BEH Clinical Strategy july-august 2013 barnet Welcome Welcome to this edition of the BEH. We are gearing up for local CCGs to take the decision in September about the timetable for service changes for Barnet, Chase Farm and North Middlesex University hospitals. As we get closer, we will be updating you more regularly. I don t know if you have visited Barnet or the North Middlesex hospitals recently but if you have, you will get a real sense of momentum with the building works. The new buildings are gathering pace and plans are starting for their formal openings, which makes it very real. We re mindful that we also treat many patients from south Hertfordshire. Only a small proportion of these - around six patients a day will be affected by the service changes planned for Chase Farm Hospital but we want to make sure that each referring GP is aware of the changes, and of the services which will remain or will be developed on the Chase Farm site and will keep Herts colleagues up to date. We are starting to see some real benefits to primary care happening. We ve got a focus on Enfield on pages 4 and 5. The exciting thing for me is to see how technology is freeing up time to allow GPs to see more patients. In one scheme, patients receive a text message to remind them of their appointment. This gives them the chance to cancel if they no longer need it, which frees up the appointment for another patient. In Enfield alone, 1,588 appointments were saved in just six months. In another, patients can use an automated pod to check their blood pressure as part of regular self care, seeing a clinician only when their blood pressure changes. This frees up practice nurses and GPs to see other patients. If GP colleagues have questions about the changes, they can ring a dedicated number to book in to have a conversation with the BEH team. There s more information inside. One last reminder for GPs and practice managers: our GP survey is still running. If you have not yet contributed, please do take 5 minutes to let us know your thoughts by completing the short questions here https://www. surveymonkey.com/s/gjyj9m6. I hope you enjoy the. Please do get in contact if there is anything you want to know. You ll find contact details on the back page. Enjoy the summer! Nick Losseff Nick Losseff Medical Director for BEH clinical strategy In this issue... Enfield haringey Keeping GPs in the loop 2 Are you a GP in Barnet Enfield or Haringey? If so, we want your views. 2 Maternity Advertising 2 Come and find out more about the BEH plans 3 Primary Care benefits realised across Enfield 4 Keeping the public up to date on transport 8 Public Eye - Updating Hertfordshire about the changes 9 1
Keeping GPs in the loop Have you got a question about the BEH Clinical Strategy? Then book one of our BEH phone in sessions. If you are a GP you are invited to find out more about changes to local hospital services being delivered through the 114.6m investment across Barnet, Enfield and Haringey. GPs can call in for a one to one conversation with one of the clinical leads and programme managers to find out more about referring patients to services across BEH. GPs or practice managers can book a time slot with the BEH team by calling 0203 688 1994. We ll ask for your name, practice, email address and best contact phone number and you will be offered a time for us to call you back. A series of drop in clinics will also be held across Barnet, Enfield and Haringey to give people the opportunity to find out more about the changes to services at Chase Farm, the North Middlesex Barnet hospitals. These will be advertised and GPs informed. Are you a GP in Barnet Enfield or Haringey? If so, we want your views. We are extending our GP survey and want as many local GPs to take part as possible. If you have not already completed our summer survey please click here to take part. There is a prize up for grabs which will be drawn at random in August. https://www.surveymonkey.com/s/ GJYJ9M6 win PRIZE Maternity Advertising You may have seen our pink maternity adverts telling the public about the labour ward moving from Chase Farm Hospital to Barnet or the North Middlesex hospitals. We shared these with you in the last edition. What you might not be aware of is that these are available in community languages: Farsi, Somali, Romanian, Polish and Turkish. If you would like copies of these to share with your patients, please email the address on the back page. Example of our poster in a community language 2
Come and find out more about the BEH plans Members of the public are invited to find out more about service changes across Barnet, Enfield and Haringey. They can come along to local shopping centres where staff will be on hand to answer questions and talk about the improvements to services which are being made. There will be a chance to see the new BEH video explaining changes and we ll be testing the public s knowledge about where they should go if they hurt themselves badly or are unwell or who to turn to for a range of common medical injuries. We will be at the following venues for seven days and staff will be on hand during the shopping centre opening hours: The Brent Cross Shopping Centre, Barnet Near Phones 4U and WHSmiths The Co Op car park, Enfield, EN3 6LZ The Spires Shopping Centre High Street entrance, Barnet The Mall ( Wood Green) Shopping Centre, Haringey outside Primark Monday 7 October 11 October 2013 10.00am - 8.00pm Monday 14 October Wednesday 16 October 2013 9.00am 6.00pm Thursday 17 October Sunday 20 October Thursday 9.00am 5.30pm, Sunday 10.00am 4.00pm Monday 21 October 2013 for 7 days Monday to Saturday 9.00am 6.00pm Sunday and Bank Holidays 11.00am - 5.00pm The Palace Gardens Shopping Centre, Enfield outside Waitrose Monday 28 October 2013 for 7 days Monday Saturday 9.00am 5.30pm Sunday and Bank Holidays 10.30am 4.30pm The Pavilions Shopping Centre, Waltham Cross, Herts Outside Sainsbury s Commencing Monday 28 October Sunday 3 November 2013 Monday Tuesday 8.00am 6.00pm, Wednesday Friday 8.00am - 8.00pm, Saturday 8.00am 6.00pm, Sunday 10.00am 4.00pm See you there! 3
Primary Care benefits realised across Enfield Primary Care benefits realised across Enfield Across Enfield the investments in primary care are becoming clearly visible. These are just some of the projects which are making a difference to patients across the borough. Next month we will showcase the improvements in Barnet and Haringey. Improvements seen in local surgeries: In a move to see long term sustainable improvements in access for patients to GP practices across Enfield, the Primary Care Foundation analysed patient demand data from practices across the borough and reported with suggestions for areas where improvements could be made: 16 practices also had visits to discuss the report and ensure easier patient access to services. Telephone triage frees up GPs: 110 Enfield GPs attended telephone triage training and this has already freed up an additional 8,000 appointments in just six months. Patients can have a telephone consultation from the comfort of their own home or from their workplace with their GP. Telephone diagnostics are becoming common across many medical fields nationally, including mental health which is reporting good results. Some GPs report that their patients are less embarrassed when discussing personal details over the phone. PODS point the way: By the end of August, 48 Enfield GP practices will be using new automated diagnostic health pods which measure a patient s blood pressure, pulse wave and the height and weight to calculate the Body Mass Index. This is provided free to the patient who can choose to print two copies, one for their records and the other to be handed to a clinician for interpretation. The majority of patients use the machines opportunistically while waiting for a consultation; the readings are handed to the clinician and form part of the consultation and the results recorded into the patient s medical history. 4
New Spirometers across Enfield New ways of communicating with patients A Respiratory Community Nurse visited 49 out of 52 practices to provide such core as text messaging appointment training to upskill practices in managing lung diseases. A new Respiratory reminders will give patients more choice. Nurses Forum has been set up and new spirometers (to measure lung fuction) and pulse oximeters have been delivered to 39 of the 52 practices in Enfield and staff have attended nationally accredited training on using the spirometers. Pharmacies play greater role Over 40 local Enfield practices have taken part in a scheme which utilises pharmacy skills and capacity to improve access for patients suffering from minor ailments. The scheme creates a direct access pathway for patients entitled to free prescriptions by removing the prerequisite for the patient to visit a GP to provide simple over the counter medicine and/or advice, free, via prescription. Patients with minor ailments, who need advice or simple over the counter medication, obtain a passport enabling them to be seen at their local pharmacy, freeing up the GP time for patients requiring complex interventions. Over 1,200 face-to-face pharmacy consultations were provided during February and April 2013 alone. Overall 50 GP practices and 52 out of 60 pharmacies are participating in the scheme. Text messaging: 1,588 appointments have been freed up by GP practices using text messaging. Patients receive a text message to remind them of their appointment and giving them the chance to cancel if they no longer need the appointment. This frees up the appointment for another patient. From October 2012-April 2013, over 1,588 appointments were rescheduled by patients who, otherwise, might have simply not attended. These are just some of the initiatives which are starting to make a real difference to local people across Enfield. In the next edition we will look at the benefits in Barnet and Haringey. 5
Update on the BCF acquisition by the Royal Free Work continues around the proposed acquisition of Barnet and Chase Farm Hospitals (BCF) by the Royal Free London NHS Foundation Trust. Under the proposal, Barnet and Chase Farm NHS Hospitals Trust would become part of the Royal Free, which would manage three hospitals (Barnet, Chase Farm and the Royal Free), as well as a number of outpatient services and specialist clinics at other hospitals. The Royal Free is committed to the BEH strategy, but the delivery of the BEH Clinical Strategy is expected to happen prior to any planned acquisition by The Royal Free Hospital. A larger trust would bring together best practice and expertise from both organisations, while making the best use of NHS resources. It would be able to provide co-ordinated and consistent care for more patients, develop as a centre of excellence and help address the future financial challenges faced by the NHS. A single organisation would also be better placed to adapt to these challenges and take advantage of the opportunities to provide better quality, modern day hospital care. The two trusts and the key clinical commissioning groups are currently working with clinicians from the three main hospitals, NHS England and the NHS Trust Development Agency to ensure the acquisition would deliver better services for patients and provide value for money. 6
AN ENFIELD UPDATE LONDON AMBULANCE SERVICE In June, Mark Docherty, the Director of LAS Commissioning and Paul Gates, the LAS Acting Assistant Director of Operations (pictured) came along to the Enfield s Health and Wellbeing Scrutiny Committee and updated them on London Ambulance Service developments. Paul gave assurances that there would be two extra ambulances in Enfield and that there were no plans to close Chase Farm Ambulance Station. He also showed the map shown below which indicated where most calls in Enfield originate from, which councillors found interesting. Paul explained that while the ambulances would be based in Enfield in areas of high demand, they would not be restricted to operation in Enfield, so that additional capacity could be drawn to situations as needed. Equally, ambulances would be drawn from other boroughs if needed. He highlighted the 14.8m investment in the London Ambulance Service, with the recruitment of 241 new paramedics or assistant paramedics across London, an increase of 7-8%, and upskilling of current workforce with the aim that every vehicle should have a paramedic on board increasing the efficiency of vehicle call-outs. New recruits should be in place by end of this financial year. In relation to BEH, Paul was asked about the impact of Chase Farm A&E being closed he stressed that the great majority of seriously ill Category A ambulance patients were already and would in future be taken to specialist stroke or heart centres. A small proportion of less unwell patients might experience longer ambulance journey times but it was expected that this would not have an impact on their health outcomes. Also interesting was the fact that currently, 40-50% of ambulance callouts could be treated by Urgent Care Centres or GPs. In the same meeting, the panel was also told that over 40% of people who go to Chase Farm Hospital s A&E did not need emergency care but would, in future, be able to be treated at the Urgent Care Centre. 7
Keeping the public up to date on transport New digital bus countdown signs are planned for Barnet, Chase Farm and the North Middlesex University hospitals for early autumn 2013. These signs give real time information to patients and visitors about when the next bus is due, and its destination. Although just a small percentage of patients who currently use Chase Farm Hospital will be affected by the changes planned to services, it is important that people are helped to quickly find out how to get to the hospitals for their appointments, and also see how long they will have to wait for buses. An example of a digital countdown system 8
Public Eye Updating Hertfordshire about the changes GPs, practice staff and patient representatives in Lower Lea Valley took part in a conversation event on Monday, 8 July to find out more about the planned changes at Barnet and Chase Farm NHS Hospitals Trust (BCF) and the North Middlesex University Hospital NHS Trust (NMUH). The event, hosted by East and North Herts Clinical Commissioning Group at Hertford Regional College s Broxbourne Campus, also involved senior clinicians and managers working with the BEH Clinical Strategy team. Some of the people present had been involved in the strategic clinical changes implemented in Hertfordshire over the last few years and it was generally recognised that no change was not an option for sustainable health services in Barnet, Enfield and Haringey. Most of the discussions centred on the range of services which will remain on the Chase Farm site urgent care centre, planned surgery, outpatients, tests and investigations. There was particular emphasis on the need for timely and clear information about where services will be provided for Broxbourne and other Hertfordshire residents. It was stressed that only a small proportion of patients from Herts - around six people a day could be affected by the service changes planned for the hospital. Local GPs were keen to find out more about a new Older People s Assessment Unit and how this will integrate with their own HomeFirst project aimed at preventing unnecessary hospital admission by looking after people in their own homes. Antenatal and postnatal care for women choosing to have their baby at either Barnet or North Middlesex maternity units will continue at Chase Farm hospital but GPs wanted to be reassured that maternity pathways in terms of bookings, early pregnancy clinics will be clearly mapped out. There were also questions about the services planned to be provided at the paediatric assessment unit (PAU). Emergency care was also an important area of discussion with both GPs and patients seeking clarity on what services the urgent care centre (UCC) will provide. by Jacqui Bunce, Associate Director East and North Hertfordshire Clinical Commissioning Group GPs mentioned that one of the lessons learnt from the Hertfordshire experience was that people attended the UCC for medical conditions which could be treated more appropriately by their GP or pharmacist and urged the BEH team to consider this in their communications. There is a localised Choose Well campaign planned to help people know when to use A&E and where to turn to for help and Hertfordshire has its own similar campaign: Where Do I Go and this would be shared with the BEH team. Patients asked about transport and car parking arrangements stressing that travel information on how to get from Cheshunt and Waltham Cross to the acute hospital sites will be needed by patients, carers and visitors. Additional car parking spaces are being created at both Barnet and North Middlesex hospitals. The BEH team also mentioned that discussions have taken place with the East of England and London emergency ambulance services on making sure that both trusts work closely together; they stressed that with the creation of specialist units for stroke and heart attacks, ambulances were already bypassing some A&E departments to take patients to these units where they could receive quick and responsive high quality care. 9
Contributions We also welcome any feedback and suggestions. If you would like to comment or contribute to the Barnet, Enfield and Haringey Clinical Strategy, please do contact us. Email the editor Stevie.Pattison-Dick@enfieldccg.nhs.uk Please note that the BEH Clinical Strategy programme team is moving to Holbrook House in Cockfosters. Our contact details have also changed: please note the new email addresses. BEH Clinical Strategy BEH Clinical Strategy Contacts PROGRAMME DIRECTOR Siobhan Harrington Siobhan.Harrington@enfieldccg.nhs.uk PROGRAMME MANAGEMENT OFFICE Catherine Ashley Catherine.Ashley@enfieldccg.nhs.uk Maggie Lam Maggie.Lam@enfieldccg.nhs.uk Shauna Sweeney Shauna.Sweeney@enfieldccg.nhs.uk Caroline Wright Caroline.Wright@enfieldccg.nhs.uk Nell Beecham Nell.Beecham@enfieldccg.nhs.uk BEH COMMUNICATIONS Anita Grabarz Anita.Grabarz@enfieldccg.nhs.uk Stevie Pattison-Dick Stevie.Pattison-Dick@enfieldccg.nhs.uk The BEH Clinical Strategy Programme is planning changes to services and working towards implementation at a currently proposed date of November 2013. A final decision about the timing of the implementation will by taken by local Clinical Commissioning Groups (CCGs) in September 2013. Full details will be in the next edition. 10