Agenda item

Purpose: To consider the proposal to close the GP branch surgery in Underwood Road, Calcot and make a recommendation to the NHS Berkshire West.

(Councillor Tony Linden declared a personal interest in Agenda Item 3 by virtue of the fact that he was a patient of the Dr. Swami & Partners Surgery.  Councillor Julian Swift-Hook declared a personal interest in Agenda Item 3 by virtue of the fact that he was Chairman of West Berkshire Mencap.  As their interest was personal and not prejudicial they were permitted to take part in the debate and vote on the matter).

Helen MacKenzie (Deputy Chief Executive, NHS Berkshire West) described the Underwood Road Surgery as a branch surgery of the Abbey Medical Centre, Russell Street, Reading.  She explained that the doctor was present at the branch surgery 8 hours a week with the Surgery premises open a total of 16 hours per week.  Outside of the opening hours the surgery was locked and not in use.  Mrs MacKenzie described the Primary Care Trust’s view which was not to support a GP surgery at the Underwood Road location.  She described how GP commissioning groups would purchase care on behalf of patients in the future.  She also described that GP practices with more than one GP resulted in better clinical outcomes for the patient, due to GP peer support and better development of clinical expertise. 

She described that 9000 patients were registered at the Circuit Lane and Theale Medical Centre practices and there was the capacity to accept patients from the Underwood Road branch. 

Mrs MacKenzie described how local clinicians (GP commissioning leads) supported the NHS Berkshire West position as a step towards providing services which were fit for purpose in the future.

Mrs MacKenzie described the proximity of five other GP practices to the Underwood Road site: Circuit Lane (1 mile), Calcot Surgery (1.8 miles), the Abbey Medical Centre (2.2 miles), Western Elms Surgery (2.1 miles) and Dr Swami & Partners (2.2 miles).

Mrs MacKenzie then described the National Patient Survey findings (2009/10) which focused on patients satisfaction and compared the Abbey Medical Centre to the practices at Circuit Lane and Theale Medical Centre.  Members wished to see the data broken down to the Underwood Road branch level however this was not possible as the data was only collected at GP surgery level.  

Members queried whether the Abbey Medical Practice had come out more favourably on any of the indicators in relation to access to GP services when compared to Circuit Lane and Theale Medical Centre.  Mrs MacKenzie confirmed it fell below the levels of the other two surgeries on all measures in relation to GP access.

Members confirmed some of the difficulties in relation to access and parking at the Abbey Medical Centre at Russell Street and reported occasions where there had been long waits for appointments.

Members enquired of the levels of deprivation in the Underwood Road area and patients’ ability to reach alternative surgeries if they had financial and/or physical disabilities.  The NHS Berkshire West reported that they did not have this type of personal information about patients but indicated that the Underwood Road branch patients would already need to travel to access the Abbey Medical Centre on all other days outside the 8 hours a week a GP was present at the branch surgery.

Members scrutinised the financial information presented which showed that Underwood Road costs were £80.30 per registered patient per square metre, whilst Circuit Lane was only £6.64 and Theale Medical Centre £2.38 per registered patient per square metre.  Members queried what other comparator figures were available.  Mrs MacKenzie responded by explaining the Berkshire West average figure was approximately £10 per registered patient per square metre for a GP surgery.

Members asked about levels of deprivation around Underwood Road and the support for facilities such as David Smith Court (elderly care) and the Walled Gardens (centre for those with learning disabilities).  Helen MacKenzie described the deprivation in the Underwood Road area as no different to levels seen in the Southwood area for example. 

Members queried the use of the designated space within the Bellwood Homes redevelopment of Underwood Road, should it not be used as a Medical Centre.  It was unclear whether the additional space would be used for social housing, shared ownership or some other mixed-use purpose. Members enquired of the potential financial gain to the developer and the ability for the developer to contribute to healthcare facilities in the locality.

Mr David Buckle (Medical Director) informed the Committee that in his opinion he was convinced that a single GP in a branch surgery was not a viable proposition and would not be able to provide the quality of GP care required by today’s standards.  As a General Practioner himself, he stressed he would not advise a branch arrangement such as Underwood Road and said that it would compromise the quality of the service offered to patients.

Mrs MacKenzie described the PCT’s view that in their opinion this change did not represent a “substantial variation” to services in health overview and scrutiny terms. 

Members discussed the options for the elderly and infirm and what access to services might exist for them should the practice at Underwood Road close.  Mrs MacKenzie described that some doctors might make provision for home visits and that in fact this was more likely in practices where there was a team of doctors. 

Mrs MacKenzie described the detailed consultation underway with the public which was due to close on 4th October and the findings would then be reported to the PCT Board.

In accordance with paragraph 6.8.2of the Council’s Constitution Standing Orders were suspended in order to allow Councillor Brian Bedwell (Ward Member for the Calcot Ward) the opportunity to relay his concerns about closure of the Underwood Road branch surgery.  He described the practice as being open Monday – Friday (3 hours a day) and the branch surgery open for a total of 18 hours a week.   He reported that a petition to keep the doctor’s surgery in Underwood Road open had been drawn up and which had to date attracted 250 signatures.  Councillor Bedwell expressed disappointment that Mrs Nirgude, the Underwood Road Practice Manager, had not been invited to attend this meeting.

Councillor Bedwell described the high levels of deprivation within the area including the 20% of Ford’s Farm Primary School children having Special Educational Needs (SEN) and the proximity of the Older Peoples residential home at David Smith Court. 

Councillor Bedwell described the potential access difficulties for patients if they attended the Calcot practice at Royal Avenue due to the uphill gradient.  He felt this would be particularly difficult for mothers with prams and those without cars.  He equally added that there was no bus service to this practice.  He explained that the Calcot Surgery at Royal Avenue was also a branch surgery with only one doctor and in a similar position to Underwood Road.  Equally, Councillor Bedwell also described his experience of delays to get a doctor’s appointment at the Theale Medical Centre. 

Councillor Bedwell argued that the new Bellwood development of 60-65 housing units would increase the population living within the Underwood Road area and provide an increased requirement for GP services in this location. 

Councillor Bedwell stated that high numbers (one third of all patients in this area) were using the Calcot (Royal Avenue) branch and that registering additional patients could lead to greater delays receiving a doctor’s appointment.  He suggested that the Underwood Road surgery should be used as a third satellite service for the Theale branch. 

Mrs MacKenzie described how the PCT had explored all options but that the contract for Underwood Road was held by Mrs Nirgude and it was not possible to pass this on to other GP surgery without undergoing strict rules of procurement and competition.

Mrs MacKenzie also added that of the 500 patients registered at the Underwood Road branch surgery 400 of these were aged 20-70 years and many would be able-bodied.  It was also reported that the majority of patients drove to their appointments at the Underwood Road branch surgery.

Mrs Beverley Searle (Director for Partnerships and Commissioning) described the targeted pieces of work which had been done within the Underwood Road area to reduce health inequalities.  She described the weight loss services and targeted interventions such as the ‘Healthchecks’.  She described the efforts made to improve public health and how the Council in future was due to have a greater responsibility for public health under the recent White Paper proposals.  

The Chairman of the Committee described the need to balance the consideration of the residents with the issues in terms of cost and clinical care.

Councillor Julian Swift-Hook (Vice-Chairman) described how in areas of deprivation high quality health care services were essential and that this supported the argument for multiple GPs operating from a single surgery.  Equally the figures had shown that even if patient numbers at the Underwood Road branch had increased by 25% that the cost was still almost ten times more expensive than the cheaper alternative.  Councillor Swift-Hook argued money would be better spent providing quality outcomes in other surgeries within this locality.  He described how doctor’s appointments were usually available if the patient showed flexibility in relation to which doctor was seen. 

Councillor Swift-Hook highlighted the statistics presented by the PCT which reflected patients concern that they were waiting too long for an appointment more often at the Abbey Medical Centre than either Circuit Lane or Theale Medical practices.  He also described the higher risk of a single GP led practice and the disruption to services that would result, for example, if this GP should resign.  He summarised that in his opinion the best outcome was not to replace the Underwood Road surgery but to reallocate funding to the other neighbouring surgeries.

RESOLVED that:

(1)       the Committee supports the NHS Berkshire West’s proposal to close the Underwood Road GP branch surgery based on the evidence presented and that the cost savings realised should be reinvested into surgeries with multiple GP teams within this geographical area;

(2)       the proposal and recommendation was voted on and carried with a majority with the exception of Councillor Adrian Edwards who abstained from voting.