‘Safe and effective care within the budget’ consultation

We, the undersigned GPs, would like to register our grave concerns over patient safety regarding the forthcoming plans of Northern Devon Healthcare NHS Trust (NDHT) to close community beds, either in totality or part of the locality, in an unprecedented move before this coming winter as proposed in your current consultation paper.

The current consultation process for “safe and effective care within the budget” has been experienced as a hasty cost improvement process given the far-reaching safety implications of the proposed changes. Whilst we recognise the current context of austerity, we are concerned that the untried, untested closures of so many community hospital beds in this area could prove dangerous for a significant population of patients who might need to rely on community beds to bridge the gap between acute hospital care and their homes when they become severely ill this winter.

The population in North Devon is 166,093 with 1555 people living in residential care homes. There are 4 community hospitals in Holsworthy, Bideford, South Molton and Ilfracombe which has 10 community beds but is temporarily closed. The current 64 beds in 3 community hospitals are fully occupied. East of the Water near Bideford and Ilfracombe are among the most deprived areas in the country with complex health and social needs. Patients in our rural areas will have more difficulties in getting transport to North Devon District Hospital (NDDH) in Barnstaple should all the community hospital beds be closed. Patients in Holsworthy areas will have to travel 35 miles to NDDH should Holsworthy community hospital be closed.

We have particular concerns over the safety of these proposals that are being made in the absence of concrete plans for bolstering and investing in safe staffing levels of the existing very stretched community nursing service. Vulnerable patients this winter could find themselves with inadequate community nursing, physiotherapy and other ancillary services, as well as an over-stretched primary care GP services which will be forced into taking clinical responsibility in an inadequate and under- resourced system. The current time-frame does not suggest any contingency or risk and impact assessment to account for laying down sufficient and timely investment in community services and staff to prevent this.

It must be recognised that North Devon District Hospital (NDDH) currently faces frequent bed shortages, resulting with patients at times having to be placed temporarily in the day surgery unit overnight in bed state emergencies with inadequate facilities as in a normal ward and delayed admissions. Closing community hospitals beds will further compound this situation and may also affect the safe running of NDDH itself.

NEW Devon CCG’s suggested strategic direction is for a timely process of reduction in the numbers of community beds shared over a number of community hospital sites, with money saved by reduction of community beds reinvested in community staffing. This is a very different proposal.

If staff cannot be attracted to work at the community hospitals, it is unlikely they will be recruited in a timely manner to provide sufficient community nursing cover to the local population, resulting in unsafe levels of staff to cover patients discharged from NDDH in the community, often very early in the course of their illness with multiple needs, both medical and social.

Similarly, we are not convinced by the proposal of a community bed unit based at NDDH to be established in time for the winter prior to the closure of all community hospital beds, nor the proposal that a “Frailty Consultant” will be recruited in time to provide clinical guidance and leadership to those proposed beds at NDDH reserved for community patients. NDHT has had severe difficulties and is unable despite multiple advertisements in replacing recently resigned Care of Older People Consultants. North Devon population will end up with no community hospital beds, no consultant with the appropriate skills to provide clinical skills and direction and an over-stretched community service in addition to an acute hospital with bed shortages over the winter.

It has been suggested that the closure of Torrington Community hospital was a success. The truth of the matter is that these patients were often placed in other community hospitals which are still open and evidence shows these community beds are needed.

We agree that patient safety is paramount and as such we do not support the current “safe effective care within budget” plans and their time-frame. We propose NDHT engage all stakeholders including the CCG and staff for a timely and proper consultation to find the best and safe solution for our population.

Yours sincerely

Dr Glenys Knight, Senior Partner, Bideford Medical Centre
Dr Mark Clayton, GP Partner, Bideford Medical Centre
Dr Geoff Spencer, GP Partner, Bideford Medical Centre
Dr Duncan Bardner, GP Partner, Bideford Medical Centre
Dr Alison Stapley, Executive & GP Partner, Bideford Medical Centre
Dr Yuk Chan, GP Partner, Bideford Medical Centre
Dr Ed Bond, GP Partner, Bideford Medical Centre
Dr Ruth Down, GP Partner, Bideford Medical Centre
Dr Richard Davies, GP Partner, Bideford Medical Centre
Dr Andrew Clarke, GP Partner, Bideford Medical Centre
Dr Sarah Ansell, Salaried GP, Bideford Medical Centre
Dr Nicky Relph, Salaried GP, Bideford Medical Centre
Dr Steffan James, ST4, Bideford Medical Centre
Dr Fiona Duncan, ST3, Bideford Medical Centre
Dr Alan Howlett, Senior Partner, Black Torrington Health Centre
Dr David Hillebrandt, semi-retired Holsworthy GP, Sessional and OOH GP
Dr Birgit Hole, Sessional GP
Dr Caroline Flynn, Session GP
Dr Chris Gibb, Senior Partner, South Molton Health Centre
Dr Justin Bowyer, GP Partner, South Molton Health Centre
Dr Rebecca Geary, GP Partner, South Molton Health Centre
Dr Wayne Sturley, GP Partner, South Molton Health Centre