Primary Care Commissioning Committee Report. 27 June Cross Plain Surgery and Bourne Valley Practice

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1 PCCC/17/06/08f and 08g Primary Care Commissioning Committee Report 27 June 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 Cross Plain Surgery holds a GMS contract and Bourne Valley Practice holds a PMS contract and, subject to consultation, the merger would take effect from 1 October Transitional funding will be required 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 Ludgershall patients were informed of the temporary closure via letters and the practice website. A further patient letter will be sent and open meetings held locally. Information on services and neighbouring practices will be widely disseminated to patients using the websites, information leaflets, text messages, letters etc., utilising the most appropriate method according to the patient demographics. Neighbouring practices have been contacted for feedback and locality meetings have been arranged. Other neighbouring cross boundary practices have been contacted. Next Steps Letter to all current Bourne Valley patients outlining next steps and process for registering with a different practice. 3

4 Open sessions in the town with information available and support with any registration questions. Ludgershall branch Surgery will continue to operate the Elderly Care Clinic until 29 th September If patients have not registered with another practice by 1 st October, they will transfer to Cross Plain Surgery as part of the merger. Executive Summary Merger The practice list sizes as of 01/04/2017 are as follows: Cross Plain Surgery 3,237 Bourne Valley Practice 2,976 Proposed merged list will be c. 6,213 Proposed date of completion of the merger is 1 October Wiltshire CCG is aware of and in agreement with the proposed merger. Closure of Branch Surgery Proposed date of closure of branch surgery is 29 September Recommendation The Committee is asked to consider the applications to: Merge the two practices Agree transitional support through continuing the PMS Premium pace of change agreement Change the practice boundary Close Ludgershall branch surgery (subject to agreement to merge) It is recommended that the applications from Cross Plain Surgery are approved, in principle, by PCCC. This approval will enable further discussions to be held with the practices concerned and patient consultation to take place. 4

5 South (South Central) Application for consideration of a contractual merger (Please add additional pages if you have insufficient room to complete fully) Practice stamp Cross Plain Surgery 84 Bulford Road Durrington Wiltshire SP4 8DH Please complete the following: 1. Details of the TWO contractual agreements you are proposing to merge Cross Plain Surgery ( GMS J83632 ) and Bourne Valley Practice ( PMS J83643 ) have been operational as one entity for 3 years as Salisbury Plain Health Partnership. The time has now come to fully merge as one GMS contract as Cross Plain Surgery (J83632) We understand from Wessex LMC that funding is available to cover the loss of the PMS premium and this will be required to facilitate this merger 2. Which of these agreements you would prefer to continue with (NHS CB final decision in this respect would be required) GMS contract Cross Plain Surgery J Indicate whether you intend to operate from three premises yes a. If yes, which premises will be considered the main and which is to be considered the branch/s (if applicable): Now :- Main Surgery in Durrington, branch surgeries in Tidworth and Shrewton 2019:- It is hoped that Durrington and Shrewton surgeries will combine into new healthcare facilities in Larkhill, and at that point Larkhill will become the main surgery b. If no, which premises do you intend to practice from: not applicable c. Of which CCG do you propose to be a member? Wiltshire CCG 4. Full details of the benefits you feel your registered patients will receive as a result of this proposed merger.

6 South (South Central) Better uses of local healthcare resources as part of a whole locality review 5. Please provide as much detail as possible as to how the current registered patients from the existing practices will access a single service, including consistent provision across: home visits; no change to current provision from SPHP booking appointments; no change to current provision from SPHP additional and enhanced services; no change to current provision from SPHP opening hours; no change to current provision from SPHP extended hours; no change to current provision from SPHP single IT and phone system; already in place premises facilities. No change in Tidworth, Shrewton or Durrington. See additional documentation re Ludgershall closure This merger is part of a series of changes planned over the next few years in order to provide sustainable, effective Primary Healthcare to this whole area. 6. Details of the proposed merged practice boundary (inner and outer): Cross Plain and Bourne Valley current areas will fully combine as they currently abut each other with some overlap. Villages in the far Eastern side of the Bourne Valley area, and the Western side of Andover will be removed. This affects few patients who will remain on the list and leave only by natural wastage. 7. How you propose to consult with your patients about this proposal, communicate actual change to patients and ensure patient choice throughout: See the communications and engagement documentation. Communications currently being planned at a wider locality level and we will be working closely with Wilts CCG communications team to ensure the right messages reach the right people. The impact of this merger change in reality for patients is minimal, as it is a natural wastage change only. To be signed by all parties to both contracts being proposed for merger Signed:. Print: Dr W M Grummitt Date: Signed:

7 Print: Dr C C Grummitt South (South Central) Date: Signed: Print: Ruth Freeman Date: Note: this application does not impose any obligation on the NHS CB to agree to this request. Map below see also larger version attached.

8 Branch Closure for Primary Medical Services Practice Name and Address Bourne Valley Practice Beacon House Station Road Tidworth SP9 7NN Please complete the following. If typing your response the cells will expand as required: Name and address of Branch Practice to be closed :- Practice Code (e.g. J54321) Bourne Valley Practice Branch closure at : High Street Ludgershall SP11 9PZ J83643 Name of person completing this form: Ruth Freeman Name of Lead GP Partner: Dr W M Grummitt Name of GP. Include vacancies (Enter in cell below) No. sessions per week. (A session lasting 4.10 hours) State if on Mat/Pat/Sick leave, sabbatical etc. State whether Partner, Salaried Employee, Locum (state replacement for whom), Registrar, Retainee, or if other please state. (Enter below) Dr W M Grummitt Dr C C Grummitt Dr E Shaw Dr P Windross Dr L Webb Dr D Woodward Dr H Bottjer Dr L Obee-Kendall ( 8 ) 4 ( 4 ) 5 2 Mat leave Partner Partner Partner (salaried from mid Sept Salaried leaving Mat leave Retainer Retainer Salaried Salaried (mat cover ) These GPs also all work at Cross Plain Surgery and these sessions are shared across both practices Total Number of Sessions 30 Practice List Size: 6400 combined Bourne Valley ( 3078 ) and Cross Plain (3322) Total Number of Sessions divided by 8 (8 sessions = Full time) = 3.75 WTE Practice List Size divided by WTE = 1706 No of Patients per GP Nurses by titles. WTE State if on State if agency, temporary Branch Closure Application 2016

9 State if vacancy (1WTE = 37.5hrs) Title of Nurse 1 Senior Practice Nurse 0.8 Treatment Room Nurse Mat/Pat/Sick leave, etc contract, replacement for which post. Total Nurse WTE = List size divided by WTE Nurse = Number of GMS consulting/treatment rooms within surgery: ( at Branch surgery - Ludgershall ) Number of consulting rooms used for non-gms purposes. State purpose: Patient List Size at date of application: Dispensing Practice - Yes/No: How long do you wish your list of patients to be closed? Minimum = 3 months and maximum = 12 months Proposed closure start date Details of all Branch Surgeries GP = 1 Nurse = 1 None See above No Patient list NOT closed, just the branch premises. To be confirmed depending on communications re other matters submitted simultaneously Bourne Valley Practice High Street Ludgershall SP11 9PZ Branch Closure Application 2016

10 Nursing/Residential Care Homes/ Residential/Sheltered/Sheltered accommodation in practice area Number of patients from the home who are registered at your practice Names of the homes Postcode Nursing care Residential care Sheltered Accommodation None Enhanced Services In this financial year the Practice provides the following Directed Enhanced Services: Avoiding Unplanned Admissions Minor Surgery Learning Disabilities Extended Hours Choice of GP Practice: In hours care No longer DES Yes Yes Yes Yes Branch Closure Application 2016

11 In this financial year the Practice provides the following Vaccinations and Immunisation Services (NHS England) All childhood vaccinations CCG Locally Commissioned Services In this financial year the Practice provides the following Locally commissioned Services All available locally commissioned services Branch Closure Application 2016

12 Public Health (Local Authority) Locally Commissioned Services In this financial year the Practice provides the following Locally Commissioned Services All available locally commissioned Please give details of any new housing developments that have an impact on your application. Local Authority planning departments and websites can provide details. Name of development Approximate location Number of houses planned Army rebasing in the area New homes in Ludgershall Unknown and number keeps changing! Approximate start date of development On going Briefly describe your main reasons for applying to close your branch hours. Closure of the small Ludgershall premises will allow the current Primary Care Workforce to operate over a smaller geographical area. Staff time is currently wasted travelling between sites. Shrewton branch surgery to Ludgershall surgery is 17 miles along busy roads with significant MoD traffic. The branch surgery is currently open for 2 clinics a week, and one elderly care clinic. There are good public transport services between Ludgershall and Tidworth The distance from this branch surgery to the main Castle Practice surgery is just 600 metres. We currently have 751 patients registered as living in Ludgershall and it is not economically viable to run a surgery building for this small number of patients, with an alternative surgery so close if they chose to re-register there. Branch Closure Application 2016

13 Describe the options you have considered, rejected or implemented? Reduced staffing levels were implemented earlier at the time of a workforce staffing crisis here and there were no complaints from patients. If any were implemented, what was your success in reducing or erasing such difficulties? Have you consulted with your registered patients about your proposed branch closure? No If so, please summarise your discussions using the attached consultation document which is part of this process. If you have not consulted with them, please complete one of the following: Consultation will be held after Communication strategy for whole proposal ( Merger / change of boundaries / closure of Ludgershall ) has been developed with the CCG comms team. Have you consulted with your PPG /No If so, please summarise your discussions If you have not consulted with them, please complete one of the following: Consultation will was held or to be held on: Consultation will be held after Communication strategy for whole proposal ( Merger / change of boundaries / closure of Ludgershall ) has been developed with the CCG comms team and other locality members Branch Closure Application 2016

14 Which are the other GP surgeries that overlap your boundary area that MAY be affected by the branch closure? Castle Practice Andover Practices Have you consulted with these contractors in your practice area about the proposed branch closure? Yes If so, please summarise your discussions Initially they were supportive, now they do not wish to help. Further locality meeting with CCG and LMC and all locality on 20 th June 2017 for further discussions If you have not consulted with them, please complete one of the following Consultation will begin on: Consultation is not required because: Have you discussed your proposed request with NHS England/ CCG and what have you put in place since these discussions Yes with Jo Cullen and Tracey Strachan, and with LMC Carole Cusack and Dr Gareth Bryant. Branch Closure Application 2016

15 What reasonable support do you consider NHS England would be able to offer, Open, honest and timely communications with all parties involved. Agreement and involvement in overall plan for Primary Care Workforce sustainability and provision in this local area in the face of Primary Care recruitment crisis and MoD rebasing in this area Continued efforts with MoD to secure the new combined MoD / NHS Primary care facility at Larkhill for the Durrington and Shrewton surgeries ( Cross Plain ) to move into by 2019 ( when troops and families return ) as current facilities are too small and time expired. What reasonable support do you consider the CCG would be able to offer, Open, honest and timely communications with all parties involved. Agreement and involvement in overall plan for Primary Care Workforce sustainability and provision in this local area in the face of Primary Care recruitment crisis and MoD rebasing in this area Continued efforts with MoD to secure the new combined MoD / NHS Primary care facility at Larkhill for the Durrington and Shrewton surgeries ( Cross Plain ) to move into by 2019 ( when troops and families return ) as current facilities are too small and time expired. Branch Closure Application 2016

16 Do you have any other information to bring to the attention of NHS England or CCG about this application? Please note that this application does not impose any obligation on NHS England to agree to this request. Details of branch proposed for closure: High Street Ludgershall SP11 9PZ Branch Closure Application 2016

17 Do you have premises approval to dispense from the branch surgery? NO Do you have premises approval to dispense from the branch surgery? NO If yes, how many patients do you currently dispense to? Do you have premises approval to dispense from any other premises? Yes Cross Plain Durrington and Shrewton a. If no, do you intend to give three months notice of ceasing to dispense as required by NHS Pharmaceutical Services Regulations 2012 schedule 6 para 10 as amended? Recruitment: Please provide as much detail as possible about how this proposed closure will impact on your current registered patients, including: access to the main surgery site i.e. public transport, ease of access; - Bus runs regularly several times an hour between Ludgershall and Tidworth. There is also a good local LINK scheme. Disabled access easier at Tidworth. capacity at main surgery site; plenty not all rooms constantly used at moment booking appointments; managed centrally already by phone and by and on line booking additional and enhanced services; none running at branch surgery currently opening hours; main surgery open all hours contracted extended hours; not at branch surgery now dispensing services (if applicable). Not capacity at main surgery site; see comments above Branch Closure Application 2016

18 booking appointments; additional and enhanced services; opening hours; extended hours: dispensing services (if applicable). From which date do you wish the closure to take effect? TBC but latest Oct 2017 when contracts are planned to merge, ( PMS premium funding agreed ) boundaries change. Note: Where an application to close premises is granted by NHS England, the contractor shall remain fully responsible for cessation or assignment of the lease for any rented premises and any disposal of owner-occupied premises. In both cases, payments under the premises directions will cease from the day of closure. Please note that this application does not concert any obligation on NHS England to agree to this request. To be signed by all parties to the contract Signed: Print: DR W M Grummitt Date: Signed: Branch Closure Application 2016

19 Print: Dr C C Grummitt Date: Signed Print Ruth Freeman Date Branch Closure Application 2016

20 Practice Application Form: Change of Practice Boundary Please complete the following. If typing your response the cells will expand as required: Name and address of Practice: Practice Code (e.g. J54321) J83632 Cross Plain Surgery Date of application Bulford Road Durrington Name of person completing Wiltshire this form: Name of Lead GP Partner: Dr W M Grummitt Ruth Freeman 1. Practice rationale for requesting a change of boundary : It is proposed, and also applied for elsewhere, that Cross Plain Surgery will merge with Bourne Valley Practice, and the new Cross Plain area should not include those villages to the North of Ludgershall or those East of Ludgershall and Thruxton see attached map. The patients in these villages will be more easily able to access Primary Care closer to home in other surgeries than at Cross Plain in Tidworth, Durrington or Shrewton. 2. Description of area you wish to remove. Include a clear map showing the present boundary and revised boundary. Boundaries should typically follow roads, railway lines or other clearly delineated boundaries and should clearly show which properties are in and out of the area. Boundaries that go through any properties will be rejected as unclear. If the change is postcode-based please state the postcodes and map their boundaries. Map attached 3. Patient List Size at date of application: Cross Plain 3302 Bourne Valley Number of patients living in the area being removed. 259 but these will only be removed by natural wastage 5. Are you a dispensing practice : Please note if you are a dispensing practice if the boundary application is approved your dispensing area does not increase or decrease a separate application will need to be made to amend this area under the Pharmaceutical Regulations. Further information can be given on request. 6. Names and post codes of your surgeries Cross Plain Durrington SP4 8DH (MAIN surgery ) Cross Plain Shrewton SP3 4DB Cross Plain Tidworth (was Bourne Valley ) SP9 7NN Yes Further information requested please so as to amend the dispensing area List Closure Application 2016 Page 1 of 5

21 7. Please list all the care or nursing homes that are in the area to be removed, and give the numbers of patients from those homes who are on your list, in each category. These should be part of the figure given in 4 above Number of patients from the home who are registered at your practice Names of the homes Postcode Nursing care None Residential care Sheltered Accommodation 8. Please give details of any new housing developments that have an impact on your application. Local Authority planning departments and websites can provide details. Name of development Approximate location Number of dwellings planned Approximate start date of development Army rebasing in this area, ie Larkhill, Bulford and Tidworth will all be within the new Cross Plain catchment 9. If approved, what will the impact be to existing patients on the practice list living in the removed area?: Existing patients on practice list in this area will not be affected, this boundary change will only apply to patients moving into this area who will not be able to register with the surgery. List Closure Application 2016 Page 2 of 5

22 10. If approved, how will the change be communicated to patients? This will only need to be communicated to new patients, so clear maps on the website will help inform new patients of our practice boundaries. 11. Have you consulted with your registered patients about your wish to change your practice area? No If so, please summarise your discussions including whether registered patients thought your practice area should or should not change If you have not consulted with them, please complete one of the following: Consultation will begin on: Consultation is not required because: it does not affect our current registered patients 12. Have you consulted with your PPG No If so, please summarise your discussions including whether the PPG thought your practice area should or should not change If you have not consulted with them, please complete one of the following Consultation will begin on: Consultation is not required because: it does not affect our current patients List Closure Application 2016 Page 3 of 5

23 13. Which are the other GP surgeries that overlap your boundary area that will be affected by your proposed boundary change? This is a rural area with a small, relatively stable population. As new patients move into the area the following practices will be registering them instead of Cross Plain Surgery, numbers are expected to be small. Castle Practice Ludgershall Andover Practices Pewsey / Marlborough Surgeries 14. Have you consulted with those GP contractors that overlap your practice area about your wish to change your practice area? No If so, please summarise your discussions including whether those GP contractors thought your practice area should or should not change. If you have not consulted with them, please complete one of the following Consultation will begin on: June 20 th at locality meeting with LMC and Wiltshire CCG Consultation is not required because: 15. Do you have any other information to bring to the attention of NHS England or your CCG about this application? This application must be viewed at same time as :- 1. Application to merge Cross Plain Surgery and Bourne Valley Practice 2. Application to close Bourne Valley Practice branch surgery in Ludgershall List Closure Application 2016 Page 4 of 5

24 Your application will be considered by the Primary Care Commissioning Committee. Please note that this application does not impose any obligation on the CCG to agree to this request. To be signed by all parties to the contract (where this is reasonably achievable): Signed:.. Print: Dr W M Grummitt.. Date: Signed:.. Print: Dr C C Grummitt.. Date: Signed:.. Print: Ruth Freeman Date Return this form to the Primary Care Team at your local NHS England office Please note that this document will be shared unedited as part of the consultation process undertaken by NHS England with other interested parties. By submitting this application you are allowing this to be shared as part of the consultation process. List Closure Application 2016 Page 5 of 5

25 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