Patient and Public Engagement Event Wednesday 13 March 2019 12:30pm - - PowerPoint PPT Presentation

Patient and Public Engagement Event Wednesday 13 March 2019 12:30pm for registration 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

12:30pm-1pm Sign in, refreshments and networking 1pm–1:10pm Welcome Kevin Sheridan, Lay Member for Patient and Public Engagement 1:10pm-1:30pm Enfield CCG corporate update Dr Mo Abedi. Chair of Enfield CCG. 1:30pm-2:00pm Transformation programme update Plans for 2019/20 - Planned and unplanned care Stephen Wells and Clare Kapoor Group work 2:00pm-2:45pm Medicines safety and polypharmacy Deanne Moonsie and Paul Gouldstone 2:45pm-3:30pm Primary Care Strategy workshop John Piesse and Peter Lathlean 3:30pm–3:50pm Questions and Answers session with the Governing Body 3:50pm Thank you and event closes Kevin Sheridan, Lay Member for Patient and Public Engagement 5

Enfield CCG Update

Dr Mo Abedi, Chair

Corporate Update

• Enfield CCG Governing Body meetings – quarterly from

April 2019 onwards. Details of meetings on our website

• NCL Joint Committees in place: NCL Joint

Commissioning Committee and Primary Care Co- Commissioning Committee in Common

• The NHS Long Term Plan – Integrated Care Systems

(ICS) – Enfield InterGreat event

• Updated NCL PoLCE policy- available on website
• Decommissioning the Minor Ailments Scheme

Local clinicians working with local people for a healthier future

• In 2018/2019, Enfield CCG is planning a total spend of £462.725m. The CCG

started 2018/2019 with an underlying deficit of £13.6m.

• As at month 10, the CCG was forecasting an in year financial deficit of £20m

with additional risk of £3.75m cost pressures not yet reflected in the position.

• 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.

• Looking ahead to 2019/20, the CCG is working to an indicative gross

transformation programme of £22m 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 programme delivery particularly challenging this year.

2018/19 Financial Plan

NCL STP update

We are currently recruiting resident representatives to be involved in the next stages of our review of Adult Elective Orthopaedic Services. We think it is likely that we will formally consult on options for this service in Autumn 2019, and we would like resident representatives to be involved in shaping the options we consult people about. We will be staging a number of discussion workshops, for patients, residents and clinicians, and some patient and resident focus groups. We are keen to have a wide range of representatives from all backgrounds and experiences as part of this exercise, and training will be offered so that people can participate with confidence. The dates are:

• Friday 15 March, training to participate in workshops (below):

10.30am to 12 midday (TBC)

• Monday 18 March, workshop: 9.30am to 12.30pm (nearest tube Warren Street)
• Monday 1 April, workshop: 9.30am to 12.30pm (nearest tube Warren Street)
• You can apply online: https://s.surveyplanet.com/eh9yEHIuo

Local clinicians working with local people for a healthier future

Transformation Programme Update Plans for 2019/20 (Planned and Unplanned Care) Stephen Wells, Head of Performance & Planning and Clare Kapoor, Head of Unplanned Care

2019/20 QIPP Programme

11 The CCG’s approach to Service transformation in 2019/20 will focus on three domains:  Urgent & Emergency Care  Planned Care  Continuing Health Care Enfield CCG is also focusing work to identify opportunities in areas where difficult choices may need to me made, these are also being considered by the NHS, as part of the NHS Long Term Plan, for example:

• Procedures of Limited Clinical Value;
• Prescribing Self-Management (over the counter medicines);
• Referral Management Service (supporting the national reduction in managing elective

care);

• MSK Physiotherapy/Triage & Assessment (triage review process implemented);
• Recommissioning selected services (cost of new services lower than current costs);
• Review of high cost drugs working with acute care providers;

Urgent and Emergency Care – 2019/20 onwards

The CCG will be embarking on a 3 year plan to support patients requiring urgent and emergency care with the aim to alleviate some of the pressure in the system so that it can cope with increasing demand. In 2019/20, the focus will be on:

• Children and Young People – Targeted areas include respiratory conditions such

as Asthma;

• Working Age Adults (18-64) – Planning to support patients within this age group to

manage their care and to access the best service for their health care needs. – Pathways – looking at end to end care pathways so that patients can be managed outside of hospital – Communications – supporting communities to understand where to go for help to ensure right service first time.

• Frail and Elderly – Community provision to manage within the homecare setting,

strengthen access to other services, focus on prevention and early intervention  Commission enhanced rapid response system primarily aimed at severely frail and maximise flow in from NHS 111, London Ambulance Service, GP Practices with Community Health Services in Emergency Departments;

NHS 111

NHS 111 Online campaign The recently launched NHS 111 Online campaign highlights the new option for people to access the NHS 111 service online, which is now available across most

• f England. The campaign encourages people to use

either the online service (111.nhs.uk) or dial 111, instead of worrying, self-diagnosing or second- guessing what they should do when they have an urgent health problem. The target audience is all members of the public, over the age of 16. Social channels will specifically target the 20-29 age group who may be more likely to use the online service. The new catch up TV ad can be viewed here: https://www.youtube.com/watch?v=N1flJsbM4es

NHS App

NHS App - Enfield CCG is the first CCG in London to go live with the new NHS App. The NHS App is a new, simple and secure way to access a range of NHS services via smartphone or tablet. It is available to the public on Google Play and Apple app stores. If you are an Enfield resident you can download the NHS App now so that you can:

• book and manage appointments at your GP surgery
• rder repeat prescriptions
• securely view your GP medical record
• check your symptoms
• find out what to do when you need help urgently
• register to be an organ donor
• choose how the NHS uses your data

GP practices are being connected to the app gradually following a successful pilot, which ran between September and December

• 2018. All functions of the app should be fully available across

England by 1 July 2019, after all GP practices are connected. More information about the NHS App is available via the NHS website: https://www.nhs.uk/using-the-nhs/nhs-services/the- nhs-app/

NHS England has launched the next phase of the Help Us Help You campaign. This phase aims to increase people’s use of community pharmacy services by encouraging them to access clinical advice and support. The primary audience for this campaign is all adults who are suffering minor health conditions – such as coughs, colds, tummy troubles and aches and pains – that do not require a GP appointment, with a secondary focus on parents and carers

• f children. The campaign will raise awareness that

community pharmacists are qualified healthcare professionals and that local pharmacy teams offer a fast and convenient clinical service for minor health concerns with no appointment needed. The campaign will run until the end of March with TV, video on demand, social, partnership activity and specific Black, Asian and Minority Ethnic (BAME) and disability groups’ communications. All GP practices should have received their packs containing campaign materials in the post for display in patient waiting areas. More information is available via the NHS website: https://www.nhs.uk/staywell/

Help Us Help You – Pharmacy advice campaign launched

Questions

Planned Care Programme 2019/20

In 2019/20 we will continue our focus on areas that impact on long term care and quality of provision which include: Cancer - improve prevention, early detection (particularly reducing patients being diagnosed in A&E) and adherence to treatment targets - improvements in patient pathways will support all of these ambitions; Diabetes – working with primary care to manage prevention; nutritional education to improve and reverse diagnosis, working hand in hand with our voluntary sector partners; Long Term Conditions – creating a system that manages these conditions in a planned way, working with our providers to develop an outcomes based approach to care; Primary Care – eliminating variation, standardised offer of care, and developing a sustainable workforce for the future;

Planned Care Programme 2019/20

Ophthalmology From April 2019, you will be able to go straight to your local high street optometrist for minor eye conditions. They will also be responsible for looking after you if you require Cataract Surgery, ensuring you understand what will happen during the procedure, that you are an appropriate candidate for the surgery and then they will manage your post surgery care. MSK service To create a seamless service with a single point of access, triage that incorporates the First Contact Practitioners for back pain management. Self referral will be the normal way for you to access the service; we will also develop self-help and on-line educational tools to support you with self management Chronic Pain – We have developed a community chronic pain service supported by consultants, psychologists, physiotherapists and support staff; this enables a multidisciplinary-led approach to managing your care . Evidence-based clinical guidance shows that care that is easily accessible, closer to peoples homes encourages people to actively and persistently commit to attending appointments and manage their recovery Cardiology – to transform pathways of care and service standards and change the pattern of how people use healthcare by establishing a “one stop clinic” approach, with access to diagnostics and treatment provided by a multidisciplinary team delivered closer to home. Respiratory Services Transforming pathways of care and service standards as with cardiology

• services. Giving people confidence that their care can and will be managed safely and quickly in a

community setting, removing the reliance on acute hospital care unless needed.

Operational Planning Guidance 2019/20

Cancer

• Improve uptake of screening for bowel, cervical and breast cancers,
• Rollout of qFIT in the bowel screening programme and HPV in the cervical

cancer screening programme,

• Development of NCEL Cancer Alliance
• Commission additional activity for colposcopies and cancer treatment from

screening tests, Urgent and Emergency Care

• London target of 80% proportion of NHS 111 calls receiving clinical assessment;
• Increase the number of patients triaged by NHS 111 that are booked into a face-

face appointment to greater than 40%;

• Designate urgent treatment centres;
• Reduction in ambulance conveyance to ED;
• 100% ambulance handovers within 30 minutes;
• Ensure Trusts are providing (12 hours per day/ 7 days a week) with the aim of

delivering 30% of NEL admissions via SEC by March 2020;

• 40% reduction in long stay patients by March 2020;
• Reduce delayed transfers of care (DToC);

Operational Planning Guidance 2019/20

Primary Care

• Primary Care Nurse Development Programme;
• Reduce variation in achievement of the diabetes treatment targets.

Mental Health

• Five Year Forward View;
• Mental Health Investment Standard;
• Expansion in capacity and capability of Children’s and Young People’s

Mental Health services;

• Improving access to psychology therapies (IAPT);
• Core24 teams to reach 50% of acute hospitals by 20/21.

Elective Care

• Maintain Referral To Treatment Waiting Times (as of March 2019 ).

Questions

Workshop sessions

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2:00pm-2:45pm Medicines safety and polypharmacy Deanne Moonsie and Paul Gouldstone 2:45pm-3:30pm Primary Care Strategy workshop John Piesse and Peter Lathlean

Medicines

Medicines Management Pharmacist NHS Enfield CCG

Introduction

• At some point we will all feel ‘under the

weather’

• Not ourselves
• Help & advice on health
• Speak to friends/relatives/neighbours
• Research on internet

Local clinicians working with local people for a healthier future

Visit the pharmacist

Local clinicians working with local people for a healthier future

Pharmacists role

• An estimated 95% of people visit a pharmacy at least
• nce per year
• Community pharmacies are easily accessible, providing

convenience and anonymity in a relatively informal setting

• No appointment needed to see a pharmacist, can

consult them in confidence in private consulting areas

• Examples of services provided; Smoking cessation

advice and treatment, chlamydia testing and treatment, flu vaccinations, health checks – BP, cholesterol

• Sell medicines after consultation e.g. morning after pill,

thrush, eye drops

Local clinicians working with local people for a healthier future

Practitioners

• Visit Optician/dentist
• Go to the GP
• See the GP practice nurse
• GP hub
• Urgent Care Centre
• Go to A + E

Local clinicians working with local people for a healthier future

GP Hub

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Urgent Care Centres

Local clinicians working with local people for a healthier future

All urgent care services are provided 365 days of the year.

Chase Farm Hospital 8am – 9 pm North Middlesex Hospital 9am-10pm Barnet Hospital 9am-11pm

Consultations

• Each registered patient visits GP on

average 4.91 times per year

• 40 - 91% of GP consultations result in a

prescription

• 73% pharmacist consultations

recommend a medicine

• 37% people buy medicines without any

advice

• Opticians & Dentists can recommend

medicines to buy if needed

Local clinicians working with local people for a healthier future

Why are medicines used

• Correct treatment – evidence based
• Prevent worsening of symptoms
• Specialist advice
• Patient expectations

Local clinicians working with local people for a healthier future

Polypharmacy

• Literally means ‘many medicines’
• People taking 5 or more medicines
• Problematic when medicines are

continued without review

• No longer appropriate or needed

Local clinicians working with local people for a healthier future

Medicine use in Enfield /person

Local clinicians working with local people for a healthier future

Age (years) Average

• No. of

medicines National Average All 3.53 3.53 >65 4.79 4.58 >75 5.29 5.01 >85 5.50 5.30

Medicine use in Enfield

Local clinicians working with local people for a healthier future

Age (years) > 10 medicines (%) National Average (%) All 5.88 5.22 >65 10.17 8.15 >75 12.45 9.58 >85 12.74 10.27

Taking medication

Local clinicians working with local people for a healthier future

ADVANTAGES DISADVANTAGES

Appropriate polypharmacy will extend life expectancy Increase risk of side effects Improved quality of life Reduced quality of life Medicine use will be

• ptimised & evidence

based Remembering how and when to take tablets There can be an increased risk of drug interactions

Medicines Review

• Pharmacist
• GP
• Specialist nurse
• Hospital
• All medicines reviewed including over

the counter (OTC)

Local clinicians working with local people for a healthier future

Medicines Review

• Patient Centredness - what matters to you?
• Aims - Do you think the medicine is making you feel

better? Think about what is important to you about your treatment

• Need - is the medicine essential? Could lifestyle

changes mean the treatment objectives are achieved?

• Effectiveness - is the medicine controlling your

symptoms?

• Safety - is the medicine making you unwell (side

effects)?

Local clinicians working with local people for a healthier future

Local clinicians working with local people for a healthier future

Annual reviews

• Yearly basis with GP / practice nurse
• Review symptoms, medicines
• Diabetes
• Asthma
• Depression
• Learning difficulties

Local clinicians working with local people for a healthier future

Diabetes

• Important for diabetes to be diagnosed as early

as possible because it will get progressively worse if left untreated

• 1 in 15 people in UK
• Complications can seriously damage your heart,

eyes, feet and kidneys

• Smoking cessation
• Keeping active & Healthy diet
• Flu jab

Local clinicians working with local people for a healthier future

Self Care

• People have a key role in protecting their own

health, choosing appropriate treatments and managing long-term conditions

• Help Us Help You campaign - including Flu

vaccine

• Over-the-counter (OTC) products currently

prescribed include remedies for dandruff, indigestion, mouth ulcers and travel sickness

Local clinicians working with local people for a healthier future

Antibiotics

• Bacteria becoming resistance to antibiotics

e.g. TB

• Drug discovery slowed down
• Antibiotics don't work for viral infections

such as colds and flu, and most coughs and sore throats

• Many mild bacterial infections also get

better on their own without using antibiotics

Local clinicians working with local people for a healthier future

Thank you for listening

.

Local clinicians working with local people for a healthier future

Any questions?

Local clinicians working with local people for a healthier future

Questions and Answers session

DRAFT

General practice as the foundation of the NHS

A North Central London Strategy for General Practice Implementation in Enfield

2018 - 2021

• I won’t have to rely as much on my GP to interpret information for me
• I’ll be able to access the information and advice I need to make more decisions for myself
• I’ll understand which services to use and when
• I can plan my care with people who work together to understand me and my carer(s), allow me

• My health records will be up to date and services that help me will be able to access them
• I will tell my story once
• The professionals involved with my care talk to each other; we all work together as a team

• I won’t have to go to hospital so much
• Investigations such as blood tests and ECGs can be done in alternative places to the hospital

• I can book and cancel appointments online, when it suits me; I won’t have to visit the GP, miss

• I can order repeat prescriptions online; I don’t need to make a special trip to my surgery to place

• I can see my health and care records and can decide who to share them with. I can correct any

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Our vision: what people want now

DRAFT

• More health and care will be available in the community, or out of hospital,

• At the heart of the care closer to home model is a ‘place-based’ population

• There are many excellent services in north central London; the health and

• f GP practices and their registered patient list (the name of which will vary

• Health and care partners, including social care and the voluntary, sector will

• We will work towards addressing the sustainability and quality of general

Our vision: resilient, sustainable and thriving general practice

• Develop and work with organisations within the system who have the capability to support general

• Build capacity and capability within the general practice workforce, ensuring people are seen by

• Work with partners in recognition of the changes in general practice workforce to test new models
• f care and demonstrate the impact of any new roles, e.g. portfolio careers, pharmacists,
• ccupational therapists, physios in general practice
• Explore more alignment of terms and conditions for general practice staff (retention and

• Work towards rebalancing the investment in general practice, recognising the historical variation in

• Encourage the development of general practice at scale provision, including at network,

• For at scale general practice providers working in partnership with their CCGs using a data-driven

• Additional skills and capacity in general practice: patients’ care is of a good

• Increased and more consistent security of service provision as a result of

• Development of new employment models; the workforce will change; a

• A valued and motivated workforce with training and development for a

• Staff enjoy their work and achieve a good work life balance; NCL is the

• Staff enabled to work at the top of their licence, so increasing

• Collaborative and integrated working will deliver economies of scale and

• GP partners will feel supported by strong management teams, so enabled

DRAFT

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• Invest in quality improvement support teams (QISTs), focusing on delivering high

• Work collaboratively towards commissioning more services through outcomes-based

• Regularly review evidence and good practice, supporting initiatives with the potential

• General practice will enable an holistic, strengths-based and more systematic

• Support patients and carers to be actively involved in their own care, working in

• Strengthen the patient and carer voice in developing of local person-centred service

• Continue to work closely with partners including local authority, public health,

• Improved outcomes, experience and patient satisfaction
• Consistent high-quality care across general practice; safer, less (unwarranted)

• Care will be centred around each person so they won’t need to have multiple

• Patients will have the knowledge, skills and confidence to enable them to work

• Working towards all practices achieving good or excellent CQC ratings
• Easy access to shared good practice (e.g. policies, procedures, protocols)
• Technology used to support long-term conditions management and safe

• Collaboration through partnership working with patients who are informed and

Our vision: high quality, equitable and safe, person-centred care

DRAFT

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• Focus on timely access to general practice, making sure that everyone can

• Focus on continuity of care for people with complex care needs, people

• Encourage practices to work together and share resources, to deliver a full

• Ensure that all services provided within the core and enhanced contracts

• Improved (and less variable) access to general practice services
• Continuity of care for those patients that need it most
• Better management and care of long-term diseases; when they are frail and elderly,

• More access to and use of digital technology, with more responsive care, delivered in

• Improved ability to book appointments
• Unregistered patients supported to register and access services
• People with more complex health and care needs will benefit from face to face

• Reduced duplication through improved sharing of data, and improved productivity, e.g.

• Use of new technology, e.g. symptom checkers, e-consultations, will lead to reduced

• Through closer working relationships with the wider MDT, GPs and their teams will feel

DRAFT

Our vision: proactive, accessible and coordinated care

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• Support the development of care and health integrated networks, through which teams of

• Work with system partners, including other health, local authority and voluntary, third sector

• ur partners; community/ integrated services should be able to access those people who do not

• Work with partners to support the development of an NCL strategy for care homes, to ensure

• QISTs will coordinate the management of people on population health management registries

• Use digital technology to improve information sharing to support 24/7 access to care, electronic

• Provide general practice with the tools to support patients to navigate their way through care,

• Patients will be able to access more care locally from a range of service

• General practice will remain the gate keeper to care, but patients will be

• Enhanced patient experience with as smooth and uncomplicated as

• patients who would benefit from support are identified early and those

• Access to a broader range of clinical skills will enable a multi-disciplinary

• Access to patient information broadened through a common clinical IT

• Integration minimises the risk of duplication
• GPs and other health and care professionals will feel like valued

DRAFT

Our vision: integrated services that respond to the needs of the patient and the population

• childhood. He lives in Enfield, with his mother, who has mental health problems and a mild learning disability. She

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Primary care networks (PCNs) are central to delivering

• ur vision

A working definition

• Primary care networks enable the provision of proactive,

accessible, coordinated and more integrated primary and community care improving outcomes for patients. They are likely to be formed around natural communities based on GP registered lists, often serving populations of around 30,000 to 50,000. Networks will be small enough to still provide the personal care valued by both patients and GPs, but large enough to have impact through deeper collaboration between practices and others in the local health (community and primary care) and social care

• system. They will provide a platform for providers of care

being sustainable into the longer term.

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Primary care networks (PCNs) are central to delivering

• ur vision

The core characteristics of a primary care network are: Practices working together and with other local health and care providers, around natural local communities that geographically make sense, to provide coordinated care through integrated teams A defined patient population in the region of 30,000-50,000 Providing care in different ways to match different people’s needs, including flexible access to advice and support for ‘healthier’ sections of the population, and joined up care for those with complex conditions Focus on prevention and personalised care, supporting patients to make informed decisions about their care and look after their own health, by connecting them with the full range of statutory and voluntary services Use of data and technology to assess population health needs and health inequalities, to inform, design and deliver practice and population scale care models; support clinical decision making, and monitor performance and variation to inform continuous service improvement Making best use of collective resources across practices and other local health and care providers to allow greater resilience, more sustainable workload and access to a larger range of professional groups

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New Workforce

Through a new Additional Roles Reimbursement Scheme, PCNs will be guaranteed funding for an up to estimated 20,000+ additional staff by 2023/24:

• Clinical pharmacists (from 2019/20)
• Social prescribing link workers (from 2019/20)
• Physiotherapists (from 2020/21)
• Physician associates (from 2020/21)
• First contact community paramedics (from 2021/22)

The Additional Roles Reimbursement scheme will meet a recurrent 70% of the costs of additional clinical pharmacists, physician associates, physiotherapists, and first contact community paramedics; and 100% of the costs of additional social prescribing link

• workers. By 2023/24, the reimbursement available to networks amounts to £891 million
• f new annual investment.

Each Network will have a named accountable Clinical Director – they will play a critical role in shaping and supporting their Integrated Care System and dissolving the historic divide between primary and community care. Each Network will receive an additional

• ngoing entitlement to the equivalent of 0.25 WTE funding per 50,000 population size to

contribute to the costs of this role. This equates to £2.01/head in 2019/20.

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Key issues for discussion:

To implement these key initiatives what are the priorities for Enfield within the following:

• Workforce
• Harnessing Technology
• Primary Care Estates
• Integrated Care
• Working at Scale

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Questions

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Ask us anything!

Panel questions and answers session

Key dates for your diaries

Governing Body Meetings 20 March 2019 1:30-3:30pm Holbrook House, Cockfosters Road, Barnet, EN4 0DR 22 May 2019 1.30-3.30pm Holbrook House, Cockfosters Road, Barnet, EN4 0DR 24 July 2019 1.30-3.30pm Holbrook House, Cockfosters Road, Barnet, EN4 0DR Patient and Public Engagement Meetings 12 June 2019 1-4pm (registration from 12.30pm) venue to be confirmed 30 October 2019 1-4pm (registration from 12.30pm) venue to be confirmed Patient Participation Group (PPG) network meetings Tuesday 4 June 2019 6-9pm venue to be confirmed. For Chairs and members of PPGs and staff at member practices who support patient groups only. 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.

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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