Patient and Public
Engagement Event
9 September
2015
Dugdale Centre
Thomas Hardy House
39 London Road
Enfield
EN2 6DS
Agenda
10:00-10:10am
10:10-10:30am
10:30-10:40am
10:40-12:10pm
Welcome - including introduction for new GB members
Teri Okoro, Lay Member for Patient and Public Engagement
and Dr Mo Abedi, Chair of the Governing Body
Our Commissioning Intentions 2016-17
Graham MacDougall, Director of Strategy and Partnerships
Introduction to the group work sessions
Paul Jenkins, Chief Officer
Three workshops each lasting 30 minutes
Urgent Care, GP Out of Hours and NHS 111
Clinical lead: Dr Hardeep Bhupal, Management Lead:
Graham MacDougall, Facilitator: Claire Kapoor
Medicines Management
Clinical lead: Dr Mo Abedi, Management Lead: Paul
Gouldstone, Facilitator: Jenny Mazarelo
Child and Adolescent Mental Health Services
(CAMHS)
Clinical Lead: Dr Fahim Chowdhury, Management Lead:
Michelle Guimarin, Facilitator: Clare Wright
12:10pm
12:20pm
12:30:1:00pm
Group feedback
GP lead for each table
Thank you and event closes
Teri Okoro, Lay Member for Patient and Public Engagement
Governing Body members and CCG staff are available to talk
to you
2
Welcome
Dr Mo Abedi, Chair of the
Governing Body
Teri Okoro, Lay Member for
Patient and Public Engagement
3
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 this floor
• You have a local GP and an NHS manager on each of
your tables. They are here to lead the group work
sessions – there are three.
• Please help yourself to refreshments throughout the
morning.
Local clinicians working with local people for a healthier future
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Local clinicians working
with local people for a
healthier future
Our Vision
We are committed to commissioning services that improve the
health and wellbeing of residents of Enfield borough through the
securing of sustainable whole system care
Our Strategic Goals
• Enable the people of Enfield to live longer fuller lives by tackling
the significant health inequalities that exist between communities
• Provide children with the best start in life
• Ensure the right care in the right place, first time
• Deliver the greatest value for money for every NHS pound spent
• Commission care in a way which delivers integration between
health, primary, community and secondary care and social care
services
5
Listening to you
Your feedback is important to us today. We want to work closely with our
stakeholders and local people to develop our plans for the future and
today we are going to focus on our commissioning plans for the next
year.
We would like you to get more involved in the CCG. You can:
• Attend a Governing Body Meeting – dates are always advertised on our website,
Twitter @EnfieldCCG and in the Enfield Independent
• Join your GP practice’s Patient Participation Group (PPG) – ask at your practice. All 49
member practices have a PPG. We have an active PPG network and an elected PPG
representative – Litsa Worrall who sits on the Governing Body.
• Sign up to our mailing list – contact communications@enfieldccg.nhs.uk
• Volunteer to be a patient representative and help us improve services for local patients
• Visit our website www.enfieldccg.nhs.uk for more information
• Follow us on Twitter @EnfieldCCG
• You also have some post-it notes on your tables, please use these to jot down any
extra questions or comments for us and add it to the feedback wall.
We will ask you to fill in a feedback form about today’s event. Please tell us what you what
topics you would like to talk about at future events.
Local clinicians working with local people for a healthier future
Our Commissioning
Intentions 2016/17
What are our commissioning intentions?
Our draft Commissioning Intentions for 2016/17 focus on:
• Primary Care and Prevention
• Integrated Care for Older People
• Unscheduled, Urgent and Emergency Care – workshop on urgent care
• Planned care and long-term conditions
• Children, Young People and Maternity – workshop on child and adolescent
mental health services (CAMHS)
• Mental Health, Continuing Healthcare and Learning Difficulties
• Medicines Management – workshop on prescribing
• Quality
• Community Services
Today we are focusing our workshops on the Commissioning Intentions highlighted
above. You can also read our draft Commissioning Intentions document online at
www.enfieldccg.nhs.uk
If you have any comments on the other areas we are not covering today, we would love
to hear your views. Please email communications@enfieldccg.nhs.uk
7
Commissioning
Intentions
What we have done 2015/16
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Implemented Integrated Locality Teams
Developed new models of care for older / frail people
Re-commissioned the Older People’s Assessment
Unit (OPAU) at North Middlesex University Hospital
to an Ambulatory Unit.
Delivered and assured Better Care Fund investment
plan
Improved Access to Psychological Services (IAPT)
access and recovery rates
Improved dementia diagnosis in primary care
Implemented Care Homes Assessment Teams
(CHAT)
Reducing unplanned admissions for over 65’s (-8%)
Liaison Mental Health services on both acute sites
24/7
Implemented on-line support networks for IAPT,
Cognitive Behavioural Therapy (CBT) and 1-1
counselling (Big White Wall / Silver Cloud / IESO)
Continued to develop the Community Intervention
Service for our learning disability patients
Commissioning two urgent primary care hubs
Early booking research with East London University
Co-located IAPT and substance misuse services with
maternity servicers to improve perinatal mental health
What we intend to do in 2015/16
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Crisis Resolution Home Treatment Teams: part of
review of adult emergency care pathway
Liaison Mental Health Services: reviewed with NCL
CCGs to review models across NCL. National
requirement for 24/7 local mental health services by
April 2017
Recovery Houses as part of Barnet Enfield and
Haringey Mental Health Trust procurement
Community and inpatient rehabilitation services
District Nursing services
Post-acute care enablement and Triage and Rapid
Elderly Assessment Team (PACE and TREAT)
OPAU
Integrated Locality Teams
Memory clinics as part of dementia
review/prevalence
Paediatric Assessment Unit (PAU) and paediatric
urgent and emergency care pathways
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Key Commissioning
Intentions
2016/17
1. Develop integrated services for older people across all health and social care
providers including voluntary sector services
2. Commission local hubs for long term conditions including: Chronic Obstructive
Pulmonary Disease (COPD), Diabetes and Heart Failure.
3. Commission extended hours urgent primary care services including urgent
care hubs in Enfield and procure an integrated 111 and Out-of-Hours services
across the 5 CCGs of North Central London
4. Redesign services including dermatology, cardiology, ophthalmology to ensure
more streamlined delivery for patients
5. Maximise resources for Child and Adolescent Mental Health Services. Our
2015/16 priorities are: eating disorders, psychological therapies and perinatal
mental health
6. Implement mental health Crisis Concordat action plan aimed at ensuring a
consistent, co-ordinated approach to adults having mental health crisis.
7. Ensure clinical and cost effectiveness of medicines management and
prescribing budgets.
8. Further develop outcomes based commissioning. In particular, commission
elective musculoskeletal services
Local clinicians working with local people for a healthier future
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Group work
Each session lasts 30 minutes
10:40-11:10am
11:10-11:40 noon
11:40-12:10 pm
Medicines Management
Led by Dr Mo Abedi, Chair of Enfield CCG and Paul Gouldstone, Head of Medicines Management,
Facilitator Jenny Mazarelo
This workshop will focus on how we can reduce prescribing costs for antibiotics (to reduce antibiotic
resistance) and on medicines available over the counter.
Urgent Care
Led by Clinical lead: Dr Hardeep Bhupal, Management Lead: Graham MacDougall, Facilitator: Claire
Kapoor
This workshop focuses on how we can improve local urgent care services.
Child and adolescent mental health services (CAMHS)
Led by Clinical Lead: Dr Fahim Chowdhury, Management Lead: Michelle Guimarin, Facilitator: Clare
Wright
This session looks at our strategy for improving local CAMHS services
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Local clinicians working with local people for a healthier future
Medicines
management
Main Issues:
• Increasing Antibiotic resistance - GPs will continue to reduce
antibiotic prescribing. Patient’s should not expect antibiotics when
they have colds, coughs, sore throats and ear infections.
• Self care and treatment for minor ailments e.g. hay fever, cough
and cold remedies - patients will be expected to visit a pharmacy
and buy medicines or may be able to receive free medicines from
pharmacy as part of minor ailments scheme. This improves access
to GP appointments.
• Stopping prescribing of vitamins where there is no evidence of
clinical benefit. This would save over £70k a year which could be
used to provide other services.
• Working with hospitals to ensure they use most cost effective
medicines to enable maximum number of patients to be treated.
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Cost of Over the Counter
(OTC) medicines on
prescription
•
•
•
•
•
•
•
•
In 2014-15 Enfield CCG’s member GP practices prescribed medicines
costing £36.8 million – which is around 10% of the CCG’s budget
Over £91,000 was spent on antihistamines which could have been bought
OTC.
Over £407,000 was spent on painkillers which could have been bought or a
more cost effective preparation prescribed.
Over £40,000 was spent on OTC nasal sprays for hay fever or colds.
Over £12,000 was spend on OTC Haemorrhoid treatments.
Over £48,000 was spent on multivitamin, minerals and antioxidants vitamins
which have limited clinical value and could have been bought OTC.
Over £86,000 was spend Omega 3 and other fish oils - this is no longer
recommended to be prescribed post heart attack except for
hypertriglyceridaemia, and can be bought OTC.
Over £93,000 was spend on Gluten Free products
12
Comparative cost of
gluten-free vs gluten
containing foods
13
Medicines management
questions
•
•
Antibiotic resistance is increasing which is very dangerous for individuals
and public health. How can we ensure that antibiotics are prescribed
only when necessary and that patients shouldn’t expect them?
How do patients feel if their GP stopped prescribing products which
could be easily bought OTC with the support of pharmacists, who can
offer expert advice on medicines?
This would save money which could be invested in other services and would
also free up GP time.
Cost of prescribing
multivitamins, minerals
and antioxidants which
could be bought over the
counter
Cost of investing in a new
neuronavigator post. This
is a therapist who
supports patients with
brain injuries and
complex strokes
£48,748
£50,000
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Improving child and
adolescent
mental health services
(CAMHS)
•
•
•
•
Enfield Council and NHS Enfield CCG are keen to engage with children, young
people and families, the providers of mental health services, and other stakeholders
on a draft CAMHS strategy. The strategy is based on national evidence and policy
direction and has a local Enfield focus.
Strategy is focused on parity of esteem – treating mental health with equal
importance to physical health
50% of mental health problems are observed by the age of 14
Fewer than 25-35% of young people are needing emotional and mental health
support are receiving it.
Key areas for improvement proposed by the strategy
• Promoting resilience, prevention and early intervention
• Preventing/responding to crisis and self harm
• Improving access to effective support – a system without tiers
• Care for the most vulnerable
• Accountability and transparency
• Developing the workforce
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Improving child and
adolescent
mental health services
(CAMHS) questions
• What services for vulnerable young people would be the most effective?
(Our definition of children and young people includes: children with learning,
disability or physical illness, children who are homeless, LGBT, young offenders
or children of prisoners, children involved in gangs, looked after children or
adopted children, substance misusing young people, homeless, experienced
violence and abuse or severe neglect, sexually abused and/or exploited.)
• What would make the most difference in improving services to young
people and their families?
• What would be effective ways of raising awareness of mental health and
emotional problems?
16
Improving child and
adolescent
mental health services
(CAMHS) - Priorities for investment
There is increasingly complex presentations to CAMHS. What would your
priorities be to maintain and to improve services?
•
•
•
•
•
•
•
Crisis
Self-Harm
Early Years work
Early intervention (when symptoms first appear)
Public information/Raise awareness about mental health
Generic CAMHS services
Web based solutions e.g. web sites where young people can communicate
their problems and seek counsellor/therapist’s assistance.
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Unscheduled,
emergency and
urgent care
Clare Kapoor Programme Lead and Dr Hardeep Bhupal Clinical Lead
NCL NHS 111 and GP Out-of-Hours re-procurement
– Ensure right care, first time
– The five NCL CCGs (Barnet, Camden, Enfield, Haringey and Islington) will
procure a single, integrated NHS 111 and GP Out-of-Hours (OOH) service
for their collective population.
Urgent and Emergency Care Review
– To deliver the best possible health care and outcomes to patients requiring
it on an urgent basis, at any time of the day or night, within available
resources.
– North Central London CCGs have agreed to undertake a joint review of
system wide urgent and emergency care provision for the populations they
are responsible for across the boroughs.
– We will be undertaking a review of urgent care services in Enfield.
18
Unscheduled,
emergency and
urgent care questions
• How do you access urgent care?
• Where do you prefer to access urgent
care?
• What areas do you think we should
review?
19
Group feedback
20
Key dates for your diaries
Governing Body meetings in public
Annual General Meeting 30 September 2015 1-2pm and Governing Body Meeting
2:30-3:30pm West Lodge Park Hotel, The John Evelyn Suite, Cockfosters, EN4 0PY
(to consider the report of the outcomes of the July engagement activity on the north central
London CCGs’ commissioning intentions to procure an integrated NHS 111 and out-ofhours service).
14 October 2015 3-5pm Dugdale Centre Thomas Hardy House, 39 London Road, Enfield,
EN2 6DS
Patient Participation Group (PPG) network meeting
For Chairs and members of PPGs and staff at member
Practices who support patient groups only.
Tuesday 22 September 2015 7.00-9:00pm (6.30pm refreshments)
Dugdale Centre Thomas Hardy House, 39 London Road, Enfield,
EN2 6DS
Patient and Public Engagement meeting
For all Enfield residents and local stakeholders
6 January 2016 1-4pm
Dugdale Centre, Thomas Hardy House, 39 London Road, Enfield, EN2 6DS
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
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Ask us
anything!
Local clinicians working with local people for a healthier future
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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 2840
Local clinicians working with local people for a healthier future
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