NHS England admits 'less than good' consultation over practice closure

NHS England has admitted failures in patient involvement in a decision to close a GP practice facing funding cuts.

Local politicians and patients in Okehampton, Devon have criticised NHS England for failing to consult after deciding not to re-procure the small, rural practice when its time-limited APMS contract ended in April 2016.

NHS England said a full consultation process was not required because the decision was a contracting issue rather than a change to services, but one expert lawyer has told GPonline there should be consultation any time required services are withdrawn, whatever the contract type.

Local commissioners have now admitted to a meeting of West Devon Borough Council’s overview and scrutiny committee that ‘consultation with local people was less than good’, according to local press reports.

Commissioners had decided that a reprocurred service would face a 42% reduction in its per-patient funding to GMS-equivalent, to bring it in-line with the national equitable funding policy. Facing such heavy losses, the 1,800 list practice was unlikely to attract providers and ‘would not constitute best use of taxpayers’ money’.

No consultation

West Devon council scrutiny committee member Cllr Tony Leach told GPonline: ‘I asked NHS England why they had not carried out any consultation, as stipulated by government policy, and they said that as it was a contractual issue, there was no need for any consultations. I called a public meeting for this to be debated, and we we're told that it was too late as the contract was about to end.’

Cllr Leach said the options for dispersed patients were to register at practices outside the area, or at a medical centre which patients felt already had access problems.

‘As a rural area with little public transport, any changes that make people travel for services cause a lot of problems for our community,' he added. ‘Removing the second practice has taken away any real choice.’

HealthWatch Devon also reported that members of the public had raised concerns over the lack of public consultation and the effect on neighbouring practices of the list dispersal.

An NHS England spokesman told GPonline that in future the patient engagement process would last a year, rather than six months. But, he suggested, the decision not to reprocure was a foregone conclusion.

‘Given the overwhelming case for not re-procuring such a small practice, with neighbouring capacity and little or no chance of bidders for a contract without its 70% enhancement, "consultation" was always going to end in one way’, he said.

The spokesman said that in the case of time-limited APMS contracts, ‘we would always expect the practice itself to have made it completely clear to the patient participation group and patients that their GPs were only there for a limited time. Then there would be no surprises at all.’

NHS England, the spokesman said, was not required to undertake patient consultation when a time limited APMS contract comes an end in the same way as would be required when decommissioning a G/PMS practice.

Patient involvement

NHS England is required under the 2006 NHS Act to make arrangements to involve the public in commissioning services for NHS patients. NHS England says that patient involvement can include a range of approaches from providing patients with information to a formal consultation, depending on the extent of changes proposed and the number of people affected. 

An expert lawyer told GPonline that commissioners should consult patients when a time-limited contract ends, unless the service itself is no longer necessary. Andrew Lockhart-Mirams, senior partner at Lockharts solicitors, said it was ‘difficult to see how the withdrawal of a service, unless it absolutely marginal’ would not require patient involvement. In general, Mr Lockhart-Mirams said, ‘if the service is still needed I think there should be consultation’.

An NHS England spokesman said that as the Okement practice had originally been commissioned in 2004 to absorb demand which was now being met by the expansion of a nearby medical centre, the service was no longer required.

GPonline revealed in March that commissioners had consulted patients in less than half of completed PMS reviews that were expected to change GP services. NHS England said that decisions to cut funding did not necessarily constitute a change in commissioning arrangements.  requiring patient involvement.  

A patient at one West Yorkshire practice is seeking a judicial review over claims from the local patients' group that it failed to involve the public in a PMS review.

Earlier this month GPonline revealed that APMS practices faced six-figure funding swings as commissioners applied the equitable funding policy to reprocured contracts.

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