"Following further extensive discussions after my meeting with residents in Harbottle last week, I have now got some clarity on the main issues of concern raised with me by many.
Q1. Will registering with another practice now give NHS England an excuse to say that there is no longer a need for the Harbottle surgery?
NHS England have been very clear to me that they are looking at how services might be provided from the Harbottle site in the medium term. They really are working to secure some alternative provision following Dr Miah handing back her contract.
It is of the utmost importance that patients register with a practice and this will NOT affect a continued commitment to try and secure services at Harbottle.
Q2. I asked for confirmation that NHS England is going to be looking at every potential method of providing some medical cover and dispensing of medication from the Harbottle surgery in the longterm, once the present contract with Dr Miah has ended.
No guarantees need be given, everyone understands that this may be difficult and take some time and negotiations, but NHS England is committed to meeting its obligations to support our most rural catchment. I have told NHS England that they have my total support to lobby the Secretary of State on finding innovative ways to fund medical cover & a dispensing framework as needed, so that those who live in this remote valley (especially outside all catchments but Harbottle) can continue to maintain our national park and farm the land which produces so much of the nation’s meat. I am reassured that in relation to dispensing services this is part of discussions with potential providers and NHS England are also looking at community pharmacy provision and the scope for further collection and delivery services.
Q3. There are a few out-of-catchment families beyond Alwinton who are not within the Rothbury or Bellingham catchment map areas, which means that when they phone to register they are told they cannot do so. What is NHS England doing about this?
As any GP has a duty to be able to provide home visits if these are out of catchment then they cannot be expected to do so without appropriate backing. I have spoken with Dr Hunt at Rothbury who says he will need extra support in the short term until new provision out of Harbottle is achieved.
NHS England confirm to me that they have now identified the specific patients concerned. There are a small number of these patients and they are sharing the information with the Rothbury practice which is most closely aligned to them. They have confirmed to me that they will write to the affected patients to advise them of the arrangements put in place in the short term through the Rothbury practice.
Please tell me if you have not had contact from NHS England as an out-of-catchment family.
Q4. Residents are mystified by the decision by NHS England to allow Dr Miah to walk away from her GP contract without having to work out her notice period. Has NHS England used all its powers to maintain provision over that workout period by providing support to find locum cover where she failed to do so?
The standard notice period for a PMS contract is six months, during which the provider is required to ensure the provision of the full range of services to patients. NHS England tell me that they would not agree a notice period of any less than this unless there were robust arrangements in place for the continuation of primary care services. Dr Miah failed to do this and has effectively defaulted on her contract. In these exceptional circumstances NHS England’s responsibility is to ensure patients have continued access to services; in this instance by asking patients to register with another practice to ensure continuity of care whilst NHS England seek alternative provision at Harbottle.
I am writing to the Secretary of State to ask for his view on whether Dr Miah's default of her contract has been managed and dealt with properly, as I am still unconvinced on this area of the process.
Q5. Isn't it the case that if GP contracts become a danger to patient safety, NHS England can put the contract into “special measures” and access extra funding to protect patient safety and give time to find an orderly solution to the crisis situation?
The “special measures” is an action that can be taken by the Care Quality Commission (CQC) but is dependent on the provider being able to meet any improvements required. The situation we are faced with in Harbottle is different, relating specifically to the provision of services rather than CQC assessment.
Current GP availability makes it extremely difficult to secure locum cover – this is a problem in many areas of the country and is exacerbated in remote and rural areas. This is one of the principal reasons why NHS England are seeking to secure the long-term provision of services through another GP contract, which will provide greater continuity of care."
