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Changing Vale of Neath GP

Services for the Better

CONSULTATION DOCUMENT

November 2011

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Introduction

This paper outlines the proposal of ABM University Health Board and Vale

of Neath General Practitioners to replace existing GP surgeries in Glynneath and Resolven in the Vale of Neath with a purpose-built, modern

primary care centre, to improve the way care is delivered in the area.

The Health Board‟s five year plan, „Changing for the Better‟, sets out an ambitious programme to improve the quality of the healthcare services

we offer. Modernising hospital and primary care services, and extending the range of services we provide in the local community, are key

priorities.

Patient expectations are ever increasing. They want better and faster access to services, and they want more of them. Many want care to be

available at home or closer to where they live.

We, the GPs of the Vale of Neath Practice and ABM University Health

Board, welcome these expectations, and are committed to doing our best to meet them, as long as it is safe and practicable to do so.

We believe the best way to increase services and deliver

healthcare of the highest possible standard to our patients in the Vale of Neath, is from a brand new purpose built primary care

centre.

This new modern centre will be as close to the centre of the area covered by the practice as possible, bringing together a number of

healthcare services in one place.

By consolidating our services on one site we can offer patients

better access to doctors of their choice and more specialised clinics, including clinics and outpatient appointments previously

only available in hospitals.

It will improve communications and joint working between different services, provide a better environment and greatly

reduce the need for people to travel to hospital for a number of treatments.

Following an engagement exercise held in September, we are now

undertaking a six week consultation exercise from 7 November to 16 December 2011 to share this proposal and to hear our partners‟ and the

public‟s views and opinions.

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The outcome of this consultation will be considered by the Health Board,

Vale of Neath GPs, and discussed with the ABM Community Health Council in January 2012.

Context

The NHS in Wales is facing large and complex changes in the way it

delivers care. People‟s needs and expectations are changing, and new medical technologies and ways of delivering care are becoming available.

Just like the rest of the public sector, the NHS is facing huge financial challenges.

This means we have to continually review how and where we provide care

and to consider whether we have the right services, in the right place, and are providing the best care we can. The need for healthcare premises

and services to meet the needs of the patient population in the 21st

century is crucial.

Our Pledge

ABM University Health Board (ABM) is committed to providing the best services possible - within our resources - for our patients, their carers,

and families.

We are determined to offer good quality treatment in accessible, comfortable, modern and safe environments, and ensure patients and

their families are treated with honesty, dignity and respect.

We are confident that this can be achieved, and there are two important principles driving this:

Quality and Safety. Providing the best quality services and facilities for our patients, their carers and families.

Rebalancing care. Too many patients receive treatment in

hospital or stay in hospital longer than necessary when it is more appropriate to offer them care in community settings or in their

own homes.

Modernising NHS Services

Our strategic plans for services in Neath Port Talbot, set out in Changing

for the Better, are based on making best use of our hospitals, our community-based services, and taking the opportunities of working more

closely with voluntary sector services.

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We are also continuing to work with the independent sector to meet

respite, nursing and ongoing long term and continuing healthcare needs of our patients in appropriate community settings.

Our proposal for the Vale of Neath Practice should be seen in the overall

context of improving health services in Neath Port Talbot, particularly as current developments include significant changes to the number and way

healthcare services are provided to patients within their local community.

Vale of Neath Practice

The Vale of Neath Practice covers an extensive area of Neath Port Talbot, with the population spread out over a wide area including the towns and

villages of Glynneath, Resolven, Cwmgwrach, Pontneddfechan, Ystradfelte, Rhigos, Melin Court, Clyne and Abergarwed.

The Practice currently has two surgeries, a main surgery in Glynneath and a branch surgery in Resolven. With six GPs (5 whole time equivalent), the

practice has 9,617 registered patients: 6,820 with the Glynneath main surgery and 2,797 with the Resolven branch surgery.

The main surgery building in Glynneath

(left) has been a GP surgery since 1946.

Despite extending and remodelling, it is now too small and poorly designed to

cope with the increased demands placed on it by the needs of modern day

healthcare.

The Health Centre at Resolven, (bottom

left) where the Resolven surgery is based, was built in the late 1960s.

Despite every effort by practice staff to

provide the highest quality service, the building itself does not support this. The

building is simply unable to cope with or deliver healthcare services at the

standards we all expect and deserve.

Compared to just five years ago, the Vale of Neath practice now provides more

appointments with a number of GPs, access to nurse led clinics and clinics for managing long term illnesses. In the first week of October 2006 the

practice saw 477 patients. Five years later, and in the first week of

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October 2011 the practice saw 1,043 patients. This is an increase of

over double the number of patient appointments in just five years.

Why the need for change?

Earlier this year, the Vale of Neath GP practice wrote to ABM University Health Board, explaining that for reasons which are outlined in this

consultation document, they felt services should be consolidated and provided from a single site. This reinforced the need for a new, purpose-

built primary care centre as the best way to provide high quality services for patients into the future.

Both the practice GPs and ABM University Health Board are committed to

providing the safest and best quality care we can within the resources we have. We aim to ensure primary care services in the local community are

accessible and efficient, and expand to meet the health needs of local

residents. The needs and expectations of the local population are changing, we need to make sure our healthcare services develop and

grow to meet them both now, and in the future.

Unfortunately, despite modernisation, there are a number of constraints and limitations to the current premises used by the practice which

prevent the further development of healthcare services to the standards and availability we expect and patients are entitled to receive.

Accessibility

a

b d

c

Examples of narrow doorways and access

and cramped conditions in:

a, b: Glynneath

c, d: Resolven

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Both the buildings in Glynneath and Resolven used to provide services

within the Vale of Neath are out of date and no longer fit for purpose. The layout and cramped space within both buildings makes it difficult to

effectively provide current services to patients, and impossible to offer additional local health services. Access is particularly difficult for those

patients with disability aids or patients with pushchairs.

In the Glynneath Surgery access to consulting rooms is limited because of a

steep flight of stairs (right) and a very narrow corridor with a sharp corner.

Although a stair lift has been fitted to help

patients access the upstairs this isn‟t an ideal or satisfactory solution.

Even though improvements have been made for disabled access, both buildings are only able to fulfil the requirements

set out in the Disability and Equality Act 2010 to a basic level. A recent Community Health Council Report (Aug 2011) referred to accessibility at

Glynneath as a matter of concern and a key issue.

Increasing the number of healthcare services from any building means an increase in the number of people attending the surgery and arriving by

car. Currently both surgeries have limited parking and drop-off facilities for patients.

At the Glynneath surgery (left) dropping-off a patient on the

main road is particularly difficult and dangerous, especially for

elderly patients, disabled

patients and people attending with young children.

The buildings in Glynneath and

Resolven are both at capacity and there is no way to further

extend or improve them.

In the monitoring report completed in August 2011, by the ABM Community Health Council, the

lack of space in treatment rooms was mentioned as a matter of concern.

The buildings as they currently stand actually prevent us from developing patient care and delivering the best quality healthcare services which you,

our patients, need and deserve.

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Confidentiality, Safety and Dignity

Patient confidentiality, safety and dignity are top priorities.

We all work hard to achieve and maintain these; however our ability to deliver these priorities is severely compromised by the current

environment at Glynneath and Resolven.

For example:

In the Resolven surgery, patients have to be taken through the waiting room if they need to go straight into hospital from the

surgery. This is not appropriate and is distressing for patients.

In both surgeries, the cramped conditions mean at times the private, confidential and often sensitive conversations which

patients have with their doctor or nurse can be overheard by

members of the public sitting in the waiting area. This is another issue raised recently by the ABM Community Health Council as a

matter of concern.

Some of the rooms are so small they do not comply with Health and Safety legislation.

Storage space for equipment, materials and files is very limited, and

therefore does not meet Health and Safety and Infection Control standards. Unfortunately the investment needed to put this right

would be impractical to implement.

Due to patients attending more than one site their confidential records have to be transferred between sites. This not only has

confidentiality and safety issues, but also means a patient‟s records

might not be available at the same place as the patient‟s appointment.

Electronic access to patient records and information is limited and

inefficient due to the poor condition of the BT line between the two sites.

Unfortunately, it is not possible to extend either building or redesign the

internal layout in order to resolve the points above and increase the number and quality of services provided.

What is also of significance is that by law all public buildings should be

compliant with the Disability and Equality Act 2010, making them accessible to everyone.

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Improving and developing services

We want to ensure that the services we provide can continue to meet the

needs of local people into the future. Running two separate surgeries has significant staffing, financial, equipment and safety constraints. GPs have

to cover two surgeries instead of working together under one roof, which results in patient access to doctors being reduced and constrains

opportunities to develop better services.

The practice has three full time and three part time GPs (equivalent to 5 wte GPs), which is the right number for the population size of 9,600

registered patients. There are not enough patients to support any additional doctors – so we need to make the most of the GPs we do have.

The greater demand for Glynneath appointments results in an imbalance

in cover, with more GPs working in Glynneath than Resolven. Resolven

therefore has fewer surgery sessions because fewer patients are registered with the branch surgery. As a result, a number of Resolven

patients already attend the Glynneath surgery instead to see the doctor of their choice. A spot check revealed that of the 157 Resolven patients who

required an appointment during one week, 14% went to Glynneath instead of Resolven during Resolven Surgery opening hours.

This also means that sometimes GPs have to work on their own in

Resolven, which raises safety implications, particularly for female GPs. In addition, there are fewer opportunities for GPs to discuss a potential

diagnosis or treatment with colleagues, or get a second opinion when they are on their own. Clinics can also be affected if a GP is on another site,

leading to patient waits.

We need to maintain a skilled and flexible workforce capable of meeting

changing healthcare needs within our communities. All these factors mean we need to target resources and make the best use of staff, to ensure we

deliver safe, high quality care in the most appropriate environment.

By consolidating our services onto one site we could offer patients better access to doctors of their choice, nurse led clinics and

specialist clinics. This would avoid the need for patients to make multiple trips for healthcare appointments at various locations.

Positive Reasons for change and our proposal

We aim to build on all the strengths of the existing primary and

community care services available in the Vale of Neath.

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We are improving the way primary care and hospitals work together, and

rebalancing care so more can be delivered closer to people‟s home - with less reliance on hospitals, unless patients really need to be there.

In the recent Monitoring Report by ABM Community Health Council, the

Vale of Neath Practice was commended for the quality of the services it provides. But by consolidating these services on one site we can offer

patients even better access to the doctors of their choice and more specialised clinics; including clinics and outpatient appointments

previously only available at hospitals.

It will also improve communications and joint working between different services, provide a better environment and reduce the need for people to

travel to hospital for some services which could be provided at the centre instead.

At other Primary Care Resource Centres in the

ABM area, a significant bonus has been the ability

to offer a number of commonly used services

which have traditionally only been available in an

acute hospital – in other words, taking services into

the community, closer to people‟s homes. (Left: a

Pulmonary Rehabilitation Clinic underway in Port Talbot Resource centre).

At this early stage in the consultation process, we have not reached the point where artists‟ illustrations of the proposed Primary Health Care

Centre for the Vale of Neath are available.

However, ABM has a significant track record for developing a number of new single site primary health care centres across the whole Health Board

area, including those at Seven Sisters, Clydach and Port Talbot.

Evidence shows that these new developments have led to improved services and wellbeing for patients.

The following pages show some images of the other primary care centres

which have been built in the last few years in the ABM area, or which are currently under construction, to give you an indication of what could be

built to serve the Vale of Neath.

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Dulais Primary Care Centre, Seven Sisters:

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Port Talbot Primary Care Resource Centre, Baglan:

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Clydach Primary Care Centre

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In addition to the above, work has just started on the £7.25 million

Beacon Centre for Health development in Swansea‟s SA1, which will be home to two GP practices, a dentist, and a range of services which had

previously only been available in hospitals, as well as other services.

The Beacon Centre for Health

(illustrated left) is due to be open in 2013.

It is another example of

ABM‟s commitment to improving community-based

primary healthcare.

Our proposal for the Vale of Neath

Discussions about the future plans for primary care services in the Vale of

Neath have been ongoing for a number of years. For the reasons set out in this document, we believe that the best solution for a sustainable and

modern service is to consolidate current services in a new single central building we are proposing for the Vale of Neath will be purpose built in

response to the healthcare needs of all Vale of Neath Practice patients. It will take into account:

The healthcare needs of all patients in the area

The importance of delivering the highest standard of care in a comfortable modern and safe environment which is fit for purpose

The requirement of patients to receive faster and more accessible

healthcare services closer to their own home The access requirements of all patients, particularly the elderly,

disabled and those with young children The number of patients accessing the practice both now and in the

future The dignity, privacy and confidentiality of all patients when talking

to doctors, nurses and other healthcare staff Parking and drop-off facilities needed by patients

The effective and efficient use of resources including space, equipment and staff

More choice, less travelling

We recognise that the relocation of services to a central point will create

additional travel time for some people. However, we believe the benefits

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of a new facility will outweigh this difficulty and will help reduce travel

times for services that couldn‟t have been provided locally in the Vale of Neath within the current facilities.

Statistics show that the majority of patients prefer to be able to have an

appointment with the doctor of their choice, and don‟t mind where the appointment is. Even when Resolven is open, an audit of one week

showed that 14% of Resolven patients currently chose to travel to the Glynneath surgery in order to have an appointment with their doctor of

choice.

As there is only about enough work at Resolven for one doctor, the practice usually only has one GP per session at the surgery fulfilling

appointments, and therefore the choice is limited. But by having all the doctors based at one central surgery, patients served by the practice will

have more choice over which doctor they see.

At the moment, the Vale of Neath Practice can only run a clinic for people

suffering from Type 2 non-insulin dependent diabetes. Those patients with Type 1 and Type 2 insulin dependent diabetes have to attend a clinic at

Neath Port Talbot Hospital. Centralising services and staff on one site will mean clinics such as the Diabetes Clinic will be able to offer more

appointments, and have more specialised staff and equipment available to patients all at once.

Because all the staff a patient might need to see for their condition are

located in one place this will not only reduce the number of appointments a patient needs to attend, but cut patient journeys to just one location.

With the additional space provided by a new building there is the potential

to move more services, such as the clinic for diabetic patients on insulin,

from Neath Port Talbot Hospital closer to patients in their own community. This would mean patients no longer having to make the 22

mile round trip from home to the hospital.

More services

Community Services are already considering centralising a wide range of its services in the new Primary Care Centre should it be built, including:

Pulmonary Rehabilitation

Ante Natal and Post Natal Services Wound Care

Podiatry Nutrition and Dietetics

Base for District Nurses, Health Visitors and School Nurses

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Facilities to support the Community Resource Team

Physiotherapy Consultant led clinics

Family Planning Clinics

The practice is a teaching practice and needs to have the facility to train GP Registrars and students in a suitable environment.

Currently a number of Resolven and Glynneath patients attend the

Pulmonary Rehabilitation Service at Port Talbot Resource Centre, which involves a round trip of 22 miles plus travel time.

By opening a new Primary Care Centre in the Vale of Neath, the Health Board would be able to run the Pulmonary Rehabilitation Service from the

new Centre.

A similar service is already running very successfully in the Dulais Valley

Primary Care Centre at Seven Sisters. (Unfortunately, at the same time as Dulais Valley welcomed their new Pulmonary Rehabilitation Service the

Vale of Neath had to decline a similar upgrade due to lack of space.)

The new centre would not only mean more space for services to be run from the community for the people of the community. But also, there

would be more healthcare staff based within the community for the people within the community to access.

Locating all the staff on one site not only increases capacity but also the

ability to ensure patients are able to access the right treatment in a timely manner. For example, if a district nurse wants a medical opinion on

a wound that is being treated, the GP would be available and accessible within the same building, and the patient would not have to make a

separate appointment, wait for the GP to arrive or return later.

Community Pharmacy

We are also proposing to have a community pharmacy within the new

building.

Where would the new centre be built?

In order to increase services and deliver healthcare of the highest possible standard to our patients in the Vale of Neath we need to provide

a fit for purpose building. To ensure the building will provide the maximum amount of space for now and for the next 25 years with the

ability to expand as services and population increase, we need to have a large site in an accessible location for all patients of the practice.

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We have spent a considerable amount of time trying to find a site that is

within the practice boundary and also provide the space required for a large building with car parking. The site that has been chosen is the

former Aberpergwm Washery site, which is near Glynneath Business Park and close to the swimming pool and fitness centre.

The overall geography of the Upper Neath Valley means we needed to

find the most accessible, flat site, for all the patients who are registered with the practice. The Aberpergwm Washery site is adjacent to the main

link road between Swansea and Merthyr Tydfil and on the main bus route. This means Resolven patients will have to travel 4 miles to the new

Primary Care Centre which is less than they currently have to travel to the Glynneath Surgery.

Public Transport

We recognise that some people have already indicated their concerns about travel arrangements from the Resolven area. We have already been

in touch with the local bus companies regarding our proposal to confirm details of existing bus services to the site, and if they could be enhanced.

There are two bus stops located on Chain Road right next to the proposed

site. These are used by the half-hourly First Cymru X5 service and the two-hourly First Call Travel direct service from Merthyr to Swansea

stopping at Resolven and Neath.

First Cymru has informed us that its half-hourly service runs as follows, Monday to Friday:

Resolven to Glynneath, stopping next door to the site of the

proposed centre: leaves Resolven four minutes past the hour, and

arrives 17 minutes past the hour, and also 34 minutes past the hour, arriving 47 minutes past the hour.

The first bus leaves Resolven at 8.34am, arriving at Glynneath around 10

minutes before a 9am surgery start.

Glynneath to Resolven, leaving from next to the site of the proposed centre: leaves Glynneath just past the hour, arriving 15

minutes past the hour, and 30 minutes past the hour, arriving 45 minutes past the hour.

We will also work closely with the local bus companies to see if a bus stop

can be incorporated even closer, within the grounds of the new Primary Care Centre.

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Also, home visits by GPs will continue to be available to patients who

need them.

Parking

There will be onsite drop-off and parking facilities. We have purposely looked for a site large enough for both the building itself and a car park.

What others think of primary care centres:

Cathy Dowling, ABM Head of Midwifery –

“This would be a positive improvement for maternity services for both

midwives and mums to be to have a base that enables women and their families to access a midwife in the early stages of pregnancy. This base

would also allow the midwives to access the Health Board information

systems and ready access to women‟s and babies records within the community.”

Jane O’Kane, ABM Head of Health Visiting –

“Child Health Clinics are currently held on a Monday in Addoldy Road and

a Wednesday in Resolven. Both buildings are very old and not ideal as venues for the clinics. The Resolven Health Centre doesn‟t have a suitable

area for children, and families have to wait in the general waiting area. Addoldy is very busy and as the clinic is on a Monday it is often missed

due to bank holidays. If health visiting services were centralised at a purpose built centre, it would change all this. There would be more

opportunities and staff available for clinics to take place. This would greatly improve the Child Health Clinic Service for all the patients within

the valley.”

Dr Mark Daniels (GP – Senior Partner) –

“The Dulais Valley Primary Care Centre at Seven Sisters is a superb new

health centre. The facilities are excellent and meet the needs of the practice population. I think the population of the Neath Valley deserve

and are entitled to the same standard and quality of facilities and services.”

Simon Boden-Tebbutt, Practice Manager –

“The Dulais Valley Primary Care Centre at Seven Sisters is a positive

working environment and I think it gives a more professional appearance. There appears to have been a positive attitude towards the building by

patients and I haven‟t heard people complain about the distance they

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have to travel to benefit from the improved services run from here. The

Retinopathy Clinic is now held here, within the community, on a monthly basis. Because of the space we have available the Community Mental

Health Team are also able to visit and see patients closer to home. As well as the Chiropody and Baby Clinic, other services have started here in

recent months including Pulmonary Rehabilitation and Stop Smoking Wales.”

Financing the New Centre

The new centre will be built and owned by a third party and be rented by

the Health Board and Vale of Neath Practice. This is the same method of development as the Port Talbot Primary Care Resource Centre and Dulais

Primary Care Centre.

Timescale

If our proposals are accepted, then a detailed design and planning

process would follow before any development could begin. The estimated timescale for the opening of a new centre would be early 2014. Until the

centre was completed, the current facilities would remain.

Conclusion

The Vale of Neath GPs and ABM University Health Board want to ensure that patients in the Vale of Neath area have access to high quality GP

services in a modern, purpose-built environment. We want to offer services in the community which previously were only available in

hospital. We want to offer patients more choice, and use resources more effectively and efficiently to improve the services on offer.

To do all of the above, we need to replace out-of-date and cramped premises in a single, modern GP centre. We are therefore proposing the

Vale of Neath existing main and branch surgeries at Resolven and Glynneath close, and be replaced by a purpose-built centre at a site on

the former Aberpergwm Washery.

We recognise that this will involve a change in location for people who use these services, and are grateful for your cooperation in helping us deliver

a new facility that can provide the highest quality services into the future.

What are the next steps?

We have already had a number of engagement events to discuss the proposals with local people. The ABM Community Health Council has

requested that we now undertake a formal public consultation on these

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plans. We will be holding a number of public meetings which you are most

welcome to attend. Dates, times and venues of these meetings will be announced shortly and widely publicised.

You can also email us at: Sendusyourviews.abm@wales.nhs.uk with the

title „Vale of Neath‟. You can also write to:

Hilary Dover Locality Director

ABMU Health Board Neath Port Talbot Locality

Suite A Britannic House

Llandarcy Neath

SA10 6JQ

As part of this public consultation we will also be consulting with the

following stakeholders:

ABM Staff Partnership Forum ABM community staff in the Vale of Neath area

ABM Primary Care staff in the Vale of Neath area ABM Stakeholder Reference Group

ABM Patient Participation Forum - East Local Medical Committee

Local Pharmaceutical Committee ABM Community Health Council

Neath Port Talbot County Borough Council Neath Port Talbot Local Service Board

Neath Port Talbot Council for Voluntary Services

Neath Port Talbot Older People’s Forum Neath Port Talbot Carers’ Forum

Neath Port Talbot Disability Forum Local Assembly Members and MP

Resolven Community Council Glynneath Town Council

Following the end of the consulation period on 16th December 2011, a

report will be prepared by 6th January, 2012 for ABM Community Health Council and ABM University Health Board on the comments made on the

proposals and the outcome of the public consultation. The outcome of the public consultation and comments on the proposals will then be

considered by ABM University Health Board at a meeting on 26th January 2012.