Oxfordshire NHS Commissioners enforce geographical restrictions to care

The Banbury Guardian has reported that patients from Brackley, Croughton, Tysoe and Kineton will no longer be directed to Banbury’s Out of Hours (OOH) emergency GP service under rearranged county rules.

Care not so close to home

The newspaper said that on a Sunday, despite the rule, compassionate GPs at the Banbury OOH clinic saw frightened Brackley mum Emma Twemlow, whose child Grace was screaming in pain.

The Brackley OOH has been closed by Nene Clinical Commissioning Group (NCCG) and patients must now go to Daventry (24 miles) or Northampton (21 miles) for appointments instead of Banbury (11 miles).

This hard hearted and dangerous rule excluding non-Oxfordshire residents from Oxfordshire NHS services seems like a cheeseparing interpretation of Clinical Commissioning Groups’ duty under the 2012 Health and Social Care Act to each arrange provision (that is make contracts) “for persons for whom it has responsibility”.

Because Brackley, Croughton, Tysoe and Kineton patients are not registered with Oxfordshire GPs, Oxfordshire Clinical Commissioning Group has washed its hands of responsibility for them.

This is likely to be a sign of things to come, if we allow the continued redisorganisation of our NHS into Accountable Care Organisations and Systems. (Now rebranded by NHS England as Integrated Care Organisations and Systems, in an effort to defuse public opposition to them. As if.)

Because far from accountability and integration, such moves represent irresponsible fragmentation of NHS services. As Prof Allyson Pollock points out, Accountable Care Organisations would worsen such issues of “cross border” access to care:

“It is unknown how ACOs can integrate health and social care services when their funding will be for a different population (GP lists versus local authority), and when ACOs will not have health service funding allocated for unregistered CCG residents who may be eligible under the ACO contract for local authority social services…

There is much uncertainty about what ACOs will provide and to which populations. The definition of “services” is complex and unclear and seems to involve finding a negotiated compromise between the services required by the commissioners and those proposed by the ACO. This could lead to confusion if, for example, an individual lived in the contract area and required health and social services but was not on the ACO’s list because their general practice was a member of a CCG which contracts with another ACO.”

Oxfordshire Sustainability and Transformation Partnership is barreling ahead to set up an Accountable Care System for the County, despite intense disagreement from local Councils over the Sustainability and Transformation Plan consultation on the proposed downgrade Horton Hospital’s maternity services, which ended up in court with a Judicial Review.

Meanwhile, it is understood Brackley patients can ‘walk up’ to the Banbury Out Of Hours to 11pm but will not routinely be given appointments there by the 111 service. And Nene CCG says 111 directions will be given according to a patient’s needs at the time.

Mrs Twemlow told the Banbury Reporter:

“I was told by 111 I could only access Daventry for appointments and was welcome to use the walk-in clinic at Banbury.
“But I was told at Banbury they no longer take ‘out-of-county’ as of October 1. I told him I was about to cry and needed someone to look at my young child. He was very nice and made sure we were seen.
“It’s all very frustrating. I feel dreadful for the vulnerable with these changes.”

Oxfordshire Health Trust, which ran the Brackley OOH, said:

“Following the Nene CCG decision to discontinue funding for the OOH service for Brackley, we no longer provide this service”

Oxford Health continue to provide GP out of hours services from the Horton site for patients registered with an Oxfordshire GP.”

It is understood Brackley Medical Centre, which ran the town’s Out Of Hours, was unhappy about loss of the service but was overruled.

Ignoring the 21 mile journey from Banbury that this would involve, Nene Clinical Commissioning Group told the Banbury Guardian:

“Northants OOH is available Monday to Friday, 6.30pm to 8am and 24 hours a day on weekends and bank holidays.

“It can be reached by first calling the free NHS 111 urgent care telephone service.”

Campaigners both locally and nationally are determined to call a halt to this redisorganisation of the NHS.

Steve Carne of 999 Call for the NHS said,

“This is no way to run a railroad – or rather, to update the NHS into a modern, responsive, universal public service that honours the founding principles of the NHS that have served us all well for generations. NHS campaigners have everything to win and we will all fight on together.

What we need is legislation such as the NHS Reinstatement Bill that will take the market our of the NHS and the NHS out of the market and restore it into public hands which allow a rational, democratic processes of planning, resource allocation and provision of services free of profiteering. It would have the added advantage of removing the £bns/year waste that NHS marketisation and privatisation creates, through the huge costs of contracts, procurement, legal and transaction expenses.”

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