12. In May 2023 one of the partners at the Practice retired. The Practice bought out their partnership, but had to remortgage to do so. The retiring GP also owned the building the branch was in. In March 2024 they told the Practice they intended to sell this. The Practice considered whether it could buy the building or if it could provide a branch elsewhere in the village. It decided it could not do either of these, for reasons of cost and ensuring any sites met the relevant clinical and safety requirements.
13. The Practice then told the ICB it was planning to close the branch. The ICB began a public consultation in July 2024 as the National Health Service Act says it must do (the start of this was delayed slightly by the General Election). Please note the sale of the building and the closure of the branch are different matters. We are considering whether the ICB followed the correct procedure regarding its consultation exercise on the Practice’s proposals about closing its branch.
14. The National Health Service Act says NHS bodies must consult the public on matters about the provision of services and decisions affecting the operation of those services. This includes the closure of a branch surgery. We can see the ICB did this once it was aware the Practice wished to close the branch.
15. NHS England’s PGM says organisations should engage with patients where the closure of a branch surgery is proposed and consider their views before a final decision is made. They should considered possible alternatives and the implications of the proposed closure. This includes whether there is a need to keep a branch open, financial viability, condition of the current/proposed premises, and if there are other primary care providers in the locality.
16. The Gunning Principles say:
• a consultation must be at a time when proposals are still at a formative stage • sufficient reasons must be given for the particular proposals to allow those consulted to give intelligent consideration and response • adequate time must be given for intelligent consideration and response • the product of the consultation must be conscientiously taken into account when the ultimate decision is taken.
17. The first Gunning principle does not mean consultations cannot take place on preferred options or a decision in principle, as long as the decision as not yet been made. The Practice’s preference and proposal was to close the branch, with patients instead going to its main site for all elements of their GP care and treatment. It said patients who did not wish to do so could join other practices which had agreed they would take them. The consultation initially lasted for three months, but was extended further to include public meetings.
18. Mr P feels the consultation was not genuinely open, as it did not give alternative options such as other GPs taking over the branch site or local residents purchasing the building so the Practice could use it. He feels the wording of the consultation meant people did not bother replying because they thought the decision had already been made. We understand his concerns about the loss of a local resource which was very convenient for patients in the village.
19. When we look at the records, we have not seen evidence the Practice could afford to either buy the building it had been using or another property or space in the village. We also have not seen evidence it could have afforded to upgrade such spaces to meet the requirements for a branch surgery. We can see the ICB provided this information in its consultation as the Gunning Principles and PGM say it should.
20. Mr P has told us the ICB dissuaded other GP practices from offering to buy the building in the village. We can see from its review it felt it would be irresponsible to liaise with other GPs about providing services from the building as the ICB thought it was no longer fit for purpose. We cannot take a view on commercial contractual issues. We have seen evidence of the ICB discussing branch services in the village with one other GP practice. Other practices could have produced plans which resolved the concerns about the building. But we have not seen evidence of either another GP practice or other interested groups suggesting a viable, tangible proposal for running a branch surgery in the village which the ICB could put before the Practice’s patients. It therefore could not offer such any options in the consultation, as that would not have been fair, open or realistic. We think the ICB acted in line with the Gunning Principles and PGM here.
21. We can see Mr P thinks the ICB should have given more weight to the fact that most of those who responded to the consultation were against the branch closure. We can see the ICB assessed the responses it received carefully. It received 84 responses to the consultation. This was around 1% of the full Practice list and around 9% of those who used the branch surgery. Of these, 51 said they were unhappy with the branch closing (5% of the number who used the branch) and only 38% of the respondents said closure would have a negative impact. 26% of respondents said there would be little or no impact and 12% suggested a positive impact (which, added together, was also 38% of the total). We understand your concerns but cannot speculate as to why more people did not reply to the consultation.
22. We can see the ICB also did offer public consultations. We appreciate many of those attending were not happy with the branch closing. We also cannot speculate about why other patients who attended the branch did not attend or what their views would be.
23. The records indicate the ICB also only received two separate direct complaints after the branch closed and the Practice did not get any.
24. When we weigh up the evidence, we can see the ICB did assess the information it received. If people chose not to respond, the ICB could not be expected to assume what they might think or why. A relatively small percentage of both the overall Practice and branch lists replied to the consultation and the responses did not clearly indicate a majority of users were dissatisfied with the proposed branch closure. Based on this information we cannot say the ICB was wrong to agree the branch could close.
25. Mr P has also told us he thinks the ICB had already made the decision to close the building and the branch from the outset. He thinks it should have agreed to keep the branch open for longer and not allowed it close in December 2024. We understand why that was upsetting for him.
26. When we look at the records, we have not seen indications the ICB had made any decision before it reviewed the consultation data. We can see from the records the owner of the building wrote to the Practice in October 2024 to say they wanted them to leave the premises before the end of 2024. This was the first time they had said this. Neither the ICB nor the Practice were able to anticipate this and the records do not suggest either had been expecting or planning for that closure date. Closing the building was, therefore, not something the ICB could prevent. We do not think it got something wrong here.
27. We also think it did a thorough review of its consultation. We can see it considered whether it had done what the guidance said it should as we would expect. It noted, for example, that the ICB should have ensured it engaged with key stakeholders (such as local MPs) much earlier in the process. We can also see it made recommendations so any future ICB consultation will be as robust as possible. These include creating a Standard Operating Policy for public consultations, identifying a senior member of staff who is responsible for the processes and providing a guide on stakeholder engagement. We cannot say it did not identify issues that it needed to put right.
28. We think this demonstrates the ICB reviewed its consultation seriously and carefully. It is what we would expect it to do. We would not ask it to do anything more to put this right. We do not think what it got wrong had a direct impact on the overall outcome of the consultation or the specific impacts Mr P said it had had on him.
29. We understand how important this issue has been to Mr P. We can see the closure of the branch has been very upsetting for him. We would like to thank him for bringing his concerns to us. We wish him well for the future.