THE FUTURE OF WILLERBY & SWANLAND SURGERY
HOW TO IMPROVE SERVICES TO PATIENTS.
For many years we have sought to improve our ability to widen the healthcare services we can offer to our patients - be they newborn right through to our most senior patients.
Below is the progress of our present proposal to relocate both Willerby Surgery and Swanland Surgery into new, modern, purpose built premises.
We know this may not welcomed by all our patients - we will do our best to understand all concerns and work to mitigate any difficulties. Please read below to see what we have done - and are doing still - to ensure a successful outcome for 21st Century patient care for all our patients
05/04/19 The developer for the proposed new premises has submitted a revised planning application to East Riding of Yorkshire Council to change the building structure from a two storey to a three storey build.
This will ensure future capacity is built in from day one and will secure for Haltemprice residents the only significant health investment since Beverley Community Hospital was opened. You can view and comment on these revised plans by visiting the ERYC website https://newplanningaccess.eastriding.gov.uk/newplanningaccess/applicationDetails.do?activeTab=summary&keyVal=POCYNCBJI5N00
05/03/19 - We are now moving forward with discussions and plans to work with Humber Wolds Rural Action Charity (HWRAC) in developing a volunteer transport scheme to support any patient who needs to get to an appointment with the doctor - or indeed and healthcare appointment and - if possible - widen this to include transport for social needs such as shopping etc.
Our planned meeting is on Tuesday 19 March and will be held at Willerby Surgery at 09.30am. Although not intended to be an open meeting at this stage, we will be asking any interested patient - and our Patient Group - to work with us to start to build a database of interested people who are happy to join as volunteer drivers.
This will be a really great opportunity which we want to start as soon as possible so that if we finally conclude a move to new premises we have a working scheme up and running.
31/12/18 UPDATE announcement from East Riding of Yorkshire CCG
"New East Riding medical centre moves a step closer
Plans to develop a brand new medical centre in East Riding of Yorkshire have moved a step forward this week, after an outline business case and additional supporting information put forward by the Willerby and Swanland GP practice was discussed and approved to progress by the NHS East Riding of Yorkshire Clinical Commissioning Group (CCG) Governing Body.
The GP practice has been working with a local developer to consider options and create plans for developing a new medical centre on Lowfield Road, Anlaby. The development would enable the practice to attract and retain vital skilled staff to the area (including GPs), enable collaborative working between the practice and community nursing teams and mental health teams in expanded premises, provide extended access with appointments available at weekends and later into the evening and secure high quality and safe GP services locally in purpose built and modern facilities.
Jane Hawkard, Chief Officer for NHS East Riding of Yorkshire CCG said:
“Our Governing Body has carefully weighed up the GP practice’s case for change and listened to the views put forward from the local community. The Governing Body agrees that, based on the evidence presented, there is a need for this practice development in order to continue to provide and sustain essential primary care services into the future. The development will also provide GP services to support people moving into the extra housing developments expected within the next 5 years.
“We would like to thank those who engaged with us and the practice regarding this proposal. We have taken seriously all the comments raised and asked the practice to provide assurances about how they intend to minimise impact on their patients, which they have done.
“We understand that a relocation may have an impact on patients travelling to appointments, particularly elderly patients. The practice confirms that they have analysed this impact through a patient survey they conducted in December 2017 and January 2018 and are working with Humber and Wolds Rural Action to improve the offer to their patients in terms of assistance with transport for appointments if needed. The Governing Body also recognised that both Willerby and Swanland have very high rates of car ownership.
“Local people also asked whether alternative sites had been looked into and the practice has provided evidence that known current alternative and available sites have been explored and considered.”
The development will now be subject to local authority planning permission and final approval by the CCG of a full business case within the identified financial envelope, expected in March 2019. Should all of this be met, the development will result in a modern and fit for purpose build by November 2020, that will ensure that GP services are sustainable as demand and population continues to grow. The proposed new centre would see patients relocate from both its existing surgeries, in Willerby and Swanland, to the new site and allow the practice to initially increase its patient capacity from 8,600 to 11,250.
The practice will continue to work with their patients through the development phase and beyond to deliver high quality GP services and ensure that patient needs are met appropriately."
Comment from the practice :
We recognise that we have some work to do to ensure, where possible, that we understand the needs of patients who might be disadvantaged by a relocation of premises - in particular, those patients who have no means of transport of their own or from family/friends. This will be a significant piece of work to build on what has already been undertaken and more details will be published early in the new year.
06/09/18 UPDATE - We continue to progress the urgent need for a solution to our premises problems with East Riding of Yorkshire CCG and NHS England. The ability for us to continue to provide primary care services to existing and new patients is a growing challenge in both financial and capacity.
There is no change to our preference for relocation to new premises (as detailed fully below).
28 JUNE 2018 - PUBLISHED FEEDBACK NOW AVAILABLE (to download this document click here)
This is our Feedback Response to the comments received during the public engagement on our premises proposals. The engagement consisted of two public meetings held 11 April at Willerby and 12 April at Swanland – followed by a collection period throughout April for written and electronic comments from patients until first week of May 2018.
Additionally, letters were received from ward and parish councillors with collected feedback and observational comments and we received feedback from the East Riding of Yorkshire Council Health, Care and Wellbeing Overview and Scrutiny Sub-Committee.
We have reviewed all the comments received and this document details our response.
We published numbers and graphs earlier this month showing the number of comments and the main issues identified by our patients (see below). The feedback is intended to address each of these issues with the outcome from our review.
Letters were received from North Ferriby Parish Council, Swanland Parish Council and five East Riding of Yorkshire Council ward councillors. The East Riding of Yorkshire Council OSC did not support the option for relocation without the presence of any other viable options and asked that we contact the Council’s Forward Planning and Housing Strategy Manager to discuss other options. Additionally we were asked to consider reopening the consultation and presenting more than one viable option
SUMMARY OF FEEDBACK FROM CONSULTATIONS
Willerby & Swanland Surgery held two public meetings and were open to receive feedback comments throughout April 2018.
In total, 295 attended the public meetings (110 at Swanland and 185 at Willerby)
126 people did not offer any comments at the meetings
169 people offered feedback/wrote comments and further feedback was received during April from 21 people (8 emails / 13 written)
Letters were received from North Ferriby Parish Council, Swanland Parish Council and five East Riding of Yorkshire Council ward councillors.
Although we closed the feedback window at the beginning of May we subsequently received a further 4 emails and 1 written comment and we have included these in the statistics:
SUMMARY OF FEEDBACK HEALTH, CARE and WELLBEING OVERVIEW and SCRUTINY SUB-COMMITTEE (OSC)
The East Riding of Yorkshire Council OSC did not support the option for relocation without the presence of any other viable options and asked that we contact the Council’s Forward Planning and Housing Strategy Manager to discuss other options. Additionally we were asked to consider reopening the consultation and presenting more than one viable option.
RESPONSE TO THE FEEDBACK COMMENTS
The greatest number of comments received (139) were about the proposed location.
The five main elements commented on were
Relocate in Willerby
Relocate in Swanland
Retain and improve current premises in Willerby
Retain the current premises in Swanland
Why the proposed site at Anlaby
Relocate in Willerby: Conclusion. At the time of agreeing to work with the site developer, Lovel Development, we had unsuccessfully sought to identify and acquire any site within Willerby capable of supporting the minimum ¾ acre site needed for any new premises. In 2016 we reached a provisional agreement with the developer that subject to planning permission and financial support being secured from NHSE/ERYCCG we would develop a long-term business case to relocate to the development in Anlaby.
We have not identified any suggested locations to develop within Willerby which we have not previously, unsuccessfully, pursued or which are deliverable in a realistic timescale. We have, nonetheless, reviewed all previous proposals and any possibilities available in the ERYCouncil Local Plan but have not found any which are available, affordable and deliverable.
The proposed location is currently the only one available to us that meets those three essential criteria.
We believe delay in pursuing this proposal will lose the support of the developer and leave the practice with no medium or long-term alternative. The outline business case stated completion of any new building would be by Spring 2020, meaning construction will need to start early 2019. Undue delay is highly likely to be detrimental to the community, jeopardizing the ongoing viability of the practice and providing no ability to absorb new patients across the practice boundary.
Since early 2008 we have sought suitable areas within Willerby to host new surgery premises that would be cost effective, future proof and within the financial envelope that the health authority would support.
Our first business case demonstrated the strategic need for redevelopment – with the condition that new premises development would involve working at scale and include a second, local practice.
The land we pursued at that time (now the site of Aldi Supermarket) was not within an affordable cost window we were unable to proceed.
Following that first attempt in 2008 to secure land we have continued to identify locations and engaged with (the then) local parish councillors, East Riding of Yorkshire Council (ERYCouncil) planners, East Riding of Yorkshire PCT(ERYPCT), local land owner/businessman, local estate agents, private developers and shopping park owners.
As early as 2010 we asked ERYCouncil what land could be identified for development and an early draft of the current housing plan showed several areas ear-marked for development.
With our then development partners, GPI, over the next three years we made approaches to acquire land in an exhaustive number of locations, including Well Lane, Grange Park Lane adjacent to Health House, land now occupied by Lidl Supermarket, current St Georges Square housing land, undeveloped land in The Parkway, land at the top of Main Street, land adjacent to the Mercure Hotel (at the time, the Ramada Jarvis), the housing development land now being constructed off Beverley Road, land behind Willerby Square public car park, land owned by Yorkshire Water in Black Lane and a number of private business and house owners. We also had dialogue with the other occupiers on the land beside our existing Willerby premises (the youth organization, social club and woodwork factory owner) to rebuild the surgery at the rear of our current location.
None of these approaches have been successful – in many instances we were unable to engage in meaningful dialogue, in other instances the land acquisition costs were so high that we could not make a financial business case or the proposed site was not large enough for a new surgery (needing a minimum area of ¾ acre).
In 2010 we were able to identify a development opportunity in Chestnut Avenue and submitted a revised business case which was well received by the ERYPCT but which was delayed due to a nesting colony of bats. By the time this colony was able to be relocated in mid 2011, the ERYPCT was unable to support any capital expenditure and the subsequent delay resulted in the loss of the site.
We continued to seek development opportunities, including revisiting many of sites above which were large enough to support new premises and which had been either declined to us without success. One of the two partner practices who would have relocated with us gained their own new premises and the second practice withdrew.
In 2013, we re-examined the possibility of developing our existing premises with our development partner, GPI, and created a business case for this. Whilst this would have addressed the immediate need for better facilities, the extra clinical space could not demonstrate working at scale nor show how we could future proof long term healthcare provision to a growing population and thus did not gain support from the ERYPCT.
In early 2014 we lost our original development partner (GPI)
Contact has recently been made with the ERYCouncil’s Forward Planning and Housing Strategy Manager to seek views on potential alternative sites, either in the Council’s ownership or other allocated land which may be suitable for such development. One site in the Council’s ownership (the vacated Wolfreton School) was highlighted as being at least potentially suitable for such development – as part of a wider housing development. However, this land, is not yet offered to market and only benefits from outline approval– getting full approval and getting a start on site could take up to 2½ years. Assuming a development partner could be identified, construction would be a further 18 months to 2 years.
Although in a more central location to that proposed as the preferred site, it is not considered that access to the Wolfreton site is particularly good in terms of public transport – so whilst it may serve the immediate catchment area well this would not be the case for the majority travelling from across the wider practice catchment. There is no costed financial structure to match the current option - and our premises in Willerby do not have 5 years of sustainability that would protect us from having to seek list closure as the pressure of new and existing patient demand is already approaching maximum capacity. Other areas of land allocated in the Local Plan were discussed but these are generally the sites that were previously considered and rejected for a number of reasons (i.e. availability, cost etc…)
Relocate in Swanland: Conclusion. Swanland Surgery merged with Willerby Surgery in July 2014. At that time Willerby Surgery was in very early discussion with Lovel Development to identify a site for relocation. Throughout 2015/2016, as the business case for new premises was developed in conjunction with discussions with NHS England and East Riding of Yorkshire CCG, the financial case for a redevelopment was predicated on Willerby and Swanland Surgery being located in a single premises.
None of the comments and feedback have identified changes we can make to the current business case within a timescale we can achieve without losing this opportunity for relocation and working at scale to provide enhanced healthcare for patients over 20/25 years. There is no identified financial support for us to maintain premises in Swanland whilst relocating Willerby Surgery premises.
At the point of Willerby Surgery and Swanland Surgery merging into a single practice (July 2014) we were already in discussion with Lovel Development on an opportunity to locate Willerby Surgery into new premises at Anlaby.
At that time it was not expected that Swanland Surgery would be affected.
In 2015 we were in active discussions with another practice to co-locate into new premises. At the same time, other support for the opportunity was sought and conversations with the ERY CCG indicated that, whilst the strategic case was made, the financial situation showed no available funding and, whilst we were listed in the top 4 practices for premises development support all the then available capital was diverted towards other priority primary care developments within the ERY CCG area.
Ongoing discussions with NHSE during 2016/2017 eventually confirmed that success of any business plan for relocation would be predicated on working at scale, provision of a future proof building over a 20/25 year timescale and a cost neutral capital project.
Additionally it was clarified by ERYCCG that additional revenue support for the new premises would have to include combing the existing two premises revenue costs into a single cost rent for any new premises.
That precluded any option of operating from two premises - the practice cannot fund the costs of a branch surgery from its own resource, whether in Swanland or Willerby.
Our recent review with ERYCouncil Planning Authority did not identify any site within Swanland or on the periphery available for a new building. Further consideration of the likely impact on all our patients regarding a decision to relocate the whole of our patient services to Swanland would have a far greater negative impact on the majority (90+%) of our patients. Our conclusion was that redevelopment in Swanland is not an option.
Retain existing premises in Willerby: Conclusion Approximately one third of feedback from Willerby in relation to location commented on improving/retaining the existing premises.
The practice has three times previously looked into making possible improvements to Willerby Surgery and we have revisited the last business case, prepared in 2010.
Our conclusion is that the capital costs associated with developing and improving our current premises would not be borne by a developer and any gain in clinical space (essential to be able to increase the revenue payment from the ERY CCG) would not be sufficient to cover the capital outlay. With substantially less improvement in clinical capacity, the practice would not be able to demonstrate working at scale nor long term future viability to meet increasing patient demand from our existing base nor meet the needs of increasing numbers of new patients from the current and planned housing developments.
Making improvements to the existing Willerby premises could be done but would not demonstrate the required sustainability nor provide a cost effective, sustainable alternative, to relocation. Capital costs are not immediately available and upgrading will not provide sufficient extra clinical space. Without such an increase in clinical space there will be no extra revenue to fund the improvements and this option would be unlikely to happen.
The original 2006 survey showed the extent to which the premises would need to be improved to fully comply with the then Disability Discrimination Act. 12 years ago, these works were costed at £43K at that time.
During 2007/2008 the ERY PCT commissioned further work across East Riding practices and Willerby Surgery was identified as one of three priority premises to improve. However, no funding was available at that time
In 2008 we worked with an accredited developer (GPI) and costed the requirements to the existing premises and, with an estimate in excess of £500K we concluded this was not an effective solution and presented a business case for new premises to ERY PCT.
This business case was accepted and we proceeded to explore that option.
In 2012, having been unsuccessful in our relocation efforts, we revisited the option of developing the existing premises and entered into discussions with other occupiers on the present site in order to be able to extend the premises and re-provide better access/parking facilities.
The costs for this proposal (£1.3M) were submitted as a business case to ERY PCT but were not supported – mainly because we were unable to demonstrate working at scale or show future proof healthcare provision from the newly developed premises. Additionally we were unable to secure the necessary cooperation from the adjacent users to acquire the space needed for expansion.
As a result of the consultation exercise we have reviewed the 2010 proposals. Even with the cooperation of adjacent site users, the capital costs for redevelopment are unrealistic for the return on investment.
Retain existing premises in Swanland: Conclusion Just over half the feedback (23 comments) from Swanland patients suggested that the current surgery could be retained in Swanland.
The surgery building in Swanland is not owned by the practice and there is no capacity to expand clinical space and thus no capacity to meet any extra patient flow.
What we provide and maintain at the present time from these premises already falls short of the necessary standards expected of primary care and we are incurring higher premises costs than we are reimbursed for. Additionally, we are paying for duplication of staff, consumables, energy costs and support services which would be more effectively delivered from a single location.
It is unclear even if the new premises option does not go ahead, whether the Swanland premises can be financially sustained or whether any imperative to comply with regulatory standards would be achievable. If new premises are the eventual outcome, the financial reimbursement from NHS England/East Riding of Yorkshire CCG for Swanland would cease and the branch surgery could not then be maintained.
Swanland Surgery premises had been run by Dr R Clarke as a single-handed practice until 2013 when he entered into dialogue with Willerby Surgery to explore options to continue providing a service in Swanland. At that time the premises lease was due to expire and renewal by Dr Clarke was not a viable option.
The partners agreed to support Swanland through reduction in management and administration costs and at the same time maintain clinical cover by sharing resource from Willerby.
Maintaining the two surgeries as independent units became financially and logistically unsustainable and in July 2014, with agreement from NHSE/ERYCCG the clinical system was migrated and the patient lists were merged into a single practice list. That enabled better clinical management and support so Swanland could continue as a branch surgery.
The cost savings from the initial merger are no longer apparent as primary care has increasingly had to comply with changes in regulatory regimes and Willerby and Swanland Surgery is now operating with duplication of equipment, premises and utility costs, staffing support and clinical cover from a decreasing financial return.
5. Why the proposed site at Anlaby: Conclusion. As detailed in Section 1 and 2 above we have previously looked exhaustively at the possible sites in Willerby without success.
Lovell Development have been the only developer to offer to work with the practice to facilitate new premises.
Before committing to the offered location we undertook an initial appraisal of the suitability of the site. We considered the potential 1250 new homes for the local area plus the potential 150 planned in Swanland and the additional patients those homes would bring. We also considered the impact on our patient list from the impending decision by neighbouring Springhead Surgery to relocate their surgery out of Willerby further into Hull. We realised that if these houses were to be completed within a 2-3 year timeframe it would place an impossible demand on us to accept and provide primary care services to an additional 3000+ patients from our existing premises.
Lastly we looked at the geographical relationship of the proposed location to Willerby patients and Swanland patients.
The location would be closer to, and easier to reach from, Swanland than our existing Willerby premises (4.5km rather than 5km) has better road links and is approximately equidistant or closer to the majority (70+%) of our existing patient population.
Our recent contact with ERYCouncil Forward Planning and Housing Strategy Manager focused on potential sites in the Council’s ownership that may be available for a new surgery and other existing allocations which could be considered. It was confirmed that the only additional Council owned site within Willerby (the former Wolfreton School) has yet to be marketed by the Council. As explained earlier, this site is not considered to provide better transport access than our existing premises and the benefit to the majority of our patients from a move to Anlaby would not be achieved.
Having had no previous success in securing a development site, and with no other opportunities available within the necessary timeframe, we reached an agreement with Lovell Development to start the planning process and business case development process for possible relocation to Anlaby development.
The business case has been given initial support by NHS England and East Riding of Yorkshire CCG because it shows working at scale, demonstrates sustainability to provide a primary care hub to meet the future needs of up to 11,250 patients and it has the capacity to deliver a financially viable healthcare model.
With no other option showing the same level of benefit, deliverable within the next 18 months, relocation to Anlaby remains the preferred option.
The second most commented on issue (48 comments) concerned transport. The four principle elements of feedback were
Lack of public transport
Length of time when using public transport
Lack of personal transport
Negative environmental impact
Lack of Public Transport: The majority of feedback commented on the lack of bus services to the proposed location at Anlaby Low Road.
5.4% of our patients live in Swanland, the majority being within 1 kilometre of Swanland Surgery with very few on or near to a bus route; approx. 24% of our patients live within one kilometre of Willerby Surgery and approximately 2/3rds of those would be on or near to a bus route.
Most of our patients (70+%) already live more than a kilometre from the Willerby Surgery and are not on or close to a bus route, which means more patients would live equidistant to or nearer to the proposed location than current.
RESPONSE: We have always supported patients who are reliant on public transport, or transport by car from family or friends, by offering and arranging appointment times that mirror as closely as possible the bus times – or which fit in with the availability of car transport from family, friends and neighbours. And, whilst it is not our responsibility for patients’ transport arrangements, we will continue with this level of support regardless of location.
The official Hull bus network map (above) shows current routes serving Swanland and Willerby. The majority of these buses stop at the Red Lion, Anlaby which is approximately 400 metres from the proposed new premises location.
The bus timetable shows 14 buses between 9.00 and 6.00 each day from Swanland and 39 buses from Willerby – some of these buses stop at the bottom of Lowfield Road.
For Swanland the X80/180 has a two-hourly service from 09.35 from Swanland to the Red Lion, Anlaby
For Willerby the X80/180 runs 12 times a day from Willerby to the Red Lion
The EYMS Network Manager also confirmed to us that, whilst most of the current buses do not go down Lowfield Road, he would take account of the new development in any future service review. This is an extract of his email response :
“At present we have no plans to make any significant changes to services between Anlaby and Swanland but would be grateful if you could confirm any details on location, times etc that may be taken into consideration in any future service review.”
We will maintain contact with EYMS and ERY Council in the event relocation is the confirmed outcome so we can demonstrate to EYMS that, together with the substantial new housing in the same area, a case could be made to justify a minor route change to satisfy new, additional demand.
Length of Time when using Public Transport: There were a number of comments – mainly from Swanland patients - expressing concern about the length of time to make a journey to and from the proposed new location.
RESPONSE The 153 bus takes 14 minutes from Swanland to Red Lion, Anlaby – arriving at 5 minutes to each hour. The return bus leaves at 7 minutes past each hour – allowing a one hour turnaround for an appointment. An analysis of appointments over two weeks shows the average time in surgery from arrival to departure is 27 minutes.
We do not have any figures to indicate how long it currently takes patients to journey to the existing surgery premises, but the current bus timetable suggests most patients would have a turn-around time of 1 hour 35 minutes from leaving Swanland to return to Swanland.
We realise that, to achieve an average of 27 minutes, some appointments take longer and some are shorter. The longest time we measured was 1 hour 8 minutes (consisting of 48 minutes waiting and 20 minutes with a clinician). That longer time would add an extra hour on the total turn-around time. Although this is not desirable – and we would work hard to avoid this - we know it could occur for some patients reliant on bus transport. With the enhanced facilities from new premises there will be a better environment to wait in and we will review these facilities to include drinks, newspapers/magazines and free wi-fi for internet access.
2. Lack of Personal Transport: Some patient feedback indicated concerns from those who do not drive now and must rely on family or friends - and others were concerned that, whilst they are able to drive now there may come a time when they too must rely on others for transport. Some of that feedback suggested that that lack of transport to drive the greater distance to a new location would inevitably lead to an increase in demand for home visits.
RESPONSE As we have already noted, the majority (70+%) of our patients already live more than a kilometre from the Willerby Surgery and, excluding Care Homes residents, there are more registered patients aged 75yrs and older now within that group (990) than there are similar aged patients living in Swanland or Willerby (240). These patients are likely to be positively impacted by a premises relocation.
We do not know how many of those patients do not have personal transport. It is rare, however, that patients currently request home visits just because they cannot arrange transport to attend for appointments - not least because this would be an inappropriate use of our service.
3. It was commented by some that taxi fares from Swanland were indicated to be around £15 and this was going to be a cost burden. In the absence of using public transport, this may be a cost not currently faced by some.
RESPONSE We have met with, and are now working with, Humber and Wolds Rural Action Charity (HWRAC) who, amongst other activities, help organise volunteer schemes taking people who cannot use public transport and with no personal transport to attend doctor, hospital or dentist appointments as well as transport for shopping and social activities
Within the East Riding of Yorkshire there are several volunteer organisations operating Community transport services and two of these, Beverley Community Lift and Helping Hands, already work with HWRAC and operate services in this area.
We met with these organisers and all have indicated they would be happy to work with us and our patients to extend the schemes in the Swanland /Willerby area – not only to take patients to the proposed site - but also to expand to cover other personal and social needs for people.
This is a development in progress and, like everything, there will be costs for development of the scheme as well as ongoing running costs of such a scheme.
This would not be a free service to patients but costs are as low as possible and the more the service develops the more cost effective it would be.
At the beginning of June we hosted a Patient Group meeting and included this volunteer transport development in discussions about volunteering in general (something the surgery is very keen to encourage amongst our staff and patients).
This was very much welcomed and we will work to ensure we involve our patient group as much as possible. The practice is very keen to develop the concept of using any new premises opportunity to build up and host voluntary groups of patients as an integral part of managing their healthcare and improving social contact.
Should a voluntary transport scheme become a reality we will commit to working to facilitate appointment days and times as closely as possible with the availability of drivers.
4. Negative Environmental Impact: There was some feedback expressing concerns that moving to a new location will increase the amount of vehicle traffic and this would negatively impact on the environment.
RESPONSE This may be the case, depending on how patients choose to travel to a new location and whilst we do not have the ability to provide detailed numbers, we know that most patient addresses (70+%) are more densely located further away from the current premises and thus, conversely, they would be nearer to the proposed new location, thus minimising journey times.
We have confirmed with the consultant architects that the proposed new premises are built to achieve a minimum ‘Very Good’ BREEAM standard as required by NHS England.
BREEAM (Building Research Establishment Environmental Assessment Method) is the world's longest established method of assessing, rating, and certifying the sustainability of buildings. There are six recognised ratings: Outstanding, Excellent, Very Good, Good, Pass, Unclassified: and these are achieved by rating and scoring the environmental impact of different aspects of the building. For more detail about BREEAM please visit https://www.breeam.com/BREEAM2011SchemeDocument/Content/03_ScoringRating/scoring.htm
One of the key contributors to achieving high BREEAM rating is energy efficiency. The energy costs (average £1650pm) for a new building are forecast to be less than the current energy costs (average £1990) incurred from both existing buildings – this represents an ongoing 17% reduction on the environmental impact seen presently.
14 comments were made to raise concerns/questions about the adequacy of the number parking spaces to be provided at the proposed new site. Comments included that the staff parking would significantly reduce the numbers of spaces for patient use. There was also a comment that the surgery’s intention to provide additional services would further impact on parking provision.
RESPONSE Although the design/layout of new premises can be influenced by the intended occupier (us), the size and space allocations (including recommended parking spaces) are mandated by Department of Health specifications and referenced to BREEAM.
Other documents also govern new NHS provider buildings (eg: Department of Health : Health Technical Memorandum 07-03 and Primary and Community Care Health Building Note 11-01: Facilities for primary and community care services) include guidance on how spaces are calculated depending on, for example, number of patients, number and duration and times of appointments, other building uses, number of clinicians, number of staff, shift patterns, opening times etc.
The architect assures us that new premises are compliant with the relevant standards for a building designed for an eventual patient list size up to 11,250 within 10-15 years (our current list size is just over 8,700) and that the parking spaces provided are on target with the guidance.
Parking, then, will thus be more than adequate for our existing patients and our expected growth capacity over the next 15+years. Additionally there will need to be a travel plan agreed as part of the planning process which will oblige the practice to encourage car sharing for staff and to publish bus times etc for patients.
6 comments were received with questions/concerns during the meetings about potential issues obtaining repeat prescriptions, including that it would be more difficult to obtain prescriptions if patients had to travel greater distance to request them and/or collect them from the surgery.
RESPONSE: We already support a variety of ways for patients to manage their repeat prescription medication needs without them having to attend the surgery in person. We can receive requests by post, by fax, by online patient access and by request from pharmacy managed prescription services.
This will not change should we relocate, and we are always happy to give any patient online access to their medical record so they can manage prescriptions requests 24/7 from any computer or smart phone/tablet.
All the pharmacies we deal with offer to coordinate prescription requests from patients. This includes ordering prescriptions from us on behalf of patients as well as collecting the prescriptions when ready, and some pharmacies also offer a home delivery service.
We do not currently offer a telephone request service (except to the elderly/infirm or housebound) and we do not plan to extend telephone ordering from any new premises, however this would be reviewed in the light of technology changes and staff capacity, both of which should improve if we are able to increase our patient list. We understand many pharmacies do accept telephone requests at the moment but this is not within our control or influence.
13 comments were received with questions/concerns that making appointments would become (or remain) difficult and we have identified 2 main elements
Extra patients will place more demand on the appointment system
Appointments with choice of doctor
Extra Demand on Appointments Some comments referred to the extra patients we would take on in a new location and that these new patients would place greater demand on the appointment system making it harder to get an appointment.
RESPONSE: We are already at capacity for nurse space and doctor space in both premises - with approximately 2300 patients per doctor. The recommended ratio from the BMA is 1800 patients per doctor – with NHS England suggesting 2100 patients per doctor. The average list size across England is 1600 patients per GP. (2014 NHS/HSCIC figures)
The comments made are indicative of our increasing difficulty in meeting patient demand now and our patient list is increasing each week with no ability to increase our manpower
Our doctors have an average 32 patient appointments per day. Dr Mary McCarthy, vice-president of the European Union of General Practitioners (UEMO) and a member of the British Medical Association’s (BMA) general practitioners committee recently stated : “Around 25 contacts is safe.” (https://inews.co.uk/news/health/gps-doctors-patients-per-day-workload/)
Recruitment is exceptionally difficult where the working environment offers reduced/unsatisfactory facilities, space restrictions (resulting in a static skill mix) and a high number of patients per doctor. Without addressing these issues there is no way to improve appointment availability or avoid deterioration of current service levels.
We have 8 clinical rooms (none meeting current standards) and the options we have are limited and may result in us being obliged to restrict patient number growth. That is unlikely to have a positive effect on existing and new residents in Swanland, Willerby and, indeed, across our practice area.
Practices in modern, purpose-built buildings are more likely able to increase their healthcare team and improve the skill mix so that patients are seen more quickly by the relevant clinician. The proposed new premises would have an uplift to 14 clinical rooms plus multi-purpose healthcare rooms and more staff accommodation – all this will enable us to offer more appointments, better access and meet the needs of all our patients, existing and new.
2. Clinician of Choice Feedback also included comments over issues when trying to get an appointment with the doctor of choice.
Some of the comments appeared to relate to the current experience of some patients and one comment suggested that we were proposing to decrease the number of doctors and replace them with other clinical staff in the proposed plans for relocation.
RESPONSE: We have always aimed to support patients with an appointment with the clinician of their choice, but when demand for a named doctor exceeds the number of appointments with that doctor we simply cannot accommodate.
Most of our doctors have 16 appointments per clinical session so when 17 or more patients want to see that doctor we will not be able to comply with that request.
We do, and will continue to, offer an alternative doctor appointment where available but if a patient declines that the only remaining option we can offer is to call on a different a day/time.
That situation will not change irrespective of location and irrespective of the number of doctors available.
In the same way, regardless of which clinician is requested, when all the available routine appointments are fully booked then every appointment request after that will not be able to be fulfilled.
A mitigating action we would like to take – and one we will aim to take if we have larger premises – is to provide more non-doctor clinicians who can manage stable patients with a chronic condition without them needing to see a doctor. This would reduce the demand on the doctors, free up capacity and will mean that when a patients’ condition exacerbates, or they become acutely unwell, it will be quicker and easier for them to access a doctor and it will be more likely than now that their doctor of choice can be seen.
19 comments were made about the public meetings including that there was insufficient notice and that the meetings were not sufficiently well publicised and that relocation was sudden and unexpected.
RESPONSE: The planning process for the development of the new housing site in Anlaby included land provision for new surgery premises. That planning application was submitted to the East Riding of Yorkshire Council (ERYC) in March 2014.
We understand that the public planning process includes notification to town and parish councils and public consultations and the practice assumes ERYC followed appropriate process before granting relevant planning approval by the beginning of 2015.
When the developer advised that planning permission had been granted, the practice began the process of working with NHS England (NHSE) and East Riding of Yorkshire CCG (ERYCCG) to develop a business case that would be a strategic fit for the NHS and which was financially viable and sustainable over at least 20-25years.
By late 2017 we had developed a business case, including a Position Statement showing all the steps we had taken in the preceding years, and formally asked for support. In February 2018 we received outline approval from ERYCCG to progress our plans to the next stage and this was the trigger for us to engage with our patients.
We discussed and agreed our plans for patient engagement with the consultant working with us and the developer and with NHSE and ERYCCG and agreed the timescale at the Project Board Meeting on 27 February. These plans included the dates in April for the public events and we followed these plans and published the dates with the suggested 2 weeks notice.
This was by way of notices in both surgery waiting rooms, in Boots Pharmacy in Swanland and in the public library in Willerby. Additionally we published the meeting times and venues on our website alongside the options we were considering.
Following a meeting with ward and parish councillors ahead of the public meetings, two local councillors contacted local media and consequently the proposals and venues were also featured in the local press and on local radio.
There was very good turnout at both meetings and we believe we reached the patients we needed to. It may be that a meeting in Anlaby would also have been very well supported, however it is unlikely we would have received as much valuable insight.
Additionally, we are confident the number of comments and feedback we have received - at the meetings and subsequently - accurately reflect the concerns and issues, as well as support, from our patient population.
LACK OF DOCTORS
3 comments were made about doctor provision – one of which commented on current lack of doctors in Swanland, one commented that there being a shortage of doctors now would mean we would not have any success increasing the number of GPs in any new premises and one commenting that that the practice stated we did not need more doctors.
RESPONSE: Our current compliment of doctors do not have a sufficient clinical support team of nurses and other healthcare professionals to enable the practice to offer patients better access to monitoring clinics for chronic conditions. Such a team is better placed to work with these controlled patients to support them to remain as well as possible without needing to see a doctor. Achieving this will give the doctors more time to see the acutely unwell quicker and for longer. Without the benefit of extra space and facilities, we are not able to increase our team and are extremely concerned that this extra demand on the GPs will inevitably mean less access to a doctor than is the case now.
Many new doctors do not want to work within primary care in the same way as previously and the burden of premises is one key factor that dissuades many from working as GPs. Others cite out-to-date facilities and access to limited support from a wider team of healthcare professionals. As a training practice with Hull York Medical School we see that students who train in well-equipped surgeries are more likely to be retained or come back to primary care, thus helping with recruitment.
In the immediate future we are not looking to increase the number of doctors but rather seek to provide a multi-skilled clinical team with strategic partners, including Humber Health and CHCP Community Services, to work alongside our existing GPs to reduce the doctor input for stable chronic disease patient management and so enable better access for patients with urgent and acute problems to see a doctor sooner and for longer.
With improved facilities we will also be able to add greater value to our new doctor training programme and increase our role in the recruitment and retention of new doctors and nurses
12 comments were made in regard to pharmacy provision, including questions about an on-site pharmacy, concerns over the viability of local pharmacy in Swanland and access to repeat prescriptions (which has been dealt with above)
RESPONSE. The practice is prohibited from directing prescriptions and therefore the choice of which pharmacy to use belongs with the patient. If an onsite pharmacy is available it will not be under the direction or jurisdiction of the practice and the provision of this is a matter for the developer. The only interest the practice has is that, by making part of the proposed new building a commercial outlet, this improves the financial case for the proposed development.
DISPOSAL OPTIONS OF THE EXISTING WILLERBY SURGERY BUILDING
2 comments asked about the use/disposal of the existing surgery premises in Willerby.
RESPONSE. Continued use as a branch surgery is not being considered as there are no funds to support this (as explained previously). The building and land will be offered for sale and the actual use by any prospective owner, which will be different from the current use as a doctors surgery, will be subject to planning permission. This will be a public process and any interested person will be able to make relevant comments at that time to the East Riding of Yorkshire Council.
McCARTHY & STONE / PERSIMMON HOMES
The feedback summary provided to us by the local ward and parish councilors included a comment attributed to a representative from McCarthy & Stone who attended the Swanland meeting and was against the proposed relocation because the current GP surgery complimented the accommodation they were building for retirement living.
The letter from Willerby Parish Council suggested that we should contact Persimmon Homes who were holding an open meeting to launch their housing development plans on the land off Beverley Road, Willerby.
RESPONSE: We have no knowledge of the business plans of McCarthy & Stone nor Persimmon Homes so we are unable to comment on whether location of GP services is an integral part of their commercial process when deciding where to construct new developments.
However, we can state that we have not been approached by either McCarthy & Stone or Persimmon Homes – nor Beal Homes or any other housing developer currently building or intending to build within our practice boundary with the exception of Lovel Development – to ascertain what primary care provision we currently provide in Swanland or Willerby and whether such provision has the capacity to deliver a sustainable service to existing patients as well as the new residents of their housing developments.
We believe that, by recognising that the new housing developments already approved in the East Riding Local Plan will overwhelm us, we have been proactive in identifying the risk to primary care and seeking support from NHS England and East Riding of Yorkshire CCG to address our own concerns of inadequate premises and growth potential. The cooperation from the developer has enabled us to identify the land requirements, associated costs and opportunities for a sustainable, cost effective and strategic alternative to up-scale in a planned deliverable way to meet this rising demand and deliver high quality healthcare for many years to come.
We are grateful to everybody who has given feedback and acknowledge the support from those who have worked with us during our reviews to ensure we have responded fully.
We have not been able to identify any viable alternative proposals to put to our patients and, having considered the financial constraints, the lack of alternative viable options and the time imperative to deliver a sustainable outcome, we do not believe reopening the consultation process will serve to benefit ourselves nor our patients.
The practice remains committed to the preferred option to relocate and we will prepare a final business case to seek full support from NHS England and East Riding or Yorkshire CCG to go ahead with that option.
We remain committed to involving our patients in the logistics of any relocation. We will ask the Patient Group to work with us and HWRACC to develop the volunteer driver scheme and review our appointments system to make a relocation the most successful it can be for all our patients.
We may not be able to deliver the outcome every patient wants – but we will work hard to ensure that what we deliver meets our patients’ needs.
END OF FEEDBACK Willerby and Swanland Surgery 28 June 2018