STATEMENT

Application to close Sandiway Surgery by Danebridge Medical Practice - decision of the NHS Cheshire CCG Primary Care Commissioning Committee

At its meeting on the 22 July 2021, the Primary Care Commissioning Committee of NHS Cheshire Clinical Commissioning Group (CCG) approved the application by Danebridge Medical Practice, Northwich to permanently close its branch premises in Sandiway, Northwich.

The CCG has now formally written to Danebridge Medical Practice outlining that the exact date of the closure still needs to be confirmed following agreement of a branch premises closure plan between the CCG and the Practice. The CCG has been clear to the Practice that this will be at a date no sooner than 90 days from the date (22 July 2021) of approval of the application by the Committee.

The Committee, at its meetings, also instructed the Practice that as part of its closedown plan that it needs to continue to engage with and communicate with its patients so as to ensure that patients are aware of the changes and the date that they will take effect.

Furthermore, the Committee has requested that Danebridge Medical Practice maintains a continual dialogue with its patients and the communities that it provides services to, listens to the feedback it receives around its service offer, and provides ample opportunity for its patients to shape the delivery model so that it meets the needs of its patients and continues the work it is undertaking to address the concerns raised around access and support to services, especially those who are clinically extremely vulnerable and/or who may face barriers to access services.

Further information regarding the closedown plan will be brought back to a future meeting of the Primary Care Commissioning Committee. Details around future dates can be found at www.cheshireccg.nhs.uk/meetings

Please refer to the Danebridge Medical Practice website https://www.danebridge.org.uk/ for further news regarding the closure and details regarding opportunities to get involved with the Practice.

Subject: Edward Timpson CBE MP - The Application by Danebridge Medical Practice to close Sandiway Surgery

Good afternoon,

As you are aware I have been following progress on this application since it was first communicated to my constituents in December 2019. Local residents have established the “Save Our Surgery” group and have produced a number of excellent reports on behalf of patients, including submissions to the Cheshire West and Chester Health Overview and Scrutiny Committee and to CCG - Primary Care Commissioning Committee. They have also reviewed the Equality and Quality Impact Assessment (EQIA) produced by the CCG and presented at the PCCC meeting; and most recently they have reported on the Patient Engagement Sessions carried out by CCG and DMP at the request of the PCCC.

I believe that there are a number of key issues that have been raised by patients and that need to be comprehensively addressed by the NHS and local government before any decisions are made about the future of Sandiway surgery.

Primary Care for Rural populations

Cuddington / Sandiway is a Key Service Centre (KSC) providing medical, commercial and social services to residents and to the surrounding rural population. Cheshire West and Chester identified a total of 10 KSCs in its Local Plan that was made in 2017. In the “Settlement Analysis”, used in determining the suitability of a settlement to be a KSC, the first listed criteria are the existence of a GP surgery and pharmacy. Every KSC in Cheshire West and Chester has a GP surgery and a pharmacy. I believe that the implication of attempting to close down the surgery at Sandiway is a matter for local government as well as NHS consideration. The Cuddington Neighbourhood Plan, made in February 2019, confirms development plans for housing and commercial development based on the presumption that Cuddington / Sandiway is a KSC.

The stark reality here is that this proposal withdraws primary care close to home, for 3500 patients and for a growing community of over 5300. If this surgery closes after 90 years of provision then it is unlikely that it will ever be replaced. This existing asset providing primary care solutions should not be lost as it is a vital part of the KSC, supporting the surrounding rural area.

NHS Strategy

The NHS vision statement is “enabling people to live healthier and more independent lives through high-quality seamless care.” National policies direct the NHS to aim to reduce its environmental impact, and the CCG has declared an intent to reduce the carbon footprint of care provision in Cheshire. Policy is now being developed to provide accessible integrated primary care, follow up treatment, and social care for all the population.

I believe that the closure of a surgery 5 miles from the Practice Medical Centre is not in line with the stated NHS mission, vision and values.

Management of the Danebridge Medical Practice (DMP)

The Practice has avoided giving any answers to its patients on the financial reasons for seeking closure but it is clear that with the announcement that two senior partners are leaving the practice, that there are possibly significant financial issues within DMP.

Patients have been told that a figure of £250-300K is required to bring the surgery up to standard but DMP has only referred to needing a new fire exit and a disabled toilet. Clearly the work must be more extensive for the quoted price.

DMP has cited other reasons for not wishing to operate the surgery including lone working. I recognise that this is not a mode of working that is acceptable these days but lone working should not be necessary when there are according to the DMP website 19 GPs (including 8 Practice Partners), 12 nurses, 4 MSK practitioners and a pharmacy team of 3.The ratio of medically competent practitioners to patients in this practice is probably 1:700, based on a total patient population of 25000. On this basis, 3500 Sandiway patients should be entitled to 5 professional staff. Even allowing for a FT equivalence of 0.6 across the practice Sandiway could be allocated 3 staff at all times.

Patients are struggling to understand why this cannot be managed.

PCCC expectations

The Chair of the PCCC wrote to Danebridge and to the chair of the CWaC OSC to describe what was being asked of the Practice, following the meeting in November 2020 DMP were asked to justify the decision to upscale services from Kingsmead over Sandiway, and to detail how the loss of capacity at Sandiway will be addressed. In addition they were asked to produce a description of the future delivery model.

Having examined the recent report written on behalf of patients by the Save Our Surgery Group I can see no evidence that any of these points have been discussed with patients. I do not believe that this aligns with the NHS Core values “care, respect, and communication.”

The reasonable expectations of patients and residents are:

• An informed report on why this proposed closure is considered necessary, including the medical impact, financial justification and the staffing implications of this proposal.
• An explanation of the impact of withdrawing the GP practice on the future development of the settlement that no longer meets the criteria of a KSC.
• An informed report on what the requirements are for a modern surgery and what it would cost to meet those standards, bearing in mind that the CQC found Sandiway surgery adequate for the level of care being provided. This should include a confirmation that all the facilities at Kingsmead and Danebridge are at that standard.
• A simple explanation and a demonstration of how primary care will be provided to all patients, including those classified as vulnerable by virtue of their age or medical condition, before any decision can be taken to close the surgery.
  
  

I believe that these are reasonable expectations and I look forward to hearing from you on this matter, including how my constituents’ expectations will be met.

With many thanks for your continued support for this important matter.

Edward

cc DMP, Healthwatch Cheshire, Kate Cernik (Chair CWaC OSC) , CWaC CEO and Leader, CWaC Cllrs

Edward Timpson CBE MP
Member of Parliament for Eddisbury

Dear Mr Timpson CBE MP,

Thank you for your recent email/ letter outlining your concerns regarding Danebridge Medical Centre’s application to close the Sandiway (SW) Surgery.

As a partnership we have discussed the points you have raised and wish to respond to you in advance of the forthcoming PCCC meeting.

Primary care for rural populations

This point is beyond the remit of the practice to comment upon however we wish to draw your attention to the fact that there is another NHS GP surgery situated just 1.7 miles from the SW Surgery and should the application to close the surgery be successful then patients can express their choice and register with that practice if they wish.

The pharmacy in Sandiway is unrelated to our application to close the surgery and should our application be successful will remain delivering a service to local residents.

In addition may we draw your attention to the recent communication from CWAC (appendix 1) relating to this point

NHS Strategy

It is our intention should our application to close SW branch Surgery be successful we would continue to offer high quality seamless care for the residents of Sandiway. The current pandemic has changed working practices all across the country in primary care. Over the past year we have had no option but to close the SW surgery for reasons of patient safety, as we were unable to meet the COVID safe working standards at SW. There is no evidence that our patients have suffered any adverse outcomes in terms of their health due to this significantly restricted service offered at SW. Their ability to lead healthy and independent lives has been unaffected by the significantly reduced service at the SW Surgery. Therefore, in conclusion we believe that due to these recent observations that the residents of Sandiway will be able to continue to live healthy and independent lives despite a successful application to close the SW Surgery.

We take the care of all or patients very seriously, both young and old. We have worked closely with Northwich Primary Care Network to improve our domiciliary service offered at the practice. We now have a paramedic who works with the team offering home visits. We continue to offer home visits to patients across all areas in our catchment area and with a successful application to close the SW Surgery this would not change.

As a practice we review our appointments system regularly and I would draw your attention to the most recent report the practice has submitted to the PCCC (appendix 2) regarding the financial implications upon the practice of needing to redevelop the SW Surgery and also the recent developments of our appointments system that allows for significantly more flexible appointment times especially beneficial to elderly and disabled patients.

We acknowledge that should our application to close SW Surgery be successful then patients would need to travel further for face to face appointments. However this is in line with the Government’s driven initiatives to develop centres of excellence and surgeries that can provide complete care for the patient at one site, e.g. offering phlebotomy services, Community Care services, minor ops, Gynaecology services, midwifery services, musculoskeletal services and many others which no doubt will be developed in time.

Management of the Danebridge Medical Centre

The departure of two senior partners is coincidental to our application to close SW Surgery and has no bearing upon our decision to make the application.

A significant amount of building work including significant structural work would be needed to develop SW Surgery into a fit for purpose building allowing the provision of safe and effective care for our patients. In addition to creating appropriate disabled access and toilet facilities and a safe and modern fire safety system (including new fire exit, fire alarm system and emergency lighting) the following works would need to be completed.

• Structural work on the existing rooms to make them bigger to allow access for disabled patients and often multiple people, e.g. additional carers, family members and also the fitting of safe and modern care facilities within the rooms. The rooms would need to be large enough to allow the use of modern clinical couches that are currently in use in all our other clinical rooms at Danebridge Medical Centre and Kingsmead Medical Centre. The rooms are not of sufficient size to have couches positioned in a way that allows for a full examination, for example the examination couches in two rooms are either attached to the wall or pushed up against the wall leading to the risk of inadequate examinations taking place.
• Work needs to take place to soundproof the clinical rooms to allow for confidentiality to be respected, currently we play a radio loudly in the waiting room to address this issue, and this is not acceptable and often ineffective.
• Work would be needed to replace the existing rotting window frames. We would also want to assess the state of the roof when embarking upon any structural work which may lead to additional costs.
• Once the structural work has been completed the surgery would need to be redecorated and have modern lighting fitted. We would need to fit clinically appropriate flooring to the same standard that we have fitted at both The Kingsmead and Danebridge Surgeries.
  
  

Having considered your points about the ratio of clinicians working at SW surgery and our other sites we feel the following points are important to understand. The issue of lone working is a serious one and an issue that the LMC are aware of as a problem. As our website states we have numerous clinicians working within the practice, however only one of these clinicians is working full time, and this GP partner is soon to reduce their commitment at the practice. We currently have approximately 10 FTE GPs working in the practice. Sandiway residents represent 14% of the practice population allowing for the provision of 1.4 GP’s time per week. One must remember that any provision we offer in the practice is also affected by annual leave, study leave and sickness.

Junior doctors and practice nurses in the practice expect another GP to be working alongside them. A pharmacist, another practice nurse or MSK clinician is not able to offer the degree of support they need. We simply cannot offer this level of provision at the Sandiway Surgery.

Primary Care Commissioning Committee (PCCC) expectations

Contrary to your suggestions at the request of the PCCC the practice has engaged with the Sandiway residents, including those members of the Residents Action Group, the practice participation group and with the support of Healthwatch. The practice has arranged four remote sessions, in-line with COVID restrictions, with patients to discuss the issues the PCCC highlighted as areas that needed further discussion between practice and patients. The CCG allocated a Chair for the meetings and the outcome of the meetings (which have been shared on the practice website and Facebook page) is summarised in the document recently submitted to the PCCC for consideration at the forthcoming PCCC meeting. Dr Mullin and Dr Perry alongside the Practice Manager will be present at the forthcoming PCCC meeting to elaborate on the written submission and answer any questions raised by the committee members.

The reasonable expectations of patients and residents are:

The practice has considered the points you have raised regarding expectations of the patients and residents. We believe that we have addressed all these issues in detail in the recent report submitted for the consideration of the PCCC.

The standard of the facilities at the Danebridge and Kingsmead sites are far superior to those currently offered at the Sandiway site. The Kingsmead site is a modern building which was purpose built and has very modern facilities with spacious and well fitted rooms to offer care from.

We have been and continue to develop the facilities at The Danebridge site. Recently we have fitted modern lighting throughout the building and modern appropriate flooring has been laid throughout the majority of the building. We have recently decorated the building throughout and continue to make financial provision to continue to modernise and upgrade the interior of the building and its facilities.

We hope that this response and the attached documents have addressed adequately the concerns you have raised.

With kind regards

The Partners at Danebridge Medical Practice