To receive a presentation from Uppingham Surgery.

Further information on the Consultation can be found at:

https://www.uppinghamsurgery.nhs.uk/ketton-branch-surgery-could-be-closing/

The Partners and Office managers from Uppingham Surgery outlined the reasons and the rationale behind their proposal to close Ketton branch surgery.

During their presentation, the Surgery confirmed the following points:

·         Uppingham Surgery had 11,000 patients and the Partners wanted to provide the best clinical care to all of these patients whilst operating under some major national and local challenges that included GP recruitment and treating patients across a 100 square mile area.

·         In 2005 it was proposed that the Ketton branch surgery at Geeston should be closed as a result of underutilisation and the building not being fit for purpose. The Parish Council came up with a solution to move the surgery to the Library and the practice were hopeful that this would increase the number of patients and decrease the number of underutilised appointments. Unfortunately there had been a net reduction in the number of patients, down by 17%, and 41% of appointments remained unfilled.

·         Uppingham Surgery was facing the challenge of increasing demand for services whilst ensuring that the resources that they had were utilised effectively.

·         Currently Uppingham Surgery had a 91% satisfaction rate compared with 85% nationally. Their patients liked the Rapid Access Clinic model they offered which meant that they were able to offer appointments on the day and respond to needs immediately. In order to maintain this model, and as they had not been immune to the nationwide GP shortage, Uppingham Surgery had adopted different ways of working using advanced nurse practitioners and clinical pharmacists in a multi-disciplinary approach. This approach had not worked at the Ketton branch which continued with a number of unfilled appointments. A significantly lower percentage of Ketton residents registered with the surgery as compared with other branches.

·         Six different options for the Ketton branch surgery were outlined. Option 1 was to maintain the status quo which would mean a high number of appointments would remain unfilled causing a detrimental effect to other patients. Option 2 was to replace GP sessions with other practice staff but that would limit the breadth of issues that could be dealt with and would lead to even more unfilled appointments. Option 3 was to reduce the GP sessions by half but that had already been attempted and the appointments were still underutilised. Option 4 was to reduce the number of sessions at all branches but there was a significant difference in the number of patients registered, for example, at Gretton. Gretton patient numbers had increased by 38% whilst Ketton patient numbers had decreased by 17%.  Option 5, the preferred option, was to close the Ketton branch surgery. Option 6 was to close all branch surgeries but the demand in Barrowden and Gretton would make it difficult to provide all services. Additionally Uppingham Surgery was the sole occupier of the premises at Gretton and Barrowden. In weighing up all these options Uppingham Surgery had to consider the care of all its patients as it cared passionately about the level of care that it offered and felt that given all the complexities of the situation, that it could not justify the continued underutilisation of appointments.

During discussion the following points were noted:

·         Members questioned whether it was right that ELR CCG should effectively be protecting Gretton surgery as it was a surgery outside of their remit. It was felt that Gretton was a false comparator to Ketton as access from Gretton to Corby was greatly superior and the Gretton patient base increase could have been as a result of the massive expansion in Corby.

·         The Partners argued that whether Gretton was there or not, it was the underutilization of appointments at Ketton that was the issue.

·         The new patients registered at Gretton came from Gretton itself as two years ago the Surgery had changed the practice boundary to protect its patients and to avoid the neighbouring Prior’s Hall development.

·         Ketton would be expanding in the near future with an additional 300 properties planned which would generate an extra 1000 patients. Members asked whether the Practice would accept a moratorium on their proposal in order to allow the Parish Council to encourage more attendance and monitor those moving in and signing up.

·         The Uppingham Surgery did not have a waiting list and its GPs were working exceptionally hard to provide something that most surgeries did not offer. The problem of underutilization was a pressing issue and needed to be addressed as soon as possible to avoid GPs suffering burn out.

·         Partners felt that most residents of Ketton village knew that that there was a branch surgery located at the Library. The Library was widely used and was next to the Primary school. Additionally the practice website gave information about the branch surgeries and in Gretton there had been an increase in patients registering without any additional advertising of the service. Only 20% of the population of Ketton was registered with Uppingham surgery with the rest choosing to go elsewhere.

·         It was felt that the reduction in service at Ketton did not make it attractive enough for patients to register. However until July 2017 there had not been a change to the service compared to other branch surgeries and the reduction in numbers had not occurred elsewhere.

·         Changing the boundary area of the practice would not reduce the number of patients on their books, and subsequently the pressure on services, as patients already registered could not be deregistered if they then fell outside of the boundary area.

·         Residents in Ketton would be able to get their prescriptions by utilising the Good Neighbourhood scheme or through community pharmacies and some pharmacies such as Boots in Stamford offered home deliveries.

·         Nationally there was a problem with recruiting GPs because many worked part-time or were retiring early. Uppingham surgery employed 4 part time GPs who shared two lists so that they could work within the named doctor scheme. In theory, if the practice was able to recruit two additional GPs it would be more feasible to continue at Ketton.

·         The proposal to close Ketton branch surgery was not a financial decision but was based on usage of the service. The Practice Partners commented that it was heart wrenching to sit in an empty surgery whilst other colleagues were overstretched and struggling elsewhere.

AGREED:

1.    The Panel AGREED that the Chair would submit a formal response to the CCG regarding the Ketton surgery closure proposal on behalf of the Adults and Health Scrutiny Panel.