Background
During August and September 2022 NHS South West London engaged on proposals for the future of the Rowans Surgery in Merton.
The proposal was to close the Rowans Surgery and ask patients to register with another practice of their choosing – support would be available to help people re-register, especially the most vulnerable.
Reasons for the proposals
The current GP partners running the surgery hold a contract with NHS South West London which is due to end on 31 October 2022. This means that a decision needed to be made urgently about how GP services are provided.
Patients at the Rowans surgery will know there have been a number of challenges in recent years. There are longstanding problems with the building – new facilities at Rowan Park are still two to three years away – as well as difficulties recruiting staff.
This has meant that services have needed to be provided from other local practices and the only GP at the practice also gave notice of their resignation.
If the services continue at the Rowans Surgery, the GP partners and local NHS are concerned the issues would impact on patient safety and the quality of care.
Engagement opportunities
We held a series of engagement events to talk about the proposals and invited registered patients and the community to give feedback, direct through email and a phone line.
The programme included a drop-in day at the surgery, a well-attended public meeting at the New Horizons Centre and a virtual event to ensure that as many patients as possible had the opportunity to give their views.
We wanted to hear patients’ views on the proposals – what impact they would have, and we asked what extra support could be offered, as well as any alternative solutions that may not have been considered.
The quotes below have been summarised and people who have submitted questions individually will receive replies.
1. New Horizon Centre public meeting
More than 50 people attended the meeting and asked questions of a panel – local GPs Dr Karen Worthington and Dr Sy Ganesaratnam and Merton Locality Director Mark Creelman.
A wide range of questions were raised, and the main areas included:
Plans for the new-build surgery at Rowan Park
Patients were frustrated about delays to the new surgery sited in Rowan Park housing development and wanted to know what was happening with those plans.
One resident said: “To say we have been waiting a long time is an understatement. Plans were submitted in 2011 and 2013. Another 1,000 patients have moved into area and there are more developments planned.”
One attendee asked: “Will there actually be a GP service at new Rowans Park?”
- The panel responded that they were committed to the plans and are doing all they can to ensure it opens as soon as possible, working closely with the council.
- The latest information they had was that building was likely to start in two to three years’ time. A team of GPs would be based at the building with other health services to meet the needs of the community.
Capacity at surrounding practices to take on new patients
Some of the questions focused on whether the surrounding practices, and in the neighbouring boroughs Croydon and Lambeth, would be able to cope with the additional patients from the Rowans Surgery, with more housing developments in the pipeline.
- The panel confirmed that practices have the capacity for an increase in patients as they monitor their list sizes and can recruit more staff if needed.
Quality of services
Patients voiced their concerns about the quality of service at the Rowans, including on the availability of appointments, long waits for calls to be answered and continuity of care.
One resident said: “When you go to Rowans Surgery it is hard to get an appointment. My Grandma went to the surgery, and we were told we were late. Then she went back and there were no doctors and she had been waiting at least an hour.”
Another said: “We should have been told earlier we should have gone [to another practice]. Ten years is a long time.”
- The panel explained that a move to nearby surgeries would mean they would be able to gain access to more GPs in larger practices and better appointments with a team approach to ensure quality of services.
Refurbishing the existing building
Some residents asked why the existing premises couldn’t be refurbished.
- The panel explained this was not possible because of the funding arrangements and because the building itself is no longer fit for purpose for modern healthcare due to the type of construction.
- There had been substantial investment in the building in the past.
- Local NHS bodies rely on external sources of funding for building projects because the majority of annual budgets are spent on delivering services.
- There is funding available for the new health centre as part of a Section 106 Agreement with the London Borough of Merton and housebuilder Crest Nicholson, who built the nearby Rowan Park residential development. The health centre will also include community facilities and a scout hall and is estimated to open in 2024/5.
Support for vulnerable patients
Registration support
People asked about the process of registration and how they could get help.
- The panel said the new practices would offer support, including from a team of care coordinators, where needed.
- Patients can check their nearest practices on the NHS website Find a GP – NHS (www.nhs.uk) and details of each practice’s catchment area can be found on surgery websites.
Travel to nearby GP practices
Travel to nearby surgeries was reported as an issue by some of the patients.
- The panel said all practices would have information on transport and bus routes and the dial-a-ride service would continue.
Home visits
Questions were asked about whether home visits would still be available. One attendee said: “I remember when you closed the Wilson, we were promised they could go to other surgeries. Can you make a commitment that there are 5,000 spaces in Wide Way and Figges Marsh and confirm all three surgeries will do home visits to vulnerable people?”
- The panel confirmed that patients would need to be registered with a practice they are in the catchment area for – which should be highlighted through the registration process. Home visits would continue to be offered if needed with paramedics also working in the community.
2. Rowans Surgery drop-in day
More than 35 residents attended a drop-in day at the Rowans Surgery, where a team from NHS South West London was on hand to answer questions. Many of the concerns raised centred on the quality of services at the Rowans and the process of registration with a new GP.
Quality of services
Patients reported that they had been unable to see a doctor face to face and were offered a telephone consultation with a locum, or a doctor at another surgery. They were also frustrated about getting through to the surgery on the phone, with waiting times ranging from 30 to 50 minutes.
One person commented: “I live very locally, but the service has deteriorated in a big way. I can see there are national problems, it’s very difficult to get through on phone to get a doctor’s appointment.”
Surgery closure proposals
Many patients felt the closure of the surgery was a “done deal”. Said one: “The surgery is rundown, a sad decline that has been happening for a number of years”. People also thought there had been a lack of communication and questioned whether the engagement meetings would have any influence.
- Residents were assured that all their views would be considered carefully before a decision was taken on the proposals.
Continuity of care
Many, especially those with long-term conditions, expressed concern about registering with a new surgery. There were fears that this would cause delays to receiving repeat prescriptions or that their condition would not be picked up by the new surgery. Patients, including those recently diagnosed with cancer, were concerned that referrals could be lost or delayed.
One patient said, “I can walk here because it’s only about five minutes from where I live. I have medical problems. Wide Way is nearest to me but it means a bus ride. There’s quite an older population who use the Rowans and people rely on having a local surgery. This is a convenient building to come to – the fact that there’s 5,000 patients still here shows it’s still popular.”
- Patients were assured that their records would be transferred across to a new practice easily. They were advised to ensure any regular repeat prescriptions were ordered well in advance if they moved surgeries.
Registration process
Questions were raised on whether neighbouring practices could take on the Rowans patients comfortably and whether they would be “unable to cope” causing delays in care. People wanted to know about the process of registering with a new surgery. A few asked if they left the Rowans now, could they come could back if the surgery remained open?
- Patients were advised there was capacity in the surrounding practices, and they could choose to move to other surgeries provided they were in the catchment area.
Rowans surgery staff
Most of the people attending praised the surgery reception staff for their support. One patient, who had a long-term condition, felt they were only receiving their current care because of reception staff’s help.
3. Virtual event
There were 5 attendees at the virtual event and asked questions of a panel – local GP Dr Sy Ganesaratnam, Merton Locality Director Mark Creelman and Merton Deputy Director of Primary Care Katharine Bugler.
Registration process
Reassurance was sought that all patients will have a surgery to go to and will receive the required support to re-register elsewhere.
A question was raised as to whether re-registration would be on a first-come, first-served basis and what would happen if practices reach capacity.
- It was confirmed that all patients would be able to register with another surgery and there will be a team of care coordinators to provide targeted support vulnerable people.
- A range of communication channels letter, the practice website and text message – would be used to inform patients about this, the re-registration process and support available.
- If a patient hadn’t registered by the point the practice closed, there would be a process to allocate them to a practice in the immediate area.
- The intention is that patients would register at the practice of choice, but the reallocation process would ensure all patients will continue to be registered at a practice.
- The panel confirmed that re-registration would not be on a first-come first-served basis, and it is expected that patients will be able to register at the practice of their choice, if they live within its catchment area.
Catchment areas
A patient asked if she could register at a practice if she lives one road outside its catchment area.
- The patient was advised to contact the preferred practice – the care coordinator team may be able to assist with re-registration if there are issues.
- The panel explained that contractually, practices cannot be required to register patients outside their catchment areas but may have flexibility over this. Practices have catchment areas to enable patients to have full access to services such as home visits.
Support for different cohorts of patients
One attendee raised the variable needs of different cohorts, including those aged 25 to 50 who are fit and well and don’t frequently access services. They felt re-registration can be a long-winded process and asked what could be done to help smooth the transition for some patients.
- It was noted that the Rowans Surgery does have significant youth and working age populations and a younger population than average. There will be a communications strategy that endeavours to target different groups.
- Re-registration support would be directed towards those who have been identified as vulnerable. Within the communications it will be made clear how additional support can be accessed if required.
- Allocating a practice to patients who don’t re-register would be a backstop to ensure people don’t slip through the net. Patients in the younger, healthier cohort who don’t re-register themselves would be part of this process.
Information
There was a question about information for patients as no details about the plans have been sent out – only about the re-registration process.
- Following the engagement period, a formal decision regarding closing the practice will be made and all registered patients will be informed and receive relevant information.
4. Phone calls and emails received
Residents also submitted their views by phone, email and post. A total of 13 people submitted their views and concerns. Their main issues were the quality of care and the support needed by vulnerable patients, who would find travel to alternative practices more difficult. All of these people who have submitted questions individually will receive replies.
Quality of services
Many of the comments centred on difficulties getting appointments at the Rowans and continuity of care for the patients. One person asked about clinical oversight and the CQC inspections at the practice.
Support with registration for more vulnerable patients
People asked about support for more vulnerable patients, including those with dementia and those with hearing impairments, and asked what support would be offered. Patients with complex healthcare needs were also thought to require extra help during any change of practice and to ensure medication supplies continued without interruption.
Requests for the Rowans to remain open with new management
Some people asked why the Rowans could not stay open under new management to improve services.
Patients from other boroughs
As the Rowans serves patients from the neighbouring boroughs, Lambeth and Croydon, some of the responses asked what options would be available for them.
Decision following engagement
After carefully considering the feedback received during the engagement events, NHS South West London has taken the decision to close the practice on 31 October 2022. We have explored every practical option to keep the surgery open but believe this is the only way to ensure people receive services that are safe and high quality.
We heard people’s frustrations about the quality of services, as well as the delays to the new build. We believe these changes will improve the GP services people receive. We have confirmed with the surrounding practices that they have capacity to take on extra patients and will continue to work with them going forward. Practices would recruit additional staff if required based on the number of people registered.
We are committed to the Rowan Park development and are making every effort to ensure it opens as soon as possible.
All patients registered at the practice will receive a letter shortly asking them to register with a new local GP surgery of their choice, before the closing date. The letter includes the details of the closest surgeries, which can also be found online at https://www.nhs.uk/service-search/find-a-gp
People can find out how to register at these surgeries by visiting their websites – or calling the reception team if they do not have access to the internet. Patients have been urged, if they take regular medication, to make sure they ask the Rowans Surgery for an adequate supply before registering with a new surgery, to avoid any disruption to access to medication during the registration period.
Key reasons for the decision:
- The current GP partners who run the surgery hold a contract with NHS South West London which is coming to an end. There have been difficulties recruiting GPs and nurses over many years which has impacted on the quality of care.
- Staffing issues have meant services needed to be provided by other local practices and the lead GP, who oversees care at the practice, has given notice of their resignation.
- There are longstanding problems with the building which is not fit for purpose. A new health centre will be built at Rowan Park, but it will not open for two to three years. Services from the new centre will be led by GPs and other local GP practices will have the option to use it as a branch site and to deliver other primary care based services, such as social prescribing. However, there will not be a GP practice based there.
Responding to concerns for the most vulnerable re-registering:
- As part of the Rowans surgery contract coming to an end, the practice will lead on identifying vulnerable registered patients and reaching out to offer support. The East Merton Primary Care Network will support this work through their team of Care Coordinators.
- We will meet the practice weekly to check on progress – such as where people are registering and numbers yet to re-register – and review arrangements for the most vulnerable. The practices where people register will receive additional funding to ensure patients get the support they need as well as an increase in their overall funding based on the number of patients they serve.
- As the contract comes to an end, anyone who remains registered with the Rowans Surgery, will be registered directly with a new practice they are within the catchment area of. Their new practice will make contact to offer a health check.