Dawn Butler to join protest tonight as Scrutiny examine NW London NHS cuts & their impact on patients

The NW London NHS Financial Recovery Plan will come under close scrutiny at the Community and Wellbeing Scrutiny Committee on Wednesday. The plan aims to tackle the deficit in a variety of ways but the fear is that it will impact on patients.

The full document with the financial background and overall strategy can be found HERE but of most importance for residents will be the actions that are planned that will affect patients. Committee members will need to look beyond the jargon and probe deeply to find out what the real implications are for patients.

Dawn Butler will lead a protest outside the Civic Centre against the cuts, the ending of an overnight service at Central Middlesex Urgent Care Centre, and the closure of Cricklewood Walk-In Centre. She will be speaking at Scrutiny. Butler has also issued a video challenge to Brent CCG to join her on the overnight bus from Central Middlesex Hospital to Ealing Hospital to show how difficult the journey is for residents seeking urgent treatment.

Cllr Mary Daly has provided a commentary on theRecovery Plan proposals via Twitter:

Cllr Mary Daly

@CllrDaly

The managers bemoan the increased use of emergency service doesn’t seem able to link it to cuts to out of hours primary care across the area or CMH urgent care centre. There is no plan for primary or community care.

There appears to be no equalities impact assessment. No meaningful consultation with residents and certainly no contact with local councillors. yet we are told £98.9m.....

£8m saved by denying brent residents over the counter medicines. This affects the most vulnerable refugees, low income residents. this is not to improve the service but to save money...,

£6m saving by stopping new and follow up outpatient appointments denying specialist to thousands......

Admit fewer emergency patients including those with pulmonary embolus and pneumonia no reference to community services social care ......

£4.6m saved by refusing referral for elective surgery if the money runs out unless you are waiting more than a year YES a year

This is the pertinent section of the report:

6. How These Changes Will Affect Brent Patients 

6.1.The section below provides further detail on how specific recovery schemes are likely to affect Brent patients, as requested by the Community Wellbeing Scrutiny Committee. 

6.2.Elective hospital services and bringing some elective hospital services back to local North West London providers 

This programme will focus on “repatriating” elective procedures begin referred by General Practitioners and Trusts to providers outside North West London back into the North West London sector. The project aims to change referral patterns where NWL GPs consider using NW London providers and only refer outside of the sector if there is no capacity or if the patient requires intervention provided by specialist centres out of area. 

North West London NHS has an agreement with local NHS Trusts that specific quantities of activity will be delivered in each trust. Any activity above a set threshold is paid at 70% of the Payment by Results Tariff. This means that if more activity is referred to North West London providers, then approximately 30% of the tariff will be saved on each procedure. This is not true of providers external to North West London or to private sector providers.
The total amount of activity that we could bring back into the sector amounts to around 15% of all secondary care activity. 

For Brent patients, they should see no change in the healthcare that they receive, except that they are more likely to be referred to a local provider rather than a provider external to the North West London health economy such as Royal Free Hospitals NHS Trust, for example. This is likely to be a benefit to patients in not having to travel longer distances across the city. 

It should be noted that patients and GPs will always retain the right under the NHS Constitution to be referred to a provider of their choice and that GP retain the right to make decisions for the wellbeing of their patients. 

6.3. Outpatient services and changes to outpatient appointments 

NWL CCGs have reached agreement with providers that all activity in Quarters 3 and 4 of 2019/20 will be at contracted (planned) levels of activity, unless this puts waiting list commitments at risk. It was agreed that there will be no rise in 52 week waiters.
Additionally, our providers have agreed to adhere an existing consultant to consultant referral policy. The key principle behind this is that referrals relating to the original complaint can be referred on directly to another consultant. However, if an entirely different complaint comes to the attention of the consultant (unrelated to the original referral) this should be referred back to the patient’s GP first. 

We have an outpatient transformation programme in North West London which has developed standardised referral guidelines. Consultants are currently triaging GP referrals against these guidelines when the referrals arrive at the hospital. Any referrals which do not adhere to the guidelines will be sent back to the referring GP with advice. In this way, unnecessary outpatient appointments can be avoided and patients may receive their care from their local GP practice. 

6.4. Reducing spending on over the counter medicine prescriptions

Using the NHS London published guidance, we are working with secondary and primary care to reduce the volume of over the counter medication (for example paracetamol or ibuprofen) prescribed to patients. We have in place a communication plan for clinicians, patients and the wider public to support roll out. We will work with secondary care colleagues to support the programme and ensure that advice to patients is consistent across primary and secondary care.
Patients who are considered to be particularly vulnerable and are in receipt of free prescriptions may still receive these over the counter medications on prescription, at the discretion of their GP. 

6.5. Standardising assessments for patient transport 

This programme involves the renegotiation of the price on the LNWHT patient transport contract and a consistent application of current eligibility criteria. Discussions are currently underway with LNWHT with regard to the first element of the programme. Patient care will not be affected and those patients who require patient transport will still be able to receive it. 

6.6.Home Oxygen and Enteral Feeds 

This programme is made up of 3 elements. The first is the benefit of a pricing change following national procurement for home oxygen. The next is a clinical review of patients on home oxygen, prioritising those patients who have not been reviewed in the last 12 months and/or those patients where the data shows they are using less oxygen than prescribed. This review process will ensure that patients are not receiving a higher dosage of oxygen than they need, and that oxygen is not being wasted where it is no longer required. It will not change the criteria for patients to receive oxygen. 

The enteral feeds procurement provides commissioners with a saving by reducing the costs of consumables and securing a better deal with the NHS’s external providers. It does not alter the care pathway and patients will not experience any change. 

6.7.Unscheduled Care 

A&E attendances and unplanned emergency admissions to hospital continue to rise in an unsustainable way. These are one of the biggest drivers of the deficit to the NWL financial system. There are a number of workstreams to address this. These schemes are divided up into “front door demand”, which is about reducing the number of patients turning up at the front door of A&E/ Urgent Care Centres, and “short stay flow”, which is about getting senior level clinician input at the start of patients’ journeys into the A&E department so that they can be turned around more quickly. This in turn means that they are less likely to be admitted to an inpatient bed. 

Clinicians from LNWHUT and Brent and Harrow CCGs are currently participating in a “6As audit”. Emergency admission to hospital is a major event in people’s lives. It should never happen because it is easy to admit or to access services that could be available as an out-patient or to administer treatment that may be available closer to home or to get a specialist opinion. All of these are spurious reasons for an emergency admission. To transform emergency healthcare we need to understand why we put patients through this process when alternatives exist and operate effectively across the country but haven’t been widely implemented.
Emergency admission implies a patient is sick and requires a high level of intervention. As such, all proposed emergency admissions should prompt a clinical conversation between senior doctors, ideally consultants. 

The 6 As audit is about establishing whether patients are currently going to the optimal place, or whether improvements could be made to better utilise community care pathways. The audit involves asking whether the following alternatives could have been used: 

·  Advice - suggest a clinical management plan that allows the patient to be managed in primary care

·  Access to out-patient services - suggest an outpatient referral for specialist assessment

·  Ambulatory Emergency Care - clinically stable patients appropriate for same day discharge

·  Acute Frailty Unit - to provide comprehensive geriatric assessment for frail older patients

·  Acute Assessment Units - to diagnose and stabilise patients likely to need admission

·  Admission to specialty ward directly - for agreed clinical pathways and specialised clinical presentations

Once the conclusions of the audit are received, we will aim to optimise our referral pathways so that patients are seen in the most appropriate service and location. 

6.8. High Intensity Users 

This programme is about pro-active case finding of high intensity users (5 or more A&E attendances or admissions within the last 12 months) and to ensure that members of the frequent attenders forum are fully informed. The forum aims to identify other services and resources that may help the patient address their needs e.g. housing, drug and alcohol treatment programmes,psychological interventions etc. As part of this process, the patient’s GP is consistently informed of their registered patient’s interactions with the ambulance/ hospital/ urgent care services. A care plan is formulated and stored on the Co-ordinate My Care system, which means that it is then accessible to hospital clinicians who need to access it as part of any future re- attendance. The aim of the programme is to reduce future unnecessary re- attendances. It will improve patient care in Brent as patients will receive pro- active care that is better tailored to their needs, rather than turning up in an A&E department, which may not be best suited to the type of expertise that the patient needs. 

6.9.LAS Demand
 
This scheme is about supporting the London Ambulance Service (LAS) to book into extended access hub appointments based in GP practices, where this would be the most appropriate course of action for the patient’s needs.
Where appropriate, the 999 service will also be able to book into the access hub appointments.
To support the LNWUHT system Brent, Harrow, and Ealing CCGs have been selected for rollout in phase 1 of GP in-hours and Extended Access booking from LAS Clinical Hub (known as CHUB). Clinical engagement is underway for opening these slots to the CHUB. 

6.10. LAS Walk-In Demand 

The Brent category of the LAS has some of the highest rates of conveyance to A&E of all categories. This may be due to higher than average vacancy rates in the service, and a less experienced cohort of incoming paramedics that may be more risk averse in their assessment of patients. This should improve over time as staff become more experienced, but a programme of shadowing is taking place so that LAS staff understand what is available in the community and can refer patients to community pathways where a conveyance to A&E is not deemed to be required. 

6.11. Same Day Emergency Care (SDEC) 

SDEC is the provision of same day care for emergency patients who would otherwise be admitted to hospital.Under this care model, patients presenting at hospital with relevant conditions can be rapidly assessed, diagnosed and treated without being admitted to a ward, and if clinically safe to do so, will go home the same day their care is provided. 

When a patient comes to hospital, an SDEC service (which may operate under the name of ambulatory emergency care unit) means patients with some medical concerns can be assessed, diagnosed, treated and safely discharged home the same day, rather than being admitted. 

SDEC services treat a wide range of common conditions including headaches, deep vein thrombosis, pulmonary embolus, pneumonia, cellulitis, and diabetes. The types of conditions that can be managed through SDEC will vary depending on the hospital and needs of the local population. 

We aim to expand the usage of SDEC as part of our financial recovery programme, which will reduce overnight non-elective admissions (1-2 days length of stay) and A&E attendances by increasing activity through the SDEC pathways and optimising the ambulatory emergency care units. Shorter lengths of stay attract a lower tariff for the CCGs and therefore reduce costs. 

6.12. Front Door Frailty 

The aim of this programme is to implement proactive frailty services which will avoid admissions by providing a holistic response for frail older people in the community and during time of crisis. Frailty practitioners will screen patients who are 75 or over and for those who have a high score, a consultant geriatrician at the front end of A&E will provide a comprehensive geriatric assessment. This means that we are usually able to turn the patient around more quickly so that they get the care they need and may never need an admission to an inpatient bed. This is safer for the patient, as they are likely to stay more mobile at home and not pick up hospital acquired infections. 

6.13. Admission conversion rates 

This programme is about the rates of which A&E attendances ‘convert’ into unplanned admissions to hospital beds. We are using benchmarking data to compare our local hospitals to national averages and London averages so that hospitals who are above the average try to bring their conversion rates down to the average. This means that more patients will benefit from being able to stay out of hospital and reduce their risk of hospital acquired infections. It is a financial benefit to the system because it means that we are not funding unnecessary numbers of hospital beds or opening new beds. It also allows those patients who are most seriously ill to access a bed when they need it. 

6.14. Demand Management 

We have a comprehensive review programme of primary care variation. Across Brent, the amount of secondary care activity and prescribing spend that are attributed to individual GP practices varies significantly, and this does not always correlate with deprivation levels of the demographics of the GP practice. We intend to reduce this unwarranted variation in practice and to enable GP practices to learn from each other to ensure that best practice care pathways are being followed. 

The programme includes:

·       Reviewing A&E and UCC attendances, and contacting patients within 2 days of discharge where attendance was inappropriate;

·       Practices promoting self-care management and continue to improve patient access. 40 practices currently offering E-consultations with a further going live imminently;

·       Ensuring visible display of GP Access Hub, NHS 111 and Online Services Posters;

·       Conducting internal and external peer reviews with CCG and PCN/network leads;

·       Locum, GP trainees and associates referrals to be triaged by the lead clinician/GP partner

·       Educational sessions for all GPs and clinical staff. Inter-practice referrals optimising skill mix at PCN level

·       Kilburn Locality has a low outpatient referral activity - learning shared with other PCNs (advice and guidance at Imperial and MDT programme)

The meeting begins at 6pm on Thursday 24th October at Brent Civic Centre. The meeting will be in the Conference Hall and is open to the press and public.

"If the community sees [PREVENT] as a problem, then you have a problem”

Image for earlier report by Rights Watch LINK

Earlier this month Brent Council organised a public discussion on Extremism at which the majority of the audience appeared to be opposed to the Prevent Strategy - not because they were in favour of 'Extremism' but because they saw the strategy as sterotyping the Muslim community and being implemented in a top-down way which excluded community organisations. Additionally it threatened free speech in schools and colleges and had a corrosive effect on good community relations.  Overall it was likely to be counter-productive.

Now Open Society has taken up many of these issues in a report entitled Eroding Trust: The UK's PREVENT Counter Extremism Strategy in Health and Education LINK

Concerned organisations in Brent has set up a Monitoring Group on Prevent on Facebook which can be found HERE.

As a contribution to the Brent debate I publish below the Executive Summary of the Open Society Report:

“I’ve never felt not British. And this [Prevent experience] made me feel very, very, like they tried to make me feel like an outsider. We live here. I am born and bred here, not from anywhere else”.

“It could have gone the opposite way if I wasn’t thinking straight, if I were the type who was being brainwashed. The way they went about it, [Prevent] could have made me do exactly what they told me not to do. I associate with Prevent negatively, it is not helpful at all”

 Executive Summary and Recommendations

The UK’s Prevent strategy, which purports to prevent terrorism, creates a serious risk of human rights violations. The programme is flawed in both its design and application, rendering it not only unjust but also counterproductive. 

Launched in 2003, the Prevent strategy has evolved against the background of increased public fears over the threat of “home grown” terrorism. The strategy in its cur- rent form aims “to stop people becoming terrorists or supporting terrorism”. In 2015, legislation created a statutory Prevent duty on schools, universities, and NHS trusts, among other public sector entities, to have “due regard to the need to prevent people from being drawn into terrorism”. This requires doctors, psychologists, and teachers, among other health and education professionals, to identify individuals at risk of being drawn into terrorism (including violent and non-violent “extremism”) for referral to the police-led multi-agency “Channel” programme (for England and Wales) or “Prevent Professional Concerns” (for Scotland), both of which purport to “support” such individuals. 

This report analyses the human rights impact of Prevent in its current form in the education and health sectors. It focuses on these sectors because they are critically dependent on trust and have particular care-giving functions that have not traditionally been directed towards preventing terrorism. Under Prevent, doctors and teachers who have a professional duty to care for their charges are now required to assess and report them for being at risk of “extremism”, which is defined as “vocal or active opposition to fundamental British values, including democracy, the rule of law, individual liberty and mutual respect and tolerance of different faiths and beliefs”. Because the conscription of these sectors into preventing terrorism is part of a growing trend, the report’s principal findings, listed below, not only apply to the United Kingdom, but are relevant and instructive for other governments grappling with these challenges. 

First, the current Prevent strategy suffers from multiple, mutually reinforcing structural flaws, the foreseeable consequence of which is a serious risk of human rights violations. These violations include, most obviously, violations of the right against discrimination, as well the right to freedom of expression, among other rights. Prevent’s structural flaws include the targeting of “pre-criminality”, “non- violent extremism”, and opposition to “British values”. This “intensifies” the government’s reach into “everyday lawful discourse”. Furthermore, Prevent’s targeting of non-violent extremism and “indicators” of risk of being drawn into terrorism lack a scientific basis. Indeed, the claim that non-violent extremism – including “radical” or religious ideology – is the precursor to terrorism has been widely discredited by the British government itself, as well as numerous reputable scholars. Prevent training, much of it based on unreliable indicators, appears to be largely unregulated. Moreover, the statutory duty creates an incentive to over- refer. This incentive is reinforced by the adverse consequences associated with non-compliance with the Prevent duty and the lack of adverse consequences for making erroneous referrals. The case studies and interviews in this report confirm the tendency to over-refer individuals under Prevent. The fundamental nature of these defects makes them unlikely to be cured by a mere renaming of Prevent to “Engage”.

Second, Prevent’s overly broad and vague definition of “non-violent extremism” creates the potential for systemic human rights abuses. On the basis of this definition, schools, universities, and NHS trusts, among other “specified authorities” subject to the Prevent duty, are required to assess the risk of children, students, and patients being drawn into terrorism and report them to the police-led Channel programme where necessary. By the government’s own admission, thou- sands of people have been erroneously referred to the Channel programme. Individuals (including children) erroneously referred under Prevent experience the referral as inherently stigmatising and intensely intimidating. They also fear continued surveillance and the creation and retention of Prevent records, which may taint them and lead others to view them as “extremists” in the future. 

Specifically, the targeting of non-violent extremism raises serious concerns about possible violations of the right to freedom of expression. Children in schools have been targeted under Prevent for expressing political views. University conferences relating to Islamophobia and Islam in Europe have been cancelled, raising questions of possible breaches under the Education Act (1986) and article 10 of the European Convention on Human Rights. More generally, the case studies and interviews in this report suggest that Prevent has created a significant chilling effect on freedom of expression in schools and universities, and undermined trust between teachers and students. This risks driving underground, removed from debate and challenge, conversations about controversial issues such as terrorism. In addition, as indicated by the large number of interviewees for this report who requested anonymity, there is a genuine and intensely held fear among some that public criticism of Prevent will trigger retaliation. This fear is particularly acute for parents who fear that their children will bear the brunt of the retaliation. 

Third, the Prevent duty creates a risk of discrimination, particularly against Muslims. Frontline professionals have broad discretion to act on their conscious or unconscious biases in deciding whom to report under Prevent. Current and former police leads for Prevent recognise that currently, Prevent operates in a cli- mate marked by Islamophobia. Significantly, between July 2015 and July 2016, Islamophobic crime in London rose by 94 percent. This climate creates the risk that Muslims in particular may be erroneously targeted under Prevent. All of the case studies relating to the targeting of individuals under Prevent raise serious questions about whether they would have been targeted in this manner had they not been Muslim. Relatedly, in some case studies, Muslims appear to have been targeted under Prevent for displaying signs of increased religiosity, raising questions about the violation of their right to manifest their religion.

Fourth, by requiring the identification and reporting of individuals at risk of violent and non-violent extremism, Prevent creates a risk of violations of the right to privacy. Many of the case studies describe individuals being intrusively questioned under intimidating conditions about their religious and/or political beliefs. One case study raises troubling questions about the collection (apparently without informed consent) of names and political opinions from Muslim children for the Home Office.

Fifth, there are serious concerns about the treatment of children under Prevent. Although the government describes Prevent as a form of “safeguarding” (a statutory term which denotes promotion of welfare and protection from harm), the two sets of obligations have materially different aims, particularly with respect to children. In contrast to the Prevent strategy, for which the primary objective is preventing terrorism, the primary objective of the duty to safeguard children under domestic legislation is the welfare of the child. This reflects the obligation under article 3(1) of the Convention on the Rights of the Child to make the best interests of the child a primary consideration in all actions relating to children. Accordingly, while compliance with safeguarding obligations would only permit referral to Channel while prioritising the best interests of the child, the Channel duty guidance does not specify that as a mandatory or even a relevant consideration. All of the case studies in this report relating to children – including one in which a four year-old child was targeted– appear to be instances in which the best interests of the child were not a primary consideration. 

Sixth, the Prevent duty risks breaching health bodies’ duty of confidentiality towards their patients and undermining the relationship between health professionals and their patients. The standard for disclosure of confidential information under Prevent appears to be much lower than that warranted by the common law duty of confidentiality enshrined in the NHS confidentiality code of practice and the General Medical Council’s confidentiality guidance. Specifically, requiring a medical professional to report to the police-led Channel programme an individual who is at “risk of being drawn into terrorism”, including “non-violent extremism”, appears to be a much lower standard than requiring the medical professional to report (under the GMC guidance) the individual only when failure to disclose confidential information would expose others to a risk of death or serious harm. This could generate breaches of the confidentiality duty along with violations of the right to private life under article 8 of the European Convention on Human Rights.

Finally, there are serious indications that Prevent is counterproductive. The case studies show that being wrongly targeted under Prevent has led some Muslims to question their place in British society. Other adults wrongfully targeted under Prevent have said that, had they been different, their experience of Prevent could have drawn them towards terrorism, and not away from it. Government data reveal that 80% of all Channel referrals were set aside, implying that there were thousands of individuals wrongly referred to Channel. This in turn risks under- mining the willingness of targeted communities to supply intelligence to law enforcement officials which could be used to prevent terrorist acts.
 

As Sir David Omand, the architect of the original version of Prevent, has observed: “The key issue is, do most people in the community accept [Prevent] as protective of their rights? If the community sees it as a problem, then you have a problem”. This report demonstrates that the UK’s Prevent strategy is indeed a serious problem. 

Recommendations

To the UK Government:

1.     Repeal the Prevent duty with respect to the health and education sectors. 


2.     End the targeting and reporting of “non-violent extremism” under the Prevent strategy. 


3.     End the use of empirically unsupported indicators of vulnerability to being drawn into terrorism. 


4.     Establish an independent public inquiry – with civil society participation – into the Prevent strategy and associated rights violations. 


5.     Create a formal and independent complaints mechanism through which individu- als whose rights have been violated by the Prevent strategy can seek and obtain prompt and meaningful remedies. 


6.     Publicly commit to a policy of zero tolerance regarding retaliation against indi- viduals who allege rights violations under Prevent. 


7.     Publicly disclose data on total number of individuals referred to and processed through Prevent, Channel, and Prevent Professional Concerns (PPC), as well a the breakdown of these figures by age, type of extremism, and referring authority. 


8.     Publicly disclose, to the extent it exists, evidence underpinning and data relating to the UK’s Extremism Risk Guidance (ERG) 22+. 


To the Children’s Commissioners for England, Wales, and Scotland:

Conduct an assessment of the impact of Prevent on children, including but not limited to whether the best interests of the child are a primary consideration in Prevent-related actions. 

To the National Association of Head Teachers, the National Association of Schoolmasters Union of Women Teachers, the Association of Teachers and Lecturers, the National Union of Teachers, and other teachers associations: 

Conduct an assessment of the impact of Prevent on teachers and children, including but not limited to the extent to which the best interests of the child are a primary consideration in Prevent-related actions.

To Universities UK:

Conduct an assessment of the impact of Prevent in universities, including but not limited to its impact on academic freedom and freedom of speech. 

To the General Medical Council: 

Review and clarify professional standards relating to the duty of confidentiality as interpreted and applied in Prevent settings. 

To the British Medical Association, the British Psychological Society,
the Academy of Medical Royal Colleges, the Royal College of General Practitioners, the Royal College of Psychiatrists, and other professional bodies in the health sector: 

Conduct an assessment of the impact of Prevent on the practice of doctors, psychologists and other healthcare professionals, and on patients and patient care, including but not limited to an assessment of how the duty of confidentiality is being interpreted and applied in Prevent settings.

'I have been put up for sale by NHS England' - Amazing Grace petitions David Cameron

Grace demonstrates outside Monitor/NHS Improvement

Grace Balogun is seeking support for her petition LINK to save her Sudbury (Vale Farm) GP Practice from the market. She tells David Cameron why he should intervene below.

Let me introduce myself .My name is Grace and I need urgent help. I am a National Health Service patient and, along with my fellow patients of the fantastic Sudbury GP surgery in Wembley. I have been put up for sale by NHS England. The same NHS England that loves to talk about "patient choice" but all NHS England really care about is "the market in healthcare". BUT I TALK - AND CARE - ABOUT MY FAMILY DOCTORS WHO KEEP ME WELL AND GIVE ME THE CARE MY COUNTRY PROMISED ME FOR WORKING AND LIVING IN THIS COUNTRY - FOR LIFE, CRADLE TO GRAVE.

I live in the London Borough of Brent, an area where we already have a shortage of GPs, more GPs retiring , and a largely deprived population which is expected to expand over the next 5 years by about 80,000 people. I suffer from a range of major health issues which means that I live my life in a wheelchair. Don't get me wrong. I have a good and happy life – or I did until NHS England decided – without asking me – that it would be a good idea to take away from me the Family Doctors who have cared for me for the last 14 years. GP's who I would follow ,if they moved halfway across the country – but my wheelchair bound status makes that pretty tricky. To add insult to injury, I have already had one fight - alongside my fellow patients - lasting 9 years, and including threatened legal action against the NHS, to keep my Doctors from being tendered out for sale before. That fight - I thought - ended in 2013. 

 

Patients make a stand against marketisation

So WHY is Sudbury Surgery Patient List again "up for sale", and my fragile care threatened?

NOT TO SAVE MONEY. THE NEW CONTRACT WILL COST NHS ENGLAND £70,0000 A YEAR MORE. NOT BECAUSE OUR GPS AND THEIR TEAM ARE NO GOOD – although senior officials in NHS England London region (including the Boss) wrote telling my MP, my local councillors and a Brent patient group that they were not "performing" - ridiculous allegations they have since had to withdraw.

 NOT BECAUSE IT IS HARD FOR ME TO GET AN APPOINTMENT WITH MY GP – no, we are known in Brent for having fantastic service from our surgery.

NOT BECAUSE OF INADEQUATE SERVICES -We have EXTRA SERVICES, like in-house professional counselling sessions every week, a GP specially trained in mental health services, a specialist diabetic clinic and diabetic nurse, methadone prescribing service, minor surgery, acupuncture and were just about to start the practice as a GP training practice. Our practice also hosts a walk-in blood testing clinic, and the out of hours "overflow" GP appointments for our locality. Sudbury Surgery does a fantastic service for the community, IN the community. It is run by a not for profit social enterprise.

NO, I have been put up for sale because MY DOCTORS ARE JUST TOO GOOD. Since their social enterprise got the contract 3 short years ago, the patient list has grown from 5000 to 8600, and is still growing. How I wish it had stayed at less than 6000! Why, you ask me? Because, at less than 6000 patients, apparently, according to NHSE England, a "patient list" is "unattractive to the market" . Market, what market ? The market to which my surgery and the 15 other practices in "Tranche 4 London GP practices" NHS England gleefully advertised as the "greatest number of opportunities to potential providers yet" -when it held a "market engagement event" helpfully timed when our GPs were serving their patients in surgery. Bulk sale opportunity! Does it sound as though NHS England is interested in keeping the practice with our ordinary, caring, hardworking GPs?

Those companies who attended the "event" included (off-shore) Virgin Healthcare (who wanted us last time), Care UK, and The Practice Group (who have just "bulk" handed back 5 GP practices in Sussex to the NHS (meaning of course the patients in their patient lists) after taking them over, when their funding was cut - there's a reassuring precedent).

When we realised what was happening, Sudbury Surgery's patients got together, had meetings, wrote many long letters to NHSE, and to NHS (so-called) Improvement who is supposed to regulate "competition" in the NHS, demonstrated outside the Department of Health, NHS England, attracted newspaper attention and explained to and collected the signatures of over 3700 INDIVIDUAL PATIENTS to a petition saying "NHS ENGLAND PLEASE GO AWAY AND LEAVE US WITH THE GPS WHO HAVE CARED FOR US FOR OVER 14 YEARS".

We have struggled for 9 months using every avenue open to us. HAS IT MADE ANY DIFFERENCE? NO. So now I am calling on David Cameron and Jeremy Hunt and The Queen to intervene and ask NHS England to take my Doctors 'practice out of the tender NOW. I was promised cradle to grave care in the NHS - not to be a commodity patient - attractive to a "market". Not that I think a patient like me with complex health needs will be very attractive to a "provider" interested in "markets" PLEASE, PLEASE LET ME AND MY FELLOW SUDBURY SURGERY PATIENTS KEEP THE DOCTORS THEY LOVE, and save the NHS £70,000 a year .

Sign Grace's petition HERE

Brent NHS CCG takes its toys away

Guest blog by Nan Tewari

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In the most extraordinary spectacle I have ever witnessed in over 40 years of attending public meetings and meetings of public bodies (two different things) on Wednesday evening, Brent NHS Clinical Commissioning Group (CCG) fell out spectacularly with its patient representatives. In short, the CCG refused a perfectly reasonable, unanimous patient request to change the order of the agenda items of the patient engagement meeting and in the face of patient disapproval, decided to close the meeting with no business having been transacted. The badly run meetings (by a CCG public appointee) had failed consistently to run on accepted lines, namely, apologies, approval of minutes. matters arising etc. and as a result, minutes of meetings held in November 2013, March 2014 and May 2014 have never been approved and therefore cannot be put onto the CCG website for the benefit of the public at large.

The law requires CCGs to consult with patients and the public on proposed changes to the delivery of health services.   Failure to comply with the requirement can be serious with the CCG being challenged by providers as well as by individual patients and groups of patients who perceive changes as being detrimental.  Even if the CCG is confident that it is making the best decision, it still needs to go through a proper and proportionate public engagement process.

In order to meets these legal obligations, the CCG set up a committee of its Governing Body called the Equality, Diversity and Engagement (EDEN) Committee to provide itself with assurance that its public involvement activity in the multiplicity of proposed service changes was as robust as it should be.

My fellow patient reps and I (some, appointed by the CCG and others, elected by fellow patients) worked really hard to help the CCG and pointed out where it could be open to challenge.  We take the view that we are neither a rubber stamp nor nodding donkeys, and it is our duty to withhold the desired assurances if patient involvement is unsatisfactory.  The CCG did not appreciate this one little bit and started a smear campaign against patient reps saying that we were failing in our duties.

The CCG is effectively rewriting the rules to tell patient reps how they must act. In the course of doing so, they are also breaching all of the accepted rules of public body committee procedure and have stated that their particular public body (the CCG) does not have to act in accordance with these norms.

I have taken up this guest blog spot, courtesy of Martin Francis, because there is nowhere officially in Brent CCG for patients to air their views on matters of public involvement in proposed changes to local health services as is required by s14Z2 of the NHS Act 2006 as amended by the Health and Social Care Act 2012. It would be interesting to hear what others patients and members of the public have to say.