Thank you for taking the time to email your questions to the dedicated email address. We have provided responses to the questions you have raised below. We will continue to monitor the email address and update you frequently on questions posed, and the responses.
- We believe Generating Health Care (GHC) and the landlord were willing to continue provision. Why was this decision taken?
East and North Hertfordshire Clinical Commissioning Group (the CCG) was prepared to offer GHC an extension of their contract on the existing terms, but this was rejected by GHC who were only prepared to extend the contract with significant additional funding provided by the CCG. Had the CCG agreed to this additional funding request and treated all other Practices equally, the cost would have been in excess of £20m a year. This level of funding is not affordable and would have required significant service cuts elsewhere. Whilst the landlord was prepared to agree to a new lease, having discussed options with neighbouring practices, it was concluded that the current Orchard Surgery premises would not need to be retained. The lease will therefore expire naturally at the end of its current term. - What other options were considered by the CCG?
The CCG considered seeking an alternative standalone provider for the service. Following procurement law, this would have been advertised for national competition and may have led to a contract award. However, the CCG was not confident that the contract would be attractive and there was risk that at the end of the process the contract could still not be awarded. The procurement process would have taken time away from the approach now being taken. - Why were patients not consulted?
The CCG values feedback from all patients, patient participation groups, community groups, and local stakeholders. However, it would have been disingenuous of the CCG to consult on ‘options’ that are not viable. The current provider (GHC) was not prepared to extend its contract on the current terms, citing lack of financial viability. - How has the impact of this closure been measured and assessed?
The CCG considered the geographic spread of patients currently registered at Orchard Surgery to identify alternative Practices whose boundaries covered that area. The CCG then held discussions to assess and confirm that there was sufficient capacity to register all the patients at Orchard Surgery. The CCG received confirmation that there was sufficient capacity. - Given increase of building/population in Buntingford, can the new practice handle a shift in patients?
Patients registered at Orchard Surgery live in a wide area in and around Buntingford and for some patients there may be more than one alternative GP Surgery for them to consider. The CCG will help patients to identify their options, making available information on Practice Boundaries. Discussions with local Practices have confirmed that there is capacity for all Orchard Surgery patients to be registered with local Practices. Expansion of premises in the local area is already planned and this will create additional capacity beyond that available now. - Will new builds provide new health facilities?
The CCG is aware of the planned housing developments in the Buntingford area together with the housing build out trajectories, which have been provided by East Herts Council. Options for further future expansion of existing or new premises will be kept under review, but it is unlikely that every development will have new health facilities within them. - Will e-records access, e-pharmacy, text reminders for attendance, Patient Participation Group (PPG) etc be provided at new surgery?
These services are generally available at all GP Surgeries. The Buntingford and Puckeridge Medical Practice, providing services from Buntingford and Puckeridge, are two of the most local Surgeries and offer all of these services. Patients can register to be contacted by text for appointment reminders, health promotion, to request prescriptions online and to receive practice news. Further information can be found on their website http://www.buntingfordandpuckeridgepractice.co.uk/ppg.aspx. - Can all patients (and notes) be automatically transferred to Buntingford, unless they choose to ‘opt out’? Or how soon should patients apply to the other surgery? Will older patients transfer directly to Buntingford Medical Centre?
The CCG will be working with Practices to ensure a seamless transition of patient notes. Patients are encouraged to take no action at this stage. GHC will continue to deliver the current service until the end of the contract (31st March 2020). You do not need to move practices now, and a mass re-registration may undermine the managed process all parties wish to undertake.
It is imagined that the majority of patients will transfer to Buntingford Medical Centre, and will be eligible for transfer. The practice boundaries that overlap with the area covered by Orchard Surgery are:
- Buntingford Medical Centre
- Baldock Surgery
- Puckeridge Surgery
- Watton Place Surgery, Stevenage
- King George Surgery, Stevenage
- Church Street Surgery, Ware
- Much Hadham Surgery, Bishops Stortford
- Newport Surgery (in West Essex)
Additionally, there are a number of registered patients at Orchard Surgery, who already live outside Orchard surgery’s boundary. Therefore some patients may be eligible to register with other practices. These practices are:
- Ashwell Surgery, Baldock
- Dolphin House Surgery, Ware
- South Street Surgery, Bishops Stortford
Further details will follow in November regarding the process for patient transfer.
- Buntingford Medical Centre cannot handle existing patient load – what provision is being made for new patients? Will the service be guaranteed as good, or even better than currently experienced?
Buntingford Medical Centre was inspected by the Care Quality Commission in 2016 and rated ‘Good’. They had their annual monitoring review in 2019 and were again rated ‘Good’. GP Patient Survey results for the Buntingford Medical Centre show high satisfaction amongst patients with the services on offer including:
- 88% of patients find it easy to get through to the GP practice by phone
- 79% of patients were satisfied with the type of appointment they were offered
- 100% of patients took the appointment they were offered
- 77% of patients waited 15mins or less after their appointment time to be seen at their last appointment
- 92% of patients say the healthcare professional they saw/spoke to was good at giving them enough time during their last GP appointment
- 97% of patients were involved as much as they wanted to be in decisions about their care and treatment at their last appointment
- 100% had confidence and trust in the healthcare professional they saw/spoke to during their last GP appointment
- 100% of patients felt their needs were met during their last general practice appointment.
The GP Patient Survey results for any Practice can be accessed and compared here: www.gp-patient.co.uk
Buntingford Medical Centre also offers a broader range of services, including: Level 3 Anti-Coagulation, Level 3 Near Patient Testing and Minor Surgery.
- In the letter you cite the use of locums at Orchard. Can you confirm how many doctors have retired from Buntingford and how many have permanently been recruited in the last 5 years?
There is a known nationwide shortage of GPs and Practices may choose to utilise locums to create flexibility and to maintain safe staffing levels. However, where services are staffed entirely by a locum workforce there is a greater risk of service interruption and loss of continuity. It is therefore preferred that at least some of the staff are Partners or have permanent contracts. The CCG are not aware of any GPs retiring from the Buntingford Medical Centre in the last five years and do not hold records on their employment of staff. The CCG is assured that the Practice can recruit and retain sufficient staff to deliver high quality services to their current and future registered patients. - I found out about the closure via Facebook, and received no communication regarding the closure
The CCG does not hold details on patient names and addresses, and letters had to be sent using information maintained by the Surgery. All letters were sent to households at the same time, but some may have arrived earlier than others and unfortunately some may not have arrived at all. The CCG’s intention was to communicate to every household in which there was a patient registered with Orchard Surgery and we apologise that it appears that we have not achieved this. - Who are GHC – are they a profit making company?
GHC is Generating Healthcare Ltd, a limited company formed by a number of local GP Practices to provide services on a more collaborative basis. - Who are the CCG, what do they do?
The CCG is the organisation responsible for commissioning (planning, designing and paying for) your NHS services. - Are all GPs private contractors to the NHS?
GPs are independent contractors and many work together in Partnerships. These individual GPs or Partnerships hold contracts with the NHS to provide services to their registered patients. GPs are therefore not employees of the NHS. Some contracts are held by limited companies who do employ GPs. - How does Primary Care funding work?
The CCG is allocated a local NHS budget each year with an element dedicated for Primary Medical Care services. Further information can be found on the British Medical Association website. - What extra resources are BMC going to need?
BMC and other Practices with whom patients register will receive additional funding from the CCG based on the numbers registering with them. In this regard, money will follow the patient. Depending on the number of patients registering at any single Practice, they may need to employ more doctors, nurses, other healthcare professionals and support staff. It will be for the individual Practices to decide what they require, but the CCG will work with the practices to help them understand patient preferences and support them with recruitment. - When will the moves take place?
Patient transfers will be completed by 31st March 2020, and further details on the process will follow in November. - Is there any truth to the rumour that some patients will be forced to go to Puckeridge surgery?
GP Practices are required to define their Practice Boundary and any patient living within this boundary can register with the Practice. Every patient currently registered at Orchard Surgery lives within the Practice Boundary of at least one other Practice and the CCG will facilitate patients in making their choice of new Practice. The CCG has been assured that there is sufficient capacity available at Buntingford Medical Centre if all patients were to choose to register with this Practice. - How will extra GPs and nurses be recruited ? Why can’t they be recruited now for Orchard Surgery?
The recruitment and ongoing employment of doctors, nurses and other staff is the responsibility of the GP Practice and for Orchard Surgery it is the responsibility of GHC. GHC has struggled to recruit and retain permanent staff and this has led to staff turnover and cost pressures. There may be a number of reasons for this and the CCG has more confidence that other established GP practices are better placed to recruit and retain the staff they require to provide the services patients need. - I would like to register with Buntingford Medical Centre now. Is this possible?
We know that a number of patients feel anxious about the re-registration process, and are already trying to re-register, despite being advised to take no action at this time, and await further communications in November. To support the smooth transfer of all patients, it has therefore been agreed that Buntingford Medical Centre will only register patients from Orchard Surgery under this managed process and not through patients directly contacting the practice. This has two purposes:
- it ensures the ongoing resilience of Orchard Surgery, to continue until 31st March 2020
- patient transfers take place in a managed way ensuring proper handover of care from Orchard Surgery to the new practice.
The CCG will be writing to patients again within in November with next steps, outlining how they will be supported to register with a practice before the 1st April 2020. No patient will be left without a GP.