'Why did nobody ask the patients?' Uproar as Chorley GP faces being be kicked out of her own practice after 10 years
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More than a quarter of the 5,500 residents registered with the Withnell Health Centre have lodged written objections to regional NHS bosses in an attempt to persuade them to reverse their controversial decision - which, if implemented, would mean Dr. Ann Robinson was no longer responsible for their care.
Scores of them also staged a demonstration at the Railway Road facility on Thursday, warning that they will not be silent in the face of losing their longstanding GP.
Dr. Robinson became the principal partner at the practice in the summer of 2013 and the most recent partnership running the health centre was dissolved just over 12 months ago, leaving her as the sole operator.
That sparked a competitive bidding process for the contract to provide GP services from the site, in which Dr. Robinson lost out to SSP Health - a company responsible for 37 practices across the North West.
However, the locally well-known GP says that if patients and staff had been asked for their opinion, the result for the practice would likely have been very different.
“We don’t believe that the ICB has got patients involved. The result was leaked, unfortunately, into the public domain and 1,500 patients made objections, saying: ‘Why weren't we involved in this decision? We don't want the health centre to change hands.’
“The current care that they get is absolutely wonderful and there is data to back that up. We have same-day appointments, a fantastic nursing team and the lowest A&E attendances across the whole of Chorley and Preston.
“My practice doesn't have a problem recruiting either, because it looks after its staff and it pays them well,” Dr Robinson said.
The deadline for the contract decision - made by the Lancashire and South Cumbria Integrated Care Board (ICB) - passed earlier this week, although the Post understands that the contract itself has not yet been handed over and a timetable for the change is now being drawn up.
Dr. Robinson was awarded a temporary contract following the dissolution of the previous partnership and that expires on 1st April.
The procurement process was set in motion by the now defunct Chorley and South Ribble Clinical Commissioning Group (CCG). That organisation - which, along with its fellow CCGs across Lancashire, has now been replaced by the ICB - wrote to patients in February 2022 advising them of the temporary arrangements.
They were told that they “should not be concerned about the future of the practice” and that the forthcoming 12 months would be used to undertake “the necessary due diligence” before a longer-term contract was awarded.
The letter did request patient views on their experience of using Withnell Health Centre, which it was explained would be fed into the analysis done ahead of the awarding of a new contract.
However, Dr. Robinson believes that the reassuring tone of the correspondence led patients to believe that nothing would change for them in either the near or distant future - and that the news of her unplanned departure will have come totally out of the blue to them.
“The bit that really upsets me is that nobody has asked my staff and patients what they want - and that’s the bottom line for me. This whole process is so unnecessary and such a waste of everybody's time and money.
“If the ICB had just come round and [asked]: ‘Do you want Dr. Robinson to stay or do you want her to go?’, all of this stress and upset would have been completely avoidable.
“At a time when the NHS is in turmoil, we are a very small part of it, that’s actually working really well - and is determined to carry on [doing so].”
She is now calling on the ICB to rethink its decision - and on Tuesday she led a delegation of almost the entire surgery staff to the organisation’s headquarters in Leyland.
It was during that unannounced visit that Dr. Anna Ressel - a newly-qualified GP who has worked as a salaried doctor at the practice since September - spotted that the almost 1,300 paper objections received by the surgery, which had been hand-delivered to the ICB last Friday, remained unopened at reception.
She said that that was symptomatic of a body that was refusing to listen to patients - in spite of having a professed duty to do so.
“The ICB is currently ignoring the patient voice. This organisation states that it…takes [patients'] views into account when commissioning services, but actually they have ignored over 1,000 patent objections.
“The most frustrating thing is that we are a good practice, we're not a failing practice. We have one of the highest patient satisfaction scores, not just in the area but in the country - so it completely beggars belief that this decision has been made,” Dr. Ressell added.
The ICB assumed the responsibility previously held by CCGs to involve the public in the commissioning process and, at its inception, produced a document setting out how the NHS in Lancashire and South Cumbria would not only be “compliant with” legislation regarding public involvement, but “exceed” it, as that would be “the right thing to do”.
Meanwhile, Dr. Robinson insists that the interests of her patients will not be served by what she describes as “supermarket GPs”.
“These big practices cut services to the bone. I know for a fact that SSP took home £4m in profit last year, which is taxpayers’ money which should be spent on improving your access to GPs.
“I actually spend the money that I am given by the NHS on recruiting staff. I’ve just taken on Dr. Reesel who is young and locally trained - she is the [kind of] GP we want for the future, who is committed to the area.”
Dr. Robinson also trumpeted the virtues - and the values - of the kind of practice she has run for the best part of a decade and fears that patients will notice a difference under a new regime.
“Many of my staff have been here for 10 or 20 years. They know the person when they walk in the building - maybe they knew your Mum - and they also know if you may have more complex needs and that we need to squeeze you in even more urgently.
“All that just goes with these faceless supermarket GPs.”
SSP Health told the Post that its aim is to "retain the team" at the facility.
The Post also understands that the ICB has agreed to meet with the practice on Friday.
Kim Snape, the Lancashire county councillor for Chorley Rural East - the division in which the Withnell Health Centre sits - said that she was “shocked, saddened and appalled by the blatant disregard that the ICB have shown to the views and feelings of the 5,500 people that the surgery serves - alongside the awful impact this is having on the staff there as well”.
“The people of our villages are standing together behind Dr. Robinson and her fantastic team and I am most definitely sure they will not stop until their voices are heard,” County Cllr Snape added.
Maggie Oldham, deputy chief executive for the NHS Lancashire and South Cumbria Integrated Care Board, said in response to the issues raised in this article: “We have a duty to undertake an open procurement process for certain services which allows for all interested providers to be fairly considered.
“In the case of Withnell Health Centre, this process ended at midnight on 16th January. As a result, a suitable provider has been identified.
“We recognise the concerns of staff and patients at Withnell Health Centre and would like to take this opportunity to reassure patients that they will continue to access services at Withnell Health Centre as they currently do.
“The ICB remains committed to ensuring high quality, safe services for its residents and we will work closely with the new provider to ensure continuity of service for patients at Withnell.”
“OVER MY DEAD BODY”
The former lead GP at Withnell Health Centre - who worked at the practice for 30 years in total - has told the Post that it “hurts” to see the facility handed over to a conglomerate.
Margaret France, who left the surgery in 2013 and passed it on to Dr. Robinson, said she did so content in the knowledge that she had left it “in safe hands”. However, the now Cllr France does not feel the same way about its forthcoming transfer to SSP Health.
She said that a locally-produced spreadsheet drawn up to compare her former practice’s performance in the most recent GP Patient Survey with 34 SSP-run facilities did nothing to assuage her concerns.
“If you look at the percentage of patients who find it easy to get through to their GP practice by phone, you've got a national [average] result of 53 percent. Withnell Health Centre is at 82 percent and if I look along the line for SSP, there are an awful lot of red numbers [indicating scores below the national average] and the lowest is 16 percent,” Cllr France said.
Only one of the SSP-listed practices outperforms Withnell on that measure, achieving 91 percent.
Across the 18 performance criteria listed, Withnell Health Centre is above the national average - sometimes significantly so - in 17 of them and equal to it in one.
On the measure of the proportion of patients who consider their overall experience of their GP surgery to be ‘good’, Withnell scores 87 percent, compared to the 72 percent national average. Twenty-seven of the 34 SSP-operated practices listed fall below that average, with scores ranging from 29 percent to 88 percent.
“Explain to me how this tendering process has been correctly followed. Where’s the due diligence in awarding a contract to a provider who scores so badly on just about every measure?” asked Cllr France, who represents the Chorley North East ward on Chorley Council.
SSP Health told the Post that the latest national GP Patient survey was carried out a year ago and its results more recently published. The firm said that results “varied” across its practices, but were “not where we wanted them to be, as we experienced challenges coming out of Covid”.
Managing director Amanda Carey McDermott added: “We've made great strides since then which have been reflected in our own practice surveys and Google reviews, which are live and up-to-date and have improved significantly in the past year or so – and score an average of four stars, much better than the vast majority of practices.”
However, Cllr France bemoaned the potential loss, in the Withnell Health Centre, of “one of the last remaining traditional GP practices”.
She also said that if the former CCG had waited just a few weeks for a change in legislation before enacting the tendering process, it would no longer have been obliged to do so and could have left Dr. Robinson in charge.
“At Withnell, It’s the general practice that I know and love, where it is a surgery of a size such that you know your patients and they know you.
“That practice is in my blood and I’ll do anything I can to prevent this from happening. Over my dead body is what I say to this.”
‘A DIFFERENT TYPE OF CARE’
Caroline Carysforth says that were it not for the commitment shown by the medics at Withnell Health Centre, her mother would have been unable to fulfil her dying wish of remaining at home during her final days.
She believes that the experience of her mum’s passing late last year demonstrates the benefits of a small, independent practice - and the threat of losing that was enough to persuade her to take time off work to attend Thursday’s protest over the plans for the surgery.
“Those doctors know who we are - they know our histories and they care about the whole family. They always asked about me and [whether] I was okay - and when I went to see the nurse one day, she sat with me while I cried. It’s just a different type of care.
“However, the main thing when someone is in the situation my mum was is that you are fighting a system that is not working - but at least you've got that team there doing everything they can to make it better.
“Dr. Ressel, in particular, could not have given a better level of care - she is one person on her own, but if that one person had not been in the system, I wouldn't have been able to help my mum with her wish to remain at home.
“She was terrified of hospitals, but I wouldn't have been able to [prevent her being admitted] - the only reason I could was because I had the fallback of that practice and they were my support through it.
“There was no tickbox exercise, which I think you get with a lot of other areas of the NHS, because they are under so much pressure. This is actually people caring and doing what they are meant to do - and excelling at it,” Caroline added.
WHAT DOES SSP HEALTH SAY?
SSP Health managing director Amanda Carey McDermott said that it had now received “confirmation from the ICB that there is an intent to award the Withnell Health Centre contract” to the firm.
“We will now be working with the practice closely to ensure the smooth transition of services, building on the excellent work of the team to continue to deliver the best possible care to the patients at Withnell Health Centre.
“We completely understand the concerns of all involved and we want to reassure both patients and staff that our primary focus is to ensure the practice continues to provide the same, or better, levels of patient care.
“We do want to reassure anyone with concerns that our aim is to retain the team, continue their good work and add to the services available to patients.
“We are proud of our very loyal workforce, with many of our GPs, nurses and practice teams having remained with us for many years. Our group model removes administration from the practice and enables practice teams to continue to focus on their patients, meaning GPs don’t drown in paperwork and admin, giving them more precious time and freedom to focus on quality patient care in their local surgeries.
“We are committed to the best possible patient care as well as ensuring our staff are happy and supported. We are very proud that the quality of our service delivery is reflected in our CQC [Care Quality Commission] results where we have consistent ratings of ‘good’ or ‘outstanding’ across all of our practices, [with] 12 percent being outstanding compared to the national average of five percent.
“We want to ensure that we have a clear understanding of the needs of our patients and the service they receive - therefore their feedback is key to our ongoing service development. We gather feedback from patients in a number of ways, including practice surveys, patient participation groups, google reviews, NHS choices and the national patient survey.
“As with all GP surgeries, Withnell Health Centre has always been privately owned, run with the local community as its primary focus, and this is something we do not want to change. At SSP Health we are great believers in the GP practice being at the heart of the community and we have every intention that Withnell’s loyal team can continue their good work and add to the services available to patients.
“We are very keen to support the wider NHS and provide services for patients more conveniently and closer to home. That’s why, in a number of our practices, we offer services such as gynaecology, family planning and minor surgery, which would normally be provided by the local hospital.
“At this time our main focus is on working towards the handover date and ensuring as smooth a transition as possible,” Ms. Carey McDermott concluded.