To Close the List to New Patients

APPLICATION BY

“Name of Surgery”

TO CLOSE THE LIST TO NEW PATIENTS

“DATE”

This is a formal application to NHS Mid Essex by the contractor Dr “Insert Name”, “Insert Surgery Address”. The application is to close the list to the registration of new patients except the immediate family members of existing patients.

This application is made under the GMS contract regulations 2012 and an extract of those regulations is attached as Appendix 1. This application is made with the support and knowledge of our patients, our staff, our neighbouring Practices and the Local Medical Committee.

The application is made to the NHS England, Essex Area Team.

Extract from GMS Standard Contract 2012

230.1. The options which the Contractor has considered, rejected or implemented in an attempt to relieve the difficulties which the Contractor has encountered in respect of its open list and, if any of the options were implemented, the level of success in reducing or extinguishing such difficulties;

The rationale for making this application is that “Insert name” Surgery has reached full capacity and cannot safely increase its list any further. Our safety concerns are for both our patients and our staff. The actions we have taken to increase our capacity have been as follows:

1. We have submitted bids for new premises.

2004 - Business Case submission Rejected by PCT

2008 - Business Case submission Rejected by PCT

2010 - Business Case submission Postponed by PCT until 2011

2011 - Business Case submission Rejected by PCT

2012 - Business Case submission Postponed by PCT until 2013

2013 - Business Case submission Postponed by PCT until 2014/15

2. We have submitted bids to expand into neighbouring premises

2012 - Application for additional accommodation Rejected by PCT

2013 - Application for additional accommodation Rejected by PCT

3. We have submitted bids for Improvement Grants

2012 - Application for Improvement Grant Rejected by PCT

2013 - Application for Improvement Grant Rejected by PCT

Extract from GMS Standard Contract 2012

230.2. Any discussions between the Contractor and its patients and a summary of those discussions including whether in the opinion of those patients the list of patients should or should not be closed;

On 25th February 2013 we began a consultation with our patients. This consultation has the support and consent of our Patient Participation Group. Patients were asked whether they supported us closing our list to new patients.

In 3 weeks, we have receive 1037 responses, 95.7% were in favour of us closing our list. Patients were also asked to free text their comments and nearly 250 comments have been received. These are attached as Appendix 2.

Extract from GMS Standard Contract 2012

230.3. Any discussions between the Contractor and other contractors in the practice area and a summary of the opinion of the other contractors as to whether the list of patients should or should not be closed;

Our neighbouring practices were consulted on 8th March 2013. The letter sent to them is attached as Appendix 3. Their replies are attached as Appendix 4.

Extract from GMS Standard Contract 2012

230.4. The period of time during which the Contractor wishes its list of patients to be closed and that period must not be less than 3 months and not more than 12 months;

This application is to close the list for 12 months. If progress in not made as detailed in Section 230.5 below, we will continue to make applications to remain closed after this period.

Extract from GMS Standard Contract 2012

230.5. Any reasonable support from the PCT which the Contractor considers would enable its list of patients to remain open or would enable the period of proposed closure to be minimised;

The list could be safely reopened only if the following criteria are satisfied:

1. NHS England give due consideration to our Business Case submitted in October 2012 and approve the case for new premises.

2. An Improvement grant is made for to enable us to safely care for our patients in the interim before a new development becomes operational.

Extract from GMS Standard Contract 2012

230.6. Any plans the Contractor may have to alleviate the difficulties mentioned in the Application during the period the list of patients may be closed in order for that list to reopen at the end of the proposed closure period without the existence of those difficulties;

As 230.5 above

Extract from GMS Standard Contract 2012

230.7. Any other information which the Contractor considers ought to be drawn to the attention of the PCT.

Our need for New Premises is well documented in our Business case which was submitted to the PCT in October 2012. In summary:

We have about 30% of the space we require to provide for our 13,700 patients

A six facet survey revealed that in almost every criteria the existing building fails to meet the necessary standards

Most of our consulting rooms are on the first floor with no lift

Patients frequently have to wait standing in corridors

4 clinical rooms, used on every session, are grossly sub-standard

Our medical records are stored in a shed in the car park

We have one toilet for 32 staff, no staff room and no meeting room.

2 sessions per week clinical staff have to do admin work as no consultation rooms are available

We have no attached staff

We request that the PCT considers and grants this application to close our list from 1st April 2013

Drs “insert all partner’s names”

APPENDIX 1

Extract from Standard GMS Contract (April 2012)

Application for closure of list of patients

230. Where the Contractor wishes to close its list of patients, the Contractor must send a written application (“the Application”) to close its list to the PCT and the Application must include the following details—

230.4. The period of time during which the Contractor wishes its list of patients to be closed and that period must not be less than 3 months and not more than 12 months;

230.5. Any reasonable support from the PCT which the Contractor considers would enable its list of patients to remain open or would enable the period of proposed closure to be minimised;

230.7. Any other information which the Contractor considers ought to be drawn to the attention of the PCT.

APPENDIX 2

Comments received up until 26th February 2013

The parking situation is poor – having to pay at supermarket is not useful either for patient or customers of the supermarket.

Severe lack of parking. No room for pushchairs when you have young children, especially if you have more than one.

Better parking facilities would be good.

Parking is very difficult especially for the disabled when no available space on arrival.

Must be accessible, similar location and better parking/access. Even walking, vehicles have some close shaves!

Location must be nearby.

The new building must still be accessible.

Poorly sighted access poor.

New location should be on a bus route so it is easily accessible, and this side of town is more convenient.

Reception too close to waiting room, you can hear everything they say.

Very hard to get parking as I have difficulty walking.

Poor parking and access.

Needs more waiting area space.

Upstairs waiting room too small and dangerous, with small children due to stairs.

The team on the desk are always so pleasant but they have to keep an eye on the blocked in cars in the car park. It is always so hot in the surgery.

I have been attending this surgery all my life, 55 years and I wonder how many people it catered for back then as how many today.

Not enough parking.

Larger car park.

Access is difficult for walking and patients in cars. Need for better parking and safer pedestrian access.

Waiting area squashed. Doctors have to come downstairs to see disabled patients.

The doctor has to come downstairs to see me.

We have outgrown this building, the car is practically non-existent, the position of the surgery isn’t practical on a busy road. Dangerous for pedestrians in this area. Only one patient toilet, often blocked by prams.

Very cramped waiting area and lack of privacy at the reception area because the waiting area is so small.

Its old, cramped and leaving prams at the door is a pain too.

Needs lift and bigger building for more people.

A good doctor’s surgery deserves good premises.

More parking, all on one floor or have a lift, bigger building to sit the patients in.

More parking.

Too small, needs to be up to date.

Parking is very difficult.

Not enough parking.

No lift for elderly people to access first floor consulting rooms, insufficient parking for cars.

Car park is far too small.

Hope for more parking.

Not enough parking area.

Appalling for wheelchair users. No room for wheelchairs in waiting room. Front doors inaccessible. Doctors’ rooms are too cramped.

Need more confidentiality in main reception.

New building.

Really old parking is really bad.

Nowhere to park.

Too old and cramped.

Lovely surgery but building is long overdue a refurbishment and modernisation.

The building is too small for capacity of patients.

Comments received up until 27th February 2013

Parking facilities are awful.

It is nearly impossible to park at any time of the day.

More staff on phones, more parking, nicer environments as we have to sit and wait so long.

Parking would be a bonus.

Larger car par a must.

Larger car park would be welcome.

Parking is an issue.

The new waiting room upstairs is an improvement, but car park is dreadful.

Better parking area.

No parking.

No parking and no privacy at reception.

Parking is terrible.

Too warm, dark and dingy, parking a nightmare.

Horrible and scruffy. Needs bigger building and modernising.

Not suitable as a modern day surgery.

Parking is terrible and the facilities within the building are far too cramped.

The building is inadequate for modern day use of a doctors surgery.

Parking issues.

Parking.

Parking and space.

On one floor, area for parking prams, as they currently block entrance/toilet. Bigger car park.

A more practical building with a larger car park.

Need parking and bigger premises urgently and more people on phones in reception.

Inadequate parking.

Comments received up until 28th February 2013

Really could do with a new surgery, new car park and new facilities. I think staff and the doctors do well in the old surgery.

Fantastic staff, fantastic service, very poor premises.

About time you were given new premises.

Needs a bigger car park.

Needs updating, better access and parking.

Totally impractical and very stressful trying to park when unwell.

Car parking very bad and needs desperate attention.

Newer building and better facilities.

Practice has grown so much and improved lately. New premises are required.

Bad parking, better modern surgeries in the area.

Out of date surgery.

Need new surgery and more parking spaces.

Hard to park, windows old, scared to open in the summer in upstairs waiting room as they are very old. I am very surprised doctors can get in and out in emergency because of the car park.

We need more room for more patients.

It would be great to have a brand new doctor’s surgery with lots of parking.

It would be better if there was better parking.

Need more parking and better waiting area. Staff are excellent for what they do.

Needs far more parking spaces.

Because there are never enough appointments, I had to wait 2 weeks for an appointment to get some antibiotics and by then I didn’t need them!

It is hard enough to get an appointment and it needs updating.

Needs more parking.

Needs more parking spaces.

A better quality service with easy access should be the goal.

Comments received up until 1st March 2013

Parking.

Parking is the biggest issue and it is not easily accessible to the elderly in that there are no bus stops nearby.

Not on bus route and too far from town bus park.