The Council and NHS partners had been working together to develop a new model of care that would provide integrated health and social care services, delivered from modern, high quality premises and able to attract the best staff.  Four new Integrated Medical Centres would locate the new model of integrated care in the heart of the communities they served, bringing a greater range of health, social care and third sector services under one roof, and improving and simplifying care pathways for residents and patients. That despite the impact of the pandemic, particularly on acute services provided by Basildon University Hospital, good progress had been made with planning, financing and service transformation for all four Integrated Medical Centres, and dedicated programme management continued in place. Christopher Smith provided members with a very detailed update on the progress of the Integrated Medical Centre programme and the proposed closure of Orsett Hospital.

Councillor Ralph thanked officers for the report and although understood that Orsett Hospital was due to close in 2025 he questioned and asked for reassurance that Orsett Hospital would not close if these target dates were extended past the 2025 date.

Councillor Ralph referred to the 2000 patient spaces at the Corringham Integrated Medical Centre and questioned whether this was a completely new surgery being built or was this existing doctors in that area taking over those spaces.

Councillor Polley also asked the same question for the Purfleet Integrated Medical Centre.

Rahul Chaudhari stated that in response to the Corringham Integrated Medical Centre it would be existing doctor surgeries from Stanford Le Hope that would be taking up those spaces. That consultation was being undertaken with GP partners in Corringham and that there were two interested surgeries who would be interested into moving into that new Integrated Medical Centre. Councillor Ralph stated that it was rubbish that these were not additional 2000 extra appointments and that Corringham critically needed extra spaces for doctor appointments and would not be fit for purpose in Corringham nor in Purfleet if those were the plans. That extra spaces and new doctors were needed not existing doctors moving into new premises. Ian Wake stated that this was not about buildings it was more about workforce and at the Integrated Care Partnership meeting today a presentation had been given that highlighted the growing pressure on primary care in terms of demand. Ian Wake continued to state that the concept of the Integrated Medical Centres was to create fantastic spaces that would be appealing for new GPs that were coming through training and in the future be able to attract more GPs into Thurrock. That it also had to be recognised that we were in a very competitive market for GPs against a national shortage and that the recruitment of workforce continued to be an enormous challenge. Ian Wake also stated that primary care was much broader than just GPs and that Rural Chaudhari had undertaken a brilliant piece of work on mixed skills workforce with the use of pharmacies, paramedics and physios and reminded Members this was not just about doctors. 

Councillor Ralph stated although he took on board Ian Wake’s points he suggested we looked at the number of houses being built in Thurrock if we cannot get the doctors to serve the patients that already live in Thurrock. Councillor Ralph continued to say it was unacceptable that new spaces in the new Integrated Medical Centres were not being generated for new doctors. That it had been promised from the beginning that these were to be new doctor practices.

Councillor Holloway stated that initial ideas were for additional health centres to be built to increase capacity within the primary care field and although understood workforce was an issue but the plan initially was to increase capacity. Councillor Holloway referred to the Purfleet Integrated Medical Centre where it was now understood that the GP practice would actually close when the Integrated Medical Centre opened and this was not the understanding and that nobody believed that this was going to happen. That the Integrated Medical Centres were not just serving the communities that they will be placed in they would be serving borough wide therefore the reassurances of increased capacity in the health system was really concerning. Ian Wake stated that nobody had ever promised additional capacity and what had been stated was that there was a national workforce challenge and that Thurrock was in a competitive market to recruit GPs. That Thurrock would need to create a work space where GPs could manage complex patients, giving them access to a whole range of services which would then become an attractive offer that would put Thurrock in a prime position to attract primary care staff. That nobody could force GPs to work in Thurrock, there was a competitive market and that needed to be recognised.

Councillor Ralph stated his confusion that new GPs would not be attracted to the new Corringham Integrated Medical Centre as there would be no space for them as the existing 2000 patients would have been relocated there. 

Councillor Fish referred to the Primary Care Strategy and questioned how the recruitment of GPs for the Integrated Medical Centres was going. Rahul Chaudhari stated the Primary Care Strategy not only looked at recruitment of GPs but also attracted a wider mix of workforce within primary care.  That this had been a challenge but some positive moves had been made but the focus had to be to recruit more GPs partners within the batch with a more balanced workforce and a long term commitment within Thurrock.

Councillor Polley stated the recruitment of GPs was not a new issue in Thurrock and her understanding was that the Integrated Medical Centres were to improve services and to free up Basildon Hospital. Councillor Polley stated that for no further provision of new GPs into the Purfleet Integrated Medical Centre was a real concern. Councillor Polley also stated her concern with this transition as she had been unaware that the new buildings would be for existing GP surgeries. Councillor Polley also questioned the design of the building and whether they were designed for unwell persons and had the emergency services been made aware that they might have to visit these sites. Councillor Polley then asked for some clarification on the meaning of Net Zero Carbon as mentioned in the report. Ian Wake stated he thought Net Zero Carbon was a new requirement of NHS buildings under NHS substantiality rules but since the report had been written the situation had moved on. That no definite answer could be provided as the guidance had not been published and was not expected to be received until December. Ian Wake stated there had been some discussions as to whether the Integrated Medical Centres would need to meet this guidance and following meetings with senior members of NHS England, Thurrock may be offered some dispensation.

Councillor Piccolo referred to the atrocious plans for Grays Integrated Medical Centre to reuse 19 old buildings which would no way near be approaching the net zero carbon efficiency. That Councillor Piccolo could not accept the proposal that 30 to 40 year buildings, spread over one site would be used for the main centre. That the cost of updating the existing buildings would be absolutely atrocious and should not be used for the flag-ship of those medical centres and stated this needed to be undertaken properly with a new building. Councillor Ralph stated that when Members attended the site visit they were shown plans for new buildings. Councillor Holloway stated she believed it was to be a mixture of both new and reused buildings.

Councillor Holloway stated her concerns on the continuing changes to plans which in turn would be difficult and upsetting for residents. Councillor Holloway stated that for new Members this report would have been informative but she had seen this report so many times and did not want to see this report again but wanted to see a more detailed report such as what was happening and what was going into each Integrated Medical Centre.

Members agreed that Ian Wake would provide a regular update in the form of a briefing note with key timescales and milestones following the monthly Programme Board Meeting.

Councillor Holloway suggested that a letter from the Chair of the Health and Wellbeing Overview and Scrutiny Committee and Councillor Mayes, as Portfolio Holder for Health be sent to NHS England asking them to formalise the timescales and when decisions would be put into place. Councillor Ralph agreed and that he would liaise with Councillor Mayes. Councillor Polley suggested in the letter it was reinforced the Council’s position on the Memorandum of Understanding that the facilities at Orsett Hospital do not close or be removed until all of the Integrated Medical Centres were up, running and staffed.

Neil Woodbridge provided a prospective from the disabled people’s point of view on the proposed Integrated Medical Centres. That the longer term medical provision of those using the buildings needed to be looked at; was having more GPs the answer or could there be another answer such as a different model of working; patients having power to control their own medication; design of the buildings should include changing spaces built into them and that good acoustic and signage would be ideal.

RESOLVED

That the Health and Wellbeing Overview and Scrutiny Committee considered and noted this report.