A review of 2017/18 and a summary of the Greenwich Commissioning Strategy Transforming our health and social care system 2018 to 2022
Welcome... 4 Who we are and what we do... 6 Our achievements... 8 Our performance... 11 How we spent NHS money... 12 Our plans for the future... 14 Health in Greenwich... 16 Our priorities... 20 Enablers... 22 Working with patients and the public... 24 Stay well in Greenwich... 26 Get involved and keep in touch... 28 2 3
Welcome to our annual review 2017/18 2017/18 was challenging for the NHS in Greenwich and nationally. We continue to see increasing demand on Greenwich services, especially in urgent and emergency care. We have sought new ways to improve patient care within our financial means, and the CCG met its financial performance targets for 2017/18. In July 2018, Greenwich secured an NHS England rating of Good for 2017/18, a marked improvement from the Inadequate rating for 2016/17. Moving two levels higher within a year is a significant step forward and testament to the hard work of staff and member practices. Our new senior leadership team are helping to bring about stability following financial turnaround. Along with neighbouring CCGs in south east London, we appointed a joint Accountable Officer, Andrew Bland, to strengthen our collaborative working. 2018/19 will continue to be challenging, and the financial forecast at Greenwich is poor at the moment. Despite this, we have weathered tougher times. As I step down as Clinical Chair this year, and we welcome Dr Krishna Subbarayan, I know I am leaving a very good team in place who have the commitment and drive to commission the highest-quality NHS services for Greenwich people. Dr Ellen Wright GP and Clinical Chair 2014 to 2018 This review of the year provides a welcome look back to my first year at NHS Greenwich CCG as Managing Director. I live and work in Greenwich and I am truly passionate about getting the best health services for local people. I would like to thank our GP member practices and Governing Body. Our GPs and healthcare professionals have spent many years caring for local people. Their knowledge and experience gives us a sound basis for decision-making, and their commitment makes progress possible. This year we saw a huge increase in participation in our annual stakeholder survey from 41% to 92%, giving us a wealth of information and feedback on which to base our future plans. I would like to thank Jo Murfitt for her work as Chief Officer from November 2016 to September 2017, Dr Ellen Wright who stepped down as Clinical Chair in September 2018, and Drs Hany Wahba, Nayan Patel and Sylvia Nyame, who left our Governing Body in 2018. We are making steady progress on our goals, thanks to partnership with member practices, staff, Royal Borough of Greenwich, NHS providers, neighbouring clinical commissioning groups in south east London such as Lewisham, community and voluntary partners and most importantly with Greenwich people. I am confident that Dr Krishna Subbarayan, our new Clinical Chair, together with the Governing Body, staff and member practices, will lead the CCG in its mission to continue to improve health and health services for the people of Greenwich. Neil Kennett-Brown Managing Director NHS Greenwich CCG 4 5
45 44 Who we are and what we do NHS Greenwich Clinical Commissioning Group (CCG) is a membership organisation made up of all of the 35 GP practices in Greenwich. We plan and buy (commission) most of the NHS services in Greenwich including: Hospital services, including urgent and emergency care GP services Mental health services Community care. We also monitor these services, in particular how safe and effective they are and how patients experience them. We work with partners to improve health and wellbeing and work closely with our neighbouring CCGs in south east London and with NHS England, on shared plans to improve health and deliver high quality sustainable services for local people. This is our Sustainability and Transformation Partnership, Our Healthier South East London. We are also part of the south east London commissioning alliance in partnership with Bexley, Bromley, Lambeth, Lewisham and Southwark CCGs. General Practices and major health service locations in Greenwich 49 8 33 37 7 LEWISHAM 58 54 24 Key Hospital Community Hospital GP Access Hub General Practice General Practice Branch Health Centre (Community Services) 5 59 26 39 18 6 20 25 GREENWICH 15 40 11 52 50 42 57 27 14/16 23 17 36 47 46 38 51 2 10 41 19 53 28 9 31 12 55 48 34 43 22 BROMLEY 29 3 4 35 BEXLEY 32 13 30 56 1 21 1. Abbey Wood Surgery 2. All Saints Medical Centre 3. Bannockburn Surgery 4. Basildon Road Surgery 5. Blackheath Standard 6. Briset Corner Surgery 7. Burney Street 8. Burney Street Wallace Centre Branch Surgery 9. Campus Surgery Primecare (Eltham) Surgery 10. Clover Health Centre 11. Coldharbour Hill 12. Conway 13. Conway (Branch) 14. Eltham Medical Practice 15. Eltham Medical Practice (Branch) 16. Eltham Palace 17. Eltham Park Surgery 18. Fairfield 19. Glyndon 20. Glyndon (Branch) 21. Goldie Leigh Hospital 22. Greenwich Health GP Access Hub 23. Greenwich Health GP Access Hub 24. Greenwich Peninsula Practice 25. Lewisham and Greenwich NHS Trust (Queen Elizabeth Hospital) 26. Manor Brook 27. Market Street Health Centre (Oxleas) 28. Memorial Hospital 29. Mostafa 30. Mostafa (Branch) 31. New Eltham Medical Practice 32. New Eltham Medical Practice (Branch) 33. Plumbridge Medical Centre 34. Plumstead Health Centre (Branch) 35. Plumstead Health Centre 36. Primecare (Eltham) 37. Primecare (South Street) 38. Royal Arsenal Medical Centre 39. Sherard Road Medical Centre (Branch) 40. Sherard Road Medical Centre 41. St Marks 42. St Marks (Branch) 43. Thamesmead Health Centre 44. Thamesmead Medical Associates (Gallions Reach Branch) 45. Thamesmead Medical Associates (Gallions Reach) 46. The Hill Surgery Coldharbour Hill Branch 47. The Hill Surgery Primecare (Eltham) Branch 48. The Trinity Medical Centre 49. The Wallace Centre 50. Triveni 51. Triveni (Branch) 52. Valentine Health Partnership (Ferryview) 53. Valentine Partnership (Ferryview Branch) 54. Vanbrugh Group Practice 55. Waverley 56. Waverley (Branch) 57. Westmount Surgery 58. Woodlands Surgery 59. Woodlands Surgery (Branch) 6 7
Our achievements Here are some highlights of what we have achieved. Narrowing health gaps With the Royal Borough of Greenwich we set up the Live Well Greenwich programme to improve the wellbeing of residents with poor health. We supported people with learning disabilities and autism to live in the community with the right level of care. With Public Health we improved access to stop smoking and weight management services in areas of greatest need in the borough. We created a mental health A&E liaison nurse role in Queen Elizabeth Hospital emergency department so that people with mental health needs get the right support and services. GP practices (primary care) We improved access to GPs by offering weekend (8am-8pm) and evening appointments (4-8pm) at two GP Access Hubs in Thamesmead and Eltham. We increased the number of people with online accounts at all 35 GP practices, so patients can book appointments and order repeat prescriptions online. We successfully bid with Bexley, Lewisham and Bromley CCGs to launch a recruitment programme for GPs through the NHS International GP Recruitment Programme. We introduced asthma review clinics in GP practices to help patients improve inhaler techniques and manage their asthma. Hospitals and care homes We expanded and refurbished the Urgent Care Centre at Queen Elizabeth Hospital to help with increased demand over winter. We launched a new unit with Royal Borough of Greenwich to provide a community based, homelike environment where patients can be assessed for discharge instead of remaining in hospital. We implemented telehealth kits in care homes and trained care home staff to manage complex cases, helping to reduce hospital admissions and London ambulance callouts. 8 9
Our performance In July 2018 NHS England published the CCG Improvement and Assessment Framework (IAF) ratings for 2017/18. NHS Greenwich CCG was awarded a rating of Good, a vast improvement from our Inadequate rating in 2016/17. This means that we are two levels higher within a year, and our special measures status has been lifted. A range of national standards reflect what is important to patients and best practice. 2017/18 saw unprecedented increase in demand on health services across the NHS. Where our providers did not meet all the standards, we have developed action plans and are committed to working with our providers to improve. A&E four-hour standard: The national standard is for 95% patients attending A&E to be seen within four hours. Lewisham and Greenwich NHS Trust achieved 89% in 2017/18 and we are working to improve, with a focus on freeing up the number of available beds and managing demand. Referral to treatment times for surgery: The referral to treatment standard requires 92% of patients to be treated in 18 weeks from the time of referral. Lewisham and Greenwich NHS Trust missed this target, achieving 86.5% in 2017/18 and we are working closely with them to improve. Cancer: Greenwich CCG met the national standards for five of the eight cancer measures in 2017/18. Our provider hospitals found it difficult to meet the 62-day cancer wait. We are working across south east London to improve performance and waiting times. Diagnostics: Ninety-nine percent of Greenwich patients were seen within six weeks of referral for diagnostic tests, ensuring they received swift diagnosis and treatment. 10 11
How we spent NHS money Our main NHS providers are Lewisham and Greenwich Healthcare NHS Trust, Guy s and St Thomas NHS Foundation Trust and Oxleas NHS Foundation Trust. The CCG funds the prescribing costs of Greenwich GP practices and from April 2017 we took on responsibility for commissioning primary care services from NHS England. The CCG achieved its financial targets for 2017/18. The 2017/18 expenditure was 415.6 million. 9.6m 18.5m 18.7m 23.4m 6.1m 2.8m 51.5% Acute (Hospital) Services 11.8% Mental Health 8.9% Delegated Primary Care Commissioning (GP Services) 36.3m 37m 8.7% Prescribing and other Primary Care Services 5.6% Community Services 4.5% Other Programme Costs (includes Better Care Fund) 49.2m 214m 4.5% Continuing Health Care 2.3% Children s Continuing Care 1.5% Running Costs 0.7% Learning Disabilities 12 13
Our plans for the future The Greenwich Commissioning Strategy Transforming our health and social care system: 2018 to 2022 In September 2018 we launched the NHS Greenwich CCG commissioning strategy: Transforming our health and care system 2018 to 2022. Along with our recent Good rating from NHS England this is a hugely positive milestone. Our strategy sets out bold ambitions to transform health and care services in Greenwich. Continuing without change is not an option. Our focus is on providing more services closer to home and easing pressure on other services. Achieving success will rely more than ever on collaboration between partners and beyond borough boundaries. Hundreds of local people and partners have been involved in designing the first comprehensive, integrated clinical commissioning strategy for Greenwich. This is part of a longer journey for health and social care locally, and across south east London. The test is putting this strategy into action, and the CCG has already made sound plans to do that in our commissioning plans for 2019/20. It is evident that everyone wants the best for local people and local services. We are working towards a shared purpose of health and wellbeing for Greenwich people, with high-quality, effective and sustainable health services. Our strategy provides the vision to achieving our shared purpose. Dr Krishna Subbarayan Clinical Chair The Greenwich Big Conversation The Greenwich Big Conversation took place between March and August 2018 and involved local people and representatives, member GP practices, staff, and key partners working together to develop and refine the Greenwich commissioning strategy. Over 350 members of the public directly had their say through meetings, outreach, workshops and online and printed surveys, with many more opportunities for conversations and feedback. Thank you to everyone who took part in our conversation. 14 15
Health in Greenwich Greenwich has particular health issues that include high levels of deprivation, inequality and unemployment. Cancer, cardiovascular disease and respiratory diseases are the leading causes of premature and avoidable death. There is a high prevalence of mental health issues and learning disability. We also have challenges as we face a shortage of GPs and need to make savings of 14 million. To improve health and social care outcomes for local people we must respond to changes in the population, our population s health and the health system. Our population 291,194 People registered with a Greenwich GP Greenwich population by age Deprivation 78th/326 Greenwich ranks 78th out of 326 local authorities of the most deprived in England. Our rank has improved since 2010 23% Of our population live within the most deprived areas nationally Population change 2 in 10 under 16 7 in 10 16-64 1 in 10 over 65 14,900 Is the estimated increase in population over the period of this three-year strategy this in an increase of 5% With the population of over 65s set to increase 7% over the next three years As the number and proportion of older people increase so does the need and service use. Ethnicity Overall our area has a more diverse population than England. 2 in 5 of our population are Black Caribbean, Black African, South Asian or Chinese. Greater diversity is seen in our children, young people and young adults. Greenwich ethnic break-down based on 2018 population projections Source: GLA population projection profiles, 2016 Over the next 10 years population increases will be greater in our Black and minority ethnic groups. We will also see increasing diversity in older age groups in the next decade. White British 46% White Irish 2% Other White 11% White & Black Caribbean 2% White & Black African 1% White & Asian 1% Other Mixed 2% Indian 3% Pakistani 1% Bangladeshi 1% Chinese 2% Other Asian 6% Black African 15% Black Caribbean 3% Other Black 2% Other Ethnic Group 2% 16 17
Our population s health Life expectancy Healthy life expectancy Lifestyle indicators On average, women in Greenwich live 3.1 years more than men. The overall difference in life expectancy between the most affluent and most deprived areas is 4.6 years for females and 6.9 years for males. 79.3 years 82.4 years Healthy life expectancy is the average number of years we can expect to live in good health. Whilst men and women are living longer, there is a gap between how long we live and how long we live in good health. 60.7 years 58.5 years Greenwich has the 6th highest rate of alcohol related hospital admissions in London (613 in every 100,000 people) Fewer than 1 in 5 (16.9%) of our adults smoke, 8.9% of mothers smoke at time of delivery More than 3 in 5 (63.8%) of Greenwich adults are overweight or obese. 26.8% Of our 10-11 year old children are obese The life expectancy gap between most deprived and most affluent: 4.6 years Female 6.9 years Male Years lived in poor health: 24.1 years Female 18.6 years Male Prevalence of disease GP reported numbers of people with long term conditions 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000 0 Hypertension Depression (18+) Diabetes (17+) Asthma (all ages) Chronic kidney disease (18+) Coronary heart disease (all ages) Cancer (all ages) Chronic obstructive pulmonary disease (COPD) (all ages) Stroke (all ages) Atrial fibrillation Mental health (all ages) Heart failure (all ages) Dementia (all ages) There is a gap between the reported disease and estimated levels of disease. In some cases this is considerable. 18 19
Our priorities These challenges have shaped the four priorities we have chosen for the next three years. To prevent illness and help our population to live well getting it right at birth through to end of life. To strengthen local support for people with mental illness, including children and young people. To better meet the needs of frail older people with care closer to home, an integrated urgent care system, and stronger community-based care. To improve the prevention, detection and treatment of cancers for our local population. The impact of our plans by 2022 Children get the best possible start in life Improvement in life expectancy, particularly for women Reductions in alcohol consumption and smoking Increase in children and adults who are a healthy weight Better mental health and wellbeing, and early identification of children s educational and communication needs Reduction in diabetes and other long-term conditions The impact of our plans by 2022 Better mental health and wellbeing for both children and adults Decrease in A&E attendances for mental health issues Reduction in the number of people being treated for mental illness far from home (out of area) Services are joined up and well-coordinated Unnecessary hospital admissions and inappropriate discharges fall Fewer people with learning disabilities in the justice system The impact of our plans by 2022 Frail people receive safe, high quality interventions in the community Fewer hospital attendances and admissions for frail people Hospital admissions occur when necessary and for the shortest periods Greenwich population benefits from better community services and greater access to primary care (GP) services More people nearing the end of life can die at home or in the community with the right support The impact of our plans by 2022 There is an increased uptake of screening for cancers Improvements in cancer risk factors (for example smoking, alcohol, diet, physical activity, sunburn) Better public awareness of cancer symptoms and the importance of getting an early diagnosis Consistent access to high quality care, timely diagnosis and treatments Increase in cancer survival rates for one to five years Improved patient experience scores 20 21
Enablers In addition to being able to manage NHS money well, there are two enablers which will help us to achieve these priorities: Primary care We need to invest in GP services and community based care, to broaden the skill mix so that patients can access the care they need at their GP practice or in their neighbourhood. This means GP practices working together and with other professionals such as community nursing and pharmacists, mental health and physiotherapy teams. The 35 Greenwich GP practices are already working together as Greenwich Health the GP federation which provides weekend and evening GP appointments in two GP Access Hubs. Integrated care We need to work together in a joined up way with other organisations, around our patients. We may share budgets or contracts with healthcare providers for example we plan to work with Lewisham CCG in contracting with Lewisham and Greenwich NHS Trust. Did you know? GP services (primary care) and pharmacy are the day-to-day healthcare available in every local area and the first place people go when they need health advice or treatment. Primary care is the first stop for new symptoms or concerns about physical or mental health. Community based care is the longer-term healthcare available for people in the community, rather than in hospital. Secondary care is provided by specialists, often in hospital. Strategy into action Putting this strategy into action will involve work with partners, community groups and local people to translate the four priorities into plans. These will influence how we plan and buy health services and create a way of using our money, staff and buildings in the best way. Our ambition for Greenwich At the heart of our ambition for the people of Greenwich is a focus on prevention, living well and self-care. We will know that we are achieving our ambition when: We see improvements in health and wellbeing in Greenwich, including an increase in healthy life expectancy, a reduction in health inequalities, and more people engaged in their own health and wellbeing. We hear better feedback and experience from users of health and social care. We achieve financial balance and work with our partners to plan future investment. We plan and buy value for money and efficient services which respond to what local people need and get results. We work effectively with our partners. 22 23
Working with patients and the public We put local people at the heart of our decision making and actively involve Greenwich residents to plan, design and give feedback on local services. We rely on relationships with our communities to best understand their needs, so that we can plan the right services. Healthwatch Greenwich and METRO GAVS are key partners. We have an extensive programme of outreach and engagement. Before each of our Governing Body meetings we hold a public forum where local people can ask questions on any matter. We have a lay member and GP on the Governing Body responsible for patient and public engagement. Our Patient Reference Group oversees our engagement and equalities work. We use Greenwich networks, events and groups to gather feedback on our ideas. We strive to work with wider and more diverse individuals and groups each year. Our engagement 2017/18 The extensive Greenwich Big Conversation programme of outreach and events around our commissioning plans. Launching our stakeholder newsletter, Greenwich News, to update on key CCG initiatives and projects. Outreach work, specifically with our Nepalese community, using local materials and a translator. Winter campaign promoting the availability of evening and weekend GP appointments, self-care and alternatives to A&E. We met with 620 local people. School outreach work with families, signposting local mental health support services, and promoting wellbeing to primary age pupils and their parents and carers. Full consultation around a proposed CCG policy regarding access to particular treatments read on to see how local people made a difference. Engagement with local people leads to changes in policy NHS Greenwich CCG was proposing to make changes to the south east London Treatment Access Policy (TAP) for Greenwich. The CCG consulted with the public, stakeholders, local partners and the voluntary sector. A survey was available online and in print, 13 public engagement sessions were held across the borough, and residents with learning disabilities took part in a focus group. There were over 750 responses to the consultation. Smoking cessation The CCG proposed that smokers should be referred for help to stop smoking before a referral for routine surgery. In response to feedback the policy was amended so that surgical procedures are not withheld for patients who need them. There is no requirement for someone to stop smoking to have surgery, although they must first attend a smoking cessation programme. Weight management The CCG proposed that patients with a Body Mass Index (BMI) of 30+ should be helped to lose weight before having planned surgery. Following feedback it was agreed that surgical procedures should not be withheld for patients who need them based on their BMI. Instead, patients who are obese are referred to weight management support services. 24 25
Stay well in Greenwich Preventing ill health Healthy habits and small changes to your lifestyle can make a big difference. Visit NHS Choices (www.nhs.uk) or Live Well Greenwich (www.livewellgreenwich.org.uk) for information and support. Pharmacy Many common illnesses like coughs or colds can be treated with over the counter treatments. Your local pharmacist can give advice and there s no need for an appointment. GP You should always be registered with a local GP. This means you will have access to health and social care if and when you need it. If you need help finding a GP practice, call NHS England on 0300 311 2233 or visit www.nhs.uk Evenings and weekends GP evening and weekend appointments are available at two GP access hubs in Thamesmead and Eltham. Hours are Monday to Friday 4pm to 8pm, and Saturday and Sunday 8am to 8pm. Book appointments through NHS 111 or your GP practice. Minor injuries Minor illnesses and injuries such as cuts, burns, sprains and suspected breaks can be treated at the Urgent Care Centre at Queen Elizabeth Hospital. For details go to www.lewishamandgreenwich.nhs.uk Call 999 In medical emergency call 999 or visit A&E at Lewisham or Queen Elizabeth Hospitals. Remember that A&E should only be used for the most serious injuries or health conditions. Need to talk? Your GP can refer you to Greenwich Time to Talk or you can self-refer. See www.oxleas.nhs.uk/gttt for more information or call 020 3260 1100. Not sure where to go? If you re unsure where to go or if you need medical advice fast, call NHS 111 or go online at www.111.nhs.uk It s free, staffed by trained advisors and available 24/7. 26 27
Get involved and keep in touch Sign up to our Greenwich News list and be the first to hear about plans, surveys and consultations. Come to our engagement events. Attend Governing Body meetings and the public forum. Get involved with the Patient Participation Group (PPG) at your GP practice. 020 3049 9000 ask for the engagement team NHS Greenwich CCG The Woolwich Centre 35 Wellington Street London SE18 6ND @NHSGreenwichCCG GRECCG.NHSGreenwichCCG @nhs.net www.greenwichccg.nhs.uk If you would like this document in an alternative format please contact the communications team 020 3049 9000 GRECCG.NHSGreenwichCCG@nhs.net Read our full 2017/18 Annual Report and Accounts at www.greenwichccg.nhs.uk