15 November 2025
Lingfield and Dormansland Community Centre
Title: Upcoming changes to the NHS and challenges within Primary Care
Chaired by Clive Jecks
Presenters: Dr Chandarana and Dr Qureshi
Introduced by CJ, who explained the purpose of the meeting and the importance of feeding back into the surgery, so improvements that affect service users can be made.
The Lingfield surgery partners, Dr Chandarana and Dr Qureshi then took it in turns to present (see PP attached).
Current set up of the practise:
Current workload for surgery is ever expanding, with current population being 11,318. The surgery has 4 GPs, 1 locum GP and 1 new GP recruited and due to start in December as a ‘frailty GP’. This frailty GP is a new role, supporting patients either approaching frailty or already frail, and is a home visiting service only, which will feed into the multi-disciplinary team. There are also care home visits once a week. The GPs are complemented by other healthcare professionals such as clinical pharmacists, an advanced clinical practitioner (paramedic by background), 2 nurses as well as administrative staff.
There are new initiatives being rolled out such as a cholesterol injection. However, the GPs pointed out that many of the NHS initiatives have strict guidelines as to who can benefit from them. One example is the weight loss drugs, whereby patients must meet certain criteria to qualify.
The GPs were keen to highlight that the registered nurses were only available on certain days of the week. They can perform complex wound management. For simple dressings, these can be done by the HCAs (health care assistants) who have been trained up in this area.
Upcoming changes to the NHS:
With the average life expectancy for males at 83 and females at 85, there is a growing elderly population. This puts considerable pressure on the NHS, which has been considered in the NHS 10 year plan.
Recently the government announced the disbanding of NHS England, to be replaced by the Department of Health. Locally the DoH is run by ICBs (Integrated Care Boards). Below the ICBs there will be ‘neighbourhoods’. These neighbourhoods will aim to reduce hospital admissions by up to 60%- however there is limited evidence as to whether this will work. The neighbourhood for our area is called Dorking Health care (DHC). The new community contracts are trying to align with councils, as well as trying to bring Consultants closer to patients.
One impact of this re-shuffle is that hospitals that once used to be used to speed up referrals (North Downs in Caterham, Queen Victoria in EG), no longer can (for certain treatments).
Current Challenges:
The change in ICB structure and contracts, means the next 5 years (everything in the NHS works in 5 year cycles) are ging to be tough.
Staffing, particularly in nursing is increasingly difficult, as nurses are no longer choosing to do community work. The current nurses working at the practice are retirement age, and despite recruitment campaigns, there has been no success. The plan is to train newly qualified nurses up. This has been successful for doctors, as both GPs are qualified to train new doctors as part of a ‘grow your own’ initiative. However, nationally there are not enough jobs for Drs in training, so keeping moral up in this sector can be challenging.
The current premises of Lingfield Surgery was discussed in depth. In short, it is too small for the requirements of the growing population and treatment requirements. Moving from paper medical notes to electronic notes some years ago meant some storage space could be changed into clinical space, but there is need for more. The proposal to build a brand-new purpose-built surgery on the site of Lingfield House, was rejected, so is being appealed. The GP partners will be attending a planning committee meeting in December to try and persuade the committee members of the urgent need for a new surgery.
The NHS uncertainty is a huge challenge to the surgery. Not being able to refer to QVH for all services, even though it’s our closest hospital, (because it sits in Sussex, not Surrey which is where the contract is) is frustrating for the GPs and inadequate for the patients (but out of the GPs’ hands).
An NHS Facebook page is apparently being introduced. This will be managed by the NHS, not by the surgery. There is a request for the PPG to be involved with this.
Questions were then taken from the public. Key points were:
- The old system of having a ‘named doctor’ is gone for numerous reasons, but predominantly: there are not enough GPs; an increasing population; and changing NHS which is putting an increased pressure on GP surgeries. However, the surgery does its best to work as a multi-disciplinary team. Their daily workload typically consists of 32 face to face consultations with patients and then 50 administrative tasks.
- The population using the surgery has grown substantially since Dr Cliff started there, which was around 9000. When Dr Qureshi started it was 10,800 and now sits at 11,318 and is due to rise. Yet this is managed with no extra resources.
- There was a compliment from a member of the public about the care his wife and father received. Then a discussion about alternative models of care/triage.
- There was a further question about a new surgery, and whether the current premises had been explored fully for expansion. The GP’s explained they had max’d out the current floor plan. Had looked at various options, including expanding backwards (towards the park behind), but apparently not possible.
- GPs meet every Monday to discuss patients for awareness of issues and joint collaborative working.
- Finally, there was acknowledgement that the surgery and partners do an amazing job. They were thanked for their hard work and commitment to the community.
CJ finished off by informing everyone that there is a Wellbeing meeting at St Peters and St Pauls Church in Lingfield on 26th November 2025
Services
- Dermatological surgery
PPG Public meeting
- •
Ear syringing
Ear microsuction
Dr Chandarana
15/11/2025
- •
- Coils, pessaries and implants
Joint injections
hr BP and ECG
Dr Qureshi
- •
Visiting Frailty GP with frailty mdt
New cholesterol management injection and weight loss injection
- •
Care home ward rounds
Complex wound management vs simple wound management
Population: 11318
Current workload
Upcoming Changes to the NHS
- Time from booking to appointment
Within 24 hours
Count of appts
7618
%of total
50.55
%
Cumulative %
50.55
%
- Stats
year plan
Within 48 hours
Within 7 days
1317
2.16
8.74
%
%
52.71
61.45
%
%
- •
Neighbourhood model coinciding with the pcn model
Multi-neighbourhood providers- DHC
Within 14 days
Within 21 days
5030
33.38
4.68
%
%
94.82
99.51
%
%
- New community contract- Surrey wide- GP led
Grand Total
Over 21 days
15070
100.00
0.49
%
%
100.00
%
Staff
Challenges
- •
- 4
GPs, 1 locum GP, new GP recruit starting in late December, Frailty GP.
nurses, 1 locum nurse, 3 health care assistants
- LCS contracts
Staffing
- •
paramedic practitioner
- •
Premises
- 1
advanced prescribing clinical pharmacist
pharmacy technician
- Uncertainty
Facebook page
- 1
prescribing physiotherapist
