Some of the Questions Put by C. Cooke to the PCT and the JHSC
SOME QUESTIONS ABOUT CHARTERS
1. Last meeting. 2 Items (Charters + minor injuries closures) were sprung upon us - neither gave us time to research or comment properly. Yet the issues were known to the PCT way back in September. Why could we not have been given this “confidential Information” sooner by way of written report?
2. A successful proposal from this PCT for funding of Charters (then simply called The Surgery, Glascote Heath.) was sent out and accepted by the Health Authorities in October 2001. How much money was made available by that application? What is going to happen to that money now?
3. That proposal makes a compelling case for the existence of Charters. In particular I note with questions that:
a. Most attendees at the Minor Injuries Unit at the Sir Robert Peel are children and young Families from Glascote Heath. Wouldn’t night closing of the Minor Injuries Unit mean a greater need for Charters?
b. Tamworth had difficulties recruiting GPs, a NORMAL length of time being 12 - 16 months. As Charters has been going less than that time and going through very uncertain times due to PCT action WHY is it now considered that Charters should close because it only has a locum GP for now?
c. Was it not true that 2,700 patients from Glascote travel three or four miles to doctors outside the area? How can this now have changed?
d. The view then amongst all other Tamworth Doctors that around 1000 patients, mainly children and young families had not registered with a doctor? How can that view have now changed when most other doctors have filled and closed their lists.
e.. Repeated surveys in Glascote Heath highlighted the need for and GP service and especially female clinicians. How can this view now have changed?
f.. Glascote Heath was the main area of deprivation and poor health in the PCT area. Is the PCT saying this has now changed?
g. The proposal highlighted Doctors list sizes and lists being closed to new patients. As this has not changed why should PCT policy on Charters?
h. What is the accepted national level for GP list sizes? What is the average GP’s list size in Tamworth?
i. The proposal sets out a number of criteria and priorities by which the success of the Nurse led project would be measured - was it an oversight that none mentioned going over estimated budget?
j. The aim of the proposal was for Charters to develop a list size of 2,200 - comparable to other surgeries in the area - over three years. That’s less than 750 each year. Charters has been going for 14 months. Half that time (because of previous undisclosed problems) they were not allowed to register new patients and indeed the nurses were removed altogether. That makes only seven months they have been properly going for. By my calculation that makes 375 their target - and they have achieved 526 - that’s well over target! Also during the close down they lost 100 patients and others have been reluctant to sign up due to uncertainty. By these calculations Charters would have had over 50% of its patient list within the first year - if only it had been left alone in the first place. Why does the PCT feel that two thirds of the target list size should be reached within the first year? Knowing these facts now does the PCT still think it is fair to blame poor list uptake for closing this practice?
k By any and all criteria in this proposal it seems that a practice like Charters was essential in Glascote Heath. As none of these factors have changed is it not true that the only reason for closure seems to be to allow the PCT to spend the money for Charters in other areas?
l. In all respects the Management and clinical Governance arrangements appear to be superior to the normal GP’s surgery. This means that people who have been attending Charters receive better monitoring and access to treatment than the normal overburdened GP in Tamworth. This is especially important as very many of Charters patients are elderly and infirm or have special medical needs. This is why they registered with Charters. Therefore the quality of treatment for such high care patients has been reducing costs and time pressures across other parts of the Tamworth GP’s network. This more personal approach, unique to Charters, also involves patient participation. Shouldn’t all this high value operation across high usage patients also be taken into account before closing Charters?
m Clearly none of the results of such innovative practices at Charters could have been evaluated by the PCT over such a very short period of their operation. Why won’t the PCT now give Charters the chance to develop this practice properly in accordance with its original proposals.
n I am thinking particular of high needs patients such as the elderly people from the nearby Russell House sheltered housing complex , who would find it very difficult to travel to other surgeries and who would be unlikely to want to transfer to the other Glascote GP practice even supposing its patient list wasn’t already too large. What is the PCT contingency plan for continuity of patient services for such people in the event that Charters is closed down.
o Has the notice period for termination of Staff jobs already started? How long is that period of notice and at what time might it be expected to operate from.
p. The cost of Charters appears to be in line with what was originally envisage for this time in its development. Two questions. What checks are in place to ensure that the estimated expenditure is accurate to the actual expenditure? Also, as Charters lists and the surgery had not been closed for several months already is it not clear that Charters has had only seven months of operation and so can still be considered on target.
q. What help has Charters had from the PCT to help it enlist new patients?
r. What methods have the PCT used to determine whether other GPs within the area are able to absorb Charter’s patient list?
s. Patient Access is a target for the PCT. How will closing Charters enable the PCT to achieve that target?
t. Of the 3 options given -:
1. Option 1. Is it realistic to hope that a local Doctor may operate over two sites? Has any Doctor in Tamworth declared an interest in fulfilling this function.
2. Option 2. What is Health Authority policy on the transfer of such pilot Nurse-Led schemes to Private Doctors practice? Have any Private practices expressed any interest to date?
3. Option 3. What is the Strategic Health Authority’s view of the closure of this 3 year Pilot scheme after effectively less than a year? Where is option 4? To keep Charters Open and to address current problems through other management and service and supply solutions?
u. There is a national shortage of GPs so it is not surprising that Charters may not get one within its brief period of operation. Am I correct in saying that the Locum Doctor has offered to become the full time doctor? Why has that offer not been accepted by the PCT?
v. The Riverside Practice in Tamworth, also under the PCT, currently operates with a locum Doctor and has also had its difficulties. Surely a merger of these two practices in one form or another would provide yet another viable option?