Dear Mr Kershaw,

We are writing as a Lewisham General Practice partnership to express our unhappiness and concern over the TSA draft report and its proposals for the future healthcare of the population in South East London. We feel strongly that the reports financial projections are inaccurate, that the proposals will place the patients of both Lewisham and adjacent boroughs who utilise University Hospital Lewisham (UHL) at clinical risk and that it places a threat to the sustainability of quality local healthcare in the future.

We believe there are several flaws to the reports financial calculations, including

 

1. The report assumes the flow of patients presently seen acutely at UHL will be seen at Queen Elizabeth Hospital (QEH) Woolwich. This is not the case and the majority of patients will gravitate towards either Kings College Hospital or St Thomas Hospital. Two centres already working at capacity, which are more expensive and more likely to investigate inappropriately than UHL. This would require considerable investment into infrastructure and staffing to cope with the increased workload.
2. The report suggests that 77% of those presenting at the A+E department presently could still be seen in the Urgent Care Centre plus (UCC+) model proposed. We are certain that this is not the case. As a provider in the present UCC we are aware of the large numbers of seriously sick adults and children that present on foot and by public/private transport to the UCC, who then require admission and even resuscitation. Without acute medical and surgical facilities at UHL these patients would have to be redirected elsewhere. We suspect that only 30% of the present caseload could continue to be seen in the UCC at Lewisham safely. This is contrary to your calculations. In addition to this it will become difficult to maintain quality medical and nursing staff, and GP Providers in an unsupported unit.
3. The unrealistic assumption that a significant proportion (30%) of secondary care workload can be shifted to primary care through a ‘community based care strategy’ is naïve. This appears to be based upon another assumption that GPs can increase their productivity by 25% by reducing consultation times to 7.5 minutes without any loss in quality of care. This is untrue. The only way we could increase our capacity by this degree would be by substantial investment in Primary Care and Community services for which the proposal shows no costing.

 

 

We believe there are significant risks to patients and that the proposals as they stand will result in unnecessary deaths and suffering.

 

1. The UCC+ model appears to us as unsafe and untested anywhere else in the UK. Patients will without doubt continue to arrive at the newly refurbished £12 million unit when sick, the vast majority of these will have to be redirected to other units with a delay in their diagnosis and emergency care. This will put them at risk.
2. The proposed transportation times within the report are incorrect and those who will be most affected by these additional journey times before reaching a point of care, will be those who are most deprived and most sick travelling by public transport or on foot. This will put them at risk.
3. There is a clear threat in the proposal to the continuation of our safe and popular maternity and birthing services at UHL. Many births are not diagnosed as high risk until the labour has commenced. It will be unsafe for maternity or midwifery services to continue without the back up of an Emergency Department (ED), Intensive care unit (ITU), acute medical, surgical and paediatric services on site. This will undoubtedly put women and newborn children’s lives at risk.
4. The proposal takes no account of the additional costs both financial and health costs from the loss of good quality integrated care that both UHL and Lewisham CCG has developed collaboratively over the past few years. We know that one of the main strengths of working closely with a local hospital accepting acute admissions is that the high quality of communication, secondary to strong historic relationships between Primary care and the Trust ensures smooth pathways with well integrated efficient care. The proposals jeopardise these relationships and pathways. If the proposal V goes ahead we will have our patients dispersed randomly across at least six different trusts with whom communication is already less efficient and likely to worsen. Care will be significantly fragmented for patients. There will be inefficiencies in communication and more distant professional relationships. This risks longer lengths of stay, higher readmission rates, duplication of investigation, loss to follow up, increased risk of litigation and clinical danger to patients

 

 

We believe that the proposals jeopardise the future of high quality training and research both within UHL and Lewisham Primary Care. If there are no longer acute services on the UHL site the Deanery and Colleges will be unable to support the continued training of both hospital doctors and our future local GPs. We will loose our local high quality vocational training scheme this will result in problems with recruitment of GPs in Lewisham in the near future. It will also affect both recruitment and retention within the acute trust with the loss of high quality clinicians. This will result in an increased dependence on locum staff both at UHL and within the local community, resulting in higher cost of delivery in healthcare and probable fall in quality. Again this places the local population at risk.

 

Finally we do appreciate the grave situation with the considerable PFI debt of the South London Trust. However it feels as if UHL a hospital offering high quality service to its patients, that has made considerable advances over the past five years in the quality of care it provides and collaborative working with the CCG, with minimal comparative debt is to be sacrificed for a completely separate trusts deficiency. Is this fair to the people of Lewisham? What message does this send out to the rest of the trusts in the UK? It seems perverse. We believe that UHL can work collaboratively with both QEH and local Primary Care under the guidance of Tim Higginson, but that this does not need the full withdrawal of acute services at UHL as proposed. We believe the risks to our local population have been hugely underestimated and the cost savings overestimated, we cannot support this proposal.

 

Yours sincerely,

On behalf of the Partners and Staff of Wells Park Practice