9:30am for registration 10am-1pm Executive Suite, Dugdale Centre, - - PowerPoint PPT Presentation

Patient and Public Engagement Event Wednesday 7 March 2018 9:30am for registration 10am-1pm Executive Suite, Dugdale Centre, Enfield

Welcome

Teri Okoro Lay Member for Patient and Public Engagement

Housekeeping

• No fire alarm is planned today. If

you hear the alarm, please make your way outside

• Please turn your mobile phones off
• r put them on silent
• Please help yourself to

refreshments throughout the event

Local clinicians working with local people for a healthier future 3

Agenda

9:30am - 10:00am Sign in, refreshments and networking 10:00am - 10:10am Welcome Teri Okoro, Lay Governing Body member for Patient and Public Engagement 10:10am - 10:20am Enfield CCG update Dr Mo Abedi, Chair 10:20am- 10:50am Quality, Innovation, Productivity and Prevention (QIPP) 2017/18 highlight and look forward for 2018/19 Mark Eaton, Director of Recovery/Transformation 10:50am- 11.20am Primary Care Transformation Achievements Peter Lathlean, Primary Care Development Manager 11:20am- 11:50pm Care closer to home workshop– which services should Enfield CCG commission to be delivered in the community? Management lead – Mark Eaton Clinical lead - TBC 11:50am- 12:20pm Primary Care workshop Clinical lead - Dr Mo Abedi Management lead – Peter Lathlean 12:20pm - 12:30pm Feedback from group sessions (including a vote on best text message) 12:30pm - 12:55pm Questions and Answers session with the Governing Body 12:55pm - 1:00pm Thank you and event closes Teri Okoro, Lay Governing Body member for Patient and Public Engagement

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Enfield CCG Update

Dr Mo Abedi, Chair

Enfield CCG’s Corporate Objectives

Updated Corporate Objectives for 2017/2018 Corporate objectives 2017/2018 a) Deliver financial sustainability b) Improve the quality of local health services c) Value and look after staff d) Work across health and social care to deliver seamless care for our patients e) Do things once, either locally or across North Central London f) Engage patients, carers and stakeholders in our decision making

Finance Update

Financial position in 2017/18 Our financial plan for 2017/18 was a year-end cumulative deficit of £35.1m on the assumption that a £2.1m surplus would be made in year based on assumptions at the planning stage. However we are currently forecasting a deficit of £6m which would take our cumulative deficit to £43.2m in 2017/18 (i.e. £8m away from control total). What we plan to spend in 2018/19 We are still in the process of producing our plan/budget for 2018/19 and as a minimum we are required to budget for in year break-even to ensure financial sustainability. This would require financial efficiencies of around £23.8m in 2018/19 (this compares to £22.8in being required in 2017/18).

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Dr Debbie Frost Chair Barnet CCG Dr Neel Gupta Chair Camden CCG Dr Mo Abedi Chair Enfield CCG Dr Jo Sauvage Chair Islington CCG Dr Peter Christian Chair Haringey CCG Helen Pettersen North Central London Joint Accountable Officer Kay Matthews Chief Operating Officer Barnet CCG Start Date: 1 June 2017 Sarah Mansuralli Local Executive Director* Camden CCG Start Date: 1 July 2017 John Wardell Chief Operating Officer Enfield CCG Start Date: November 2017 Tony Hoolaghan Chief Operating Officer Haringey and Islington CCGs Start Date: 1 June 2017 Simon Goodwin Chief Finance Officer Start Date: 1 June 2017 Will Huxter Director

• f

Strategy Start Date: 5 June 2017 Paul Sinden Director of Performance and Acute Commissioning Start Date: May 2017 Shared North Central London role Local CCG role

Organisational Structure for North Central London Clinical Commissioning Groups

Key:

* The Camden Local Executive Director post reflects the integrated commissioning

management structure adopted by Camden CCG and Camden Council in 2016. The CCG Local Executive Director works in partnership with the Director of Integrated Commissioning at Camden Council. The Local Executive Director post has the same responsibilities as the Chief Operating Officer posts in other North Central London CCGs

Strategic Challenges in NCL

• Prevention. Prevention and population health needs to be central to
• ur plans to reduce the health and wellbeing gaps, care and quality gaps,

and finance and efficiency gaps in North Central London (NCL).

• Financial challenge. Developing the STP has led to a common

understanding that we operate as a system in deficit.

• Delivery of the Sustainability and Transformation Plan.

The Sustainability and Transformation Plan (STP) provides a plan for our system to work together to better meet the needs of the population, improving quality, and setting out how local services will evolve and become sustainable over the next five years.

• Continuing to deliver value and reduce variation in care.

We know across the range of providers in North Central London (NCL) there are inequalities in outcomes, service quality, and unwarranted variations in cost.

• Redefining our business as usual. The Five Year Forward View sets out

new models of care many of which support delivery of our Sustainability and Transformation Plan (STP).

System Intentions for 2018/19 Principles for Working Together

 Partner organisation will work together for the benefit of local people;  We will involve local people on our design, planning and decision-making;  Partner organisations will find innovative ways to cede current powers and controls to explore new ways of working together;  We will be open, transparent and enabling in sharing data, information and intelligence in all areas including finance, workforce and estates;  Partner organisations will find ways to risk-share during transformational change;  We will find ways to share joint incentives and rewards;  Partner organisations will make improvements by striving to be the best together;  We will be rigorous in ensuring value for money and financial sustainability.

About the Sustainability & Transformation Plan (STP)

STP triple aims:

• 1. Close gaps in Health & Wellbeing
• 2. Close gaps in Care and Quality
• 3. Close gaps in Finances

http://www.northlondonpartners.org.uk/

Local clinicians working with local people for a healthier future

Questions

Quality, Innovation, Productivity & Prevention (QIPP) 17/18 Highlights and Look Forward for 18/19

Mark Eaton Director of Recovery/Transformation

17/18 QIPP Highlights

The CCG is on track to deliver £15m of Net Savings in 17/18 whilst continuing to deliver high quality services. Some of the highlights for this are shown below:

• Our extended access hubs have delivered more 26,000 additional patient

appointments in the community reducing the pressure on A&E.

• Our Community Anticoagulation Service has shifted nearly 30% of all follow up

activities into the community reducing the demand for secondary care services.

• The Locally Commissioned Service for Atrial Fibrillation has identified nearly

1,000 more patients with the condition. Over the next five years this is estimated to ensure that 30 Strokes are avoided.

• Our Community Ophthalmology Service is now seeing nearly 1,300 patients

per month and reducing demand for secondary care services.

• The use of Teledermatology in partnership with the Royal Free Hospital is

helping both to reduce waiting times and reduce the costs of secondary care.

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17/18 QIPP Highlights

• 38% more patients are being ambulated rather than admitted at North

Middlesex Hospital meaning that they avoid the need for an overnight stay and also helping the hospital reduce pressure on beds.

• Through improved management of our Mental Health resources we have

managed to reduce the number of patients who need to be sent out of the borough by more than 40% and are on track to reduce this by 70% within 6 months.

• We have eliminated the backlog off patient with Diabetes waiting for education.
• Our Community Heart Failure and COPD Services continue to contribute to

improving outcomes for patients and helping them avoid unplanned admissions.

• We have dramatically reduced the amount of Estate that the CCG is

responsible for managing that is ‘void’.

• We have a well developed Transformation Plan and have reduced the CCG’s

dependency on non-recurrent claims and challenges.

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Look Forward to 18/19

• Increasing investment in Primary Care and Community Services to support the

proactive management of patients with Long Term Conditions, Older People and Children.

• Putting in place new ways of helping patients who attend A&E to ensure that our

system can cope with increasing pressure.

• New models of care for a wide range of services including MSK, Dermatology,

Cardiology and Gynaecology that will reduce pressure on scarce hospital resources and provide care closer to home.

• Continued focus on reducing medicines wastage and supporting prescribing

decisions.

• Increasing the amount of support and advice available to GPs from hospital

specialists and increasing access to diagnostics that can be directly accessed from primary care.

• Continued transformation in the services we provide to patients with mental

health needs to ensure they get the right support in the right place.

• Continued focus on reducing the CCG’s Running Costs and Estate Costs.

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Local clinicians working with local people for a healthier future

Questions

Primary Care Transformation Achievements

John Piesse – Head of Primary Care Commissioning Peter Lathlean – Primary Care Development Manager

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Local clinicians working with local people for a healthier future

• Pan – Enfield GP Federation
• Enfield Single Offer
• Extended Access
• Walk in Services
• Long Term Condition Hub
• Enablers
• IM&T
• Estates
• Workforce

Content

Pan – Enfield GP Federation

• Enfield Healthcare Cooperative Ltd

formed (Nov 2017).

• Federation comprises of 8 directors –

equal representation for all four localities.

• Commissioned to deliver Enfield's ‘Single
• ffer’ – a collection of 8 locally

commissioned services.

Local clinicians working with local people for a healthier future

Enfield Single Offer

• The ‘single offer’ is a consolidation of 8 Locally Commissioned

Services:

– AF & Pre-diabetes – Stable Prostate Cancer – Latent tuberculosis (TB) – Medicines Optimisation – Locality Commissioning – Diabetes Quality Improvement Support Teams – Patient Experience – 7 day access for Wound Care Management

• Services selected to address:

– Improving access and outcomes for patients managed within general practice – Equitable access for all Enfield residents – Reduce acute and emergency admissions

• This collection of services will result in £1.2m being invested into

general practice over the following 12 months.

Local clinicians working with local people for a healthier future

Extended Access Services

• Enfield CCG commissions three primary care access hubs:

– Carlton House Surgery – EN1 3LL – Evergreen Primary Care Centre – N9 0TW – The Woodberry Practice – N21 3LE

• These services provide access to GP and nurse appointments

between 18:30 - 20:00 weekdays and 8:00 – 20:00 on weekend and bank holidays.

• The extended access service has provided 448 days of a continuous

service – throughout this time the providers have never defaulted on providing the commissioned amount of appointments required on any given day.

• Evergreen Primary Care Centre is the closest purpose built care

centre within our borough to North Middlesex University Hospital’s Accident and Emergency department, only 1.5 miles away.

• Carlton House Surgery is the closest general practice facility to

Chase Farm Hospital’s urgent care centre – only 2 miles away.

• These site locations were chosen to ensure patients had a genuine

alternative to A&E/ UCCs commissioned within the borough.

Local clinicians working with local people for a healthier future

Extended Access Services - Continued

• Enfield CCG commissioned our extended

access provision from the first of December 2016 (first across North Central London).

• Enfield was the first access service to

commission a dedicated telephone booking service (03000 333 666). The service is staffed 8am – 8pm seven days a week.

• Enfield's utilisation of appointments is the

best in North Central London and one of the top in London.

Local clinicians working with local people for a healthier future

Extended Access Services - Continued

• Headlines

– Since December 2016 the service has provided 58,735 primary care appointments. – This equates to over 14,500 additional primary care clinical hours. – The service has collected over 2500 patient experience questionnaire responses, the largest survey commissioned by Enfield CCG.

Local clinicians working with local people for a healthier future

Extended Access Services - Continued

The chart reflects that 82% of patients would recommend the service to a friend and/ or family member. This has increased by 1% since the mid- point review. 95% patients using the service felt they received an appointment convenient for them.

Local clinicians working with local people for a healthier future

Extended Access Services - Continued

Over 50% of patients were seen within 5 minutes of their allocated appointment time. Only 2% waiting more than 30 minutes. Over 50% of patients gave our service 10/10 – less that 5% of patients provided a poor satisfaction rating.

Local clinicians working with local people for a healthier future

Extended Access Services - Continued

The graphic demonstrates that patients receiving treatment within the service are satisfied with the ‘5 care’ indictors.

Local clinicians working with local people for a healthier future

Extended Access Services - Continued

The chart demonstrates the service is absorbing a mixture of primary care and unscheduled care service demand. Since December 2016 the service has saved 8,222 A&E attendances and 7,048 attendances to Urgent Care Centres.

Extended Access Services - Continued

Hubs marketing activity to date:

• Placed several adverts in the local press.
• Placed advert in Enfield Council’s Our Enfield magazine (distributed to every household

in the borough).

• 3 different creatives were developed aimed at targeted audiences: Parents of young

children, those in full time work or education, young people.

• Outdoor advertising campaign comprising bus shelter adverts and adverts deployed at

every underground and train station across the borough. The campaign in total provided an estimated 3,760,000 opportunities to view. (Figures provided by advertising provider based on locations and footfall.)

• Details of the Hub service were shared with our stakeholders: Healthwatch Enfield,

Enfield Council, local MPs, community and voluntary organisations, PPGs.

• Over 100,000 text messages were sent to Enfield patients informing them of these new

services.

• Promoted the service via Enfield CCG website – one of the most viewed pages - and via

Twitter.

• Individual GP practice websites have been updated to promote the use of Hub services

and provide signposting information to alternatives to A&E, such as pharmacy, UCC.

• GP practice answering machine messages updated to promote 111 and Hub telephone

booking line.

Extended Access Services – Advertising campaign

Local clinicians working with local people for a healthier future

Walk in Services

• From October 2017 – Enfield has

commissioned 3 walk in centre services:

– Evergreen Primary Care Centre – Carlton House Surgery – Eagle House Surgery

• The service is open for all – irrespective of

their registered GP practice.

• On 17 and 18 February these services

provided an additional 600 GP appointments

• Most patients are seen within 30mins to 1

hour of arriving to the site.

Local clinicians working with local people for a healthier future

Long Term Condition (LTC) Hub

• Established January 2018 – the service is available only for

the north east locality patients – Practices within the north east can refer patients for 68 treatment areas including, long term conditions, physical (men’s and women’s health) and mental health services.

• The service is held at a local hub every Saturday and

Sunday.

• The service is diversifying the range of services to provide
• utreach clinics at the individual practice sites to improve to
• nsite access and patient convenience specialist services.
• The LTC Hubs ambition is to reduce unwarranted variation

in LTC outcomes across the locality and the reduce acute admissions.

Local clinicians working with local people for a healthier future

Enablers – Information Management and Technology (IM&T)

• Deployment of an ‘at scale’ clinical solution
• Deployment of data sharing agreements which allows:

– Access to patient records (via expressed consent) – Access to patient correspondence (patient letters) – Discharge of structured coded data back to general practice.

• Primary care refresh – Enfield CCG has invested £1m in replacing

technology at general practice.

• Deployment of general practice public and professional WIFI.
• Deployment of remote technology to support patient direct access to

care external to the GP practice.

• £200,000 invested in GP infrastructure improvements.

Local clinicians working with local people for a healthier future

Enablers - Estates

• Relocated 5 GP practices from converted

residential/council properties to purpose built health centres:

– Park Lodge to Winchmore Hill – Angel Surgery to Silverpoint – Dover House to Silverpoint – Chalfont Road to Evergreen PCC – Boundary Court to Evergreen PCC

• Reduction in general practice void space -

£400k savings made within 2017/18.

Local clinicians working with local people for a healthier future

Enablers - Workforce

• Over 45+% of both GP and nurses within the borough are over the

age of 55.

• General practice nurses programme – since 2016/17 recruited 15
• placements. Another 8 places are commissioned for 2018/19
• Medical assistant pilot – 16 places filled
• Health care assistants – 10 on apprenticeships
• Advanced Nurse Practitioners Programme – 3 existing places filled.
• Professional development opportunities

– Enfield ‘the movie’ promoting people to come work in Enfield. – Integrated multi-disciplinary learning network – upskill healthcare across Enfield. – Locum GP and newly qualified group.

Local clinicians working with local people for a healthier future

Additional Commissioning Commitments

• Personal Medical Services (PMS) Premium Specification - Improving Access.

– Service will provide at least 16.5 hours of consultations per week per 1,000 weighted patients with an appropriate clinician.

• x3 Alternative Provider Medical Services (APMS) - Provide General Practice provision on

Saturdays mornings

• 40/48 Practices provide the Extended Access – Enhanced Service

– Clinical sessions are provided outside of core contracted hours (8am-6.30pm for General Medical Services (GMS) practices and the hours set out in PMS contracts). – Opening hours must be in line with patient preferences either established through the GP patients survey, patient participation groups, the Friends and Family Test or other feedback. – The amount of extended access 30 minutes per 1,000 registered patient – Routine appointments must be provided in continuous periods of at least 30 minutes and in line with patient preferences, this can include face-to-face, telephone consultations, using

• ther technology or a mix.

– Extended hours access must be provided on a regular basis in full each week. – When a practice provides out-of-hours services it must not limit access to any of these clinical sessions to patients it would have been obliged to see under out of hours arrangements.

• SMS text messaging services – since April 2017:

– 522,368 text message reminders has been sent to patients. – 14,118 appointments have been cancelled. Appointments then released back into the system – The service is projected to have saved 1,413 A&E appointments as 10% of appointments no cancelled using these solution would have resulted in a A&E attendance.

Local clinicians working with local people for a healthier future

Local clinicians working with local people for a healthier future

Questions

Workshop sessions

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Group work: 11:20am-12:20pm Each topic is discussed for 30 minutes and then facilitators move to the next table. 11:20am-11:50pm Care closer to home workshop– which services should Enfield CCG commission to be delivered in the community? Management lead – Mark Eaton Clinical lead - TBC 11:50am-12:20pm Primary Care workshop Clinical lead - Dr Mo Abedi Management lead – Peter Lathlean

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Care closer to home

“The CCG is committed to delivering more care closer to home and to better supporting patients with complex needs such as those in care homes and people with multiple long term conditions such as Diabetes. What services and improvements to the way that care is delivered out of hospital and closer to home do you feel the CCG should be focusing?”

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Primary care

• Did we miss anything?
• How can you help?
• Design/ refine a new text message for patients. Here is a

message we sent out: If you need to see a GP or nurse at weekends 8am-8pm, book an appointment at our access hubs. Call 03000 333 666 or visit www.enfieldccg.nhs.uk for more info. (158)

• Your message needs to be:

No more than 160 characters (including spaces) It must include:

• GP & Nurse at weekends (22)
• 8am-8pm (7)
• Provide the telephone number 03000 333 666 (13)
• Provide a link to our website www.enfieldccg.nhs.uk

(21)

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Ask us anything!

Panel questions and answers session

• Your feedback is important to us
• We want to work closely with local people to

develop our plans

• We will ask you to fill in a feedback form (in your

pack) about today’s event.

• Please tell us what you what think of today and

tell us about topics you would like to see at future events.

Listening to you

• Join your GP practice’s Patient Participation Group (PPG). Ask your

practice if you can join. We have an active PPG network and an elected PPG representative Litsa Worrall who sits on the Governing Body

• Volunteer to be a patient representative and help us improve services

for local patients forms are available.

• Attend a Governing Body Meeting – dates are advertised on our

website, on Twitter and in the Enfield Independent

• Follow us on Twitter @EnfieldCCG
• Sign up to our mailing list – contact enfccg.communications@nhs.net
• Contact us if you would like someone to attend your voluntary or

community group meetings

• Visit our website www.enfieldccg.nhs.uk

How you can get more involved in the work of the CCG:

Key dates for your diaries

Governing Body Meetings Wednesday 21 March 2018 1.30-3.30pm Dugdale Centre, Thomas Hardy House, London Road, Enfield, EN2 6DS Wednesday 23 May 2018 1.30-3.30pm Committee Room, Holbrook House, Cockfosters Road, Barnet, EN4 0DR Wednesday 23 May 2018 1.30-3.30pm Committee Room, Holbrook House, Cockfosters Road, Barnet, EN4 0DR Wednesday 18 July 2018 1.30-3.30pm Millfield House, Silver Street, London, N18 1PJ Patient and Public Engagement Meetings For all Enfield residents and local stakeholders Wednesday 13 June 2018 2-5pm Executive Suite, Dugdale Centre, Thomas Hardy House, London Road, Enfield, EN2 6DS Wednesday 10 October 2018 2-5pm Executive Suite, Dugdale Centre, Thomas Hardy House, London Road, EN2 6DS Patient Participation Group (PPG) network meetings For Chairs and members of PPGs and staff at member practices who support patient groups only. Tuesday 13 March 2018 6-9pm Conference Room 1, Dugdale Centre, Thomas Hardy House, London Road, Enfield, EN2 6DS Monday 4 June 2018 1-4pm Executive Suite, Dugdale Centre, Thomas Hardy House, London Road, Enfield, EN2 6DS Monday 3 September 2018 6-9pm Executive Suite, Dugdale Centre, Thomas Hardy House, London Road, Enfield, EN2 6DS Tuesday 4 December 2018 1-4pm Conference Room 1, Dugdale Centre, Thomas Hardy House, London Road, Enfield, EN2 6DS Please email enfccg.communications@nhs.net to be added to our stakeholder list and be notified of news and events. All events are advertised on our website: www.enfieldccg.nhs.uk; Twitter @EnfieldCCG and in local newspapers.

Thank you for attending today’s event For more information

www.enfieldccg.nhs.uk Follow us on Twitter @EnfieldCCG Contact: enfccg.communications@nhs.net 0203 688 2814

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