Want to know what is happening with the future of health services in - - PowerPoint PPT Presentation

Patient and Public Engagement Event

Want to know what is happening with the future of health services in Enfield? Then come and talk to us.

Wednesday 16 November 2016

Room 1, Community House, Fore Street, Edmonton N9 0PZ

1

Welcome

Teri Okoro Lay Member for Patient and Public Engagement

2

Housekeeping

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

please make your way outside

• Please turn your mobile phones off or put them on

silent

• The toilets are on the ground floor
• You have a local GP and an NHS manager on each of

your tables. They are here to lead the group

• discussions. We have two group work sessions today.
• Please help yourself to refreshments throughout the

afternoon.

Local clinicians working with local people for a healthier future 3

Agenda

4

1:30pm - 2:00pm Sign in, refreshments and networking 2:00pm -2:05pm Welcome Teri Okoro, Lay Governing Body member for Patient and Public Engagement 2:05pm-2:20pm Enfield CCG update Dr Mo Abedi, Chair 2:20pm-3:00pm Adherence to evidence based medicine Clinical lead- Dr Jahan Mahmoodi, Medical Director Management lead -Gina Shakespeare, Project Consultant 3:00pm-4:20pm Workshops: Each topic is discussed for 40 minutes and then the facilitators will move to the next table. Session 1: 3:00pm- 3:40pm; Session 2: 3:40am-4:20pm GP Governing Body Members and CCG commissioners lead discussions on the following key areas: Sustainability and Transformation Plan (STP)- Clinical lead –Dr Mo Abedi; Chair Management lead- Deborah McBeal, Director of Primary Care/ Deputy Chief Officer Paediatric Assessment Unit (PAU) Consultation- Clinical lead- Dr Fahim Chowdhury, GP Governing Body member and clinical lead for maternity, children, young people and safeguarding children. Management lead- Claire Wright, Head of Strategy and Commissioning 4:20pm-4:40pm Feedback from the tables Clinical leads 4:40pm-4:55pm Questions and Answers session with the Governing Body 4:55pm-5:00pm Thank you and event closes Teri Okoro, Lay Governing Body member for Patient and Public Engagement for Patient and Public Engagement

Local clinicians working with local people for a healthier future

Enfield CCG Update

Dr Mo Abedi, Chair

5

Investing in Primary Care in Enfield

• Access to GP primary care services 8am – 8pm 7 days a week- Enfield CCG

has secured funding to deliver 8am – 8pm 7 day access to GP primary care services in line with the Governments’ General Practice Forward View. The funding will be used to establish up to 4 hubs across the borough

• Delegated commissioning- NHS England has authorised Enfield CCG to proceed

to apply for fully delegated commissioning of primary care GP services alongside the

• ther four CCGs in north central London (Barnet, Camden, Haringey and Islington).

This will mean that Enfield CCG will have a greater input into the decisions that are currently made by NHS England about primary care GP services in Enfield

• Practice nurse training- Following the successful recruitment of five nurses onto

the General Practice Nurse Trainee Programme last year, Enfield CCG has secured funding for a further eight places in 2017/18. Qualified nurses will undertake a year- long postgraduate training programme at the University of Hertfordshire while working within host practices in Enfield for the remainder of the week.

• Four general practice nurses in Enfield will be undertaking the Advanced Nurse

Practitioner Programme which will enable them to increase their range of skills and experience to see patients with a wider range of health conditions.

Local clinicians working with local people for a healthier future 6

Other developments in Primary Care in Enfield

• Family Nurse Partnership (FNP) programme -delivered by teams at Barnet,

Enfield and Haringey Mental Health NHS Trust (BEH) in partnership with NHS Enfield Clinical Commissioning Group and Enfield Council - is a home visiting service for first time mums, aged 20 or under, in Enfield

• North Central London integrated 111 and out-of-hours service started

in October 2016- The NHS in north central London – Barnet, Camden, Enfield,

Haringey and Islington Clinical Commissioning groups (CCGs) – has launched an integrated 111 and out-of-hours service. Run by London Central and West Unscheduled Care Collaborative (LCW), a GP-led, not-for-profit social enterprise, this combines the 111 service, which LCW already runs, and the GP out-of-hours service.

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Primary Care Work In Progress

• IT

– Digitalisation of records to free up practice space for clinical services – Integrated Digital Care Record – Patient online services – Electronic consultations

• Estates

– Local Estates Plan developed – Space utilisation surveys – Silverpoint opening in Autumn 2016 – Feasibility studies planned for Chase Farm, Alma and Ladders Wood regeneration areas – Potential new premises and extensions being scoped in all four localities

• Workforce

– General Practice Nurse programme – 5 new GPNs by February 2017, 8 new GPNs by February 2018 – Practice Nurse and Practice Manager mentoring schemes introduced – Workforce planning underway

• Services

– Integrated Commissioning scheme from July 2016 – AF and Pre-Diabetes scheme from October 2016 – GP See and Direct – 8am – 8pm / 7 day GP Service

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Feedback and Questions

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Adherence to evidence based medicine

Dr Jahan Mahmoodi, Medical Director Gina Shakespeare, Project Consultant

10

Balancing our Finances

• The CCG is obliged by the NHS Act 2006 to live within its annual budget

and at the moment is in ‘special measures’ as it has not been able to so

• The CCG has adopted polices concerning ‘Procedures of Limited Clinical

Effectiveness’ – these are clinical treatments where the medical evidence suggests the benefits to patients might be limited and particular thresholds or conditions are set before the procedure takes place - our current policy can be down loaded from the CCG’s website

• The CCG’s financial situation means it needs to explore ways to ensure

it achieves the very best value it can from the money it spends, including making sure the services we pay for are based on clinical evidence

• We are therefore comparing our clinical policies with the medical

evidence and with those of other CCGs, under the direction of our clinical leaders

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Considering Clinical Policies

We will start with areas where:

• a. Our research shows that other CCGs have adopted clinical

polices and we have not or they have adopted different polices from ours

• b. Our clinical Governing Body members consider there is a case

for change

• Today Dr Mahmoodi, our Medical Director we will share with

you three examples of where we think we can stick more closely to the clinical evidence and make savings as a result

• We’d welcome your feedback:
• Were the examples clearly explained - was the language used

too technical or about right? How was the level of detail you were given?

• What is important to you about the way we conduct our review?

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What does this mean in practice? Dr Jahan Mahmoodi GP and Medical Director, Enfield CCG

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Hernia – Activity & Spend

Activity 2015/16 663 Cost 2015/16 £1,102,771

ENFIELD CCG Data

Local clinicians working with local people for a healthier future

ENFIELD

Enfield CCG has not adopted a policy / criteria for conducting elective hernia surgery

North Central London

Other North Central London (NCL) CCGs do not have a Policy/Criteria regarding Hernia’s.

Other CCGs

Organisation Eligibility Criteria Exist

CAMBRIDGE & PETERBOROUGH CCG Y DEVON CCG Y MID ESSEX CCG Y WEST SUFFLOK Y HILLINGDON CCG Y

Hernia – Policy/Criteria Comparison

Local clinicians working with local people for a healthier future

Hernia - Cambridge & Peterborough CCG Criteria Example

SURGICAL THRESHOLD POLICY – CAMBRIDGESHIRE & PETERBOROUGH CCG Patients with symptoms of incarceration, strangulation or obstruction Surgery will be funded. Patients without symptoms of incarceration, strangulation or obstruction Femoral Hernia Surgery will be funded. Inguinal Hernia Patients with asymptomatic or mildly symptomatic inguinal hernias should not be referred. Surgery will not be funded unless there is:

• difficulty in reducing the hernia OR
• an inguino-scrotal hernia OR
• pain with strenuous activity, prostatism or discomfort significantly interfering with activities of

daily living Abdominal (including incisional and umbilical) hernia Surgery will not be funded unless:

• there is pain/discomfort significantly interfering with activities of daily living AND
• for patients with BMI≥30kg/m2, there have been attempts at weight reduction and these have

not resolved the pain/discomfort Divarication of Recti Surgery will not be funded Groin pain with clinical suspicion of hernia (obscure pain or swelling) These patients should not have diagnostic testing in primary care, but be referred for specialist

• assessment. Funding criteria for surgery are then applied as laid out in this policy.

Day surgery For patients meeting the criteria for day-case surgery and where day-case surgery is possible,

• nly day-case surgery should be funded.

Recurrent and bilateral hernia These are considered in the same way as primary hernias and funding criteria for surgery will be applied as described in this policy. Referral should be made to appropriate specialists with expertise in open and laparoscopic surgery.

Vasectomy – Activity & Spend

Activity 2015/16 26 Cost 2015/16 £19,189

ENFIELD CCG Data

Local clinicians working with local people for a healthier future

Vasectomy – Policy/Criteria Comparison

ENFIELD Enfield CCG has not adopted a policy / criteria for conducting vasectomies

Other CCGs

NCL

Organisation Eligibility Criteria Exist

BARNET CCG N HARINGEY CCG N ISLINGTON CCG N CAMDEN CCG N

Organisation Eligibility Criteria Exists

Harrogate and Rural District CCG Y – Restricted Scarborough and Ryedale CCG Y – Restricted (Under General Anaesthetics) Kent and Medway CCG Y – Prior approval Vale of York Y – Restricted (Under General Anaesthetics)

Local clinicians working with local people for a healthier future

Vasectomy – Scarborough and Ryedale CCG Criteria Example Referral Criteria/Commissioning position Vasectomies are routinely commissioned under local anaesthetic. GA procedures are only considered where: There are exceptional clinical circumstances when the requests for funding are submitted by the clinician to the Individual Funding Request (IFR) panel

Notes Most vasectomies are carried out under local anaesthetic. This means only the scrotum and testicles will be numbed.

Royal College of Obstetricians and Gynaecologists (RCOG)

The RCOG Guidelines recommend general anaesthetic will usually be used if there is a history of allergy to local anaesthetic and/or surgery has been carried out before on the scrotum or genital area. In this case, a request should be made to the IFR panel. The RCOG Guidelines also recommend a ‘no-scalpel’ approach as there are lower levels of complications such as bleeding, pain and infection, the use of fascial interposition or diathermy, clips are not used due to high failure rates; local anaesthetic is used wherever possible, effective contraception be used before the operation and until follow-up tests show the vasectomy has been successful and that practitioners must be trained to the level of the FSRHC requirement.

Hip & Knee Replacement Surgery – Activity & Spend

Activity 2015/16 567 Cost 2015/16 £4,206,033

ENFIELD CCG Data

Local clinicians working with local people for a healthier future

Hip & Knee Replacement Surgery – Policy/Criteria Comparison

ENFIELD NCL

Other CCGs

Organisation Eligibility Criteria Exists

BARNET CCG N HARINGEY CCG N ISLINGTON CCG N CAMDEN CCG N Organisation Eligibility Criteria Exists South Warwickshire CCG Y Kernow, Northern, Eastern and Western Devon, South Devon and Torbay CCGs Y Hull CCG Y South Norfolk Y North West London CCGs Y

Enfield CCG has not adopted a policy / criteria for conducting knee replacement surgery

Local clinicians working with local people for a healthier future

Hip & Knee Replacement Surgery – North West London CCG Criteria Example

SURGICAL THRESHOLD POLICY – North West London CCGs (NHS Brent CCG, NHS Central London CCG, NHS Ealing CCG, NHS Hammersmith and Fulham CCG, NHS Harrow CCG, NHS Hillingdon CCG, NHS Hounslow CCG and NHS West London CCG) Funding for total or partial knee replacement surgery is available if the following criteria are met

• 1. Patients with BMI <40

AND

• 2. Patient complains of moderate joint pain AND moderate to severe functional limitations that has a substantial impact on quality of life,

despite the use of non-surgical treatments such as adequate doses of NSAID analgesia, weight control treatments and physical therapies. AND

• 3a. Has radiological features of severe disease;

OR

• 3b. Has radiological features of moderate disease with limited mobility or instability of the knee joint

Next Steps

• The CCG’s clinical Governing Body members will

review policies and thresholds in use in other CCGs

• They will review how medical evidence was used to

compile them

• They will consider what changes would be suitable

to propose for Enfield

• The CCG will then pursue a programme of

engagement on our proposals with our member practices, our partners in Enfield and our public, taking into account feedback you have given us today

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Feedback and Questions

• Were the examples clearly explained
• Was the language used too technical or about right?
• How was the level of detail you were given?
• What is important to you about the way we conduct
• ur review?

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Workshop sessions

25

3:00pm-4:20pm Workshops: Each topic is discussed for 40 minutes and then the facilitators will move to the next table. Session 1: 3:00pm- 3:40pm; Session 2: 3:40am-4:20pm GP Governing Body Members and CCG commissioners lead discussions on the following key areas: Sustainability and Transformation Plan (STP)- Clinical lead –Dr Mo Abedi; Chair Management lead- Deborah McBeal, Director of Primary Care/ Deputy Chief Officer Paediatric Assessment Unit (PAU) Consultation- Clinical lead- Dr Fahim Chowdhury, GP Governing Body member and clinical lead for maternity, children, young people and safeguarding children. Management lead- Claire Wright, Head of Strategy and Commissioning 4:20pm-4:40pm Feedback from the tables Clinical leads

Local clinicians working with local people for a healthier future

Sustainability and Transformation Plan (STP)

Dr Mo Abedi, Chair Deborah McBeal, Director of Primary Care Commissioning and Deputy Chief Officer

26

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

Enfield CCG / Enfield Council 320k GP registered pop 48 GP practices Barnet CCG / Barnet Council 396k GP registered pop 62 GP practices Camden CCG / Camden Council 260k GP registered pop 35 GP practices Haringey CCG / Haringey Council 296k GP registered pop 45 GP practices Islington CCG / Islington Council 233k GP registered pop 34 GP practices

What is North Central London (NCL)?

University College Hospital Barnet General Hospital Chase Farm Hospital North Middlesex Hospital Royal Free Hospital St Ann’s Hospital The Whittington Hospital Edgware Community Hospital Finchley Memorial Hospital St Michael’s Primary Care Centre London Ambulance Service East of England Ambulance Service Moorfields Eye Hospital Great Ormond Street Hospital Central Middlesex Hospital Highgate Hospital St Pancras Hospital Stanmore Hospital Tavistock Clinic, Portman Clinic, Gloucester House Day Unit

The NCL case for change Health & Wellbeing Gap Care & Quality Gap Financial Gap

Health and care practitioners across NCL have been working together to understand and analyse the current issues across the system. This has been developed into a case for change. The case for change identified the following major gaps:

Case for change: the health and wellbeing gap

People in NCL are living longer but in poor health There are differing levels of health and social care needs There are different ethnic groups with differing health needs There is widespread deprivation and inequalities There is significant movement of patients into and out of NCL Lifestyle choices put local people at risk of poor health and early death There are poor indicators of health for children There are high rates of mental illness among both adults and children

Case for change: the care and quality gap

There is not enough focus on prevention Disease and illness could be detected and managed much earlier There are challenges in provision of primary care in some areas Lack of integrated care and support for those with a long term condition Many people are in hospital beds who could be cared for closer to home Disease and illness could be detected and managed much earlier Hospitals are finding it increasingly difficult to meet demanding emergency standards There are challenges in mental health provision

Current position…

Our current spend on health and care services in NCL is approximately £2.5bn. Health commissioners and providers were already approximately £120m in deficit in 2015/16. If nothing changes, this will rise to nearly £900m deficit by 2020/21.

In the next 5 years… Case for change: the financial gap

Our vision is for North Central London to be a place with the best possible health and wellbeing, where no one gets left behind

Our vision

Help people who are well to stay healthy Work with people to make healthier choices Use all our combined influence and powers to prevent poor health and wellbeing Help people to live as independently as possible within their own homes and communities Deliver better health and social care near to home wherever possible Reduce the costs of the health and social care system, so that it is affordable for the years to come Ensure services remain safe and of good quality

This means we will…

Residents and patients will be at the heart of what we do and how we transform NCL Health and social care providers will work together across organisational boundaries to achieve better health and social care for all We will be radical in our approach and not be limited by the system that exists now We will work with local communities and organisations and their expertise We will be advised by clinicians and frontline staff who are close to residents and patients We will build on existing good practice in North Central London

Our core principles are…

How we will do this?

Service trans- formation Improving productivity Enablers

• Focus on prevention and self care
• Upgrading care that can be provided closer to home
• Joining up mental and physical health services and supporting

people to live well

• Improving care through integrated approach to health and social

care

• Focus on improving patient safety, quality and outcomes in

hospitals

• Delivering efficiencies through better alignment of health and care

services

• Increasing productivity of current workforce
• Sharing back office services across different organisations
• Design of new workforce models to deliver transformed care
• Review the estates across NCL to improve facilities for

delivering care

• Harness technology to provide new ways of managing and

delivering care

• Development of strong commissioning through partnership

working

Service transformation - proposed priorities

Prevention

Care closer to home Achieving the best start in life

• Invest more in prevention
• Promote and empower people to live healthy lives
• Work with employers and schools to promote good health
• Diagnose at risk population sooner
• Treat people in best possible environment so they do not have to go to

hospital unless they really need to

• Extended 7 day 8 am to 8 pm access to primary care services
• Integrated health and social care teams to better coordinate delivery of care
• Easier access to specialist advice in primary care settings
• Create healthy environments, promote active travel, sport and play in

schools

• Focus on maternal health and mental health in children
• Provide improved parenting support and targeted health visiting

Mental health

• Give equal priority to physical and mental health services
• Improve access to primary care mental health services
• Invest in mental health liaison services
• Strengthen perinatal and child & adolescent services

Service transformation - proposed priorities

• Develop high quality ambulatory care services so patients can be assessed,

diagnosed, treated and able to go home on same day

• Simplify discharge arrangements to reduce the time people stay in hospital

when ready to go home

• Enhanced community services to avoid the need for admission
• Clear pathways with consistent approaches across NCL to ensure patients

can access the right expertise locally

• Improve access to information so patients can manage conditions without

surgical intervention

• Earlier diagnosis and improved chemo & radiotherapy
• Focus on colorectal and lung cancers to improve outcomes
• Improve palliative care so patients have better quality of life in their final

weeks

• Improve co-ordination and collaboration between health and social

care to help deliver earlier discharge from hospital where safe and appropriate

• Strengthen supply of social care workforce

Urgent and emergency care

Planned care Cancer Social care

How will the plan reduce costs?

Our plans will help us reduce waste in the health and care system by:

• Treating people right first time and improving co-
• rdination of services
• Avoiding unnecessary admissions to hospital
• Speeding up discharge when people are ready to

go home

• Being less reliant on agency and temporary staff
• Avoiding unnecessary duplication of services

between organisations However the plans at the moment do not achieve financial balance over the next five years, so we will continue to look for opportunities to improve our efficiency.

Engagement

Our commitment to openness and transparency means:

• Engagement on the issues before any

decisions

• Stakeholders, including local residents,

help devise the solution

• Transparent decision-making
• Dialogue throughout the process
• Working closely with North Central London

Joint Health Overview and Scrutiny Committee We can only improve our plans though effective engagement with our partners, patients, local residents and our staff

Published our case for change in September 2016 Held stakeholder events to discuss the case for change and our emerging STP thinking in each of the boroughs in September 2016 Submitted draft STP to NHS England on 21 October Councils published draft STP from 24 October Published the draft STP submission and summary on 15 November following NHS England assurance process

What have we done so far?

What happens next?

Discussion at the Joint Health Overview and Scrutiny Committee on 25 November 2016 Further local engagements events arranged through local health and care

• rganisations

Staff workshops and feedback sessions Development of a communications and engagement strategy, working with Healthwatch

Our plan is still work in progress. We will continue to work on it and engage more widely as we develop more specific ideas and proposals. Next steps include: If you have ideas about how to improve the plan, how you would like to be engaged, want further information or have other feedback please contact nclstppmo@nhs.net

What do you think are the most important health and social care issues over the next five years? Do you recognise the challenges set out in our plan?

Do you agree with our suggested priorities for service transformation? How would you like to be engaged in the process of further developing our plans?

Discussion

Paediatric Assessment Unit (PAU) at Chase Farm Hospital

Dr Fahim Chowdhury, GP Governing Body member and clinical lead for maternity, children, young people and safeguarding children Claire Wright, Head of Strategy and Children’s Commissioning

44

What does the Chase Farm PAU do?

• Consultant led service that enables children aged 0-18 to be assessed,

treated and observed by trained paediatric staff How do patients access this service?

• Referrals to this service are made by the Urgent Care Centre (UCC) at the

Chase Farm site, or by your GP or other services. The PAU is not a self- referral unit which means you cannot just turn up or make appointments directly What happens next?

• In most cases a child or young person would be assessed and treated

and sent home. However if a child or young person is deemed to be more appropriately seen in another setting then there is a transfer protocol in place from Chase Farm Hospital to the other hospital sites

About the PAU at Chase Farm Hospital

Local clinicians working with local people for a healthier future 45

Clinical review of the PAU

• A review of the PAU has taken place in line with

last year’s commissioning intentions

• The review was chaired by Enfield CCG’s

Governing Body lead for children and involved clinical staff from the Royal Free Hospital, including clinicians who work in the PAU

• The review group was asked to review the

effectiveness of the current model in the context of the overall provision for children

About the PAU at Chase Farm Hospital Continued

Local clinicians working with local people for a healthier future 46

Range of urgent care services for children The PAU at Chase Farm is one of many options for children who need urgent care in

• Enfield. Other choices include: calling NHS 111, visiting your GP practice, attending the

urgent care centres (at Chase Farm, Barnet or North Middlesex University Hospitals) or contacting GP Out of Hours services (via NHS 111), or in a life-threatening situation, visiting A&E (Barnet and North Middlesex University Hospitals). Patient choice Clinicians provide parents with a choice of which PAU they would like to attend. There are more attendances at the other PAUs (at North Middlesex and Barnet Hospitals) Low attendance In the last year (2015) the majority (94%) of the children or young people who presented at Chase Farm’s Urgent Care Centre ( UCC) were seen and treated by the staff there without needing a referral to the PAU. Only a few (6%) of these patients needed to be referred into the Chase Farm PAU for observation and treatment and of those less than 1% were transferred to Barnet or North Middlesex University Hospitals for further care.

Issues

Local clinicians working with local people for a healthier future 47

Staffing and skills The PAU at Chase Farm is staffed by a paediatric consultant and two nurses on rotas. The more patients that clinicians see, the more skilled they become. If clinicians can’t see the patient numbers recommended by their Royal College, then it’s likely that recruitment and retention of staff could become difficult in the future. All the PAUs provide clinical advice and guidance for Enfield GPs, however a limited number of GPs use this service in spite of an extensive promotional campaign to GPs. Local GPs provide a high level of service and are very confident in managing paediatric ailments. Therefore the majority of the times GPs use the PAU at Chase Farm is to obtain advice, which is also available via a GP Hotline for North Middlesex & Barnet Hospitals. Cost The cost of the PAU service at Chase Farm Hospital is £409,000 per year. A PAU would usually be funded by the Payment by Results tariff (payment for each attendance). For the PAU at Chase Farm, this would not cover the cost of providing the service with the current levels of attendance. In the current financially challenged health environment, we are continually looking at how we can improve services while ensuring they are of high quality and value for money Chase Farm redevelopment The Chase Farm Hospital site is being redeveloped by the Royal Free London NHS Foundation Trust. Enfield CCG as lead commissioner for the Chase Farm Hospital site has an opportunity to influence how children’s services are provided at this site in the future.

Issues continued

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What are we proposing to do?

Given that 94% of children attending the Urgent Care Centre (UCC) are managed within the UCC, with very few children referred into the PAU. Our proposal is that the current PAU service is re-designed so that:

• Children with urgent care needs would still be seen and managed within the Urgent Care

Centre;

• Some children may require a transfer to Barnet Hospital or North Middlesex University

Hospital (NMUH) for more specific paediatric care and those transfers will continue as they do now;

• Local GPs will continue to obtain advice from a Paediatric Consultant if required;
• However there will be some children who would benefit from seeing a paediatrician but

will not have immediate needs. These children will therefore be given access to an urgent outpatient appointment within two weeks. GPs and clinicians in other services such as the Urgent Care Centre will be able to refer into the service, following discussion with a paediatrician.

Future Proposed Options

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What is an urgent outpatient service?

The urgent outpatient service is a new service where children who have been seen by their GP and require an assessment by a paediatrician could be seen within two weeks. This option would also be available to a wider group of children rather than just those that are currently seen within the PAU, benefitting more patients.

Referral Criteria for the urgent outpatient service

Children at Enfield GP practices who require early assessment and cannot wait to be seen as a routine out-patient appointment.

Referral process

GPs and clinicians in other services such as the Urgent Care Centre will be able to refer into the service, following discussion with a paediatrician.

Exclusion Criteria for the urgent outpatient service

Currently, children with acute illness or who require an immediate referral are seen in an alternative paediatric setting.

Diagnostics for the urgent outpatient service

Children seen in the urgent outpatient service will have access to pathology, imaging and other testing to support their care.

Future Proposed Options Continued

Local clinicians working with local people for a healthier future 50

The wider health system The urgent access outpatient appointments would form part of a wider health system including:

• Further promotion of the GP Hotline to enable GPs to access clinical advice via

email or telephone from a consultant paediatrician and book children into an urgent access outpatient appointment within two weeks.

• Children’s services, including urgent access outpatient appointments, would still be

available on the Chase Farm site and will form an integral part of multi-agency developments going forward. More information on the services planned for the new Chase Farm Hospital is available on the Royal Free London NHS Foundation Trust website. https://www.royalfree.nhs.uk/about-us/investing-in-our-future/chase-farm-hospital- redevelopment/

• Further reviews of the urgent outpatients’ service will be undertaken periodically (at

three month and six months stages).

Future Proposed Options Continued

Local clinicians working with local people for a healthier future 51

Due to the low attendances at the unit we are considering how the provision of children’s urgent care will work at the Chase Farm site in the future What are your thoughts on the issues?

• Range of urgent care services for children
• Patient choice
• Low attendance
• Staffing and skills
• Cost
• Chase Farm redevelopment opportunities
• Are there any other issues that we need to consider?

Your views

Local clinicians working with local people for a healthier future 52

What are your thoughts?

• The current PAU service is re-designed.
• Those children who would benefit from seeing a

paediatrician but do not have immediate needs will be given access to an urgent outpatient appointment within two weeks.

• Children seen in the urgent outpatient appointment service

will have access to pathology, imaging and other testing to support their care.

• Is there anything else that we need to consider?

Your views Continued

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Group feedback

54

55

Ask us anything!

Local clinicians working with local people for a healthier future

Panel questions and answers session

Key dates for your diaries

Paediatric Assessment Unit Public Consultation Event For all Enfield residents and local stakeholders Thursday 8 December 2016, 2pm-4pm, Community House, Fore Street, Edmonton, N9 0PZ Governing Body Meetings Wednesday 18 January 2017 2.30pm-5pm Dugdale Centre, Thomas Hardy House, London Road, Enfield, EN2 6DS Patient and Public Engagement Meetings For all Enfield residents and local stakeholders Wednesday 1 March 2017 Dugdale Centre, Thomas Hardy House, London Road, Enfield, 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 6 December 2016, 1.30-4.30pm Dugdale Centre, Thomas Hardy House, London Road, Enfield, EN2 6DS Tuesday 7 March 2017, 6-9pm Dugdale Centre, Thomas Hardy House, London Road, Enfield, EN2 6DS Please email communications@enfieldccg.nhs.uk to be added to our email and be notified of news and events. All events are advertised on our website: www.enfieldccg.nhs.uk Twitter @EnfieldCCG and in the local press.

Local clinicians working with local people for a healthier future 56

• Your feedback is important to us today
• We want to work closely with local people to develop our plans
• Today we are going to focus on our plans for the next year
• 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.

We would like you to get more involved in the CCG:

• 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 communications@enfieldccg.nhs.uk
• Visit our website www.enfieldccg.nhs.uk

Listening to you

Local clinicians working with local people for a healthier future

Thank you for attending today’s event For more information

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

58 Local clinicians working with local people for a healthier future