Too many people, not enough doctors

Villagers are calling for a new, larger, doctors’ surgery to cope with the influx of new residents.

Between 2001 and 2011, the population of Marston Moretaine and Cranfield increased by nearly 500 (from 9469 to 9925). Over 460 dwellings were built in Marston between 2011 and 2015.

As well as the surrounding villages, students at Cranfield University also make up Cranfield and Marston Surgery’s patient list.

This catchment area gives this doctors’ surgery an above average number of patients. Sue Carmalt, practice manager at Cranfield and Marston Surgery, said:

“List size [of patients] fluctuates between 9,800 and 10,500.”

Outline planning application abandoned

The local Primary Care Trust (PCT) secured outline planning approval (MB/09/00318/OUT) for a new GP surgery in 2009.

This application was for a new four-GP primary care centre on the open ground next to the school in Braeburn Way.

Also included in the plans was a dental suite, a nurse treatment area, a pharmacy, a library and a café.

Can a doctors' surgery still be built on this land in Cranfield?

What happened?

The consultants mentioned on the application (Assemble Community Partnership and CPMG Architects) would not confirm why this application wasn’t taken further.

However, the coalition government abolished PCTs as part of the Health and Social Care Act 2012. NHS Property Services then became the land owners. 

 

How is NHS England structured now?

Doctors' Surgery - reduced numbers of GPs

Nikki Barnes, head of primary (community & social) care modernisation, at Bedfordshire Clinical Commissioning Group, said:

“When NHS England took responsibility for GP Practice contracts in 2013, this [application] was not transferred to NHS England as a fully committed legacy project.

“The land is still available for NHS use, if required.”

 It’s ok for us to build because…

Developers have referenced this 2009 application when applying to build their own developments. Central Bedfordshire Council also referenced it when replying to residents’ concerns over planning.

In reply to resident objections to the Willow Green development it said:

“Planning obligations will be sought for health services.”

It is unclear what these ‘planning obligations’ would be. It may have been as simple as to contribute to a special fund.

Cranfield and Marston Surgery opened the Marston Surgery in 2002

Land is available, but what about the money?

If a new, larger surgery was built it would be the first expansion since the Marston Surgery opened in 2002.

As Ms Barnes mentioned, the land in Braeburn Way is still available for NHS use. But where is the money for the building and all the equipment?

Money for projects can be raised as part of planning applications. These negotiated interest-related payments are called a ‘developer contribution’.

These are also known as a section 106 (s106) payments. Payment date(s) it will be also be formally agreed.

A s106 obligation is not just about financial contributions. It can also:

  • restrict the development or use of the land in any specified way
  • require specified operations or activities to be carried out in, on, under or over the land
  • require the land to be used in any specified way

 

Early payments were not for Cranfield and Marston Surgery

If any aspect of the s106 is not met, councils can take direct action and also can recover any expenses. Payments and payment dates are listed on the council’s website.

Earlier s106 payments were specified for primary care. However, this money wasn’t ring-fenced for the Cranfield and Marston Surgery.

This general primary care s106 contribution for the combined Cranfield and Marston parishes totalled £18,471.47.

Housing developments contribute to community projects as part of agreements with the council

Specific payments have now been allocated for an “improved/new GP Surgery Marston/Cranfield”.

These payments have different codes based on the development:

· H011 CB/15/00209 Moreteyne Farm, £226,665

· H012 CB/14/05007 Mill Rd, Cranfield, £110,629

These funds are not due for collection at the moment. Payment dates are set depending on certain goals being met, such as the number of new homes completed.

The money has to be spent

S106 contributions do have a time limit for funds to be spent. There is not a standard period of time as such. Instead it is defined within each agreement.

If funds are not committed or spent (as defined within the agreement) then the funds are to be returned to the developer.

Is this plot still practical?

When the outline planning was given for the new surgery in 2009, the land next to the plot was still a field. This field is now a new school and 135 homes.

These use the same access (Flitt Leys Close) as the plot of land. This road is narrow due to resident parking.

Parking by school run parents restrict access along the road out of Willow Green to Flitt Leys Close.

Patients who drive to the surgery for an early appointment would have to negotiate these parked cars.

At the same time, residents will be driving out of Willow Green. This might cause Willow Green residents to raise objections to any new planning application.

Also, Marston residents may feel that any new surgery should be built there. After all, Marston developments will be donating a larger amount to the s106 pot.

Councillors for the Cranfield and Marston Moretaine Ward, and both Cranfield and Marston Moretaine Parish Councils did not comment if building a new surgery in Marston is a possibility.

Central Bedfordshire Council’s Draft Local Plan would mean more patients

Further planning for new houses in the area might cause further delays in building a new surgery. These new villages might mean that plans for any new doctors’ surgery in Cranfield might be abandoned altogether.

Central Bedfordshire Council’s Draft Local Plan looks at future housing requirements for the next 20 years. This draft local plan calls for 5,000 new homes in Cranfield and Marston Surgery’s catchment area.

Could this expansion postpone any development of the Cranfield and Marston Surgery?

A spokesperson for Central Bedfordshire Council said:

“Within the Central Bedfordshire Draft Local Plan is an acknowledgment of the need for more healthcare facilities.

“The council consults with health services as part of the Local Plan process, and has considered the capacity of schools and GP surgeries throughout Central Bedfordshire.”

As mentioned earlier, developers contribute to essential facilities, with s106 payments.

“If the growth location in the Marston Vale does go ahead, then the developer will be required to build a new health facility to serve the villages.”

The council collects payments for primary care, but..

The council is aware of the pressures on the existing health services, but says that is is an NHS issue.

“This isn’t just about housing growth, but also how the NHS intends to deliver their services themselves.

“We have lots of evidence of how residents feel about the pressure on the surgery from the Community Planning Events. This information has been passed to our colleagues in the NHS.

“They acknowledge that the present building in Cranfield is severely constrained, and seem keen to find a solution too.”

The NHS is working to understand future health requirements for the existing population and for further growth.

“They are fully aware of the proposed growth locations in the Draft Local Plan and meet regularly with Council Officers.”

Nikki Barnes, Head of Primary (Community & Social) Care Modernisation, said:

“We have developed some possible solutions and we are working through these with both the GP practices and Central Bedfordshire Council. Once a suitable way forward has been agreed by all parties, we will develop a business case and start to engage with patients as part of the process.”

Is a new doctors’ surgery really needed?

Complaints on social media may not give a true account of the surgery’s service levels. How does this surgery serve its patients?

There is one GP on each site during the consultation periods. They are joined by two Independent Prescribers, two Practice Nurses and one Health Care Assistant.

Not all the nursing team are on site full time.

From 08:30, each surgery has 16 routine appointments per clinician on a first come, first served basis. On certain days this means that there are 32 appointments shared between a GP and a minor illness nurse.

Queueing since dawn

It is the walk-in appointment which causes most of the discussions on social media. Patients feel that they need to queue outside of Cranfield Surgery an hour or so before it opens.

One post on the closed Facebook Group called Cranfield Community Group, said that:

“I arrived at GP surgery at 07:25 in the hope of getting first place so I wouldn’t be too late for my shift.

“There were 5 people in front of me, including a gentleman of advanced years really struggling to stand for so long.”

This early queueing is rare at the Marston Surgery. But this surgery has 32 appointments each day. Cranfield only advertises 32 on Tuesdays and Wednesdays.

Nikki Barnes, Bedfordshire Clinical Commissioning Group, said:

“We are aware of the significant capacity constraints within the current GP surgery in Cranfield, which is causing concern for our patients.

“As such, we are working with NHS England to conduct scoping work of the GP practices in Cranfield, Marston Moretaine and Wootton to determine how we might improve the facilities used by the GPs in that area.”

 

Official surveys

Are the online comments the opinion of a vocal minority? How does Marston and Cranfield Surgery compare to others?

The GP Patient Survey is an independent survey run by Ipsos MORI on behalf of NHS England. The results show how people feel about their GP practice.

The selected results shown below do show that Cranfield and Marston Surgery is below average both nationally and regionally. It is also behind the Wootton Vale Healthy Living Centre, which some former patients now use.

Patients can help to improve service levels in the short-term

In an article for the Cranfield Express, Rina Persaud, who is the chair of the Cranfield and Marston Patient Participation Group, said that there is an average of 8.25 missed appointments per working day (between 2/1/17 and 2/6/17).

This is around two lost hours a day. Patients cancelling unwanted appointments by phone or email in good time would free these slots for others to use. It would also reduce waiting times.

Alternatives to using Cranfield and Marston Surgery

There are alternatives for those who can’t get an appointment.

Use the Walk-In Centre in Putnoe 

The Walk-In Centre is open from 8.00am to 6.30pm, 7 days a week, 365 days a year

Use a pharmacist

A common suggestion, but there is only so far a pharmacist is able to offer a diagnosis. A pharmacist will be able to recognise symptoms and recommend treatments for common ailments and illnesses. More complicated issues should be seen by a traditional GP.

Call NHS 111

You should use the NHS 111 service if you urgently need medical help or advice but it’s not a life-threatening situation.

Use an online service

There are online GP services, such as Push Doctor and Babylon. There are extra fees, and prescriptions will be  private, so can work out expensive.

Sign up to another surgery

Other surgeries in the area may accept patients from ‘out of area’. However, they may not agree to home visits.

 

If you are concerned about the service levels at Cranfield and Marston Surgery

Patients can join the Cranfield and Marston PPG. It can be found on Facebook, there is information on the group on the Cranfield and Marston Surgery website, or you can email the group direct.

As well as being able to voice any concerns about the doctors’ surgery at the regular meetings, you will also be kept up-to-date on any progress in surgery expansion.