses, pharmacists, physicians associates etc to carry out functions that would have previously been undertaken by a GP. Date: 3 February 2018 Name: Brian Millward 1. Bearing in mind the proposed merger will increase the Lion Centre practice by some 20%, what guarantee will there be that a patient will be seen when they need an appointment on the same day. 2. As all the staff will be reallocated at the Lion Centre, and the fact that a great number of elderly patients will find it difficult to get there, why could there not be a side way switch and run the Whittington Road practice alongside the Lion Centre by purchasing Whittington Road. 1. Lion Health operates an appointment system that encourages advance booking and appointments are available at least 4 weeks ahead. They have a selection of acute appointments available each day for patients that need to be seen quickly and once those are exhausted they hold a daily open access clinic where patients who are prepared to turn up and wait will be attended to. In addition they offer emergency appointments and telephone consultations 2. The CCG is a Commissioning Organisation and legally are prevented from owning assets such as premises. Lion Health would not consider buying the building to run as a branch surgery. Across the Country more and more surgeries are coming together to provide resilience and maintain primary medical services.

4 Date: 9 February 2018 Name: Yvonne Marshall May you please advise patients how our voice is heard in a NHS that places us at the very bottom of a hierarchical system. The patients are the ones who fund all the groups set up with the expressed priority to deliver a good service to all of us. The philosophy of the CCG and its partners in local healthcare is absolutely about putting the patient at the centre of what we do and that s why so much effort is going into achieving this. Specifically about this proposal, the public consultation is about giving a wide group of people a voice and is the mechanism for having the public voice heard. Date: 11 February 2018 Name: Mrs Bills 1. Would the merger mean there would be no GP at all in the district of Norton? 2. Would there be any transport for patients to go to the Practice in Lowndes Road from Norton? 1. That is correct. Lion Health is the nearest GP Surgery and also the branch surgery of 3 Villages in Wollaston which are both only 1 mile from Norton MP. 2. There are currently no direct buses. X96 leaves from Stourbridge bus station to Mamble Road off Enville Street 276 leaves from Norton to Stourbridge Ring Road It is our understanding that there was previously a direct route, the 294/295, however the service was stopped due to lack of use Commitment was made to relay concerns raised about public transport links to see if the transport agenda can be influenced. One of the patients suggest volunteer drivers and names and addresses of those who may be able to help the community were taken at the end of the meeting and the CCG will be getting together with these folk to explore any suggestions and alternatives.

5 Date: 10 February 2018 Name: Derek Perks 1. Would we have to wait until the day we ring up to make an appointment for that day as we have to do at Norton? 2. When a doctor says he wants to see us in, say, 2 weeks would we be able to make the necessary appointment when we leave the original appointment? 3. What are the arrangements for urgent appointments? 4. When Drs Watkins and Brindley retire will Lion Health attempt to replace them or will the patient/doctor ratio deteriorate further? 1. Lion Health operates an appointment system that encourages advance booking and appointments are available at least 4 weeks ahead. They have a selection of acute appointments available each day for patients that need to be seen quickly and once those are exhausted they hold a daily open access clinic where patients who are prepared to turn up and wait will be attended to. In addition they offer emergency appointments and telephone consultations. 2. As above. 3. As above. 4. Dr Watkins and Dr Brindley will be working fewer days per week following the merger. They will continue working to ensure the process happens smoothly for patients and staff. No date has been set for complete retirement. In anticipation of the retirement, Lion Health has already managed to recruit 2 new salaried GPs and are in the process of appointing an additional GP to expand the team. Lion have also been impressed by the standard of the non-medical workforce and plan to expand the nurse practitioner team in order to support the GPs. Via 19 February 2018.

6 Date: 30 January 2018 Name: Mrs Stevens We would like to know how is lion health going to cope with an extra 6000 patients, from Norton medical, as they already struggle to see a doctor at times, also still find it very hard to believe that no doctors can be found to run Norton medical practice, so that the elderly and patients unable to travel can carry on at their local practice, as lion health is not convenient for the bus route, even if bus stops at top near main road it is a long walk down Lowdnes Road to Lion Health. 1. Lion Health coping with extra patients In anticipation of the retirement of Dr Brindley and Dr Watkins, Lion Health has already managed to recruit 2 new salaried GPs and is in the process of appointing an additional GP to expand the team. Lion have also been impressed by the standard of the non-medical workforce and plan to expand the nurse practitioner team in order to support the GPs. The practice is also exploring the possibilities of introducing a new improved telephone system. 2. Hard to believe difficult to find doctors to run Norton Norton Medical Practice have been unable to recruit new doctors to continue with the Contract and take over the premises and the CCG, legally are not allowed to own buildings. Dr Brindley and Dr Watkins have been trying to recruit for some time now and even delayed their retirement plans to try and find suitable GP s. It is easier for a practice to attract a salaried GP; most young GP s just don t want to buy premises so a partnership is often not very attractive and as such reduces the number of potential candidates. Countrywide practices are joining together to provide resilience for a sustainable services for patients. This will be ever increasing given MCP aims of keeping patients out of hospital and treating in the community. 3. Public transport The CCG, Local Councillor and Lion Health made a commitment to relay concerns raised about public transport links to see if the transport agenda can be influenced. Via 19 February 2018.

7 Date: 7 February 2018 Name: Kaye Radford 1. Is it usual practice for GPs to own the building they deliver their NHS practice from? 2. Is the lack of applicants willing to take over the practice due to them having to buy the premises? 3. How much money will the closure of this service save? Is it a cost cutting exercise? 4. Is there a plan to increase the number of GPs at Lion health centre to cope with the additional six thousand patients from the Norton practice after the retirement of Dr Brindley and Dr Watkins? If not how will the present GPs cope with the additional workload? 5. Is there a planned date for the retirement of The Norton GPs? We were told they will go "when their patients are happy". This could be a long time and how will this be determined? There must be a planned date. 6. Is it possible for the NHS to buy the Norton premises to enable this surgery to remain open with either new GPs or at the very least as a satellite to Lion? 7. Is the future plan for GP practices in Dudley to be large practices such as Lion and Three Villages? If so is this the end of small practices such as Norton? 8. What is being actively done to address the poor public transport access to Lion H.C other than asking prospective patients to contact their councillor as suggested at the drop in session. 9. What has the consultation process consisted of? Two drop in sessions and a letter to all patients? What efforts have been made to consult with "hard to reach patients" and those of working age? 10. What are the options the CCG will consider in January 2018? Option 1 Merge Norton and Lion Option 2 Close Norton on the retirement of the GPs and leave patients to find alternative GPs with no transfer of records and staff? Any other options? 11. Comments: Is this a merger or a take-over of Norton by Lion? It seems a done deal whatever the response from consultation. 12. One specific question I would like to ask from my previous list is how can Lion take over six thousand new patients from Norton without any additional GPs or resources? 13. I would appreciate if you could send me details of the final decision and the minutes of the meeting if this is possible.

8 1. In Dudley 54% of practices own their own premises, the remainder are rented. Those that are owned have generally been so for many years. It is unusual now for doctors to take a mortgage against property. 2. It may have been in part. The premises of modern day general practice, requires high standards to be met. The premises in Whittington Road would have required significant investment going forward. 3. It s not a cost cutting exercise. The closure of Norton Medical Practice will result in Rent and Business/Water rates ceasing to be payable by the CCG, reducing costs to the healthcare system by 31, Yes 2 already recruited and another 1 in the process. Lion are also increasing their non-medical staff 5. There is no planned date but both doctors made it clear to patients at the meeting that they had already delayed their retirement plans 6. No Legally the CCG is unable to own premises 7. Larger practices do fit with the National Strategy for delivering Primary Care at scale which the CCG supports but does not enforce. 8. We recognise the concerns raised by some patients in relation to public transport access to Lion Health. Patients are able to use the Ring and Ride service for GP appointments, although we understand that a wait for transport may be involved. In addition, we have said we will work with Healthwatch Dudley to explore the possibility of developing, with the community, a community transport scheme. Some patients from Norton have already asked to be involved in further discussions if you feel that you would be interested in this, please let us know as we are looking to arrange a meeting soon. Mr Steve Wellings has also written to the transport provider to highlight the public concern in this matter. 9. As part of the consultation, a letter was sent to every household for Norton patients by Dr Brindley and Dr Watkins to advise of the proposed merger and ways to get involved. Drop in sessions were held at Norton Medical Practice and Lion Health and over 100 patients attended. For patients who did not wish to attend a drop in, they could either ring the practice or to either ask questions or leave feedback (although I note your next statement advises you received no response to the you sent to the practice). With reference to your comment on hard to reach, we aim to build on the strong relationships we have with partners and local community groups and are always happy for suggestions/invites to meet with people. The practice would be aware of who their patients are and for any consultation we work with the practice to identify groups or patients that need a tailored approach. 10. There are no other options.

9 11. The 2 GMS Contracts will be merged - Dr Brindley & Dr Watkins will be in partnership. 12. In anticipation of the retirement of Dr Brindley and Dr Watkins, Lion Health has already managed to recruit 2 new salaried GPs and are in the process of appointing an additional GP to expand the team. Lion have also been impressed by the standard of the non-medical workforce and plan to expand the nurse practitioner team in order to support the GPs. 13. As above. Date: 8 February 2018 Name: Robert Haywood 1. I don't know how information about this apparently-comprehensive 'consultation process' was publicised. I realise it would have been a mammoth task - and ruinously expensive - to send letters to all 31,000 patients (25,000 at Lion Health and 6,000 at Norton Medical Practice), but I wonder why modern technology (texts and s) was not employed? 2. Purely as a lay person, there seems to be precious little point in having public consultation and participation on important issues if (as I assume) the conduit is curled-up posters in medical practice waiting rooms and adverts in little-read local newspapers. I commend the 21st century to you in future. 3. Will current patients of Dr Brindley and Dr Watkins be able to continue to be treated by them at Lion Health? 4. How many sessions per week will Drs Brindley and Watkins carry out at Lion Health immediately after the merger? 5. Will this number subsequently taper off? If so, by what amount - and when? 6. When is it envisaged that Drs Brindley and Watkins will retire completely? For instance, will it be before the end of 2018? 7. At that point - whenever it arriveves - will Lion Health take on 2 replacement GPs? 8. What practical steps - not simply aspirations - are Lion Health/ Dudley CCG taking the cope with the impact of having to cope with up to 6,000 extra patients from Norton Medical Practice? 9. Specifically, what improvements will be made to the telephone appointment-booking system at Lion Health which, from posts on its own website and on NHS Choices, seems overwhelmed by the existing volume of patients, soon to be significantly increased?

10 10. Will Lion Health be replicating the Norton Medical Practice system of making appointments, or simply forge ahead with its own (clearly flawed) arrangements? I ask because Norton Medical Practice seems unusual - if not unique - these days in allowing patients to make appointments by telephone on the day, rather than days (or even weeks) ahead as with some GP practices. The system seems to work extremely efficiently. By contrast, it appears that Lion Health operates an on-the-day appointment system only for patients (presumably including the very ill) who turn up at the surgery and wait for an appointment which seems very antiquated and even demeaning. There is, of course, the added problem of patients who are suffering from infectious or contagious illnesses being in close proximity to others, for long periods of time. 11. Typically, how long does a Lion Health patient have to wait for an appointment at the moment, whether booking by telephone or on-line? 12. Is it expected that this time frame will be roughly the same, longer or shorter after the merger? 13. Can Dudley CCG give a categorical assurance that patients of Norton Medical Practice who transfer to Lion Health will be provided with a service at least as good, or even better, than they experience now? 1. Letters were sent to household for all Norton Patients - you should have received a letter. The letters were sent out by NHS England and the national database is used as the source. We will ask the practice to check your registration on the database to ensure your details are correct. 2. Some modern technology was used including websites, twitter and facebook. You make a very valid point and the CCG will make sure the use of text messages/ s are promoted for use by any practice undertaking a patient consultation in the future. 3. Yes until they retire, however they will both be working a reduced number of sessions days per week. 5. This will depend upon retirement plans at this moment in time no concrete decision has been made. 6. As above new GPs have already been recruited.

11 8. In anticipation of the retirement of Dr Brindley and Dr Watkins, Lion Health has already managed to recruit 2 new salaried GPs and are in the process of appointing an additional GP to expand the team. Lion have also been impressed by the standard of the non-medical workforce and plan to expand the nurse practitioner team in order to support the GPs. 9. Lion are exploring the introduction of a new improved telephone system. There are also positive comments on the website including relating to appointments. Lion Health operates an appointment system that encourages advance booking and appointments are available at least 4 weeks ahead. They have a selection of acute appointments available each day for patients that need to be seen quickly and once those are exhausted they hold a daily open access clinic where patients who are prepared to turn up and wait will be attended to. In addition they offer emergency appointments and telephone consultations and are will be exploring on line consultations in the future. 10. Appointment system as above. 11. Appointment system as above. 12. Appointment system as above. 13. Lion Health will be subject to the same scrutiny either by CQC or CCG outcomes and contract monitoring. The change to partnership will also trigger a CQC Inspection. Lion Health offers a state of the art medical facility and will offer more onsite services than are currently available at Norton. Some patients who have chosen to re-register at Lion provided positive comments at the meeting held in public. Date: 16 February 2018 How received: At PCCC meeting Name: Ms Teag Question related to continuity of care. Would a patient who has a number of health issues be seen by the same Dr who will know their history etc. Response provided by Lion Health provided assurance that Long term conditions are dealt with in a clinic setting staffed by the same members of staff each week. Acute sudden problems may be dealt with by a different GP so that any concern is consulted on as appropriate. Via on 20 February 2018.

12 Date: 16 February 2018 How received: At PCCC meeting Name: Chris Hare Although patient records are going to be transferred seamlessly, would this be the case for GP patient online? Response provided by Patients will need to re-register for online access. Information relating to re-registering will be included in the letter that will be sent to patients by Dr Brindley. Via on 20 February Date: 16 February 2018 How received: At PCCC meeting Name: Cllr Helen Rogers 1. Would there be a sufficient turning circle for public transport e.g. ring and ride? 2. Why don t the CCG buy the premises at Whittington Road to ensure patients with mobility issues can get to there? Response provided by 1. There is a turning circle at Lion Health however buses would not be able to enter the car park as the foundations of the premises will not take the weight of the turning vehicle. There may be possibility of using the end of the cul-de-sac for turning however there are known issues with reversing buses without an attendant. 2. The CCG is a commissioning organisation and are legally unable to buy premises. Via on 20 February 2018.

13 Date: 16 February 2018 How received: At PCCC meeting Name: Simon Phipps on behalf of Margot James MP 1. There are currently no direct public transport links between Norton and Lion Health and buses can only reach Enville Street, which is approximately 320 metres from the surgery itself. Elderly patients or those with mobility problems may find this unworkable. What measures will the CCG take to ensure that all patients currently at Norton Medical Practice will be able to access a GP surgery? 2. Further to question one, should there be a way of getting to the practice that the CCG can offer, who would be eligible for this service? 3. Should the merger proceed, what information will be provided to patients of Norton Medical Centre prior to the merger with Lion Health? For instance, will an information pack be provided to all patients detailing relevant information about Lion Health, including information about making appointments, transport and home visits? 4. If such an information pack is provided, will there be information on other nearby practices that are easily accessible by bus and how patients may request to transfer? 1. There are currently no direct buses. X96 leaves from Stourbridge bus station to Mamble Road off Enville Street 276 leaves from Norton to Stourbridge Ring Road It is our understanding that there was previously a direct route, the 294/295, however the service was stopped due to lack of use Commitment was made to relay concerns raised about public transport links to see if the transport agenda can be influenced. One of the patients suggest volunteer drivers and names and addresses of those who may be able to help the community were taken at the end of the meeting and the CCG will be getting together with these folk to explore any suggestions and alternatives. 2. The CCG cannot offer transport service but will explore with community volunteers, the idea referred to above for a volunteer transport scheme Lion Health have developed a comprehensive leaflet available in the public and online here A letter will be sent to all Norton registered patients, with a summary information sheet to include the key contact numbers. 5. Details of the number to call, the website to look at for other practices will be included in the letter. Anyone wishing to move will be supported by NHS England to do so. Via on 20 February 2018.