NHS Waltham Forest Clinical Commissioning Group Estates FAQs About our plans What is the Waltham Forest estates strategy? Waltham Forest faces a number of major challenges over the next few years from more people moving to the borough to the number of residents with long term health conditions. WFCCG is working with our local residents, representative organisations and neighbouring boroughs in East London to identify how we can provide better access to a wider range of health services within local communities by, amongst other things, making better use of our existing NHS and GP practice buildings. WFCCG has now produced an estates strategy, which seeks to identify the right property solutions and locations for Waltham Forest and how these solutions may work in our three distinct areas (or localities) of Leyton/Leytonstone, Walthamstow and Chingford. The strategy calls for more services to be provided in the community, which means that we need to examine how services can be reconfigured and located to best support this change. This involves looking at the infrastructure, information technology and workforce that we will need to support new models of care, working out what this means for our current estate and identifying solutions that work better for everyone involved. One example of this, included within the strategy, is the development of GP practice hubs so they can provide a wider range of health services, which could include cancer and other disease screening (including gynaecology), minor surgery (such as vasectomies and colonoscopies), blood testing, treatment for skin conditions and physical therapy What is the Waltham Forest primary care strategy? WFCCG produced its primary care strategy in 2015. The strategy aims to improve primary care services and patient access to these services; ensure effective community and clinical engagement; embrace technology and ensure the primary care infrastructure and estates are fit for purpose; and help practices work collaboratively with other agencies to support the delivery of integrated care. At the heart of the strategy is the desire to make local decisions about primary care services for our population. The strategy sets out our challenges and the priority areas that have been identified to ensure we have a primary care system that can thrive and deliver the care that patients need and deserve. How do the Waltham Forest estates strategy and primary care strategy relate to the Transforming Services Together (TST) programme? Both the primary care and estates strategies aim to address specific issues and service improvements within Waltham Forest. However, health challenges do not stop at our municipal borders. We are working in partnership with our neighbours in Tower Hamlets and Newham CCGs, along with Barts Health NHS Trust, to improve health and social care outcomes across East London through the TST programme. Page 1
The TST programme specifically addresses: population growth and the associated demand for health services; variations in service access and quality; financial sustainability; and developing a high quality workforce that can deliver the health services needed in the future. Each of these crosses over with our own work to improve health services within Waltham Forest. As with our primary care and estates strategies, the TST programme suggests a shift of some patient appointments from hospitals to GPs and community services. Also, a proposal to develop Whipps Cross hospital with partners (subject to funding) and to strengthen the services provided at the site is under consideration through the TST programme. I haven t seen much about TST, are you actually engaging with people on it? TST is a relatively new initiative, having launched as a public facing programme last year. We believe it s hugely important and complimentary to our efforts to join-up health and social care, improve primary care, build the right workforce and improve end of life care. The public engagement around the programme began in March 2016 and to date, over 5000 emails, 5000 summary documents and questionnaires and 5000 leaflets have been distributed across Waltham Forest, Newham and Tower Hamlets. A series of focus groups and workshops have also been arranged within each of the three boroughs. We will continue to work with our local partners, residents and other interested parties as the programme progresses. Potential effects on GP surgeries Is my GP surgery going to close? The proposals will mean different things for different GP practices. Some GPs may choose to move buildings and be located together on one of the bigger sites with better facilities, or they may choose to merge their practices. Some will not change at all. Importantly, this is a five-to-ten-year strategy, and any changes will be developed over that timeframe in partnership with the public and GPs. Under the proposals, some GP practices will gain further funding for expanding their range of services, enabling community clinics and nurse-led services to move from the hospital to community GP hubs. Does this mean that I will have to travel further to see my GP? The hub/network model aims for geographical coverage borough wide, ensuring high quality services are located within 1.3km or a 20 minute walk. As new locations for GP practices and hubs are established, we want to ensure that Waltham Forest residents have fair and equal access to services and we will be using this distance/walking time as a guide to help us reach decisions on the location of different services. Page 2
How can you call the work on urgent care, primary care and integrated care close to home when you are looking at having fewer small GP practices? The proposals described (more care at home, more self-care, more telecare, more care at pharmacies etc) are designed to move services into a community setting, as opposed to having to visit a hospital for appointments. WFCCG supports moving more care provision into the community and we are examining how we can help make this happen through our estates strategy. When will we know what the plans for our local practice are? If there are to be any major changes, your GP practice will communicate directly with you. If you wish to become more involved or informed about your GP practice, ask about joining their Patient Participation Group (PPG), or a mailing list for their PPG newsletter, if they have one. If a GP practice is to close, NHS England writes to all patients beforehand offering them the opportunity to move to another nearby practice. Will I be able to still see my own GP? We realise that many people wish to see the same GP each time they visit a practice. Although this is not guaranteed at present, there are no plans to restrict or change the current arrangements. However, in the future patients may be able to gain quicker access to appointments from a larger network of GPs working together through a hub or network. Will I be able to book an appointment online in the future? WFCCG has supported a number of practices in the introduction of online appointment booking over the last year and will be expanding this assistance in 2016/17. This will include the development of standardised practice websites, which patients will be able to use for booking and cancelling appointments, ordering repeat prescriptions, viewing their medical records and self-managing their conditions. All 44 general practices in Waltham Forest are now using a new two-way text messaging service to confirm patient appointments, allow cancellations and inform patients about immunisation campaigns. We will also expand the use of (Skype) video conference consultations, which were piloted during 2015/16. What are you doing to support smaller GP practices who have concerns regarding the estates strategy? WFCCG has offered every practice (large or small) the opportunity to have individual discussions regarding the draft estates strategy and how it fits into the wider primary care strategy, as well as offering locality based discussions where requested. Throughout the next three months, time will be made available to discuss any particular concerns GPs may have. In addition the estates strategy is a jointly developed document, which has been compiled by WFCCG in partnership with GP leads, the London Borough of Waltham Forest, Page 3
NHS Property Services and other partners. As we progress to the delivery of the estates strategy we will continue to hold informal and formal discussions with practices as opportunities arise. We are committed to making this a jointly agreed process for the most efficient use of public estate. In addition to this we are reviewing all funding opportunities (as highlighted in the draft estates strategy) to improve local facilities through the Primary Care Transformation Fund. 2.8M of NHSE funded bids were successful in 2015-16 and we will continue to work with GPs to support schemes which have a natural fit to the primary care strategy. GP Hubs What can I expect locally from a GP hub or hub plus? The first thing to note is that you can, as now, expect high quality GP services, wherever they are delivered in Waltham Forest. Secondly, you can expect a good local service. The hub/network model we have developed in the estates strategy aims to deliver borough wide geographical coverage. Once the strategy has been delivered this should ensure high quality services are located within 1.3km or a 20 minute walk of your home. Finally, you can expect a wider range of health services to be available to you through your local hub. This could include cancer and other disease screening (including gynaecology), minor surgery (such as vasectomies and colonoscopies), blood testing, treatment for skin conditions and physical therapy. How will hubs be used to both integrate and provide a better range of services for the people of Waltham Forest? We want to provide better access to a wider range of health services across Waltham Forest but to do this we need to improve and make better use of our existing NHS and GP practice buildings. Many of the facilities that are currently used by GPs are not suitable to support some of these expanded services so we will be working with GPs and our other partners to improve the available facilities, including through hubs. The hub proposals include the provision of a wide range of health services, which could include cancer and other disease screening (including gynaecology), minor surgery (such as vasectomies and colonoscopies), blood testing, treatment for skin conditions and physical therapy. Where GPs wish to work together in hubs, the CCG will facilitate the reforms and ensure all partners are included in the negotiations. Page 4
What is the plan for dealing with car parking at hubs? Once the estates strategy has been delivered and the hubs established, all Waltham Forest residents should be within a 1.3km or a 20 minute walk of a hub. We will also work with our partners to assess public transport links to hub locations. We realise that some patients require car parking facilities and adequate provision will be considered as part of the consideration of hub proposals. Other issues What is happening with potential development at Whipps Cross? A proposal to develop Whipps Cross hospital with partners (subject to funding) and to strengthen the services provided at the site is under consideration through the TST programme. Given you talk about the recruitment and retention of staff, what is the situation with nurse training as there have been reports that they will have to pay for this themselves? The issues around payment for nurse training relate to the Department of Health led bursary reforms this is not something we have any control over. As a CCG we are not responsible for funding clinical training programmes, but we do fund statutory safeguarding and prevent training for both nurses and GPs. We also work in partnership with various education bodies and providers to make sure the correct training programmes are being commissioned. We (WFCCG) in partnership with our colleagues in Newham and Tower Hamlets CCGs are developing an integrated workforce strategy for all services including primary care. In addition we are supporting the delivery of continuing professional development (CPD) programmes, as well as investing in the following new workforce roles, using a localised Community Education Development Network (CEPN): Practice nurses Integrated healthcare assistants Care coordinators across health and social care services in the community GP based pharmacists Patient care/self-care activation and coaching School-based health and social care staff Physician associates Community pharmacists. What does engagement mean? When we say engagement we effectively mean explaining our latest thinking or plans to the public, our partners and other interested parties AND (importantly) seeking their views and feedback on what we set out. Page 5
Engagement with our partners is also an ongoing part of the commissioning process - through this we have regular conversations with key partners and then share our latest thinking/plans in public facing forums (from Patient Participation Groups to workshops or drop-in events). This differs from formal consultation, which is a statutory requirement at times of major service change. Page 6