Dr Peter Smith describes his battle to open a new surgery and how his practice mobilised local support - and even the health secretary - to overrule PCT bosses.
The day dawned bright and clear over Kingston on 16th July, 2010 as the gentle carousel of local village life in Tudor Ward stirred slowly into action. A casual observer would have noticed little out of the ordinary, but closer inspection would reveal that the boarded up memory of a flower shop in the local shopping parade had been transformed to a bright welcoming surgery frontage bedecked with NHS insignia.
Later that day a small crowd gathered to celebrate its opening. Local people, community leaders, the mayor of Kingston and the local MP Zac Goldsmith gathered to celebrate victory for the local community against powers that saw themselves as the sole arbiters of the needs of the local population.
The joy and expectation were palpable as community organisers attempted to keep the mood triumphant, rather than triumphalist, a tall order given that the battle to open the surgery had taken two years almost to the day and had involved every tier of the NHS and local government, up to the secretary of state.
Churchill Medical Centre is a popular practice with a constantly increasing list size. Unable to extend our severely pressured hub site, we took the decision in 2007 to consider opening a care-only spoke surgery. In this model, no space is required for administration, all communications are paperless and some services such as minor surgery are delivered only from the hub site. This allows delivery of high quality care from a very small footprint.
A site was identified a mile from the hub which would allow 1,500 predominantly elderly patients to be seen within a small stroll from their homes. The practice approached the chief executive of the PCT in December 2007 to discuss its plan to open the surgery at its own expense. With characteristic encouragement we were informed ‘we can't stop you'.
A couple of months later the PCT chose to put another local practice out to tender. Despite this, it raised no objections to our detailed plans to convert a shop to a surgery. In the summer of 2008 - with two weeks to go before it was due to open - the PCT threatened contract removal if we did so, on the grounds that it wished to prevent competition with the private provider it had introduced through the tendering process.
Initially, we attempted local contract dispute resolution, but the PCT as both judge and juror unsurprisingly found in its own favour. We then referred the issue to the NHS Co-operation and Competition Panel on the basis that we believed the PCTs conduct had broken the Principles and Rules of Competition in the NHS.
No-one in primary care had attempted this before, so we had a steep learning curve with no assistance from any outside organisation, the LMC having seemingly aligned itself with the position of the PCT.
Everyone underestimated the power of the community. Led by our patient champion, Grace, it threw its weight behind CMC, beginning with an 800 signature petition, making representations to the Oversight and Scrutiny Committee and then arranging a ‘March for Choice' demanding the right to see the GP of their choice. Grace (now joined by another local hero, Ray), local councillors, our local MP, Susan Kramer and our patients took part and then persistently bombarded the Parliament, the PCT, the health secretary and the DH with demands that the surgery be allowed to open.
Throughout the long, thorough and fair CCP investigation, a number of attempts were made by the PCT to thwart the process, first saying that we were seeking to alter the outcome of the tender (though we had approached them before the tender was announced), then that the CCP had no jurisdiction over it and, finally that PCTs were was not subject to the rules of competition that apply to the rest of the NHS.
Finally, in December 2009 the Panel found that the PCT's conduct in preventing competition was indeed inconsistent with the rules on competition and recommended that we be allowed to open our branch surgery.
Several further months elapsed as the SHA considered the implications of the findings before making its own decision. When it finally recommended that PCT reconsider its decision, the PCT attempted to limit the use of the surgery. Only when the Secretary of State's office gave its opinion on the matter did the PCT relent. Hence it was that the surgery opened, four days short of two years since the surgery was originally due to open.
No apology has been received for the poor decision making and no-one has accepted any blame. The lack of any PCT presence at the opening of the surgery demonstrates its continuing corporate inability to accept responsibility for its actions and move on. But the local community has taken this in its stride - they are the heroes and winners in this episode.
Long after the PCT has gone, they will continue to enjoy what they wanted and deserve - delivery of their care in a convenient location by their own trusted local GPs.
Dr Peter Smith is a GP at Churchill Medical Centre, Kingston upon Thames, and is vice-president of the NAPC
Dr Peter Smith and his patients fight their PCT
