Read GP's angry response to hospital report

Dr Duncan Keeley gave NHS chiefs the 14-point attack after they approved the findings of an independent report into the controversial changes.

The report supported Community Health Buckinghamshire’s earlier decision to let one practice send GPs to Amersham, Marlow, Buckingham and Thame community hospitals.

Practices near the hospitals previously sent GPs to check on patients – but the report said this proved inconsistent and was hard to evaluate.

Yet the study – asked for by health bosses in September after the changes took affect – said doctors should spend longer on wards and blasted a total lack of consultation.

See the links at the bottom of this story for the full report and our story on its findings.

Today’s angry response by Dr Keeley, of The Rycote Practice, Thame, among surgeries which lost the contract, says the report’s findings were “very disappointing”.

It said: “The board, we submit, should think very carefully before deciding to ignore such strong and clearly expressed public feeling.”

Dr Keeley motioned to submit the paper before chiefs made a decision today – but was only able to make his points once they agreed to the report’s findings.

Stewart George, chair of NHS Buckinghamshire, said: “If they are matters that should have been submitted to the review when it was reviewing.”

NHSB chief executive Ed Macalister-Smith said: “I am happy to accept the recommendations that are in here.”

Dr Keeley’s written response, which mostly concerned Thame Community Hospital and had input from concerned patients, said the report: • Got it wrong to say there were eight beds before changes instead of 12.

• Ignored the affect of subsequent bed cuts on how well the new service performed.

• Backed ditching practices such as daily ward rounds, “multidisciplinary” staff meetings and “support for enhanced nursing practice”.

• Does not accept that the new contract demanded too few hours from doctors – even though it now recommends they spend more time on wards.

• “Systematically underplays” involvement of local GPs at Thame and does not recognise their ability to respond quickly in an emergency.

• Did not acknowledge support for the old system from the GP training “deanery”.

• Notes public support for the former system – then “pays no further attention” to it.

• Says the changes were not “substantial” and requiring public scrutiny despite GPs and staff strongly disagreeing it was.

• Criticises the new arrangements but recommends they stay.

• Treats CHB’s admitted failure to consult as of “minor importance”.

• Ignores the “lack of professional medical advice” before making changes.

• Is inconsistent by saying the hospitals treated simple problems – but should take on care from major hospitals, which treat complex cases.

• Misses out “failings” in the contract process. These were a sudden cut in its value and the demand that hours – today agreed to be “insufficient” – should be low.

The board pledged to look into the comments. You can read what Dr Keeley gave them with the link at the bottom of the story.

Earlier, David Lunn, chairman of the panel which compiled the report, acknowledged concern about his impartiality as he is also a non-executive director of NHSB.

But he said: “I had nothing to do with the letting of the contract.”

External health experts and a patients representative from League of Friends groups were also on the panel, which was unanimous in its agreement.

While the new contract was cheaper and NHSB is in financial turmoil, he told members: “This was not done as a savings exercise.”

In fact, the deal was slightly higher than similar arrangements in England, he said.

When the contract was agreed, winners The Practice plc said the lower hours were “do-able” – but it soon became clear more GP hours were needed on wards, he said..

But he insisted the new deal was better. No records of hours worked, of incidents and formal checks on safety, known as “clinical governance”, were kept under the old contract, he said.

And he knocked back concerns that as GPs are no longer “next door” they will be slow to respond to emergencies.

Mr Lunn said: “It is best for the nurse to call 999 straight away.”