Patient Participation Group Network Meeting, Tuesday 7 March 2017

1. Patient Participation Group Network Meeting, Tuesday 7 March 2017 Dugdale Centre, Executive Suite

2. Welcome Litsa Worrall Local clinicians working with local people for a healthier future

3. Agenda 6.30-7.00pm Sign in and refreshments 7.00-7.05pm Welcome Litsa Worrall 7.05-7.30pm Dementia services in Enfield Graham MacDougall, Director of Strategy and Partnerships, Enfield CCG 7.30-8.00pm Donor Donation and Cycle Enfield Glenn Stewart, Assistant Director for Public Health and Kavinda Costa, Community Cycling Officer, Enfield Council 8.00-8.30pm Prescribing over the counter medicines Paul Gouldstone, Head of Medicines Management, Enfield CCG 8.30-8.45pm Conflicts of interest Gail Hawksworth 8.45-9.00pm Any other business All Local clinicians working with local people for a healthier future

4. Dementia Services in Enfield Graham MacDougall Director of Strategy and Partnerships, Enfield CCG

5. Dementia Increasing dementia diagnosis rates, whilst optimising post-diagnosis support, has been a high priority for Enfield CCG via: Building positive relationships with our practices, Local partners Service providers Local clinicians working with local people for a healthier future

6. Dementia Diagnosis ECCG committed to maintaining reported diagnostic rate at the national standard of 66.7%. The December performance showed further increase to 69.8% Local clinicians working with local people for a healthier future

7. Dementia Diagnosis GP practice visits will be used to encourage practices with low diagnostic rates to identify and refer suitable patients (e.g. by using the Dementia Quality Toolkit) and to update the registers Average waiting times for the Enfield memory service referral to assessment dropped down to 6.4weeks in November following a high of 8.4weeks in September. Waiting times from assessment to diagnosis dropped below 4 weeks. Progress is reviewed at the Memory Service Action Planning Group. Local clinicians working with local people for a healthier future

8. Post-Diagnostic support for dementia patients In March 2014 London Borough of Enfield and NHS Enfield CCG commissioned an end-to-end dementia pathway review. A key recommendation from the review was the development of post-diagnostic support for patients and families. In response, Enfield CCG commissioned Age UK Enfield to provide a post-diagnostic support service. Service function include: Early Support:When GPs refer clients for diagnosis, simultaneous sign-posting/referrals to the Post-Diagnostic Service will also be facilitated. The provider is also expected to work closely with Barnet Enfield and Haringey Mental Health Trust’s Memory Service during and after the formal diagnosis of dementia. Community Navigation: A navigator acts as a point of contact to help people with dementia and carers to access relevant information, advice & signposting to initial & ongoing solutions they need, act as an advocate and help them come to terms with the diagnosis. Promoting Dementia-Friendly Communities: The provider will work in partnership with Enfield Dementia Action Alliance in cascading training among volunteers as part of its role in promoting dementia-awareness amongst organisations in 2015/16. Local clinicians working with local people for a healthier future

9. Care Home Residents The vast majority of older residents in care homes fall under the cohort of people who are “frail” or “high-risk” pre-frail. Two-thirds of people with advanced dementia live in care homes or in supported accommodation, particularly as they develop significant problems in daily living. Enfield CCG commissioned a Care Home Assessment team to work in care homes to identify and manage physical and mental health problems in residents at an early stage to help prevent the need for acute care and reducing call outs to GPs. The Team includes a band 7 prescribing mental health nurse who provides specialist mental health review which involves the reduction of unnecessary low dose Antipsychotic use in Dementia patients and optimise treatment of behavioural disturbances. and also provides training to care home staff on Medication (side effects, how or when to take, risks & benefits), challenging behaviour, dementia awareness, depression and anxiety. Local clinicians working with local people for a healthier future

10. Questions?

11. Prescribing over the counter medicines Paul Gouldstone Head of Medicines Management, Enfield CCG

12. What We Did In February 2016 a recommendation was agreed by the Medicines Management Committee and the CCG Board to stop prescribing some over the counter medicines for minor illness. Included preparations for antihistamines, vitamins, painkillers-paracetamol and ibuprofen, eye drops for dry eyes, indigestion, muscle and joint pain, and Gluten free foods. Local clinicians working with local people for a healthier future

13. Benefits reported GPs have reported seeing fewer patients for minor illnesses enabling them to see more patients with more serious illnesses. Reduction in spend on these medicines-enables money to be spent on maintaining other patient services. Local clinicians working with local people for a healthier future

14. Repeat Prescribing Accounts for two thirds of all prescriptions at cost of £30m per annum. Encourage on-line ordering where possible. Encourage patients to order their own medicines where possible as third party ordering often leads to more waste. Local clinicians working with local people for a healthier future

15. How can PPGs help? Inform patients about over the counter message-posters are being produced. Repeat prescriptions: encourage online ordering and appointments. Encourage patients to order their medicines themselves direct from GP. Local clinicians working with local people for a healthier future

16. Conflicts of Interest Gail Hawksworth Head of Communications and Engagement

17. Conflicts of Interest - Background • NHS spends over £110 Billion of taxpayers money on health care • Care organisations work together and with local authorities, industry and other public, private and voluntary bodies - this partnership working brings benefits but also creates actual and potential conflicts • The CCG already has in place a Conflicts of Interests Policy (COI) developed with partner CCGs in North Central London and this is on the Web Site • NHSE issued Guidance on COI for CCGs in June 2016 and has issued Guidance on COI for all health organisations in February 2017 • It is for the CCG to ensure its staff, members of the GB, members of CCG committees, those attending meetings, acting on behalf of the CCG or influencing decisions declare interests and keep these declarations up to date Local clinicians working with local people for a healthier future

18. Conflicts of Interest - Definition • A set of circumstances by which a reasonable person would consider that an individuals judgement is or could be influenced by another interest they hold [abbreviated wording taken from NHSE Guidance Feb 2017] • Conflicts can be actual or potential, they can involve gain or loss • Interests can be • Financial (e.g. gain direct financial benefit) • Non-Financial Professional Interests (e.g. increase in professional reputation) • Non-Financial Personal Interests (e.g. gain not linked to professional career) • Indirect Interests (e.g. close relationships with family or friends) Local clinicians working with local people for a healthier future

19. COI: What does it mean for me? • Declare any conflicts or potential conflicts & encourage others to declare (attending meetings, acting on behalf of an organisation or in a personal capacity) • Be open – it is better to declare and be safe than not • Be willing to question/ challenge others who do not declare an interest • If you are attending meetings in different capacities then be aware of which ‘hat’ you are wearing and make it clear that if you speak for an organisation or if you are speaking in a personal capacity • The CCG has a COI Policy on its web site – this contains useful advice • The Governance Team at the CCG is available to advise on conflicts and can be contacted through the Board Secretary david.triggs@enfieldccg.nhs.uk telephone 0203 6882867 or 0203 6882892 (Executive Office) Local clinicians working with local people for a healthier future

20. Questions? Local clinicians working with local people for a healthier future

21. Date of next meeting Tuesday 6 June 2017, 1.30-4.30pm, Conference Room 2, Dugdale Centre, Thomas Hardy House, London Road, Enfield, EN4 0DR Dates of future meetings: Tuesday 5 September 2017, 6.30-9.00pm, Dugdale Centre Tuesday 5 December 2017, 1.30pm-4.30pm, Dugdale Centre Local clinicians working with local people for a healthier future