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
1:30pm - 2:00pm
2:00pm -2:05pm
2:05pm-2:20pm
2:20pm-3:00pm
3:00pm-4:20pm
4:20pm-4:40pm
4:40pm-4:55pm
4:55pm-5:00pm
Sign in, refreshments and networking
Welcome
Teri Okoro, Lay Governing Body member for Patient and Public Engagement
Enfield CCG update
Dr Mo Abedi, Chair
Adherence to evidence based medicine
Clinical lead- Dr Jahan Mahmoodi, Medical Director
Management lead -Gina Shakespeare, Project Consultant
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) ConsultationClinical 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
Feedback from the tables
Clinical leads
Questions and Answers session with the Governing Body
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
4
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
other 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 yearlong 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.
Local clinicians working with local people for a healthier future
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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
Local clinicians working with local people for a healthier future
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Feedback and
Questions
Local clinicians working with local people for a healthier future
9
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
Local clinicians working with local people for a healthier future
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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
Local clinicians working with local people for a healthier future
13
Hernia – Activity & Spend
ENFIELD CCG Data
Activity 2015/16
663
Cost 2015/16
£1,102,771
Local clinicians working with local people for a healthier future
Hernia – Policy/Criteria
Comparison
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
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,
only 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.
Notes
I Patients should be referred directly for surgery.
II Patients should be managed with observation and review.
III Activities such as meal preparation, laundry, housekeeping, shopping, using the phone, driving or using public transport.
Smoking
Patients who smoke should have attempted to have stopped smoking 8 to 12 weeks before the operation to reduce the risk of surgery and the risk of post-surgery complications. Patients should be routinely offered
referral to smoking cessation services to reduce these surgical risks.
Vasectomy – Activity &
Spend
ENFIELD CCG Data
Activity 2015/16
26
Cost 2015/16
£19,189
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 NCL
Other CCGs
Organisation
Eligibility Criteria Exist
BARNET CCG
N
Organisation
Eligibility Criteria Exists
Y – Restricted
N
Harrogate and Rural District
CCG
ISLINGTON CCG
N
Scarborough and Ryedale Y – Restricted (Under General
CCG
Anaesthetics)
CAMDEN CCG
N
HARINGEY CCG
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
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.
Notes
Most vasectomies are carried out under local anaesthetic. This means only the scrotum and testicles will be numbed.
Hip & Knee Replacement
Surgery – Activity &
Spend
ENFIELD CCG Data
Activity 2015/16
567
Cost 2015/16
£4,206,033
Local clinicians working with local people for a healthier future
Hip & Knee Replacement Surgery –
Policy/Criteria Comparison
ENFIELD
Enfield CCG has not adopted a policy / criteria for conducting knee replacement surgery Other CCGs
NCL
Organisation
Eligibility Criteria Exists
BARNET CCG
N
HARINGEY CCG
ISLINGTON CCG
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
N
N
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
Notes: Patients not meeting the above criteria can be referred via the IFR route where there are exceptional circumstances present.
Definitions of pain and functional limitation levels:
Mild
Pain interferes minimally on an intermittent basis with usual daily activities Not
related to rest or sleep
Pain controlled by one or more of the following; NSAIDs with no or tolerable side
effects, aspirin at regular doses, paracetamol
Moderate
Pain occurs daily with movement and interferes with usual daily activities.
Vigorous activities cannot be performed
Not related to rest or sleep Pain controlled by one or more of the following;
NSAIDs with no or tolerable side effects, aspirin at regular doses, paracetamol
Severe
Pain is constant and interferes with most activities of daily living
Pain at rest or interferes with sleep
Pain not controlled, even by narcotic analgesics
Functional limitations
Minor
Functional capacity adequate to conduct normal activities and self care
Walking capacity of more than one hour
No aids needed
Moderate
Functional capacity adequate to perform only a few or none of the normal
activities and self care
Walking capacity of about one half hour
Aids such as a cane are needed
Severe
Largely or wholly incapacitated
Walking capacity of less than half hour or unable to walk or bedridden
Aids such as a cane, a walker or a wheelchair are required
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
Local clinicians working with local people for a healthier future
23
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
our review?
Local clinicians working with local people for a healthier future
24
Workshop sessions
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) ConsultationClinical 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
25
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
What is North Central London (NCL)?
Enfield CCG / Enfield
Council
320k GP registered pop
48 GP practices
Barnet CCG / Barnet
Council
396k GP registered pop
62 GP practices
Haringey CCG / Haringey
Council
296k GP registered pop
45 GP practices
Chase Farm Hospital
St Michael’s
Primary Care
Centre
Barnet General Hospital
Stanmore Hospital
North Middlesex
Hospital
Edgware Community Hospital
Finchley Memorial Hospital
St Ann’s Hospital
Islington CCG / Islington
Council
233k GP registered pop
34 GP practices
Camden CCG / Camden
Council
260k GP registered pop
35 GP practices
Highgate Hospital
The Whittington Hospital
Royal Free Hospital
Central Middlesex
Hospital
Tavistock Clinic, Portman Clinic,
Gloucester House Day Unit
St Pancras Hospital
University College Hospital
London Ambulance Service
East of England Ambulance Service
Moorfields Eye Hospital
Great Ormond Street Hospital
The NCL case for change
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:
Health & Wellbeing Gap
Care & Quality Gap
Financial Gap
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
Case for change: the financial gap
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.
In the next 5 years…
If nothing changes, this will rise to nearly £900m deficit by
2020/21.
Our vision
Our vision is for North Central London to be a place with the best possible health and wellbeing, where no one gets left behind
This means we will…
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
Our core principles are…
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
How we will do this?
Service
transformation
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
•
•
•
•
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
•
•
•
•
Achieving the
best start in
life
Mental health
•
•
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
•
•
•
•
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
•
Urgent and
emergency
care
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
Planned care
•
Cancer
•
•
•
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
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 coordination 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
We can only improve our plans though effective engagement with our partners,
patients, local residents and our staff
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
What have we done so far?
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 happens next?
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:
Discussion at the Joint Health Overview and Scrutiny Committee on 25 November 2016
Further local engagements events arranged through local health and care organisations Staff workshops and feedback sessions
Development of a communications and engagement strategy, working with Healthwatch
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 [email protected]
Discussion
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?
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
About the PAU at Chase
Farm Hospital
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 selfreferral 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
Local clinicians working with local people for a healthier future
45
About the PAU at Chase
Farm Hospital Continued
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
Local clinicians working with local people for a healthier future
46
Issues
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.
Local clinicians working with local people for a healthier future
47
Issues continued
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.
Local clinicians working with local people for a healthier future
48
Future Proposed Options
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.
Local clinicians working with local people for a healthier future
49
Future Proposed Options
Continued
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.
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Future Proposed
Options Continued
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-hospitalredevelopment/
•
Further reviews of the urgent outpatients’ service will be undertaken periodically (at
three month and six months stages).
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Your views
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?
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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?
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Your views Continued
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?
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Group feedback
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Panel questions and
answers session
Ask us
anything!
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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 [email protected] 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.
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Listening to you
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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 [email protected]
• Visit our website www.enfieldccg.nhs.uk
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: [email protected]
0203 688 2814
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