Thanet GP Hubs: Q & A with head of CCG

Understanding changes to Thanet GP / Primary Care services Save Our NHS in Kent QUESTIONS & ANSWERS - THANET GP HUBS Emails between C Jeffrey (SONIK) and Dr Tony Martin (Chair, Thanet CCG) on the topic of changes to Thanet GP surgeries (aka ‘supersurgeries’) —- On 29 March 2018 at 12:07, C Jeffrey wrote: Hello Tony, I hope you are well. I have a few questions regarding the new GP superhubs plan for Thanet, and I'm hoping that you can provide answers as you are a spokesperson for this proposed change to services and also you are head of Thanet Clinical Commissioning Group.
  1. Would you say that this is overall an increase in services and amenities, a reduction, or will the services and amenities stay the same?
  2. Will there be a public consultation on they change, and if so, when?
  3. Will the change result in fewer GPs or other medical staff in the short or long term?
  4. Will the any of the existing GP surgeries be closed, merged, or left to wither on the vine? Will there be continued and adequate funding for the existing surgeries? Are they likely to lose staff to the new units, and therefore have to close?
  5. Will the 'extra' NHS spend allocated for this proposal be spent entirely on construction work? Is it possible to provide a breakdown of where that spend will go?
  6. We are concerned that the infirm, elderly and people without cars will be forced to out of town locations for primary care; we would like to see guarantees that people in those categories will be able to continue receiving primary care within close proximity in the short and long term. Will this be possible?
Many Thanks, Carly Jeffrey —- On 30 Mar 2018, at 15:02, C Jeffrey wrote: Three more questions I'm afraid!
  • 7. is there an estimate for how many GPs in Thanet are likely to retire in the next 5 years?
  • 8. What is the current GP FTE to patient ratio in Thanet, and how does that compare to the UK average and to ten years ago?
  • 9. Will the number of GPs in Thanet increase or decrease in the next 5 years? Many Thanks, Carly Jeffrey —- On 30 March 2018 at 19:02, MARTIN, Tony (BETHESDA MEDICAL CENTRE - G82105) wrote:
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Good evening Here is an attempt to answer your questions 1. Are we looking at spend, staff numbers, experience or other? Spend should be stable after the injection of build capital. Staff numbers probably increase but with change in mix to reflect modern working methods. So multidisciplinary and working “at the top of your license” are concepts I am sure you are aware of. Patient experience has been greatly improved ( from survey results) for services that are currently provided in the community rather than hospital ( migraine, epilepsy and Ophthalmology to name a few). 2. The entire look at local care in Thanet will be the subject of an open meeting in the next couple of months following on from the one last week at Canterbury cricket club. We want to give residents the opportunity to look at some models and help shape the future. There are changes that have to be consulted on and of course we will. I would be rather driven by wanting to develop a system of care that does what I would want “for me and mine” rather than limiting our consultation scope to the legal must. Surgeries moving or merging must engage with their registered population and submit that consultation to the CCG Primary Care Commissioning Committee with their formal application for change.
  1. As we have discussed at stroke meeting, the traditional model of primary care Is becoming ever more difficult. As an aside a recent survey of newly qualified GPs showed that on average they wish to work 5.5 sessions a week ( for clarity 10 is full time). We are having to change our working pattern to use more non-doctor clinical staff, paramedics, advanced nurse practitioners, physicians associates and others. There is no directive that we must it is the reality of supply that is driving these changes yet one has to say that some of the change is overdue. I don’t need to see coughs and colds and feel my time is best spent having longer to see more complex patients.
  2. Plans beyond Cliftonville are too early for me to try to presume a detailed answer. Our survey of premises last year did highlight a number of surgeries which even with large sums invested would not come upto current requirements for new premises. With regard to the development currently out to planning it will mean the merger of the two practices and relocation of services from Northdown, there has already been communication with those patient groups and more will follow as they move forward . There will have to be consideration as further applications are received of how the surgeries will propose to both improve quality of care and not disadvantage any group.
  3. I probably need you to help me understand what other areas you are concerned about. Of course we have architects, quantity surveyors, planning designers etc as well as the builders but the spend is entirely on delivering the project.
  4. This one will be the subject of the discussions with the patients in the individual projects. As I have said the PCCC will require to be convinced, and it has a lay majority with only two GPs on it.
  5. No precise figure. They are independent contractors so we can only work on averages. The average GP currently retires at 58 or 59. I don’t have the age spread graph with me at home but there is if a remember it right a bulge coming up rather than a linear distribution.
  1. This one will have to wait until next week when I can get the workforce analysis, we have it by practice but that is less useful as it can vary greatly depending on use of non-medical clinicians and locums.
  2. We should see an increase this year with recruitment from outside UK. The new medical school starts its intake in two years and will take another ten to produce GPs. My own view is that we will not see significant increase within 5 years.
I appreciate that these answers may spark more questions and there is a lot that we cannot give set answers on, however our aim is to develop services across Thanet to address our commissioning aims of reducing health inequalities. We have another piece of work that you would be interested in, pulling together the public sector provision of health and well being and looking at how we can collaborate more closely to maximise our impact. This involves TDC, KCC, health and police, the agencies are formulating ideas of how this might be most effective. Kind regards Tony Apologies for brevity, sent mobile —- From: C Jeffrey Date: Monday, 9 April 2018 at 18:14 To: "MARTIN, Tony (BETHESDA MEDICAL CENTRE - G82105)"
Subject: Re: A question regarding the new GP Superhubs Hello again Tony, Many thanks for your answers. Could you reply to these questions too?
  1. Will there be receptionist triage?
  2. You mention that you 'don't need to see coughs' - what if they appear to be simple coughs, but are not coughs, and get missed as the patient has been seen by someone without full GP training?
  3. Who will be seeing these minor cases, if not GPs, and what level of training all they have?
  4. The 'change in mix' - so is it fair to say that this will this result in more, but less qualified staff?
  5. Will there be a formal consultation?
Many thanks, Carly —- 11 April MARTIN, Tony (BETHESDA MEDICAL CENTRE - G82105) Dear Carly, Looking to your questions, we of course work within the recommendations of our professional bodies and require all our staff to work within their professional competencies.
We also have the additional control and needing to ensure that medical indemnity organisations are happy with the range of services an individual is undertaking as they will only cover staff and doctors undertaking care that falls within an expected style of care. For example a nurse who has satisfactorily completed the independent prescribers course can then issue prescriptions for medication themselves as long as it is within an area of care that they have relevant training. So a nurse who has done the prescribers course and an asthma course can then issue prescriptions for asthma medication. Our receptionists ask for details of problems and put them on the appointments page and may escalate a problem but not de-escalate. So if a patient rings in with chest pain and asks for an appointment they will ask whether the patient needs an ambulance rather than waiting and will contact a doctor if in doubt. Across Thanet there are physios, nurse practitioners, paramedics undertaking frontend care roles with physicians associates in training. So there are more staff, I would not like to say a paramedic is less qualified than a doctor but is qualified in a subset of GP work and to be honest has training in some areas I don’t. As you heard last night there are to be listening events called “design by dialogue” relating to health services in Thanet. Individual practices will want to engage with their populations about these changes which I believe are good news for local people. I do not think there will need to be statutory consultation. Regards, Tony Martin ——- 11th April Carly JeffreyDear Tony, Thank you for the information. Do you know when the Thanet 'Design By Dialogue' event will be? I would suggest that a better title for these meetings would be something that people can understand, such as 'Future of GP Services in East Kent', or 'Consultation meeting on Primary Care and Health services in Kent' - currently people have no idea what he meetings are for, if they know of their existence at all. Is there a page online where we can look out for details of Thanet and other 'Design by Dialogue' meetings, or can we subscribe for an alert of some kind? Many Thanks, Carly —- 12 April MARTIN, Tony (BETHESDA MEDICAL CENTRE - G82105)Morning Carly
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Thanks for your comments, I will forward to the event planners, we don’t want this work to be “white middle class”. They will be posted on the CCG web site and we usually notify members of Thanet health network, I’ll let you google it if you aren’t a member already, Kind regards— 12 April Hello Tony, I'm not sure what you mean by 'we don’t want this work to be “white middle class”.' Can you explain? Carly —- 12th April MARTIN, Tony (BETHESDA MEDICAL CENTRE - G82105) Only that, We really want to get the views of a good cross section of the population and suggestions about matters such as event title can be really helpful in engaging Regards

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