Monday, October 16, 2017

New Cross Walk-In Centre threatened with closure

There's still a couple of weeks to give your views on proposals to close the NHS Walk-in Centre at the Waldron Health Centre in New Cross. The Walk-in opened in March 2010 and offers appointments with a GP 'for patients who are unable to get an appointment with their GP with a minor injury or medical condition that is not life-threatening but needs to be seen'  ( Unlike most GP practices it is open from 8am to 8pm,
7 days a week, including public holidays.

In its consultation document NHS Lewisham Clinical Commissioning Group (CCG), the body responsible for commissioning local primary care services, argues that the walk-in model is not the best for patients: 'The easy access to advice at walk-in centres means that people can avoid registering with a GP. It is important for people to be registered with a GP so they can benefit from care that encourages healthy living, early detection and prevention of diseases and a holistic approach to health'.

They have a point, for instance when you go to the Walk-in the doctors there can't see your patient record so can't judge whether your current health complaint relates to your previous history. It probably would be better if everybody was registered with a local GP and could see a doctor or nurse there when they needed to. But the problem is they can't!

As the consultation paper makes clear, most people are using the Walk-In precisely because of difficulties getting an appointment:

'- 46% said they went directly to the Walk-in Centre because didn’t think they’d be able to get an appointment at their GP practice;
- 33% said they had contacted their GP that day but no appointments were available.
- 5% reported they were unable to get through on the telephone to their GP practice'.

My own experience of a busy SE14 GP practice is that I have given up trying to get through on the phone, to have a chance of getting an appointment I go down there. And when I do get to speak to someone on reception I can rarely get an appointment that week. Most recently I was given a date more than 2 weeks later before a doctor could even phone me and decide whether to offer an appointment. As for weekend appointments for people who struggle to get time off work, forget it. This is not an isolated issue at my practice, nationally there a recruitment crisis with not enough GPs available to fill posts - which translates directly into longer waiting times for appointments.

Although the CCG states that it wishes to 'Improve the provision and access to GP services for all Lewisham residents' it is hard to see how closing a very busy existing service is going to improve access to GP services. The only concrete proposal is to make 'increasing use of the GP Extended Access Service', a kind of overspill facility for people registered with a Lewisham GP and based at Lewisham Hospital. But has this really got the capacity to replace the New Cross service?

In 2016/17, the  New Cross Walk-In saw 29,528 patients. The service at Lewisham Hospital 'plans to deliver around 25,426 bookable appointments per year. In 2018, this will increase to 29,914 bookable appointments'. So that's only an expansion next year of 4,500  appointments. Never mind the fact that the Office for National Statistics estimates that the population in Lewisham will grow by 14.4% by 2024 (source)

It is also questionable whether just offering more appointments at Lewisham Hospital is going to work for people who don't live near to it. The current Walk-In  'is mainly used by people who
live in the north of the borough'. Will they travel to Lewisham?   

To close the Walk In while there is a crisis in access to timely GP appointments near to where people live will only mean many people won't see a doctor at all - typically the most vulnerable who struggle to travel or who don't want to be seen to make a fuss and demand appointments. And delays in seeing GP leads to delays in diagnosis than can have lethal consequences as the Less Survivable Cancers Taskforce has identified.

The  CCG - and the Government's Department of Health - need to sort out GP services before they consider taking away the safety net offered by the Walk-In.

You can reply to the consultation online until 5 pm on 30 October 2017. There will also be a drop-in session at the Telegraph Hill Assembly meeting at, Somerville Youth & Play provision, 260 Queen's Road, SE14 5JN on Tuesday 17 October 6.30pm.

The CCG say  that 'The contract for the Walk-in Centre ends on 31 December 2017 and cannot be renewed. If it were to continue running, we would need to set up a new contract'.  If that is the case they have left it rather late to consult, presumably they must have a contingency plan to keep the Walk-In going, otherwise the outcome would be a foregone conclusion and the consultation a sham.

(The Save Lewisham Hospital Campaign is opposed to the closure. They say: The decision to close the WIC looks to us that it was driven by a need to shift resources from a local service to a central one to comply with Department of Health demands based on Jeremy Hunt’s diktat about 8am-8pm GP services, and not by a genuine appraisal of the strengths and weaknesses of a current local service in order to replace it with a better local service.  However, we believe Lewisham CCG should not cut current provision without replacing it with at least as good, safe and accessible a service alternative – and better is sorely needed').

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