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Introduction
This paper outlines the proposal of ABM University Health Board and Vale
of Neath General Practitioners to replace existing GP surgeries in Glynneath and Resolven in the Vale of Neath with a purpose-built, modern
primary care centre, to improve the way care is delivered in the area.
The Health Board‟s five year plan, „Changing for the Better‟, sets out an ambitious programme to improve the quality of the healthcare services
we offer. Modernising hospital and primary care services, and extending the range of services we provide in the local community, are key
priorities.
Patient expectations are ever increasing. They want better and faster access to services, and they want more of them. Many want care to be
available at home or closer to where they live.
We, the GPs of the Vale of Neath Practice and ABM University Health
Board, welcome these expectations, and are committed to doing our best to meet them, as long as it is safe and practicable to do so.
We believe the best way to increase services and deliver
healthcare of the highest possible standard to our patients in the Vale of Neath, is from a brand new purpose built primary care
centre.
This new modern centre will be as close to the centre of the area covered by the practice as possible, bringing together a number of
healthcare services in one place.
By consolidating our services on one site we can offer patients
better access to doctors of their choice and more specialised clinics, including clinics and outpatient appointments previously
only available in hospitals.
It will improve communications and joint working between different services, provide a better environment and greatly
reduce the need for people to travel to hospital for a number of treatments.
Following an engagement exercise held in September, we are now
undertaking a six week consultation exercise from 7 November to 16 December 2011 to share this proposal and to hear our partners‟ and the
public‟s views and opinions.
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The outcome of this consultation will be considered by the Health Board,
Vale of Neath GPs, and discussed with the ABM Community Health Council in January 2012.
Context
The NHS in Wales is facing large and complex changes in the way it
delivers care. People‟s needs and expectations are changing, and new medical technologies and ways of delivering care are becoming available.
Just like the rest of the public sector, the NHS is facing huge financial challenges.
This means we have to continually review how and where we provide care
and to consider whether we have the right services, in the right place, and are providing the best care we can. The need for healthcare premises
and services to meet the needs of the patient population in the 21st
century is crucial.
Our Pledge
ABM University Health Board (ABM) is committed to providing the best services possible - within our resources - for our patients, their carers,
and families.
We are determined to offer good quality treatment in accessible, comfortable, modern and safe environments, and ensure patients and
their families are treated with honesty, dignity and respect.
We are confident that this can be achieved, and there are two important principles driving this:
Quality and Safety. Providing the best quality services and facilities for our patients, their carers and families.
Rebalancing care. Too many patients receive treatment in
hospital or stay in hospital longer than necessary when it is more appropriate to offer them care in community settings or in their
own homes.
Modernising NHS Services
Our strategic plans for services in Neath Port Talbot, set out in Changing
for the Better, are based on making best use of our hospitals, our community-based services, and taking the opportunities of working more
closely with voluntary sector services.
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We are also continuing to work with the independent sector to meet
respite, nursing and ongoing long term and continuing healthcare needs of our patients in appropriate community settings.
Our proposal for the Vale of Neath Practice should be seen in the overall
context of improving health services in Neath Port Talbot, particularly as current developments include significant changes to the number and way
healthcare services are provided to patients within their local community.
Vale of Neath Practice
The Vale of Neath Practice covers an extensive area of Neath Port Talbot, with the population spread out over a wide area including the towns and
villages of Glynneath, Resolven, Cwmgwrach, Pontneddfechan, Ystradfelte, Rhigos, Melin Court, Clyne and Abergarwed.
The Practice currently has two surgeries, a main surgery in Glynneath and a branch surgery in Resolven. With six GPs (5 whole time equivalent), the
practice has 9,617 registered patients: 6,820 with the Glynneath main surgery and 2,797 with the Resolven branch surgery.
The main surgery building in Glynneath
(left) has been a GP surgery since 1946.
Despite extending and remodelling, it is now too small and poorly designed to
cope with the increased demands placed on it by the needs of modern day
healthcare.
The Health Centre at Resolven, (bottom
left) where the Resolven surgery is based, was built in the late 1960s.
Despite every effort by practice staff to
provide the highest quality service, the building itself does not support this. The
building is simply unable to cope with or deliver healthcare services at the
standards we all expect and deserve.
Compared to just five years ago, the Vale of Neath practice now provides more
appointments with a number of GPs, access to nurse led clinics and clinics for managing long term illnesses. In the first week of October 2006 the
practice saw 477 patients. Five years later, and in the first week of
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October 2011 the practice saw 1,043 patients. This is an increase of
over double the number of patient appointments in just five years.
Why the need for change?
Earlier this year, the Vale of Neath GP practice wrote to ABM University Health Board, explaining that for reasons which are outlined in this
consultation document, they felt services should be consolidated and provided from a single site. This reinforced the need for a new, purpose-
built primary care centre as the best way to provide high quality services for patients into the future.
Both the practice GPs and ABM University Health Board are committed to
providing the safest and best quality care we can within the resources we have. We aim to ensure primary care services in the local community are
accessible and efficient, and expand to meet the health needs of local
residents. The needs and expectations of the local population are changing, we need to make sure our healthcare services develop and
grow to meet them both now, and in the future.
Unfortunately, despite modernisation, there are a number of constraints and limitations to the current premises used by the practice which
prevent the further development of healthcare services to the standards and availability we expect and patients are entitled to receive.
Accessibility
a
b d
c
Examples of narrow doorways and access
and cramped conditions in:
a, b: Glynneath
c, d: Resolven
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Both the buildings in Glynneath and Resolven used to provide services
within the Vale of Neath are out of date and no longer fit for purpose. The layout and cramped space within both buildings makes it difficult to
effectively provide current services to patients, and impossible to offer additional local health services. Access is particularly difficult for those
patients with disability aids or patients with pushchairs.
In the Glynneath Surgery access to consulting rooms is limited because of a
steep flight of stairs (right) and a very narrow corridor with a sharp corner.
Although a stair lift has been fitted to help
patients access the upstairs this isn‟t an ideal or satisfactory solution.
Even though improvements have been made for disabled access, both buildings are only able to fulfil the requirements
set out in the Disability and Equality Act 2010 to a basic level. A recent Community Health Council Report (Aug 2011) referred to accessibility at
Glynneath as a matter of concern and a key issue.
Increasing the number of healthcare services from any building means an increase in the number of people attending the surgery and arriving by
car. Currently both surgeries have limited parking and drop-off facilities for patients.
At the Glynneath surgery (left) dropping-off a patient on the
main road is particularly difficult and dangerous, especially for
elderly patients, disabled
patients and people attending with young children.
The buildings in Glynneath and
Resolven are both at capacity and there is no way to further
extend or improve them.
In the monitoring report completed in August 2011, by the ABM Community Health Council, the
lack of space in treatment rooms was mentioned as a matter of concern.
The buildings as they currently stand actually prevent us from developing patient care and delivering the best quality healthcare services which you,
our patients, need and deserve.
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Confidentiality, Safety and Dignity
Patient confidentiality, safety and dignity are top priorities.
We all work hard to achieve and maintain these; however our ability to deliver these priorities is severely compromised by the current
environment at Glynneath and Resolven.
For example:
In the Resolven surgery, patients have to be taken through the waiting room if they need to go straight into hospital from the
surgery. This is not appropriate and is distressing for patients.
In both surgeries, the cramped conditions mean at times the private, confidential and often sensitive conversations which
patients have with their doctor or nurse can be overheard by
members of the public sitting in the waiting area. This is another issue raised recently by the ABM Community Health Council as a
matter of concern.
Some of the rooms are so small they do not comply with Health and Safety legislation.
Storage space for equipment, materials and files is very limited, and
therefore does not meet Health and Safety and Infection Control standards. Unfortunately the investment needed to put this right
would be impractical to implement.
Due to patients attending more than one site their confidential records have to be transferred between sites. This not only has
confidentiality and safety issues, but also means a patient‟s records
might not be available at the same place as the patient‟s appointment.
Electronic access to patient records and information is limited and
inefficient due to the poor condition of the BT line between the two sites.
Unfortunately, it is not possible to extend either building or redesign the
internal layout in order to resolve the points above and increase the number and quality of services provided.
What is also of significance is that by law all public buildings should be
compliant with the Disability and Equality Act 2010, making them accessible to everyone.
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Improving and developing services
We want to ensure that the services we provide can continue to meet the
needs of local people into the future. Running two separate surgeries has significant staffing, financial, equipment and safety constraints. GPs have
to cover two surgeries instead of working together under one roof, which results in patient access to doctors being reduced and constrains
opportunities to develop better services.
The practice has three full time and three part time GPs (equivalent to 5 wte GPs), which is the right number for the population size of 9,600
registered patients. There are not enough patients to support any additional doctors – so we need to make the most of the GPs we do have.
The greater demand for Glynneath appointments results in an imbalance
in cover, with more GPs working in Glynneath than Resolven. Resolven
therefore has fewer surgery sessions because fewer patients are registered with the branch surgery. As a result, a number of Resolven
patients already attend the Glynneath surgery instead to see the doctor of their choice. A spot check revealed that of the 157 Resolven patients who
required an appointment during one week, 14% went to Glynneath instead of Resolven during Resolven Surgery opening hours.
This also means that sometimes GPs have to work on their own in
Resolven, which raises safety implications, particularly for female GPs. In addition, there are fewer opportunities for GPs to discuss a potential
diagnosis or treatment with colleagues, or get a second opinion when they are on their own. Clinics can also be affected if a GP is on another site,
leading to patient waits.
We need to maintain a skilled and flexible workforce capable of meeting
changing healthcare needs within our communities. All these factors mean we need to target resources and make the best use of staff, to ensure we
deliver safe, high quality care in the most appropriate environment.
By consolidating our services onto one site we could offer patients better access to doctors of their choice, nurse led clinics and
specialist clinics. This would avoid the need for patients to make multiple trips for healthcare appointments at various locations.
Positive Reasons for change and our proposal
We aim to build on all the strengths of the existing primary and
community care services available in the Vale of Neath.
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We are improving the way primary care and hospitals work together, and
rebalancing care so more can be delivered closer to people‟s home - with less reliance on hospitals, unless patients really need to be there.
In the recent Monitoring Report by ABM Community Health Council, the
Vale of Neath Practice was commended for the quality of the services it provides. But by consolidating these services on one site we can offer
patients even better access to the doctors of their choice and more specialised clinics; including clinics and outpatient appointments
previously only available at hospitals.
It will also improve communications and joint working between different services, provide a better environment and reduce the need for people to
travel to hospital for some services which could be provided at the centre instead.
At other Primary Care Resource Centres in the
ABM area, a significant bonus has been the ability
to offer a number of commonly used services
which have traditionally only been available in an
acute hospital – in other words, taking services into
the community, closer to people‟s homes. (Left: a
Pulmonary Rehabilitation Clinic underway in Port Talbot Resource centre).
At this early stage in the consultation process, we have not reached the point where artists‟ illustrations of the proposed Primary Health Care
Centre for the Vale of Neath are available.
However, ABM has a significant track record for developing a number of new single site primary health care centres across the whole Health Board
area, including those at Seven Sisters, Clydach and Port Talbot.
Evidence shows that these new developments have led to improved services and wellbeing for patients.
The following pages show some images of the other primary care centres
which have been built in the last few years in the ABM area, or which are currently under construction, to give you an indication of what could be
built to serve the Vale of Neath.
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In addition to the above, work has just started on the £7.25 million
Beacon Centre for Health development in Swansea‟s SA1, which will be home to two GP practices, a dentist, and a range of services which had
previously only been available in hospitals, as well as other services.
The Beacon Centre for Health
(illustrated left) is due to be open in 2013.
It is another example of
ABM‟s commitment to improving community-based
primary healthcare.
Our proposal for the Vale of Neath
Discussions about the future plans for primary care services in the Vale of
Neath have been ongoing for a number of years. For the reasons set out in this document, we believe that the best solution for a sustainable and
modern service is to consolidate current services in a new single central building we are proposing for the Vale of Neath will be purpose built in
response to the healthcare needs of all Vale of Neath Practice patients. It will take into account:
The healthcare needs of all patients in the area
The importance of delivering the highest standard of care in a comfortable modern and safe environment which is fit for purpose
The requirement of patients to receive faster and more accessible
healthcare services closer to their own home The access requirements of all patients, particularly the elderly,
disabled and those with young children The number of patients accessing the practice both now and in the
future The dignity, privacy and confidentiality of all patients when talking
to doctors, nurses and other healthcare staff Parking and drop-off facilities needed by patients
The effective and efficient use of resources including space, equipment and staff
More choice, less travelling
We recognise that the relocation of services to a central point will create
additional travel time for some people. However, we believe the benefits
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of a new facility will outweigh this difficulty and will help reduce travel
times for services that couldn‟t have been provided locally in the Vale of Neath within the current facilities.
Statistics show that the majority of patients prefer to be able to have an
appointment with the doctor of their choice, and don‟t mind where the appointment is. Even when Resolven is open, an audit of one week
showed that 14% of Resolven patients currently chose to travel to the Glynneath surgery in order to have an appointment with their doctor of
choice.
As there is only about enough work at Resolven for one doctor, the practice usually only has one GP per session at the surgery fulfilling
appointments, and therefore the choice is limited. But by having all the doctors based at one central surgery, patients served by the practice will
have more choice over which doctor they see.
At the moment, the Vale of Neath Practice can only run a clinic for people
suffering from Type 2 non-insulin dependent diabetes. Those patients with Type 1 and Type 2 insulin dependent diabetes have to attend a clinic at
Neath Port Talbot Hospital. Centralising services and staff on one site will mean clinics such as the Diabetes Clinic will be able to offer more
appointments, and have more specialised staff and equipment available to patients all at once.
Because all the staff a patient might need to see for their condition are
located in one place this will not only reduce the number of appointments a patient needs to attend, but cut patient journeys to just one location.
With the additional space provided by a new building there is the potential
to move more services, such as the clinic for diabetic patients on insulin,
from Neath Port Talbot Hospital closer to patients in their own community. This would mean patients no longer having to make the 22
mile round trip from home to the hospital.
More services
Community Services are already considering centralising a wide range of its services in the new Primary Care Centre should it be built, including:
Pulmonary Rehabilitation
Ante Natal and Post Natal Services Wound Care
Podiatry Nutrition and Dietetics
Base for District Nurses, Health Visitors and School Nurses
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Facilities to support the Community Resource Team
Physiotherapy Consultant led clinics
Family Planning Clinics
The practice is a teaching practice and needs to have the facility to train GP Registrars and students in a suitable environment.
Currently a number of Resolven and Glynneath patients attend the
Pulmonary Rehabilitation Service at Port Talbot Resource Centre, which involves a round trip of 22 miles plus travel time.
By opening a new Primary Care Centre in the Vale of Neath, the Health Board would be able to run the Pulmonary Rehabilitation Service from the
new Centre.
A similar service is already running very successfully in the Dulais Valley
Primary Care Centre at Seven Sisters. (Unfortunately, at the same time as Dulais Valley welcomed their new Pulmonary Rehabilitation Service the
Vale of Neath had to decline a similar upgrade due to lack of space.)
The new centre would not only mean more space for services to be run from the community for the people of the community. But also, there
would be more healthcare staff based within the community for the people within the community to access.
Locating all the staff on one site not only increases capacity but also the
ability to ensure patients are able to access the right treatment in a timely manner. For example, if a district nurse wants a medical opinion on
a wound that is being treated, the GP would be available and accessible within the same building, and the patient would not have to make a
separate appointment, wait for the GP to arrive or return later.
Community Pharmacy
We are also proposing to have a community pharmacy within the new
building.
Where would the new centre be built?
In order to increase services and deliver healthcare of the highest possible standard to our patients in the Vale of Neath we need to provide
a fit for purpose building. To ensure the building will provide the maximum amount of space for now and for the next 25 years with the
ability to expand as services and population increase, we need to have a large site in an accessible location for all patients of the practice.
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We have spent a considerable amount of time trying to find a site that is
within the practice boundary and also provide the space required for a large building with car parking. The site that has been chosen is the
former Aberpergwm Washery site, which is near Glynneath Business Park and close to the swimming pool and fitness centre.
The overall geography of the Upper Neath Valley means we needed to
find the most accessible, flat site, for all the patients who are registered with the practice. The Aberpergwm Washery site is adjacent to the main
link road between Swansea and Merthyr Tydfil and on the main bus route. This means Resolven patients will have to travel 4 miles to the new
Primary Care Centre which is less than they currently have to travel to the Glynneath Surgery.
Public Transport
We recognise that some people have already indicated their concerns about travel arrangements from the Resolven area. We have already been
in touch with the local bus companies regarding our proposal to confirm details of existing bus services to the site, and if they could be enhanced.
There are two bus stops located on Chain Road right next to the proposed
site. These are used by the half-hourly First Cymru X5 service and the two-hourly First Call Travel direct service from Merthyr to Swansea
stopping at Resolven and Neath.
First Cymru has informed us that its half-hourly service runs as follows, Monday to Friday:
Resolven to Glynneath, stopping next door to the site of the
proposed centre: leaves Resolven four minutes past the hour, and
arrives 17 minutes past the hour, and also 34 minutes past the hour, arriving 47 minutes past the hour.
The first bus leaves Resolven at 8.34am, arriving at Glynneath around 10
minutes before a 9am surgery start.
Glynneath to Resolven, leaving from next to the site of the proposed centre: leaves Glynneath just past the hour, arriving 15
minutes past the hour, and 30 minutes past the hour, arriving 45 minutes past the hour.
We will also work closely with the local bus companies to see if a bus stop
can be incorporated even closer, within the grounds of the new Primary Care Centre.
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Also, home visits by GPs will continue to be available to patients who
need them.
Parking
There will be onsite drop-off and parking facilities. We have purposely looked for a site large enough for both the building itself and a car park.
What others think of primary care centres:
Cathy Dowling, ABM Head of Midwifery –
“This would be a positive improvement for maternity services for both
midwives and mums to be to have a base that enables women and their families to access a midwife in the early stages of pregnancy. This base
would also allow the midwives to access the Health Board information
systems and ready access to women‟s and babies records within the community.”
Jane O’Kane, ABM Head of Health Visiting –
“Child Health Clinics are currently held on a Monday in Addoldy Road and
a Wednesday in Resolven. Both buildings are very old and not ideal as venues for the clinics. The Resolven Health Centre doesn‟t have a suitable
area for children, and families have to wait in the general waiting area. Addoldy is very busy and as the clinic is on a Monday it is often missed
due to bank holidays. If health visiting services were centralised at a purpose built centre, it would change all this. There would be more
opportunities and staff available for clinics to take place. This would greatly improve the Child Health Clinic Service for all the patients within
the valley.”
Dr Mark Daniels (GP – Senior Partner) –
“The Dulais Valley Primary Care Centre at Seven Sisters is a superb new
health centre. The facilities are excellent and meet the needs of the practice population. I think the population of the Neath Valley deserve
and are entitled to the same standard and quality of facilities and services.”
Simon Boden-Tebbutt, Practice Manager –
“The Dulais Valley Primary Care Centre at Seven Sisters is a positive
working environment and I think it gives a more professional appearance. There appears to have been a positive attitude towards the building by
patients and I haven‟t heard people complain about the distance they
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have to travel to benefit from the improved services run from here. The
Retinopathy Clinic is now held here, within the community, on a monthly basis. Because of the space we have available the Community Mental
Health Team are also able to visit and see patients closer to home. As well as the Chiropody and Baby Clinic, other services have started here in
recent months including Pulmonary Rehabilitation and Stop Smoking Wales.”
Financing the New Centre
The new centre will be built and owned by a third party and be rented by
the Health Board and Vale of Neath Practice. This is the same method of development as the Port Talbot Primary Care Resource Centre and Dulais
Primary Care Centre.
Timescale
If our proposals are accepted, then a detailed design and planning
process would follow before any development could begin. The estimated timescale for the opening of a new centre would be early 2014. Until the
centre was completed, the current facilities would remain.
Conclusion
The Vale of Neath GPs and ABM University Health Board want to ensure that patients in the Vale of Neath area have access to high quality GP
services in a modern, purpose-built environment. We want to offer services in the community which previously were only available in
hospital. We want to offer patients more choice, and use resources more effectively and efficiently to improve the services on offer.
To do all of the above, we need to replace out-of-date and cramped premises in a single, modern GP centre. We are therefore proposing the
Vale of Neath existing main and branch surgeries at Resolven and Glynneath close, and be replaced by a purpose-built centre at a site on
the former Aberpergwm Washery.
We recognise that this will involve a change in location for people who use these services, and are grateful for your cooperation in helping us deliver
a new facility that can provide the highest quality services into the future.
What are the next steps?
We have already had a number of engagement events to discuss the proposals with local people. The ABM Community Health Council has
requested that we now undertake a formal public consultation on these
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plans. We will be holding a number of public meetings which you are most
welcome to attend. Dates, times and venues of these meetings will be announced shortly and widely publicised.
You can also email us at: [email protected] with the
title „Vale of Neath‟. You can also write to:
Hilary Dover Locality Director
ABMU Health Board Neath Port Talbot Locality
Suite A Britannic House
Llandarcy Neath
SA10 6JQ
As part of this public consultation we will also be consulting with the
following stakeholders:
ABM Staff Partnership Forum ABM community staff in the Vale of Neath area
ABM Primary Care staff in the Vale of Neath area ABM Stakeholder Reference Group
ABM Patient Participation Forum - East Local Medical Committee
Local Pharmaceutical Committee ABM Community Health Council
Neath Port Talbot County Borough Council Neath Port Talbot Local Service Board
Neath Port Talbot Council for Voluntary Services
Neath Port Talbot Older People’s Forum Neath Port Talbot Carers’ Forum
Neath Port Talbot Disability Forum Local Assembly Members and MP
Resolven Community Council Glynneath Town Council
Following the end of the consulation period on 16th December 2011, a
report will be prepared by 6th January, 2012 for ABM Community Health Council and ABM University Health Board on the comments made on the
proposals and the outcome of the public consultation. The outcome of the public consultation and comments on the proposals will then be
considered by ABM University Health Board at a meeting on 26th January 2012.