City and Hackney Members Forum

1. City and Hackney Members Forum Thursday 7th March 2016 - 1pm St Joseph’s Hospice AGENDA Constitutional change Consortia elections Programme Board clinical lead appointments

2. Background and context • Members will be familiar with the need for the CCG to consult with representatives of our member practices and to also gain agreement for changes to our constitution from NHS England. • In the last 6 months a number of areas within the constitution have been reviewed however these will be brought to a later MF once further discussion has taken place with members and the LMC. • The following specific change is being reviewed today; • Extension of Governing Body (GB) Members • Currently all GB members (other than the Chair, Clinical Vice Chair and CCG Officers), can only complete two consecutive terms of office (a term is 2 years) • The following changes are recommended; • GP members – Of the three GP members appointed to the GB, two of the members to be allowed to serve an additional third term of office (an additional 2 years) however one member only to complete an additional 1 year extension. • Other members – Lay, Consultant and Nurse members to have the option for an additional 1 year extension.

3. Rationale • GP Members – Allowing two of the three GP members to complete a third term provides for continuity. Restricting this to two members encourages preparation for new GP membership whilst ensuring all GPs do not leave at the same time. • The GP member not undertaking a full term, will have the option to remain for the extended 1 year period. At the end of this extension, the other consortia leads would then need to select a new GP GB member. • Other members – The incorporation of an additional 1 year extension provides increased flexibility for preparation to replace members whilst avoiding members leaving at the same time. In addition this also allows for increased retention for high performing members.

4. NextSteps • If members support the recommendation to allow an extension for GB members, the change will be authorised by the GB, incorporated into the constitution and ratified by NHSE.

5. Consortia Leads Election Results The following members have been appointment consortia leads and deputies. The term of office will be to 31st March 2018. These will form the new Clinical Executive Committee North East: Lead -Nikhil Katiyar, Barton House | Deputy - Katie O'Beirne, Nightingale Practice (Temporary basis) North West: Lead - Mark Rickets, Nightingale Practice | Deputy - Katie O'Beirne, Nightingale Practice South West: Joint leads - Gary Marlowe, De Beauvoir Surgery & Paul Kelland, Shoreditch Park Surgery KLEAR: Lead - Haren Patel, Latimer Health Centre | Deputy - Suresh Tibrewal, Richmond Road Medical Centre Rainbow & Sunshine: Lead - Abdul Pathan, Gadhvi Practice | Deputy - Kawal Sabharwal, Southgate/Whiston Road Medical Practice Well: Lead - Claire Highton, Lower Clapton | Deputy (joint) May Cahill, London Fields, Anu Kumar, Sorsby

6. Governing Body GPs • The 6 GPs elected to the CEC have to agree which 3 GPs will be on the CCG Governing Body • The 3 GPs who have put themselves forward are:- • Clare Highton • Haren Patel • Gary Marlowe • Clare wishes to stand as CCG Chair and Haren as Clinical Vice Chair • If the GB agrees this at its March meeting then they will take on these roles and:- • Clare will also step down as Well Consortia rep and May/Anu will become the Well rep • Haren will become Chair of the CEC and Suresh as the Klear deputy will represent Klear at the CEC

7. Programme Board Clinical Lead Appointments • The following members have been appointed to Programme Board Clinical Leads until the 31st March 2018. • Long Term Conditions – Clare Highton • Maternity – Kirsten Brown • Mental Health – Rhiannon England • Planned Care – Gary Marlowe • Prescribing – Haren Patel • Primary Care Quality – Mark Rickets • Urgent Care – May Cahill • Childrens and Early years – Rhiannon England for 6 months

8. CCG Clinical Commissioning Forum Thursday 3rd March 2016

10. VARIOUS UPDATES MARCH 2016

11. CCG CONTRACTS • Contracts Committee agreed • LTC contract with the Confederation • FHV contract with the Confederation • Clinical commissioning and engagement contract with practices • Award of wound care contract to Confederation • These will all start on 1 April for 2 years – with changes to specs for 17/18 • Rollover of all other CCG contracts to 30 June

12. Revised specs – which have all been consulted on – to start from 1 July will go to Contracts Committee on 29 April with recommendations on length of contract • Once approved they will be negotiated with the Confederation • Extended hours, Duty doctor, Early years, EOLC, SMI/Mental health

13. Demand management • Contracts Committee awarded a contract for £600k to the Confederation • This is to work with practices and patients to agree which demand management initiatives to pursue and then implement them, including training to use • Practice digital offer - websites and on line access to test results, repeat prescribing, booking appointments • Self care and health advice • Increase use of text messages • Pharmacy First and extended role of Pharmacists • Other ideas! • Overseen by Primary Care Quality Board • Part funded by the IT underspend mentioned at last CCF

14. Other • Tackling workforce issues • £900k reported at last CCF; 50% to be spent on out of hospital issues • “Back office” functions • Offer to providers to fund exploring the interest and potential

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16. The City and Hackney Mental Health Crisis Service:

17. 24 Hour Crisis Line020 8432 8020 The Crisis Line aims to intervene with advice and support for City and Hackney residents in order to help them during times of psychological distress and mental health crisis. It provides an immediate 24/7 response to anyone who seeks advice and support for mental health issues for themselves or on behalf of another. This includes external agencies such as the police, new service users, existing patients, mental health professionals, carers, family and friends. The service provides instant access to a qualified mental health professional (Band 6 or above) such as a mental health nurse, social worker, or occupational therapist, etc. Signposting or direct transfer The Crisis Line is an ageless service with the ability to refer into the MHCOP or CAMHS pathway via CHAMRHAS (as the single point of entry). It will also provides members of the public with information relating to the Crisis Café, Service User Network and advise of other services as appropriate: MIND, Housing, Drug and Alcohol Services, Primary Care, other ELFT services or A&E, the police or ambulance service for urgent assessment, as appropriate.

18. Crisis Cafe Service Description A safe, supportive and therapeutic environment, promoting independence, opportunity and recovery for people with mental health issues in the community. The service has an open door policy, with self-referrals, primary and secondary care referrals all welcome. The Café operates Monday – Thursday 6pm – 9pm and Saturday 12 noon – 4pm. IRIE building, 15 Homerton Row E9 6ED Signposting or Direct Transfer Individuals will be signposted to the Crisis Line service for ‘out of hours’ support. Regular attendees will be signposted to the Service User Network if appropriate, or alternative services within the Crisis Network. In times of emergency, (Eg. Self-harm or overdose) staff will refer directly to A&E. In addition, if required, a referral can be made for an assessment to be carried out under the Mental Health Act. People will be signposted to additional information and support in other areas, such as housing and welfare, etc. Service Model This service aims to support users who experience emotional and psychological distress, to provide a safe space, the opportunity for peer support and to promote self-help in times of need, to prevent crisis escalation.

19. Service User Network (SUN) Service Description SUN offers a safe, supportive and therapeutic group for individuals who may or may not not have a formal ‘Personality Disorder’ diagnosis, but experience frequent mood dis-regulation, emotional instability, self-harm and/ or suicidal ideation. The service operates an open door policy  primarily encouraging self-referrals. however Primary and secondary care referrals also welcome, as well as  informal referrals from the Crisis Café and Crisis Line. Signposting or Direct Transfer Aimed at users who frequently present to health services in crisis but who find it difficult to commit’ to treatment which requires consistent and regular attendance. SUN acts as a point of liaison for significant others involved with the service users, signposting them as appropriate to other primary and secondary care provision. Service Model SUN will provide psycho-education and skills sessions within a group that offers a blend of both clinical expertise and peer support, the aim of which is to support recovery and provide self-help management strategies for the prevention of future crisis.

20. Home Treatment Team (HTT) Service Description A crisis intervention service with the ability to urgently assess patients with mental health problems within their homes. Unknown users require afirst tier risk assessment by a health professional prior to being referred to HTT, However join assessment is offered where there is urgency or where appropriateness is questionable. HTT performs a second tier risk assessment through telephone triage (24 hours a day). For those known to the service with an urgent need, visits are conducted within 4 hours, for those with non-urgent needs, visits are made within 24 hours. Signposting or Direct Transfer CHAMHRAS (single point of entry) and the HTT team can refer patients to an Authorised Mental Health Professional (AMHP), who can arrange an assessment under the Mental Health Act. The HTT service can also provide onward referrals to other specialist agencies for treatment, therapy, advice or support. Service Model HTT provides ‘ward services within the community.

21. Hours of Operation

22. Signposting and Referrals A&E (MH Assessment) A&E (Out of Hours Emergency) Normal Hours of Operation If known to ELFT HTT 9am – 5:30pm HTT 24/7 telephone advice and referrals 2nd Tier Assessment CHAMHRAS single point of entry Mon – Fri, 9am – 5:30pm Crisis Line (24/7 Signposting) Crisis Café Mon – Thurs, 6pm to 9pm Saturdays, 12noon – 4pm SUN Mon, Wed, Fri 1pm – 3:30pm Signposting Signposting Members of the public , MH Profs, external agencies, Carers, existing patients Self-referrals/ Primary & Secondary/ Carers/ Patients/ General Public Primary & Secondary Care, self-referrals

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24. Mild Cognitive Impairment Group & Cognitive Stimulation Therapy Lisha Shiel Dementia Alliance

25. Mild Cognitive Impairment Group • A reminder: “Mild cognitive impairment is defined as cognitive disorder which is greater than expected for age and education level, but does not interfere notably with activities of daily life” (Gauthier et al, 2005) • A psychoeducational peer support group for service users with a formal diagnosis of mild/vascular cognitive impairment and their relatives. Consists of 8 weekly 2 hour sessions. • The purpose is: 1. To improve coping skills and facilitate adaptation to impairments. 2. To reduce anxiety and improve feelings of competence in service users and their close ones.

26. MCI Group: Evidence base and Outcomes • Growing evidence base for this type of intervention. • Similar groups run by the Mayo Clinic in the States. • Meta analysis found that with appropriate training, individuals with MCI can and will use strategies to compensate for their memory difficulties (Greenaway et al, 2005). Outcome measures: • Two quantitative outcome measures used pre and post group. • Illness cognitions questionnaire (Evers & Kraaimat, 1998): 18 item questionnaire measuring hopelessness, acceptance and perceived benefits of illness • Quality of Life measure • Qualitative feedback is obtained pre and post group.

27. Cognitive Stimulation Therapy (CST) • CST is a structured 14 session group therapy for people with a diagnosis of mild to moderate dementia. • NICE recommends all people diagnosed with mild/moderate dementia should be given the opportunity to participate in CST (NICE, 2011). • Each session includes: a social time, reality orientation, warm-up, song, news article, main topic and close of group. • Includes a 1 hour carers group to teach basic principles of CST and address carer stress.

28. Evidence base and Outcomes • Research suggests that CST significantly improves cognitive skills and quality of life for people with a diagnosis of dementia (Spector et al, 2003). • CST is cost effective when compared with usual activities (Knapp et al, 2006). Outcome measures: • 1 quantitative measure used pre and post group: Quality of Life: Alzheimers Disease (Longsdon, 1996) • 1 ‘Monitoring Progress’ measure used after every session to assess level of engagement. • Qualitative feedback obtained pre and post group.

29. Conclusion Service User feedback “I feel more confident in myself after this course. I feel prepared to face the future” (MCI group participant) “ Listening to others problems made me feel like I wasn’t alone. I enjoyed every session and came away feeling refreshed and validated.” (MCI group participant) “My mum is a lot brighter now that she’s been coming to the group. She seems more alert and cant wait to share what was done in the session” (CST group participant) • Referral Route: • City & Hackney Memory Service.

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