West Wandsworth Health Priorities
Local Initiatives 2012-13
CVD
Roehampton and West Hill also have higher CVD rates when compared to the national average.
Locality clinicians will work alongside public health, local authority, patient representatives and service
users living in the area to support the health education of adults, children and young people. The
Locality will continue to support the uptake NHS Vascular Health Checks. This work will support the
‘prevention, screening, early diagnosis and awareness initiative,’ currently being implemented across
Wandsworth.
Smoking Cessation
Smoking prevalence is above 25% in more than 50% of West Wandsworth practices. Admissions for
Cancer in the period 2005-2008 were higher than the PCT average, particularly in the practices
located in high deprivation areas. Locality clinicians will further support the smoking cessation
programme to educate and promote reduction of smoking in the local population. The locality will also
work alongside multiple organisations such as public health, local authority and patient
representatives and service users living in the locality to tackle smoking prevention. This work will
support the ‘long term conditions initiative’ currently being implemented across Wandsworth. Linked to
this, the locality is working with Public Health and Paul’s Cancer Support Centre to raise awareness
amongst members of the public of the signs and symptoms of lung cancer - this is being achieved
through a team of Cancer Champions who are specially trained volunteer members of the public.
Obesity
The highest reception age obesity levels are in West Putney (11.0%). However Thamesfield and East
Putney have similar prevalence at 10.4% and 9.7% respectively. Except for Thamesfield all wards in
West Wandsworth show that one in five years 6 (aged 10-11) children may be obese. The Locality
clinicians support the need to reduce adult and childhood obesity. Working alongside public health,
local authority and patient representatives and service users living in the locality we will raise
awareness of the health issues associated with obesity, promote healthier lifestyles and encourage
obese patients to access weight management services. This supports the ‘prevention, screening,
early diagnosis and awareness initiative,’ being implemented across Wandsworth.
Mental Health Services
Work needs to take place to prevent high rates of admission to mental health services and improve
the health and wellbeing of the local population. The West Wandsworth clinicians will work alongside
the mental health trust to Improve Access to Psychological Therapies (IAPT). The locality will also
work alongside multiple agencies such as public health, local authority, voluntary organisation and
patient representatives and service users living in the locality to promote positive mental health and
reduce health inequalities across the local population. This work will support the work Mental Health
agenda currently being implemented across Wandsworth.
Teenage Sexual Health
Wandsworth has had a teenage pregnancy strategy since 1st April 2001, with a target of achieving a
55% reduction on the 1998 baseline (71.1 conceptions per 1,000 girls aged 15-17). In the wards of
Roehampton, West Hill and West Putney experience high rates of under 18 conceptions (per 1000
population. A clinical project lead will help promote clinicians knowledge and skills around sexual
health within the young and better access to and use of effective contraception. This supports
Wandsworth Teenage Pregnancy and Sexual Health objectives.
Alcohol / Drugs prevention in children and young people
Roehampton is estimated to have one of the highest numbers of problem drug users in the borough.
There are high numbers of ambulance calls outs for alcohol related problems are around Putney town
centre, Roehampton and West Hill. Locality clinicians will work alongside drug and alcohol services,
public health, local authority and patient representatives and service users living in the locality to
reduce the numbers of drug and alcohol related admissions to hospital and support the ‘urgent care
initiative’ currently being implemented across Wandsworth and link with WCCG’s Long Term
Conditions, Mental Health and Cancer/CVD priorities
CVD
Overall project lead: Amanda Cranston
Background
Taken from public health needs assessment 2010
Under 75 Cardiovascular disease mortality (2003-07):
250.0

200.0
150.0

100.0
Roehampton (164.7) has an
under 75 years old
cardiovascular disease
standardised mortality ratio that
is significantly higher than the
national average (= 100).
West Hill (125.6) is also high;
however the confidence intervals
are wide.
50.0
0.0
Thamesfield
East Putney
West Putney
West Hill
Roehampton
Source: London Health Observatory
Need for CVD prevention:

A recent health needs assessment looking at CVD mortality and associated risk factors found that the
ward of Roehampton had the greatest need in relation to the improvement of heart health and primary
prevention of CVD.
Admissions rates:

The Mayfield surgery, Roehampton surgery and Alton practice record high admissions for Coronary
Heart Disease.
Estimated cardiovascular at risk population (QRISK 2):

16.0%
14.0%
Male
Female
12.0%
10.0%

8.0%
6.0%

4.0%
2.0%
0.0%



This graph shows the estimated
proportion of GP registered people at
risk (20% or greater risk) of
developing cardiovascular disease
over the next 10 years.
Those assessed are in the age group
40-74 years and have no previous
record of CVD.
The proportion of males at risk is 2-3
times greater than in the female
population.
GP practices in Roehampton show the
largest proportions at risk. These are
Mayfield, Roehampton, The Alton and
Danebury practices.
One in eight men in Mayfield surgery
is at risk, while one in 25 women is.
One in ten men at Alton and
Roehampton practices is at risk here.
NB: The locality have specific action plans to tackle smoking as key risk factor of CVD and related LTCs / Health
issues. See below ‘Smoking’
Pilot of LDX
Action: Pilot of LDX machines to aid increased activity of NHS Health Checks. HN and KS to coordinate training and
evaluation process with management team
Aim: Improve the uptake of NHS Health checks
Key Actions
Lead
Deadline
Progress
Key Risk
RAG
 Children and Young People specific:
Action: What actions do the locality take forward to enable the below aims be achieved?
Aim: Improve health and wellbeing of children and young people
 Increase uptake of Anti-Obesity and Healthy Lifestyle activity across Roehampton Extended School Cluster
 Continued support to the Healthy Schools agenda
 Healthy eating, exercise and tobacco education and policy to continue to be promoted through youth club settings.
 Continued support to exercise promotion through Sports Development initiatives
 Referral by Children’s Services to healthy lifestyle schemes run by Health – ensure services know about these schemes
Key Actions
Lead
Deadline
Progress
Key Risk
RAG
Key Risk
RAG
Ready for School Packs
Action: Distribution across WW practices. Evaluation of effectiveness of ready for school packs
Aim: To educated and promote health and wellbeing of nursery and preschool age
Specific to:
Childhood Imms
Healthy eating & physical activity
Toilet training
Applying for school / nursery
Key Actions
Lead
‘Ready for School Packs’ to be
distributed to locality practices.
HN
Agree with management team
effective way to evaluated
effectiveness of the packs
Deadline
Progress
Smoking
Overall project lead: Amanda Cranston
Background
Taken from public health needs assessment 2010
GP registered smokers 2009
35
30
Percentage
25
20
15
10
5
0
% Smokers







Putne The
The
St
ymea Surge
Chartf Heath Paul's
d
ry,
ield bridg Cotta
Medic Balm
Surge
e
ge
al
uir
ry Practi Practi
Centr Garde
ce
ce
e
ns
15.6
18.8
19.0
19.3
23.1
Inner
Tudor
The
Park
Lodge Mayfi Roeha The
Road
Healt eld mpto Alton
Healt
h
Surge
n
Practi
h
Centr ry Surge ce
Centr
e
ry
e
25.2
25.8
25.9
26.6
28.8
Dane
bury
Aven
ue
Surge
ry
30.6
GP smoking data shows a clear distinction between prevalence at GP practices located in high
deprivation areas and those not.
Danebury, Inner Park Road, Alton, Roehampton, Mayfield and Tudor Lodge practices all record
prevalence above 25%.
GP practices located in less deprived areas record prevalence below 20%.
Smoking prevalence is under-reported across the borough therefore it is possible this pattern may
change if all patients were questioned about their smoking status
The higher smoking prevalence areas in West Wandsworth coincide with the high deprivation
areas in north West Hill and Roehampton.
Thamesfield shows relatively low prevalence of smoking.
Locality Actions:
Illicit tobacco
Action: West Wandsworth LCG requested Trading standards to undertake some focused work around illicit tobacco in
West Wandsworth
Aims:
It is understood that there is illegal tobacco selling in the Roehamptopn area, this would be a hard project to evaluate but
one would hope this would provide positive benefits to the area whist the locality works on more sustainable approaches
with partner organizations.
Key Actions
Lead
Deadline
Progress
Key Risk
RAG
West Wandsworth LCG to provide
evidence of issues in the area.
HN
19.06.12
Smoking Cessation training for GPs
Action: Roll out smoking Cessation training for GPs and Health Care Assistants in West Wandsworth (more specifics, how
many, rep per practice, how to disseminate within practices?
Aim: Smoking cessation training for practices, keep up to date with best produces to recommend using etc
Key Actions
Lead
AC and HN to coordinate two
separate training sessions for the
locality and backfill for GPs.
AC /HN
Deadline
Progress
Key Risk
RAG
Key Risk
RAG
Shared learning – Best practice
Action: Shared learning from in house and GP Engagement Scheme best practice
Aim: share learning across the locality, re best practice
Key Actions
Lead
Deadline
Coordinate session at LCG forum to
share learning from 2011-12 GP ES
HN
19.06.12
Progress
 Children and Young People Specific (also see other comments above re. CVD prevention in general
also apply)
PHSE
Action: How to take forward?
Aim: Involve School Nursing in Smoking cessation activity
Key Actions
Lead
Deadline
Coordinate session at LCG forum
to share learning from 2011-12
GP ES
HN
19.06.12
Progress
Key Risk
RAG
Obesity – Adult and Children
Overall project lead: Amanda Cranston
Background
Taken from public health needs assessment 2010
Child Obesity (Percentage of age group on 3-year average)

30
25
Reception
Year 6
Percentage
20
15

10
5
0
Thamesfield
East Putney
West Hill
West Putney
Roehampton
Source: National Child Measurement Programme (NCMP).
The highest reception age
obesity levels are in West Putney
(11.0%). However Thamesfield
and East Putney have similar
prevalence at 10.4% and 9.7%
respectively.
Except for Thamesfield all wards
in West Wandsworth show that
one in five year 6 (aged 10-11)
children may be obese. The
proportions range from 23.3% in
Roehampton to 20.3% in East
Putney. Thamesfield has a much
lower obesity level (13.2%) for
the year 6 group.
Childhood obesity
All children have their height and weight measured in reception and year 6 and are sent a letter
outlining the results including the weight category their child is in (underweight/healthy
weight/overweight/ very overweight).
The School Health and Nursing team conduct the measurements as well as follow up all those
children in year 6 who have been identified as obese to provide support and signposting to services.
The most recent results for this target ( measurements taken in 2010/11) are summarised below.

534 children in year 6 were identified as overweight or obese (>91 st Centile). 327 of these
parents were contacatable and lived in Wandsworth . Of these:
o 62 (19%) were referred to weight management services
o 83 (25%) were sent more information and referral forms
o 149 (46%) parents refused additional information or referral
o 10 (3%) already had health or other professional involvement around weight issues.
Locality Actions:
Referrals to children’s healthy weight programmes.
Action: All GPs to opportunisticaly Identify obese adults who visit the surgery with their children, record BMI centile in the
children, offer encouragement and support to reduce barriers to referral, refer families with overweight children to
healthy weight programmes.
Target: (Percentage to be agreed based on current level of performance – this is currently being collated)
 >xx% of children (<18 years) have BMI centile measured (EMIS report)
 >xx% of children with BMI >91sth centile are referred to weight management service (Footsteps referrals by
practice or EMIS coding?)
Aim: To improve on the proportion of parents of overweight children who are willing to accept referrals, further support
and encouragement from their GP may help to:
o reduce the stigma attached to BMI categories
o help parents to understand the future risks for their children if the pattern of weight gain continues
o explain the benefits of attending a family support programme (e.g. fun, learning, healthy lifestyle, family
time together
GP Lead:
Key Actions
Lead
Deadline
Progress
Key Risk
RAG
National Children’s Measurement Programme
Action: Wandsworth Obesity lead to discuss with DoH National Obesity Team the possibility of routinely ensuring that all
NCMP letters outlining results of height and weight measurements of children in school can be automatically sent to GPs
(This does not happen at the moment due to information governance issue).
Contact for Healthy Schools is Lorraine King in the Council.
Aim: as above
Key Actions
Lead
Deadline
Progress
Key Risk
RAG
Key Risk
RAG
Anna
Darcy
Walking groups from GP surgeries
Action: Explore opportunities for starting regular physical activity groups from GP surgeries
Aim:
Key Actions
Link with Rebecca Willans – is this
something health trainers can
support with
Lead
Deadline
Progress
Walking groups from GP surgeries
Action: Explore opportunities for starting regular physical activity groups from GP surgeries
Aim:
Key Actions
Lead
Link with Rebecca Willans – is this
something health trainers can
support with
HN
Deadline
Progress
Key Risk
RAG
health trainers can set up this service
for the LCG and practices
Lifestyle Directory required
Action: Need to link into existing directories and know what these are- AC to follow up before deciding next steps
Aim:
Key Actions
Lead
Deadline
Progress
Key Risk
RAG
 Children and Young People Specific (also see other comments above re. CVD prevention in general
also apply)
Lifestyle Directory required
Action: How to take forward?
Aim: Increase uptake of Anti-Obesity and Healthy Lifestyle activity across Roehampton Extended School Cluster.
Key Actions
Lead
Deadline
Progress
Key Risk
RAG
Sexual Health
Overall project lead: Amanda Cranston
Background
Taken from public health needs assessment 2010
GP registered smokers 2009
Rolling 3 year teenage conceptions West
Wandsworth
120
2003-5
100
2004-6
80
60
40
20
0
East Putney
Thamesfield West Putney Roehampton
West Hill
Total
Wandsworth
Source: ONS.


The wards of Roehampton, West Hill and West Putney experience high rates of teenage
pregnancy (per 1,000 population).
The wards of East Putney and Thamesfield record much lower rates of teenage pregnancy.
Locality Actions:
Pilot project- CRG specific
Action: LB to link with the CRG to understand if there is he scope to pilot a project in West Wandsworth.
Aims: Contribution to reduction of teenage pregnancy through the uptake of LARCs. Education, promoting and delivering
use of STI services
Key Actions
Lead
Deadline
Progress
Key Risk
RAG
Shared learning – Best practice
Action: HN coordinate a shared learning session via LCG forum, what is happening within practices to promote sexual
health.
Aims:
Key Actions
Lead
Deadline
Progress
Key Risk
RAG
TBC (AC to liaise with VG to find out if the locality could increase or further partake in any other existing primary care CCG
work streams to reduce teenage pregnancy and improve sexual health)
NB. Is LCG involving Teenage Pregnancy Co-ordinator (Beth Kelly) on initiatives in this area?
Action:
Aims:
Key Actions
Lead
Deadline
Progress
Key Risk
RAG
Roehampton Primary Schools to commission Christopher Winterson SRE project
Action: Raising Aspirations Project roll out in key Roehampton Primary Schools, with effective targeting through profiling
PHSE/SRE/Testing: Ensure effective use of school nursing team (is this different action to the above?)
Aims:
Key Actions
Lead
Deadline
Progress
Key Risk
RAG
Drugs and Alcohol
Overall project lead: Amanda Cranston
Background
Taken from public health needs assessment 2010
Alcohol Related London Ambulance Service Callouts (2008-09)
Source: Wandsworth DAAT 2009.




The highest concentrations of callouts are around Putney town centre.
The immediately surrounding areas also seem likely to have slightly elevated volumes of callouts.
The cluster of callouts in Roehampton is around much smaller shopping parades, with less night
life, which may indicate areas of more embedded drinking in the home rather than binge drinking.
Most alcohol related hospital admissions come from Roehampton and West Hill.
However there is not a high concentration of people engaging with treatment services from this
area, suggesting people are not accessing treatment and therefore are much more likely to
present in hospital with a non-emergency condition related to their drinking.
Locality Actions:
ACTION: DS to liaise with Tom Bailey, fresh start clinic lead and locality lead for the CRG. Find out if there are
existing activities the LCG can support with. If there is anyway practices can link in with alcohol liaison service
to support patients being discharged.
Children and Young People
Catch 22 ??
Action: LB to link with the CRG to understand if there is he scope to pilot a project in West Wandsworth.
 Worth linking with Drug and Alcohol Reference Group (Clare O’Connor) and noting that the Council’s Youth Work
Service employs a FT drugs and alcohol education worker
Aims:
Action: LB to link with the CRG to
understand if there is he scope to
pilot a project in West Wandsworth.
Lead
Deadline
Progress
Key Risk
RAG
Aims:
Key Actions
School Nursing Involvement
Action: How to take forward?
Aims: School Nursing Involvement in PHSE delivery. Effective targeting using A and E admissions data. Community
Delivery by School Nursing Team
 Also part of healthy schools agenda and curriculum of youth clubs.
 Worth noting that Wandsworth uses an assessment and prompt tool called DUST for use with young people. Used or
could be used by school nursing?
Key Actions
Lead
Deadline
Progress
Key Risk
RAG
Mental Health
Overall project lead: Amanda Cranston
Background
Taken from public health needs assessment 2010
Patients recorded on the Sereve Mental Health (SMI) register per 1,000 (January 2009 Mental
health Needs Assessment)
Source: EMIS Web.



GP practices in Roehampton and West Hill record the highest rate of patients on the SMI register.
They include; Mayfield, Inner Park Road, Danebury and St. Paul’s Cottage.
Roehampton also has one of the highest JSA claimant rates and lone parent claimant rates in
Wandsworth.
Admissions to Mental health services, 2005/6 – 2007/8
Rate per 100,000 population
1200
1000
800
600
400
200
0
The
Surger
y,
Balmu
ir
Garde
ns
St
Daneb
Putne The
The Inner
Chartfi Paul's
Tudor Mayfi The
ury
ymead Heath
Roeha Park
eld Cottag
Lodge eld Alton Avenu
Medic bridge
mpton Road
Surger e
Health Surger Practic e
al Practic
Surger Health
y Practic
Centre y
e Surger
Centre e
y Centre
e
y
MH rate 125.0 227.3 242.8 285.8 377.8 445.1 459.4 526.9 673.6 734.9 836.1
Tbale Source: The Information Centre.
 GP practices in high deprivation show the highest admissions to mental health services.
 The highest rates are seen at Danebury Avenue, The Alton practice, Mayfield and Tudor Lodge.
Danebury Avenue experiences admission rates four times the rates in practices with the lowest rates
(Balmuir Gardens, Putneymead and Heathbridge).
Gaps exist in services for mental health.
ACTION: PI to invite MH commissioning manager to 30th May LCG management team meeting to
understand local services and possible gaps before LCG can work up a locality initiatives.
Children and young people
 Worth noting scope for mental health promotion and not just increased uptake of mental health
services. MH commissioning manager could advise on this too. This applies to all age groups of
course.
Locality Actions:
Action:
Aims:
Key Actions
Lead
Deadline
Progress
Key Risk
RAG