Evolution not revolution is the way to improve health services at Epsom Hospital and in the community, according to local health chiefs.
Dr Simon Williams, locality chair for Mid Surrey, and Miles Freeman, chief officer, both of Surrey Downs Clinical Commissioning Group (SDCCG), gave a presentation and answered questions from the floor at The Station pub, in Stoneleigh Broadway, on Tuesday evening.
Chaired by Epsom Town and Downs Surrey County Councillor Tina Mountain and Jose Fiuza, chairman of Epsom and Ewell Conservative Association, a number of issues were discussed including GP provision in the area, the CCG’s budget and the future of Epsom Hospital.
Dr Williams said the CCG aims to continue investing in primary care and reduce unnecessary admissions to hospitals, reduce the length of hospital stays and improve discharge rates.
He said a new out-of-hours GP service will be in place by October and acknowledged that GPs surgeries need investment and further integration with secondary care.
Both men acknowledged the tensions between the aims of commissioners and providers.
Dr Williams said: "As a CCG we are trying to improve costs and get value for money.
"Providers are also organisations trying to ensure their own financial stability.
"We are trying to engender greater integration of our organisations."
When pressed on the difficulties people have in calling their GPs for emergency appointments, Mr Freeman said the CCG does not hold the budgets for GP practices.
"There has been a rationing of appointments.
"As a CCG, whilst we don’t have responsibility for the primary care budget, we are trying to take some responsibility and would like to use some of our budget to provide enhanced primary care for the chronically ill and elderly," he said.
The CCG is looking to create networks of GPs surgeries to provide community medical services to the most frail - and keep them out of hospital.
Mr Freeman said that while health bosses are "absolutely convinced" that more needs to be spent on community care, he does not know if they are convinced that the money for this must come out of budgets for hospitals.
Mr Freeman said the money per person allocated to SDCCG for its residents’ care was about £1,100 - compared to £2,000 in Liverpool, which he had visited the day before.
Mr Freeman said despite the demise of the Better Services Better Value (BSBV) review, Epsom Hospital is still making plans to meet the London Quality Standards (LQS).
The standards were developed by NHS England London, in conjunction with clinicians and patients, in 2012-13, to improve the quality and safety of emergency care, following concerns about heightened mortality risks at weekends and high maternal death rates in London compared to the rest of the UK.
The BSBV review of Epsom, St Helier, Kingston, Croydon and St George’s hospital - which proposed that Epsom and St Helier lose their A&E, children’s and maternity departments - wanted to reconfigure services for the LQS to be met.
Mr Freeman said: "The LQS are aspirational targets.
"We didn’t necessarily feel they were completely appropriate for our population and had trouble reconciling applying one set of standards in one area that providers in the rest of Surrey were not able to meet.
"But BSBV did focus on improving quality standards and that’s been beneficial."
He said Epsom Hospital has developed its own plans to meet the LQS without having to reconfigure.
He added: "However precious we are as Epsom, as a hospital, it’s part of a trust with St Helier and it’s not viable as a stand-alone trust."
When asked about South West London Collaborative Commissioning - BSBV’s successor - Dr Williams said: "We are not actually in control of the economic or political landscape.
"There is a renewal of the process of looking at hospital reconfiguration involving St Helier and not Epsom.
"We need to prepare for that, if there were any changes in it to St Helier which would affect Epsom. Their services are cross-related and interlinked."
Mr Freeman said no changes are currently planned for the Epsom Hospital site.
"We need to think of what the whole map of hospital services needs to be.
"We are also majorly reliant on St George’s hospital in Tooting for trauma.
"What do we want for our local hospital when it can’t be everything?
"I think most people are happy to drive past a couple of hospitals in a blue-light ambulance to a specialist hospital if they are having a stroke," he said.
"We certainly have no plans to change the services on the Epsom site.
"Whilst there have been so many different strategic reviews in the last 10 years I want to focus on improving services within the existing configuration.
"I’m going for a more gradual improvement."
After this article was published, Mr Freeman contacted the Epsom Guardian to say that his comments on funding allocations in Liverpool were inaccurate.
He said: "Liverpool Primary Care Trust had an allocation of over £2,000 per patient but the CCG is about £1,413.
"The broader point still holds in that if we were funded at that level we would be £100m better off per year."