Welcome Message Ian Porter Director of Corporate Services - - PowerPoint PPT Presentation

Welcome Message

Ian Porter Director of Corporate Services

Programme

1: Setting the scene 2: Patient Participation Group success stories 3: General Practice Neighbourhoods 4: Improving local care for people with mental health problems and/or learning disabilities 5: Closing remarks – next steps

Setting the scene

Saloni Thakrar Co-chair CPPEG

Setting the scene

The last forum meeting was rated between good to excellent (N=15) Based on the feedback received by PPGs members (November PPG forum meeting and CPPEG open meetings) - todays agenda reflects what people want

• More PPG success stories
• More information and discussion about GP neighbourhoods
• Camden local care strategy (with a focus on mental health and learning

disabilities at todays meeting – there will be opportunity for more discussion in relation to Adults and Children & Families at future PPG forum and CPPEG open meetings).

• More time for group work and discussion

PPG Success Stories

Adelaide Medical Centre PPG Carers Project

Hilary Lance PPG Chair: How the project came about David Williams Practice Manager: The project Abbie Sherwin Camden Carers: Where next?

Background to the project: the PPG

• Adelaide PPG is a proactive bridge between the patients and the practice
• Our aim is to improve the patient experience of the practice and improve

patient outcomes

• 16 patients plus the Senior Managing Partner , the Practice Manager and a

senior member of the admin team

• Meet 5/6 times a year plus two open meetings

Background: how it happened

• Many years of agonising over lack of a truly representative PPG
• Agreed new approach: one project a year aimed at a “hard to reach” group
• This year a result of learning more about Camden Carers we met with them to

discuss an ongoing project

The project

We have established a monthly clinic at the practice for Camden Carers:

• Allows Carers to be seen in a familiar environment
• Carers invited by Drs and staff
• Empowers all practice staff to offer something extra

Presentation Discussion: Camden Carer’s perspective and a practice perspective

Where next? Involving patient volunteers

Ideas Going forward: Training Adelaide patient volunteers Camden Carers will have the infrastructure (ie training, DBS checks etc) to do this

Cholmley Gardens PPG success story Saloni Thakrar and Karen McCormack

Our practice:

• Relatively small (~7000

patients)

• Friendly and informal ethos
• Maintains traditional values of

a family general practice, with continuity of care for people of all ages

• Embraces innovation, e.g.
• nline and phone consultations

Our PPG:

• Supported by Karen

McCormack, Practice Manager

• Reflects the ethos of the

practice

• Open to all
• 8 members
• Meets quarterly

About Cholmley Gardens Medical Centre

Where did we start?

Survey of patient priorities PPG formed an Action Plan Focused on 4 top priorities

• 1. Improving the waiting room

What did the PPG do?

• Declutter and paint the room
• Relevant, up to date health information for

patients

• Comfy chairs
• Created more seating space for patients
• Wheelchair accessible

What difference did it make? “The old waiting room was dark and cramped. The renovated space is very pleasant now and I don't mind waiting. The chairs are comfy and the room is lighter and spacious” – a patient

2.Early morning appointments

What did the PPG do?

• Made the case for early morning and

extended evening appointments

• 2nd most popular priority in

patient survey What difference did it make?

• Additional 62 appointments per week
• Meets the needs of busy

professionals – mostly young working people and families with children

• Booked almost 2 weeks in advance

45% 34% 21%

Are you likely to use online booking?

Yes Perhaps No

• 3. Making booking accessible to everyone

What did the PPG do?

• Based on feedback, made the

case for online booking, with leaflets to explain

• And ‘Patient Partner’ – for people

who prefer offline What difference did it make?

• Allows people to book quickly,

without waiting in a long phone queue

• Ask patients what they’d like to change

and respond to feedback

• Focus on what you can change; start

small

• Develop and agree on a realistic

achievable action plan

Top tips for other PPGs

Camden GP Neighbourhoods

Dr Neel Gupta & Vanessa Cooke, Senior Commissioning Manager – Primary Care

National challenges

Health and wellbeing gap Care and quality gap Funding gap

Camden Local Care Strategy

Where we want to be

• Enablers: Quality & Safety – Workforce - Estates - Technology & Systems –

Leadership - Commissioning & Contracts - Engaging Residents

Includes all these things:

• Neighbourhood Development and Integrated care teams (CHINS)
• Improving quality and reducing unwarranted variation (QIST)
• Alternative means of booking
• Extended access
• Patient education and support services
• Primary Care at the front door
• Care Navigation and social prescribing
• Outcomes based LCS
• Specialist elective care within primary settings

Health & Care Closer to Home

• Builds on what practices had started. Practices were starting to form neighbourhoods and the CCG wanted to

build on this development rather than develop a separate response to the STP

• Ensure patients have equal access to all services. Practices working more closely in neighbourhoods can

support a reduction in variation and ensure patients have equal access to services. No patient should be disadvantaged by which practice they are registered with

• Encourage practices to support eachother. Working more closely together will help sustain general practice and

enable practices to learn from each other

• Support the development of integrated care. Local services, in particular community health services, need to

have a defined population (and practices) to build services around

• Enable patients to be cared for closer to home. Strengthening links between practices and expanding the teams

working in the community will support patients to be cared for locally

Why develop neighbourhoods in Camden?

Neighbourhoods will:

• comprise a number of GP practices
• have a reasonable level of geographical cohesion to support delivery
• have general practice at the centre
• work with other providers, the Council, the voluntary sector and local people
• build on integrated working and person centred care already happening in Camden
• potentially change the way existing services are provided and lead to an expansion of the

integrated teams working in the community

Camden GP neighbourhoods

4 neighbourhoods in Camden

Camden neighbourhoods

NW5 NW3 South Camden Camden Health Evolution (CHE)

Caversham Parliament Hill James Wigg Regents Park Ampthill Prince of Wales Group Queens Crescent Hampstead Group Park End Surgery Daleham Gardens Rosslyn Hill Keats Adelaide Medical Centre Brookfield Park Museum Holborn St Philips Gray’s Inn Brunswick Abbey Medical Centre Belsize Priory Bloomsbury Surgery Brondesbury Cholmley Gardens Fortune Green Surgery Gower Street Practice Kings Cross Practice Primrose Hill Surgery Ridgmount Practice Somers Town Swiss Cottage Surgery West Hampstead

What could neighbourhoods mean in practice?

• Agreeing patient outcomes that all health and social care

providers work towards.

• A specific group of professionals (for example, a

therapist, psychologist, independent prescriber) working with a small group of practices to provide care and improve outcomes for patients.

• More focus on prevention with stronger voluntary sector

links

• Aligning a wider range of community and specialist

services to support patients.

• Developing hubs to offer particular services to a wider

range of patients.

• Specific services for those at risk of deterioration in

health and or hospital admission

In 2017/18 Camden neighbourhoods will:

1. Develop and deliver services together for their local population (from September) 2. Work to improve the quality and reduce the variation in local primary care services (from September) 3. Work with commissioners to ensure other service developments are aligned to neighbourhoods 4. Develop as organisations, involving stakeholders in service delivery plans 5. Put together plans for neighbourhood services, priorities and outcomes in 2018/19

What will Camden neighbourhoods do in 2017/18?

General Practice Neighbourhoods

David Williams Practice Manager Adelaide Medical Centre

Frailty Neighbourhood Project

Who is in our neighbourhood (7 practices, 52k pts)

• Adelaide, Keats, Hampstead Group Practice, Park End, Rosslyn Hill, Daleham Gdns, Brookfield

Park This is wider than just practices

• Aim to integrate a lot of the care at a neighbourhood level (eg community team, hospital specialist

teams, palliative care team, social care). First substantive neighbourhood work has explored the service of a “Frailty Duty Dr.” across our practices.

• To co-ordinate all the necessary inputs (to act as an integrated team) to reduce the number of A&E

attendances, Emergency admissions, and reduce hospital stay for our Frail patients

• The Pilot ran through May 2017, we are now seeking to relaunch the service later in the year.

Frailty Duty Dr - High level results

Insight The number of pts seen 85pts with 111 contacts This equates to ~5/day, with some seen multiple times Pts avoided some sort of Hosp’ admission 49 of contacts (~44%) Whilst this was the Drs opinion, this is still a good indicator that the right pts were being referred How many interventions had Palliative Care (PC) input 8pts 11 contacts (~10% of pts seen) *Across NW3 practices there are ~190 on PC registers. Extrapolating for a whole year this could mean ~50% of PC pts would benefit from additional GP input at the point hospital intervention is considered. Pts directly referred from RFH (most from TREAT) 35 contacts (~30% of pts seen) Re-enforces the point of collaborative working and supporting the drive of ‘Care Closer to home’ What proportion of our Frail pts were seen ~10% in a month **Across NW3 practices for 2016-17 there are ~850 on

• ur Avoiding Unplanned Admissions registers.

Opportunity for a large number to benefit in a year

• * - Palliative Care registers: AMC 46, HGP 54, Keats = 45, Park End ~30 est, Daleham Gds 2, Roslyn Hill 12: Total = ~190
• ** - Avoiding Unplanned Admissions: AMC 198, HGP 267, Keats 176, Park End ~140 est, Daleham Gds 37, Roslyn Hill 33: Total = ~850

Improving local care for people with mental health problems and/or learning disabilities

Team structure

Debra Holt Assistant Director Richard Elphick

Strategic Commissioner

Malgorzata Surdziel

Commissioning Manager

Mansur Quraishi

Strategic Commissioner

Sarah Lui

Strategic Commissioner

Michelle Hill

Strategic Commissioner

Helena Quinn

Commissioning Manager

Poppy Green

Commissioning Manager

Morelda Nanton

Commissioning Manager

Emily Rainbow

Commissioning Manager

Kate Langan

Coproduction Lead

Mental Health demographics

Demand on services

Number of contacts with the Assessment and Advice team

• An estimated 4,636 adults in Camden have a learning disability

(PANSI 2015).

• 1,005 have moderate or severe learning disabilities.
• 727 people with learning disabilities needs known to Camden

Learning Disability Service.

• Approx. 10% have profound and multiple learning disabilities.
• 477 people with learning disabilities registered with a Camden GP.
• The numbers of people with autism in the borough is currently being
• analysed. National estimates suggest around 1,900.
• Camden currently has six patients in the Transforming Care cohort.

Learning Disabilities demographics

Demand on services

• Of the 727 people known to CLDS, 417 are receiving social care
• 215 are receiving are receiving clinical/ health services
• Of people on GP registers with learning disabilities, 54.9% received

an annual health check.

• The waiting time for an autism diagnostic assessment currently

stands at 77 weeks (1.5 years), and 260 weeks (5 years) for ADHD.

• The number of people with eligible care and support needs due to

learning disabilities is expected to rise by between 1.2% and 5.1% each year, increasing demand on services

There is no income allocation growth over the medium term to offset the impact of forecast demographic and inflationary cost increases. The plans for 2017/18 show that the CCG will seek to limit the deficit to £2m. This will only be achieved if we are able to deliver more than £24m of savings through developing Quality, Innovation, Productivity and Prevention saving plans.

Financial challenge

Financial challenge

There is wide variation in the spend per head of population across London, and England

'Parity of esteem' is defined as 'valuing mental health equally with physical health', which would result in those with mental health problems benefitting from:

• equal access to the most effective and safest care and treatment
• equal efforts to improve the quality of care
• the allocation of time, effort and resources on a basis commensurate with need
• equal status within healthcare education and practice
• equally high aspirations for service users
• equal status in the measurement of health outcomes.

Parity of esteem

Engagement

• Coproduction Lead for mental health established in 2014/15 to

increase engagement at all points in the commissioning cycle.

• Established Service User & Carer group and an engagement

network.

• Recently we have reshaped employment services, peer mentoring

and BME cultural advocacy services and reviewed the Recovery College with residents.

• We want to build engagement and coproduce tasks at all levels

around Local Care Strategy priorities.

• We want to hear from a diverse range of voices.
• Kate Langan – Coproduction Lead – Kate.Langan@camden.gov.uk

What is the initiative? A number of providers working together to achieved resilience within Camden. Why are we doing it? Working with the voluntary sector, it is an opportunity to introduce and embed non-clinical services within care pathways. Services include social prescribing; support to maintain housing; employment support; mental health training; the Wellbeing Hub and the Recovery College. What is the benefit to people in Camden? The resilience network aims to increase awareness of mental health and address stigma; access early help; empower people to improve self-care and address social determinants of mental health challenges. When are we doing it? The network has started meeting with providers and residents with services in place by October 2017.

Mental Health initiative Community Resilience

What is the initiative? Giving people with a range of mental health conditions better access to a wider range of mental health services within the community, provided by GP neighbourhoods. Why are we doing it? Integrating highly valued services and identifying clear pathways will improve support for patients that is more timely and closer to home, resulting in improved holistic physical and mental health outcomes. What is the benefit to people in Camden? It will improve patient experience by reducing waiting times, bringing more care into the community, avoiding secondary care admission and joining up physical and mental health care. When are we doing it? A draft model is being developed which will be consulted

• n over summer 2017 with the aim of developing a new offer from April 2018.

Mental Health initiative Primary Care Mental Health

What is the initiative? Providing a specialist community perinatal mental health team so that more women have access to evidence-based specialist care. Why are we doing it? To make sure that women who experience mental health problems during pregnancy or during the postnatal period, and their families, get access to appropriate, timely specialist health care. What is the benefit to people in Camden? This team will identify ‘at risk’ groups, permitting an early intervention and prevent avoidable escalation of need. When are we doing it? This service commenced in March 2017.

Mental Health initiative Perinatal Mental Health

What is the initiative? A number of initiatives to improve the crisis pathway:

• Investment in Psychiatric Liaison Services at UCLH
• Section 136 suite at the Highgate Centre
• Home Treatment Services.

Why are we doing it? These initiatives will ensure that service user crises are managed efficiently and in the most timely manner possible. What is the benefit to people in Camden? The services are all aimed at minimising the stress that service users experience during a crisis, whilst ensuring that they have access to the most appropriate care possible. When are we doing it? The improved psychiatric liaison service has already

• started. Other initiatives are in the planning stages with implementation expected in

2018.

Mental Health initiative Crisis Care

What is the initiative? Reduce the number of people with learning disabilities in long-stay hospital beds who could appropriately be supported in the community. Why are we doing it? To support this group of patients (those with learning disabilities and/or autism and behaviour that challenges) to receive appropriate care and support in the community, closer to home. What is the benefit to people in Camden? Long-stay patients will be supported to be discharged where possible, new admissions will be prevented or be shorter, and appropriate care and support is in place to avoid re-admission. Care and treatment reviews will also aim to avoid, where possible, initial admission or re-admission. When are we doing it? Working in partnership across North Central London Camden’s Transforming Care initiative has commenced and aims to reduce the use

• f long-stay hospital beds by 50% by March 2019.

Learning Disabilities initiative Transforming Care

What is the initiative? Develop a pathway of support for adults with autism, including reconfiguration of both autism and ADHD diagnostic services. Why are we doing it? This pathway will improve access to care and support for adults with autism both before and following diagnosis. What is the benefit to people in Camden? Adults with autism will have improved health and wellbeing. This pathway will also improve prevention and early identification of crisis amongst adults with autism. This initiative will also increase general awareness amongst professionals and the public of autism and support available in Camden. When are we doing it? This initiative has commenced with the commissioning of a needs analysis for adults with autism (due for completion Autumn 2017) with a view to securing preventative services and reconfiguring diagnostic services in 2018. .

Learning Disabilities initiative Autism Pathway

What is the initiative? Ensure everyone with a learning disability is registered as having a learning disability with their GP and is offered an annual health check, in line with national guidance. Why are we doing it? To reduce inequalities and improve the health and wellbeing

• f people with learning disabilities.

What is the benefit to people in Camden? Prevention, early identification and intervention for people with learning disabilities. People with learning disabilities will also experience improved accessibility as GP awareness is raised about making reasonable adjustments. When are we doing it? Patients with a learning disability do receive annual health checks in Camden (currently 54.9%) and this work looks to work closely with primary care to identify more patients on GP registers.

Learning Disabilities initiative Annual Health Checks

mentalhealthcamden.co.uk

mentalhealthcamden.co.uk is an

• nline resource featuring a

comprehensive, searchable directory of mental health and wellbeing related services and support in Camden. It also provides other useful information and self-help resources. mentalhealthcamden.co.uk is for everyone in Camden. This includes people experiencing more common mental health problems such as stress, anxiety and depression, and those experiencing illnesses such as schizophrenia, bipolar disorder and eating disorders.

mentalhealthcamden.co.uk

mentalhealthcamden.co.uk

• Contains a large service directory of organisations,

groups and forums that provide support for mental health problems in Camden.

• Has an A – Z of general information about mental

health conditions or disorders, and includes information about symptoms and treatments.

• There is also information about news and events

across Camden that support mental health, meet

• ther people and improve wellbeing.
• Includes more than 20 self-help guides with signs

and symptoms, and sign posts to a range of local and national support and services. mentalhealthcamden.co.uk aims to enable individuals to find out what is available in Camden and make informed choices that suit them best.

Closing Remarks

Kathy Elliott Lay Governing Body Member – Communications & Patient Engagement