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All change at Fairfield Medical Centre

Fairfield practice manager retires


October 16, 2009: Chris Boughey, practice manager for the Fairfield Medical Centre, is to retire. Asked if the move was planned, the former bank manager, who turns 60 at Christmas, told the Bugle, that, though immediate plans for his retirement had been in train for five years, "I've been planning it since I was 18 actually."

The Bugle's article about concern over the running of the Bookham practice meant the clinic had to postpone the advertising of his post. To do so as planned, straight after the Bugle's article, he said, "would have given the wrong message."

The job ad, which appeared in the Leatherhead Advertiser of October 8, carries a salary of up to £40,000. Interviews take place on November 13.

Inevitably Boughey's retirement and the need to find and appoint a successor have slowed the practice's efforts to improve its communications with local people. The practice's promised Patient Participation Group has met once, but other meetings are under way and more are planned.

Boughey agrees that the local concern is the process patients have to use to make appointments with a doctor. During the past year Fairfield has been short of staff, partly because of maternity leave. "Unfortunately last year the patients were subjected to dramatic turnover [among the medical staff]." The five-strong practice is also recruiting another GP to bring the salaried total back to three.

The practice will set out its plans in a forthcoming article in the Bookham Broadsheet, to be published later this year by the Bookham Residents' Association.

[] If you wish to comment about local health provision, the Department of Health has launched an online rating service to let patients rate and compare GP practices via its flagship website, NHS Choices. The service is available by clicking on this page.

Patients can upload comments on how easy a practice make it to get an appointment, how highly they recommend the practice, how well staff treat patients and whether they feel involved in decisions about their care.

Announcing the rating service, the Department of Health said, "The Government recently announced that it is opening up more choice for patients as they will soon be able to register with a GP practice of their choice. This new tool will help patients make that choice and is now available at NHS Choices to give people all the information they need to decide which of England’s 8,300 practices is right for them."

From the Partners at Fairfield Medical Centre

"We DO care"


August 11, 2009: The Bugle has received the following response from the partners of Fairfield Medical Centre to its report, below, of a recent meeting of Bookham and Fetcham Area Forum:

"We are most concerned at your report of the recent MVDC Bookham and Fetcham area forum meeting, concerning the perceived poor customer service experienced by those speakers at the meeting.

"Whilst we accept that on occasion there will be shortcomings in these areas, you can be absolutely assured that we strive to do all possible to ensure that our patients receive a service that will, as far as possible, address and satisfy all their needs.

"We have in place systems that monitor the performance of our front line staff and they are encouraged to participate in internal meetings, to have an influence on service standards and to improve their own performance levels. External monitoring of standards is also carried out and training is being provided through NVQ qualifications.

"The ethos of any medical practitioner and indeed of all those staff that are involved with this profession is that the most important aspect is the quality of treatment received by patients.

"We all endeavour at all times to achieve this; but given the sheer demand for services there will inevitably be times when there is a perception by a minority of customers that they haven’t received the full service that they feel entitled to expect.

"Mr Boughey has been the Practice Manager with the surgery for 8 years. He has during that time carried out his duties with the utmost conscientiousness and is renowned for his cheerfulness and politeness. He has for many years been involved in charity work with the Bookham and Horsley Rotary Club and also involved locally, in the Scouting movement for over 20 years.

"Mr Boughey says he is sorry if he is seen by some as ‘fairly formidable and not very pleasant’ but 'at 6ft 6inches and 20 stone perhaps my physical presence is larger than life but having spent my 40 plus years working life in business serving customers and latterly patients, I have never had complaints like this before. I believe that I am always approachable and prepared to listen to ideas for change and improvement.'

"The question of a separate surgery for Fetcham is not really an issue in that the Molebridge Surgery in Cannon Grove is still very much providing service there. Historically the Fairfield Medical Centre was created when the two surgeries at 17 Lower Road and the previous Bookham Surgery in the back of the Somerfield Car Park were amalgamated into the newly built centre in 2003.

"It was felt, even then, that the future lay in providing more services under one roof that would enable people to have access to a greater range of treatments and at the same time providing these services on a more cost effective basis. We offer extended hours surgeries on a daily basis, but to do this we have had to employ more doctors, as the Partners are unable to offer extended hours, routine appointments, emergency appointments and specialist clinics within the time available. We do however emphasise that we would like patients to follow through a particular problem with the same doctor.

"We have excellent scores on our Quality and Outcomes Framework reports – the Government’s measures of Quality service which indicates a high level of clinical care.

"With regard to Mr Hall’s concerns about the warfarin clinic we would like to point out some improvements over the service originally offered at Leatherhead. Patients can now have an early morning blood test - even prior to going to work rather than fitting in with the Leatherhead Clinic times and we now run twice weekly clinics as well as a domiciliary service for the housebound in conjunction with the district nursing teams. Whilst appreciating that some patients may find any change daunting and that there were a lot of issues at the time of the transfer of care to the surgery these issues have been successfully addressed judging from the feedback we are receiving from those using the clinic.

"We have always been and always will be open to feedback from our patients. We welcome suggestions for improvements to our customer services and to all our services in general. To this end we recently initiated our Patient Participation Group and are delighted to see that councillor Dixon is looking to be involved in its ongoing commitment to the best possible care for our customers.

"We have in the first instance set up four working parties to look into various areas such as :- Patient Information booklet, the Newsletter, Appointments and Prescriptions. We will of course advise all interested parties of the date of the next meeting when the working parties have had time to consult and provide reports on their progress.

"We will be delighted to keep councillors Dixon and Hall advised of the progress of the PPG if, as last time, they are unable to be present at the meeting due to other prior commitments.

"We have a stable core partnership of doctors with Dr Evans having been in the Practice for 27 years, Dr Stephenson for 14 years, Dr Haydon for 11 years, Dr George for 10 years, Dr Mehta for 3 years and Dr Edgar as a salaried doctor for 8 years. The Practice has always been committed to being a Training Practice helping to bring through registrar doctors to be fully trained GPs. In recent years that demand has accelerated and last year a new central programme has meant that registrars rotated every 4 months to widen their experience of different practices. The result of this has been a higher turnover of doctors – and in the last year this was compounded by the need for locum doctors to cover a maternity absence.

"We would finalise our response by advising, that, contrary to Mrs Dixon’s summary that we “don’t really care”, that we all very much DO care. We hope that a positive dialogue will be established between ourselves and our patients. We are proud to serve our community as best we can and proud of the positive responses we receive from very many of our patients who let us know of their satisfaction with our efforts.

"We will however always strive to improve and provide all our patients with the services and standards they expect."

The five partners in the practice are:
Dr Aoife Evans MB, BS (1978 London), FPCert: "Our senior partner has an interest in womens’ health, diabetes and is a member of the local GP referral triage service (EDICS)".
Dr Jeremy Stephenson BMedsci, BS, BM (1989 Nottingham), MRCGP, FPCert, who has special interests in orthopaedics, minor surgery as well as GP training.
Dr Sarah Haydon MB, BS (1991 London), MRCGP, DRCOG, DFFP, DIPOH
has a special interest in womens’ health and GP training.
Dr Sabina George MBBS, (1996 London), MRCGP, has a special interest in paediatrics, diabetes and contraceptive services.
Dr Amit Mehta MB BS (2002 London), MRCGP, DRCOG, the newest member to the partnership, joined in 2008 after working at the practice as an associate GP since 2007.

Bookham and Fetcham Area Forum

Mounting anger over Fairfield indifference to patients


July 16, 2009: Patients are in open revolt over the way Bookham's Fairfield Medical Centre deals with its patients. Fetcham residents and their local councillors are particularly incensed that, having lost their own surgery when it was combined with the Fairfield clinic, which opened on March 17, 2003, they are forced to travel further to get a worse service. A recent meeting demanded that NHS Surrey, the local patient care trust (PCT), look sympathetically at giving Fetcham its own surgery.

One speaker after another at a meeting of Mole Valley District Council's Bookham and Fetcham area forum last month gave their own experience of the Fairfield Medical Centre's apparent indifference to patients' needs.

[] District councillor and former MVDC council leader Tim Hall (Con, Fetcham West) described trying to get an appointment as "nightmarish": "The last time I wanted a blood test result it took me four attempts to get through." Hall said the only way his father can get an appointment is to travel to the surgery at 8am: "[He] has given up ringing up."

Hall complained that the highly efficient warfarin clinic had been transferred from Leatherhead hospital to Fairfield. Someone thought it looked at great idea to provide a more local service but, "There is constant grief, particularly from the pensioners of the village."

Hall said he and his constituents are getting tired of Fairfield receptionists being "positively hostile to patients". In one conversation they had asked why he was phoning: "I'm ill," he told them: "Well ring us tomorrow," they told him, "We can't give you an appointment today."

The centre's ethos is to keep the patients at arms' length: "The only reason they didn't close the car park to patients," said Hall, "was that they were unlucky I was leader of the council when the surgery was built."

Hall said the centre showed no interest in consulting residents or councillors over this or any other matter: "They really were not keen on dealing with us. It was quite interesting."

In the experience of several people, said Hall, Chris Boughey, who runs the surgery, is "fairly formidable and not terribly pleasant." (Boughey is an employee of the practice appointed by the GPs.) The doctors don't seem terribly interested either, said Hall: "We have constant aggro – what do we do?"

'We want our own surgery'

[] Cllr Rosemary Dixon (Con, Leatherhead South) said Fairfield recently told her to ring back for an appointment at 8am the following day. When she rang punctually at 8am she was told all the appointments had been taken. Fairfield's loss of a repeat prescription caused her "no end of problems".

Cllr Dixon said she had joined Fairfield's patient involvement group but no date had been set for its second meeting. The first had merely set up 11 working parties for each of the problems the group identified. They will meet 'on dates to be arranged', said Dixon.

Dixon also complained of the high turnover of doctors: "Every time I go there's another strange name that I've never heard of." If she were seriously ill she would want continuation of care, and that doesn't seem to be available from Fairfield: "They don't really care," Mrs Dixon summarised.

[] Local resident Denis Loretto noted that the problem was not the phone ringing and ringing it was that it was constantly engaged and you had to spend a whole morning redialling. Why could Fairfield not use ring-back?

[] Several speakers complained that the link between patient and GP had been broken. Fetcham resident Colin Langley said his wife had been told they hardly work to a patient to a particular doctor any more; you get the doctor who's available. "That's not good enough. That's not the way the UK's medical profession, the understanding and the trust in it, was built up. It is all done in that practice for the convenience of the practice. And that comes out glowingly."

Since the new contract, said Langley, "We've had to knock the door down against their resistance to give us good service." We had to phone up in the morning for a morning appointment. If you couldn't have a morning appointment you had to phone after one o'clock to get an afternoon appointment." The practice manager appears to be deaf, said Langley.

Langley said Boughey dominates the doctors. When he has complained to the doctors, "they say you've got to refer that to the practice manager. They just put their hands up."

[] Bookham Residents' Association chairman Peter Seaward pointed out that there are two practices in Bookham, 500 yards apart. He goes to the surgery at Eastwick Park. The comparison is "unrecognisable", said Seaward.

[] A lot of the patients that were seen in Fetcham were forcibly transferred to Bookham, said Fetcham residents' association chairman Paul Fairweather, and the perception was that people were extremely unhappy with it. "There is a need in Fetcham for people who live in Fetcham to be seen in Fetcham at our local surgery rather than go to a centre they are far from happy with."

"We in Fetcham need a surgery and we need it as soon as possible," agreed John Howarth. "The tail is wagging the dog."

The response

Wendy Lockwood, NHS Surrey's associate director of public engagement, told the meeting that, though the PCT is "developing a fairly robust attitude" about practices which are "failing to deliver", there were limits to what the PCT can do because the GPs are, in effect, "small businessmen".

But one thing it could do is achieve a good and effective appointments system. The figures she had checked showed that Fairfield was "not exactly anywhere near the top within Surrey," said Lockwood, "and we've noticed that. Well over 60 per cent of our surgeries in Surrey do manage to achieve a system that can give you an emergency appointment and at the same time do allow you to book an appointment a week ahead if that's what you want."

The PCT can turn off some of these practices' money if they don't perform, said Lockwood, for example by allowing patients to make appointments when they want them. But NHS Surrey needs evidence, not just anecdote so, "If you are having problems, said Lockwood, "please tell us."

Asked whether NHS Surrey would support a group of doctors keen to set up a local Fetcham surgery she stonewalled: "That would depend on whether there was sufficient need," she said.

Lockwood replied that NHS Surrey would have to look at the facts and figures about the demand for such a service in Fetcham, whether there's an existing building, whether it needs money spent on it. The individual who would look at this is Chris Botten.

Lockwood said NHS Surrey had an obligation to provide for the whole of Surrey, which included making provision for areas that didn't have any surgery or where their facilities were in dire need of replacement. It was a question of making the best use of the finite amount of money available.

Seaward noted that the money NHS Surrey was spending on the prime practice was ineffective. Lockwood agreed that that was something NHS Surrey had a responsibility to address. In that case, said Seaward, could Lockwood come back in six months' time and let residents of both Bookham and Fetcham know what progress had bee made. She agreed. The first thing she wanted to know was what that appointments working party was going to do and what targets it was going to set.

Wendy Lockwood is on 01372 201719.

The complaints about Fairfield appear to be borne out in the 'What patients think' page NHS Surrey has published for this practice.

Though over half appear to be satisfied with how easy it is to phone the surgery, the satisfaction is well below the 80-plus per cent levels recorded for either the PCT or nationally. The same response rates apply to seeing particular doctors. Fairfield is slightly better at offering appointments on the same day. But barely 30 per cent of patients said they were able to make an appointment with a doctor more than two days in advance.

Fairfield Medical Centre practice manager Chris Boughey told the Bugle he would give a considered response to the issues raised in this article within the next few days.

[] If you have need advice or have concerns about your treatment in any part of the NHS, the Patient Advice and Liaison Service (PALS) was set up to offer information, help, advice and support. Your local PALS contact is at
Leatherhead Hospital
Poplar Road,
Leatherhead
KT22 8SD
01372 384397
or email pals@surreypct.nhs.uk

The Bookham Residents' Association is also keen to hear about residents' experience of the Fairfield centre. Email chairman Peter Seaward on pseaward@aol.com

What do you think? Tell the editor.

YOUR LETTERS

The letters below are from Fairfield patients whose identities are known to the editor. It's only fair to add that other comments the Bugle has heard, though not in writing, have been favourable to the practice.

Fairfield is indeed one of the crappiest medical centres I have ever known... You come out there feeling like factory processed meat.
I had to phone back no less than 6 times to get my blood results which in fact had been sent to another practice, getting an appointment is a nightmare and I had months and months of back pain before getting referred to an osteopath...
EC

Hello
It has been my misfortune to have to need medical attention rather more than I would like over the last year or two. I am so glad that the issues have been raised because I have had great difficulty in getting an appointment with the same doctor twice. I have been told that it is a teaching practice and I replied that it is not good for patient continuity. I have also had the same experience of being told to phone back on a certain day at a certain time, only to find that there are no appointments left. When I have asked how that can be so, the explanation of the way they work was so complicated that unless written down, no member of the public would remember. I have had two different stories from two different members of staff explaining things to me, and it seems to me that even the staff don’t all sing to the same hymn sheet. How can the patients understand the mode of practice if one is receiving mixed messages at reception.
Since finally getting to see the doctor with whom I was registered and telling him of my concerns, things have changed. Perhaps that is because he wanted to see me regularly to check progress and I have been given a ticket with his signature to take to reception and book a month in advance.
We have to keep on complaining if we want to change things.
AS


Having read your piece on Fairfield Medical Centre I confirm that this mirrors my own experiences in every respect. I am now reluctant to see any doctor and I would certainly not complain in case I am blacklisted.
[name and address supplied]

Barn Hall event was a gamble too far for charity organisers

March 20, 2009: Leatherhead childrens' charity the Rainbow Trust had to cancel the Casino evening it was due to hold on Saturday, March 28, at the Old Barn Hall.

The event, organised by Bookham & Horsley Rotary, was to raise money to support families with terminally or seriously sick children. Supporter Neil Walker said, "The Trust do fantastic work providing counsellors and support for families in the home, and a respite home here in Bookham for families to spend a bit of time away."

The £10 ticket included dinner, but those attending had to bring their own drinks.

...But Trust now has 68 new donors

organiser 'disappointed' with response to bone marrow appeal

The Antony Nolan Trust, the charity behind the recent appeal for bone marrow donors for local leukaemia sufferers, were "happy" with the number of attendees, according to local organiser Neil Walker.

As reported (below), Walker arranged for the Trust to run a clinic to recruit bone marrow donors Bookham Baptist Church, Lower Road, on March 4.

About 100 turned up to register as donors, and 68 of those were accepted.

Walker says the numbers were "about double what they would [normally] get at this kind of event." Altogether, he says, "we now have 68 chances for life-saving that were not there the day before yesterday – and that is for patients all over the world. But he adds, "If you ask me, and I’m honest, I’m disappointed."

Walker outlines the next steps:

I Missed The Clinic – What Can I Do?

If you are 18-40 go here and follow the instructions. They will send you a pack and you can take it to your GP who will take a tiny sample of blood. And that’s it. Easy peasey. You can call them if you prefer: 020 7284 1234.

If you are over 40 – give blood – go here, put in your postcode and you’ll get the next nearest donor session. Make an appointment (click on the little clock face next to the clinic date/time/location details).

When you give blood, and if you are under 50 years old – ASK TO GO ON THEIR BONE MARROW REGISTER, it isn’t automatic. You can phone them if you prefer: 0845 7 711 711.

Thanks

There are lots of “thankyou”s for the help with the clinic.

· Friends & family (& their children!) delivering leaflets, forwarding emails, putting up posters…
· Marion Haines & Bruce Simpson, local bone marrow donors, for coming along and telling people of their experiences.
· Debbie Masters for holding the fort on refreshments for the whole clinic, along with my son Arthur, and Ann Vaughn and Lauren Ward who were ready if needed.
· Bill & Arthur Walker-Trivett and Kieran Whiteman, local Howard students, for running up and down the High St on the day handing out leaflets, and serving tea and coffee at the clinic.
· Tanya Hulford & Beverley Tabard, volunteer phlebotomists (people qualified to draw blood!), who gave up their evening to help the Anthony Nolan Trust.
· Local independent traders, the Library, medical centre, dentists, pubs, businesses on Bookham Industrial Estate… putting up posters and distributing flyers.
· Jo Walker-Trivett for sitting on the Welcome Desk for four hours and talking herself hoarse.
· Ros Thomas at Look Local.
· Schools, playgroups, churches, scout groups, orchestras, local campaigns (especially DDOCA), radio stations (especially BBC Southern Counties), press (especially the Bookham Bugle), Bookham & Fetcham Residents Associations, Bookham Community Association… for spreading the message.
· Local Liberal Democrat and Conservative party members for ideas, help & support (yes, they DO do stuff away from election time… you should talk to them).
· Lynsey Dickson & Alex Frazier at the Anthony Nolan Trust, and the rest of the team of counsellors and nurses from Anthony Nolan who were there on the day.
· Bookham Baptist Church for the use of their building and the constant support the fellowship have given me during this campaign. It’s a great place – you should go there….

Will There Be Another One?

Walker says, "We have discussed whether it should be an annual fixture. I’d be interested in feedback on that idea."

Appeal for Bookham, Effingham and Fetcham bone marrow donors

February 18, 2009: A week or so ago two boys, one aged 8 and Alastair Burnett of Fetcham, aged 5, were being treated for leukaemia at the Royal Marsden. Both needed a bone marrow transplant. The families of both boys had been tested and found not to be suitable donors, so the search went on, spurring a local donor recruitment campaign.

The local publicity campaign has already been outstandingly successful. The Bugle has never received so many emails asking it to publicise a cause. Alex Frazier of the Anthony Nolan Trust, which holds the register of donors the NHS uses to find donors in the UK and abroad, says there has been, "an overwhelming response from the local community," which has "reacted strongly and immediately to help with this campaign."

The effort to save the lives of children like these could not be more urgent. Since local resident Neil Walker launched an appeal for donors, the eight year old, whom we've been asked not to name, has died. "We are all clearly devastated," says Walker.

Now he has learned of three more children from Effingham, Bookham and Fetcham who have leukaemia, all being treated at the Marsden. Some are in or near ‘maintenance’. "In other words, chemo seems to have worked for them and they are well enough to return to normal life," says Walker.

Amy is one of these. But her mother, Kirsty, cautions that, "The nature of this disease is that it can change at any time, and Amy might need a transplant in the future".

Frazier says 16,000 people worldwide currently need a bone marrow transplant. Finding "a bone marrow donor whose tissue type matches their own could mean the difference between life and death," he says. But individual genetic makeup is so varied that the chances of finding a suitable donor are slim. In the UK, 27,000 adults and children are diagnosed with leukaemia each year. But not enough donors are currently registered to find a match for those who need a life-saving transplant.

Since 1974 the Anthony Nolan Trust has helped over 5,800 children and adults gain a new chance of life. The Anthony Nolan Research Institute conducts research into the treatment of bone marrow disorders and the improved effectiveness of bone marrow transplants.

Walker has arranged for the Trust to run a donor recruitment clinic in Bookham on Wednesday 4th March at Bookham Baptist Church, Lower Road, from 4:30pm to 8:30pm. "If you are aged 18 to 40 and in good health," he says, "please come along and talk to the Anthony Nolan Trust, who will provide the information about what it means to be a donor. You can register as a donor on the day.

"It's fantastic that Bookham residents have been so supportive in arranging this donor recruitment clinic," says Frazier. "A potential match for a leukaemia sufferer in Surrey could be found, and for everyone who signs up there is the chance that they might be a match for someone else. We need as many healthy people aged between 18-40 to come forward and sign up as possible."

Registering at the clinic involves giving a small blood sample, which is tested to establish the tissue type. The results are stored on the charity's confidential database. Each new potential donor receives a registration card and written confirmation of being a potential lifesaver. A donor may be found to be a match for a patient almost immediately or may wait many years before being asked to donate. If there is no match they may never donate at all.

Anyone unable to attend the clinic can register by calling The Anthony Nolan Trust on 020 7284 1234.

"If you are over 40, you can still help," says Walker. "Spread the word about this event and consider signing up as a blood donor. Leukaemia sufferers need a lot of blood products during their treatment. The National Blood Service will also be at the clinic providing information on giving blood, and there is a blood donor session at the Old Barn Hall, Bookham, on Friday 27th March."

To ensure the organisers enough people to run the clinic, please let them know you are coming by calling Neil Walker on (01372) 451582 or emailing him on neil@walker-trivett.co.uk leaving your name & number.

Finally, says Mr Walker, "The villages of Bookham, Fetcham and Effingham are well known for their community spirit – please help us find donors for these children. Pass on the message. Thank you."

Article modified February 23, 2009

Demos and consultation are your last chance to save services

July 5, 2007: The Epsom Hospital Campaign has organised two demonstrations against the closure of maternity services at Epsom Hospital. The first takes place next Monday, July 9, and the next a week later.

The Bugle here reprints the text of the Epsom Hospital Campaign's statement plus, below, the two relevant announcements by the Epsom and St Helier University Hospitals NHS Trust, which now runs what used to be Epsom 'General'.

The changes at Epsom are not inevitable. First, there is a new secretary of state for health, Alan Johnson, who has shown signs of distancing himself from his predecessor, Patricia Hewitt.

Second, the decision to change Epsom Hospital's services has to be ratified after a public consultation. Much hangs on whether the consultation is real or a window-dressing exercise. If it's real, and you feel strongly about the changes, make your views known.

As reported in the Bugle/ (click on that link and go down to 'NHS – what now for local health care?'), the local MP, Sir Paul Beresford, is keen to track the conduct of the public consultation exercise. Write to him. Write to the people mentioned in the statement below. And attend these and other protest meetings.

The Epsom Hospital Campaign is an informal group involving representatives of four local authorities, local MPs, local doctors, trade union representatives, hospital staff, volunteers and patients. It can be contacted via Chris Grayling MP, at 212 Barnett Wood Lane, Ashtead, Surrey, or County Councillor Chris Frost, at County Hall, Kingston upon Thames.

Epsom Hospital Campaign
Fight the closure of Maternity
Thousands wanted to form a ring around the hospital
Please bring a flower to lay outside the hospital gates
Meet in Rosebery Park at 10.30 am on Saturday July 14th
Help the fight to save Epsom Hospital's Maternity Department


The Epsom and St Helier Trust has taken the decision to close Epsom Hospital's maternity department, and transfer all inpatient services to St Helier. The decision has to be ratified after a public consultation this autumn.

The Trust is basing its decision on false claims about the safety rules that apply to Epsom Hospital. Epsom's maternity unit conforms to all the latest guidance from both the Government and the Royal College which sets professional standards for maternity units.

We are planning a series of protest events to begin our efforts to get the NHS to change its mind.

On July 9th, there will be a protest outside St Helier Hospital at 9.30 am to mark the first day of work of the new Chief Executive. We want her to be fully aware of the strength of feeling. Details from John Bland - Click the link and send him an email.

If you cannot be there, please write to her to coincide with her arrival: write to Samantha Jones, Chief Executive, Epsom and St Helier NHS Trust, Wrythe Lane, Carshalton, Surrey, SM5 1AA. Post your letter on Friday July 6th, so it arrives on the day of her arrival.

Then on Saturday July 14th, there will be a big event at Epsom Hospital. We will aim to form a huge walking line of protestors right around the hospital, and to lay flowers outside the gate as a lasting floral tribute to the work of the staff and as a reminder of the strength of feeling. Meet in Rosebery Park at 10.30. Any questions, email: Chris Grayling Or visit Epsom hospital website /.

We will be holding further protest events, and organising a mass response to the consultation this autumn. Please make sure we have your details by either emailing John or Chris with contact information and we will keep you involved in what we are doing.

Please display the poster on the other side of this leaflet in your window, or another suitable place locally.

Help us continue the fight for Epsom Hospital.

Statement, June 2007: Press Release from board of Epsom and St Helier University Hospitals NHS Trust.

Board agrees to public consulation on Women's and Children's service changes

On Friday (8 June, 2007), the Trust Board agreed to go to public consultation on the proposed changes to women and children’s services under the second phase of the Safety and Sustainability Review.

The proposal is for all doctor-led births to move to St Helier Hospital, as would all children requiring an overnight stay in hospital for surgery or medical treatment.

The majority of patient care would stay at Epsom Hospital, including all prenatal and postnatal appointments. An extended-hours children’s assessment unit would be created at Epsom, and home-birth capacity expanded.

Family services clinical director and consultant paediatrician Dr Ruth Charlton, who presented the case for change to the Trust Board, said:

“This is about safety. If we don’t change - services will become unsafe. If they are unsafe they will need to close.

“We have to follow national medical expert advice from the Doctor's Royal Colleges and the lessons learned from the maternal deaths at Northwick Park Hospital. These changes will ensure we are delivering the safest services to women and children."

Acting Trust Chief Executive Patricia Wright said: “We recognise that for many people these changes will be unsettling, but we must take action now. Modern medicine is changing and we cannot stand still.

“We all need to work together to put patients first to ensure our services are as safe as possible. We will now be looking to start discussions about consultation with the local Overview and Scrutiny Committees and other stakeholders.”

The Trust Board agreed the following, subject to public consultation:

• The Board supported the preferred clinical proposal to provide the Trust's consultant led obstetrics and inpatient paediatric services at St Helier, an extended-hours paediatric assessment unit at Epsom and expanded capacity for home birth by August 2008.

• The Board approved the creation of a short term plan, to refurbish obstetric and paediatric facilities at St Helier.

• The Board approved the development of a detailed long term plan to replace or substantially upgrade the facilities, consistent with the Better Health Care closer to Home project and strategic review in London and Surrey.

The Board also agreed that the consultation document would cover the following areas:

1. Explanation of the costings for each of the options considered, including maternity services to be unified and based at Epsom
2. Justification of why a midwife led service was not an option for Epsom

More detail can be found in the Board paper available on our website at www.epsom-sthelier.nhs.uk/6_7.html. Also available on this site are the reports from the two panels of national medical experts who examined and approved our Safety and Sustainability Review proposals.

Next Step
We will begin work with Surrey PCT, Sutton and Merton PCT and the Joint Overview and Scrutiny Committee to agree the best consultation approach.

Statement, January 2007: Press Release/ from board of Epsom and St Helier University Hospitals NHS Trust announcing reorganisation.

Safe and Sustainable Hospital Services (S2): Trust board agrees maternity options

The Trust Board has now given its support to take two options for the reorganisation of maternity services to public consultation, subject to approval from NHS London.

Both options include an investment of around £4 million into upgrading maternity facilities, and will deliver better, safer services through:
§ More senior clinical input to patient care
§ Better clinical training for doctors
§ Better working conditions for junior doctors
§ More cost effective use of scarce NHS resources.

The first option is to consolidate obstetric and neonatal services at St Helier Hospital with development of a Midwifery Led Delivery Unit and Early Pregnancy Assessment Units on both Epsom and St Helier hospitals.

The second option is to consolidate all obstetric and neonatal in-patient services to St Helier Hospital without the development of Midwifery Led Delivery Units at Epsom.

Under both options ultrasound, antenatal, community midwifery, and Maternal Day Assessment Unit will continue on both sites. Three other options were examined, including maintaining the status quo, and were found to be clinically unviable.

More detail can be found in the Board paper available on our website at www.epsom-sthelier.nhs.uk/6_7.html

As the recommendations make clear, these changes are about clinical viability and providing safer services, with constant consultant cover. They are not part of the Trust's financial recovery plan.

The Next Steps

Formal public consultation will take place on these maternity service proposals after the Trust Board has agreed to proposals for the necessary changes to children's services and received support for public consultation on both maternity and paediatric services from NHS London.

The recommendations for paediatric services are now being finalised and will be presented to the Trust Board at its February 2, 2007 meeting.

In the meantime, we will be discussing the process for consultation with the local Overview and Scrutiny Committees and other stakeholders.

The Need for Change

Changes in medical practice, working hours and training are increasing the amount of consultant cover required for obstetric units to be clinically viable and offer the safest possible service to patients.

Providing the necessary cover required at both Epsom and St Helier would require more consultants and junior hospital doctors. But the comparatively small workload, in particular at Epsom, would not provide doctors with adequate experience to train or maintain their skills.

This issue is becoming more acute as both the new training programme for doctors driven by "Modernising Medical Careers" and the European Working Time Directive will reduce the total numbers of doctors in training and the hours available to support service provision from August 2007 and 2009 respectively.

These changes also mean that dedicated anaesthetics cover will no longer be available to support obstetric services at Epsom Hospital from August 2007.

It is also anticipated that within the next two years the Royal College of Obstetrics and Gynaecology will cease to recognise and accredit training posts in units where the minimum consultant presence is not met.

The need to provide this level of consultant cover on labour wards was also emphasised in the recent Healthcare Commission report into maternal deaths at Northwick Park Hospital in North West London.

To meet these challenges and provide the best service to patients we need to increase the amount of obstetric consultant cover for labour wards in line with the Royal College of Obstetrics and Gynaecology best practice guidelines.

The only way to achieve these changes is the consolidation of obstetrics services at St Helier Hospital. As the reports show, it is clinically and financially unviable to consolidate these services at Epsom Hospital.

What do you think? Tell the editor.

BRA AGM 2007

Unanswered questions after lacklustre PCT presentation


April 27, 2007: Wendy Lockwood opened a gap between herself and her audience at last night's Bookham Residents' Association AGM the moment she opened her mouth. Lockwood works for the Surrey Primary Care Trust (PCT) which, since last autumn, has been running NHS provision for Bookham and elsewhere.

The first crack opened when the audience learnt her title – 'associate director for public engagement'. Most people whose job involves manipulating public opinion are happy to say they're a public relations director. In today's NHS, it appears, such honesty isn't an option.

But then Lockwood spent much of the rest of the presentation translating herself into English. Some of it was merely well-sounding piffle without any roots in reality – 'the future hospital', or 'programme for change', 'expert patient programme.' Parts of one of her slides could have been in Albanian: 'GPOOH', 'WIC', 'UCC', 'HOSC', 'PPIF' and 'LVOS'. But when she got round to the 'virtual ward' some of it began to sound faintly scary.

Surrey PCT (SPCT) was formed last October 1 by merging five former Surrey PCTs – North Surrey; East Elmbridge and Mid-Surrey; East Surrey; Surrey Heath and Woking; and Guildford and Waverley.

SPCT doesn't run hospitals. It buys those services in by using the hospitals and other health providers – GPs and community nurses – as contractors. SPCT's budget is about £1.3 billion to cover a population of 1.2 million people.

SPCT is 'one of the few PCTs that has improved,' Lockwood told us. Not difficult. The largest new PCT in the country, it began with debts to match, and its improvements in medicine management have not been driven solely by the need to deliver happier patients. They 'helped us save some money', she reported.

Patronising platitudes
The BRA had invited Lockwood to tell its AGM about this and Surrey PCT's other challenges, not least how it justified the downgrading of Epsom General Hospital. Instead the audience heard a string of vague, poorly justified and, it must be said, patronising platitudes about how the PCT had our best interests at heart.

Like every other bureaucrat in Surrey's NHS, her current job is to live down the NHS's last brainwave, 'Better Healthcare, Closer To Home' (BHCH). BHCH hadn't inspired confidence. The NHS bean counters expected local people to believe that healthcare would be 'closer' if they moved the hospitals further away and seemed surprised when no-one believed the 'better' bit either.

Strangely enough, BHCH did have a point. What healthcare experts were driving at was that if local facilities, here in Bookham and its surroundings, were improved, you might not need to go to hospital. The way the medical think tank the Kings' Fund puts this (click here to download its 164kb document) is that the government wanted to 'move more care out of hospitals and into the community on the grounds of improving efficiency and access.' The problem for current soon-to-be-deservedly-ditched Health Secretary Patricia Hewitt is that by labelling it with a slipshod slogan she and her officials undermined an exercise local people might have benefitted from.

We'll never know. What we do know is that the latest wheeze in Surrey and Sussex is more of the same under a different label. 'Fit for the Future' (FFF) is an effort by the five Surrey and Sussex PCTs – Surrey, West Sussex, Brighton and Hove, Hastings and Rother, and East Sussex Downs and Weald – 'to design a new health system that will bring more care closer to people's homes', says the FFF website, 'and, at the same time, ensure the local NHS lives within its means.'

Even as a PR stunt it isn't going that well. The first FFF newsletter is nearing nine months old.

Follow the money
It won't be a great shock that a lot of this is about money. Some of it is also about medical egoes. But if you have any faith in doctors at all, you also have to weigh what they say about clinical outcomes.

Even local people who don't know a lot about healthcare feel strongly that they want hospitals to be as near as possible. Local politicians don't care whether it's right or wrong to spend healthcare resources on local hospitals. They've just leapt aboard the 'save Epsom' bandwagon as a way of punishing the government. They may be right, and if you agree with them you can sign the save Epsom petition on the prime minister's website.

But there's another side to this too. As Lockwood struggled to make clear, when you need a doctor, it isn't good enough to find any doctor. You need the right doctor. The clinicians' research appears to show that the most favourable 'outcomes' – 'results' to you and me – are determined not by how quickly patients with, say, strokes reach 'a doctor' but how quickly they reach a stroke specialist. And this means that if you have a stroke it's better to find a stroke doctor than a non-specialist, even if the stroke doctor takes longer to reach. 'That's work the clinicians have done,' said Lockwood, 'and it's what the clinicians tell us.'

And what that means is that journey times to hospitals are less important for the health of patients than whether they reach the right specialist. 'There are better surgical outcomes if they are seen by a specialist in a specialist centre,' says Lockwood.

Do journey times matter?
What this leaves out is that journey times do matter if you're visiting the patient, especially if you’re a near relative who lives in the same house. That's why much of the fuss about Epsom has centred around whether or not it retains an accident and emergency (A&E) department. The instinctive view of local people is that, the quicker the patient gets to hospital the better and an A&E department is equipped, first, to deal with any life-threatening problems and, second, to sort out what should happen next and where it should happen.

According to Lockwood, however, 'More than 50 per cent of the people who go to A&E at the moment, it's not necessarily the best place for them. We should be providing the right kind of care.'

If someone falls over in the street, says Lockwood, the first thing people do is call an ambulance to take them into hospital. Then, she says, they spend the next two days there trying to get out [because] they didn't need or want to be there.' They'd be better off if someone took them home and made sure they were looked after, in touch with social services and all the rest of it.

New NHS thinking, says Lockwood, is that one size doesn't fit all: 'People need a whole range of different types of care.' One of the ways the NHS has to develop is 'improving the way people are helped to look after themselves.' The Bugle can reveal that the NHS's plans for looking after ourselves go a lot further (see below).

We'll be looking after each other
Not only that, but the service has plans for us to look after each other. Lockwood told AGM attendees of the SPCT's 'expert patient programme' (EPP). This consists of groups 'run by people who have a long term condition themselves for people who have a long term condition. It's about people who really know, because they are in the same position themselves,' said Lockwood.

Surrey PCT's Press office says the programme covers condition such as MS, diabetes and arthritis. The PCT is running the courses in Epsom now – at 1pm every Thursday from May 24 to June 28.

The PCT cites the example of Jean Brooks, one of 17.5 million people in the UK with an unnamed long-term health condition. Jean said the free EPP course in Epsom was 'a real inspiration', according to Surrey PCT. 'The tutors taught us how to find out more information using the internet, and also gave us lots of useful materials and publications. Each week, we set ourselves targets, and then reported back on our progress. It gave us a real sense of encouragement to achieve our individual goals,' said Mrs Brooks. 'There was a good feeling of involvement and I enjoyed being in the company of other people with chronic health problems.'

Lockwood said some of the people who have attended these courses are still meeting three years later.

Surrey says course attendees report increased confidence, an improved doctor and patient relationship, less-severe symptoms and a feeling of being more in control. But Lockwood also mentioned that belonging to an EPP group made participants less likely to call out the hospital or their GP. 'Someone may get support via a telephone service where they won’t get an answerphone. They will get understanding and advice.'

That'll really save money.

To give Lockwood credit, not only did she acknowledge concerns that 'the family has to do it all' in supporting the chronically sick, but she said 'that's not good enough.' And she added that the acute services must be available 'for people who most need it.'

'It is broke, and it must be fixed'
A telling part of her presentation was her report of anecdotal evidence from those who had gone into hospital, found that they had been well cared for and were happy with the experience. Those stories, she said, bred the idea that, 'if it's not broke, don't fix it.' For many who need urgent care, 'it is broke,' said Lockwood, 'and it does need fixing. That's why we need to do modernisation and we do need change.'

She expressed concern about the lack of availability of GPs out of hours (that's GPOOH, by the way). It's another concern being picked up in Gordon Brown's 'election' campaign. In mid-May the Sunday papers reported that Brown wants GP's surgeries to open at weekends.

Lockwood reports survey evidence that some parts of urgent care are working well and others where they aren't. 'If it's working in one area it can work in others,' she said.

Surrey is looking at its provision of walk-in centres (WICs), staffed by nurse practitioners who can prescribe antibiotics and other medicines. Surrey has WICs at Ashford, Redhill, the Royal Surrey, Weybridge and Woking. 'Is it a good model? Should we have more of them and where should they be?', Lockwood asked.

Turning to hospital provision she went for it: 'Having everybody in one place may not be a good idea. We need to have something far more streamlined.'

Lockwood spoke of 'triage', the battlefield technique for the most effective use of resources to treat the wounded. Ambulances would be despatched to patients who were 'urgent', 'less urgent', and 'not urgent but they still need to go' to hospital. Outside those, non-urgent cases might be asked to see their GP the following day. That would make sure ambulance paramedics got to the people who needed them.

When is a UCC an A&E?
Lockwood says demand for A&E services is expected to fall as these developments take hold. Hospitals without A&E departments will instead have 'urgent care centres' (UCCs). These are able to treat 60 per cent of the people who go there, says Lockwood. She even suggested that they were, in effect, A&E departments. The rest of us are sceptical.

The UCCs would be supplemented by 'a small number of specialist A&E services where you would be at a specialist burns centre, not a local district hospital.'

The question then, she says, is 'what do we need to provide in Surrey, so one or other of our hospitals will become a centre of excellence for stroke or for cardiac [treatment]?' They will not book appointments, she said: 'We're talking about crisis treatment.'

The consultation: "Clinicians… are the ones who count"
The decisions about what goes where will be made 'when we are truly ready to do so,' after consultation. The consultations will involve 'our clinicians. They have to deliver. They are the ones whose views are important.' Then added, 'and with people who use the services'. Finally, she said, 'we have to be able to afford it. It has to be financially viable. If we have £1.3bn to spend, we can't plan something that costs £3bn.'

The deciders will be the Health Overview and Security Committee (HOSC), and the Patient and Public Involvement Forum (PPIF) will sanction the requirements.

Lockwood said no decision had yet been made about how the consultation would be carried out. If it leaflets were dropped through every door that would be 'hugely expensive' and most people would throw the information away. Using free newspapers wasn't a satisfactory alternative because their 'coverage is poor'. The decision as to which method was used would be taken after talking to patient groups.

MP asks unanswered questions
During questions Mole Valley MP Sir Paul Beresford pointed out that the consultation over the Sutton decision was 'abysmal'. This time, he said, the leaflets should go through every door. 'People don't throw it away,' he said.

Beresford also wanted to know what savings Surrey PCT was aming for in this review. And he wanted to know why only off-peak times were used to calculate travel times to hospitals.

Lockwood said the PCT would need to consider whether people do or don't read the information coming through the door and whether it was the best way to provide the information.

On finance, she said she could not answer that because it was 'not my specialism'. The consultation document would make clear the financial information 'in some considerable detail'.

Surrey PCT is talking to the ambulance service about travel times, not just 'blue light' (emergency) travel times but the PCT recognised that there's a need for people to travel who are visiting patients as well as the patients themselves. 'We’re looking at all the travel times,' she said.

One resident suggested from the floor that the last consultation the local NHS was involved in, over the future of Epsom and St Helier, showed that it 'didn't make a bit of difference' what local people think. 'You have your minds made up whatever the public say.'

Lockwood replied, 'I do hear what you are saying, and I have a huge amount of sympathy with it… A lot hasn't been done right.'

Beresford returned to the fray in Any Other Business. 'I was concerned about the presentation from the PCT,' he said. There was a lot going on that had not come out.

The Royal Surrey at Guildford is under threat, and this affects people that live in this area, he said. 'We are fighting to try and keep it and I've got the impression we are going to keep it, but we're not sure what they're going to put in it.'

On Epsom Hospital he said a bid had gone in from the owner of Denbies vineyard to run the hospital but its future was still unsure.

The problem they all faced was that, as soon as Gordon Brown took over as prime minister there would be a new secretary of state for health, and the lobbying would have to start all over again.

He didn't know why Lockwood couldn't answer his question about finance. Local MPs had met the PCT and they were going for £120m worth of cuts.

He had also asked how they were modelling travel time. Plainly, they're measuring it off-peak, he told the meeting, when on-peak is a large proportion of the day at both ends, and that's when a lot of people will be either going to hospital or visiting people in hospital – 'We're trying to get them to change it,' he said.

The consultation document will list a number of options,' said Beresford, but there will be no recommendation from the PCT on which options to choose. 'If you don't get the documents,' he added, 'I want to know.'

There's still a big fight local people had to get stuck into, said Beresford. Local people wanted both hospitals with access to them in a reasonable time.

The travel times are key. What was being tried worked in the north, where traffic and population densities were lower, 'but it doesn't work down here.'

On-line petition to the prime minister


The campaign to save Epsom General Hospital has started an on-line petition on the prime minister's website.

The petition says, 'I call on the Prime Minister to ensure that the Epsom and St Helier Hospital Trust halts the possible closure or reduction of services provided at Epsom General Hospital in Surrey. The Hospital provides high quality healthcare to the local community whose needs would be greatly damaged by such closure or reduction of provision.'
Click here if you wish to sign it.

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