24.08.17 - Suspension of travel clinic due to vaccine shortages
Due to a national shortage of HepA and Typhoid vaccines we are unable to undertake travel vaccinations at present. Some private travel clinics will still have stocks of these vaccines as they buy bigger quantities that us but will charge for them. We will let you know as soon as we get more in though typically there could be a 6 month wait.
07.08.17 - Mid Summer Newsletter
Summertime is usually a little quieter as the holidays kick in and people start to go away for their well earned summer breaks. Historically it is the time when Practice Managers can catch up on work, plan and introduce changes ready for the more busy winter period. We are introducing a few changes in the next few weeks mainly to opening hours and reception. The details appear in our Mid Summer Newsletter which is available to download now. A hard copy is also available at reception.
09.06.17 - Summer Newsletter
A lot has happened since our last newsletter. The “Practice Update” tab on the website will keep you abreast of all the newest information at the practice, a summary of which will appear in the quarterly newsletters.
The Surgeries Future
Following Dr Bellamy’s letter and exposure in the national press in which NHS Property Services confirmed that we had been sent the incorrect figures relating to our service charge, we have been working with them to determine the correct figures for years 2014-2017. This has been a complex issue and should be resolved shortly. I am pleased to let you know that the revised service charge, whilst significantly higher, do not affect our immediate viability and will allow us to plan how we manage the increase moving forward.
We would like to thank NHS Property Services for their time and willingness to resolve our issues.
It is our intention to remain in Shepperton serving our patients for as long as we possibly can. At this point in time we will not be holding a public meeting as there is nothing significant to discuss having come to an agreement that does not impact on our current viability.
In the coming months we will be looking at the premises themselves as we work towards signing a lease and will keep you updated as this progresses through the update page on the website and our quarterly newsletters. Thank you once again for all your support.
Dementia Friendly Week
Janine and I went to the launch of” Dementia Friendly Shepperton” and it was great to see so many of the community involved in this project. We came away asking ourselves what the practice could do to get our Dementia Friendly t-shits as we would like to become the first Dementia Friendly Practice. You might think this a little strange as our doctors diagnose and treat dementia patients every day but it is the small things that make a difference, staff recognising signs, making it easier for those suffering from dementia when they come to the practice, offering support to relatives by pointing them in the right direction etc...
The Alzheimer’s Association have offered some training which staff will be undertaking in one of our quarterly educational afternoons and we will be adding a help page to our website similar to that of carers which will have some useful links.
Sit and Wait Clinics
In redefining urgent care as being “a medical condition that needs treating today” we have found that the number of non-urgent care booked in as urgent care has reduced and enabled us to re-introduce those appointments as routine appointments.
In this busy world it is difficult sometimes to set aside time to plan, we are not an emergency service and whilst we appreciate that people are taken ill on the day and will see them in our sit and wait clinics it is prudent for those that know they will need to see a doctor to book a routine appointment before it gets to an urgent situation.
We were not one of the sites hit by the recent cyber-attack. Our CCG has spent some time upgrading us all to a Windows 7 operating system and all our security updates are up to date.
There are several ways in which you can reduce time spent queuing at reception or on the phone. This can be done by registering for EMIS on-line access. Once registered, you will be able to order repeat prescriptions and book routine appointments. With our text service you can receive appointment reminders and cancel them if they are no longer needed.
Our CQC Inspection happened in December and they have recently sent us their report. The report is available to access via the front page of our website. Like many other surgeries we require improvement. Sadly the way their reporting system is set up in patient groups, if you require improvement in one area, you require it in all. Patient care was found to be good and we will continue to provide the best care possible for our patients. Areas that require improvement are:
Our building is owned by NHS Property Services and they hold the portfolio of all NHS owned property. As such they maintain the site and hold all logs centrally so that they can schedule, plan and check that things like fire/water tests are undertaken regularly, I have only named two tests for ease but there is a whole raft of them. CQC prefers for these to be kept on site. Unfortunately I was unaware of this and though they were sent the next day they were not available on the day.
The practice undertakes its own Health and Safety risk assessment but this was not requested on the day.
DBS checks, training logs and appraisals have historically been kept separately. Since joining the practice, I have been trying to pull them all together into single personnel files at appraisal. I have to put my hands up and say that as the information was in the practice, it was not a priority and a lot of my energies this year have been spent on service charge issues.
The separate files were offered to the CQC when they visited but they did not have sufficient time to peruse them either
Some errors were identified in historic coding. The practice was aware of the issue and whilst it does not affect patient care it does affect internal searches and unidentifiable data viewable by the public. This is being rectified internally.
Moving forward, CQC are changing their reporting structure which should make it easier for both them and us.
We have had several bouts of long term sickness which are now drawing to a close and look forward to welcoming Jane and Carrie back.
Cheryl, one of our Healthcare Assistants will be leaving us at the end of the summer to pursue her nursing degree. We wish her every success and hope that she might return as a nurse one day.
We welcome Carmina to our reception team this week and look forward to working with her.
Virgin Care lost the contract to supply community services this year in our locality. Services such as District Nursing and complex wound dressing. Central Surrey Health will now provide these services. Existing staff have moved from one provider to the other and therefore patient care and continuity should remain as it was with little change, though it may take a little time to replace staffing numbers in some areas.
On behalf of the practice, I would like to wish you all a happy summer, may the sun shine and when it does, please remember your sun cream and hats, especially on those very important sports days. I hate to wish the year away but we will be letting you know our flu dates in August. For those of you who normally attend, please book your slot early so that we can save time on chasing and put those resources to better use. Stay safe.
15.05.17 - Cyber Attack
Precautionary measures were put in place on Friday following the National Cyber Attack. This involved reverting to pen an paper whilst we could assess the risk.I would like to reassure all patients that these have now been lifted and the practice is working normally.
The practice does not operate on Windows XP however some of our third party suppliers do so we wanted to ensure we could isolated these applications and talk to suppliers before turning the computers back on.
Thank you for your support and understanding.
Caroline Self, Practice Manager
The practice met with NHS Property Services yesterday following Dr Bellamy's letter to patients and will be working with them to resolve the issues highlighted. We would like to thank you all for your support and believe this meeting would not have occurred without your help.
The practice will be meeting NHS Property Services on Thursday 6th April with a view to agreeing backdated charges and those moving forward. It is important that we know what our future liability is before discussions on a lease can move forward. A further update will be posted here on Friday.
02.04.17 - Sunday Times Article
Dr Bellamy gave an interview to Josh Boswell of the Sunday Times which appeared in yesterday’s paper. We feel it is a true reflection of our situation and backed up by his independent investigations. Dr Sidhu was unable to have his picture taken on Saturday with the rest of us as he was working with the out of Hours doctors.
Please see below as Josh has kindly given permission for us to re-post it here:
NHS threatens GPs with closure
Doctors hit by increases of up to £100,000 in service charges
Josh Boswell and Jon Ungoed-Thomas
April 2 2017, 12:01am, The Sunday Times
Simon Bellamy, left, and colleagues at the Shepperton Medical Practice face a service fee increase of 1,000% JEREMY YOUNG
Dozens of GP surgeries across the country are threatened with closure after the NHS increased its property service charges by up to 1,000%.
Hundreds of surgeries that rent premises from the NHS have been hit by the increased charges. Practices say they may have to close or else cut back on nurses and doctors. Some surgeries that have refused to pay the invoices have been sent letters threatening legal action and the use of debt collection agencies. The demands are being made by NHS Property Services (NHSPS).
NHSPS is a limited company owned by the Department of Health. It is headed by Elaine Hewitt, a former BT executive, who was paid more than £265,000 in 2015-16, including a bonus of more than £65,000. The organisation, which has a £3.5bn property portfolio and covers about 10% of the NHS estate in England, took over the property management of about 1,400 GP practices when primary care trusts were abolished in 2013.
Practices facing demands of up to £100,000 in extra maintenance costs complain that the charges are unfair and unjustified. They also say that some of the figures have been miscalculated.
“We can’t pass on these costs to the customer — the only way for us to sustain ourselves is to cut services,” said Gaurav Gupta, a GP who is part of a British Medical Association team disputing the charges, formed after doctors started disputing the increased fees; it is overseen by the British Medical Association (BMA), the doctors’ union.
“This is an NHS body trying to run NHS practices out of business. It’s complete madness — it should never have got to this stage.”
NHSPS says it has increased what were traditionally low service charges to reflect more accurately the maintenance costs at practices. GP practices have their rents reimbursed by the NHS, but pay service charges out of their own budgets.
GPs say the increases have been introduced too fast and many of the charges have been “plucked out of the air”.
Among the hardest hit is Shepperton Medical Practice in Surrey, which is facing about a 1,000% rise. It has been billed an extra £100,000 in backdated service charges, more than 11 times last year’s costs, with another £100,000 charge to follow next year.
The surgery said it might be forced to close if the bill was not reduced.
“They’ve increased the service charges out of all proportion to what they’re actually providing,” said Simon Bellamy, a GP at Shepperton. “They appear to have stuck a finger in the air and come up with a sum, basically. If we have to pay all of that money then the practice won’t be viable — we won’t be able to provide the service any longer.”
Bellamy added that 19 of the 48 practices in his area were facing similar charges from NHSPS. NHSPS said the bill sent to Shepperton was incorrect and it was meeting the GPs to discuss the fees.
Kent Mullis, 70, from Leigh-on-Sea in Essex, is a patient who has been campaigning against the charges. His local practice, Valkyrie Surgery, closed one of its premises in September, partly blaming the NHSPS which had increased its bill by thousands of pounds.
NHSPS now says the figures were incorrect, according to the practice.
Mullis said the charges were disgraceful. “I can’t understand why one part of the NHS is ripping off another part of the NHS,” he said.
Evergreen Practice in Bracknell, Berkshire, had service charges increased by 320% from £14,976 in 2015-16 to £62,916 this financial year. This included annual management fees which rose from £1,127 to £43,000.
Prash Nelli, a GP at Evergreen, said: “If this carries on we will have to shut down. And I don’t think other practices can survive either.”
Faversham Medical Practice in Kent says its service charge bill rose from £15,000 in 2014-15 to £60,000 in 2015-16 and then to £80,000 in 2016-17.
These included an increase in maintenance fees from £2,600 two years ago to £40,991 this year and an increase in electricity and gas charges from £5,000 to £12,000 over the same period.
Ian Hume, head of GP premises for the BMA, said: “NHSPS needs to reconsider urgently any charges it intends to levy if these are going to threaten the ability of that practice to deliver patient care.”
Surgeries standing up to their NHS landlord may face legal action. NHSPS threatened one GP surgery with “immediate referral to an external debt recovery agency” and “possible commencement of legal proceedings” if it did not pay up in seven days.
“This is a national issue affecting almost every GP practice which occupies NHSPS property,” said Victoria Armstrong, a partner at Sintons Law, a Newcastle-based firm helping practices to dispute the bills. “There is no real basis in most cases for the increased charges. Our advice is: don’t pay the increase. It would financially cripple practices.”
She said one practice with four partner GPs had received a backdated demand for £100,000. Some GPs had been sent the wrong invoices, while others had been charged extra for gardening and cleaning already covered by their rent.
NHSPS says it is increasing the service charges to reflect maintenance costs more accurately but is keen to address GPs’ concerns. It said: “We have been getting better information about the space our customers actually occupy and this is one reason why some are seeing costs increase and others reduce.
“We want to explain any increases fully and make our bills more understandable. We know we’ve got some way to go on this but we are making improvements. Every penny we generate is reinvested back into the NHS.”
02.04.17 - Mail on Sunday Article
We declined an interview with the Mail on Sunday but note they printed an article on the Mail On-Line, some of the facts reported were incorrect:
Dr Bellamy did not tell patients we ”would be forced to close” his letter stated that “the practice is in a very difficult situation” and “our practice is being put at risk”
Dr Bellamy did not tell 13000 “hospital” patients, the letter was addressed to patients of the practice.
We have been unable to secure a room to hold a public meeting this side of Easter. The purpose of the meeting was to explain the letter from Dr Bellamy more fully. We know that you have a lot of questions and hope this communication will answer some of those frequently asked.
What is our status?
The practice is an independent small business. We hold a contract with the NHS to deliver general medical services within a primary care umbrella. As a small business we need to be able to plan and budget to ensure that the business continues to meet its obligations under that contract.
Who are NHS Property Services and what do they do?
Formally property belonging to the NHS was held and looked after by the Primary Care Trusts. NHS Property Services (NHSPS) was founded in 2013 when the PCT’s disbanded and the Clinical Commissioning Groups emerged.
Who owns the building?
NHSPS owns our building and due to a historical anomaly we do not hold a lease as such. The easiest way of explaining this is that we are tenants in kind.
Who does this affect?
This is a national issue affecting all practices in NHSPS buildings, though we seem particularly hard hit. We have had meetings with North West Surrey Clinical Commissioning Group, the Local Medical Committee and other practices who are affected locally to seek a resolution. We have all been frustrated with the information coming from NHSPS and with no end date of when we might get confirmation of the 16/17 amount.
Request to sign a lease by November
NHSPS are asking practices in their properties to sign a fully repairing lease by November. This lease means that we become liable for repairs on an old building and keeping it in good order. Whilst work has been undertaken on the premises, there are areas that still need significant investment in them. As a small business we would be looking to lease premises which are in a good state of repair. This site does not meet those standards at the present time.
A further complication
David Mowat, Parliamentary Undersecretary of State recently spoke of reducing general practices down from 7500 to 1500 super hubs. We will need to understand how this will work in practice to assess the risk connected with making a commitment of 25 years.
Whilst there is an offer of help from NHS England to pay stamp duty and reduce legal fees if we sign before November, it does not make good business sense to do so until there is clarity on the use of super hubs.
Rent and service charges are often confused. We have no issue with regard to rent, though the way it has been calculated recently has changed with NHSPS work towards a market rent basis.
The service charge covers the day to day running costs of the building and we would expect to pay this against sight of invoices. Unfortunately, over the last year we have received numerous invoices from NHSPS, each with a differing amount and increasing steadily through the year. The figures quoted have been so substantially higher that if correct brings in the viability of the practice I coming years.
We have spent the last year seeking clarity from NHSPS on these figures and have been unsuccessful. No business would pay a bill without sight of the invoice. We had been paying £755.46 per month and accept this probably has not covered the running costs in their entirety. We finally received notification that the amount for the year and revised invoices meant the new figure was to be £7184 per month. We also received a schedule showing the individual items (though no invoices to confirm the figures were correct). This means our bill for the year 16/17 is £85776. This figure included an amount of £34051 in respect of “Reactive Maintenance”. In other words we are being asked to pay for years of under investment in the property. We acknowledge some works have been undertaken.
The Heads of Terms lease we have received includes a service charge for the year 17/18 of £8800 per month though no breakdown is yet available. This would be due from April 17.
The uncertainty of our liability has meant that we have had to put on hold those things a business would do to ensure their service is maintained and improved. This has been especially challenging with already shrinking budgets and has meant that we have been unable to invest in our telephone system, replace staff lost through natural wastage and led to us reviewing the services that do not break even.
As a small business we needed to work out how long we would be able to operate with the potential liability increasing each month, we wanted to be open and honest with our patients. We were at that point when Dr Bellamy published his letter on the website.
A big thank you
Thanks to the overwhelming support from our patients we received a phone call on Monday from the Operational Excellence Manager at NHSPS promising to review the figures and a meeting. A date has not yet been forthcoming but this is progress.
You have asked what have we actively done to seek alternatives?
You may recall that Dr Bellamy drew up plans for a new health centre some time ago to be built on the skate park site but we were unable to get the planning consent for this. We have spent the last year looking for viable sites sufficient with parking to accommodate a practice list size of over 13,000.
We have considered reducing our footprint on the building and working out of 6 consulting rooms instead of 12 on a three hour shift basis but the pressure this would put on patients and staff in sticking to a ten minute consultation makes this untenable as a long term option.
You have asked if we have miss-managed our finances?
As a business we need to manage our cash-flow and evaluate our out-goings and in-comings, we have done that and determined that a 25 year repairing lease and a hike in service charges to upgrade a property which in the future would see us spending considerably more does not make good business sense. When the building was in the hands of Surrey PCT, we were number two on the list of re-builds. This alone speaks volumes. As far as we are aware there is no longer a list.
You have asked us whether we are looking for financial support by way of extra government funding, local health authority funding or crowd funding?
The answer to all three is no. Our aim is to have a meaningful dialogue with NHSPS to determine the figures they quoted are correct and to make a business decision based on that information.
If we had a wish list it would be that the Health Centre be rebuilt on the same site from back to front in two stories, allowing additional parking at the front. We would be happy to work out of 6 consulting rooms for a short period of time as work progressed. This new building could then be leased back to us at a reasonable rate without the need for “Reactive Maintenance”
Finally for now…
We hope the above goes some way to answering some of the questions we know you have been asking. We would like to take this opportunity to thank you all for your support and lobbying over the last week, it has gained a response from NHSPS and we hope we can now work with them to seek a resolution not only in respect of the service charge but with regard to the proposed lease. It is our intention to carry on giving the service we have to our community and improving that service in an unsettled and challenging time for as long as we can. Further updates will be posted when there is something concrete to add. Significant updates will be notified by text to those we hold mobiles for and we would ask that you let those without internet/mobile facilities know the up to date position. We will hold a paper copy at the surgery and place copies on our front door.
Thank you once again. Shepperton Medical Practice.
We know a lot of patients are checking this website for updates and we would like to assure you that things are moving behind the scenes. An update will appear here on Fridays or sooner as developments happen. Once again thank you all for your support and patience.
The practice is currently looking for a venue to hold an open meeting following Dr Bellamy's letter to patients of 24.03.17.
We will keep patients informed via text message (please let us have your mobiles if you have not done so already) and by postings on this website. For patients without website or mobile access we will put updates on our front door and hard copies can be obtained from reception. Should you know of any patient that does not have access to these mediums we would be obliged if you would let them know of developments.
We would like to thank you all for your support and kind comments to date.