Circuit Lane surgery in Southcote lies outside the South Reading CCG area but developments there could be an indicator of future changes here. When the GP partners were unable to recruit a replacement for a partner who had announced their resignation, they found themselves unable to guarantee the safe continuation of the service and all resigned together. NHS England (Thames Valley) was left with the problem of how to push forward the GP service for around 11,000 patients from Southcote and areas further afield. NHS England and the Berkshire West CCG Federation resolved to replace the GP service in two steps. Firstly, a 12-month interim service, from February 2015 to hold the fort at Circuit Lane. A more permanent replacement would be appointed to start from February 2016. The reasons for this are not altogether clear, but at public meetings it was explained that from April 2015, NHS England and the Berkshire West CCGs will be co-commissioning GP services rather than NHS England having sole responsibility. It was suggested that this will allow an innovative replacement service in 2016. Although the details have not been made clear it has been suggested that a centre integrating GP services with full community care could be under consideration. Alternatively, mention has been made of the use of "Physician's Assistants" alongside traditionally trained GPs and nurses at the new centre. It has now been announced that the interim 12-month service contract will go to Berkshire NHS Healthcare Trust which already operates the Berkshire West out-of-hours GP service through its Westcall organisation. This allays immediate fears for patients of having to deal with a very different "business-oriented/profit-seeking" organisation - as was strongly expressed at the public meetings about the change of service. The contract award to Berkshire Healthcare Foundation Trust is an interesting development which should provide interim assurance to the patients at Circuit Lane. They will now want to know more about the long-term solution for 2016 and onwards. Ths underlying problem at Circuit Lane - the difficulty of finding replacement GP partners at a practice - is likely to be widespread, particularly in areas of relatively less prosperity where workloads can be somewhat higher and income opportunities somewhat less. There is a firstly a shortage of new GPs. Half the training places in the Thames Valley are empty although there are 5 applicants for every GP training place in the North West. Then, since a large majoriity of newly qualifying GPs are female and in their late twenties or thereabouts, part-time salaried work can be a more attractive option than the demands of partnership. Further, the attractive but relatively familiar conditions in countries like Australia and Canada induce a certain number to seek work abroad. Some think that this is all leading to the demise of the GP partner model. It is certain that there will be a big role for salaried GPs in the near future. South Reading has quite a few small practices and quite a few GPs approaching retirement and a measurable shortage of GPs. It has been said that North and West Reading CCG has 69.8 whole time equivalent GPs per 100,000 population, while South Reading had 53.9 per 100,000. How will all of these developments come to affect us in the South Reading CCG area?

South Reading CCG has received winter pressures funding which can be used for GP services. It will be used to open a 7-evening a week childrens' urgent care centre at a location still to be determined over the winter months. The sum of 129,000 awarded to the South Reading NHS CCG will provide 20 20-miinute appointments between 5:30pm and 8pm every evening until April 2015. It is hoped that as well as aiding the children of South Reading this arrangement will lessen the pressure on the A&E department at the Royal Berks Hospital.

The CQC has today published risk indices for most GP practices, using readily available data to give an indicator of the priority that should be afforded to their inspection. The great majority of South Reading practices fall into the low risk category - Band 6 - along with about half the practices in England. So we can expect few early inspections by CQC at most South Reading practices. The banding is based on a scoring according to a number of criteria available from practice surveys and practice returns. Full details are available on the CQC web site. They scoring is merely an indicator and should not be considered in any way definitive. In South Reading Chatham Street Surgery and University Medical Centre were placed in band 1 - the highest risk band, Pembroke surgery, Whitley Villa surgery and Melrose (Dr Williams) in band 5 and others in band 6, except for the Walk-in Centre (not classified) and London Road surgery (not classified it had been recently inspected), If South Reading had followed the national figures we might have expected 2 practices in band 1, 1 in band 2, 1 in band 3, 2 in band 4, 3 in band 5, and 11 in band 6. As it was we had no presence in bands 2,3 and 4 and band 6 made up the difference. The CQC admits that the scores make no explicit allowance for different populations although some of the component measures do have a built-in allowance. Given the classification for South Reading practices some might think the indicators more indicative of demographic factors than of inherent risk. The upshot is - expect just a few CQC inspections of GP practices in South Reading (and other parts of Reading!) in the near future.

We will be meeting between 6.15pm and 7:45pm on Wednesday, 29th October 2014 in the Reading Community Learning Centre 10, Eaton Place, RG1 7LP (see Agenda for directions) . There will be an election for group officers, reports of current developments in local healthcare and a talk and discussion led by Dr Rosemary Croft on "What will Parity for Mental Healthcare Require?"

We will be meeting between 6.15pm and 7:45pm on Wednesday, 26th November 2014 in the Reading Community Learning Centre 10, Eaton Place, RG1 7LP (see Agenda for directions) . There will be an election for group officers, reports of current developments in local healthcare and a talk and discussion led by Dr Rosemary Croft on "What will Parity for Mental Healthcare Require?"

The well-respected Patients' Association is recommending that patients do not make the effort to appeal to the Health Service Ombudsman. In an alarming report , citing many shocking cases the association finds that the Ombudsman failed to establish the facts of the cases cited, didn't take the views and information provided by the complainant relatives into proper account and failed to take proper clinical and medical advice. The Patients' Association found:

• 1. The jurisdiction of the PHSO is unclear, leaving ill-defined boundaries between the organisation and other public funded bodies such as the CQC.
• 2. The PHSO hides its failings behind legislation.
• 3. Individual cases take far too long to be assigned to an investigator and subsequently, the investigations are far too lengthy.
• 4. The current process relies heavily on families providing the burden of evidence. If evidence is not presented by the families, the PHSO does not look further to find it.
• 5. There are too many gaps involving clinical decisions that the PHSO refuse to investigate, therefore families fall into a bureaucratic no mans land, for example, cases under the Mental Health Act or where there is a case of Do Not Attempt Resuscitation (DNAR).
• 6. The right people, with the right skills, are not always assigned to cases and as a consequence, this can negatively impact on the outcome of an investigation.
• 7. Investigations are not diligent , robust or thorough.
• 8. The PHSO investigators fail to appropriately consult medical and clinical advisors who might be available to them.
• 9. Complainants are refused the chance to meet with the person investigating their case, in order to explain their concerns, agree the remit and terms of reference of the investigation, timelines and communication pathways.
• 10. The PHSO fails to acknowledge that many relatives have intimate knowledge of the care received by their loved ones and detailed facts relating to their particular case.
• 11. The PHSO also declines requests from families for additional crucial information and evidence to be submitted, once a written complaint has been made and an investigation has begun they frequently ignore evidence from families and carers.
• 12. Linked to this, there is little evidence that PHSO investigation conclusions are entirely evidence based. Crucial mistakes in investigations result in flawed decisions and recommendations.
• 13. As a consequence, the PHSO continually make errors of judgement and mistakes, which ultimately leads to re-investigations, which then result in a dditional cost to the public purse and considerable further distress to the families.
• 14. The PHSO compound their errors by frequently re-assigning the same investigators to re-investigations. As a consequence, mistakes made the first time round remain unchallenged and are even, on some occasions, repeated. The investigators are in effect re-investigating themselves.
• 15. If and when the PHSO appeal process agrees to a re-investigation and despite their possession of the papers from the initial investigation, the families are expected to submit all the relevant papers all over again and are only afforded two weeks in which to do so.
• 16. The PHSO requires families to keep the outcomes of draft reports confidential under dubious application of the law, effectively gagging the families concerned.
• 17. Families are not consulted prior to finalisation of reports and as a consequence, have no influence or say regarding the final recommendations.
• 18. Even when recommendations are made, there is little evidence that they are followed up, reviewed or the Trusts held to account for failing to implement any recommendations.
• 19. Throughout the whole PHSO process, families are left distressed, exhausted and distraught by the failings of the body to carry out their public function in an efficient, effective and caring manner.
• 20. In real terms, the total cost to society and families of the PHSO far exceeds the 40 million funding the body receives.
• 21. The PHSO appears to be both unaccountable and untouchable.
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The Public Accounts Committee of the House of Commons is currently looking into the work of the Health Service Ombudsman. Concerned members of the public may write to their MPs to stress the importance of taking the Patients' Association evidence most seriously.

Safeguarding children is everybodys responsibility. Any adult who is concerned that the situation is urgent where a child is at risk of suffering significant harm should consult or refer to the Children's Multi-Agency Safeguarding Hub, Tel: 0118 937 3641, 9am to 5pm, Monday to Friday (excluding bank holidays). Outside these hours, contact the Emergency Duty Team, Tel: 01344 786543. Emails about safeguarding of children may be sent to safeguarding@brighterfuturesforchildren.org . If a child is at immediate risk dial 999 and ask for Police assistance. Abuse of vulnerable adults can occur in many ways, through a poorly run residential home, through an abusive relationship at home or elsewhere. Reading Borough Adult Safeguarding Team exercises statutory responsibility for safeguarding vulnerable adults and liases with many other bodies who assist in this protection. Concerns about an adult you know or about an institution can be passed on to the Adult Safeguarding Team at their website or by phoning 0118 937 3747.

Abuse of vulnerable adults can occur in many ways, through a poorly run residential home, through an abusive relationship at home or elsewhere. Reading Borough Adult Safeguarding Team exercises statutory responsibility for safeguarding vulnerable adults and liases with many other bodies who assist in this protection. Concerns about an adult youknow or about an institution can be passed on to the Adult Safeguarding Team at their website or by phoning 0118 937 3747.

Public Health England publishes data from its National Public Health Outcomes Framework on its website. There is also Public Health England's health profile data website.