Chorley, Lancashire, a small town just north of Wigan. It is a nice place, with a decent market. Located in between parks and fields, it has a population of about 120,000. You would think people are happy living in such a nice place. But recently, many residents have been unhappy.
Chorley primary care services
Chorley has several GP-led health centres. One of them, Withnell Health Centre, was run by two GPs, one of whom decided to leave the practice in 2021 and dissolve the partnership. This was the end of the contract with the NHS.
In order to find a new partner for the practice, the remaining GP, Dr Ann Robinson, (who has been there for almost ten years), was awarded a temporary one-year contract. She knows the staff and patients, and it was widely expected she would take over the franchise to run the centre when the temporary contract runs out.
In order to take over formally, she had to make a bid for the £12mn contract, which was put out to tender. She needed to show what her strengths were, and how she would run the health centre and care for the 5,500 patients registered at the centre.
Hers wasn’t the only bid. A large company, SSP Health, made a bid as well, so she had to bid against a company with a lot more capital behind them, and large human resources and information technology departments.
The decision who gets such a contract is made by the local integrated care board (ICB).
What exactly are ICBs?
ICBs are the boards that decide how and where money is spent in a district. They replaced clinical commissioning groups last year. They decide which treatments are funded. Your doctor may tell you need a certain procedure or medication, but this may not be automatically allowed on the NHS; an application for funding is required showing that yours is an exceptional case, and that the benefits justify the expense.
ICBs have legal responsibilities as set out in the Health and Care Act 2022 regarding, for example, patient involvement in decisions that affect them (section 14Z36) and public involvement in consultations (section 14Z45). ICBs also decide on other funding, such as health centre contracts.
The British Medical Association is quite critical of this new system, and one of their many concerns is the lack of medical representatives in the new board structure. After all, what professionals are more qualified to decide on medical procedures and expenditure than medical professionals?
The contract was put to tender
With the old contract dissolved, a new contract was put out to tender. The remaining GP Dr Robinson made a bid, and unbeknownst to her, so did SSP Health. SSP Health runs over 40 GP practices, mainly in the North West. The two bids were compared, with a 75-point scoring system. Dr Robinson’s bid failed, scoring just four points lower than SSP Health’s bid.
Patients didn’t know SSP Health had also put in a bid and medical centre staff were told explicitly by letter that the proceedings were confidential and they were not to talk about it until the day before the contracts would be signed. This meant they could not inform patients what was going on, until it was a done deal.
Save Withnell Health Centre
Needless to say, when Withnell Health Centre patients found out, they were not happy. They formed an action group, Save Withnell Health Centre, to make their feelings known. Letters started flowing to the Lancashire and South Cumbria ICB (LSC ICB) and the local MP, Sir Lindsay Hoyle, who has asked for the decision to be reviewed.
On the morning of 17 January, when the papers were to be signed, health centre staff entered the LSC ICB building, Jubilee House, in protest (photo), and refused to leave. On arrival at reception they found a large box with signatures collected by Cllr France to protest the sale to SSP Health. The box had been handed in on 13 January, but had not even been opened. This made the protesters feel that the LSC ICB was not interested in their views.
On 19 January, around 150 patients held a demonstration outside Withnell Health Centre to make their feeling known, and on 1 February another demonstration took place, outside Chorley House where the LSC ICB was having a meeting, this time with around 100 patients present.
ICB Lancashire and South Cumbria’s lack of consultation
Patients are supposed to be at the heart of the NHS.
LSC ICB’s website states that they have “adopted the principle to start engagement early when developing plans”. This is in direct contrast to issuing health centre staff with a confidentiality clause so they cannot talk to patients or other lay people about the planned changes. And why is a confidentiality clause needed?
Traditionally this may have been to prevent patients leaving when a practice was being sold, in order to give a new doctor a fair chance to build a relationship with patients and community. In this case, the reason is not clear.
Patients were not consulted. The LSC ICB broke its own rules.
Why do patients not want SSP Health to run their Health Clinic?
Dr Robinson has indicated she does not want to stay on and work for SSP Health. This will mean new doctors and possibly a succession of locum GPs until permanent staff are found.
SSP Health runs many health centres, and checking the online reviews for some of them, patient satisfaction is not great, as shown in neighbouring Bolton and in Liverpool. And staff satisfaction is not much better it seems.
SSP Health has sued the Care Quality Commission for giving it inadequate ratings in the past, but maybe changing its own procedures would have been more conducive to patient trust?
Is it any wonder patients would prefer to keep the doctor they know and trust? Someone who they know will look after their health and support them for the next ten to 15 years at least?
LSC ICB’s reaction
LSC ICB has admitted failing to consult patients about their wishes, and admitted that more could have been done to keep patients informed. But the company has not started a patient consultation; it only postponed signing of the paperwork for three weeks, to give themselves the time to “resolve the matter”.
Locals don’t really expect them to change their minds. The LSC ICB may risk court action from SSP Health if they did, considering SSP Health’s former history. And of course, if SSP Health offered to perform the service for less money, why care about the standard of service? Even if it is less than Dr Robinson would provide.
What next for Chorley?
Uncertainty reigns for now. Sir Lindsay Hoyle has assured residents that ‘their voice has been heard’. But whether the local voices will persuade LSC ICB to think again, and to seriously consider the residents wishes, we can only hope.
For now, residents fear that their beloved GP service will be replaced by something sub-par. And that would be disastrous for the health of many people living in this lovely old town.
