Cockermouth GP Merger
Around 50 members of the Patient Participation groups
for both Castlegate and Derwent surgeries attended a meeting
on Monday, June 1 2015 where GPs and the hospital manager
explained the current situation. The meeting was told
that the sudden departure of two GPs had led to a decision
to merge the two GP practices.
It was stated the merger would lead to 'tangible benefits'
and increased sustainability and the plan was to merge
by October 2015. Dr Desert said the main aim was sustainability,
both financially but also in terms of creating a unit
that would attract GPs and continue a role in training.
He pointed out that "10% of UK GP surgeries are having
difficulty recruiting and some have sold out to Virgin
Health Care." Dr Kingan said the merger had been necessary
after two Derwent GPs left. The meeting heard that there
had been seven possible applicants being considered.
There was praise and spontaneous applause from the meeting
at the levels of service provided by the GP team. Dr Desert
said the GP part of the new hospital had proved "much
more expensive than expected". There was some disbelief
when he claimed the running costs had not been disclosed
until a year into the project. The meeting was told by
Sid Williamson, Castlegate Practice Manager, that the
first floor part of the hospital cost £230,000 a
year in fees, with £170,000 for the surgeries. He
said and organisation called CHP were the landlords and
"we haven't paid a penny yet" as there were legal bids
to get the contract adjusted.
Dr Desert added "we are stuck in a perfect storm." He
said the problems faced by the acute hospital trusts meant
those hospitals had not been able to progress moving services
to Cockermouth. Yet again the meeting was given a promise
of earlier and later opening times. Dr Desert was asked
why there was no charge for car parking and he explained
that the number plate recognition system was ready to
be used and when it became live, patients would not have
to pay and other users would get one and a half hours
free access.
Addressing the meeting were: Mr Sid Williamson, Castlgate
Practice Manager; Dr Simon Desert, Dr Mark Kinghan, Dr
Rebecca Qualtrough; Dr Gill Campbell.
D.S.
Subsequent article in Times&Star newspaper:
A TOP doctor has revealed the challenges faced by staff
at Cockermouthâ€s flagship community
hospital.
Sixteen months after the £11 million hospital opened:
l Staffing issues mean services like X-rays and an ultrasound
scanner cannot be installed
l Basic running costs are £230,000 a year - far
higher than anyone had anticipated
l Large areas of the hospital remain unused, including
the dental practice
l A full minor injuries service has not been funded
l Doctors are holding back payment to landlords
l There are fears that GP vacancies will not be filled
l Its pharmacy is not profitable
Dr Desert, of Castlegate Surgery, said while they and
Derwent Surgery were happy working in the new building
on Isel Road, it was frustrating for medical staff because
politics gets in the way of healthcare.
He added: It's inordinately frustrating. We had to fight
for a long time to get the building but actually constructing
the services is proving more difficult than the building.
Multiple reorganisation in the NHS has created these problems.
The challenges that we face with our two acute hospitals
makes it very difficult for them to focus on anything
other than the most critical thing.
Being able to sort out a peripheral hospitals at Cockermouth
is not on their A-list.
We have been a hostage to fortune with the times.
Doctors are keen for the acute trust, which runs the West
Cumberland Hospital in Whitehaven and Carlisle's Cumberland
Infirmary, to provide more outpatient services.
Dr Desert said it would benefit patients and save the
NHS money.
He said: The NHS spends money in mysterious ways.
An emergency ambulance taking someone to the West Cumberland
Hospital costs more than £350 for one trip. So many
journeys would not be necessary if you could perform investigations
closer to home.
By having more services based in the Cockermouth hospital
it would also save the acute trust spending huge amounts
on transporting patients to clinics at Workington, Whitehaven
and Carlisle.
When plans for the new hospital were announced, patients
were told that alongside the surgeries and hospital beds
there would be a dental practice, X-ray and ultrasound
and minor injury units.
But 16 months later, the many rooms built to house the
additional services are in pristine condition and vacant.
Large areas of the hospital sit unused.
The dental suite which was created but never filled is
likely to be refitted so it can be used by another health
care provider.
Dr Desert added: The acute trust have been to see it a
number of times and are considering it.â€
The hospitalâ€s league of friends has
money set aside for the ultrasound scanner but, according
to Dr Desert: The acute trust is unable to commit to providing
staff to use it.
The reality is they struggle to get staff.
Staffing is also preventing the opening of the X-ray service.
Dr Desert added: We have not got all the money for the
X-ray service but are convinced we could soon raise that
once we had a clear undertaking that we would have it
staffed and functioning.â€
The minor injuries unit is not funded yet so is restricted
to practice hours.
He said: The minor injuries unit is complicated to staff
because you need nursing staff specifically trained, they
also need medical back-up.
But we feel run in conjunction with other services in
the building we could provide a much more comprehensive
service than we do now.
If we had the X-ray and scanner that would make it supportable.
The population is of a size where it is difficult to support
individual services on their own, so everything is co-dependent
on another service.
Everyone wants to be doing everything we promised.
The main thing within the NHS is the hospitals trust being
in special measures, the funding gaps and constant political
reorganisation.
You can be half on track doing something and then it changes
again.
All the political parties would say what we have been
trying to create here, integrated care, is the future
but it's the future that we can't quite attain. Implementing
it is the problem.
We designed this building at a time when we were an integrated
care organisation where everything in Cockermouth was
run as within one organisation.
The difficulties we have now is that every step you want
to make, such as getting the X-ray service working, requires
you to work with lots of different organisations.
It's very frustrating because politics gets in the way
of health care, we need to get back to a sensible patient-centred
programme rather than fragmentation.
The doctors are also concerned about the numbers of people
using the pharmacy.
The purpose of it, apart from the ability to provide the
pharmacy service over extended hours, was to make a small
profit to subsidise the cost of the rest of the building.
But it's not profitable, its underused. I don't think
patients are aware it helps finance the building.'
The landlords are the Department of Health-owned Community
Health Partnerships.
It charges rent, which is paid by the NHS, and running
costs, which are paid by the groups using the building.
In the minutes of a Patient Participation Group meeting
held at the hospital recently, Castlegate practice manager
Sid Williamson said of the running costs: The first floor
of the hospital costs £230,000 a year, with
£170,000 for the surgeries. This is double
or even triple what other GPs nationally pay.'
Dr Desert explained: We were not able to get any assessment
of running costs when we had to commit to having the building
because we undertook to lease the building some two-and-a-half
years before it was started.
The running costs are inordinately high and that places
a very severe financial burden on the practices.'
The surgeries are contesting some of the bills and will
not pay them until a satisfactory resolution is reached,
Dr Desert said.
They did not receive a bill until a year after they moved
in.
He said: We have paid the rent, since January 2014, but
have contested and not paid the facilities management
bills.'
He said the bills included heating, lighting, power, cleaning
and some staffing.
Within that there are some services which we regard as
wasteful and others we regard as inefficiently provided
so we are contesting the way these services are being
provided.
But however much we can negotiate these costs down we
are left with a very substantial ongoing commitment,'
said Dr Desert.
Although we live in one of the safest towns in England,
the company that runs this building felt we needed seven-day-a-week
24-hour security guards.â€
This has been cut back to after working hours.
They were also being charged for a porter service, which
involved someone being paid to collect and distribute
mail.
Dr Desert said: We only have two offices so this was not
necessary. We asked them not to deliver letters but have
not been advised of any reduction in costs.
They have a build manager who works seemingly full time.
Ostensibly her role is to manage the booking of rooms
but they do not have any rooms to book, therefore her
only role is to co-ordinate repairs and manage the cleaners.
The cost on the budget sheet for that management role
is, I think, £70,000.
We have been to director level with the company we rent
the building from, the Community Health Partnership,s
and we have taken this to board level. There will be another
meeting next week. We may go to some form of arbitration.'
The GP practices are planning to merge following the resignation
of two doctors from the Derwent Surgery.
They feel there will be many advantages to this, including
helping with recruitment.
By merging they would have 17,200 patients, creating one
of the largest practices in Cumbria. They are hoping to
take on three new GPs.
Dr Desert said: Doctors and patients quite like to be
in smaller practices but as more and more work is passed
from hospitals to primary care it becomes very difficult
to provide that breadth of services required in small
practices.
The most sustainable solution is to merge the practices
and work with teams within the practice. Hopefully we
can then give patients as much of what they want and also
make the practice look more attractive to prospective
staff.
Recruitment of medical and allied health staff is extremely
challenging in Cumbria at the moment, we have vacancies
throughout.
Castlegate has always been able to recruit as it's a training
practice but Derwent Surgery, following two resignations,
would be looking at trying to attract GPs at a time of
a national shortage.
We have had some applications but I am not confident we
can fill all three roles.''
Tracy Walker
Cockermouth reporter
Times and Star
Details
of merger plans on Castlegate Surgery website