Rfrom Mr J.R. Lucas, F.B.A.
telephone 01 460 240413
mobile 0771 8286 705
Station: Crewkerne OS grid reference: ST433188
E-Mail email@example.com WWW site http://users.ox.ac.uk/~jrlucas
August 3, 2008
Dear Mr Hayes,
I should greatly regret the removal of the South Petherton Surgery to the South Petherton Hospital site.
It would be a sacrifice of the central virtue of the South Petherton Practice, accessibility, for peripheral benefits that would not justify the loss.
The South Petherton Practice was exceptionally good by Twentieth Century standards. I often had occasion to remark to friends how lucky we were in South Petherton. Although doctors now are the target of a lot of government initiatives, it is desirable to keep the distinction between what is desirable, and what is really important. On page 2 there is mention of disability access requirements. Of course it would be nice to have an inclined plane at the back entrance so that wheel chairs could manoeuvre themselves in under their own steam, and it is true that purpose built access at the hospital site would provide this. But if one considers patients rather than NHS targets, wheel-chair users are not going to have easier access if they have to go along St James' Street, down Silver Street to Prigg Lane, up past King Ina's Palace, along past the Wheatsheaf, down to the Hospital turn, and then along to the purpose-built entrance on the Hospital site. They would have far easier access in real terms if there were a bell-push by the door, and helped from the door to the consulting room by the extremely helpful people in the surgery. I have seen many other institutions meet the need for disabled access in this way. Not only would it be cheaper, but it would make life easier for the disabled rather than more difficult.
Parking would be more convenient on the Hospital site for car-borne patients: but it is not that bad in South Petherton generally, and we seldom have difficulty in finding a space somewhere. But the proportion of car-borne patients is likely to diminish with increasing longevity and more expensive petrol. When I have been in the waiting room, most of the other patients are either toddlers with their mothers or Old Age Pensioners, and their needs should outweigh the requirements of the car owners.
It is suggested on page 4 that there might be bus routes to and from the surgery. But will there be any buses on those routes at the time patients need them? It has taken years to get a feeder service to Yeovil Junction that actually caters for passengers' needs; unless there is a dedicated minibus service running to and fro during surgery hours, patients are going to have to wait at bus stops. When a mother arrives in January with flu, it will be it will be embarrassing to tell her that she should keep warm. The receptionists are going to have some difficulty in making appointments at non-bus time. At present most patients are happy to have either 10.20, or 10.30, or 10.40, because they can fit in other business around the appointment: they can go as well to the Post Office, the green-grocer, the co-op, the public library, in a single expedition. Having the surgery at the centre not only makes it easier for patients to get to it, but saves a visit to the surgery being a burdensome extra. If there is a bus every hour, patients will be unwilling to accept appointments before the bus is due to arrive, and will become agitated in the waiting room if delays look like making them miss the bus back. Only if there is a frequent and reliable (and therefore expensive) bus service will the Hospital site be reasonably accessible to the car-less. Otherwise the elderly, having collected their pensions at the Post Office will have to walk down St James' Street, up Roundwell Street, along Lightfoot Road, past the Recreation Ground and along the track to the Hospital site, in order to have their chests listened to or their dressings renewed.
One of the enormous benefits of the present arrangement is the symbiotic relationship with the Alliance Pharmacy in Market Square. If the doctor prescribes a medicine, it is a short step to hand over the prescription, often to be given the medicine straight away. A further great convenience is the system whereby repeat prescriptions can be requested by telephone, and then collected later on one's next visit to the shops. There is no mention of a pharmacy in the proposal. It may be that it is intended to have a pharmacy connected to the surgery at the Hospital site; if so, it will cost a lot of money, and---if the one at Yeovil Hospital is anything to go by---be fairly slow in making up prescriptions. At present the overheads of making up NHS prescriptions are shared with all the other business of a chemist's shop. To secure this still, it might be suggested that the Alliance Pharmacy itself should move to the Hospital site---to the great inconvenience of the young healthy who only want to buy beauty cream. The worst scenario is that South Petherton would have two pharmacies for a season, but, deprived of NHS custom the chemist's shop in Market Square closes down, followed a little later by the pharmacy on the Hospital site having to close too, as part of a cost-cutting exercise. The underlying economic fact is that South Petherton can only sustain one chemist's shop, which must be located among the other shops if it is to survive. If the surgery is to continue its beneficial collaboration with a pharmacy, it must itself be located near the centre of South Petherton. The price of moving medical services to the Hospital site will be the non-availablity of medicine.
The advantage of being able to provide a wider range of health services, such as family planning, cytology, X-rays and physiotherapy depends in part how frequently the need for them arises in the course of an ordinary consultation and in part on how available they will be.. If it is only occasionally that a consultation shows the need for, say, an X-ray, the advantage then of not having to make a separate visit will not compensate for the disadvantage of having in all the other cases to make the journey to the Hospital site. The bigger question, however, is availability. Even in Yeovil, when a consultant wants an X-ray there is often a considerable wait before he gets it. In South Petherton Hospital it is weeks before one is given an appointment for an X-ray or podiatry, and although an X-ray photograph is immediately transferred to Yeovil electronically, it takes a week or more for the interpretation to get back to South Petherton. Without extra funding, so that the specialist services have uncongested bookings and can be immediately available, there will be no advantage to the patient in their being next door to the doctor's consulting room. The wart may need to be removed, but the minor surgery clinic is booked up until next Wednesday, when you will have to make another journeyto the Hospital site.
If lavish funding were available and guaranteed to go on being available, then treatmentld be medical advantages in having all the services on one site, and it would be feasible to mitigate the disadvantages to patients by having frequent mini-bus service and an on site pharmacy. But it is unrealistic to count on this. Central sites are usually cramped and often old, but they are accessible, and that from the patient's point of view is the most important thing. If I am ill, I want to get to the doctor first of all. If then he says I must go to the Hospital for specialist treatment, I shall go, but it will be a next, and less immediate, stage.
PS I shall send this also by E-mail, in case that form is more convenient
Mr John Hayes,
South Petherton Surgery