Proposal to close Ulceby Health Clinic

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					                                                Patient and Public Involvement Forum for
                                                                        North Lincolnshire
                                          Freeman Street Resource and Community Centre
                                                                       41 –43 Kent Street
                                                                                  Grimsby
                                                                  North East Lincolnshire
                                                                               DN32 7DH

                                                                Telephone 01472 325 943
                                                                    Mobile 07969 611 628
30th March 2004

Mr P West
Assistant Director of Corporate Affairs (PPI)
North Lincolnshire Primary Care Trust
Health Place
Wrawby Road
Brigg
North Lincolnshire
DN20 8GS

Dear Mr West

Proposal to close Ulceby Health Clinic

We noted from the Internet that the Primary Care Trust is carrying out a
consultation process on its proposal to close the Ulceby Health Clinic. Two
members of the Patient and Public Involvement Forum for North Lincolnshire
visited the village to speak to residents and obtain their views on the closure. A
copy of their report is attached to this letter.

Your statistic stating that the population of Ulceby is approximately 1500 residents
is undated and so may not in fact represent the current situation; it is without
argument that the village is a growing community demonstrated by the new
housing being built all around. Our members found there to be strong feelings
within the village against the closure of the Health Centre and it is believed that
there will be four (4) petitions against the proposal presented by the village
population. They also found that the general practitioner that they spoke to was
not in favour of the closure and would be quite happy to continue holding his
surgeries there and paying the rent for the option to do so.

Your statistic for patients seen by the two doctors, 20 – 26 patients per week,
represents over 1.5% of the village population each week but this attendance is
limited by the time available for appointments and the limited services provided at
the health Centre. The booked appointments do cause some problems in that the
appointment must be booked in the morning or afternoon that the appointment is
required. This may be difficult for those members of the public that rely on public

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        Working in partnership with North Lincolnshire Primary Care Trust
telephones to make the call or older people who are not comfortable making
telephone calls. From the information given to our members by villagers, clinics
and services have been discontinued in the recent past; these have included
chiropody services and the baby clinic. It is understood that in 1997 that there were
a further two doctors sessions as well as the opportunity to see a nurse.

This closure would create an inequality in access to health services to the rural
community, especially the disadvantaged, older people, families with young
children and babies and those people on lower incomes. Should the closure go
ahead then we understand that patients will have to travel to Barton to have an
appointment with a GP, a distance of approximately 14 miles as the crow flies but
up to two hours by public transport. No figures were presented relating to private
car ownership but we would suggest that the majority of these vehicles would
actually be used to transport the wage earner out of the village, thus removing their
availability to access the surgery in Barton. We have attached a scenario of the
impact on a patient of using public transport to attend an appointment to the Barton
surgery for both a morning and an afternoon appointment. For a scholar having to
use public transport an appointment with a GP will mean a half a day from school!

We understand that your main reasons for proposing this closure are financial in
that there is a shortfall in income of £2174 per annum and an investment to be
made connected to the Disability Discrimination Act.

If the Health Centre has a shortfall of £2,174, we would ask what steps have been
taken to find alternative users for the centre. How much did the chiropody services
contribute to the budget? Are there other practitioners that would be willing to pay
a small rental charge to bring services to the community? The need for patients to
travel to the Barton surgeries will incur extra charges to the local council in the
payment of fares to those on lower incomes. Under the government’s “joined up”
working theme has the local authority been approached to contribute to this
shortfall that may prove to be a lesser sum to them than the subsidy of travel
fares?

It is noted that in your proposal document the recently conducted Disability
Discrimination Act audit identified the need to invest at least £30,000 on the
property in order to ensure appropriate compliance. As this audit report was not
attached to the consultation document we are not able to comment on the detail.
However, we would point out that during our members’ visit to the Health Centre
some of the requirements were identified as being already in place. As
“appropriate compliance” is a subjective statement we would ask if the Health
Centre could be made compliant under “fitness for purpose” at a lesser sum.




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We would ask you to confirm that this proposal has been formulated with
consideration to the Department of Health’s document of December 2003 “Building
on the Best - Choice, Responsiveness and Equity in the NHS”, especially with
respect to health needs being personal and services being shaped around the
needs of the users.

If, whilst giving these comments your due consideration, you have queries please
do not hesitate to contact the Forum.

Yours sincerely




Diane Brent
Chair
Patient and Public Involvement Forum
North Lincolnshire Primary Care Trust

Enclosures:
   1. Members Visit Report -Ulceby
   2. Public Transport Scenarios




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               REPORT ON VISIT TO ULCEBY VILLAGE
     REFERENCE THE PROPOSED CLOSURE OF THE HEALTH CENTRE


We had problems in finding the surgery. We stopped the car to ask a lady for
directions and this was fortunate because this lady had carried out a door-to-door
petition in her area, which is away from the village proper, against the closing of
the surgery. About fifty people signed it an area continuing to so do.

Unfortunately, by the time we found the surgery it was 11.45 am giving us 15
minutes before it closed.

The surgery is situated in the middle of housing for the elderly and looks well
looked after. It is set amid very pleasant lawns, trees and flowers. Access for the
disabled, i.e. ramp and wide doors without steps for wheelchairs is good. I
introduced myself to the receptionist and Joyce was interviewing patients. I asked
if we could do this and she was delighted when she knew why we were there. She
asked if we wanted to see the doctor (Dr Banerjee) and I suggested when he was
finished surgery in 15 minutes.

She was very helpful with information. She gave me a practice leaflet, told me that
morning surgery has eleven attendees. She informed me that when there was no
appointment system, the surgery was always full. The doctors adhere strictly to the
number of patients they can see in the surgery. If one wants a morning
appointment one must phone on the same morning, if one wants an afternoon they
can only phone the same afternoon. If the doctor’s list is full, you have to try
another day.

The receptionist, on my request showed me the toilet facilities and these were
large enough with plenty of room for a wheelchair. The only thing lacking was bars
on either side of the toilet to help the disabled. She then showed me a room for
the practice nurse, chiropodists and therapists. It was warm, pleasant and clean
and in my opinion it would not cost much to make it perfect as it seemed in good
repair.

It takes two hours to go by bus for an appointment at the Barton surgery because
of the times of buses. Also complaints about the closing of family planning clinic in
Barton as some patient preferred to go there for their smear test, now they had
nowhere.

We were next shown into the doctor’s office. Dr Banerjee seemed very pleased
when we introduced ourselves and explained what we were doing there. He is
very much against the proposed closure, he said that he didn’t mind paying rent for
the use of the premises, which had all the facilities for different clinic; i.e. well
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        Working in partnership with North Lincolnshire Primary Care Trust
woman’s, children. I remarked that I was told a visiting chiropodist as far back as
May 2003 told a patient about the proposed closure. We were then finished our
conversation and thanked him for the courtesy we had been shown. We said
good-bye and left

I next paid a visit to then Post Office, which I found out is run by a member of the
village council. She told me that the Parish Council is very worried about the
proposed closure. The have an ageing population because of the building of new
houses. The council is advising people to write individually to Phil West protesting
at the proposed closure.

I next went to the Yarborough Arms where about forty people, mainly pensioners,
were having lunch. I asked the owners permission to speak to his customers and
when he found out why he was delighted.

I interviewed a number of people and they were all very worried about the situation.
They had also organised an ongoing petition protesting against the closure.

To my knowledge at the present moment there are four petitions on the go.
    1. School and neighbourhood
    2. The Yarborough Arms pub
    3. The village Post Office
    4. The Pensioners Group

There is no sign of apathy in the village but there is a determination to try to save
the surgery.

Since my visit I have had a telephone call from the Parish Council. The member I
spoke to reported our visit to them and they ask if it would be possible to go to talk
to the Parish Council on 22nd March at 7 pm in the Village Hall, I said that I must
report to our group and ask their permission and I would get back to her.




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                        Public Transport Scenarios


A patient with a 9 am appointment
8.21 am      Bus leaves Ulceby Post Office
8.44 am      Bus arrives at Barton Market Place
             Assuming 30 minutes surgery time 9 – 9.30 am
9.59 am      Bus leaves Barton Market Place
10.22 am     Bus arrives Ulceby Post Office
             Total time of 2 hours 1 minutes
             If there was a delay then the next travel time would be;
10.59 am     Bus leaves Barton Market Place
11.22 am     Bus arrives Ulceby Post Office



A patient with a 5 pm appointment
4.26 pm      Bus leaves Ulceby Post Office
4.49 pm      Bus arrives Barton Market Place
             Assuming 30 minutes at the surgery 5- 5.30 pm
6.19 pm      Bus leaves Barton Market Place
6.42 pm      Bus arrives at Ulceby Post Office
             Total time of 2 hours 16 minutes
             If there was a delay, there would be no public transport to take the
             patient back to Ulceby as the 6.42 pm bus is the last to run between
             Barton and Ulceby each day




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