Update from the public meeting on 30/01/2019
Welcome and introduction from Sarah Bellars, Director of Nursing, NHS East Berkshire CCG.
In the November meeting, there was standing room only, so this time we found a bigger venue. Sorry we have called you at short notice. At the first meeting, Dr Judge spoke very honestly about the challenges in general practice, and the difficulties she faced running Heath Hill Surgery as the only Partner. Dr Judge explained how she was looking for options to improve the situation, and had approached other local GP partnerships, to offer them a merger opportunity. With support from the CCG, a procurement process was held in December 2018 and Ringmead Medical Practice emerged as the preferred provider.
During the selection process to identify the preferred local practice to join with, some risks around the management, financial position and clinical running of Heath Hill surgery were identified. The CCG in collaboration with the Care Quality Commission (CQC), Local Medical Committee (LMC) and NHS England has taken the challenging decision to bring forward the planned changes to 1st February 2019.
At the first public meeting in November, a particular concern highlighted by patients was the need for general practice services to be provided from the Heath Hill site. We are pleased to say that we are doing just that. We are not taking away – we are adding. Ringmead Medical Practice offer more services that Heath Hill patients are currently receiving, they have more partners, the practice has a “good” CQC rating and over time, all legislators want to bring Crowthorne to the same level as Ringmead Medical Practice. Further detail about the process and the way forward can be found in the questions and answers section.
Where is more information available?
All patients registered at the Heath Hill site will have received letters explaining what is happening and who to contact with questions
Background information regarding services provided by Ringmead Medical Practice can be seen here.
Patients are encouraged to take a look at the rest of the Ringmead Medical Practice website to get an understanding of the services that are on offer.
Questions and answers from the public meeting
1. Why was the change to the practice brought forward?
In November, Dr Judge publically raised the difficulties she faced running Heath Hill Surgery as the only Partner and announced she was looking for options to improve the situation, and had approached other local GP partnerships, to offer them a merger opportunity. With support from the CCG, a procurement process was held in December 2018 and Ringmead Medical Practice emerged as the preferred provider. During the selection process to identify the preferred local practice to join with, some risks around the management, financial position and clinical running of Heath Hill surgery were identified. The CCG in collaboration with the Care Quality Commission, Local Medical Committee and NHS England, as the regulators, took the challenging decision to bring forward the planned changes to 1st February 2019. This joint decision meant we had to move faster.
2. Is the list size too big for the number of GPs employed?
The current clinical staff employed at the Heath Hill site will remain the same. Now Heath Hill patients will have access to clinical staff at the Ringmead sites as well, including the pharmacist, paramedic and dementia services for example. What is important is that every patient is seen by the most appropriate member of staff. Now, Heath Hill site patients can also come to either of the other two sites for appointments.
3. The involvement of the Patient Participation Group (PPG) at Heath Hill could have been better. Why wasn’t the engagement better?
During the public meeting on 30 January 2019, Sarah Bellars, Director of Nursing, NHS East Berkshire CCG acknowledged that the PPG only met with Ringmead Medical Practice the day before , which was very last minute. This entire process has been very fast paced and it is not how we would normally like to proceed. The CCG apologises for this.
4. We have a named doctor who only works 1 day a week. How will these changes affect this?
The fact that your named doctor works one day a week is his/her decision and it is not in our gift to change working hours. However, the practice can ensure that the quality of the consultations, the record keeping, the evidence based practice they follow, should all mean that if you do need to see someone else in an emergency, they will strive to make sure that you receive the best possible care. We hope in time you won’t mind who you see, as each experience will be positive.
5. Will I still have a named GP?
The existing clinical staff at Heath Hill are remaining in place, and so you will still have the same named GP going forward. There is no proposed change to this.
6. Dr Judge said no partners would join Heath Hill Surgery. Why couldn’t partners from other practices join Heath Hill as a partner?
At Ringmead Medical Practice, we have been very lucky with our staff and not just getting but also retaining good partners. They are highly skilled and they joined because they liked what they saw in Ringmead Medical Practice. Nationally, the NHS is losing staff, so we need to make our practice a good place to work. The Heath Hill site will now benefit from the experience and leadership of these partners.
7. Great Hollands has a very different population. How will you manage that?
Yes, patient populations are different, but we will provide high quality care to all. We may take time to learn, we will have challenges, but we are confident that things will get even better than they are now.
8. Which hospitals will I have access to?
All three of the sites that Ringmead Medical Practice provide health services from, form part of East Berkshire CCG, so there will be no change to the hospitals that patients can visit.
9. We have been patients at Heath Hill for 40 years, but we didn’t hear anything about the meeting. Where was it advertised?
We apologise that you did not see any of the posters produced to advertise this meeting. With help from the PPG, posters were displayed on parish notice boards, in shops, within pharmacy bags, on the Heath Hill website and on social media pages. The PPG will work with the Practice Manager from Ringmead Medical Centre to find a way to collect patient email addresses to help spread the word, going forward.
10. Why didn’t the CCG tell patients about concerns previously?
This information was available in the public domain. The CQC published their report in 2018 which highlighted the various concerns from the regulator’s perspective. In addition, during the last public meeting, Dr Judge advised she was struggling and explained why she couldn’t continue to run Heath Hill in the same way.
11. How have HeathWatch Bracknell Forest been involved?
Mark Sanders, representative from HeathWatch Bracknell Forest responded acknowledging that he has been part of the procurement process, and has been challenging back, thinking of the various questions the patient population could ask, and asking them on patients’ behalf. Mark was also involved in the decision to bring forward the date for Ringmead Medical Centre to begin providing health services from the Heath Hill site. Mark was reassured by the process and believes that Ringmead Medical Practice want to make the best possible experience for Heath Hill patients, and in a years’ time, the majority of patients will be really supportive of this decision and the services being provided.
12. Can patients choose where to be seen?
Currently, patients from Great Hollands and Birch Hill can visit either practice, and their patient record can be seen on the same system. That is the ambition for Heath Hill. From the 1st February, Ringmead Medical Practice will be able to view and manage all patient records. The only difference is that the records are not merged onto the same system. They are however fully accessible and there is no risk to patients.
13. How will the Heath Hill service cover the additional care homes planned?
The CCG are aware of the detailed planning application for extra care homes, as well as there being a new transport site nearby. The CCG are in conversation with those developers as are the local authority to ensure all provisions are accounted for e.g social care.
14. Are you working with Wokingham Borough Council the same way you are working with Bracknell Forest Council?
The East Berkshire CCG can ensure that we work with our counterparts in West Berkshire CCG going forward, to ensure councillor engagement.
15. What is Dr Judge’s role in this process?
Dr Judge gave notice on her General Medical Services contract. Having become aware of some risks around the management, financial position and clinical running of Heath Hill surgery, the regulators made a joint decision to bring this forward. Ringmead Medical Practice has invited Dr Judge to join the practice and she has confirmed she will be staying on as a practising GP.
16. What will the practice be called?
We will welcome suggestions as it would be good to hear from you. It could be Ringmead Medical Practice, Crowthorne for example, but we believe the name isn’t important – what is important is that we deliver a quality service to our patients. If you have any ideas, please hand them into the reception at the Heath Hill site.
17. How strict is your practice boundary?
All existing Heath Hill patients are welcome to join Ringmead Medical Practice.
18. What will happen to the Heath Hill website?
Patients will be encouraged to use the Ringmead Medical Practice main webpage http://www.ringmeadmedicalpractice.org.uk so that all patient information can be kept in one place. Currently the page is still live, but request patients to use the Ringmead Medical Practice website.
19. How will patient access work?
Online Patient Access will still work, as we will have access to your records. At the moment, Heath Hill patients can only order repeat prescriptions. Ringmead Medical Practice patients have access to their entire medical record online. It is all about efficiency. Give us time to get it right for you too.
Currently, E-consultation will not work for Heath Hill patients, but we are working on making that happen.
20. Will Ringmead Medical Practice use the NHS app?
The aspiration is yes – just need time. Ringmead Medical Practice are a high performing practice and are quick to pick up new initiatives when possible.
21. Currently the turnaround of prescriptions is 5 days. Can that be improved?
Our aim was to improve the standard of services. 5 days is not achieving the standard we require and the CCG would expect this to improve in due course. Ringmead Medical Practice currently has a turnaround time of 48 hours to get to the pharmacy. The pharmacy then takes time to process it. Going forward, patients will be encouraged to register for online prescriptions, which increase effectiveness further.
22. Where do I put my repeat prescriptions?
Please hand in your repeat prescriptions as you normally would. There is no immediate change until we review the current systems and then we will let you know accordingly.
23. How does GDPR apply re merging the patient records?
Dr Jim Kennedy, Medical Director of Local Medical Committee, explained that GP practices are partnerships not limited companies and NHS regulations mean that data can move from one practice to another, as long as they hold the General Medical Services contract. This is to avoid patients being left in limbo, and to ensure you always have a GP. These special clauses in the NHS act ensure a smooth transfer across.
Background information about Ringmead Medical Practice
Ringmead Medical Practice going forward will have three sites from the 1st February. Dr Sachdev highlighted the services the current two sites offer, to explain what services Heath Hill patients will have access to. Regarding the future of the Heath Hill practice, Dr Sachdev sees all three sites working as one practice to continue all the good work that has been happening. Ringmead Medical Practice currently look after Wellington College so are familiar with the area.
Ringmead Medical Practice has 6 partners and over time has attracted the right staff; clinical and non-clinical to make it an excellent team. The practice is using innovative strategies to ensure that patients can be seen appropriately, without long waiting times. This is done by having a pharmacist working in the practice to organise medication, routine consultations for non-complicated blood pressures for example. There are also 2 paramedic practitioners, who are highly trained in the field of minor illnesses and so do same day appointments and home visits when required.
The current two sites are “dementia friendly” and we have a dementia advisor to help patients and their carers. They also offer psychological support for those with long term conditions; these are hour long appointments looking at the overall wellbeing of the patients. Ringmead Medical Practice are in discussions to support patients with orthopaedic needs, as so much can be done before surgery is even needed. These treatment plans could perhaps be put in place locally, at the GP surgery. These are the kind of skill sets that we can offer to new patients at the Heath Hill site.
The clinical team have great doctors and a fantastic nursing team, supporting all the practice team and have a great relationship with the practice, but no clinical team works without a strong administration team. Ringmead Medical Practice has a strong practice manager, with a medical background, who has been with the practice for 5 years, and is hugely involved with lots of the new innovative work that Ringmead Medical Practice does. There is also a “Patient Services Manager,” and specialised administrators. This strong management is the “power house” of the practice, ensuring the practice runs smoothly, and that everyone is doing the job they are supposed to, in the most effective manner. The reception staff and administrators are “Patient service advisors,” as that is their role – ensuring each patient is seen by the right person. Have a look at the Feeling Unwell leaflet at the end of this document, to see how staff help to signpost patients. Other areas want to adopt this approach as it has found to work well as it contributes towards making sure patients are not waiting.
The ethos at Ringmead Medical Practice is to learn and improve so they can be the best for patients, and offer the best possible service. Currently, there are 16,000 patients on the Ringmead Medical Practice list, and staff at the practice have a wealth of knowledge and experience, being local and national leads for various different clinical areas e.g. Cancer lead for Thames Valley. Ringmead Medical Practice train junior doctors, and have links with Frimley Park Hospital and other areas, and want to be a specialist training facility.
The NHS is changing and smaller practices can’t be effective. The national push is towards bigger practices who can deliver specialist services so patients don’t have to go far to get what they need. Ringmead Medical Practice, offer an extended hour service, so are open late in the evening and at weekends. Ringmead Medical Practice do specialist services eg cardiology 24 hour monitoring and have won the national Cardiovascular award and GP innovation award.
A reminder to Heath Hill patients: general practice services will continue as they are – in the same place. Change will come slowly, and in consultation with staff and the Patient Participation Group, it is hoped a joint vision will be developed and together implement the changes. Ringmead Medical Practice want to retain staff, as they hear from patients the excellent work they have done and we want to keep them.
The CQC are supportive of the process to date, but Ringmead Medical Practice will be accountable for patient safety and quality from the 1st February. In order to ensure these factors are looked out for, few immediate changes will be made to patient facing services – everything will remain as it currently is. Quality and safety of patients at the heart of all decisions.
Documents shared at the public meeting
Please review the documents below: