Commissioning Intentions Event November 27 th 2013

1. Commissioning Intentions Event November 27th 2013 Feedback from the Programme Board Discussions

2. Updates on Call to Action and Commissioning Intentions Event • The City and Hackney CCG have been taking part in the London Call to Action consultation which comes to an end in December 2013. The focus has been on engaging healthcare professionals, decision makers and most importantly members of public in discussions about the future of the NHS. • This consultation is led by NHS England who will collate and analyse the feedback and comments from the participating CCGs and use the information towards their strategic planning for the next five years. • The attached activity log details the Call to Action activity the PPI Team within the City and Hackney CCG have undertaken over the last few months. As the consultation is still on-going there will be opportunities to add more detail.

3. Prescribing (focus on waste and adherence) • What works well? • Adherence: Pharmacists discussing medication with patients in hospital wards. Pharmacists providing blister packs to make taking medication easier. • Waste: Pharmacists are well trained and are able to monitor patients from time to time. • What would you change? • Adherence: Sufficient time with GP to discuss medication and information about different options available. Considering varying levels of literacy when prescribing. Ensuring up to date information is available re safety. GPs to be open to people asking questions about their medication. Patients have requested specific support groups and would like to see these implemented (more information needed on this). • Waste: GPs and pharmacists to monitor the quantity of medicines prescribed and engage the patient more. Patients feel medicines are wasted if they are asked to continue taking them even after symptoms are gone. Review to avoid overprescribing some medications. Ensuring patients get their medication on time. • What does success look like? • Adherence: Support line, more regular medicine reviews by GPs, use of any healthcare professional to review medicine use at the time of the appointment. • Waste: Targeted advertising campaign, follow up meeting to discuss points raised at the Commissioning Intentions meeting

4. Maternity • What works well? • Home support group, specific midwifery team, maternity helpline • Birthing centre and refurbished labour unit both well liked • More patients want to go to Homerton • Prioritised GP appointments when pregnant although otherwise long wait • Specific projects: Bump Buddies, Pronatal Project (holistic project, incl. socioeconomic factors relating to pregnancy) • What would you change? • Ensuring that information and services reach vulnerable groups incl. migrant and homeless women. New ways of promoting services needed to target those with no access to internet. Taking the services out to community. • What does success look like? • Holistic, community based approach which is based on direct feedback from women on how to make service available and easy to access • Emphasis on ensuring services reach vulnerable groups

5. Children’s Services • What works well? • Holistic approach between CCGs and local authorities • Children’s immunisations – fears for outsourcing in the future • What would you change? • More emphasis on asthma, vulnerable families and children’s mental health when commissioning the services • Children’s Mental Health: looking at the family as a whole, community engagement and youth participation, ensuring children’s voices are heard in commissioning • What does success look like? • Ensuring CCG and local authorities work together • Maintaining a holistic approach when commissioning children’ s services

6. Mental Health – specific focus on Children’s Mental Health • What works well? • Community engagement, expert knowledge and peer support • Pathways between statutory and voluntary services • Looking at emotional health along with physical conditions • What would you change? • Training and information available to all those working with children in order to reduce stigma and the fear of “children being taken away” if something is wrong in particular in some of the hard to reach communities. • More peer support and emphasis on prevention. • Being aware of issues such as FGM and believes relating to witchcraft etc. in some communities – and the effect this can have on mental health. • Focus on smooth transition from children’s mental health services to adult services (age limit to increase to 25?) to avoid issues escalating for the 20-30 age group. • What does success look like? • Peer support, school, teachers, voluntary sector – different ways of joining everything up. • Recognising physical issues or behaviors can be masking underlying mental health; • Better training for people working with people with learning disabilities – not just a tick box exercise. Giving people a voice.

7. Planned Care (focus on dressings and chronic pain) • What works well ? • No specific information provided on the notes • What would you change? • Chronic pain: waiting times too long leaving people in pain and relying on pain killers • Chronic pain: need for more effective pain management treatment with focus on patient choice (massage, community based chronic pain clinics) • Dressings: District nursing – clarification on what is available through district nursing, improving the appointment system • What does success look like? • Holistic approach • Ensuring clinic availability and easy access • Focus on patient choice

8. Urgent Care • What works well? • Springfield and Tollgate satellite walk in centres provide good urgent care • Support lines • Pharmacies in the community • What would you change? • More focus on managing expectations and ensuring people have access to information about how the urgent care and out of hours services work • What does success look like? • Sufficient information about Urgent Care and Out of Hours services and how to access these • Restoring confidence in the Out of Hours care • All sectors to work together to ensure efficient delivery of Urgent Care services

9. Long Term Conditions • What works well? • No specific comments –it was recognised that some services already work well, no need to change. No further information available. • What would you change? • Encouraging people (men in particular) to come forward earlier for check ups preventing CVD and offering yearly check ups. More emphasis on prevention. • More focus on the psychological effects of LTCs • Treatment and services based around the life cycle • Concern over cut backs and how these will influence care • Focusing on tackling health inequalities in relation to LTC • Community organisations need to be given the support to operate successfully • What does success look like? • Considering the changes in family dynamics resulting from a LTC diagnosis • More people powered services • A system which encourages men to come forward earlier • Integrate pathways (such as stroke pathway) to provide holistic care

10. Primary Care Quality • What works? • Good staff and clinical lead who keep up with research • What would you change? • Better utilisation of the internet and new technologies in helping people manage their health and ill health as well as make bookings etc. • Good communication between practices and patients as well as between practices and hospitals to ensure effective referral processes • Information about primary care quality and managing expectations • Increased support for patients to manage their conditions themselves • What does success look like? • “Healthy NHS which is not under threat.” • “Appointments on the same day. Being listened to. Not waiting. Not being rushed. Coming out feeling happy.” • “Being conscious that different communities have different needs.” • Running individual practice surveys to map good patient experience