Feb
24
Chloe's formal response and open letter on NHS Norfolk and Waveney's GP services consultation
Author: Chloe Smith, Updated: 24 February 2023 14:39
Today I published my formal response to the NHS Norfolk and Waveney consultation on GP services and the walk-in centre at Rouen Road in Norwich confirming my opposition to the proposal to close the walk-in centre.
In an open letter to Tracey Bleakley, CEO of NHS Norfolk and Waveney Integrated Care Board, published below, I am seeking answers to a list of questions, firstly about pressure on GP and A&E services, and secondly, about how the consultation has been carried out.
I have had to campaign on behalf of residents repeatedly over 15 years in Norwich North, against attempts to close walk-in centre services. They are popular and helpful and have served thousands of Norwich people over many years. When A&E and GP services are under particular pressure, it is hard to believe that a proposal is made once again to stop a simple way for people to see a doctor when they need to. Too many constituents tell me that they are concerned they can’t get a GP appointment when they need one, and they're worried about A&E. So we need to better help patients to get the right care rather than make it harder.
Constituents need better answers. I've put comprehensive questions to the NHS on their proposal, and I hope they can provide much greater reassurance to residents that a good service is not going to be taken away. I am certainly not convinced that the removal of a well-used, CQC-rated 'good', seven-days-a-week, walk-in facility will improve patient care for my constituents in Norwich North.
I have profound concerns about aspects of this consultation, and I believe the ICB needs to do much more work to set out a more specific, costed, better-explained option so that the public can take a proper view.
I believe the ICB now needs to undertake further work to set out a more specific third option so that the public can take a proper view. I also await more reassurances on all the points made in my letter, and by others in responding to the consultation.
The GP services consultation remains live until 26 March, and constituents are actively encouraged to share their views and give their feedback on the proposals through the survey.
Details of the survey are available here:
A link to the live survey is here:
You can read my open letter to Tracey Bleakley, CEO of NHS Norfolk and Waveney Integrated Care Board, below:
24 February 2023
Ms Tracey Bleakley
CEO
NHS Norfolk and Waveney (ICB)
By email
Dear Tracey,
Re: Consultation into GP services at Rouen Road
Thank you to your team for meeting me recently, to take me through your plans for the future of the GP services, the Vulnerable Adults Service and the walk-in centre (WiC) located at Rouen Road in Norwich.
As indicated during the meeting, I am writing to provide my official feedback to your GP Services consultation which launched on Tuesday 24 January 2023.
My office received an embargoed copy of your consultation on the evening of Monday 23 January, and I published your consultation to my website on Tuesday 24 January 2023 supported by social media posts to encourage participation. This news came as much as a shock to me, as it has my constituents.
Concerns about pressure on primary care
Firstly, we all want to see improvements in primary care, because too many constituents tell me that they are concerned they can’t get a GP appointment when they need one.
However, having conducted my own constituency research throughout November and December 2022, constituents' main healthcare concern is accessing a GP. With no prior knowledge of the proposal to review the Rouen Road collection of services, feedback from my constituents indicates how valuable the walk-in centre is in meeting an urgent need, when a constituent is unable to access a GP appointment quickly enough. Quite simply the walk-in centre is a lifeline for patients.
Your own data corroborates the high level of footfall at the WiC. You will have already received opposition to the plans, and a petition to save the walk-in centre has garnered over 6,300 signatures to date.
So, I am concerned that the timing of your suggestion to close the walk-in centre will only compound pressures on primary and urgent care. Constituents have told me that they fear that local A&E services will suffer with increased attendance as a consequence of closing the walk-in centre. You have told me your views on that fear, and I would be interested to know wider sector views.
What are the views of the Norfolk and Norwich University Hospital on your proposals, particularly in relation to closing the walk-in centre?
What views have been received from the wider primary care network in Norwich to your consultation?
You have said that your data indicates that patients are using the walk-in centre to meet the unmet demand for GP appointments, which chimes with the feedback that I have received from constituents. I have asked for your assurances in your modelling of the future size of GP patient lists, which I appreciate may vary by practice, but is helpful in recognising GP workloads.
Is it your intention to grow GP patient lists across the city? If so, please specify.
How many residents of Norwich are not currently registered with a GP?
I am equally concerned at how you propose to re-distribute the funding across Norwich's existing GP practice network, at a time when practices are not fully delivering GP appointments within 2 weeks. Given the footfall into the walk-in centre, and your view that the walk-in centre is being used for GP services;
What proportion of the 6,000 plus appointments per month are for clinical time that would routinely fall into the remit of a GP practice?
You said that patients are experiencing difficulty with identifying the correct 'front door' for their needs. More may need to be done to encourage the use of NHS 111, and otherwise to direct patients to the right service, at the right time for their needs, but simply removing one of those 'front doors' seems unlikely to be a common-sense way to achieve this.
What steps will you take to encourage people to use the right NHS help, beyond the proposals in your consultation that could remove the walk-in centre?
I am always mindful of some elderly and disadvantaged constituents who find accessing GP services is a challenge where GP practices have encouraged a 'digital first' approach. Those constituents benefit from the simplicity and accessible service offered by the walk-in centre. People who already struggle to use services should not be further disadvantaged in the pursuit of streamlining healthcare services or re-balancing need.
What considerations have you made for patients without the means to access services digitally?
I have asked for reassurance of an out-of-hours GP service, and have been told me that this is unchanged. An out-of-hours GP service must remain accessible for constituents.
I recognise that you feel that the city has unmet and increasingly varied needs in respect of healthcare. Aside from a heat map provided in appendix 1 of your consultation document, there does not appear to be any further detailed information on the varied needs of the local population.
What specific health inequalities are you actively seeking to address?
Is change to the GP services contract and closure of the WiC at Rouen Road, the only means by which to achieve this?
What service are you expecting to offer to visitors and traveller communities?
What other work is taking place to address health inequalities?
Whilst GP recruitment is increasing, more progress needs to be made in growing and retaining the GP workforce, and therefore I would be keen to understand;
What are your plans as an ICS, to further expand the workforce locally and attract more healthcare professionals to work and remain in Norwich and Norfolk?
Concerns about the consultation
The Eastern Daily Press reported on the consultation on Monday 13 February, that it had "emerged that of the more than 5,000 people who have tried to take part in an NHS survey over the issue, just 1,600 completed the process." When we met, your representatives characterised this as an opportunity for people to finish the consultation. I am concerned at the suggestion that around two thirds of the individuals who had made an attempt to complete the survey were in some way unable to, and I'd be interested to hear your response and more detailed evaluation of reasons for non-completion.
Healthwatch Norfolk have commented on the accessibility of the language used in the survey and consultation document, and having reviewed the consultation pack, I share those concerns and question the accessibility of the published consultation communications. I would be most grateful if you would provide me with a copy of your response to Healthwatch’s concerns.
I am surprised at the lack of financial data contained within the consultation, which suggests that no cost-benefit analysis has been conducted on the three options contained within the proposal. I would be interested to have sight of your financial assessments for each proposed option, if they have been carried out.
I have profound concerns that you are expecting the public to try and conceptualise a meaningful service in option 3, that you yourselves have not yet fully scoped. You will be aware of the Gunning principles that govern public consultation, and I would be grateful for your assurance of how you believe option 3 can support “intelligent consideration”. At the moment, my constituents tell me they have real concerns that a vital service will simply be withdrawn, and they have not yet received reassurance of what will replace it, or if they will be able or eligible to access it.
Finally, I would be interested to know what case studies you have examined across wider Integrated Care Systems and Primary Care Networks where the closure of a walk-in centre was under consideration.
What examples of healthcare innovation and efficiency have you explored?
What patient care outcomes and actual benefits to the community can you identify?
Conclusion
I have had to campaign on behalf of residents repeatedly over 15 years in Norwich North against attempts to close walk-in centre services. They are popular and helpful and have served thousands of Norwich people over many years. When A&E and GP services are under particular pressure, it is hard to believe that the proposal is made once again to stop a simple way for people to see a doctor when they need to.
The creation of Integrated Care Systems was designed to improve the health outcomes of a population, by bringing together the key players across primary care, the Local Authority, and partner organisations, with a view to increased collaboration and better health outcomes for patients. I need to be further convinced that the removal of a well-used, CQC-rated 'good', seven-days-a-week, walk-in facility will improve patient care for my constituents.
I believe you need to do much more work to set out a more specific third option so that the public can take a proper view. I also await more reassurances on all the points made in this letter, and by others in responding to your consultation.
Please be advised that I will be publishing this response on my website.
I look forward to receiving your response in due course.
Yours sincerely,
Chloe
The Rt. Hon. Chloe Smith MP
Member of Parliament for Norwich North
Email: chloe@chloesmith.org.uk
Tel: 01603 414 756
Chloe Smith