Moray coast branch surgeries closure: independent report

Executive summary

Following the closure of the Hopeman and Burghead branch surgeries, noted by the Moray Integration Joint Board (MIJB) on 26^th January 2023 (amended minute 30^th March), and in light of concerns raised by members of the impacted communities, an independent view was sought by Scottish Government’s Primary Care Directorate.

In November 2023 I was commissioned to meet relevant stakeholders and provide a view. The remit of this work was to seek assurance for the Scottish Government that consultation and engagement with communities during a process of service change has been carried out appropriately, in the context of the General Medical Services regulations. Scope was also given to make recommendations to the Scottish Government if it is possible to identify any wider lessons from the visit, and make recommendations for both Health and Social Care Moray (HSCM) and Scottish Government.

There is no remit to review decisions taken by Moray IJB as a public body.

I had the pleasure to discuss the situation with committed and insightful individuals, both members of the community, and leaders within HSCM. I was impressed by the willingness of all to tackle complex issues relating to the provision of modern general practice in an increasingly challenging context; the balance of local services vs co-located multi-disciplinary teams; the need for proactive and innovative rural solutions rather than an acceptance of ‘second best’ for rural communities. I was inspired by the values and person-centeredness of all participants.

I was joined by members of the Argyll and Bute primary care team. I am accountable for the accuracy and judgement in the comments provided here. I am also aware that health and social care services are collaborative endeavours and the views of individuals should not be taken in isolation. It would be unwise to accept any recommendations made by an individual unless subject to full discussion within well-governed structures.

My focus here is on the process, governance and decision-making relating to the closure of the branch surgeries. The substance of those decisions is multi-faceted and outwith the scope of this review. Complex decisions relating to the strategic direction and operational delivery of services are best served by discussion between those accountable for and users of those services, rather than by external comment.

Findings and recommendations were themed around three areas:

Process

I found no grounds to indicate that HSCM had followed anything other than a rigorous and thorough process of engagement and consultation. This was well-documented and with appropriate advice from relevant experts.

However, it is also the case that those members of the community I spoke to felt, and continue to feel, poorly-served by the consultation, and that a ‘done deal’ had been formalised by Moray Integration Joint Board. These things may be true at the same time, and I have offered reflections and recommendations on this subject. I also note that the difference between “engagement”, as a process of informing and gathering ideas, and “consultation” which is focussed on understanding and mitigating the impacts of a proposed change, does not appear to have been well understood.

Regulation

The regulations relating to branch surgery closures are minimal. They offer little by way of a framework to support authorities (Boards or IJBs) in making decisions relating to branch surgeries. They offer little by way of protection or clear expectations for those impacted by that decision making. They also do not reflect the current context relating to general practice sustainability, the state of the health and social care estate, or changed clinical standards and multi-disciplinary team-working.

The regulations do make clear that Boards and/or IJBs have the power and the responsibility to make decisions relating to branch surgery provision. I have offered reflections and recommendations around how the governance around this can be strengthened.

Innovation

Though discussions around the withdrawal of local services are inevitably challenging, my most positive interactions were around the vision and excitement for innovative rural services.

It is reasonable to accept that residents of Hopeman and Burghead were negatively impacted by the closure of branch surgeries close to their homes. At the same time these decisions may have been necessary to sustain general practice in the area, and this picture will likely be repeated across Scotland in similar instances. Boards and IJBs by necessity must make decisions where this is the case, and impact assessments exist to ensure these impacts are understood and mitigated where possible. However, this does not mean that innovation, especially that outside of the constraints in which public sector providers work, is not possible in such situations. Indeed the fact that communities impacted by branch surgery closures are by definition impacted negatively could mean this innovation is essential.