Losing the NHS Slice by Slice

SHROPDOC

Back in 2005, GP practices lost the responsibility for providing their own Out of Hours GP care. A variety of new approaches sprang up around the country – some of them good, some of them absolutely rotten. When GP Out of Hours services don’t work well, patients can die. It’s important that GP Out of Hours care is effective. This is the service you contact when you’re ill, scared – and you don’t know whether to go to A&E or go back to bed. Good clinical advice from a doctor you trust is as important as it gets.

In Shropshire and Telford and Wrekin, we’re very, very lucky.  Our GP Out of Hours service is provided by Shropdoc. It’s a GP cooperative, staffed by local doctors who know their patients and know the area. When we ring Shropdoc, we can pretty much rely on speaking to a doctor with little or no delay. Shropdoc provides phone advice, and face to face appointments. It’s a valued and trusted service. A CCG survey found that 88% of respondents know about Shropdoc, and 82% of those had used Shropdoc themselves. Satisfaction rates were extraordinarily high: 94% of those who had used the service were satisfied or very satisfied, with just shy of four out of five being ‘very satisfied’. It’s a service that works well. The 94% of users satisfied with Shropdoc stands in sharp contrast to the 33% satisfaction rate of NHS 111 users.

Shropdoc under threat

Most of us will have found this out by accident – but our two NHS Clinical Commissioning Groups (‘CCGs’, the local organisations that plan and buy NHS care) have been discussing changes that could lead to the end of Shropdoc. They think they’ve run ‘an extensive engagement programme’ with the public. Feedback from members of the public is that most of us regard this as a ‘semi-secret engagement programme’. It’s particularly remarkable that their engagement exercise didn’t actually mention that Shropdoc was at risk! The feedback they’ve had from the public, once we worked out what the plans were, is that Shropdoc has to stay.

Where are we now?

Shropshire CCG and Telford and Wrekin CCG are meeting on Wednesday 10^th February to decide their next steps. Their plans are complicated, and may be dressed up to try and convince us that nothing will change. The reality is that we are going to lose the opportunity to call Shropdoc directly, and will have to go through the NHS 111 computer pathway and its unqualified call handlers before we get to speak to a doctor. This will take effect sometime between 1^st May 2017 and 1^st April 2018. Shropdoc itself will be put out to tender, probably in June 2017. Significant changes to the contract mean that local GPs will have to think very carefully about whether or not they will want to bid for the new service, given the pressures they are already under. The new Out of Hours service – run by Shropdoc or another provider – is intended to be in place from 1^st April 2018.

These are the ‘preferred options’ going to the meeting on Wednesday. It is confusing, but the outcome – if these plans are rubber stamped – will be very damaging. At the moment, we can ring the Shropdoc number and speak to a local GP quickly and easily. In the future, we will not be able to do this. The Shropdoc phone number will be taken away. We will be allowed to speak to a doctor only if the computer says we can speak to a doctor.

The paperwork going to the CCG Boards tries to give the impression that they have to do this because it is a ‘requirement’ from NHS England. This is just not true. The guidance from NHS England is for provision of an NHS 111 service – but does not require them to take away the separate phone number for Shropdoc (or whatever Out of Hours service replaces Shropdoc if Shropdoc doesn’t bid for or win the new contract). All of us support integration – different services talking to one another and sharing records. This can and should be done. The CCG plans, though, are for a worse service – a service that takes away our choice, and restricts our access to our locally provided GP Out of Hours service. And lying ahead is the threat of Shropdoc being decommissioned and replaced with a very different service.

Let the NHS chiefs know your views

The meeting that takes the decisions will be at The Reynolds Suite, Holiday Inn Telford/Ironbridge, St Quentin Gate, Telford, TF3 4EH at 5.30 pm on Wednesday 10^th February.

This is a public meeting – anybody can attend. If you can’t make the meeting, think about submitting a question to the Board. These can be sent in writing to the Chair: Dr Helen Herritty, Shropshire CCG, Somerby Suite, William Farr House, Mytton Oak Road, Shrewsbury, SY3 8XL or emailed to Helen.Herritty@shropshireccg.nhs.uk.

A NEW THREAT TO COMMUNITY HOSPITAL BEDS

It can start to feel that we’re losing the NHS slice by slice.

Shropshire Clinical Commissioning Group is working out how to make £14.6 million cuts next year. The sad reality is that there is just not enough money coming into Shropshire’s NHS, reflecting real funding discrimination against rural areas and areas with an older population. The CCG is looking at its expenditure line by line.

We know that the CCG is comparing the cost of beds in community hospitals with the cost of independent sector care home beds. They’ve found that community hospital beds cost more than three times as much. That’s no surprise. Community hospitals have far higher levels of nursing and medical care. They’re hospitals, after all! There is a risk, though, that the cost difference means community hospital beds will be ‘decommissioned’ – taken away and replaced with care home beds. This would be a substantially worse service for Shropshire people, and could destabilise all the other services available at community hospitals.

We contacted the Chief Executive of Shropshire Community Trust and the interim Accountable Officer of Shropshire CCG, asking them for more information. We hoped they would rule out a threat to community hospital beds. Neither of them was able to do this.

Decisions will be taken before the 31^st March, when new contracts are signed. We’ll be watching closely.