Thame hospital League of Friends rejects review result

THE League of Friends of Thame Community Hospital are urging local people to join them on a coach from Thame to attend a crucial meeting about the future of medical cover at the hospital.

The Overview and Scrutiny Committee ? the health watchdog of Buckinghamshire County Council ? will meet next week to debate the recent decision of the Buckinghamshire PCT Review Group that the controversial new arrangements for medical cover should stay in place.

Sarah Taylor, Chair of the League of Friends said: “We are very disappointed about the Review Group?s recommendation and hope that the Overview and Scrutiny Committee will instead recommend that responsibility for medical cover at the hospital is returned to local GPs. We want to see our own local doctors looking after our hospital.”

Doctors from the Rycote Practice have compiled a detailed list of the factual errors in the the report of the review group and are sending this to the committee for consideration in advance of the meeting.

Dr. Richard Harrington said: “The petition supporting our bid to continue looking after the in-patient beds at the hospital has 4,800 signatures, and we very much hope that the Overview and Scrutiny Committee will take account of the strength of local feeling in its deliberations next week. We feel that the Review Group has based its decision about medical cover for Thame Hospital on incorrect information.”

Dr Duncan Keeley said: “The PCT has repeatedly assured us that there are no plans to close the in-patient beds at the hospital, but we are very concerned to make sure that the four closed beds are re-opened as soon as possible. For that to happen better medical cover arrangements are needed.”

The Overview and Scrutiny Committee meeting takes place at South Buckinghamshire Distict Council, Oxford Road, Denham UB9 4LH, at 10am on Friday, December 11, 2009. Anyone who would like a place on the coach, which will leave Thame at 9 am, should contact Elisabeth Orde-Browne on 01844 216515.

QUESTIONS FOR THE OVERVIEW AND SCUTINY COMMITTEE

The following are the comments and questions sent to the committee in advance of its meeting on December, 11, by the Thame GPs.

We hope that the committee will stand by its previous unanimous decision that the change in arrangements for medical cover at Thame Community hospital constitutes a substantial change in service. This remains the strongly held view of local GPs and the local population.

Regardless of its decision in this respect, given the very clearly expressed views of the local community in and around Thame on the changes in medical cover at Thame Community Hospital, and the factual errors of fundamental importance to its conclusions identified in the Review Panel Report, would the Committee consider recommending to Buckinghamshire Primary Care Trust that responsibility for medical cover at the hospital be returned to the Rycote and Wellington House practices?

THE RYCOTE PRACTICE’S RESPONSE TO THE REPORT OF THE BUCKS INDEPENDENT REVIEW PANEL, ISSUED ON NOVEMBER 23, 2009:

? We thank the Overview and Scrutiny Committee once again giving their attention to this matter.
? We wish to draw committee members? attention to important errors of fact in the Review Panel report and we hope that these issues, and the level of public concern in our community will be taken into account in the committee?s deliberations.
? We hope that the committee might recommend a variation in the conclusion of the Report in respect of Thame Community Hospital.

1. We are delighted that the Panel recognizes the need to re-negotiate the hours of medical services provided to the Community Hospital (p21, 24) as we have long argued. We consider our refusal to bid for the lower option of medical cover to TCH (4 hours per week) to have been entirely vindicated by the Panel?s report, more so when one allows for the fact that TCH since the new arrangements started has only had 8 beds open and the original specification was to cover 12 beds.
2. We endorse the development and enhancement of a nurse-led service at TCH which we hope will mirror initiatives in the nursing role long-established at the Rycote Practice. We look forward to a continuing, close and supportive role with our nursing colleagues at TCH.
3. We note that the Panel disagrees with the unanimous view of The Buckinghamshire County Council Overview and Scrutiny Committee that the change in medical cover is a substantial variation in service. We disagree with the Panel?s conclusion (p22) ?that the change in medical cover arrangements was not a substantial variation of service? with respect to Thame. We can conclusively demonstrate that this is because the Panel simply perpetuated the PCT?s failure to understand the previous and interim medical arrangements in respect of TCH; see appendix below.
4. We note that the Panel acknowledges (p3) the level of public concern in Thame . However the Panel makes no detailed reference to the petition, to the unanimous vote in a packed public meeting in support of the petition, and to the vociferous public criticism of the tender process and outcomes. The Report does not mention, and appears to ignore, the Darzi criteria for world class commissioning.
5. We concur with the Panel?s criticisms (p21) of the service specification (including failure to engage with local GPs, insufficient thought with regard to development of a nurse-led model and failure to understand the previous arrangements). However we believe that these failures sufficiently undermine the tendering process to render it untenable.
6. We are disappointed the Panel pays scant regard to the unique educational opportunities provided by the synergy between the Rycote Practice and TCH with regard to the training of nurses, nurse practitioners, general practitioners and medical students. This synergy will be lost if medical cover is not retained by the Rycote Practice given its current role in nurse training (linked to Luton University), GP training (through the Oxford Deanery) and medical student training (through a substantive post with Oxford University medical school).
7. We regret that the Panel fails to recognize the stature of the Rycote Practice as a beacon of good medical practice within the PCT particularly with regard to prescribing costs, referral practice, the continued provision of a Saturday morning service.
8. We disagree with the Report?s conclusion that responsibility for medical cover of Thame Community Hospital should remain with The Practice plc, and believe instead that this responsibility should be restored to our local practices The Report contains a number of significant factual errors, detailed in an appendix to this document. We believe that these errors may help explain why the report has reached the wrong conclusion in respect of Thame Hospital.
9. The Report calls on the PCT/NHS Buckinghamshire to ?explore ways of creating closer links with each community hospital?s League of Friends and local GPs? (Recommendation 5) and to ?redouble its efforts to ensure patient and public involvement in the commissioning of services? (Recommendation 7) , but the main conclusion of the Report is in flat contradiction of these principles.
10. We call on the Overview and Scrutiny Committee to change the Report?s recommendation that the Practice plc should remain responsible for medical cover at Thame Community Hospital and recommend that the responsibility be restored to the Rycote and Wellington House practices.

Appendix: factual errors in the Report relating to Thame Community Hospital

We appreciate that the Panel was required to assimilate, digest and report on a great deal of material in a short space of time. Unfortunately during this process some vital and specific information relating to Thame and some important general details have been misreported or overlooked.

1. The Report attaches major importance to the number of hours for which local GPs attended TCH after the ending of the placement for GP registrars This figure is set at ?up to one hour?s medical cover per day from the Rycote Practice? on page 8 of the report and this figure of one hour per day is given no less than seven times: on pp 8 (twice), 13, 15, 18 (table), 21 and 27. Importantly, this figure is INCORRECT . More than double this level of medical cover was being provided during that period.

The correct situation is that Rycote and Wellington House practices had agreed to provide a minimum of 2 hours per day of GP time to be spent at TCH on a planned, pro-active basis (9-11am) with additional GP visits to be provided on an emergency or urgent basis between 8am and 6.30 pm Monday to Friday and 9-11 on Saturday mornings. These arrangements were in place for one month (not two months as stated in the report) during August 2009 (with the same GP visiting each day as described) and would have continued indefinitely had Rycote / Wellington House been awarded the contract.

It is a matter of the deepest regret that the Panel having attached such importance to this issue provides data which is simply inaccurate. As a result the Report?s conclusions in respect of Thame are incorrect and should altered.

Rycote Practice GPs continue to visit their patients at TCH even under the present arrangements, to maintain contact and liaise with family members as necessary e.g. regarding end of life issues or future locus of care.

2. The Report states (p18) that 8 beds were open at Thame prior to the changes. In fact 12 beds were open. The Panel were fully informed of this by us, and that patient outcomes under the new arrangements could not be properly evaluated as a result.

3. The report fails to mention or acknowledge the letter from Dr Simon Plint of the Oxford Deanery supporting the GP registrar placement at the hospital and the likelihood of its eventual restoration, and the quality of educational supervision provided by the Rycote Practice.

4. The Report states ((p10) that ?the range of duties provided was not being changed? ? but in fact the level of medical cover was being substantially reduced, and key requirements in the original tender specification ( daily ward rounds, attendance at multidisciplinary meetings, support for enhanced nursing practice) had been dropped .

5. The Report states (p13) that there had been ?insufficient? involvement of GPs on the development of the service specification. In fact there had been no involvement of GPs whatsoever, and no involvement of the Professional Executive Committee of the PCT. The Report attaches no importance to this extraordinary failure.

6. The Report states (p14) that ?the GPs felt that eight hours would be sufficient.? We in fact argued that eight hours was also insufficient for the duties as set out in the original tender, but safely sustainable given the easy availability of our practices for urgent and emergency situations and our willingness to work above and beyond the letter of the contract.

7. The Report states (p14 para3) that ?ward rounds were not considered as a key part of the role? despite the fact that these were stated as a key deliverable in the original tender specification.

8. The Report states (p16) ?on the question of safety it was noted that the current system of provision of medical cover was not significantly different from that which was in place immediately prior to the new service.? This is not true. The paragraph goes on to state a need to ?manage admissions avoiding medically unstable and complex admissions? as being ?key to future success?. In fact such a restriction on use of the community hospital in-patient beds would substantially reduce their usefulness and their ability to relieve pressure on the acute Trusts.

9. The Report states (p8) in respect of the role of GP registrars at TCH that ?the level of security even within this system depended upon the varied practice and experience of the Doctor in place at the time as would be the case for all models?. This is incorrect; ?security? was provided by the GP trainer, a Rycote partner with several decades of experience of primary care and GP training and who visited TCH at least once a week. In addition, patients? usual GP?s were available and free to visit and advise on management issues or terminal care.

Other aspects of the report worthy of comment include:

a) The Report refers to ?the views of a large number of local residents? which were reported to the Panel but it fails to set out these views. We ask: What were the views of local residents and why are they not included in the Report?

b) The Report states (p 23) ?The panel concluded that the public?s concern that the tender was awarded to a commercial organization was unfounded. GP practices are similarly profit making businesses, which contract independently with the NHS. Thus there is no material difference between the two types of organization.?

We would point out that 4,947 people have now signed our petition, the wording of which is repeated in pp 3-4 of the Report. It makes no reference to the role of a commercial organization in the tender process. There are however material differences between the Rycote / Wellington House practices and The Practice plc. In the former, care is provided by a small group of GPs, nurses and other colleagues who have a long tradition of providing high quality, personal and continuing primary care limited to a single, geographically discrete and local population ? which forms a significant proportion of the population that is served by Thame Community Hospital.

b) The Report states (p15 para 1 ) in respect of emergencies that ? it is considered inappropriate practice to call a GP first in these circumstances as they would mostly have to call 999 in any case?? This is a strange and incorrect statement, implementation of which would substantially increase unnecessary demand on 999 ambulances and avoidable admissions to acute trusts. It is then acknowledged that ?the Practice plc was not always easy to contact? and suggested that the ambulance service should play an increased role in emergency response to the community hospitals.

c) We regret that the original procurement process did not run its course and wish to put on record the full co-operation of Rycote / Wellington House practices with all aspect of the tendering process and PCT requirements across the whole board of primary care activity.