Patient and Public Engagement Event Wednesday 12 June 2019 1pm-4pm - - PowerPoint PPT Presentation

Patient and Public Engagement Event Wednesday 12 June 2019 1pm-4pm Committee Room, Holbrook House, Cockfosters Road, Barnet, Herts, EN4 0DR

Welcome

Kevin Sheridan Lay Member for Patient and Public Engagement

Housekeeping

• No fire alarm is planned today. If you hear the alarm,

please follow the CCG fire warden who will help you to evacuate.

• Please turn your mobile phones off or put them on

silent

• Please help yourself to refreshments throughout the

event

• Feedback forms will be emailed to you after the event

and a small number of printed copies are available

• This is the first time we have used Holbrook House

as a venue. Please tell us what you what think of today’s event on the feedback form and tell us about topics you would like to see at future events.

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• 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 or a North Central London CCGs

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 - we will add your email address from the

sign-in sheet to our list OR 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

Agenda

1:00pm-1:30pm Sign in, refreshments and networking 1:30pm-1:40pm Welcome Kevin Sheridan, Lay Governing Body member for Patient and Public Engagement 1:40pm-2:00pm Enfield CCG corporate update Dr Fahim Chowdhury Workshops 2:00pm-2:45pm Commissioning a new community phlebotomy service Clinical lead – Dr Yogasakaran Arjuna Management Lead - Philippa Mardon 2:45pm-3:30pm Chase Farm Urgent Care Centre Clinical Lead - Dr Fahim Chowdhury Management Lead – Clare Kapoor 3:30pm - 3:40pm Clinical Advice and Guidance Management Lead –Julian Chiew 3:40- 3:50pm Launch of new ophthalmology service Management Lead - Philippa Mardon 3:50pm - 4:00pm Questions and Answers session with the Governing Body 4:00pm Thank you and event closes Kevin Sheridan, Lay Governing Body member for Patient and Public Engagement 5

Enfield CCG Update

Dr Fahim Chowdhury

Corporate Update

• New interim Chief Officer for Enfield CCG from 21 May – Rob Larkman.

John Wardell is currently on long term sick leave. Rob Larkman recently covered for Chief Finance Officer NCL CCGs, Simon Goodwin’s sick leave has agreed to cover for John for the duration of his sick leave. Rob is a very experienced Chief Executive and we are pleased that he has agreed to join us in Enfield.

• Enfield CCG Governing Body meetings are now quarterly from April 2019
• nwards. Details of meetings on our website. Next meeting is on 19 June

1:30-3:30pm at Holbrook House.

• NCL Joint Committees already in place: NCL Joint Commissioning

Committee and Primary Care Co-Commissioning Committee in Common. Details on the CCG’s website. http://www.enfieldccg.nhs.uk/about-us/north- central-london-ccgs.htm The meetings are held in public.

Local clinicians working with local people for a healthier future

Primary Care Hubs

• Enfield CCG’s procurement committee has formally agreed not to renew the GP

hubs single point of access (SPA) telephone service contract. With effect from Monday 1 July the 03000 333 666 telephone number will no longer be available.

• The SPA number was initially set up due to technical and IT issues at the time of

establishing the GP hubs service. These technical and IT issues have since been resolved.

• From 1 July onwards patients will be required to request a GP hubs appointment

via their own GP practice directly during core opening hours, or via NHS 111 weekday evenings, weekends and bank holidays when the practice is closed.

• To support these changes a pre-recorded message will be added to the SPA line

provided by LCW, so that if patients call they can be signposted appropriately. Enfield CCG will support the withdrawal of materials promoting the SPA number and will replace with the nationally bran ded ‘Help Us Help You’ campaign materials for GP extended access service. We will also notify relevant stakeholders, such as Healthwatch Enfield and other community and voluntary

• rganisations, in advance of the SPA number close down.
• All GP practices will be required to update their answerphone messages and

individual practice websites accordingly before the changes are implemented on 1 July.

Local clinicians working with local people for a healthier future

• Enfield CCG’s reported deficit for 2018/19 was £24.8m. After adjusting for non-recurrent

items, the underlying position was a deficit of £14.6m.

• For 2019/2020, Enfield CCG is planning to a planned deficit of £15.4m which equate to a

total spend of £505.3m. There is potentially a net risk of a further £6.3m.

• In order to deliver to the plan, the CCG is working to a gross transformation programme
• f £18m which will need to phased and supported by investment. As well as contractual

agreements with acute providers, successful delivery will require an integrated approach to patient care across involving primary care, mental and community health and voluntary

• sector. The plan is expected to improve the patient journey and/or maximise the use of

finite resources. Although the CCG has a developed and mature transformation programme, many of the easily achievable efficiency areas have already been adopted in recent years making transformational delivery vital.

• North Central London commissioners and acute providers continue to work collaboratively

to develop and implement the Sustainability and Transformation Plan (STP) assumptions to ensure that the Enfield CCG and the North Central London wide the financial control total is achieved.

Finance update

NCL STP update

Local clinicians working with local people for a healthier future

NCL Orthopaedic review We are recruiting six local people to be part of the review process looking at options for the future of planned bone and joint surgery. http://www.northlondonpartners.org.uk/ourplan/Areas-of-work/Ortho- service-review/get-involved.htm Three residents representatives opportunities:

• Analytics Board
• Digital Board
• Neurology

Role descriptions on the website: http://www.northlondonpartners.org.uk/getinvolved/residents-representatives.htm NCL STP website http://www.northlondonpartners.org.uk/

Public consultation on proposed move of Moorfields Eye Hospital services (City Road)

Local clinicians working with local people for a healthier future

A public consultation is running on a proposal to move Moorfields Eye Hospital’s services to a new centre, bringing together excellent eye care, ground-breaking research and world-leading education in ophthalmology. The consultation is running from Friday 24 May to and Monday 16 September and your views are sought. Eye care services would move from the current hospital at City Road, London, along with Moorfields’ partner in research and education, the UCL Institute of Ophthalmology and Moorfields Eye Charity. Have your say Download the consultation documents at Oriel-london.org.uk/consultation-documents For more information – including many different ways you can take part in the consultation go to oriel-london.org.uk/get-involved/

Community Phlebotomy Service

Philippa Mardon, Dep Director Transformation, Planning & Delivery

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Local clinicians working with local people for a healthier future

• The current Enfield community phlebotomy service provider is

North Middlesex Hospital (NMUH).

Current provision

• Freezywater Primary Care

Centre

• White Lodge Medical Practice
• Forest Road Primary Care

Centre

• Evergreen Surgery
• Winchmore Hill Practice
• Grovelands Medical Centre
• GP surgeries:
• Domiciliary

phlebotomy service

Local clinicians working with local people for a healthier future

• The Royal Free Hospital Trust also provided an un-commissioned

practice phlebotomy service.

• This service ceased as of 31st March 2019.

Recently ceased provision

• Abernethy House Surgery
• Carlton House Surgery
• Cockfosters Medical Centre
• Eagle House Surgery
• Gillian House Surgery
• Highlands Practice
• Lincoln Road Medical

Practice

• Oakwood Medical Centre
• Riley House Surgery
• Southgate Surgery
• Trinity Avenue Surgery
• Willow House Surgery
• The Woodberry Practice

Local clinicians working with local people for a healthier future

• Chase Farm Hospital and NMUH provide access to blood tests

Monday to Friday, from early morning till late afternoon, but provide no weekend provision.

• BEH will bleed patients for those already on District Nurse

caseload.

• Domiciliary service does not do urgent blood tests.
• If urgent blood test required then, as a failsafe, only option is A&E.
• Reduced convenience and longer travel times are concerns that

have been raised by practices, and local stakeholders.

Gap/Variation in system?

Local clinicians working with local people for a healthier future

• What do you think about the current

community phlebotomy and domiciliary service?

Feedback

Local clinicians working with local people for a healthier future

• What should a 21st century service look like?
• How should it operate?
• What should it include?
• New patient survey:

http://www.enfieldccg.nhs.uk/news/phleboto my-services-patient-survey/84494

• Would you like to join patient group?

What are the aspirations for a future community phlebotomy service?

Local clinicians working with local people for a healthier future

Questions

Chase Farm Hospital Urgent Care Centre

Dr Fahim Chowdhury Clinical Vice Chair, Enfield CCG Clare Kapoor Head of Unplanned Care, Enfield CCG

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Local clinicians working with local people for a healthier future

The Urgent Care Centre (UCC) at Chase Farm Hospital (CFH) opened in January

• 2013. The UCC was open from 9am-9pm,

365 days of the year. In January 2015, the CFH UCC opening hours extended from 8am-10pm. The extension to the opening hours has continued.

Background

Local clinicians working with local people for a healthier future

The Royal Free London has approached commissioners about the possibility of reducing the opening hours of the Chase Farm UCC by one hour with the last patient being booked at 9pm. We would like to hear your views on the

• pening hours at Chase Farm Hospital Urgent

Care Centre.

Background

Local clinicians working with local people for a healthier future

We have been seeking clinical view from local health care partners. We have a GP online survey in place, have presented at GP events and are in the process of meeting with local partners, upon request.

Clinical View

Local clinicians working with local people for a healthier future

CFH UCC Activity

Local clinicians working with local people for a healthier future

UCC Activity by Borough

The main users of UCC services at the Chase Farm site are Enfield patients followed by Hertfordshire residents. During the last hour of service there is a lower % of Enfield resident attendances compared to overall attendance. General activity is at 82% Enfield residents but this drops to 70% during 9pm-10pm. This may indicate that users are travelling to this service as other services have already closed by this time. Summary of 9pm-10pm attenders:

• 70% Enfield
• 10% from East and NE HERTS
• 5% from Haringey
• 4% from Barnet
• 3% from Herts Valley
• 8% from other areas but not neighbouring boroughs

Local clinicians working with local people for a healthier future

UCC Activity

Chase Farm Urgent Care Centre Activity

Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Number of attenders 3458 2930 3386 3228 3565 3581 3587 3153 3500 3482 3561 3334 Average attenders per day 112 105 109 108 115 119 116 102 117 112 119 108 Average hourly attenders 2100- 2200hrs 3 2 2 4 3 4 4 4 3 3 3 4

Data provided by RFL Jan-Dec 2018

The last hour of service between 9-10pm is the quietest hour of the day, with 1,139 attendances in 2018. This is an average of 3-4 patients who present in the last hour and is 2.75% of daily activity.

Local clinicians working with local people for a healthier future

UCC Activity

Legend Scale

The busiest hours at the UCC are 8am -12 noon. Monday and Wednesday are the two busiest days of the week and generally weekdays are busier than weekend.

Data provided by RFL Jan-Dec 2018

Local clinicians working with local people for a healthier future

UCC by Age

Age split by % Age Band 9pm-10pm Total Activity 9pm-10pm 0 - 17 241 9,152 34.9% 18 - 64 400 16,303 57.9% 65 - 74 35 1,988 5.1% 75 & Over 15 2,193 2.2% Grand Total 691 29,636 Arrival by Age

Data provided by NEL CSU 2018/19

Greatest service users during 9-10pm are the working age adult group between the ages of 18-64. Followed by 35% children and only 7%

• ver the age of 65.

UCC activity by age 9pm-10pm UCC activity by age all hours

Local clinicians working with local people for a healthier future

UCC by Gender

Gender 9pm-10pm Female 56.4% Male 43.6% Data provided by NEL CSU 2018/19

UCC activity by gender

Local clinicians working with local people for a healthier future

Data has been grouped by main symptom.

• 64% illness
• 32% injury

This would support the use of the GP out of hours service at CFH site for the majority of attenders and this would limit the need to travel to other services.

UCC reason for attendance

Allergy 5 Asthma 7 Bite 13 Celluitis 1 Cough 34 D&V 18 Dental 1 Diabetes 1 Dressing 22 Foreign body 20 Heart 2 Infection 93 Injury 324 Lump 18 Mental health 4 Pain 245 Pregnancy 5 Rash 59 Respiratory 18 RTA 15 Stroke 1 Swollen 22 Temperature 77 Tonsillitis 15 Unkown 76 UTI 38 Virus 2 Wound 3 Grand Total 1,139

Local clinicians working with local people for a healthier future

Travel time analysis

Alternative services to CFH UCC include Barnet Hospital UCC and North Middlesex Hospital UCC. Although anyone attending with an illness can been seen by the GP

• ut-of-hours service if appropriate, accessible via 111.

Travel time analysis is detailed below.

Local clinicians working with local people for a healthier future

While engagement on these proposals is ongoing, the Chase Farm UCC remains open to walk-in patients from 8am-10pm. The integrated urgent care service (GP Out of Hours) which is based at the Chase Farm Hospital UCC from 6:30pm - 8am, 7 days a week. Access to this service is via NHS 111.

CFH UCC

Local clinicians working with local people for a healthier future

Public engagement 24th June to 19th July 2019: Please fill in the online questionnaire. Your views can be submitted anonymously. The survey and seeking views will be supported by Enfield Healthwatch. If you would like to talk to someone about the proposed change to Chase Farm UCC’s opening hours, you can contact enfccg.communications@nhs.net

How can you help?

Local clinicians working with local people for a healthier future

Public engagement:

• Questions we should we ask?
• Additional information required that

members of the public may want to know?

How can you help?

Local clinicians working with local people for a healthier future

Questions

Clinical Advice and Guidance

Local clinicians working with local people for a healthier future

Julian Chiew Primary Care Development Manager

As part of a national drive, Enfield CCG is rolling out a new way for GPs to request clinical advice and guidance from Consultant, and other Secondary Care based colleagues, through an electronic, and fully auditable method. This is done using the e-Referral Service (e-RS), the National platform through which referrals are booked into hospitals (formerly known as Choose and Book). GPs can request advice via the e-RS portal, including test results etc. and a Consultant from that specialty will be able to review the information and provide advice, a management plan, or recommend a referral. If a referral is recommended, the patient still has the right to be seen at any hospital

• f their choosing, regardless of which hospital the original request was sent to.

Clinical Advice and Guidance

Benefits of using Advice and Guidance

• Allows GPs to clarify test results/seek advice
• Provides a platform for GP learning
• Saves patients from having to travel to hospital when not required to
• Advice can be given within a number of days, rather then patients waiting for

potentially months for an appointment

• All Patients have access to consultant level advice through their GPs through

this system

• Helps to reduce pressure within hospitals by reducing demand for outpatient

appointments

• Full accountability – System automatically records actions giving a complete,

un-editable audit trail.

• Minimal disruption - Nationally supported system which is already established

in Enfield

• Helps to make better use of Health Service resources
• Reinforces “Right Place, Right Time” ethos.

Thank you for listening Any Questions?

New ophthalmology service

A new enhanced optometrist service is going to be on the 17th June 2019. This is an enhanced primary eye care service managed by Primary Eyecare Services. They will link a number of optometrist practices across Enfield and other parts of NCL to provide the following;

• Glaucoma and cataracts screening
• Minor Eye Conditions assessment and treatment

The service will be advertised to patients and a list of participating practices will be uploaded onto the CCG’s website. Patients can directly access the service, or will be redirected into it by other local services.

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Ask us anything!

Panel questions and answers session

Key dates for your diaries

Governing Body Meetings 19 June 2019 – 1:30-3:30pm 18 September 2019 1:30-3:30pm 18 December 2019 1:30-3:30pm All meetings take place in the Committee Room at Holbrook House, Cockfosters Road, Barnet, Herts, EN4 0DR Patient and Public Engagement Meetings 30 October 2019 1- 4pm (registration from 12.30pm) venue to be confirmed Patient Participation Group (PPG) network meetings For Chairs and members of PPGs and staff at member practices who support patient groups only. Wednesday 4 September 2019, 2-5pm, venue to be confirmed Thursday 5 December 2019, 6-9pm, venue to be confirmed Please email enfccg.communications@nhs.net to be added to our stakeholder list and be notified

• f news and events.

All events are advertised on our website: www.enfieldccg.nhs.uk; Twitter @EnfieldCCG and in local newspapers.

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Patient representative opportunities

Urgent Care We need one patient representative to join a working group. Phlebotomy We would like patients to join a patient reference group to support the design of the new Enfield service. All patient opportunities are uploaded on: http://www.enfieldccg.nhs.uk/volunteering-opportunities.htm

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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