NHS Lewisham CCG Annual Review 2017/18 for Lewisham people
Message from our Chair Marc Rowland Chair Welcome to our 2017/18 annual review. This was a year of challenge and change. We are pleased to report that we met our financial duties and were able to use the money we received to better meet the needs of Lewisham residents. Our focus remains on the needs of people in Lewisham. We made good progress in our diabetes care, dementia care and mental health work which were rated outstanding and good by NHS England through the Improvement and Assessment Framework (IAF). But there is much work still to be done and we will continue to monitor and work with local partners and services to make improvements in the coming year. From April 2017 under delegated commissioning arrangements we assumed full responsibility for contractual GP performance management, budget management and the design and implementation of local incentive schemes. During the year we also became a member of the South East London Commissioning Alliance along with Bexley, Bromley, Greenwich, Lambeth and Southwark CCGs. These new arrangements will bring new ways of working through collaboration, sharing expertise and using our resources more effectively. And, whether we are working at Lewisham borough level or at a wider south east London level, our focus remains on the needs of people in Lewisham. I d like to thank our members, partners and local people for all of their hard work over the past year and for sharing our vision of better health, best care for Lewisham people.
Who we are and what do we do? NHS Lewisham Clinical Commission Group (CCG) is a membership organisation made up of 38 local GP practices across the borough of Lewisham. We are responsible for planning, buying and monitoring NHS services with money from central government aimed at improving health for people in Lewisham. Our aim is to secure the best possible health and care for everybody in Lewisham. We work in partnership with organisations in the borough and in neighbouring areas so that local people receive high quality, safe and accessible health services. What did we set out to do? At the start of each year, we agree our plan and how to make the best use of our allocated budget to plan and fund health services and improve quality of these services and the experience of patients. We have focused on the following three main priorities: Planned care (including prevention and early action) This included work to support people with long term conditions (such as chronic obstructive pulmonary disease (COPD), diabetes and asthma) better; improving the quality of primary care in residential and nursing care homes; and preventing strokes. Urgent and emergency care This is our work to improve access to primary care services; to ensure that people have the information they need to access the right care, at the right time in the right place; reducing unnecessary hospital admissions and improving what happens when people are discharged from hospital. Contract management Our work to ensure that we manage the range of contracts that we have, meeting our financial targets and delivering value for money for our residents. The following pages include some examples of the progress we have made in these areas. You can read more about this in our Annual Report and Accounts 2017/18 which is available on our website www.lewishamccg.nhs.uk. Better health, best care 1
Diabetes As part of a programme to improve diabetes care in Lewisham, we commissioned One Health Lewisham Ltd (our local GPs working together in a federation) to roll out a programme of diabetes education and training for staff who provide diabetes care. The federation worked with 13 practices during 2017/18 to provide staff access to an online learning tool that supports all levels of healthcare practitioners to further develop their knowledge and skills about diabetes. Comfort Bright-Davies is a practice nurse at St Johns Medical Centre, she took part in the programme and said: I heard about the training at a practice nurse study day where we could sign up if we were interested. The course is really informative and educational. It is a lot of work as there are lots of modules but as it is online, I can fit this in around my work pattern. It has really raised my awareness of the options available to treat diabetes patients, by assessing their needs whether they are better suited to insulin or tablets. It also covers nutrition, which is an important factor for managing diabetes so I can offer advice about diets as well. I would recommend that all practice nurses sign up for this training, it has been invaluable. Jane Dolega-Ossowski, is one of four general practice nurse advisors at the CCG, their role is to support nursing practice across the borough. She said: What many people do not realise is that it is the practice nurses that manage these patients long term. So it s really important for us to develop our workforce in the practices with extended training like this, so that we can continue to improve the outcomes for patients with long-term conditions such as diabetes. I would recommend that all practice nurses sign up for this training, it has been invaluable. 2 NHS Lewisham CCG Annual Review 2017/18 Jane Dolega-Ossowski General practice nurse
Child and Adolescent Mental Health Services (CAMHS) In partnership with Lewisham Council we commission South London and Maudsley NHS Foundation Trust (SLAM) to provide specialist Child and Adolescent Mental Health Services (CAMHS). A key element is the eating disorders service which includes family therapy, multi-family therapy and cognitive behavioural approaches that could be caused by the presence of one or more additional diseases or disorders. Family therapy enables parents to be central to the treatment process for anorexia nervosa in childhood and adolescence and focuses on identifying and building parental strengths and skills to support their child s treatment at home, reducing the need for lengthy inpatient treatment. Michael and Alice s story Following a devastating event, Michael* and his family accessed services from Lewisham Children and Young People s Mental Health Services (CAHMS) for support with his daughter Alice s anorexia. He said: We tried to deal with it ourselves, but we needed professional help. Our GP referred us to SLAM. We were seen immediately. Alice, our daughter was quite ill at this point, she was not coping with the anxiety and stress. The service was, and is amazing. She was diagnosed with anorexia really quickly. First they had to prevent further crisis, so they helped with a meal plan, portion sizes and ways to encourage her to eat and support with weight recovery. Then they worked with us to support her mentally. We were assigned a therapist who was a great fit with our family and most of all, built a great rapport with our daughter. The therapist had weekly sessions with Alice as well as sessions with us as a family and with my wife and me. The therapist supported the whole family. It has been a stormy year for our family, but Alice is making great progress and we are on the road to recovery. She would not be where she is today without this service, they saved her life. Patients can be referred by GP, school, or social worker, and they or their family can also refer themselves. There is also a duty referral line: 020 3228 2545 which anyone can call to discuss a referral with one of the team clinicians, Monday to Friday. *Names changed at request of patient. It has been a stormy year for our family, but Alice is making great progress and we are on the road to recovery. She would not be where she is today without this service, they saved her life. Better health, best care 3
Caring for people in our care homes Brymore care home We have a contract with Brymore House, a nursing home that provides 25 community beds (beds that are not based in a hospital) which are both step up and step down. Step up beds support patients who do not need admission to an acute bed, but are not able to remain in their own homes either through illness or needing some other short term support to help them to remain in their own home. Step down beds support earlier discharge of patients from a bed in hospital once they are medically fit, facilitating (where appropriate) a short spell of rehabilitation at Brymore House for up to six weeks. John* is 79 years old and lives in Lewisham. He had been admitted to Lewisham Hospital with a bowel obstruction, a medical emergency. He was referred to the Brymore Intermediate Care Unit as he had some of the symptoms of Parkinson s disease and reduced mobility which had got worse when he was unwell and in hospital. When he arrived at Brymore he needed lots of support with his mobility and personal care such as taking his medication, kitchen tasks, cleaning, shopping and laundry as well as drinking from a cup and eating his meals. He stayed at the unit for five weeks where he received rehabilitation treatment from a range of professionals including occupational therapists, physiotherapists, rehabilitation assistants, social worker, medicines optimisation team and nursing care staff. Following his treatment, John restored his independence with the aid of a four wheeled walker, shower stool, electric bed, blister pack for his medication and was able to go home and continue to live independently. *Name changed at request of patient. John restored his independence with the aid of a four wheeled walker, shower stool, electric bed, blister pack for his medication and was able to go home and continue to live independently 4 NHS Lewisham CCG Annual Review 2017/18
Lewisham Integrated Medicines Optimisation Service (LIMOS) LIMOS provides targeted support for care home staff The LIMOS team works across Lewisham hospital, local care homes and patients at home, to support people leaving hospital to manage their own medication. They review the medication and develop individualised medicine care plans. Jean is 84 years old, she has lived alone in Lewisham since her husband died 20 years ago. She was admitted to Lewisham hospital with confusion thought to have been due an infection. She previously had a stroke and was recently diagnosed with dementia. During her admission to hospital, Jean was referred to the LIMOS team for support to manage her medication at home. Becky is one of the senior pharmacy technicians within the LIMOS team; she began working with Jean to find the right combination of medicine and take them at the right times, helping Jean to continue to live independently. Initially, they met weekly but as time went on and Jean s confidence grew the visits became less frequent. Together they found the best way for Jean to manage her medication; this involves post-it notes in her kitchen, weekly blister packs for her medications and reducing the medications so that she could take them once in the day instead of throughout the day. Jean said: Before Becky came to help me I felt so isolated. My daughter helps me but we had so many questions about the tablets, but Becky was able to answer all of them and talk through our concerns. She has helped me manage my medicines and it s so much easier now. The pack keeps me on track and all I need to do, is take all 5 tablets at 10am and I m sorted for the day. I m really pleased with my medicines. Jean has responded positively to her medications and is due to be discharged from LIMOS imminently. Before Becky came to help me I felt so isolated. Better health, best care 5
GP Extended Access Service The GP Extended Access Service has been running since April 2017. It offers bookable appointments to patients registered with a Lewisham GP, seven days a week, from 8am to 8pm. In November 2017, the service relocated to a purpose built suite in the yellow zone within University Hospital Lewisham. The new location means that the service can offer appointments to babies and children and there was additional space for more nurse appointments. Many patients such as Jennifer have found this service to be most convenient. During April 2017 to December 2017 88% of people who used the service, would recommend it to their friends and family. Over the same period 87% of people who used the service were either very satisfied or satisfied with the care and treatment they received. Jennifer visited the service with her 18 year-old daughter. Her daughter had a painful and swollen arm, she said: My practice could not offer us an appointment that day so they referred us to the service. If I hadn t been able to come here, I probably would have gone to A&E. This was not the first time she had an appointment at the GP Extended Access Service. I knew about it because I came here about three weeks ago, on that day I d been feeling really unwell and I went to A&E. They told me there that I could be treated in the Extended Access Service so they made an appointment for me. I was treated very well and was even able to lie down while I waited for the appointment. My practice could not offer us an appointment that day so they referred us to the service. If I hadn t been able to come here, I probably would have gone to A&E. 6 NHS Lewisham CCG Annual Review 2017/18
Cancer services Care for patients with bowel cancer is provided by Lewisham and Greenwich NHS Trust. Once the GP has made the referrals, patients are sent for further tests (diagnostic procedure) or will see a consultant within 2 weeks. Following diagnosis patients are supported by the CNS pathway (consultant nurse specialist). There are 3 nurses in the team led by a consultant nurse supported by a consultant surgeon. Patients undergo a series of treatments and tests. If a patient has a reoccurrence, this is all reset and the patient starts the intensive surveillance again. Tony s story Tony is a father of two sons and has lived in Lewisham for 30 years. In January 2018, he was diagnosed with secondary bowel cancer. This was to be his third battle with the disease he was told was terminal. He received treatment very quickly after diagnosis which was coordinated by his oncology doctor. Tony fitted the criteria for immunity therapy (this involved injections directly into his veins targeted to control the bowel cancer). The treatment required 3 to 4 hour appointments every two weeks for 2 years. The side effects included fatigue, nausea and dermatitis. His treatment was delivered across many services including oncology, pain nurses, physiotherapy and dietitian. He was brought into A&E via ambulance twice and had both planned and emergency admissions. Tony said, Each and every person involved in my care has been amazing, the receptionists, nurses and consultants. They were always kind and patient and friendly and they explained everything to me! I believe they have extended my life. Most of all, I am grateful to my doctor and the team. They ensured that I received the support and care from all the right places to help me fight the cancer. They have been with me from the beginning and continue to support me today. Tony s cancer is now considered incurable, as opposed to terminal his life has now been extended, which Tony attributes to his care at Lewisham Hospital. Each and every person involved in my care has been amazing, the receptionists, nurses and consultants. They were always kind and patient and friendly and they explained everything to me! Better health, best care 7
Involving our residents in our decisions During 2017/2018 we carried out well over 100 engagement activities, reaching more than 2,000 people, including at the Phoenix Festival in May 2017, the Our Healthier Lewisham event in June, Lewisham s People s Day in July 2017, our Annual General Meeting in September 2017 and in many meetings with local voluntary and community groups throughout the year. During the year we strengthened our Public Reference Group, whose role includes: Ensuring that public engagement is integrated into the commissioning process Acting as a mediating voice between the public and the CCG Supporting the CGG in engaging and communicating more widely with the public to gather their views, and to inform the public of the challenges facing the NHS and any proposed changes to services. In 2017/18 we engaged extensively with local people about proposed changes to prescribing. The proposals included to no longer support the routine prescribing of a range of self-care medicines which are available over the counter in pharmacies and to no longer prescribe malaria prevention medicines on an NHS prescription. During the public consultation, which ran from August to October 2017, we shared information widely across the borough including in GP practices, pharmacies, faith groups, voluntary and community organisations. Following our Governing Body s decision to go ahead with the proposals we used the feedback to develop campaigns to inform people about self-care, our Pharmacy First scheme, and we worked with the West African community to develop information about malaria prevention. We consulted with our patients, the public and stakeholders on the future of the NHS Walkin Centre at the Waldron Health Centre, New Cross and proposals to improve access to primary care in Lewisham. During the 12 week formal consultation from August to October 2017, we conducted 40 face to face outreach activities. These included providing drop-in sessions at the Waldron Health Centre and meetings with homeless charities, community development groups, community hubs, children s centres, parents forums, patient participation groups, faith groups, local ward assemblies and students. The consultation also included a survey that was completed by 1,768 people. We carried out well over 100 engagement activities, reaching more than 2,000 people We identified through our Equalities Impact Assessment that people not registered with a GP would not be able to access the alternative service. During the consultation concerns were also expressed by politicians, residents, homeless charities, GP practices, and faith groups about the impact of the proposed closure on vulnerable and homeless people who may not be registered with a GP. The case studies below demonstrate some of the ways in which we responded to these concerns. 8 NHS Lewisham CCG Annual Review 2017/18
GP services for rough sleepers in Lewisham Co-production is an approach that ensures both people delivering and planning services and those using them are equal partners in the design, delivery and review of services. It recognises that all parties have vital contributions to make to improve the quality of life for people and communities. In partnership with Lewisham Council, we organised a multi-agency Homeless Summit on 18 October 2017 for local partners and agencies. We committed to working with local GP practices located in the Waldron Health Centre to develop an additional service for rough sleepers in Deptford and New Cross. A key requirement for the CCG from the Homeless Summit was to consider the barriers to accessing primary care services for people who are rough sleepers that would be used in the development of any additional provision or services. We held a number of workshops with key stakeholders. We undertook wide engagement with potential service users to develop a pilot service for rough sleepers. We have now commissioned the pilot service which operates two weekly drop-in clinics offering six hours of primary care provision to rough sleepers in Lewisham aged 18 years and over. One clinic operates from a local GP practice and the other is delivered as an outreach clinic located at one of the local homeless charities. The pilot will operate for 18 months and there will be an independent evaluation which will include feedback from users and local stakeholders. We have now commissioned a pilot service which operates two weekly drop-in clinics offering six hours of primary care provision to rough sleepers in Lewisham aged 18 years and over. Better health, best care 9
Helping patients get registered with a GP in Lewisham Being registered with a local GP is really important for continuity of care. GPs deal with a whole range of health problems. GPs also provide health education, offer advice on smoking and diet, run clinics, give vaccinations and carry out simple surgical procedures. If your GP cannot deal with a problem, then you ll usually be referred to a hospital for tests, treatment, or to see a consultant with specialist knowledge. To help people register we provided additional support from our Patient Advice and Liaison Service (PALS) based at the Waldron Health Centre from October 2017 to May 2018. had been encouraged by a local charity to do so. The PALS team helped him complete the forms and he is now registered at a local practice. He said: I really wanted to say thank you. Getting registered has probably saved my life. It s made a massive difference. I have been able to get seen by my doctor then get an operation I needed on my leg. I have had all sorts of health tests too and it s really helping me to get sorted. We supported and encouraged people who live in Lewisham to register with a local GP regardless of their circumstances, like Ray Hoyle. We came into contact with Ray when he had received support from our PALS team to gain access to a GP. He did not have all the relevant paper work to register but Ray Hoyle and PALS staff at the Waldron I really wanted to say thank you. Getting registered has probably saved my life. 10 NHS Lewisham CCG Annual Review 2017/18
Use the Right Service Minor cuts and grazes Bruises and minor sprains Coughs and colds Self Care Stock your medicine cabinet Minor illnesses Headache Stomach upsets Bites and stings Feeling unwell? Unsure? Anxious? Need help? Pharmacy NHS 111 Persistent symptoms Chronic pain Long term conditions GP Advice Out of Hours call 111 Choking Chest pain Blacking out Serious blood loss A&E or 999 Emergencies only For more information, please visit: www.nhs.uk Lewisham Health and Care Partners Better health, best care 11
How we spent the money In 2017/18 we were responsible for a budget of 470 million that we used to pay for the hospital, primary community and mental health services for the people living in Lewisham. You can read our full annual report and accounts including the auditor s report and statements, together with the annual audit letter, on the publications page of our website at www.lewishamccg.nhs.uk. Commissioning Expenditure 2017/18 ( m) Mental health services 15.47% - 72.77m Community Services 6.66% - 31.30m Hospital services (acute) 50.40% - 237.04m Continuing Care Services 3.69% - 17.36m Prescribing and other primary care services 8.38% - 39.41m Primary Care Co-commissioning 8.92% - 41.95m Better Care Fund 4.36% - 20.52m Running costs and other programme expenditure 2.12% - 9.99m 12 NHS Lewisham CCG Annual Review 2017/18
Managing the money We commission the majority of NHS services for Lewisham people. We aim to spend the money allocated to us in the best way that will improve the health and care of Lewisham people, which delivers value for money to the taxpayer and is financially sustainable in the long term. We achieved all of our statutory financial duties and other financial targets for the year. Our net annual expenditure was 470.4m and we delivered a cumulative surplus of 10.4m; which was 0.02m better than planned. The table below shows how we did against our statutory financial duties in 2017/18: Duty Achieved Expenditure not to exceed income Capital resource use does not exceed the amount specified in Directions Revenue resource use does not exceed the amount specified in Directions Capital resource use on specified matter(s) does not exceed the amount specified in Directions Revenue resource use on specified matter(s) does not exceed the amount specified in Directions Revenue administration resource use does not exceed the amount specified in Directions We achieved all of our statutory financial duties and other financial targets for the year. Better health, best care 13
Working together to improve health and care We are working even more closely with other health and care organisations across the borough to improve the health and care of Lewisham people. We want to make the best use of our resources as the demand for health and care services continues to grow and to change the way we work together so that we can all meet the challenges we face. In working together, Lewisham Health and Care Partners (LHCP)* are committed to supporting people to maintain and improve their physical and mental wellbeing, to live independently and to have access to high quality care when needed. Martin Wilkinson During 2017/18 we collaborated more effectively than ever before to achieve better health and care outcomes and experiences for our 310,000 residents. Martin Wilkinson, CCG Managing Director and Chair of the LHCP Executive Board, said: We are working in stronger partnership with commissioners and providers to commission and deliver preventative, accessible and co-ordinated care to meet the needs of our residents. During 2017/18 we collaborated more effectively than ever before to achieve better health and care outcomes and experiences for our 310,000 residents. Prevention is better than cure and we supported more people to look after their own health and care. This included Lewisham community facilitators supporting over 800 vulnerable adults with person centred care plans to improve their social integration, health, well-being and reduce isolation. We also jointly ran promotional campaigns to provide residents with the information they need to use the right service and to care for themselves where appropriate. We successfully piloted new ways of working which brought together professionals from different services to plan and deliver coordinated care and support. 100% of participants agreed that the pilots enabled them to work more effectively and improved patient outcomes. We also worked closely with partners to ensure we are making best use of our buildings, ensuring they are accessible and support integrated working. Also our plans to bring together all health and care records into one electronic system are well underway. The new system will benefit both patients and staff, and provide valuable information for commissioners to use up to date information about the needs of our residents to improve care and transform our services. *Lewisham Health and Care Partners is a partnership of the main health and care commissioners and providers in Lewisham. The partners include NHS Lewisham Clinical Commissioning Group, Lewisham Council, One Health Lewisham Ltd GP Federation, South London and Maudsley NHS Foundation Trust and Lewisham and Greenwich NHS Trust. 14 NHS Lewisham CCG Annual Review 2017/18
Prevention is better than cure and we supported more people to look after their own health and care. Better health, best care 15
STP & Our Healthier South East London NHS organisations in 44 areas of England were asked to work together to produce a five-year plan to implement the NHS Five Year Forward View. These plans are being delivered through partnerships called Sustainability and Transformation Partnerships (STPs). Our STP plan is called Our Healthier South East London and aims to address three problems in local healthcare: The health and wellbeing gap people should be helped to lead healthier and longer lives The care and quality gap variation in the accessibility and quality of care should be improved The funding and efficiency gap the NHS must become more efficient and make better use of the money available. Find out more at: www.ourhealthiersel.nhs.uk/ SEL Commissioning Alliance The South East London Commissioning Alliance is made up of the six CCGs in south east London (Bexley, Bromley, Greenwich, Lambeth, Lewisham and Southwark). As of April 2018, a new leadership structure has been established which works across these organisations and the wider south east London STP. Although each of the six CCGs maintain their own governance and statutory responsibilities, the Alliance builds on the ongoing strong collaboration of the organisations and continued commitment to supporting delivery of both individual and collective objectives. Together these organisations have a responsibility for a total health budget of around 2.74 billion per annum. The Alliance builds on the ongoing strong collaboration of the organisations and continued commitment to supporting delivery of both individual and collective objectives. 16 NHS Lewisham CCG Annual Review 2017/18
Healthy London Partnership NHS Lewisham CCG, along with all London CCGs and NHS England (London), funded Healthy London Partnership (HLP) in 2017/18 to bring together the NHS in London and our partners to deliver London s 10 ambitions to transform health and care for all Londoners. Our partners include the Mayor of London, Greater London Authority, Public Health England, London Councils and Health Education England. We believe that collectively we can make London the healthiest global city in the world by uniting all of London to deliver the ambitions set out in Better Health for London: Next Steps and the national NHS Five Year Forward View. During 2017, HLP set up the Urgent and Emergency Care Improvement Collaborative on behalf of NHS England (London), NHS Improvement (London) and The Association of Directors of Adult Social Services to transform the way that Londoners receive unplanned urgent care and support. This includes preventing the need to go to hospital, supporting patients to become medically fit and well in hospital and then helping them to go home as soon as possible. Other highlights during 2017/18 have included: The findings from our year-long engagement with Londoners on childhood obesity, the Great Weight Debate, were published and are being used to inform every London borough s childhood obesity strategy and the Mayor s London Plan which includes a policy to prevent new hot food takeaways from opening within 400 metres of a school. Finally at the beginning of 2018 we began working with partners including the Mayor of London, London Councils, Public Health England and the NHS, on a joint plan to cut rates of new HIV infection and eliminate associated discrimination and stigma. We believe that collectively we can make London the healthiest global city in the world Better health, best care 17
Help shape health and care in Lewisham We need local people to work with us to design future services. We want to hear about your experiences and get your feedback about our ideas at an early stage. There are lots of ways you can get involved: Join our email list - send an email to LEWCCG.Engagement@nhs.net and we will add you to our email list. Join our readers panel Come to a meeting or event Find out more at www.lewishamccg.nhs.uk/get-involved Contact us 020 7206 3200 LEWCCG.enquiry@nhs.net or LEWCCG.engagement@nhs.net Cantilever House, Eltham Road, London SE12 8RN www.lewishamccg.nhs.uk @NHSLewishamCCG nhslewishamccg