Patient and Public Engagement in Croydon

Patient and Public Engagement in Croydon 2015-16

Contents Introduction 3 Section One Context setting 5 Page Section Two Section Three Developing the infrastructure for engagement and participation Meeting the collective duty: engagement and participation activity 8 16 Section Four Meeting the individual participation duty 27 Section Five Forward plans for 2016/2017 32 Section Six Healthwatch Croydon statement 35

Introduction Since 1 April 2013, NHS Croydon Clinical Commissioning Group (CCG) has been responsible for planning and funding NHS services for the estimated 381,000 Croydon residents (Source: Croydon Observatory). Croydon CCG is a clinically-led membership organisation bringing together 57 GP practices in the borough of Croydon into one commissioning organisation. Within this is a locality structure made up of six geographically based areas, each with a GP lead who is also a member of our Clinical Leadership Group. Our key priorities for 2015-16 These were: Transforming care for older people through outcomes based commissioning. Improving access to mental health services Ensuring a strong urgent and emergency care service Helping people look after themselves (including self-care and selfhelp as part of our Together for Health programme) Improving performance, quality and safety Improving our financial position. Patient and Public Engagement in Croydon 2015-16: Page 3 To help us achieve these aims we have worked closely with our partners, voluntary and community sector stakeholders and Croydon residents.

An outline of the CCG s patient and public involvement duties is available here. Croydon CCG is in its third year of operation and is undertaking a series of ambitious and forward thinking procurements and redesign of services to ensure that the local health system can meet the health care needs of its residents, while supporting them to improve their own health and well-being. To support this, the CCG has developed a flexible Patient and Public Involvement (PPI) structure to ensure patient and public voices are at the heart of our commissioning. This report outlines how Croydon CCG has met these duties for the period 1 April 2015 to 31 March 2016. Alongside detailing all of our PPI activities this report presents three case studies which show how we have fulfilled our commitment to PPI throughout the commissioning cycle in practice. Patient and Public Engagement in Croydon 2015-16: Page 4

Section One: Context setting Our Borough Croydon s Joint Strategic Needs Assessment (JSNA) produced with our public health colleagues and local authority partners provides very detailed data on our population. The JSNA also provides data from the Public Health Outcomes Framework (PHOF) to show where Croydon is succeeding and where we could improve against these outcomes. Patient and Public Engagement in Croydon 2015-16: Page 5 Croydon is a large borough in south London. It is a very diverse borough geographically, socially and economically. Its communities, neighbourhoods and proximity to central London in the north, east and west of the borough and the Surrey countryside in the south make it an exciting place to live with a wealth of opportunities for residents. But not all of our residents are able to enjoy the same access to these opportunities. Croydon has areas of significant social and economic deprivation, particularly in the north and south-east corner of the borough. Croydon has an estimated 381,000 residents which makes it the second most populated borough in London. If Croydon were a city is would be the eighth largest in the UK ahead of Wakefield and Coventry. Our population is growing and becoming more diverse. Life expectancy is increasing and our population is aging, but we also expect to see an increase in the number of younger people in the borough. These changes affect the health needs of our residents.

Croydon has the highest number of looked after children in London (830 in 2016), 433 of these children and young people were unaccompanied minors refugee and asylum seekers. Luna House, a Home Office screening unit, is based in Central Croydon. Any unaccompanied minor who enters the UK but does not pass through Dover, Gatwick or Heathrow is required to come to Croydon to claim asylum. If these young people (below the age of 18) do not have any family or guardians living in the UK, Croydon Council are legally obliged to ensure their housing, health, and education needs are met, as well as to provide accommodation and other support when they leave care at 18. Croydon's children and families social workers additionally monitor 336 young asylum seekers who have left care. The CCG recognises that looked after children and young people are vulnerable residents who will have additional needs, particularly in relation to engaging with the CCG around health needs. It is for this reason that we were particularly keen to engage with this section of our residents around the re-design of our urgent care services. Some of the factors that make Croydon distinctive are: We have one of the largest populations of children and young people in the country. We have one of the highest proportions of black and minority ethnic groups in South London. Some of the most expensive houses in the country are in Croydon, but we also have some of the most deprived neighbourhoods in London. Croydon contains one of the highest number of care homes in the country. See here for more details of the make-up of Croydon s communities. Deprivation Croydon is the 19th most deprived borough in London and the level of deprivation in Croydon is lower than the England average. However, between 2004 and 2010, levels of deprivation in Croydon increased more than in any other borough in south London. This downward trend has not shown signs of reversal to date. What this means for Croydon residents is that 17,700 (23%) of Croydon s children live in poverty. Children who grow up experiencing poverty are: More likely to be obese, with all the health consequences that can bring later in life. More likely to experience poor mental health. More vulnerable to experiencing substance abuse. Four times more likely to be poor as adults. Patient and Public Engagement in Croydon 2015-16: Page 6

Life expectancy and healthy life expectancy are key indicators of health inequalities. Further information of life expectancy across Croydon is available here. The data presented above helps to guide the CCG s PPI activity. The CCG also use local intelligence from our public health colleagues at Croydon Council to track health inequalities and their impact upon the services the CCG commissions and, importantly, how the CCG can best commission services to support the narrowing of health inequalities in Croydon. Croydon CCG s PPI vision Croydon CCG is dedicated to commissioning the best possible services for the people of Croydon. Key to this is on-going effective communication and engagement with our patients, residents, the wider health and social care community, Healthwatch Croydon and other stakeholders. We want to build clear and visible mechanisms that support engagement throughout the entire commissioning process, from pre-planning to implementation and on-going review. The principles upon which we build our vision can be seen here We know that the best way to achieve our vision is to work closely with our partners, especially Healthwatch Croydon, who hold a wealth of knowledge on patients and carers experiences of healthcare provision in Croydon. We aim to be open and honest in all of our communications and actively seek ways to facilitate dialogue with our diverse communities. Our recent PPI Review provides more detail of how we aim to achieve this. PPI Resources: Croydon CCG has two Governing Body members who are responsible for PPI Helen Pernelet, Vice Chair and Lay Member, Governance and PPI which is a statutory role, and Elaine Clancy, Director of Quality and Governance. The Communications and PPI function for Croydon CCG is provided by the South East Commissioning Support Unit (CSU), with operational support delivered by: 0.5 whole time equivalent Communications Lead Full time Patient and Public Involvement Manager 0.5 whole time equivalent Communications Manager. The Communications and PPI team is accountable to the Director for Quality and Governance. Commissioning managers work closely with the CCG s Communications and Engagement professionals and are often heavily involved in leading on engagement. These are hidden costs and contribute a significant additional PPI resource. Patient and Public Engagement in Croydon 2015-16: Page 7

Section Two: Developing the infrastructure for engagement and participation Between October 2015 and March 2016, the CCG undertook a complete review of its PPI strategy, plans and working structures, both internally and externally. The review was undertaken at a point at which the CCG had matured as an organisation. It recognised that as Croydon s communities and their needs change, we need to evolve our thinking around PPI to ensure that we more widely reach out to all of our diverse communities. The review introduced four key objectives to focus our PPI work in the future. Our approach Croydon CCG adopts an open and flexible approach to PPI that seeks to normalise it within commissioning. This means that PPI becomes part of everyone s day-to-day business. The way in which commissioners will undertake PPI is dependent on the work they are doing at the time: one size will not fit all. Therefore, our methods are flexible and proactive. We believe that this allows for a more co-operative approach, and gives us opportunities to work closely with our residents and partners in a variety of ways. For example, patient working groups (either based around specialty/disease group, community or service area), citizen s juries and patient and public representatives playing key roles in decision-making bodies. Patient and Public Engagement in Croydon 2015-16: Page 8

Examples of PPI tools and methods used The table below gives a breakdown of some of the key PPI activity undertaken by the CCG in 2015-16 and the methods used. Full details of Croydon CCG s PPI activity in 2015-2016 can be found here. Theme Purpose of PPI Methods used Dermatology (Re-procurement) To gain patient insight into current experience of the service and to be informed by patients on how to increase choice. Online survey. Commissioning Intentions (Strategy and planning) Intermediate Gynaecology Service (Re-procurement) To gain guidance, comment and feedback on our commissioning intentions from partners, stakeholders, patients and members of the public. The gather feedback about the service currently, and ideas and innovation for the future service delivery. Outreach to four clinic sites to talk to patients one-to-one. Friends and Family Test data. Online survey. Website information and invitation to feedback. Outreach through LBC Public Health event. Online survey. Anticoagulation To inform current patients Letters to patients (see section 3 for more details) (Re-procurement) Together for Health (Self-care, selfmanagement, shared decision making programme) Ear, Nose and Throat Community Clinics (Re-procurement) Urgent Care (see section 3 for more details) Patient and Public Engagement in Croydon 2015-16: Page 9 of the new service and transfer of service arrangements and to address any concerns patients and/or carers may have. To work with patients and the public to co-design local shared decisionmaking and self-care projects and initiatives. To gain patient insight into their current experience of the service and ask for suggestions for innovations in service delivery as part of the reprocurement process. Working directly with patients and the public to develop new models of informing them of the changes. Three open meetings for patients and carers. Patient representatives on the Steering Group Outreach and project development through Croydon Voluntary Action. Outreach to two clinic sites to talk to patients one-to-one. Online survey. Online survey. Face-to-face interviews.

(Re-procurement) Outcomes Based Commissioning (see section 3 for more details) urgent care; shaping the options presented for the re-design of services and developing patient led service standards. Patient and Healthwatch Croydon representatives were engaged in the bidder evaluation process to ensure that the patient and public voice was heard throughout the process. Working directly with patients, carers and community and voluntary sector groups to: Targeted one to one work with seldom heard groups (through CVA). Small group work with target groups e.g. mental health service users, parents of young children, young people. Participating in Healthwatch Croydon urgent care workshop. Two patient working groups to help develop the final service specification. Patient, public and CVS workshops. Public meetings. (Strategy and Planning) Termination of Pregnancy (Re-procurement) develop key outcomes for the project, based on Croydon residents needs and wishes. translating those outcomes into KPIs. supporting the refinement of the new models of care. guiding the implementation of the new models of care through the project development groups (PDGs). To gain patient insight into current experience of the service and to gain feedback on patient choice. Small group work with target groups e.g. Carers, BAME groups. Specialist patient and public working group (on-going). Online survey Friends and Family Test data. Provider patient survey data. Patient and Public Engagement in Croydon 2015-16: Page 10

PPI Structures Croydon CCG established a PPI structure when it was operating in shadow form, which has been adapted as we have developed as an organisation. The following external structures were in place to support our PPI work in 2015-16. See here for how we embed PPI internally. Patient and Public Involvement Reference Group Patient and Public Forums The CCGs PPI forums are open meetings which are held quarterly. The forums are an opportunity for Croydon CCG to share its early thinking on commissioning areas and hear the views of patients, stakeholders and members of the public. This learning helps the CCG to shape the healthcare services we buy to meet the needs of our local residents. The Patient and Public Involvement Reference Group (PPIRG) were formed in June 2014. Members include representatives from patient participation groups (PPGs) and the community and voluntary sector (CVS). Representatives from other key partner organisations have also been invited to attend, such as other NHS organisations, Croydon Council and Healthwatch Croydon. When setting up the PPIRG, the CCG committed to developing a membership that was as representative as possible of the local population. The PPI review suggested that the CCG had struggled with this commitment and should pursue a more pro-active and flexible approach outreach model. The last PPIRG meeting was in October 2015. Since October 2015 members of the CCG have attended meetings with a variety of groups to fulfil the functions previously undertaken by the PPIRG. These groups include the Croydon PPG Network, Croydon Communities Consortium, Probus, Croydon Asian Elders and Children's Centres. Patient and Public Engagement in Croydon 2015-16: Page 11 The PPI forum was also part of the PPI review and continues as a way to help the CCG to be visible and engaged with the wider public. Alongside continuing the CCG s quarterly forums, we have increased our involvement in existing networks and open meetings, e.g. Healthwatch Croydon events, Croydon Patient Participation Group Network meetings and other CVS opportunities, where members of the CCG can talk with and listen to a broader range of patients. Three PPI Forums were held in 2015-16 which focused on antibiotics awareness and urgent care re-design. Practice Engagement The CCG is made up of six geographically based networks, each with a GP lead and deputy who are members of our Clinical Leadership Group (CLG). Engagement with practices is a very important way to gather feedback on the day-to-day issues facing patients within general practice.

This intelligence can help us to spot trends and acts as an early warning system that the CCG can act upon swiftly. The CCGs variation team, which consists of four full time members of staff, visit every Croydon GP practice regularly. Patient experience forms a key part of the discussions during the variation team s visit to a practice. The team use patient satisfaction data, from the national GP survey, to identify areas that the practice may require additional support on and develop agreed actions to address any issues. The CCG also work with practices to pilot models and initiatives to help support patients with managing long term conditions and other self-care support. For example, as part of developing the Outcomes Based Commissioning Models of Care in local practices, the Altogether Better project was commissioned to run in seven of our GP practices in March 2016. This work is discussed in section four. Croydon Patient Participation Group Network Croydon benefits from a self-running PPG network. The Croydon PPG Network has been set up by its members to help PPG representatives to share information and good practice across Croydon. They have played a very important role in the PPI review through providing constructive feedback and helping the PPI Manager to refine and develop ideas. Patient Participation Groups During 2015-16, the CCG has continued to work with our local PPGs who provide an important way for patients registered with a Croydon GP practice to engage with commissioners and vice versa. PPGs are crucial to ensuring that the views of local patients can work to influence their own GP practices as well as helping to shape and support the CCGs commissioning programmes. Croydon CCG has supported many of our PPGs through funding promotional materials for PPG awareness week (June 2015). In 2014-15 and again in 2015-16, the CCG have made funding available to all Croydon PPGs to fund their membership of the National Association of Patient Participation (NAPP) so that they can benefit from the support that NAPP provide. Governing Body meetings The CCG s Governing Body meetings are held in public and attendees regularly take the opportunity to ask questions and raise issues. These questions and answers are made available to the wider public through the CCG s website. Patient and Public Engagement in Croydon 2015-16: Page 12

Networks Croydon CCG Virtual Health Network The CCG recognises that not everyone is able to, or wants to, attend a public meeting or a focus group. For some of our residents, online engagement is an effective and preferred way for them to receive and comment on information and provide insight into local health services. During 2015-16, Croydon CCG set up a virtual Health Network to open up alternative ways for people to engage with the CCG. Members of the virtual network are able to give their views and input into healthcare decisions and policies. The network is administered through a generic mailbox Getinvolved@croydonccg.nhs.uk Currently there are over 300 contacts on our virtual network which is made up of individuals and local organisations. As part of our PPI review, the CCG have identified a need to make the network smarter so that we can maximise the impact. For example, we need to be able to better target information based on a member s area of interest. To help us achieve this, the CCG will undertake an exercise to contact all members individually to ask them how we can tailor our virtual engagement more effectively and not overload members with information that may be of little interest to them. Community and Voluntary Sector Networks Throughout our PPI activity this year we have started to develop better Borough wide networking opportunities. CCG representatives have attended meetings as part of the following networks during 2015-16: Croydon Asian Resource Centre Croydon PPG Network Croydon Communities Consortium The Mental Health Partnership Board The Learning Disabilities Forum Croydon Carers Forum Partnership and Stakeholder working Croydon Council Croydon CCG has continued to work very closely with Croydon Council on a range of commissioning programme, including the Outcomes Based Commissioning (OBC) programme. OBC is a way of paying for health and social care services based on rewarding the outcomes or results that are important to the people using them. OBC encourages a focus on the personal experiences of people using Patient and Public Engagement in Croydon 2015-16: Page 13

the services and achieving the results that matter to them like staying healthy and remain living independently, for as long as possible. The OBC programme is a 10-year contract to provide health and social care services for people aged over 65. The contract is held by a group of five organisations who have come together to form an Accountable Provider Alliance (APA). The organisations in the APA are: Age UK Croydon Council Adult Social Care Croydon GPs Consortium (all GP practices in the borough) Croydon Health Services NHS Trust South London & Maudsley NHS Foundation Trust. A service user experience group (SUSEG) has been formed to support the development of the new models of care developed through OBC. SUSEG provides a platform for the CCG and the APA to come together with patients and CVS representatives to support the progress of the OBC programme. The Better Care Fund is another jointly funded and managed programme with Croydon Borough council. Healthwatch Croydon The CCG has, over the past year, developed a closer working relationship with Healthwatch Croydon and has benefitted from their insight and guidance in our urgent care review and anticoagulation reprocurement in particular. For example, Healthwatch Croydon held an urgent care and emergency services public meeting just ahead of the launch of the CCG s urgent care engagement period (23 November 2015). The discussions and findings from Healthwatch Croydon s urgent care meeting supported the CCG in developing our engagement approach and provided crucial local intelligence which had a real impact on our thinking. For example, the recommendation, There is concern across the borough about access. There is a need to make the level of service consistently good for everyone with equal access to services wherever they live, guided the decision to include GP Hub functionality at the current urgent care centre, based in Croydon University Hospital in the north of the borough. This will ensure that Croydon residents have equitable access to GP hubs. The CCG also benefitted from having Healthwatch Croydon representation in the urgent care tender evaluation panel. The representatives were able to bring their broad knowledge of residents concerns and provide challenge to the CCG at every stage of the process. Patient and Public Engagement in Croydon 2015-16: Page 14

Patient representation Our patient representatives have been involved with both Croydon CCG and South West London Collaborative Commissioning (SWLCC) decision making processes to ensure that the patient voice is heard in service redesign, service delivery and in developing strategies. Croydon patients and members of the public have been represented through the following groups: Croydon CCG urgent care procurement South West London wide urgent care procurement South East England Patient On-Line steering group Croydon CCG Together for Health steering group Croydon CCG Digestive Disorders and Disease steering group South West London CC (SWLCC) Pan-Borough Patient and Public Engagement Steering Group. SWLCC have formed a Patient and Public Steering Group (PPESG) to ensure the patient voice in each borough is represented across SWLCC programmes. Croydon is represented by Healthwatch Croydon, Croydon Voluntary Action and the CCG Lay Member for Patient and Public Involvement, Helen Pernelet. Annual patient and public perception survey The CCG monitor the perceptions of our stakeholders through an annual 360 degree stakeholder survey. The results are reported to the Governing Body to identify how best to improve our engagement with local residents and patients through action planning. South West London Collaborative Commissioning The six south west London CCGs have come together to share and align strategic priorities and commissioning intentions on issues that are of common interest to all six boroughs. SWLCC have a PPI resource to carry out PPI activity across all boroughs. Croydon CCG PPI lead supports SWLCC PPI activity at a Croydon level. Patient and Public Engagement in Croydon 2015-16: Page 15

Section Three: Meeting the collective duty - engagement and participation activity As GPs and commissioners, it is important to the CCG to design and commission services that meet the needs of our patients and provides the best health outcome. We must also engage all our communities around accessing preventative health services, which will improve the health and well-being of our population and support a reduction in health inequalities in Croydon. During 2015-16, Croydon CCG have worked to engage stakeholders, patients and the public in a range of activities to ensure that their voices have helped to shape how we design, deliver and improve local health services. The CCGs PPI activities are all designed to increase our understanding of patient s experiences of the health services we commission, where we need to improve, and guide us on our commissioning intentions for the future. During 2015-16 the CCG s PPI activity focussed on two key areas: The urgent care review Outcomes based commissioning. Another significant piece of work involved the anticoagulation community based service re-procurement. These three areas of work are presented as case studies below to exemplify the breadth and range of our PPI activity in 2015-16. A full summary of the CCGs PPI activity undertaken in 2015-16 which details the purpose, range and outcomes is available here. Patient and Public Engagement in Croydon 2015-16: Page 16

Case Study 1 Croydon CCG Urgent Care Review: Right Care, Right Place, First Time The Project: Croydon CCG wanted to redesign Croydon s urgent care services to give local people better access to services with longer opening hours. This redesign took into account patient insight collected through public meetings and patient and public workshops held in 2014 and 2015. On the basis of this engagement, alongside national guidelines and clinical need, three options were developed for the future delivery of urgent care services in Croydon. The challenges for PPI: In some parts of the borough there are high levels of urgent care service use, with a wide variety of languages spoken, and different levels of understanding of how to access urgent care services. All of the current urgent care services are housed in areas of high deprivation: Central Croydon, Thornton Heath and New Addington. Traditionally communities living in areas of high social and economic deprivation are less likely to engage through public meetings. So we knew we had to develop a more proactive approach to ensure that their voices would be heard during the engagement period. This would help assure the CCG that our urgent care services were designed to meet the needs of our very diverse communities. To provide additional support to the CCG PPI team to reach seldom heard groups, we commissioned a local community and voluntary sector umbrella organisation, Croydon Voluntary Action (CVA), to carry out 100 informal interviews with specific population groups to ensure their voices were heard and reflected in the outcomes of the engagement. What we did: The CCG PPI team captured local views via online and paper surveys and face to face interviews and discussions. Details all the events and outreach sessions undertaken during the seven week period can be viewed here. By using an opportunistic and creative engagement approach we were able to broaden our contacts and seek out a wider range of public opinion, targeted towards groups that were known to make higher use of existing urgent care services. As well as posters and leaflets in GP practices and public places, public meetings and drop-in clinics, the PPI team reached out to parent and toddler groups, user-led groups of mental health service users, youth clubs for young people with learning disabilities, commuters at West Croydon station, shoppers in central Croydon, and residents attending Crystal Palace FC football match in Selhurst. Between 27 November 2015 and 17 January 2016, Croydon CCG gave out 6,280 engagement documents. We spoke to over 1,000 people. Some of the conversations we had with groups of residents were in-depth and lasted for an hour or more, other conversations were shorter. Every contact we had, and continue to have, was of equal value. Patient and Public Engagement in Croydon 2015-16: Page 17

PPI within the procurement process: Panel Selection Two patient and public meetings were held to discuss the draft service specification with the aim of developing patient led service standards. The attendees included patients, members of the public, representatives from the community and voluntary sector and PPG members. In total, 33 people attended the meetings. Through the meetings a series of service standards were developed and were included in the urgent care draft service specification under the Our commitment to you section. Of the 33 people who attended these meetings, six were invited to join the procurement panel, including Healthwatch Croydon representatives. The patients who joined the procurement panel were broadly representative of the demographic profile of Croydon urgent care services users and/or were representative of communities sharing protected characteristics under the Equalities Act, 2010. Outcomes: During the engagement process three key concerns were raised on many occasions. They were: None of the options included a proposal for a GP hub to be sited in north Croydon. A need for consistency of quality and care across the urgent care sites. Concerns around an all appointments based system. As a result of these concerns, the following changes were made prior to completion of the procurement process: The Urgent Care Centre, based at Croydon University Hospital will have additional GP hub functionality (4 GP hubs in total). Patient designed service standards, titled Our commitment to you, were incorporated into the service specification. The service standards include a commitment that patients will receive the same levels and standards of care and quality of service regardless of which GP hub they access. This is important as these patient-led standards now form a part of the key performance indicators against which the provider will be monitored. A walk-in element will remain in all of our urgent care centres, due to concerns that for some patient groups, making and keeping an appointment may prove difficult. For example, patients who are homeless. An additional and very important outcome is that the CCG now has a number of patient representatives who have taken part in a complex procurement process and are a skilled resource that can support the CCG in future procurements. The diagram below shows the key stages of PPI in Croydon CCGs urgent care review. Patient and Public Engagement in Croydon 2015-16: Page 18

Patient and Public Engagement in Croydon 2015-16: Page 19

Case Study 2 Outcomes Based Commissioning The Project: Outcomes based commissioning (OBC) is a way of developing a contract that promotes the integration of health and social care services to transform the way services are provided for older people in Croydon. OBC aims to deliver services that meet patients' needs with greater emphasis on prevention and working together to improve the quality of care provided to older people. It is estimated that over the next five years, the number of people over 65 living in Croydon will have grown by 10%. Increasing numbers of people are living with long-term conditions; these include conditions such as diabetes, heart and lung conditions. Between June 2015 and March 2016 we: developed an online survey. took part in face-to face engagement (26 events and group meetings over 400 individuals took part). ensured we had public involvement at provider hothouse sessions, set up to develop the new models of care. created a service user specialist engagement group (SUSEG). A full breakdown of the activities can be seen here. What we heard: The main themes from what we heard are represented diagrammatically below: What we did: The CCG and Croydon Council recognised at the outset that our joint ambitions for OBC would only be realised if the outcomes were meaningful and effective for patients and service users. In order to do this the CCG spoke to a wide group of patients, carers and voluntary and community sector representatives to better understand and develop the OBC outcomes. Throughout 2015-16, the CCG and APA representatives listened to hundreds of Croydon residents at events, in focus groups and through oneto-one discussions to make sure they were able to co-produce the outcomes. Patient and Public Engagement in Croydon 2015-16: Page 20

PPI in service planning and design: From everything that we had heard the APA, working with SUSEG, developed five new models of care, designed to meet the needs and wishes of the people who had spoken with us. Outcomes The goals and aspirations of people aged 65+ in Croydon are enshrined in the outcomes framework for our OBC Programme. The five new models of care are built around the outcomes Croydon residents have developed throughout their engagement with the CCG. Our partners have been informed and supported in their work through this engagement with patients, carers and third sector organisations. Individual members of SUSEG have been directly involved with the development of the models of care and have shaped them. For example, the original My Life plan was felt to be too similar to a standard care plan, with little real information about the patient s own beliefs and aspirations for their care. The My Life plan has now been significantly amended to place the patient at the centre of it. A standing group (SUSEG) was set up to oversee the CCG s OBC programme and are involved in its monitoring and evaluation. The diagram below shows the key stages the process: Patient and Public Engagement in Croydon 2015-16: Page 21

Patient and Public Engagement in Croydon 2015-16: Page 22

Case Study 3 Anticoagulation Community Services reprocurement The Project: Anticoagulation services were re-procured in 2015. Four independent providers (two GP practices and two community pharmacies) were currently providing the service and delivering it from six sites across Croydon. The CCG wanted to commission a community anticoagulation service which was accessible across the borough, could offer extended opening hours to increase patient choice and was delivered in the community with equitable and consistent access to the service. The outcome of the procurement: Boots UK Ltd were awarded the contract for a period of three years, which began on the 1 April 2015. The CCG felt the benefits of this for patients were: A choice of seven sites which cover the six geographical GP network areas in Croydon. Flexible hours and days, with extended weekend clinics at Purley and Coulsdon. Initiation of warfarin for newly-diagnosed atrial fibrillation patients. A service run and managed by a team of anticoagulation pharmacists supported by a clinical lead pharmacist. Access to a consultant haematologist for anticoagulation pharmacists in an advisory capacity. Seven days per week access to an anticoagulation pharmacist for support and advice. Domiciliary service for housebound patients (phase 2 in 2016). What we did: As the new Boots service would be more accessible both in terms of location and opening hours, the focus of PPI was on communicating the changes to patients. Letters were sent out to all registered patients on anticoagulation medication through their GP practice informing them of the change, any transitional arrangements and information on their next appointment. In addition to the letters from GPs, three patient meetings were held in specific areas of Croydon which were geographically further away from local Boots stores and/or had smaller Boots stores with more limited facilities. The presentation is available here. It became clear during the meetings and subsequent questions raised by local councillors, that for a minority of patients, the transfer of service would prove very difficult due to frailty, a lack of private transport and challenges with local public transport options due to their locality or caring responsibilities. Healthwatch Croydon received a number of queries and concern from patients taking anticoagulation medication and felt that the level of contacts and concerns which had been reported to them required further investigation. The outreach sessions and patient survey that Healthwatch Croydon undertook falls outside this reporting period. Healthwatch Croydon s Patient and Public Engagement in Croydon 2015-16: Page 23

report is an excellent example of how the work of Healthwatch Croydon is critical to holding the CCG to account and helping us to improve. Outcomes: As a result of the concerns expressed, and a better understanding of the difficulties a small cohort of patients would face after speaking to them, the CCG worked with Boots to introduce two additional clinics at Old Couldson Medical Practice and at Queenhill Medical Centre within a month of the patients transfer to the new service. Lessons Learnt: The learning the CCG has taken from our experience of re-procuring anticoagulation services are: We must engage with patients at an earlier stage so that we have a better understanding of their needs when accessing services we commission. The CCG should discuss its early thinking on significant service innovations or improvements with Healthwatch Croydon representatives at a much earlier stage and be guided by their knowledge of local patients and services. Where data shows that groups with protected characteristics form a significant percentage of service users a full equalities impact assessment should be completed as part of the planning stage. Where there is a potential for a patient pathway redesign to impact upon groups with protected characteristics an action plan to mitigate any adverse impact must be agreed and signed off by our Equalities and Diversity Lead. We should consider, where applicable, the inclusion of patient representatives and Healthwatch Croydon in procurement evaluation panels. This would enable the patient and public voice to be represented throughout the procurement process. The CCG are pleased to state that all of the above points have been actioned and implemented in 2016-17. Equality and Diversity System 2 In 2015-16 Croydon CCG reviewed the following services for EDS2 in the goal 1 (Better Health Outcomes) and goal 2 (Improved Patient Access & Experience) domains, see here. 1) Tier 3 CAMHS (Child & Adolescent Mental Health Services) Tier 3 CAHMS services provide specialist multi-disciplinary services for children and young people who are experiencing severe mental illness. Specialist Tier 3 services can be provided in the community or through day in-patient facilities. 2) Croydon CCG OASIS (Early Detection in Psychosis) Service Patient and Public Engagement in Croydon 2015-16: Page 24

The panel included representatives from: Healthwatch Croydon Croydon MIND Parents in Partnership Croydon Off the Record Croydon Drop-In Croydon Council Children s Services, SLaM Croydon Oasis Psychosis Service, SLaM Senior Consultant, Oasis Psychosis Team. Engaging with Seldom Heard Groups Seldom heard is a term used to describe groups who may experience barriers to accessing services or are under-represented in healthcare decision making. Groups who may be identified as seldom heard include rural communities, black and minority ethnic (BME) groups, gypsies and travellers, lesbian, gay, bisexual and transgender, asylum seekers and refugees and young carers. However, in reality, teenagers, employees, people with mental health issues and many others may be considered as seldom heard and engagement with these groups may not be straightforward. Given the diversity of our communities Croydon has a wide number of populations who may be defined as seldom heard. However, Croydon also benefits from a vibrant and diverse community and voluntary sector that have excellent networks into the very heart of our communities. Croydon CCG recognises that the only way to effectively engage with different groups is to find out who they trust and have good relationships with. This is most usually not statutory service providers but CVS groups. This year the CCG have concentrated on developing good relationships with CVS groups and have asked them to help us reach out to people. Croydon Voluntary Action and Healthwatch Croydon have been especially generous in responding to the CCGs requests. Social Media The CCG has built up its work on digital channels as a means of engaging with patients and the public in 2015-16. The CCG website www.croydonccg.nhs.uk acts as a source of information and engagement for patients, the public and stakeholders. We place information on our website about up and coming engagement events and opportunities on the Get Involved section of the CCGs website as well as disseminating feedback reports. Anyone can feedback or ask a question via the Get Involved page which links to getinvolved@croydonccg.nhs.uk. Patient and Public Engagement in Croydon 2015-16: Page 25

Croydon CCG also benefit from being a member of Croydon Councils Get Involved workspace. This membership allows the PPI Manager to upload information on PPI events and opportunities onto the local authority portal which is available to all Croydon residents. Twitter Croydon CCG use Twitter as our social media platform. Tweets cover a wide range of topics and include re-tweets of partner organisations posts. It is also used to respond to queries and comments. During 2015-16 there has been a marginal increase in tweet numbers however, impressions have doubled from 8,000 to 16,000 and mentions in other Twitter feeds have increased five-fold. In addition to these formal mechanisms providers are regularly offered the opportunity to support the dissemination of CCG patient surveys and undertake joint patient experience work, e.g. Ear, Nose and Throat services. Healthwatch Croydon is our most effective source of independent patient experience data and real time service information which supports the CCG in holding our providers to account. We have begun to develop a more ongoing way of incorporating their intelligence into the CCG s quality work. Integrating this further will be a key action for our 2016-17 PPI work. Type of Survey Frequency Method of Reporting Method of Publication Application Holding our providers to account The CCG hold our commissioned providers to account through formal meetings such as the Clinical Quality Review Group (CQRG) and through the regular monitoring meetings commissioners have with our providers. Service providers are required to report on patient experience through specific key performance indicators. An example of the information we regularly request and review is on the right. This is supported by a monthly performance report which details scores and response rates to the Friends and Family Test along with an action plan to address any issues. Friends and Family Test Service User Surveys: Maternity; Children and young people; Inpatient; Outpatient and A&E As required by FFT Guidance Monthly As required by FFT Guidance Survey Monkey As specified in NHS England Guidance Care Quality Commission Website All All Patient and Public Engagement in Croydon 2015-16: Page 26

Section Four: Meeting the individual participation duty As well as undertaking collective PPI with Croydon residents, the CCG has a duty to support patients to be in control of their own health and the choices they make in the care and treatment they receive. Changes to the make-up of Croydon s population and lifestyle trends are likely to lead to more people needing care in the future. An ageing population, increases in long term conditions and changing social trends will mean that people will need better organised care, closer to home, to help them self-manage their conditions and live as independently as possible. Croydon CCG want to support this by making sure that the information, tools and support patients need to make informed decisions about their care is available. Equally important to making information and decision making support tools available is creating a culture in which shared decision making becomes the norm. Our Together for Health programme aims to support a cultural shift in the way patients and clinicians interact. Together for Health The CCG s Together for Health programme is a strategic approach to ensure prevention, self-care, self-management and shared decision making are at the heart of all local health services. Partners in Together for Health include Croydon Council, South London and Maudsley NHS Foundation Trust, Croydon Health Services NHS Trust, the Croydon Local Pharmaceutical Committee and Croydon Voluntary Action. Patient and Public Engagement in Croydon 2015-16: Page 27

The principles upon which Together for Health is based can be viewed here. One way the CCG are trying to achieve these goals is through the development of the Health Help Now (HHN) app. HHN is a new digital tool to help local communities find the right NHS service when they need treatment in a hurry, especially at night or at the weekend. HHN will help Croydon residents to avoid unnecessary queues and get them to the right place for treatment faster. HHN can be downloaded onto smart phones and there is also a supporting website. HHN also has advice and information sections on lifestyle and well-being services and information about Croydon Council and CVS health and wellbeing services. Health Help Now will be launched across Croydon and Sutton CCG s in November 2016. Another patient centred workstream developed through Together for Health is a monthly column in the Croydon Guardian called Dr Know. Dr Agnelo Fernandes, Croydon CCG s Assistant Clinical Chair, writes a monthly column linked to national health campaigns to support public health messaging. Recent topics have included: Flu vaccinations December 2015 Be Sugar Smart (PHE campaign) January 2016 Emotional Well-Being February 2016 Stop Smoking (to highlight National Stop Smoking Day) March 2016. Self-management The CCG s self-management work to support patients with long term conditions has focused on the areas of muscular-skeletal services (MSK) and diabetes in 2015-16. An example of this is patients who present to their GP with muscular-skeletal problems. There are safeguards in place during the initial consultation and once the GP is satisfied there are no red-flags they will support patients to better manage their own conditions for a six week period, prior to a referral to the MSK service, if this is then required. The patient is given advice and information to support their access to community-based exercise programmes for a period of six weeks to assess whether their condition will improve through doing regular structured exercise, for example, Pilates. Self-care Croydon CCG are exploring different ways of commissioning services which support patients (and their carers) to manage their own conditions more successfully based on what patients have told us is important to them. This includes needing to know the best place for them to go to so they can get the right treatment, in the right place at the right time. Croydon CCG has promoted Pharmacy First widely across Croydon as part of our minor ailments and injury services and to make it easier for Croydon residents to access healthcare professionals within their local community. Patient and Public Engagement in Croydon 2015-16: Page 28

Pharmacy First is available to anyone living and working in Croydon and covers a very broad range of illnesses from acne to warts and verruca s to sprains, diarrhoea and teething. Shared decision making Throughout 2015-16, the CCG focused its shared decision making work on educating and training healthcare professionals working across Croydon to fully understand shared decision making and their role in supporting patients to feel confident to become their decision making partners. act as Community Connectors, whose role is to support local people to navigate services. The evaluation of this work indicates that the project has helped these patients to realise that being responsible for their own health and wellbeing is their own choice. Altogether Better The CCG, through the OBC programme, commissioned the Altogether Better project to run pilots in seven local practices ahead of the APA implementing the five new models of care. The aim of this training is to promote a cultural change and upskill the workforce to plant the seeds for shared decision making to really take root across Croydon. Empowering Patients In 2015-16 the CCG began to build on the work we had been doing with clinicians, around Ask 3 questions across Croydon practices and commissioned CVA to work in practices with GPs to explore the challenges for implementing an Ask 3 Questions scheme locally. The Altogether Better project works within GP practices to engage patients, and staff, to volunteer and train to becomes community health champions who then reach out to support others. The evaluation of the Altogether Better project in other areas has demonstrated its effectiveness in supporting behaviour change, improving health, more appropriate use of health care services and decreasing hospital admissions. The Altogether Better programme was commissioned to begin work in Croydon practices from February 2016 and will support the CCG s self-care, self-management and shared decision making work in 2016-17. Patient Choice CVA undertook asset based community development (ABCD) work in some of Croydon s more deprived wards to involve patients, carers and community The CCG works to commission services that actively support and encourage group representatives in planning new services which support patients to be patient choice, particularly in our community based services, through in more control of their health. Through this work, 40 volunteers joined up to ensuring providers offer a variety of extended clinic times in different locations across the borough. Given the size of our borough and the high Patient and Public Engagement in Croydon 2015-16: Page 29

levels of public transport use amongst our more vulnerable patient groups, the CCG want to ensure that our community based services are accessible to all residents and believe that commissioning for a wider variation of choice is one way to help us to achieve this. To assess how well we are doing on this the CCG has added the following questions into our standard patient experience surveys. Were you given the opportunity to choose where and when you attended the service? Was the location of the service convenient for you to attend? The data we receive through our patient experience surveys helps to shape service specifications in future procurements. GP Survey The CCG uses the data from the GP Survey as a tool to provide a baseline assessment of how involved in decision making about their care patients feel within their GP practice. In particular we use data from the following areas help us identify practices that might need additional support to improve shared decision making and self-care initiatives: Is your GP giving you enough time? Do you feel your GP listens to you? Does your GP explain tests and treatments? Is your GP involving you in decisions about your care? Does your GP treat you with care and concern? Do you have confidence and trust in your GP? Engagement with our PPGs indicates that the above areas are all precursors to creating the right environment for effective shared decision making to flourish. Where patients do not feel they are given sufficient time or do not have high levels of confidence and trust, it will be very difficult for them to feel able to participate in shared decision making. Data from January 2016 show that Croydon practices vary in performance, but overall the results are quite positive. The Together for Health team will be using on-going data from the National GP Survey to track any changes in patients perceptions of how involved they feel in decision making as one way to support us in assessing the impact the Together for Health programme has. Personalised care planning and personal health budgets Croydon CCG does not have a significant number of patients who benefit from a personal health budget (PHB) currently. This is due to a number of factors including not having had the infrastructure required to support the wider scale rolling out of personal health budgets. While 2015-16 did not see an increase in the number of Croydon residents accessing personal health Patient and Public Engagement in Croydon 2015-16: Page 30

budgets, it has seen progress made in developing the systems required to support patients to do so in 2016-17. For example, the CCG has set up an agreement with an agency that specialises in personal budgets to help support patients and carers to manage a PHB. We believe that this will increase the take up of PHBs among Croydon patients. The CCG will also be employing a Personal Health Budget Support Manager and the CCG s Continuing Healthcare Team will be offering personal health budgets much more widely, now that the CCG are confident the structures are in place to support people. Personal Independence Co-ordinators One of the OBC new models of care, developed with Croydon residents, is for personal independence co-ordinators (PIC). Feedback from people in Croydon emphasised the need to have someone to talk to when needed or wanted. Age UK Croydon, funded in part by Croydon CCG, will be employing a small number of PICs to provide individualised support to help patients by coordinating and establishing links with the right services and support networks in the community in autumn 2016. The PICs will provide an additional way to support eligible patients who have or are interested in having a PHB. Patient and Public Engagement in Croydon 2015-16: Page 31

Section Five: Forward plans for 2016/17 Key areas of development for 2016/17 are: Closer working with Healthwatch Croydon As mentioned earlier in this report Healthwatch Croydon has robust systems in place to gather and analyse patient experience data which is crucial to supporting the CCG to improve the quality of the services we commission. Patient and Public Engagement in Croydon 2015-16: Page 32 The CCG has begun to develop more effective relationships with Healthwatch Croydon and now need to concentrate on developing robust systems to ensure that the CCG are aware of the themes emerging from the data Healthwatch Croydon are gathering and that this information is fed upwards to commissioners and the Senior Management Team. The CCG are aware that this needs to be a two-way flow and we will work to guarantee that Healthwatch Croydon have early sight of potential commissioning plans and are engaged in our pre-planning work. Develop an Equalities Panel As an action from the PPI Review, it was agreed that various models would be developed to improve the representation of seldom heard groups. An Equalities Panel had been agreed for further development. This will be an open panel of local CVS staff and volunteers who the CCG could work with to tap into seldom heard communities, similar to the approach we took for

urgent care. The CCG believes that this will provide us with a way of undertaking more representative PPI activity than a regular standing group. Urgent Care Croydon CCGs reprocured urgent care services are due to commence on 1 April 2017. It is important that we capitalise on the extensive engagement we did in 2015-16 and work to maintain the interest and support many Croydon residents have shown in the procurement. An engagement plan will be developed in autumn 2016 to ensure that patients and the public have the opportunity to engage with the new provider and help support them to develop GP hubs and monitor the performance of the newly emerged system. Outcomes Based Commissioning The SUSEG group will continue to ensure that engagement activity influences the development of the APA and models of care. The five models of care will launch in the Mayday network in winter 2016 and SUSEG members will support this launch and the further engagement with the CVS ahead of the roll out during 2017. SWLCC Strategic Transformation Plan & Grass Roots Engagement Work Croydon CCG will continue to support SWLCC with the grassroots programme being delivered through Healthwatch Croydon. The CCG will also be integral to engaging within Croydon around the Strategic Transformation Plan and look forward to ensuring that Croydon residents are active and engaged within this important piece of work being delivered across the six boroughs. Financial Improvement Plan 2016-2021 and Extended QIPP programmes In July 2016, NHS Improvement and NHS England announced a range of new measures to help address the financial challenges faced by a number of NHS organisations across the country. Croydon CCG was one of the organisations identified as requiring additional support to close our financial deficit. This means that the CCG is required to make further savings this financial year, while continuing to build on the quality improvements we have made in local health services over the last three years. Patient and Public Engagement in Croydon 2015-16: Page 33

The requirement to save money will involve making some very difficult decisions about the health services the CCG can buy on Croydon residents behalf. The CCG need to start the conversation with Croydon residents and listen to their ideas about how the CCG can make the changes we need to. Our business as usual We will also continue to: implement the agreed recommendations of the PPI review. reach out to seldom heard groups through outreach and working with our CVS partners and Heathwatch Croydon. work with the active community and voluntary sector in Croydon. make sure that all PPI documents are written in plain English. develop and strengthen our links with PPG s and the Croydon PPG Network. engage with the wider community through events such as our PPI Forums, commissioning intentions events and the CCG s Annual General Meeting. embed consistency in PPI practice and know-how across the organisation, standardising procedures and staff development. widen patient inclusion in internal decision making structures. Patient and Public Engagement in Croydon 2015-16: Page 34

Section Six: Healthwatch Croydon statement Healthwatch Croydon (HWC) has been asked to provide a statement to reflect on Croydon Clinical Commissioning Group s (CCG) patient public participation (PPP) activity from 2015 to 2016. The statement reflects on the CCG s infrastructure for PPP, its PPP activity and individual PPP duty. HWC has reviewed the report and made recommendations to support the CCG s development in PPP. Healthwatch Croydon and Croydon Clinical Commissioning Group Partnership Healthwatch Croydon s business plan 2016 to 2017 explains that the majority of health services in Croydon are bought and provided by NHS Croydon Clinical Commissioning Group. This Group includes Croydon Health Services NHS Trust (CHST) which runs two hospitals and community health services, and South London and Maudsley NHS Foundation Trust (SLaM) which run mental health services. The CCG has financial levers which contribute to its decision-making and Healthwatch Croydon has tried to bring its influence to bear on these decisions. To achieve this it facilitates community views through volunteering opportunities, within the development of commissioning intentions, through formal procurement and through Healthwatch Croydon s non-voting seat on the CCG Governing Body. The business plan is currently available on the Healthwatch Croydon website, see www.healthwatchcroydon.co.uk/annual-report-business-plan. Patient and Public Engagement in Croydon 2015-16: Page 35

One significant improvement is that the CCG Board now recognises Healthwatch Croydon as an official attendee at Governing Body meetings, along with the Director of People at Croydon Council and the Director of Public Health. This is a public acknowledgement that the independent patient voice is taken seriously. Healthwatch Croydon s patient and public feedback As the statutory patient voice on Croydon s health and social care services, Healthwatch Croydon has an independent perspective on the strategy, decision-making process and commissioning delivered by the CCG. It independently gathers views and experiences of patients and service users and is in an apt position to support the CCG in robust patient participation and good governance as well as in the marketing of CCG activity through its broad networks. There has been success this year, with the CCG responding positively to our own research reports on Urgent Care Services Re-procurement and Child Autism Services. However, the CCG has not being proactive in requesting reports, or asking Healthwatch Croydon to look into any issues. Healthwatch Croydon recommends that CCG is more proactive in inviting us to contribute independent local intelligence to CCG decision-making in commissioning and patient experience quality assurance. PPP infrastructure For the period 2015 to 2016, the CCG s participation duty report stated vision for patients, carers and local communities having influence has made more progress, with three volunteers being asked to sit on the urgent care reprocurement panel, giving them insight and influence into a complex process. This marks real engagement with residents and more of this should be encouraged. However, Healthwatch Croydon has still found marketing and communications on consultations and engagement to be unavailable in a timely manner, particularly around the announcement of Urgent Care plans in December 2015. Things have improved since then but could be better. Closer working around major announcements would be advantageous, For example sharing embargoed press releases many days before announcements means that Healthwatch Croydon is more aware of the issue or project being announced and can communicate with its network effectively and support the aim of the CCG in communicating issues. The Healthwatch Croydon Marketing Officer continues to work hard to publicise NHS work through tailored materials and briefings to the widest possible range of people in Croydon, both via e-newsletter, social media and the website. The CCG has recognised the need for separate communications/press and public engagement roles, and relations between these and Healthwatch Croydon have grown stronger over the past year. Patient and Public Engagement in Croydon 2015-16: Page 36

Materials around recommissioning of urgent care were better designed than previous campaigns, but the consultation timescales were very short, with material arriving on Friday publicising events happening the following Tuesday. A more effective communications plan needs to be developed to ensure there is plenty of time for communicating engagement events. Strategic Partnership The Participation Duty report does not appear to be sufficiently inclusive of Healthwatch Croydon and the views of Croydon residents. Healthwatch Croydon is not acknowledged as a Strategic Partner. Stakeholder communications Healthwatch Croydon was given the opportunity to take part in the 360 degree stakeholder survey. The CCG closed its PPP Forum for review to improve its representation of the Croydon community. The CCG has extensively improved its 'get-involved' opportunities by reaching the relevant organisations and wider population and remunerating Croydon s particularly hard-to-reach in its patient and public involvement (PPI) for Issues Paper hosted by NHS South West London Collaborative Commissioning. In the reprocurement of urgent care services in particular, the CCG provided extensive resource and utilised extensive PPI in the modelling of GP hubs. Evidence of PPP activity through the service planning. Healthwatch Croydon does not receive proposals for service change in advance or a calendar of upcoming CCG activity, and is notified within a short time-frame, on a busy agenda in the public section of the CCG Governing Body meeting. Healthwatch across England has long been championed by user groups and the NHS. The CCG can benefit from patient, carer and staff input. If HWC did receive these documents or proposals Croydon residents would have a voice, independent and empowered in the design of the Croydon NHS. The various appendices attached to the CCG s participation duty report have improved based on last year by showing how many people attended or a little of the background of attendees, but it would be good to know more of the protected characteristics (age, gender, ethnic background) to ensure all part of the Croydon community are reached. Stronger working relationships are needed with user-led community groups and voluntary organisations. Healthwatch Croydon is disappointed with the lack of engagement of third sector organisations on key decisions. For example, in 2016 concerning the future of IAPT services, the CCG and SLaM decided to redirect funds that had been planned for IAPT, and the funds that had been provided by NHS England for IAPT were used for acute beds at SLaM (see CCG Governing Body papers Sept 2016). Redirection of funds was decided between provider and CCG with no public engagement /communication. The Governing Body meeting reports, on for example, service re-design or quality improvement do not provide an evidence-base or map engagement Patient and Public Engagement in Croydon 2015-16: Page 37

Healthwatch Croydon providing patient experience Healthwatch Croydon would welcome the opportunity to participate in engagement prior to decision-making and support the CCG in efficiency savings and service improvement. HWC s extensive collection of insight from patients and carers would potentially provide better governance, improve quality and the CCG s public relations. In addition when funding new services or contract monitoring current services, Healthwatch Croydon can provide the CCG with patient experience complimenting the CCG s own clinical and patient referral data, enabling the CCG to make informed decisions. It would also be a significant advantage to have the CCG s support to increase the profile of Healthwatch Croydon s role in the 57 GP surgeries and other places where the CCG commissions services. This would include prominent and continued display of materials, opportunities to deliver outreach in the surgeries on a regular basis, and direct access to Patient Participation Groups (PPGs). Croydon still does not have a full comprehension of PPGs. All GP Surgeries should utilise the support and training services for patient representation NAPP to immediate effect and embrace the patient voice in delivering services, see www.napp.org.uk. This in turn would support increased patient experience data which Healthwatch Croydon can feedback to each surgery the CCG to aid decision-making. This ties in closely with the CCG s objective of supporting closer working with our local community and voluntary sector groups. Patient and Public Engagement in Croydon 2015-16: Page 38