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 

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For Willerby the X80/180 runs 12 times a day from Willerby to the Red Lion 

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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. 

1.  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.

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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. 

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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). 

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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. 

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    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.

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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. 

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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. 

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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.  

PARKING 

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. 

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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. 

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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. 

PRESCRIPTIONS 

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. 

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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. 

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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. 

APPOINTMENTS 

13 comments were received with questions/concerns that making appointments would become (or remain) difficult and we have identified 2 main elements 

1.  Extra patients will place more demand on the appointment system 

2.  Appointments with choice of doctor 

1.  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. 

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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 

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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. 

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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. 

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    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. 

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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.  

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PUBLIC MEETINGS 

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. 

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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 

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PHARMACY 

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. 

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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.

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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.  

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NEXT STEPS  

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. 

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END OF FEEDBACK        Willerby and Swanland Surgery 28 June 2018