Category Archives: Post Code Lottery

England follows Scotland in funding CF drug. Wales and NI cant afford it.

The drug for CF does not cure, but slows down the decline. It cost far more (normally)m than NICE recommends for each year of life gained (QALY) but presumably the “deal” struck means it is much cheaper. Since the price is secret, it is covert, and we cannot judge. What does seem to have occurred is that one Single Interest Pressure Group (SIPG) has succeeded where many others are unsuccessful. All trusts and regions should have policies on how they deal with SIPGs. Such policies will make the need for rationing clearer. We can afford the low volume and expensive items if we ration the high volume and cheaper items. Once again, although reported as a national decision, this is only for |England. Wales and NI cannot afford it, but then politically perhaps they cannot afford to refuse it. The perverse outcome if the situation remains the same, should be that CF patients move to England and Scotland.

October 25th in the Times: NHS agrees deal to fund cystic fibrosis lifeline drug

A life-saving cystic fibrosis drug is to be made available on the NHS after a deal with a private health company.

The drug Orkambi, which improves lung function, reduces breathing difficulties and can be given to children as young as two, should be available to patients on prescription within 30 days.

NHS England reached a deal with Vertex Pharmaceuticals, the drug’s manufacturer, after a row over the cost, which dragged on for more than three years. The company wanted to charge £100,000 per patient per year but a compromise was reached in a confidential deal. It is, according to the BBC, understood to involve significantly less than the sum originally asked for.

Two other drugs made by Vertex — Symkevi and Kalydeco — will also be made available as part of the deal, meaning that about 5,000 NHS patients will have full access to the drugs. Symkevi is restricted to over 12-year-olds, while Kalydeco can be used from 12 months.

Simon Stevens, the NHS chief executive, said that the deal was a “long hoped-for moment”. He added: “The UK has the second highest prevalence of cystic fibrosis of any country in the world, so today is an important and long hoped-for moment for children and adults living with cystic fibrosis.

“That fact also means that any drug company wanting to succeed commercially in this field needs to work constructively with the NHS.”

Matt Hancock, the health secretary, said that the decision was “great value for money for the NHS”.

Gemma Weir, 35, from Portsmouth, has campaigned to get the drug on the NHS for her six-year-old daughter Ivy for the past four years. She told The Times: “I’m completely ecstatic, as I can’t believe the government agreed to it. My daughter’s life expectancy has just doubled and she will no longer have to live with a horrible life expectancy hanging over her head.”

The drug is said to slow decline in lung function — the most common cause of death for people with cystic fibrosis, a life-shortening genetic condition that can cause fatal lung damage. Only about half of those with the condition live to the age of 32.

NHS England said that the deal was made possible by the company agreeing confidential commercial terms that constituted good value for British taxpayers.

 

The best and worst places to have your hip operation (In England. No global comparisons)

All hail the honesty of the Health Services Journal. Unfortunately they are not allowed to advocate rationing and freedom of speech is limited. But the stories they expose and the issues they address are relevant to  us all. There are many problems, which include poor staff hygiene, poor hospital cleaning, inadequate training, and above all, the failure to separate cold orthopaedics from “dirty” hospital cases where infected wounds and guts are operated on in the same building. The old fashioned DGH has served its time for hips and knees. But why are there no comparable figures for the Scottish, Welsh and Irish Hospitals? Because there is no “National” health service, I as a taxpaying citizen in Wales cannot find out how my service performs compared to England. Indeed, I would like to know comparisons with other countries, and with the private sector. Only with such data can patients be properly advised, and of course they also need to be “led” ask the right questions! Rationing by lack of choice, restriction to a local DGH, and long waiting lists, can only lead to more infections and complications (increased obesity and heart attacks from immobility). Should your GP air these issues when you choose to be referred? Of course he should even if it means telling the truth about your local services.

In the Times Monday 14th October a short report ( not in the on line edition) reads:

Repeat Offenders

The hospitals with the worst records for having to repeat knee and hip surgery on patients are revealed in a report in the Health Services Journal. The sick/ Six NHS hospitals are Southampton General, Milton Keynes, Chichester, Wansbeck, (Northumbria), Weston General, Somerset, and Ormskirk DGH Lancashire. Overweight patients, high infection levels and shortcomings in supervising trainees are blamed for poor performance.

In the Telegraph they report: “Revealed: the best and the worst places to have your hip operation”.

As it gets worse, YOU are going to have to wait longer and longer – or pay up. A “grim reality”..

The evidence basis of all practice(s) needs to be challenged – continuously. There are perverse Incentives in private systems, but why do the UK health services still overtreat?

NHS rationing: hip-replacement patients needlessly suffering in pain on operation waiting lists

Orthopaedic waiting lists: time for more, and equal access to, non-urgent centres

South Wales NHS: Plan to centralise services on five sites

 

Perinatal Mental Health Care: Post Code Rationing, for citizens who pay the same taxes and deserve the same services.

Perinatal Psychiatric care is disproportionately provided around the country. Mother and child units offer the best solution, keeping the family together and offering specialist support.

Numbers: It is anticipated that there will be at least 1300 admissions per year nationally. It is estimated that 0.25 In-Patient Mother and Baby beds per 1000 live births will be required (if Specialised Perinatal Community Mental Health Teams are available) or 0.5 per 1000 if no Specialised Teams are provided. There is no doubt that specialist services save lives in this very unpredictable but serious condition. Patients in Wales have no service and have to leave the Region and go to England. Since money moves with the patients, Wales hates having to pay up for its most severely psychiatrically ill, and patients from West Wales have to travel vast distances. I understand there was a unit for treatment in Cardiff but this has now closed. Is this prioritisation, restriction, reduction, limitation, or rationing? In 5 years there are not enough signatures for a debate on this issue….

Specialised Perinatal Mental Health Services (In-patient Mother and Baby Units and LinkedOutreach Teams – In England

In 2003 M Oates published Perinatal psychiatric disorders: a leading cause of maternal morbidity and mortality in the British medical bulletin

and in 2014 Samantha Meltzer-Brody and others, published Evaluating the clinical effectiveness of a specialized perinatal psychiatry inpatient unit in Springer Link

The Maternal Mental Health Alliance publishes a map of the UK with a description of what services are available.

38 degrees started a website “No mother and baby unit in Wales” some 5y ago, and have failed to get enough signatures to their petition asking for a debate.

The Maternal Mental Health Alliance published 16th June 2018: New mums face gaps in vital specialist mental health services in Wales

and on 6th February 2019 Sophie Bennet for RadcliffesLeBrasseur reports: Perinatal mental health services: Where are we in Wales?

In January 2019, Cabinet Secretary for Health and Social Service, Vaughan Gething AM, met with the Children, Young People and Education Committee to discuss the progress of recommendations provided in the October 2017 report on perinatal mental health services.[1]

What is the perinatal period?

This extends from conception to the end of the first year of the baby’s life. This is a crucial time in a woman’s mental health and that of her baby. One in four women experience mental health difficulties during this period.[2]

Main issues identified in 2017:

  • Lack of a mother and baby psychiatric unit in Wales
  • Inconsistencies in the existing services
  • Lack of continuity in care
  • Need to de-stigmatise and normalise the mother’s experience

In a letter to the committee published in October 2018, Mr Gething outlined plans for each of the recommendations. This included a deadline for June 2019 to extend the ‘More Than Just Words’ initative to increase the presence of Welsh language options in the service.

Progress in relation to the recommendation for all Local Health Boards to have a specialist perinatal mental health midwife as five of the seven Health Boards in Wales have implemented this, while one has a specialist perinatal health visitor.

Mother and baby unit

A key focus of the meeting held in January was the fact that there is still no mother and baby psychiatric unit in Wales. Mr Gething explained that in South Wales one cause for the delay was difficulty in agreeing the location of the unit and how it is to be run. Initial interest in housing the unit has reduced to only the Abertawe Bro Morgannwg Health Board.

Meanwhile, in North Wales a lack of women who require a unit is a cause for the delay with ongoing conversations with NHS England to block book beds. Currently women in North Wales have to travel to Manchester or Birmingham to attend a unit with facilities to host them and their babies. NHS England is unwilling to create a unit closer to the border and the success in a similar scheme in England has resulted in a decrease in the number of women referred.

Committee members noted that the mother’s support network are included in the perinatal mental health initiative and removing the mother from her family and partner may be counterproductive.

Future requirements for Local Health Boards

The Assembly currently expects Health Boards to publish data concerning perinatal mental health. However this is not mandatory. This was questioned by the committee and Mr Gething explained that this was a period in the run up to mandatory publication.

Information that would be collected included time frames from referral, assessment and treatment, the experience of the mother and her improvement.

Practical take away

NHS England began a later but similar review which has been more successful. Mr Gething stated that NHS England itself is uncertain as to why its scheme has been more successful in a shorter period of time.

It could be suggested that the perinatal mental health services are another example of the differences between the devolved health care systems.

Scotland’s first Mother and Baby Unit is located at Leverndale Hospital in Glasgow#

The West Lothian Perinatal unit

And in Norther Island there are calls for a unit where there is none (as in Wales)

This is Post Code Rationing, for citizens who pay the same taxes and deserve the same services.

Don’t believe we are rationing? Do you believe in transparency and honesty? Why not use the correct word?

Just in the last few days these news items reveal the truth. Despite this the “R” word can never be acknowledged by politicians. None since Enoch Powell has embraced the truth. (Described by Richard Smith, former BMJ editor as “the best book written on the NHS”. A new look at medicine and politics: 1975 and after. Pitman Medical 1976. 2nd edition. ) 

Link to his book published by the Socialist Health Association

Why do you think we had no PET scanners until 20 years late! Why are there waiting lists longer than any other G7 country (and the results to match)? Why have the two countries that emulated the original NHS reconsidered? (NZ and Scandinavia). Why are we only appointing 1 doctor for every 10 who apply and have been encouraged to do so by their careers officers? Why are botched operations so commonplace?  Why does the NHS Ombudsman produce reports which have no notice taken? Do the politicians read these reports?

If you believe in honesty and transparency why not use the correct word? We will never win the hearts and minds of the health service staff if politicians and media and public collude in the language of denial.

Henry Bodkin in the Telegraph 14th September 2019: NHS bosses tried to “gag” father of boy whose life was ruined in botched operation

In The Guardian 30th August 2019 Dennis Campbell: ‘Crumbling’ hospitals putting lives at risk, say NHS chiefs  –  Four in five NHS trust bosses in England fear Tory squeeze on capital funding poses safety threat

Why cannot Cheshire recruit enough GPs? Pulse reported by Lea Legraien 14th September

Why do we still get fraudulent managers promoted (The Independent 19th December 2018)

Why are half of the 4 health services’ trusts using out of date radiotherapy equipment? ( Andrew Gregory in The Sunday times 15th September 2019 )

This is particularly important for Pembrokeshire and West Wales as we have a long distance over difficult roads to travel to Swansea at present. Our planned new Hospital, wherever it is, needs Radiotherapy, Radio Isotope Investigations, and STENT treatment for Coronary Heart Disease if our options are to be the same as those in more favoured areas. I reproduce the article at the bottom of this post.

Adam Shaw for the Harrow Times reports 13th September 2019: North-West London CCGs dismiss claims of “rationing” services.

Kat Hopps September 13th in the Express reports: IVF: How NHS IVF treatment is unfair postcode lottery and keeps couples childless

A disgrace and a shame on politicians: “Surge in patients raising own cash for amputations”. Rationig by waiting and by incompetence.

Pembrokeshire Oncology cancer services in crisis

There is a “need to put doctors in charge and force them to take account of patients’ views. Cancer survival rates are (just) one of the prime examples of NHS mediocrity.”

Desperate NHS needs a desperate remedy – care is already rationed

The 3 myths of the NHS…..& …No learning from other countries – no co-payments, and more scandals..

Britain ranked last (out of 20 rich countries) by a wide margin in the number of CT and MRI scanners per head of population. Australia has six times as many CT scanners per head, and spends roughly the same as Britain on healthcare overall as a share of GDP.

Why are half of the 4 health services’ trusts using out of date radiotherapy equipment? ( Andrew Gregory in The Sunday times 15th September 2019 )

Almost half of NHS trusts are using outdated radiotherapy machines that are far less effective at killing cancer cells to treat patients.

The revelation comes days after the UK came bottom of an international league for cancer survival rates in The Lancet Oncology journal.

In 2016 the NHS said it was investing £130m in upgrading radiotherapy equipment but the figures, revealed via freedom of information requests, found 46% of trusts are still using outdated linear accelerator (Linac) machines beyond their recommended 10-year lifespan.

Dr Jeanette Dickson, president of the Royal College of Radiologists, said more advanced radiotherapy techniques enable “greater precision when targeting specific tumours and have been shown to be less harmful to surrounding tissue than older types of radiotherapy, depending on the complexities of the cancer being treated”.

Rose Gray, policy manager of Cancer Research UK, said it was “deeply concerning” to hear outdated radiotherapy machines were being used.

She said: “The NHS has grappled with the question of how best to replace outdated equipment for many years, and the government has repeatedly been urged to put a long-term plan in place.

“But . . . that still hasn’t happened. These investigation findings prove the urgent need for a solution to this persistent problem.”

In total, 57 of the 272 Linac machines used this year are 10 or more years old. One of them that is still in operation has been used for 17 years.

Dr Peter Kirkbride, the former chairman of the government’s radiotherapy clinical reference group and spokesman for the Radiotherapy4Life campaign, said: “That radiotherapy has been put on a lower footing than other cancer treatments — such as chemotherapy — by successive governments is an open secret within the NHS.”

The Liberal Democrat MP Tim Farron, chairman of the all-party parliamentary group on radiotherapy, described the figures as “shocking”.

He said they proved the investment in 2016 had been a “drop in the ocean” when compared with what is required to meet soaring demand.

Saffron Cordery, deputy chief executive of NHS Providers, which represents hospitals, added: “What we do know is that for year after year, money earmarked for capital investment has been siphoned off just to keep services running.”

An NHS spokeswoman said 80 radiotherapy machines had been upgraded since 2016 and patients were benefiting from “a range of improvements” to cancer services.

Enoch Powell 4 Supply and Demand – Rationing

 

A&E waiting times – are a dangerous disgrace. Casualty should be manned by more rather than less experienced doctors.

A recent admission to my local DGH A&E was an eye opener. It was as if nobody cared when a retired GP arrived at 00.30 to say he had a painful infected hand and needed an operation. The time taken to be seen was appalling, with 30 mins to see the triage nurse, 4 hours later to see the SHO and 1 hour later to see an F2 covering orthopaedics from another speciality. (Surgery). The result of a sleepless and painful night without adequate analgesia was my walking away at 06.00 (after being advised that there would be no way to see anyone before 10.00 am!) with a compartment syndrome not yet diagnosed or seen by somebody able to take action. This was a wait of 5 and a half hours, but then I got access to the specialist via my GP by barging in first thing. (GPs are not meant to be an emergency service!). She rang the consultant and arranged for me to be seen mid morning, and an operation ensued at 19.30 which was some 18 hours later than it might have been. The result, even for a doctor who presented himself, was delayed decompression of my dominant R hand, and a long recovery on antibiotics. I suspect that the pain could have been less, the operation sooner and the recovery quicker if the right person had been in A&E. 

This type of story is commonplace. Retired colleagues all tell me “dreadful” stories of their own experiences. It would have been better for me if I had travelled to a properly staffed tertiary centre than my local DGH, even though it is 90 mins away. We need honesty and transparency in all areas of health, and I suspect increased death and complication rates are already a fact if you happen to live in the wrong post-code.

Rosie Taylor in  the Times 13th September reports: Alarm grows over A&E waiting times

The number of patients kept waiting at A&E departments in England reached its highest level in a decade last year, prompting warnings that pressure on the NHS would rise this winter if it faced the “perfect storm” of high demand and a no-deal Brexit.

Patients kept waiting at least four hours more than trebled in the past five years. Last year only 88 per cent of patients were seen within four hours compared with 98.3 per cent ten years ago, according to the NHS’s Hospital Accident & Emergency Activity 2018-19 report.

Separate NHS figures show that last month was the busiest August ever.

Tim Gardner, senior policy fellow at the Health Foundation charity, said: “A no-deal Brexit would only exacerbate these pressures, intensifying staffing shortages, driving up demand for hard-pressed services, disrupting supplies of medicines and other necessities, and stretching the public finances which pay for healthcare.”

Helen Fidler, deputy chairwoman of the British Medical Association’s consultants’ committee, said: “This summer emergency departments had their busiest August on record. As we move into what will undoubtedly be a difficult winter the situation will get worse . . . A no-deal Brexit threatens to pile even more pressure on overworked staff.”

A&E attendances last month were up 6.4 per cent on the same month last year. Although doctors treated an extra 1,200 patients within four hours, the percentage of people seen within that time dropped from 89.8 per cent to 86.3 per cent.

About 24.8 million people attended emergency departments in 2018-19, a 21 per cent increase on the 20.5 million who visited in 2009-10. However, while attendances rose 2 per cent year-on-year, the population has grown by only 1 per cent a year over the same period.

Miriam Deakin, director of policy and strategy at NHS Providers, which represents hospitals, said the sheer dedication of staff was stabilising A&E performance despite a record number of patients. However, she added: “This winter will be a very testing time for trusts. We anticipate that performance will slip even further, with patients waiting longer for treatment across various services.”

Rising demand has also increased the time patients are left on trolleys. Last month 362 patients waited for more than 12 hours in A&E after it had been decided to admit them, more than double the figure for August last year.

An NHS spokesman said that in July a record number of patients were seen within two weeks of referral for urgent cancer checks, routine tests or treatment for serious mental health problems. He added: “Every part of the health service is playing its part in meeting the rising demand for care.”

Treatment or cure. In cancer the UK lags behind many other systems. No wonder nobody copies us.

It is odd for the WHO to report on the UK when it had previously said that it would report on 4 systems. The earlier the diagnose cancer the better your chance of survival. With a shortage of GPs and access to diagnostic manpower (GP, Radiology, pathology etc) it is not surprising that the UKs 4 systems perform badly. There is a post code lottery in all care, but especially cancer, in the UK. There is also a lottery in handover from oncology treatment to palliative and terminal care. Those trusts who can make this interface more humane and efficient will save more money for better outcomes for those who need treatment for cure.

update 13th September. Times leader: Cancer complacency

Medscape: Why is the UK Bottom of the Global Cancer Survival League Table?

Image result for cancer therapy cartoon

In Scotland the Herald announces today that the UK is “Stuck at the bottom of the cancer survival league”.

And Laura Donelly in the Telegraph points out that ovarian cancer survival in the UK is equivalent to Norway 20 years ago!

in the Guardian attributes Australia’s better result to earlier diagnosis.

Cancer Research Uk reports 11th September 2019: Measuring up: how does the UK compare internationally on cancer survival?

…the latest figures, covering 1995 to 2014, reveal some stark differences in cancer survival between countries. Generally, cancer survival is higher in Australia, Canada and Norway than in Denmark, Ireland, New Zealand and the UK.

…But despite the improvements, there’s clearly more work to be done in the UK.

Science Daily comments: Cancer survival in high income countries is improving, but international disparities persist

An observational study including 3.9 million cancer cases in seven high-income countries between 1995-2014 finds that survival of seven cancers is generally improving, although the overall level and pace of improvement varies between countries and for each cancer type.

The Guardian hails the improved figures but notes how far behind Australia and Canada we are. UK Still behind…

In a world where nobody trusts any experts, who will trust the UN report? Not our politicians it seems…

Terrifyingly, according to the World Health Organisation definition the UK no longer has a NHS

To paraphrase Spike Milligan: “I told you the Health Services were all ill”.

The Brexit deadline and the Health Services planning – standards and services are going to get worse..

Image result for cancer therapy cartoon

Even London and the Home Counties are feeling the squeeze… as standards and staff numbers fall re revert to the pre-NHS divide.

Just some of the pain felt in the rural shires is now feeding into London and suburbia. Standards of staffing and clinical diagnosis and speed are all falling. The blame is long term political neglect and denial from an elected elite who always felt they had access to the best – in London. No longer… it is impossible to report on all GP surgery closures as there are so many. The reality is that private services for ambulance, GP, A&E etc will follow… Bevan wanted the same high standards for the miners as the bankers – instead the standards are falling, but as before we had a health service, the bankers can afford the private option.

Owen Sheppard for MyLondon reports 7th September 2019: West London overspends by £112m!!

GP surgeries across Surrey are facing an uncertain future, with two confirmed closures and a third possibly following suit, which are set to put pressure on those nearby.

Patients say they are worried about the pressures on neighbouring services following the announcement of closures of surgeries in Staines and Guildford.

In Burpham, a petition has been launched to save the Burpham New Inn surgery which is also facing closure.

So why are surgeries closing?

The Guildford and Waverley Clinical Commissioning Group (CCG) has cited problems with leases and premises, which have led to the closures of two practices in the area.

In Staines, the Staines Thameside Medical Practice shut on Saturday (August 31) following a decision by the doctors to end their contract with the NHS to provide GP services. This was reportedly due to personal reasons.

Patients will lose the St Nicolas branch surgery in Bury Fields, Guildford, which will close at the end of October following issues with the premises and its lease.

Guildford and Waverley CCG has confirmed the surgery will close on October 24. All services will instead be provided by the main surgery at Guildford Rivers Practice in Hurst Farm, Milford.

One St Nicolas patient, who did not wish to be named, said: “I am very upset about the closure of St Nicolas Surgery, it came as a shock.

“[I believe] this was pre-planned since last year but without telling patients previously. I have not received a letter as yet about the closure.

“I think it’s been about a year that all the telephone calls to St Nicolas Surgery have been re-directed to the general practice in Milford.

“The closure of St Nicolas Surgery will put extra pressure on other GP surgeries in Guildford as patients who are ill, disabled, elderly or who don’t drive won’t be able to get to Milford.”

The CCG has said it will work with the practice to ensure that despite the changes, patients will continue to receive high quality care.

A spokesman said: “The CCG received an application from Guildford Rivers Practice that proposed the closure of its branch surgery, St Nicolas Surgery, due to issues with the premises and the lease which was proposed to have had a negative impact on the service offered to patients.

“Following a period of engagement with patients and neighbouring GP practices, the application to close the branch has now been approved by Guildford and Waverley’s Primary Care Commissioning Committee (PCCC).”

The spokesman added: “Registered patients of Guildford Rivers Practice will remain so, following the branch closure, with GPs from St Nicholas Surgery transferring to the main site and continuing to offer appointments to patients.

“Any patients who require home visits will continue to receive these in the usual way.

“The practice is committed to providing the best service for patients by operating solely from the Guildford Rivers Practice main site and the CCG will work with the practice to ensure patients continue to receive safe and high quality care moving forward.”

The news comes as patients await the decision on the future of Burpham’s New Inn surgery. A decision was set to be made on August 28 but this has been delayed.

A spokesman for Guildford and Waverley CCG said: “The PCCC has been re-arranged to ensure every option put to the CCG is fully explored, before a final decision is made.

“The committee has been rescheduled for September 13.”

In a letter to patients sent on July 31, the CCG said it was likely the New Inn Surgery in London Road would have to close later in 2019 due to problems securing a long-term home.

The letter said the surgery’s lease was expiring and no other suitable alternative sites have been found.

Patients launched a petition to save the surgery, which has been signed by 282 people to date.

Staines

Around 4,500 patients have had to re-register with another GP surgery after Staines Thameside Medical Practice closed its doors on Saturday (August 31).

Other GP surgeries in the area are accepting new patients despite some having recently had their lists capped.

Two Staines councillors are concerned about the additional pressure on those surgeries.

Councillor Jan Doerfel, Green Party member for Staines, said: “Expecting other GP practices to absorb the additional 4,500 patients is likely to result in longer waiting times for all those affected and additional travel for those that had to enrol with those practices. This is not acceptable.”

Councillor Veena Siva, Labour member for the ward, said: “Yet another GP surgery closes. Smaller practices are closing due to underfunding and insufficient GPs which means they can no longer be run safely and sustainably.”

She added: “As it stands, it is unfortunately no surprise that there was no interest from GPs to take over the surgery when in doing so all they would face is under-resourcing, enormous pressure and stress.”

NHS North West Surrey Clinical Commissioning Group (CCG) was responsible for supporting patients as they switched to a different GP service.

St David’s Family Practice Doctor Jagit Rai works at one of the surgeries receiving patients from Staines Thameside and is a governing body member at NHS North West CCG.

Doctor Rai said: “The closure of this practice does not relate to funding or staff shortages. The CCG was disappointed to receive notification from GPs at Staines Thameside of their decision to end their contract with the NHS to run the surgery.

“They made this decision due to a change in personal circumstances that could not have been predicted or planned for. The CCG asked neighbouring practices about the option to take over the running of Staines Thameside and reviewed their capacity to take on new patients.

“The surgeries decided the best way to care for Staines Thameside patients is at their practices where they can benefit from an established team and range of services.”

It’s slightly brighter news for the residents in Chiddingfold, where a new surgery is being built after the former building was destroyed by a fire.

Chiddingfold Surgery in Ridgley Road was gutted on January 7, 2019.

Plans were submitted in March to Waverley Borough Council for the complete rebuild.

The surgery has relocated to Cedar ward at Milford Hospital, where full doctor and nurse surgeries are in place. Expanded opening hours are available for patients at Dunsfold surgery.

Update : Diane Taylor in the Guardian 8th September 2019: London GPs told to restrict specialist referrals under new NHSThe New “Rationing Plan”. Plans for new cuts sent same day Boris Johnson reinforced NHS spending commitments..