Attach 5 West Wandsworth Locality Update - July 2014 1) Introduction The West Wandsworth Locality covers the areas of Roehampton and Putney, and the nine practices that lie in these areas. The 2013 GP registered population for West Wandsworth was 79,329 and is anticipated to increase by about 3,000 in the next five years. West Wandsworth represents a diverse demography, from Thamesfield, an area of low deprivation with an older population, to Roehampton an area of higher deprivation and a younger population. While sharing many of the same health priorities as the rest of Wandsworth, public health analysis shows that West Wandsworth has specific issues such as: High levels of sexually transmitted infections, with rates in Roehampton higher than 3,000 infections per 100,000 population (2012) High prevalence rates for CVD risk factors: o Recorded smoking rates above 25% for the 16 years and older registered population, in Roehampton and parts of West Hill and West Putney (2012) o Six practices in West Wandsworth have a higher recorded prevalence of hypertension compared to the Wandsworth average (2013) o Recorded diabetes prevalence higher in five practices compared to Wandsworth average Higher levels of coronary heart disease and cancer in primary care (2012/13) compared to other areas in Wandsworth The adult (18+) obesity rate in Roehampton and West Hill is significantly higher than the Wandsworth average (2012) The Quality and Outcomes Framework (QoF) recorded prevalence of depression is higher, at 4.7%, compared to other localities 2) The Locality Members Forums: Monthly Members Forums are held, attended by representatives of each of the locality practices, Public Health, Prescribing and two members of the Locality Patient Group. Joint Localities Members Forum: Twice a year a Joint Localities Members Forum (JLMF) is held, to bring together the three localities and discuss borough wide issues. The last JLMF was held in May 2104 and was attended by representatives of eight of the locality practices. Management Team: The locality Management team meets twice a month and is comprised of the management and clinical leads, two other elected GPs, an elected nurse, Public Health, Local Authority (who attend when relevant) and patient representation. Practice Managers Forums: The monthly Practice Manager Forum is attended by the Locality Management Lead and is an opportunity to engage with the practice managers. Locality Patient Consultative Group: The Locality Patient Group meets on a monthly basis, ahead of the Members Forum, and has representation from over half the practices. Weekly Updates: A weekly email is sent to practice managers, GPs and nurses, providing information both locality specific and Wandsworth wide. This communication is well received by the practices. Practice Visits: The Locality Manager and Clinical Lead will continue to visit practices to provide support, listen to and address concerns and continue to build relationships with locality members. Locality Board Road show: In October 2014 West Wandsworth will be hosting a CCG Board Road show, giving the local population an opportunity to meet the Board and discuss local issues. Page 1 of 5
Locality Support: The locality has a Clinical Lead and a Management Lead who work closely to ensure the smooth running of the locality, provide support to practices and deliver on locality priority areas. The three localities also share dedicated administrative support. 3) Engagement 3.1) Locality Patient Consultative Group West Wandsworth has an active Locality Patient Consultative Group, currently formed of members from five practice s patient groups. The group developed its own action plan, which included support to practices to develop their patient groups, and engaging with key priority areas such as Queen Mary s Hospital, and the Clinical Reference Groups. The group has had a range of speakers on topics including Mental Health, Children s Services, Weight Management, Domestic Violence and the Roehampton Regeneration. The group has a specific interest in mental health. The group raised concerns about the NHS 111 service and following meetings with the CCG it was agreed that the Putneymead Patient Group would carry out a survey of patients who had used the service. This was carried out between August 2013 and January 2014 and a full report on the survey outcomes was submitted to the CCG for review. 3.2) Joint Locality Patient Groups Event The Chairs from the three locality patient groups meet on a regular basis with the locality managers. It was agreed that a joint event should be held to bring the three locality patient groups together. The event was held in February 2014. An overview of each locality was followed by group work focusing on what makes a good patient group; what works well in practice and locality patient groups and what could be improved. All those who attended gave positive feedback and it is hoped another joint locality patient group will be held event later this year. 3.3) Seldom Heard Groups Over the last two years GPs have been encouraged to visit Seldom Heard Groups, to create links and further understand the role of these groups and how they may be beneficial to their patients. A wide variety of groups have been visited by the locality GPs as shown below. 2012-13 Groups visited 2013-14 Groups visited Wandsworth Carers Centre SHARE, Clapham Laverstoke Gardens Residential Care Centre Roehampton Activity Centre Pocklington Trust Resource Centre Thrive, Battersea Hostel for those with mental health conditions Regenerate Rise Wandsworth Community Empowerment Network Residential care centre for service users with Somali Community Advancement Organisation severe learning disabilities and autism STORM The visits were discussed at the Members Forum where Dr Sian Job talked about the benefits of the programme and GPs shared their experiences. As part of the 2014-15 Members Development Programme practices are again undertaking these visits. 3.4) Roehampton Regeneration The Local Authority is undertaking significant work to develop proposals and engage with local communities around the redevelopment of the Alton area, which directly affects two of the locality practices. To ensure all practices in the locality were aware of the developments the Project Manager for the regeneration was invited to attend the locality Members Forum and the Locality Patient Group. This enabled those practices that, although not directly in the area, but close by and so potentially affected, to find out more. These practices have since been able to engage with the regeneration team, who have visited the practices to discuss the plans in more detail. 3.5) Clinical Reference Groups (CRGs) A number of locality GPs are engaging, on behalf of West Wandsworth, with CRGs including diabetes, children s services, mental health, cardiovascular disease, cancer, NHS 111, out of hours, COPD, stroke and substance misuse. Page 2 of 5
3.6) Providers The locality is represented on the Kingston Hospital Council of Governors and is looking to appoint a local GP to sit on the Kingston Clinical Quality Review Group, as a significant number of patients from the locality attend Kingston Hospital. The locality is also represented on the Queen Mary s Hospital Strategy Group by both clinical and patient representatives. 4) Locality Priorities The West Wandsworth priorities were developed with the Management Team, Members Forums, and the Locality Patient Consultative Group. Public Health provided data to support the identification of the priorities which build on the work previously carried out, to improve the health and wellbeing of the population. These are shown below. 2013-14 2014-15 Key Priorities Secondary Priorities Key Priorities Supporting Priorities Mental Health Healthy Schools Mental Health Patient and Public Queen Mary s Hospital Obesity Sexual Health Engagement Sexual Health Cancer Diagnosis CVD Healthy Schools Patient and Public CVD Cancer Diagnosis Queen Mary s Hospital Engagement Smoking Cessation Smoking Cessation Obesity Over the year the locality will meet with key commissioners, Public Health leads, and other relevant stakeholders to discuss these priorities, and review, monitor and expand on the actions being taken. 4.1) Mental Health The locality has been working with Public Health to launch the Mood Manager DVD pilot. The DVD has been developed to enable people to play a more active role in managing their depression. It provides information to increase awareness of the condition, increase compliance with medication and provides advice to encourage enhanced physical health and wellbeing. The latest version is available in six languages and will be launched to practices in July. GPs will distribute the DVD to appropriate patients, encouraging them to provide feedback on how helpful the DVD has been. Public Health will carry out an evaluation of this pilot to assess its impact. Family Action provides an early intervention mental health service across the borough. In West Wandsworth the locality worked with Family Action to set up this service in a local surgery, and the service has been running since September 2013 accepting referrals from all the local practices. Big White Wall presented at Members Forum in November 2013 to promote their service, especially the new initiative of GPs being able to directly refer patient to live therapy. This led to more practices in the locality signing up to be able to refer patients to this service. The Locality is currently working with the Community Mental Health Team (CMHT) for Putney and Roehampton to identify ways of improving the physical health of those with mental health disorders. 4.2) Sexual Health West Wandsworth worked with the Public Health sexual health lead to produce an awareness raising campaign for practices. A factsheet was developed providing an overview of the sexual health services primary care can offer. Most practices are now providing Chlamydia screening; five are providing long acting reversible contraception services and one HIV testing. The use of condoms is being promoted to support the reduction of teenage pregnancies and STI s in at risk groups. 4.3) Healthy Schools The locality worked with the Local Authority to develop a proposal for GPs going into schools to meet with staff and explore what work around health was already undertaken and what issues they had. This presents an ideal opportunity to co-ordinate key health messages being delivered within the school curriculum or healthy schools programme supporting the role of the school nurse. The Page 3 of 5
Management Team will be meeting with the School Nursing Team to discuss the outcomes from the visits and to look at how they can work together more closely. A number of GPs and schools expressed an interest in taking part in this pilot and to date two successful visits to primary schools have been completed, with plans to expand the programme and carry out further visits. Following the initial visit one of the schools has asked the GP to talk to their Reception class about visiting the doctor. The locality has also provided feedback and input into the new school nursing specification. 4.4) Cardiovascular Disease (CVD) Parts of West Wandsworth, especially Roehampton, are areas of high CVD risk. Therefore it was identified there would be an increased benefit for this population to attend for NHS Health Checks. In 2013-14 eight practices signed up to continue to deliver NHS Health Checks, achieving 81% of the locality target. There was significant variation across practices in the level of Health Checks delivered, from 15% of to 111% of target. To support delivery of Health Checks a mobile clinic has been funded by Public Health in Roehampton and Putney Heath, undertaking 50 checks last year. A near patient testing pilot for NHS Health Checks has also been undertaken and evaluated with the aim of improving uptake. The LDX machine has the potential to provide for more flexibility in provision, as patients do not need to attend a fasting blood test prior to their appointment. The pilot has been extended for six months to further refine it. This continues to be a priority area and West Wandsworth is keen to focus on achieving these targets through joint working to deliver this service. 4.5) Cancer As part of its cancer priority it was agreed that each practice would meet with the Macmillan GP Facilitator to discuss cancer referrals and diagnosis; areas where there is potential for improvement, safety netting and the Cancer Care Review. Over the past year six practices have held these meetings, resulting in greater awareness and improved systems in practices for managing two week referrals and ensuring these patients are followed up. These visits will be continuing. 5) Locality Investment 5.1) Freed Up Resources (FURs) With FURs no longer available to practices after 31 st March 2014 the locality agreed that practices would have until August 2013 to submit individual bids against their remaining allocation. After this date any FURs not claimed would be pooled for locality wide investment. Over the time FURs was available practices in West Wandsworth ran a number of schemes including: Extended hours: above and beyond the Access / Extended Hours Enhanced Services Home visiting services: a dedicated GP enabling urgent home visits to be carried out as required Sexual health clinic: focused on young people and sexual health education Women s Health Clinic: a surgery with only male doctors provided a clinic with a female GP The FURs that were pooled by the locality were used to support a number of locality priorities: School visits LDX pilot Waiting room BP machines a number of practices already had these machines and it was agreed that those practices that did not would be offered the opportunity to have these funded 5.2) Locality Investment Schemes For 2014-15 each locality has a budget to fund projects, assessed against set criteria which include need, equality, benefits and feasibility. West Wandsworth has 63,000 to invest in locality schemes. Suggestions from practices were reviewed by the Management Team, who developed the final proposals set out below. Two of the proposals came from the Locality Patient Group. Healthy Schools This project will continue, and expand on, the work already done in the locality around working with schools and the school nursing team. The aim is to improve communication, co-ordinate key health messages and improve care. (see section 4.3) Page 4 of 5
Cardiovascular disease NHS Health Checks To implement an alternative model of delivery through working collaboratively, ensuring all patients have the opportunity to access this service (see section 4.4) BP campaign To complement the delivery of NHS Health Checks the majority of practices now have waiting room Blood Pressure machines. Practices will be provided with protocols and guidance on how to make the most of the machines, and patient information to be displayed alongside the machines Mental Health Physical health To work with the Putney and Roehampton Community Mental Health Team to develop a proposal to improve the physical health of those with mental health conditions Mindfulness To work with the Wandsworth IAPT service to pilot Mindfulness course. It is proposed to run four courses over the next few months. This proposal came from the Locality Patient Group, which is working with the locality to further develop and deliver this scheme Sleep disorders To work with Wandsworth IAPT to develop and pilot a series of sleep education workshops for patients with sleep disorders 6) Members Development Programme (MDP) The MDP allows protected time for practices to focus on developing and improving quality. In 2013-14 eight West Wandsworth practices took part in the MDP focusing on areas such as front of house, back office, prescribing and referral management, to improve efficiency and quality of services. For 2014-15 all nine practices have signed up to the MDP, focusing on areas such as infection control, significant events, safeguarding, controlled drugs, Family and Friends feedback, improving customer service, repeat prescribing and internal practice processes. Practices will submit regular action logs of activities they have undertaken and the outcomes achieved. Five practices are taking part in the Productive GP Programme - a structured programme designed to support practices in continuously improving how they work, as well as releasing savings. 7) Quality Premiums The CCG had three local quality premiums to deliver on over 2013-14. Practices were specifically asked to support on achieving two of these areas referrals to smoking cessation and secondary prevention of fractured neck of femur. West Wandsworth practices engaged with this work and by the end of March 2013 had delivered 867 referrals to smoking cessation (16% of the total number of referrals 5476) contributing to the CCG exceeding its target of 4800 referrals. 8) Quality and Outcomes Framework (QoF) - Quality and Productivity All practices were involved with the Quality and Productivity section of QoF, attending a borough wide event where a number of pathways for the outpatient and emergency admission sections were proposed. Practices provided feedback on the pathways before they were finalised, and also discussed how to reduce A&E attendances. The pathways agreed were: Outpatients: Antenatal, Carpal Tunnel, Heart Failure Emergency Admissions: Diabetes, Fractured Neck of Femur, Peripheral Arterial Disease All the West Wandsworth practices attended the meeting and engaged with the pathways, auditing patients referred through them, especially focusing on exceptions and reasons for not following pathways. These pathways should now be embedded in practices for continued use. 9) Summary West Wandsworth will continue to engage with member practices, patients and the public and other relevant stakeholders. On-going development and delivery of the priority areas and investment schemes outlined above, will take place and the locality will continue to work closely with all stakeholders to build on and develop the work undertaken so far. Page 5 of 5