Freshford Surgery

Freshford Hall redevelopment plans include designs for a new GP surgery for Freshford. Starting in 2013, the trustees were in discussion with the partners at Beckington Family Practice with regard to moving their branch surgery from its previous premises in the Younghusband Trust building, Freshford to a new purpose built extension at the Hall. During 2019 and early 2020 discussion moved to the stage of negotiating on an agreement to lease in order to secure up-front support for ongoing rental payments from the NHS (the Clinical Commissioning Group – ‘CCG’) prior to starting any fundraising and build works. 

All GP Practices reclaim rent for their premises from the CCG. The Beckington Family Practice (‘the Practice) falls under the Somerset CCG while Freshford and Limpley Stoke are in B&NES and Wiltshire CCG’s respectively. The rent paid by the practice at Freshford surgery’s old location was very low, reflecting the fact that the building does not meet current standards. It was (temporarily) closed in April 2018 following a CQC inspection which found that the old premises were inadequate. 

Rent at new surgery premises at Freshford Village Memorial Hall (‘the Hall’) – designed to current NHS standards - was assessed at £22k/yr, 4+ times historic rent. Somerset CCG’s budget is flat and therefore extra rent for Freshford would have to come from savings elsewhere. Some increase might be justified but a 4x increase, for a building only used for the equivalent of 2 whole days/week would be difficult to support. The Trustees proposed a novel agreement that would give the Practice (and therefore the CCG) a 50% rent reduction in return for sharing the building with other private health professionals, such as physiotherapists, audiologists, podiatrists etc. The Hall would receive some guaranteed rent from the Practice topped up with payments from other users of the space. Both the Practice and the CCG were initially supportive of this proposal.

The Practice looked into whether the Freshford surgery could be used more than 2 days/week, but given its location on the edge of their patch and forecast patient numbers over the coming years, 2 days/week remains their maximum anticipated usage.

The Practice had some concerns with the sharing model - mainly the additional cost of adequate cleaning and tidying of the surgery, between their sessions and those of other tenants. These expenses are not reimbursable by the CCG and so must be borne by the Practice. Until very recently they assumed that additional dispensing income would offset these costs.

The Practice’s application to re-open the Freshford surgery at the Hall was submitted to the CCG for decision in January 2020 (alongside an application to permanently close the old surgery). The trustees found out, the day before the meeting, that the CCG did NOT support the application, partly on the basis of value for money (the 50% saving from sharing was largely ignored), but primarily because Freshford and Limpley Stoke lie outside Somerset CCG, so money spent “would not benefit the residents of Somerset”! Following a last minute intervention by Hall Trustees, the decision was deferred for the CCG to gather more information.

The Practice wrote to the CCG in February 2020 saying that their dispensing income had dropped and is likely to drop further. This, together with the additional costs of sharing meant they thought the new surgery would no longer be financially sustainable. They also said that GPs prefer to work in larger centres and therefore it may be challenging to find staff to work in a small branch surgery. The Trustees made a further proposal to the Practice to help mitigate some of their costs, but unfortunately the final decision was taken by the CCG on 10th March 2020 not to re-open the surgery.

The Trustees approached the Combe Down Practice (in B&NES) in early January 2020 to investigate them taking on the surgery space instead. They expressed some initial interest which was then put on hold because of the Covid pandemic. Unfortunately in November 2020, the Hall trustees heard that with more practice closures in Bath, the planned shift in patient numbers to the Combe Down Practice from those closures, as well as Covid and the NHS reset that will follow, the Combe Down practice had decided that they simply did not have the time or resources to devote to a practice premises expansion into Freshford and to do it properly and in the way it deserves. 

The trustees will now review the surgery component of the Community Right to Build Order to assess whether other appropriate users of the space can be identified which will still bring a strong benefit to the community.