Lincolnshire Community Health Services hands over private board minutes on Spalding GP Surgery closure – but blocks the full information

Health chiefs say they did not have the space or staff needed to keep a GP surgery open - as newly-revealed private board minutes released to this paper show.

Lincolnshire Community Health Services NHS Trust (LCHS) chose to axe Spalding GP Surgery last year but has previously refused to fully explain why it chose to stop running the Johnson Hospital-based doctor’s service.

A Freedom of Information request lodged by this paper was initially rejected - but we forced a review into that decision and redacted details have now finally been handed over.

The minutes spell out the fact that bosses struggled with a ‘number of challenges’ - including manpower and room.

This news comes as:

*Bosses have still not come good on a promise to hold a public meeting on wider healthcare concerns for residents in Spalding and Pinchbeck

*A review is promised into how to cater for the ‘current and growing’ population

*A campaigner raises key questions with the information now released

*Chiefs still say the full reasoning cannot be made public - arguing it would have a ‘chilling effect’

The GP practice was rated as providing a ‘really good service’ by users - but its 3,361 patients have now been spread across the Munro, Beechfield and Gosberton practices.

Today we can finally report that the private minutes state: “Since providing the GP services at Spalding the practice had experienced a number of challenges with regard to recruitment and retention of staff, and in addition expansion of the service had been difficult due to limited clinical space.”

Further questions on what’s next for the rooms vacated by the GP practice remain unanswered.

In continuing to block our request for the rest of the information, the trust ruled: “I can confirm that the ‘qualified person’, Deputy Director of Corporate Governance, has decided that disclosing the information you have requested would be likely to inhibit the free and frank provision of advice; inhibit the free and frank exchange of views for the purposes of deliberation; and prejudice the effective conduct of public affairs.”

Resident George Scott, who teamed up with Coun Angela Newton before her death to fight the surgery closure, said: “I don’t know what it’s going to prejudice because it’s all done.

“What are they afraid of? We had all of that consultation work and meetings - for a big price no doubt - and what was the point? They ignored it.”

He also said that - contrary to what bosses have said - that doctors told him they wanted to stay and run the popular service.

What they have released

The private minutes from the meeting of July 12 show:

The Director of Nursing, AHPs and Operations reminded those present that the Trust had taken over the running of the Spalding GP practice following a competitive tender exercise in 2019, the contract was initially awarded for a three-year period with an option to extend for another 1+1 year, making the whole contract award potentially a five-year contract.

Since providing the GP services at Spalding the practice had experienced a number of challenges with regard to recruitment and retention of staff, and in addition expansion of the service had been difficult due to limited clinical space.

The contract was due to end in September 2022, however due to a change in strategic direction with regards primary care, it was proposed that LCHS did not extend the contract for a further 12 months, but instead worked with the CCG in relation to a longer-term solution for sustainable primary care services for the population of Spalding.

[a confidential discussion paragraph has been redacted]

The CEO explained that there was potential for the Trust to be asked to extend the contract for the Spalding Practice after 30th September 2022 and she asked about the Board’s decision should this be the case. The Trust Board unanimously agreed that it would step back from this service on 30th September 2022 however would work with the ICB and incoming provider to ensure there was a smooth transition.

LCHS also released an extract from the minutes of the January 10 2023 meeting, although this came after a final decision had been made to close the surgery and disperse the patients to the Munro, Beechfield and Gosberton. It was also after our original information request.

At this meeting, the timeline was discussed for the transfer of patients. Two further ‘confidential’ paragraphs were redacting and the minutes also show:

It was noted that the CQC had been fully appraised of the plans to disperse the patients and terminate the contract for the Spalding GP practice and had confirmed that unless any specific complaints or whistle blowing concerns were received, they would not be scheduling a visit during the handover period.

The Director of Finance and Business Intelligence asked Board members to consider this request.

The Trust Board received the report and agreed a further contract extension to 28th February 2023 with a hard stop date of 31st March 2023.

Our fight for answers

This newspaper lodged a Freedom of Information request in January to try to find out what actually led to the decision.

This request was rejected - with LCHS arguing that explaining this ‘would currently impact the commercial interests of both NHS Lincolnshire ICB and the Lincolnshire Community Hospitals NHS Trust (LCHS)’.

We asked for a review into this decision - arguing that the public interest should outweigh any commercial considerations and that residents deserved the trust be open and transparent.

The trust twice wrote to this paper to say it could not meet the deadline for conducting this review before finally conducting one.

It argued: “The panel has reviewed the previous disclosure and has decided that at the time of the 5 January response the trust was not in a position to be able to share the information requested regarding trust decision conversations related to Spalding GP Surgery as communication with patients following a period of consultation was in progress.”

In fact, at the time of the initial request, the final decision has already been made and announced - with patient’s in the process of receiving letters telling them where they would be going.

When asked to explain if the trust is satisfied that the public is not being left with ‘incomplete’ information, Maz Fosh, LCHS chief executive, reiterated the line in the private minutes about the lack of clinical space and retention and recruitment issues.

She added: “The Trust decided to focus on working in partnership with GP surgery providers to develop services in local communities rather than as a provider of GP services.”

‘We have been fobbed off’

A campaigner who fought the closure of Spalding GP Surgery feels residents have been ‘fobbed off’ - and accused bosses of ‘rearranging the deckchairs on the Titanic’.

George Scott, who teamed up with late councillor Angela Newton to fight the decision to axe the popular Johnson Hospital service, criticised bosses for still failing to spell out the full reasons for shutting the surgery.

During a consultation on the closure plans - which closed last September - campaigners were promised a full public meeting on wider healthcare concerns for Spalding and Pinchbeck.

A date has still not been set for this - although bosses promise they will speak to residents after they have finished a review.

A spokesman for Lincolnshire Integrated Care Board, which commissions healthcare services, said:

“We are continuing to work on understanding the future health needs for the current and growing population of Spalding.

“Our work will cover all aspects of the healthcare for the local population. Once we have completed this we will engage with local residents and their representatives to see their feedback and comments.”

Mr Scott said: “What’s the timescale for all of that?

“We have been fobbed off. I believe you can’t trust them if they can’t be forthright.”

With several large housebuilding projects underway - including around the new relief road roundabout - campaigners were concerned about how Spalding’s existing surgeries could cope. Access to dentists was also flagged as a concern, with just 10 NHS dentists for the whole of South Holland.

The dental facilities at the Johnson Hospital are unused - with NHS England struggling to find someone to run it.

The majority of the 3,361 Spalding GP patients went to either the Munro or Beechfield practices - both of which opened up satellite services at the start of the year.

However, Mr Scott feels this was a short term measure that does nothing to address what will happen when the population grows.

He said: “It was a case of ‘rearranging the deckchairs on the Titanic’.”

He also expressed concerns as to what is going on in the vacated Johnson Hospital rooms - with both the GP surgery and dentist facilities mothballed.

Why is it prejudiced?

LCHS explained why the full board agenda items and comments cannot be revealed.

It argued that:

*prejudice would be caused on the basis that discussions as referenced above are often controversial as they require unfettered ‘out of the box’ thinking at a point of exploration not implementation

*prejudice would also be caused by the sharing of incomplete information which would not provide a full position and context for public consumption which would lead to misinterpretation. It would almost mean potentially incomplete and inaccurate information regarding activity and strategy remains in the public domain once the position is finalised

*prejudice would be caused on the basis that as ideas evolve over time it is likely that several of them will not be viable or would need considerable re-think. If shared before they reach the appropriate developmental stage this would inhibit any challenging aspect being fully explored – for example patient concern, workforce confidence and political considerations

*prejudice would be caused when early options and proposals are discussed prior to future discussion within individual organisations, at Board level, with staff or with patients. Often at the initial stages of discussions, there will not have been enough detailed operational consideration that would enable colleagues to fairly describe or present in public

*prejudice would be caused if there was no option for a ‘safe space’ to explore and analyse the ideas, strategies, and information, and to assess the impact(s) within the Trust. There must be an appropriate environment in which the Trust and its system partners are able to share challenges, experiences, and ideas, freely and safely. This is to safeguard appropriate discussions held in good faith for the wider public benefit. In effect poorly timed disclosure could have a chilling effect on the exchange of information, ideas, and thoughts within and by the Trust and system partners.