Chorley GP whose patients campaigned to keep her as their doctor faces fresh uncertainty

Dr. Ann Robinson has run Withnell Health Centre for the past 11 years. But when a partnership with another doctor at the surgery was dissolved at the end of 2021, the contract to provide GP services from the Railway Road facility had to be opened up to anybody who wanted to bid for it.

That process ended a year ago, with Dr. Robinson being told that she had lost out to a conglomerate that operates more than 40 practices across the North West - much to the fury of many of her 5,500 patients, who formed a campaign group to keep her in post.

However, the NHS's decision later unravelled after the Lancashire and South Cumbria Integrated Care Board (ICB) accepted that users of the health centre had not been properly consulted - leaving Dr. Robinson in place on an interim contract while the lengthy procedure was wound back to the beginning.

The ICB had been due to decide the arrangements for securing a permanent operator for the surgery - for up to the next 15 years - at a meeting of its primary care commissioning committee on Thursday. Members had been advised to launch a fresh round of bidding as part of competitive tender for the contract - having received two expressions of interest in operating the facility. It is not known whether the firm that was chosen last year - SSP Healthcare - is among them.

However, as the Lancashire Post revealed earlier this week, the Save Withnell Health Centre group had demanded NHS leaders instead make a so-called “direct award” to Dr. Robinson - meaning that she could stay on at the surgery without facing competition from anybody else wanting to take over the running of it.

That was an option the ICB had concluded was not available to it, but - just an hour before the start of the meeting - the Post understands that the organisation received the latest of three pieces of legal advice that it has sought over the procedure it should be using, following a change in national commissioning rules introduced on 1st January. Its arrival prompted the committee to defer the decision, so the contents of the guidance could be properly considered.

Speaking to the Post after the gathering, Dr. Robinson said while the move at least kept alive the hope that she could still be handed the contract without having to go through the upheaval of another competitive bid, the delay was merely adding to the “stress and anxiety” felt by patients and staff over the longstanding uncertainty.

“[The ICB] say it’s because they’re listening - but I firmly believe, when you look at the criteria, that they could just directly award the contract.

“There is a feeling of incredulity that we [could be] going down this road again. People genuinely cannot understand why, when they have got the feedback they have from 2,500 patients [as part of a recent engagement process], that in the next breath they have said they might have to go out to procurement again.

“The ICB has got a massive deficit and our acute hospitals are in crisis - so why are we wasting time and money on a part of the health service that is working?

“We just have to reassure our patients and staff that we’ve just got to keep strong and trust that they will make the right decision - and so we fight on,” Dr. Robinson added.

WHAT’S THE COMPLICATION?

Under the new NHS provider selection regime, which came into force at the start of the year, there are three routes by which organisations and individuals can be directly awarded health service contracts without competition.

Withnell Health Centre is ineligible for two of them, which apply only where the existing operator is the only one that can deliver the service in question or where patients have an unrestricted choice of providers.

The third option requires the existing provider to be satisfying its current contract and be judged by commissioners as being “ likely” to satisfy the new one “to a sufficient standard”. But it comes with a caveat that the new contract must not be worth “considerably” more than the deal it will replace - defined as it exceeding the existing arrangement both by £500,000 in cash terms and 25 percent as a proportion of the total contract value.

Dr. Robinson and her practice team argue that the proposed new contract for the Withnell facility would fall within those limits when compared to the arrangement that was dissolved in 2021.

However, the Post understands that the ICB has been advised the benchmark for the comparison must be the current interim contract between Dr. Robinson and the NHS, which can run for a maximum of 30 months - and so is worth far less than the up to 15-year deal now on offer.

It is likely that NHS commissioners in Lancashire and South Cumbria are amongst the very first to be procuring a service under the new England-wide rules, which are barely a fortnight old - meaning that there are no precedents to inform decisions about nuanced issues like those that surround the Withnell Health Centre case.

In a statement issued to the Post, Craig Harris, chief operating officer at the Lancashire and South Cumbria ICB, said: “A decision on the approach to be taken in relation to the procurement option was due to be made [on Thursday] at our primary care commissioning committee meeting; however, the committee has agreed to defer a formal decision on the procurement route until further advice is sought.

“The Provider Selection Regime, which is the national guidance we have to adhere to, was published on 1st January, 2024, and we are one of the first ICBs in the country to apply this. During the meeting, a few points were raised by committee members that we need to seek legal clarity on before going forward.

“We know this isn’t an ideal situation, but we’d like to reassure the local population that we are still on track with the timeframes that were originally set. We remain committed to securing the best outcome for Withnell Health Centre and its patients within the legal guidance we are required and permitted to consider.

“Securing high-quality services for our local population remains a priority for the ICB,” Mr. Harris added.

It is not yet known whether the matter will be considered at the February or March meeting of the primary care commissioning committee.

Dr. Robinson’s existing contract for services at Withnell Health Centre is due to expire on 30th September, 2024.

PERFECT PRACTICE?

After concluding that the previous level of engagement with Withnell Health Centre patients over its future was inadequate, the ICB set out to better involve locals in the process second time around by inviting them to drop-in events last year and to complete a survey about their experience of the practice. More than 2,500 people took part, both via face-to-face sessions and online.

According to a summary of their responses drawn up by the ICB, the “overwhelming” sentiment was one of “high levels of satisfaction with the current management and service”.

It was noted that there was, amongst patients, a “deep-seated desire to preserve the level of service they were currently receiving and…a real concern that this excellent care was under threat for what many felt to be a second time”.

“Patients value the relationship built with Dr. Robinson over a number of years and have high praise for the standards of care provided by the current team at Withnell Health Centre,” the document added.

Feedback received by the ICB described how patients felt “blessed with what we have” and were “treated as human beings”.

“The practice is absolutely wonderful,” one said, while another added that the team went “over and above” to help and care for people.

When asked if there was anything wrong with Withnell Health Centre, 62 percent of respondents said “nothing” - but a minority did raise issues about an “over-reliance on locum GPs”, the privacy of the reception area and difficulty getting appointments. Yet many said the reverse, citing a good “continuity of care” and ease of access to services.

The ICB survey summary concluded any concerns were “hugely outnumbered by the number of patients stating they were happy with the practice as it currently is”.