Popular Withnell Health Centre GP will have to battle further to stay in post

A popular Chorley GP whose village surgery has been at the centre of a longstanding wrangle over who runs it looks like she will have to make a fresh bid to be allowed to stay in her post.

A question mark has hung over the future of Dr. Ann Robinson since Lancashire NHS bosses began the process of awarding a new contract for the operation of Withnell Health Centre more than two years ago.

Dr. Robinson has been the lead GP at the Railway Road facility since 2013, but when a partnership with another doctor at the surgery was dissolved at the end of 2021, the practice had to be opened up to anybody who wanted to pitch to take it over.

As the Local Democracy Reporting Service (LDRS) has previously documented, that originally resulted in the contract being handed to a conglomerate that operates more than 40 practices across the North West. However, flaws in the consultation with patients – who were appalled at the prospect of losing their long-term medic – saw the outcome reversed and the process restarted instead.

Back in January, a decision on the method by which the new contract would be awarded was halted on the morning it was due to be made after the Lancashire and South Cumbria Integrated Care Board (ICB) received legal advice over how to proceed, following the introduction of new health service procurement rules at the start of the year.

However, the regional NHS body has now revealed that its primary care commissioning committee will next week be recommended to launch another competitive tendering procedure like the one under which Dr. Robinson lost out last time.

She – and the Save Withnell Health Centre campaign group – had previously pressed for the ICB to make a so-called ‘direct award’, which would allow her to stay on without the need for a competition, But the NHS said that option was not open to it because of the nature of Dr. Robinson’s current interim contract, which ends in September.

The committee will next week be told that another possible procurement route – whereby the NHS assesses all of the possible providers of a service and decides which is the “most suitable” – is not considered the best option in the Withnell case.

Responding to the news that she will likely have to go through another bidding process – with the chance that the contract will once again go elsewhere – Dr. Robinson said she thought many of her 5,500 patients would be “really cross” at the news.

“The staff, too, are just so devastated. Eighty per cent of the women that work here have been [at the surgery] for between 10 and 20 years. They are so loyal – and their loyalty is what makes the place so great. They know people [as well as] I do,” she said.

Dr. Robinson added that she believed the option of directly awarding her the contract could still be on the table if the ICB was “prepared to be a bit braver” – especially because of the regard in which the practice is held.

“Our patient satisfaction score ranked us as the fourth-highest across the ICB [area] and they’ve also had feedback from 2,500 patients.

“I would say to any surgery: ‘Bid, if you think you can do better’ – and I’m not being arrogant, it’s the patient feedback that backs that up. Patients want the current team to stay.

“If we were really bad and you couldn’t get an appointment and patients were complaining, [that would be different] – but it’s the opposite.

“[The uncertainty] hampers our recruitment, too – there are all these knock-on effects, but that doesn’t register at a higher level. They are a slave to the bureaucracy,” Dr. Robinson said.

Professor Craig Harris, chief operating officer for the Lancashire and South Cumbria ICB, said the organisation has “explored in detail all guidance on the new Provider Selection Regime and how this can and must be applied”.

“This is new guidance, which only came into effect on 1st January, 2024, and so it has only been used in a small number of cases nationally, which we have reviewed. We have also sought independent legal advice and tested our understanding of the guidance with NHS England so, as an NHS organisation, we can be confident we make the right choice legally in how to proceed, “ Professor Harris said.

He added that the ICB had “engaged widely with the local population and continues to work closely with the Withnell patient steering group, which provides strong advice on public sentiment”. Professor Harris visited the surgery last week and spoke to the group to explain the current situation and respond to any concerns raised on behalf of the wider community.

Explaining the recommended procurement route, Professor Harris said: “We believe the competitive procedure is the option which will give the quickest resolution. It will also allow us to use a new evaluation process which we have developed with involvement of the patient steering group and embeds learning from the procurement process in 2022.

“It provides an opportunity for a potentially quicker resolution within the timeframes we have set out, while ensuring we follow due process for equity and fairness. This also allows us to involve members of the public in the process and the evaluation, which didn’t happen last time.

“The legal advice received has confirmed that the ‘most suitable provider’ (MSP) route would involve the significantly wider identification, and possibly assessment, of all suitable and ‘likely’ providers. A process which takes longer presents greater risk for patients, provider and commissioner.”

“We remain committed to securing the best outcome for Withnell Health Centre and its patients within the legal guidance we are required and permitted to consider,” he added.

Dr. Robinson noted that by the time the issue is eventually resolved, it could be almost three years since the first flawed process was launched by the now-defunct Chorley and South Ribble Clinical Commissioning Group (CCG).

“We are fighting on – it’s just such a shame that we have to, when we have got far more important things to do in our day job,” she said.

‘Unfair fight’

Save Withnell Health Centre campaigner Louise France told the LDRS that the proposed contract process is loaded in favour of larger organisations.

She also said it was unfathomable that it was on the table after “12 months of appeals from patients asking to avoid [it]”.

“Procurement is a process that undeniably favours big business over small independent teams, like that of our wonderful NHS GP, Dr. Robinson.

“Professional bids for this process costs thousands of pounds to build – and the bigger a business is, the more money it has at its disposal.

“Dr Robinson is on the back foot before this process even starts.

“Patients [have been] ignored at every turn, despite what has turned out to be 12 months of a pointless ICB ‘patient engagement’ exercise,” Ms. France said.

She warned that the group plans to appeal to the health secretary directly and ask her to use her powers to take over this matter and remove the ICB entirely from the process.

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