Stethoscope hopes that replacement of the hugely unpopular Patricia Hewitt by Alan Johnson as Health Minister in the new Cabinet reshuffle will signify a turning point in the Government’s recent campaign of ‘Doctor Bashing’ in their attempts to deflect blame for the recent failings of the NHS.

Despite this campaign, local Gps have shown their persistent ability to rise to the challenges that politicians and managers have put in front of them and the recent high Quality framework achievements and the excellent results achieved by local practices in The National Patient Survey are a testimony to this effort.

For those of you who don’t know what I am talking about, the Quality Framework was an incentivised system brought in 3 years ago by the Labour Government to link a long awaited pay rise for Gps to a rise in standards of clinical practice in primary care. Gps rose quickly to this challenge, delivered the standards required and demanded the payments that they had been promised.

In other words they had succeeded in delivering what was asked of them. However the Government had under-estimated the quality of clinical care which could be achieved and therefore had under-budgeted for the payments which were to be required. Thus began the PR campaign that GPs were over- paid and under-worked and this campaign paved the way for the Government to refuse to negotiate a further deal for this year, resulting in a significant drop in forecast practice income. In reality, this means that GPs and their staff have been penalised across the country for working hard and doing well.

The Government was not convinced that GPs were doing all that well, so this year conducted a national patient survey asking about access, choice and opening times. Some of you may have filled in these questionnaires.

Bearing in mind that opening times have been dictated by Government policy and access and choice has been made more difficult by the huge administrative burden imposed by the data collection of the new contract and the scarcity of new GPs qualifying, due to cuts in the training scheme budgets, GPs generally felt that they were being set up to fail in this survey, so giving ammunition to the critics. Well there was no need for us, or you – the patients, to worry.
Local GP surgeries have had excellent survey results with most practices receiving at least 80% levels in all areas.

Which leaves me wondering about other parts of the local NHS.
Take for example, the local Community Hospital and Locality Team Services and the challenges facing them.

Take for example the chaos resulting from the new computer based Junior doctor appointment process which threatens the careers of many enthusiastic young doctors and the stability of many hospital teams.

If the salary of NHS managers was also performance linked and a National patient Questionnaire was circulated enquiring about local satisfaction with the situation, I wonder how they would fare.

Stethoscope has learnt about the recent changes of personnel at the PCT Offices and apparently the Director post for Partnership and Planning in the new re-organisation remains unfilled after a first round of interviews.

Apparently the present incumbent, Nicholas Gillard, will continue to take this role on a temporary basis until a permanent appointment is made.

Stethoscope is very concerned that Mr Gillard has either not been offered this post, or has decided not to complete the work which he has been leading in North and West Wiltshire and Kennet around the reorganisation of our Community Hospitals.

He is one of the few remaining PCT Directors from the previous regime and was responsible for orchestrating the planning and consultation around Pathways for Change, which has resulted in the most significant service change and local hospital service closure proposals that we have ever seen.

He personally presented these recommendations and the results of the Consultation exercise to the Professional Executive Committee and Board of the new organisation in January and urged them to approve these proposals despite strong local resistance from local clinicians, politicians and public, many of whom who had been involved in many of the planning processes and felt that they had been mislead. This protest was swept aside and the decision swiftly taken.

His plans are beginning to be implemented.
The change of leadership at this crucial stage seems very significant. What is less clear is whether the PCT is seeking to break from its past and is looking for new ideas and a breath of fresh air, or whether it is currently tacking into a strong headwind and making inadequate progress.

All individuals experience a number of life events. Too many life events result in excessive stress and too few may lead to stagnation. Patients at each of these extremes often seek help from their GP.

The last month has been very stressful for Chippenham Hospital and many of the people who work there. The last opportunity to challenge and reverse the dramatic reduction of medical in patient beds proposed and approved by the Primary Care trust seems to have been lost as The Health Overview and Scrutiny Committee of the County Council approved the PCT board decision. We continue to be informed that the proposals which were discussed during the consultation period were crystal clear and yet local doctors and nurses continue to maintain their surprise and resistance to this proposal which appears to dismantle and fragment our nationally recognised in-patient rehabilitation service. However we should not be surprised when we realise that the main health service priority of the PCT management is to save money and the main health service priority of the County council is to reduce ‘Bed Blockers’. Closing community hospital beds satisfies both of these requirements.

The march in support of the staff providing the local hospital NHS services in Chippenham was poorly supported, especially if you compare it to the outcry that accompanied the proposals to close Devizes Maternity unit several years ago. Incidentally that proposal had quite wide clinical support but at least that public action delayed the inevitable by a few years to the benefit of a significant number of Mums, Dads and babies in the Devizes area.
There are three possible reasons for this recent apathy:
The first, and most optimistic explanation of this, is that local clinicians have got it all wrong, and that this life event for the local hospital is a positive, rather than a negative event, to be accompanied by the tones of a wedding march, rather than a funeral dirge. There was no such positive sentiment at the march.
The second and most pessimistic explanation is that local residents are less interested in their local services than the global net. Unfortunately the residents who are most likely to benefit from in- patient rehabilitation, are the people who are least able to march.
The third and most likely explanation is that most local people are not aware of the significance of this proposal and have been lulled into a false sense of security by the possible offer of £17 million development money , which is by no means guaranteed.

What ever the reason, a golden opportunity appears to have been lost to develop a local ‘New Generation Community Hospital’ with a comprehensive high quality rehabilitation service which would have the capacity to genuinely relieve the pressures on our local District General hospitals . In the future, residents of North Wiltshire, who are lucky enough- or unlucky enough, depending on how you look at it- to get into a Community Hospital bed are more likely to find themselves in Warminster or Marlborough, than closer to home. Stethoscope has already received several letters saying how difficult this is for elderly relatives without transport.

One way or the other, it looks as though there are busy times ahead for local GPs, looking after the former patients and former employees of the local Community Hospitals.

So what exactly are the plans for Chippenham Community Hospital?

Local doctors were as surprised as some of your readers to find out about the new proposals for Chippenham Community Hospital last week.

Less than a month ago we were informed for the first time that the general Medical bed numbers were going to be slashed from 43 to only ten, due to budgetary restraints and now we find that the Primary Care Trust (PCT) has put in a bid to The Government for ?17 million for the redevelopment of the Hospital. You are not alone if you think that this all seems rather paradoxical.

Dont get me wrong- change is necessary and ?17 million sounds wonderful, but are you sure that the PCT management is doing the right thing?

Chippenham Hospital has a long tradition of providing excellent care in Community Hospital beds, which helps elderly patients with complex medical and social needs 'to take the next step' towards a successful return home.

The recent 'Pathways for Change' process has been all about 'taking the next step' towards financial balance and I hope that local patients dont end up falling over in the process. Local doctors and nurses are united in their efforts to secure more beds for the 'New Chippenham Hospital'.

And what about these new proposals? Many of the listed services are already being provided appropriately by local GP surgeries and this would appear to be a duplication. Many of the services are already being provided at the old site, although of course £17 million will certainly provide a welcome upgrade.

Some of the new services seem rather ambitious and it is not clear that these plans have been discussed and agreed with the relavent experts.

But of course the most important question is not when, but if. I am sure that Wiltshire is not the only organisation bidding for their share of the £750 million central fund and I suspect that it is oversubscibed many times over.

I'm sure that it will not escape the notice of the man or woman who decides these things, that Devizes has been chosen as a site for one of the new diagnostic and treatment centres, so why should we get more money, especially as we dont seem to have a very good record of managing it? What happens if our bid fails?

At the very least, somebody will have to take responsibility for pre-maturely raising our expectations.

Meanwhile we must all show our support for the services which we have, rather than the services which we may or may not get in the future.

In this respect I urge you all to join the staff of Chippenham Hospital, this Saturday, on their march in protest against the closure of 33 beds.