Welcome Message. Ian Porter, Assistant Director Corporate Services

Transcription

1 Camden Patient Participation Group (PPG) Forum Meeting Welcome Message Ian Porter, Assistant Director Corporate Services

2 Programme 1. Setting the scene a) PPG Survey Feedback Speaker: Saloni Thakrar, CPPEG Co-chair (Chomley Garden PPG member) b) General Practice Neighbourhoods & Camden GP Federation Speaker: Eleanor Sturdy, Patient Advocate Camden GP Federation (Primrose Hill PPG member) 2. Patient Participation in General Practice (success stories) Caversham PPG (North) Speakers: Roderick Allison (PPG Chair) & Kathy Elliott (PPG & Governing Body member) West Hampstead Group Practice PPG (West) Speakers: David Richards (PPG member) & Tushar Shah (Practice Manager) James Wigg PPG (South) Speakers: Gill Walt (PPG member) Loni Booker (Associate Practice Manager)

3 Programme 3 (a): What can Camden CCG do to improve performance of local NHS Providers? Speaker: Dr Matthew Clark, Camden CCG Governing Body member (Secondary care Clinician) (b): How can PPGs influence the CCG? Speakers: Hilary Lance (Adelaide PPG) David Green (Hampstead Group PPG) 4: Question Time Panel Camden Local Care Strategy Panel members Dr Lance Saker, GP, Clinical Vice Chair, Camden CCG Sally Mackinnon, Transformation Programme Director, Camden CCG Donna Turnbull, Community Development Manager - Voluntary Action Camden

4 Camden Patient Participation Group (PPG) Forum Meeting a PPG Survey Feedback Saloni Thakrar Camden Patient & Public Engagement Group (CPPEG) Vice Chair (Chomley Garden PPG member)

5 PPG Survey Feedback Background: As a result of PPG member feedback we changed the approach for this PPG forum meeting. Instead of a top down approach we moved to a bottom up approach - and based on the feedback received todays agenda reflects what the majority of respondents wanted. In summary: 41 PPG members completed the survey Responses were received from 17 (49%) General Practice PPGs CPPEG members wanted the topics to reflect a bottom up approach PPG members completed an online survey or paper questionnaire. Survey results have been sent to the respondents that completed the survey which will also be disseminated in the November PPG newsletter.

6 PPG Survey Feedback From the feedback given the CCG and CPPEG were told that people want to know more about Patient Participation Group success stories (N = 25 (61%)) What can Camden CCG do to improve performance at local NHS providers (how can PPGs influence the CCG) N = 24 (59%) Camden Local Care Strategy N = 20 (49%)

7 GP Neighbourhoods & Camden GP Federation a Eleanor Sturdy, Patient Advocate, Camden GP Federation & Primrose Hill PPG member

8 GP Neighbourhoods & Camden GP Federation 400 GP s work in 35 GP practices in Camden There is a shortage of GPs everywhere Our 35 GP practices came together in September 2015 Haverstock Healthcare not for profit, owned by the GPs - Focus has been on Access - Saturday and evening appointments - Home Visiting

9 Close to home

10 Participation and Priorities Clusters of GPs want to work together Neighbourhoods 1 Streamlining paperwork to increase GP time for patients 2 Serious Mental Health nursing to support complex health needs 3 Somers Town Integrated primary care with voluntary sector and Camden Council 4 Diabetes IPU management of Long-term conditions 5 Sharing of specialist paediatrician, availability of blood testing PPG s could also share knowledge and ideas

11 PPG collaboration 1. Best PPGs are engaged with practice manager or GPs and have impact a two-way relationship is working well in many practices. Some practices not engaging with patients in this way at all. 2. Expertise developing around Long-term conditions e.g. Vasculitis 3. Speakers come to PPG meetings Could more be shared across PPGs using a platform?

12 PPG Success stories Caversham Group Practice Roderick Allison (PPG Chair) & Kathy Elliott (PPG Member & Governing Body Lay Member responsible for Communications, Patient Engagement & Member Relations)

13 Caversham Group Practice The PPG promoted health matters by: outreach to Bengali community (via Friday prayers Diabetes 2 test and talk in partnership with Diabetes UK and constructive discussion to agree further talks) The PPG provided the patient perspective by: collecting feedback in the waiting room advising the practice and patients of new systems and treatments The PPG improved communications by: building two-way relationships between patients and the practice

14 PPG Success stories West Hampstead Group Practice David Richards- PPG Chair & Tushar Shah - Practice Manager

15 Introduction The Practice has over the past 18 months increased its list size by 25%. This has increased the list from 10,000 to 12,500. We have a fully established PPG since The Steering Group aims to organise 2 Open PPG meetings each year either at the surgery or a local venue that will hold 100 plus patient attendees. The PPGSG has 10 appointed members plus one partner and the Practice manager and meet in the evenings. We publicise the open meetings by placing notices in the surgery and on our website, local Pharmacies, Dentists, Schools, Library, and Student Halls well in advance to encourage patients to attend and this is usually effective.

16 PRACTICE TEAM 3 Partners Clinical Team Non Clinical 7 Sessional GPs 2 GP Registrars 2 Part Time Nurses 2 Health Care Assistants Practice Manager Office Manager Admin Reception Apprentice Summariser / Read-coder Referral manager / scanner Admin Office Manager

17 Services Travel clinic Contraceptive Implants IUCD / IUCS Midwife antenatal clinic Baby clinic / health visitor Team around the Practice Saturday Clinic MSK Physiotherapy due to commence Phlebotomy for elderly / reduced mobility Joint injections CBT / Psychology Service Counselling / psychotherapy NHS health checks Embedded social worker / O.T. Smoking cessation

18 9 8 Percentage Population Practice Male Practice Female UK Male (ONS) UK Female (ONS) plus 85 to to to to to to to to to to to to to to to to 14 5 to 9 0 to 4

19 Our PPG Success ACCEPTANCE OF PPG ROLE (working to promote effective communication between the practice and patients and ensure that patients are involved in the development and monitoring of services at the practice). At first the practice partners wanted to stay outside the PPG other than a reporting back involvement of the PM, but there was soon an acceptance of the benefit of direct involvement, and one of the three partners is now a permanent member of the PPGSG.

20 CONTINUING INVOLVEMENT covering a range of ongoing issues e.g. discussing staffing needs, staff training needs, changes to the appointments system(frequent tweaking but no permanent solution in face of growing practice size), use of reminders (iplato configuration), clearing up reception area, tackling DNAs, reviewing ideas in Suggestion Box, FFT and NHS Choices comments. This works to the extent of the partners seeking positive PPG support in progressing their plans for meeting needs of a growing patient list.

21 AND HERE LIES THE MAIN SUCCESS SO FAR - obtaining section 106 funding from the Council for the creation of two new consulting rooms to allow for the recruitment of three further doctors. This has also allowed for alterations to existing offices, facilities (i.e. toilets) and storage room for patient s records.

22 This was a protracted process of frequent stone walling by NHS England and delayed support at CCG level following council acceptance of proposals (subject to CCG and NHS England being happy about things). The PPG chair was involved in on site meetings and discussion with council planning staff and lobbied local Councilor's, and the PPG sent an open letter to Camden CCG, the council, NHS England to get and keep things on track. I am happy to say that final touches are now being applied, and last two of the three new doctors start work in December. This has allowed the practice to offer an additional 200+ appointments each week! The practice now has capacity to absorb the additional 1000 new patients that will be moving into the new developments on West End Lane.

23 PPG Success stories James Wigg Practice Gill Walt - PPG Chair & Loni Booker - Associate Practice Manager

24 James Wigg Group Practice It s a two way conversation

25 James Wigg Group Practice Research - NOCLOR - Nursing study - Care Planning (QIP Project)

26 James Wigg Group Practice Reception Queuing Project

27 James Wigg Group Practice Support - Volunteers - Cancer Support Group - Advanced Care Planning Month

28 Improving performance of Local NHS providers What can Camden CCG do to improve performance of Local NHS providers? Dr Matthew Clark Camden CCG Governing Body member (Secondary Care Clinician)

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32 Heat Map Camden A&E Delivery Board Out of Hospital Hospital 111 General Practice A&E Department Community Services (CNWL) Out of hours GP London Ambulance Service Beds Available Social Care RAPIDS Mental Health

33 Out of Hospital 111 General Practice Out of hours GP London Ambulance Service Extended access to GP appointments Integrated 111/ Out of hours GP service RAPIDS

34 Hospital A&E Department Local GP service Beds Available Mental health liaison nurses

35 Community Services (CNWL) Step down beds Social Care Seven day working of social workers Increases access to rehabilitation Mental Health

36 Improving performance of Local NHS providers Contractual monitoring Contract Query Notices (CQN) relating to performance Recovery Action Plans Recovery Action Plans (RAP) Monitor performance against RAP) Financial sanctions Contractual levers Some further potential actions are described below, described as either incentives or penalties: Incentives - for example Completion of commissioner actions from a workplan Local incentive schemes Provider operational efficiency schemes Penalties for example Contract Performance Notices Request an audit Information Breach Notification Reinvestment of penalties outside of provider Initiation of the Dispute Resolution Process

37 Improving performance of Local NHS providers Non-contractual levers Incentives for example Support for provider service developments Benchmarking and sharing best practice Accessing external support Involve Associates in performance discussions (additional CCG engagement) Penalties for example Communication to GPs to divert referrals elsewhere Limit access to additional funding Increased scrutiny Deep dives Patient Choice Wider commissioner levers For example Addressing sector wide issues Investigating rise in GP referrals Invest in community and primary care services Commission additional capacity

38 How can PPGs influence the CCG? Hilary Lance, Chair of Adelaide PPG & David Green, Chair of Hampstead Group PPG

39 How can PPGs influence the CCG? Q1. Historical context does this have an impact? It can and should do - national initiative with initially financial incentives Overall aims, broadly: o o o to improve the patient experience and outcomes to inform patients of how the Practice functions and of issues facing the Practice i.e. to be a an informed critical friend and bridge between the practice and patients, and the patients and the practice. So accountable to the practice and very firmly embedded in being practice-focussed and monitored via Practice annual report and Care Quality Commission inspections, which are increasingly examining the function of PPGs Q2. How are Camden PPGs functioning at present? Great variety between PPGs: size, approach, activity, numbers who attend, frequency and duration of meetings, who chairs and effectiveness so - plenty of scope to learn from another Without exception PPGs members identify and align themselves with their own GP Practice Some PPG members are interested individually in a wider role e.g. CPPEG Camden CCG led public and patient engagement group, GP Federation & PPG alliances No doubt that those PPGs which achieve the most impact are strongly supported by committed and engaged practice staff.

40 How can PPGs influence the CCG? Q3. Who are PPGs influencing currently? Principally their own Practices and on occasion other PPGs Most significantly in the culture of how patients experience their services and achieving greater understanding by patients of the constraints the GP practice faces Q4. Should PPGs be influencing GP Federation and developing GP neighbourhoods, GP alliances? Yes. This is vital PPGs will need to find ways of working together where GP practices are working together in the delivery of patient services This will take energy and focus This may not be comfortable for all current PPG members

41 How can PPGs influence the CCG? Q5. What is the current pattern of CCG patient engagement? Current vacuum of engagement between PPGs themselves and CCG - not surprising given the above CCG has developed extensive and effective and comprehensive approaches to patient engagement focussing on e.g. particular patient groups, hard to reach groups, focus groups Election of CPPEG patient representatives by PPG members & Active engagement of CPPEG members on CCG committees and key groups Active communication through seminars, open meetings for patients, PPG newsletters, interactive website Q6. What needs to change if PPGs are to influence the CCG? An enhanced approach to communicating with patients and PPGs about change - most patients want to know how will/might this impact on me? Information for patients needs to be written in the simplest terms (no jargon) from a patient perspective CCG needs to be very much clearer about what they actually want from PPGs The CCG could ask PPGs for responses to specific proposals (but this needs to reflect the timing of many PPG meetings) and may need more Practice support Provide PPGs with a clear route for communication with the CCG Need to accept that PPGs cannot represent all patient groups in any Practice.

42 How can PPGs influence the CCG? Q7. Is it realistic or practical to expect PPGs to significantly influence the CCG? Depends on enough being known by PPGs about what the CCG itself can and cannot determine. CPPEG elected patient representatives are in a much better position both to know what is possible, particularly through participation in the different CCG committees / groups. The patient reps essentially have to used their own judgment and experience in participating in those committees and can rarely consult PPGs, in part because some of the issues are confidential The experience of the patient reps is that they are carefully listened to and their views are taken into account. Securing resulting action through the commissioning process is, however, more difficult for a variety of reasons interaction with national policies, reaching the responsible person and, of course, the vast range of challenges the NHS is facing with increasingly constrained resources. Patient reps have to work hard to establish through which channels the patient wishes they are representing can be implemented and then be persistent in following up in the face of competing demands on CCG staff time and resources We can offer reassurance that much effort is devoted to improving the patient experience at all levels, but that the range of areas to be covered is very broad and so input from patients as to what their greatest priorities are can be key but they need a framework

43 How can PPGs influence the CCG? Q8. What do we conclude? The CCG takes patient engagement seriously and puts considerable effort and resources into it and should continue to do Resourcing CPPEG and, via it, CCG committees/groups with PPG members is practical and opens up opportunities for some PPGs to become more informed The CCG relationship with PPGs as groups is ambiguous and challenging.

44 How can patients give feedback to General Practice? Martin Emery Deputy Head of Engagement Camden CCG

45 Giving Feedback Suggestion Boxes Practice (Local and National surveys) Friends and Family test Comments & Suggestions / Complaints (Voiceability independent complaints advocacy service) Speak/write to the Practice Manager PPG Notice Boards PPG open / business meetings What happens Practice staff can review the information obtained at PPG meetings GP s can issue Quality Alerts which are raised with the CCG and issues taken up with service providers (CCG can announce visit protocol with service providers) reviewed at Clinical Quality Review Meetings

46 CAMDEN LOCAL CARE STRATEGY November 2016

47 The story so far Camden is a very diverse and complex borough. While outcomes for local people in many areas have been improving over the last decade, there are still significant inequalities that need to be addressed. The local health and care economy is facing decreasing financial resources at the same time as increasing demand for services. Diverse population Biggest area of inequality Decreasing financial resources

48 What is the Camden Local Care Strategy? Aim: Health and care services will work together with local people to provide coordinated, proactive, accessible, good quality care in order to improve the health and wellbeing of people in Camden Why do we need a strategy? Need to bring together all key health and care organisations to agree a single model for the delivery of health and care services in the future Have an agreed approach on how we will achieve a sustainable system that provides high quality care To set out a shared programme of work to deliver the model using the agreed approach so that we can jointly work on implementing our vision by 2021 The strategy will complement and contribute to the NCL sustainability and transformation plan (STP).

49 National challenges Health and wellbeing gap Care and quality gap Funding gap

50 Where we are now Several large specialist services providing different levels of care, and many different community organisations with different systems and processes. Too much care is focused around hospitals instead of being delivered in the community. Some community and primary care organisations are not joined up, and there is too much inconsistency in the care provided. Patient pathways between different care settings and services aren t always clear and consistent. This system doesn't make the most of skills and resources in the voluntary sector. Emphasis is on treating people when they get ill, instead of helping them to stay well and building resilience. Self care Camden Local Care Strategy

51 Where we want to be Enablers: Quality & Safety Workforce - Estates - Technology & Systems Leadership - Commissioning & Contracts - Engaging Residents Camden Local Care Strategy

52 Our three horizons for successful implementation Soundings from local partners, during the development of our Local Care Strategy have indicated that there may be three organisational development horizons for successful implementation Horizon 1: Complete Horizon 2: Work in progress Horizon 3: Future What is the purpose? Deliver seamless integrated local health and care services to improve outcomes, narrow health inequalities and achieve sustainable services Finalise Local Care strategy Develop a strategy and dedicated mobilisation plan by an integrated project team with buy-in from all stakeholders Integrate commissioning in a comprehensive way Develop and implement changes to joint commissioning arrangements to create a much more integrated health and social care commissioning Create new entity/entities for further changes in implementation Develop and implement innovative partnership models towards accountable care with a range of organisations influencing health and social outcomes of Camden s residents (commissioners, providers, third sector, employers, etc.) Camden Local Care Strategy

53 Supporting Information: National Association for Patient Participation (NAPP) A summary of how PPGs have made a difference nationally - Growing patient participation (21 ways to help your practice thrive (click here)) N.A.P.P. Commissioning Champions Project (click here) Building better participation is a framework of four inter-linking Areas: Getting PPGs in place, Helping PPGs work well, Knowing and working with patients & Influencing beyond the GP practice Building better participation Getting PPGs in place Helping PPGs work well Knowing and working with patients Influencing beyond the GP practice Making online GP services work well for patients