The community in East Brighton is reeling from the news that our much-admired GP practice at the Wellsbourne Health Centre has lost the contract to provide future GP services in the area. The Integrated Care Board for Sussex has provisionally awarded the new contract to a healthcare company based in Leeds with no connection to Sussex. Now, an alliance of patients, staff and colleagues from across the health and community sectors, are trying to assemble an effective appeal to lobby the ICB for the commonsense solution, before the deadline on 8 May.
The non-profit Wellsbourne Centre was established as a Community Interest Company (CIC) in direct response to the failure of the last private healthcare provider in Whitehawk, in 2016. For over 10 years prior to that, the people of Whitehawk had no permanent GPs and services were in disarray.
Since 2018, Wellsbourne CIC has built a stable, trusted, and high-performing practice from the ground up. Rooted in the principles of continuity, community, and care for those facing the greatest health inequalities, our work has set such a pioneering example of good practice in addressing health inequalities that we were featured in the Marmot Review in 2020.
An innovative practice trusted by patients and run by local doctors and staff
The practice takes an innovative approach.
As a GP in this team, I know this community needs hands-on, relationship-based care, delivered by people who know the area and are trusted by those who live here. And they need continuity: we know that being looked after by a GP who knows you leads to better outcomes and higher satisfaction rates, and is more likely to keep you out of hospital than any other factor.
Over 10% of our patients have safeguarding concerns. Over 60% of our patients have more than one long-term condition, like diabetes or heart disease. Many live with serious mental illness, trauma, addiction, complex social needs, poor housing and financial problems.
Life expectancy in this area is 10% lower than the other side of the city. This is not a setting where care can be safely or effectively outsourced to a generic model.
Unfortunately, this appears to be exactly what is going to happen.
As is proper, there has been a tender for the new contract. The decision to award this to a private company with no connection to Sussex would, however, seem to disregard both local needs and public health evidence and therefore puts staff retention, service continuity and, of course, patient safety at risk.
This decision will have an enormous impact on residents of East Brighton, many of whom live in some of the most deprived wards in the country. And it will be a costly transition, using up time, staff and resources, almost certainly to a greater degree than anticipated.
From my position on the frontline, I have observed other transitions in Brighton and Hove, like the services for Domestic Violence and Drug and Alcohol support, where bringing in new providers did not go well.
An unnecessary and expensive transition
Changes on this scale require new systems and new staff to build new relationships from scratch, and the patients are the ones who suffer. There is also much evidence that when public sector services rely on procurement models overly weighted towards business metrics, time and resources are wasted while the standardised packages developed don’t meet people’s individual needs and disregard patient choice.
Instead, we should be advocating for approaches which can respond to the complexity of the real world, such as a human learning system approach which encourages recognition of messy reality as well as collective learning and improvement.
Our CIC model has been admired by academics and other practitioners for a number of reasons. Like the traditional GP surgery, we receive funding from the NHS and we have the same constraints and problems as everyone else, principally providing enough appointments in a safe time frame.
But being a CIC means we can apply for other funds (e.g. from the Lottery or other charities) to run community programmes of a more adventurous and holistic nature, bringing enormous additional social value.
We have volunteers running a community garden – a programme to which we can refer patients, who thrive in the setting of being outdoors and with others. This helps reduce isolation and mental health challenges, while improving the local environment.
We also have an in-house artist who works with local arts organisations and projects, with art shows in the waiting room and art as therapy opportunities for our patients, see here. He even negotiates free tickets to local events for patients who would not be able to afford them.
The practice has added Focus Care Practitioners (FCP) to our team and they meet patients who struggle to attend the surgery and help them unpick where their problems start – be it their housing, care-needs, finances, family stressors, mental or physical health – and then get them the support they need.
Sometimes this might involve going with them to appointments and helping them with technology to make applications or fill in paperwork. As a GP this is unbelievably important and beneficial to us: we cannot offer this kind of assistance in our short slots but knowing someone has FCP support means we can concentrate on the health stuff.
These services are highly likely to be lost with a new provider.
We have also worked hard to forge strong connections with other local providers and voluntary sector organisations such as Encounter Wellness which provides complimentary therapy for the community, the Crew Club (the local youth club), the Whitehawk Foodbank, the Manor Gym, and The Trust for Developing Communities. All this lived-experience knowledge will likely be lost with a new provider.
In the seven years the CIC has been operating, we have built a team of like-minded and highly experienced colleagues. I have been a GP for nearly 30 years and this is one of the most effective surgeries I have worked in. I do not work there for the money. I work there because it is something I really believe in and because we are such a good team. I and my colleagues do not want to be working for a private for-profit provider as it doesn’t fit with our view of the NHS.
Still time to rethink
If you care about local, non-profit NHS care, now is the time to act. If this decision goes unchallenged, it won’t just change the name above the door, it will dismantle a model that is working. It will scatter a team that has fought to earn trust. And the people who will pay the price are those who already face the steepest climb to care.
Don’t let that happen quietly.
The deadline for our appeal is Thursday 8 May and we desperately need supporters to make their voices heard by whatever way they can. Contact NHS Sussex here or on 0300 1409854 or on email: sxicb.contactus@nhs.net.
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