Barnet – local service changes

1. Barnet – local service changes Chief Officer: John Morton Workstream Lead: Becky Kingsnorth Clinical Lead: Dr.Philippa Curran Primary care and community services in Barnet have already been improved since the clinical strategy was agreed. Improvements to date* (2007 – 2013) • Providing the right care at the right time, in the right place: • Significant developments at Edgware Community Hospital • Redeveloped Finchley Memorial Hospital opened in October 2012 with rehabilitation beds, additional outpatient services, pharmacy, walk in service, out of hours and GP practices • Continuous improvements in local services e.g. new kidney centre at Edgware opened in October 2011 • More services provided in the community resulting in fewer patients having to be seen in hospital (MSK, COPD, diagnostics, urology, gynaecology, ENT, minor oral surgery, ophthalmology, cardiology and dermatology) • Implemented a referral management system for all GP and dental referrals to make sure patients get to the right service first • In November 2011 a nurse navigation scheme opened at Barnet A&E to redirect people with primary care problems to GPs and pharmacies. This developed into an urgent Care Centre at Barnet Hospital, fully operational in April 2013 • Developing an integrated care system across health and social care: • The Intermediate Care Team (ICT) has been expanded and enablement services with 2 hour response time put in place; • A risk stratification tool has been procured that will enable GPs and community teams to identify frail elderly patients at highest risk of deterioration so that proactive care can be provided to avert a crisis; • Rapid response palliative care service for people in own home and care homes was introduced in 2011; *Note: these are improvements to primary care and community services since the consultation in 2007

2. Barnet – local service changes Chief Officer: John Morton Workstream Lead: Becky Kingsnorth Clinical Lead: Dr.Philippa Curran Improvements to date* continued (2007 – 2013) • Developing primary care to support the system: • 68% of practices score above the England average for their Quality Outcome Framework (QOF) score • 88% of practices provide extended opening hours • 90% practices now able to send patients appointment reminders by text; this will reduce the number of missed appointments, and enables patients to cancel if they no longer need an appointment, so that another patient in need can see the doctor. 47% of practices now have web-based information systems with the remaining practices set to move to a web-based system by October 2013. This will be vital for information sharing as we develop more integrated models of care; • Over 90% of practices have received funding to purchase additional diagnostic equipment that will enable them to provide more care on site and will inform referral decisions; • A large proportion of practices are engaged in smaller scale pilot projects that have arisen through the ideas and innovation of local GPs, for example: • Nine practices are embarking on the NHS Institute Productive General Practice programme; • A pilot minor ailments scheme has been launched with a number of practices and pharmacies; this will evaluated between now and September 2013; with a decision regarding the wider roll-out of the service to be taken after that; • A number of practices with patients in care homes, have been selected to pilot a developing software called ‘EMIS Mobile’ which will enable the GPs to access patient records when they are visiting patients in a care home; and • A group of practices are developing a shared health and wellbeing resource centre in one practice, which will be accessed by patients from other practices. *Note: these are improvements to primary care and community services since the consultation in 2007

3. Barnet – local service changes Chief Officer: John Morton Workstream Lead: Becky Kingsnorth Clinical Lead: Dr.Philippa Curran Further work is underway to develop care closer to home in line with the Clinical Strategy and more broadly to improve access and patient experience. Next steps (2013 – 2014) • Led by the Barnet ‘Plan on a page’ actions of particular relevance to the Barnet, Enfield and Haringey Clinical Strategy are to: • Embed new maternity care pathways and commissioning arrangements; • Use benchmarking to identify those elective and non-elective services where we have a greater reliance on hospital care than our peers and build our care closer to home programme to provide alternatives to hospital care in these areas. • Develop an integrated urgent care system ensuring that patients do not need to access A&E for minor conditions, and that there are alternatives to an emergency admission for those patients with complex needs requiring an increased level of care; • Put in place proactive integrated care for patients with complex needs, beginning with the frail elderly and using risk stratification to identify patients at greatest risk of deterioration. *Note: these are improvements to primary care and community services since the consultation in 2007

4. Enfield – local service changes Chief Officer: Liz Wise Workstream Lead: Graham McDougall Clinical Lead: Dr. Alpesh Patel Primary care and community services in Enfield have already been improved since the clinical strategy was agreed. In 2012 with the development of the primary care strategy and additional investment there has been the development of four networks in primary care and clinical network leads have been identified. • New primary care diabetes service offers more care closer to home, in GP practices • Increased diagnostics in the community (ultrasound, Dexa scans, MRI and echo tests) • Provision of new community services, e.g. ophthalmology at Chalfont Road and a sexual health outreach service for under-18s • A Parkinson’s Disease Specialist Nurse • New clinics being offered in the community, e.g. Town Clinic offers Genito-Urinary Medicine and gynaecological clinics • Improvements in screening programmes, e.g. high level of coverage on cervical screening and a joint bowel cancer awareness and screening programme with Bowel Cancer UK and Tottenham Hotspur Football Club • Consolidation of some single-handed GP practices, e.g. five practices consolidating into the Evergreen Surgery • 85% of GP practices signed up to offer extended hours • 80% of practices have taken up an Enhanced Access service with telephone triage to provide c 30,000 additional appointments. • Positive patient feedback on GP Out of Hours services • Full implementation of a minor ailment scheme allowing patients to access over the counter medication without the need for a GP appointment • Developed new model of care for older people in nursing homes to keep people well and prevent unnecessary hospital admissions • Development of community services such as COPD, Deep vein thrombosis and anticoagulant services • The premises work stream, has surveyed the primary care estate to prioritise funding for premise improvements with 12 schemes having been completed in 2012/3 • Installed a self service blood pressure and BMI monitor in each practice Improvements to date* (2007 – 2013) *Note: these are improvements to primary care and community services since the consultation in 2007

5. Enfield – local service changes Chief Officer: Liz Wise Workstream Lead: Graham McDougall Clinical Lead: Dr. Alpesh Patel Next steps (2013 – 2015) • A sub-committee of Enfield’s Health and Wellbeing Board was created to oversee the implementation of the primary care strategy (Jan 2012) • Primary Care implementation plan in place with additional investment of £10.7m from 2012-2015 • Four additional GPs will be working in Enfield as part of a unique UCL initiative which will create additional capacity in primary care and further education opportunities • The IT work stream has begun key projects to implement text message appointment reminders, a web based IT system and improvements to patient self check arrival screens • Joint work is underway between London Borough of Enfield and the NHS to re-develop a site in the Ordnance Road area to increase services offered to local people through co-locating council services • The NHS is also working closely with London Borough of Enfield to ensure that the Council’s Highmead development has GP services situated within development • There are also 3 other schemes being facilitated across primary care with GPs regarding new or refurbished premises which may involve practice mergers. • Target investment in an additional 12.6 Health Visitors by April 2013 • Roll out a Domestic Violence Service for patients in the east of Enfield • Roll out a support provision for carers • Roll out of training for practices and referral service for obese children • Commence a Coronary Heart disease support programme

6. Haringey – local service changes Chief Officer: Sarah Price Workstream Lead: Jill Shattock Clinical Lead: Dr. Helen Pelendrides Primary care and community services in Haringey have been improving since the clinical strategy was agreed. Improvements to date* (2007 – 2012) • Developments to four large neighbourhood health centres, all providing primary care through GP practices, Community services via Whittington Health and care closer to home. • Lordship Lane – more clinics for long term conditions supported by diagnostics • Hornsey Central – more outpatient clinics such as gynaecology, dermatology and diabetes, supported by diagnostics. Community services such as physiotherapy and dementia services • Laurels Healthy Living Centre – phlebotomy service provided from here • Tynemouth Road – community midwifery team and women’s services • Assessment and Urgent Care Centre provided at both the Whittington and NMUH, including a GP led front-end • Community anti-coagulation service • Community pharmacy network providing emergency hormonal contraception (EHC) and Chlamydia screen and treat services. • 84% of GP practices in Haringey have signed up to offer extended hours *Note: these are improvements to primary care and community services since the consultation in 2007 6

7. Haringey – local service changes Chief Officer: Sarah Price Workstream Lead: Jill Shattock Clinical Lead: Dr. Helen Pelendrides • Primary Care Alcohol Hubs Project - Based in four GP surgeries, HAGA’s weekly hubs offer residents from any practice, or those without a GP, alcohol specialist interventions. • Welfare Advice Hubs - Funding four pilot sites for Citizens Advice Bureau to provide advice in GP surgeries on the new benefit system changes. • Active for Life - To increase the physical activity levels of the most inactive adults and those who have the most to gain from making such increases, namely disadvantaged people. • BP/BMI patient operated monitors have been placed in 27 practices. • Clinical Pharmacy Support to Care Homes & Frail Elderly Patients - to provide pharmacy services aimed at improving the pharmaceutical care of nursing home patients and frail elderly patients on high risk medicines. • Increasing Medicines Management support to each of the collaboratives, thus embedding medicine management support within the networks. • Primary Care Based Counselling for those with dual Alcohol and Mental Illness • Migration of all practices to a web enabled, inter-operational technology, based on either EMISWeb or Vision 360 by July 2013. • 45 practices have signed up to IPLATO, a SMS text messaging software. • Improvement Grant funding of £120,000 for minor works across 15 practices completed by March 2013. • A pilot is currently being completed to review current demand and capacity and to redesign the practice processes and realign their capacity to more effectively meet the demand. • 22 HCA apprenticeships have been funded and recruited. • Improving sexual health outcomes and access to contraception services in general practice through improving the knowledge and skill of primary care. • The provision of a menu of nurse training courses to improve practice nurse knowledge and capacity to deliver best practice. Two courses per month provided during 2013 • A three month project to develop an educational strategy that supports the delivery of Quality Innovation Productivity and Prevention strategy. 7