Report from public meeting about proposed Surgery Closure

Notes from the Public Meeting held at the Cricket Pavilion, Shadwell, Uley

4th August 2021 at 6.00 PM

Purpose: To discuss the application to close the dispensary at Uley Surgery and to relocate it to the surgery at Cam, and the subsequent proposal to close Uley Surgery completely and move all medical services to Cam.

Present on the veranda:

John Penley – Chair of Public meeting

Melanie Paraskeva – Chair of UPC

Caroline Penley – Chair of Patient Participation Group (Cam & Uley Family Practice liaison)

Siobhan Baillie MP

Becky Parish – Clinical Commissioning Group NHS

Dr Marion McDowell – Senior Partner – Cam & Uley Family Practice

Ian Cawthorne – Practice Manager – Cam & Uley Family Manager

Cllr Jo Dee – UPC

Cllr Janet Wood – UPC

Cllr Mike Griffiths – UPC

Cllr David Lungley – UPC

Cllr Juliet Brown – UPC

John Kay – Clerk to UPC

Belinda Holley – taking minutes

Members of the public attending – in excess of 230 persons (recorded on the clicker and checked via a head count, but people were entering from several directions and so not all could be recorded)

Apologies: Pami Davies; Cllr Tim Martin

18.05 PM – The Chairman of the meeting, John Penley, introduced himself and welcomed the assembled villagers/patients from the veranda of the cricket pavilion via a public address system.

Everyone was asked to move across in front of the pavilion for photographs to be taken to record the event.

The Chairman stated that the meeting had been called by Caroline Penley, Chair of the Patient Participation Group (PPG) for Cam & Uley Family Practice, and that on the platform with him were Caroline Penley, Melanie Paraskeva, Chair of Uley Parish Council (UPC), Becky Parish from the NHS Clinical Commissioning Group in Gloucester, Siobhan Bailie, our Member of Parliament, Dr Marion McDowell, a partner of Cam & Uley Family Practice, Ian Cawthorne, the Practice Manager and Belinda Holley who would be taking notes.

The Chairman stated that time was short for this meeting, as the UPC August meeting was due to start at 7.00 PM immediately after this public meeting.  He stated that it was necessary to call this meeting at such short notice because:

  • 14th August is the closing date for public responses to the Practice’s application to the NHS Pharmacy Market Management Services to close the Uley Surgery and relocate the dispensary to their Cam surgery
  • 20th August is the deadline set by the Cam & Uley Family Practice for comments via their questionnaire for their consultation for the closure of the surgery

and to ensure that a public meeting could take place before the August Parish Council meeting, to enable Uley Parish councillors to discuss the views of those present at the public meeting in order to take them into consideration when formulating their response to these proposals.

The Chairman stated that anyone who wanted to stay on to attend the PC meeting afterwards could do so, and the Clerk would come out to invite them in once the meeting had started.  He also said there would be a head count and that photographs would be taken to record the meeting.

The Chairman explained that the purpose of the Patient Participation Group (PPG) is as a link between the Cam & Uley family Practice, its patients, and any other organisations that it liaises with.  He stated that the purpose of this meeting would be to discuss two proposals – namely the application for the closure of dispensary at Uley Surgery and its relocation to the surgery at Cam, and the complete closure of the Uley Surgery and the withdrawal of all medical services from Uley.  Many patients would have received a text today regarding this, with a link to the consultation questionnaire on the practice website.

If the measures are to be opposed by UPC and the PPG, the Chairman stated that it is necessary to ensure that a public consultation takes place to enable patients to state their opinions and views, and that this is the reason for this meeting and the public platform to do so.

The Chairman then explained that the Regulatory body for the closure of the surgery is the local NHS Clinical Commissioning Group, based in Gloucester, and represented at this meeting by Becky Parish, who would outline the processes involved later in the proceedings.

The Chairman advised that petitions opposing both proposals are available for signature in the event tents, and that if people wish to oppose both they will need to sign both petitions, the white version for opposition to the loss of the dispensary in Uley, and the green one to oppose closure of the surgery in Uley.  The petition to oppose the closure of Uley Surgery will subsequently be available at the Village Shop and at The Vestry at Prema.

The Chairman also asked attendees to send personal letters or emails to express their views, and to fill in the practice website questionnaire – and that paper copies would be available from Uley Surgery for those without access to a computer.  He advised that the deadline for opposition to the relocation of the dispensary is 14 August, and for the Surgery it is now 17 September, and reminded all that the new petition, objecting to closure of the surgery, is available for signature tonight.

The Chairman then stated again Becky Parish from the CCG would answer questions about the procedure for the closure of the surgery. and Dr Marion McDowell, a Partner from Cam & Uley Family Practice, would outline why the Uley Surgery is to be closed.  Siobhan Baillie MP will listen from the platform, but unfortunately must leave halfway through to attend another engagement.

The Chairman said that people in the audience would now be able to make comments and ask questions, but that any speakers must keep make sure their statements were short and to the point, as time before the UPC meeting was so short.  There was not time for any speeches and please keep things brief.

David Lungley then took the microphone to member of the audience.

Speaker 1 – Said she wanted to know where they expect everyone to go for medical services?  There are 1000 people in Uley, plus others in Nympsfield and Coaley.  She felt there is not enough room at Cam for Uley patients to be seen there and that it would be impossible to get to see a doctor easily.

Speaker 2 – Said she is a lifelong villager.  Uley has always had a surgery, and if Uley Surgery is to be closed then we need to be able to register at Dursley because older people can use the bus to get there, which they just can’t do if we have to use Cam.  Applause

Speaker 3 – noted that planning applications for 3000 new houses at Cam have been approved recently, with more applications on the cards, so it just doesn’t make any sense to close any existing facilities that the practice operates currently.  Applause.  He stated that the world is currently in the grips of the biggest crisis ever faced with Covid and so why would anyone consider making NHS services for so many people actually worse?  Applause.

Speaker 4 – asserted that he had looked at the Care Quality inspection of the Surgery in 2015, which stated that there were no risks and that the building was well-equipped to serve patients – so what is the rationale by Cam Surgery that the current surgery is inadequate? Applause

Speaker 5 – stated that she had lived in village for 45 years, and in that time she and her family had used the Uley Surgery constantly, so she was extremely surprised to get text earlier today to the effect that it is neither safe nor effective.  That is just not true.  Why would they say that?  Applause

Speaker 6 – stated that there is much confusion between the two matters under discussion, and he requested that the following resolution be put to the meeting with a show of hands:

‘This meeting requests that the practice immediately withdraws its dispensary application pending the outcome of the surgery application, and that UPC writes immediately to the practice and pharmacy marketing management service to this effect’. 

The Chairman asked for a show of hands and all present, but one dissenter, agreed and the motion was carried.

[Post-meeting note: The Parish Council did not agree to trying to halt the dispensary decision. The NHS will make their decision when they want, and UPC did not want to undermine the will of the 500 plus people who have already signed the petition to oppose the closure of the dispensary at Uley Surgery and its relocation to the surgery at Cam as it stands. Proposed by M Griffiths and seconded by J Wood.  The petition to oppose the loss of the dispensary will be sent off on Friday 6 August 2021].

Siobhan Baillie MP then stood to address the meeting.  She said that she had submitted a formal request to the partners at Cam & Uley Family Practice and she was now delighted to announce that they had today agreed to extend the deadline for consultation about closure of the Uley Surgery from 20th August to 17th September to give patients in Uley more time to express their views.

The Chairman then allowed further public comments and questions.

Speaker 7 – Stated that her understanding was that doctors’ practices get additional funding if they cover a rural area, although it seemed that there appears to be no requirement to provide any additional services with these funds.  She wanted to know that if Uley Surgery was closed, what would happen to the extra funds that the Practice gets for Uley?

Speaker 8 – said that climate change is at the top of world’s agenda at the current time; so, what sense is there in making everyone in Uley travel to Cam for medical services, a round trip of 11 over miles by car, when nearly a thousand people can all currently walk to the Uley Surgery?  Applause.

Speaker 9 – wanted to know what people are supposed to do if they can’t drive a car?  How are they supposed to get to see a doctor or obtain prescriptions?  Applause.

Speaker 10 – stated that he felt it all comes down to money – so could we see any accounts from the Practice to prove that Uley Surgery is costing them money and that it has to be subsidised by funding for Cam patients?  Applause

Speaker 11 – asked if the decision to close Uley Surgery was being driven by the doctors in the practice themselves, or by any other nameless bureaucrats?

Speaker 12 – said she was very keen to say that the contents of the questionnaire on the Cam & Uley Family Practice website were very leading in the way the questions had been posed, by stating that the facilities at the surgery in Uley were unsafe and then referencing only the services available in Cam, so she didn’t feel it gave Uley patients the opportunity to accurately give a view on Uley.  Applause.

Speaker 13 – said that there is a very strong feeling in the village about these proposals, and she wanted to put on record her concerns about the lack of notice concerning both the deadlines and the public meeting.  Lots of families with young children are currently away on holiday, for instance, and these proposals will affect them greatly and yet they can’t be here tonight in representative numbers to make their feelings known.  Applause.

The Chairman then halted questions and introduced Becky Parish from the Gloucestershire NHS CCG, who then addressed the meeting.  She thanked everyone for taking the time to attend and stated that she was present to speak about the processes of consultation re closure of the surgery.  She noted that most of the questions so far are for the Practice GPs and managers to respond to.

(At this point Siobhan Baillie MP left the meeting)

Ms Parish said that lots of people have already got in touch with her, our MP, and the Parish Council about the timing of survey.  She clarified that the consultation process is run entirely by the GP practice, and repeated that they had already agreed to extend their deadline for consultation from 20th August to 17th September.  This additional month will take us out of the holiday period.  The practice website will be updated shortly to reflect this.

She said that there were some questions she could help with – and that somebody had asked whether it is the GP practice or bureaucrats that are asking for closure of the Surgery.  She confirmed that it is definitely at the request of the GP practice, and it will be their decision whether to make the application to close the surgery or not.

She clarified that the CCG haven’t actually received an application from the Cam & Uley Family Practice yet, and that the purpose of the consultation process is to help the Practice put patients’ views into the mix.  If an application is then submitted, the CCG will review all of the evidence submitted and will then make a decision.

Lots of people have already written to Ms Parish, and she will pass all these comments on to the Practice as it is their consultation.  There are other points she could help us with, although she was not sure about the resolution mooted earlier, as her group don’t have any influence over the application to NHS England to close and relocate the dispensary (this is dealt with by the Pharmacy Market Management Services on behalf of Primary Care Support England).  She stated that she would try to find out more.

Ms Parish stated that surveys are difficult to construct.  She said that she has advised with regard to the one put together by the practice for this consultation and that they are using CCG software.  She had personally given advice about the flow of the questionnaire.  There needed to be a balanced mix of Yes and No quantitative questions, as well as qualitative questions with free text boxes to enable all views to be collated.  Every questionnaire will be analysed and added to the evidence and all views would be included – nothing would be hidden.  She also confirmed that the survey was anonymous, and that all views would be confidential.

The Chairman then asked Dr Marion McDowell, Partner, from Cam & Uley Family Practice, to address the meeting to give an overview of the situation re Uley Surgery, the dispensary and the Practice’s reasoning.

Dr McDowell thanked everyone for coming out.  She said she realised that these proposals had upset and worried people, and that it wasn’t their intention or hope.  She apologised for this distress.  (Incredulous laughter).  She said they were merely exploring the option of moving the dispensary to Cam, but the NHS rather jumped the gun, and it went out publicly before the Practice had a chance to consult.  It was not at all what they wanted.  But once it was out there, they thought it would be better to start the consultation about withdrawing clinical services for Uley too.

She said that the Orchard Medical Practice combined with the Uley Surgery in 2013 – at the time there were around 7000 Orchard Medical Practice patients and about 3000 in Uley.

The current Cam & Uley Family Practice is 10 miles across and Cam is bang in the middle.  The building was extended subsequently, adding six more consulting rooms and a further two clinical rooms to the Orchard building, and so now they have 18 consulting rooms, as they knew that more building of homes in the Cam area was very likely to take place.  Heckling occurred and the Chairman intervened to insist that Dr McDowell should be allowed to speak.

Dr McDowell stated that dispensaries are an unusual part of NHS; they began in1911 for doctors who mixed their own drugs.  The Practice can only dispense to 800 Uley residents, who are registered for this service, and also for the further patients in Cambridge, Stinchcombe, Nympsfield, North Nibley, Kingscote etc.  New patients can be dispensed to, but many don’t have a right to it.  Staff at Uley are trained dispensers, and are not pharmacists, and so need the input of GPs.  She stated that they get a small amount of money from the dispensary, and they also operate a delivery service to housebound people in Uley, Coaley, Kingscote and those beyond Cam.   (More heckling).  This would continue in the future.  This service is free.  Whereas the chemist in Cam does have to charge for delivery.  So, Uley gets a free service, and this would continue if the dispensary moved to Cam.  There are plans for a new area for the dispensary in the Cam building, which only 80% of the Uley patients would be registered to use.

Dr McDowell went on to explain that the main reason they are concerned about the services in Uley is the age and state of the building in Uley.  A CQC inspection hasn’t taken place for seven years and in that time new dispensary rules have become very are onerous and the Uley Surgery does not meet them.  She also has safety concerns for patients and her staff.  She would not want members of her family either working there or being treated there.  Indeed, Midwifery services withdrew from the operating out of Uley because the midwives decided that the building was not safe for pregnant women. More heckling and dissent and the Chairman called for Order.

Dr McDowell then said that it is just not an accessible building.  She is not happy about her staff working in a building with no fire escape.  Anyone disabled finds the steps difficult to get up and down, and there are steps to the waiting room, the loo, and the consulting rooms.  She is worried about patient and staff safety in the building.  You can’t get a paramedic stretcher into the building and there is no couch in the nurses’ consulting room downstairs.  So, her conclusion is that the surgery building has come to the end of its useful life.  They have had architects look at it and they can’t make enough accessible space on the ground floor for administration, the waiting room, the loo, plus two rooms for the dispensary and two consulting rooms.  The building has not been used to see patients since Covid began last March 2020 and wouldn’t be used for the foreseeable future due to social distancing guidelines and indeed four members of staff had caught Covid there.  She stated that they will continue to visit patients in Uley – and asserted that doctors do still come here, though many in the audience disputed this very vocally.  She said that nurses had continued to visit patients as needed and she said the changes won’t stop any services that are currently in place being sent out of Cam….

The Chairman then asked for more questions from the floor.

Speaker 14 – said he is a father of three and the demographics of the village should be considered.  If you have children in the school, it is a five-minute walk to take a child out of school to take them to see a doctor at the Uley Surgery.  If families now have to go to Cam, it’s a nightmare as it takes so much longer, and they can’t miss school for that length of time and so have to go after school.  Do the Practice expect families to have to get babysitters if they have multiple children to avoid clogging the surgery up?  The dispensary in Uley is a godsend for families like his.

Dr McDowell asserted that mother and babies have got used to going to Cam.  She also stated that all consultations now start with phone call to GP.  She says that younger patients like to embrace digital technologies and that patients are grateful for this….

Speaker 15 – said she has had to visit Cam Surgery in recent times as it is the only option recently.  There are always queues outside.  And what about the parking?  It is bad enough at the moment.  What will happen when all the new building of 3000 homes is complete, and all these new families and children want to get to the doctors.  Parking at Cam is terrible at the best of times.

Dr McD said that there is no parking at Uley (hecklers pointed out that it doesn’t matter as everyone walks there) and stated that the Cam Surgery meets NHS requirements.  She said that you could also park in the parish car park or at Tesco.  More heckling at this due to the distance needed to walk through to the surgery and having to cross busy roads….

Speaker 16 – stated from personal experience she knew that modification could be funded by the NHS, so it would not be impossible to modify the current practice.  Is the current consultation merely because there is no wish to do so at the Uley Surgery?

Dr McDowell said that they have looked at it, and it will be impossible to alter the existing building to meet requirements.  They don’t own the building and so can’t modify it.  The building is rented from Dr Steve Alvis – who happily used it for thirty years for his practice, but the tenancy comes up next year and the Practice feels for many reasons that they will not renew the rental agreement.

Speaker 17 – said that if the building is not fit for purpose, then the Practice should look at building a new Surgery in Uley instead.  Applause.

Dr McDowell says it would easily be a million-pound project and would need a minimum of seven ground floor consulting rooms.  It is an ongoing problem that cannot be resolved and is the reason why the services need to be centralised in Cam.  They could use the pub, for instance, but she doesn’t think any of the audience would like that, and there are no other suitable alternatives in the village.

Speaker 18 – said that as the practices merged in 2013, would it be possible to unmerge?  Applause.

Dr McDowell said that if we wanted to talk to the CCG and if we could find doctors who would be willing to work here then it could be possible.  But the practice really wants to keep Uley patients.  She said that the practice has received lots of praise on how it has dealt with the pandemic – and they are not trying to save money but are trying to use the resources they have in best way to benefit patients.

Speaker 19 – said that whilst she understands that the current Uley Surgery practice doesn’t suit all staff and all patients, surely if enough patients and enough staff want to make it work, could it not continue on that basis?  Applause.

Dr McDowell said that their bread and butter are young families with children and the elderly – and that mobile people have no problem getting services and so they don’t see why this majority should continue to benefit most.

Caroline Penley from the PPG then addressed the meeting – and said that she speaks on behalf of the PPG and UPC.  She knows that Practice has worked very hard during pandemic, and we are all grateful for the services that they offer.  We are also very grateful that the Cam & Uley Family Practice has very kindly granted an extension for the consultation, as it will give us time to look at the existing building and understand in detail what the issues are and also to look at possible alternative sites in the village.

Melanie Paraskevas, Chair of UPC, then stated that it was very unfortunate that UPC hadn’t been consulted to date about the issues with the services or the problems with building in Uley.  If the Practice had contacted them when the merger happened or afterwards, they could have worked with the Practice to find alternatives as so there are just so many people in Uley who really can’t travel easily to Cam but who can get to the Surgery in Uley and who rely on the dispensary in Uley too.  It was very unfortunate that up until now UPC hadn’t been consulted or given the chance for input.

Speaker 19 – said that the Practice still haven’t addressed that point about how those without transport can get to Cam Surgery?  The elderly, those with children or those who can’t afford transport.  She referenced that during Covid there was the option of virtual consultations – but these are often people who don’t have access to that type of technology, so they are doubly hit.  Applause.

Dr McDowell said that they have nurses specifically to go out to do these consultations with those type of patients.  They have been coming into Uley and plan for that care to continue.  They have a lot of experience in providing services to similar patients in North Nibley, Slimbridge, Cambridge, Stinchcombe and beyond and this can extend to Uley.  There are definitely nurses visiting and offering services.

Melanie Paraskevas stated that Uley is a Tier 3b settlement and is much larger than the other villages Dr McDowell has just mentioned and so that is the reason it has always had a surgery and a dispensary.  Situations in much smaller villages and hamlets are not comparable with the situation in Uley and so don’t apply.

Speaker 20 – wanted a show of hands to ask a question about seeing a doctor fact to face but the Chair intervened and took the meeting back.

The Chairman stated that the meeting would have to draw to a close and that the purpose of the meeting was for the PPG to sound out patients on two matters.

He then asked for a show of hands:

All those who object to closure of the dispensary in Uley?

All who object – overwhelming.

Against – 0

All those who object to the second proposal to close the surgery in Uley?

All who object – overwhelming.

Against – 0

Melanie Paraskevas intervened, and Speaker 20 was able to state that there seemed to be a very big assumption on the part of the Practice that patients were perfectly happy with telephone or online consultations, and could there be a show of hands to ask if those present would rather be given the opportunity to actually see a doctor face to face?

Despite objections from Dr McDowell who asserted that it was an unfair question due to Covid, which many people pointed out was only the situation now and would not be permanent, the Chairman allowed a show of hands.

If you have the option of seeing a doctor or having a telephone consultation, would you prefer seeing a doctor face to face?

Face to face – overwhelming yes

Speaker 20 absolutely agreed that in certain circumstances telephone appointments would be entirely appropriate, but the Practice should not assume that this is acceptable for the majority of patients from now on.

The Chairman then closed the public meeting to allow Uley Parish Council to begin the August meeting in the pavilion.  He gave thanks to the Dembrey family for organising the event tents and the parking, and gave thanks also to David Lungley for racing round with the microphone so that all questions could be heard clearly on the PA system.

The meeting ended at 6.55 PM

Post meeting notes:

Several suggestions for alternative sites were mooted and included the BT Exchange in Raglan Way; knocking down the existing surgery building and replacing it with a purpose-built surgery, putting a mini roundabout at the Fop Street crossroads and using the waste land adjacent to it on the Stouts Hill side to build a car park, a new surgery, a new shop, and a new Village Hall.