Maypole Surgery: Retirement of contractor and closure of practice August 2016 1
Maypole Surgery: Retirement of Contractor and Closure of Practice Name of CCG: Name of Commissioner: Author Date: Executive summary 08J - Kingston Kingston CCG William Cunningham-Davis 26 August 2016 The provider of Maypole Surgery in Surbiton, Dr Stuart Mackie, has served Kingston Clinical Commissioning Group (CCG) and NHS England with three months notice to terminate his contract and retire from providing primary medical services as of 31 st October 2016. As a level three commissioner, Kingston CCG, together with NHS England as contract holder, is therefore required to explore alternative GP provision for the patients registered at Maypole Surgery. Due to the urgent nature of the notice period and the small list size of registered patients, NHS England and Kingston CCG have been required to take urgent action to ensure continuity of care and patient access to primary medical services from 1 st November 2016. On consideration of these circumstances, Kingston CCG and NHS England have initiated an urgent and reactive patient list dispersal procedure. Patients have been written to advising that their practice will close permanently from the 1 st November and that they should seek a new local GP as soon as possible. Patients are being assisted to register with a new GP and have been provided with information to aid them in making this selection. NHS England and Kingston CCG have committed to helping patients choose the best practice for their care. All key stakeholders have been engaged to explain the urgent nature and impact of contract termination. In addition, the 10 practices located within a 1.5 miles of Maypole Surgery (see Appendix 1 and 2) have been consulted and it has been established that there is sufficient capacity in the local system to register patients from Maypole Surgery. However, Kingston CCG recognise however that the closure of Maypole in addition to Gray s and Gosbury may put some short term pressure on Kingston practices and has commissioned an interim team of GP, nurse, and admin support to provide additional capacity in the immediate months to ensure continuity of care for Kingston patients. 2
This paper explains rationale as to why an urgent decision to disperse the patient list has been initiated, and requests the Primary Care Commissioning Committee s formal endorsement of the action taken, noting that this closure and recommended actions has been discussed and recommended by the Primary Care Quality & Development Group. Background Information Maypole Surgery provides primary medical services to registered patients under a General Medical Services (GMS) contract held between NHS England and Dr Stuart Mackie. Maypole Surgery s contract commenced on 1 st April 2004. There is no end date specified, as GMS contracts are held in perpetuity, but there is a three month termination notice, which has been duly fulfilled by Dr Mackie. The current registered list size at Maypole Surgery at 1 st July 2016 is 1,453 patients. A list of this size is considered to be very small and is well below the number considered for dispersal by NHS England (6,000 patients). The registered list size at Maypole Surgery has decreased over the duration of the contract. The scale of growth potential at the practice is minimal and is predicted to be insufficient for the practice to be independently viable for any future provider. The consistently decreasing small registered list indicates that patients in the area are choosing to receive primary care services from other GP practices in the area and Surbiton is an area with a dense concentration of GP surgeries, a number of which have sustainable registered lists over 8,000 patients. NHS England and Kingston CCG have worked together to engage with the key stakeholders, including Healthwatch and the Local Medical Council, as well as the local MP and Councillors to provide assurances in regard to continuity of care for the patients registered at Maypole Surgery. Kingston CCG has responded to potential local practice capacity issues by working with GP Chambers and putting in place an interim team of GP support, nurse and admin support. This interim support will be available to practices that are seeing significant numbers of new registrations until the end of November 2016. Normally, NHS England and Kingston CCG would undertake a full patient consultation exercise to seek views on the type of service patients wish to access after the closure of the practice. Options would normally include dispersal or procurement of a new provider. However a consultation 3
exercise of this type takes a number of months. Due to the urgent and reactive action required as a result of contract termination, it was not considered appropriate to carry out a full patient consultation into the options available post closure of Maypole Surgery. In order to engage with patients regarding the changes, representatives from NHS England and Kingston CCG held two drop-in engagement sessions at the practice on the 17 th August 2016. Patients were invited to attend in person to discuss the implications of the closure, and how they can register with a new provider. A total of seven patients attended both drop-in sessions. Feedback from patients indicated understanding that Dr Mackie was retiring and that registration with a new GP would be necessary. A small number of patients requested detailed bespoke advice and information relating to a preferred shortlist of practice they wished to register with, which NHS England facilitated and is continuing to support with the registration process. Patient that were not able to attend the two drop-in sessions in person, but still wished to have their views considered, were provided ways in which to contact NHS England (by post, email and telephone). This enabled patients with alternative way in which to engage with the NHS England Primary Care Team. Kingston CCG s Primary Care Quality and Development Group (PCQDG) discussed the urgent nature of this termination, and the required next steps to ensure continuity of care and patient access to services, on 21 st July 2016. This paper was subsequently reviewed and discussed at the PCQDG on 17 th August 2016, where the group was asked to formally note and support the urgent decision to disperse the patient list. This group therefore recommends the Primary Care Commissioning Committee formally endorses the action taken. Options There are usually a number of options available to primary care commissioners when practices close including procuring another provider or dispersing the list to other practices. Normal practice would be that the commissioners consider all options available, conduct patient/public engagement on the options and then recommend an option. However, due to the urgent and reactive action required as a result of Dr Mackie serving three month notice to terminate his contract and retire, Kingston CCG and NHS England urgently initiated the only viable, and most appropriate, option to ensure continuity of care and secure patient access to GP services. 4
The most viable option available to commissioners was dispersal of the patient list to surrounding practices. This is the process where patients registered at the practice are written to, advising them of the closure and are provided with information to allow them to choose the most suitable new practice to register with. The other option that could be considered would be procurement of a new provider. In the case of Maypole surgery, with a small registered list and the lack of list growth in recent years, the procurement option is not considered to provide continuity of care for patients nor represent best value for public money. NHS England s previous procurement experience has shown that patient lists of fewer than 6,000 patients generally do not attract market interest, and procurements of such services generally result in an expensive caretaking provider being appointed, only for the list to be dispersed a few months down the line. Three months is not sufficient time to carry out a procurement of new services as procurement exercises generally take between nine and 12 months. The short notice period would require the installation of a care-taking provider to manage the practice clinically and administratively during procurement process which will be disruptive for patients in the short and long-term, as well as requiring considerable financial resource support. Based on the above considerations, the decision to initiate a dispersal of patients as a result of urgent termination of contract was deemed to be the only viable, and most appropriate, option. Finance Currently there are annual recurrent premises costs of 21,250 rent and 7,539 rates: 28,789 in total. In addition to this, there is the annual contract value of approximately 141,558 (after OOH Deduction, and including QOF & Enhanced Services). Dispersal would be cost neutral to the commissioner. This is because: a) rent and rates reimbursements will cease; and b) patients will register with other local practices - hence any potential savings will be redistributed to fund the increase in contract values of those other practices (which are funded on a price per patient basis). However, if a procurement option was chosen, a care-taking arrangement would need to be put in place whilst the procurement process was 5
undertaken. Care-taking is estimated to cost an additional 10,000 per month for the period of the arrangement and the average cost of a procurement exercise is c 10,000. The practice is currently funded at a rate of 81.71 per weighted patient (based on a list of 1,453 weighted patients). Dispersal would result in the absorption of patients by local practices at the prevailing PMS / GMS price, which is c 21.00 above the current price resulting in a recurrent cost pressure of c 30,500 per annum. However, it is important to consider that any potential procurement would need to offer a price in excess of Maypole Surgery current price per patient, based on the Standard London APMS Price 98.38 (on a recurrent basis). In Maypole Surgery situation, due to the small list size, and in order to attract interest from the market, a premium of as much as 30 per weighted patient above Standard London APMS Price would need to be offered to attract potential bidders. It should therefore be concluded that procurement would lead to a recurrent cost pressure of up to 192,800 per annum, about 74,100 per annum more than a dispersal (not including caretaking costs that could be in excess of 100,000). Patient consultation Feedback In normal circumstances, NHS England and Kingston CCG would undertake a full patient consultation exercise to seek views on the type of service patients wish to access after the closure of the practice. As explained in this paper, it was not appropriate to undertake such an exercise into potential delivery models as the only viable, and most appropriate, option is to disperse the c1,400 patients registered at Maypole Surgery. However, NHS England and Kingston CCG are committed to engaging with patients and hosted two drop-in sessions on 17 th August 2016 for patients registered with Maypole Surgery. A total of seven patients attended both drop-in sessions. Feedback from the drop-in sessions indicate that whilst there was evidently some patient concern and sadness over the closure of Maypole Surgery, there was a general willingness to register with an alternative local practice. Comments In response to Dr Mackie s termination, NHS England carried out a review into the alternative GP service provision in the local area to understand whether there is enough capacity to absorb the patients registered at Maypole Surgery. This review has demonstrated that there are a number of practices within close proximity of Maypole Surgery which offer good 6
alternatives for patients in the area, and all welcome new registrations. Kingston CCG are aware however that Maypole Surgery closing in such a short time frame to Gray s and Gosbury could create some immediate, short term, capacity problems and have commissioned Kingston GP Chambers to provide an interim team of GP, Nurse and admin support to practices experiencing high levels of registrations. The local area does not have a high deprivation score, however we know that the area does have a large proportion of elderly people and families with young children that tend to use GP services more frequently. There is a clear and detailed plan to assist and manage the transfer of patients to their new practice of choice. This will be carried in full in collaboration with the contractor and by NHS England. Despite the fact that a full consultation with patients on potential options was not undertaken, it must be taken into account that the urgent and reactive nature of the three month termination notice was one of the major influencing factors facing commissioners decision to initiate a dispersal of patients as it was deemed to be the most appropriate and viable option. The commissioners of the service have been actively supporting patients through the process registration since the provider s decision to hand back their contract and retire. Commissioners will continue to ensure patient access to primary care services is not impeded or diminished. The monies released from the closure of Maypole Surgery would be most efficiently and economically used in funding the redistribution of patients to local surgeries which have the space to grow and develop a practice that will provide local patients with optimum access and GP services, rather than contribution towards procuring a short-term care-taking service that is proven to attract unsustainable patient registrations. Recommendation(s) to Board Kingston CCG requests the Primary Care Commissioning Committee s endorsement of the urgent and reactive action taken to disperse the registered list at Maypole Surgery to the local practices. 7
Next steps All stakeholders and patients have been notified of the decision to disperse. A letter has been sent to the registered patients notifying them of the change and what next steps they should take to continue accessing GP services. This communication included information to assist patient in making decisions about their care needs and choosing a GP with which to register. Kingston CCG will continue to work closely with the local providers to aid the re-registering of patients at their practices. There is a closedown procedure that NHS England follows in the event of practice closures which will be followed efficiently and effectively. Any patient that does not transfer to another practice by 1 st November 2016 will have their records held securely until they register with a new practice. The practice has identified the patients who are deemed vulnerable and at risk, and/or have long-term conditions, and will contact them to ensure they are assisted with re-registration if needed and ensure they have continuity of care by during the handover. 8
Appendix 1 Map of practices within 1.5 miles of Maypole Surgery Practice Name Address 1 Postcode Kingsdowne Surgery 34 Kingsdowne Road KT6 6LA Red Lion Road Surgery 1 A Red Lion Road KT6 7QG Central Surgery Surbiton Health Centre KT6 6EZ Claremont Medical Centre 2a Glenbuck Road KT6 6BS Berrylands Surgery Surbiton Health Centre KT6 6EZ Brunswick Surgery Surbiton Health Centre KT6 6EZ Langley Medical Practice Surbiton Health Centre KT6 6EZ The Orchard Practice Orchard Gardens KT9 1AG Chessington Park Surgery Merritt Medical Centre KT9 2GY Hook Surgery Merritt Medical Centre KT9 2GY 9
Appendix 2 GP practices within 1.5 miles of Maypole Surgery Practice Code Practice Name Address Borough Contract Type H84058 Kingsdowne Surgery 34 Kingsdowne Road Surbiton, KT6 6LA Distance (Mile) NHS Choices Rating Would recommend the surgery Kingston PMS 0.4 2.5 82.7% H84054 Red Lion Road Surgery (Mediventure Ltd) 1 A Red Lion Road Tolworth, KT6 7QG H84030 Central Surgery Surbiton Health Centre Ewell Road,, KT6 6EZ H84619 Claremont Medical Centre 2a Glenbuck Road Surbiton, KT6 6BS H84053 Berrylands Surgery Surbiton Health Centre Ewell Road, KT6 6EZ H84015 Brunswick Surgery Surbiton Health Centre Ewell Road, KT6 6EZ H84062 Langley Medical Practice Surbiton Health Centre Ewell Road, KT6 6EZ H84034 The Orchard Practice Orchard Gardens Chessington, KT9 1AG H84050 Chessington Park Surgery Merritt Medical Centre Merritt Gardens, KT9 2GY H84025 Hook Surgery Merritt Medical Centre Merritt Gardens Chessington, Surrey, KT9 2GY Kingston PMS 0.5 4.5 63.1% Kingston PMS 0.7 3.4 73.5% Kingston GMS 0.7 4.5 80.8% Kingston GMS 0.7 5 79.9% Kingston GMS 0.7 3 92.7% Kingston PMS 0.7 4.5 88.5% Kingston GMS 0.9 2.5 66.9% Kingston PMS 1.5 3 86.4% Kingston GMS 1.5 4.5 77.4% 10