Camden Clinical Commissioning Group Patient Voice Report

Report title Governing Body Patient Voice Report (November 2018)

Chair Dr Neel Gupta, Chair

Report author Martin Emery, Communications and Engagement Team

Report summary This paper gives a synopsis of the patient and public engagement activity undertaken since the previous Governing Body meeting.

Recommendation CPPEG is asked to Note the summary report.

Strategic objectives links

Working with the people in Camden to achieve the best health for all is part of Camden CCG’s vision; and the completion of the work plan will help us to achieve our aspirations.

CPPEG- Lay Governing Body member (Kathy Elliott)

We continue to welcome contributions and support to strengthen patient and public engagement. Since the last Governing Body meeting, highlights have been:

My thanks to the two practices – Hampstead and Park End for their PPGpresentations, one on an overview of how the PPG works, and the secondon a volunteer initiative to increase patient use of on-line access.

My thanks to everyone who contributed to the Accessible InformationStandard project, which has now been taken up by all practices in Camden,ensuring everyone benefits. I am particularly pleased to see this work, ledby Healthwatch, being given national recognition.

My thanks to El Collis (CPPEG Representative) who has proactivelypromoted self-care workshops to the local community.

I appreciated meeting representatives of the Patient Governors from themental health trust.

Moving forward:

Citizens’ Panel Winter Pressures / Cold Weather Planning event (November)

CPPEG open meeting (11 December – St Pancras Hospital, ConferenceCentre)

Camden Clinical Commissioning Group Governing Body Meeting 14 November 2018

Report Title Patient Voice Report

Date of report 14/11/18

Agenda

Item:

Lead Director /

Manager

Simeon Baker, Head of Communications and Engagement, Camden CCG & NCL (Corporate)

Tel/Email simeon.baker@nhs.net

GB Member Sponsor

Kathy Elliott, Lay Governing Body member responsible for Patient and Public Engagement

Report Author

Martin Emery, Senior Engagement Manager

Tel/Email martin.emery@nhs.net

Report Summary

This paper gives a synopsis of the patient and public engagement activity undertaken since the previous Governing Body meeting. The report is linked to Strategic Objective E: Work jointly with the people and patients of Camden to shape the services we commission.

Recommendation The Governing Body is asked to note the content of the report.

Identified Risks

and Risk

Management

Actions

Not Applicable

Conflicts of Interest

Not Applicable

Resource

Implications

Not Applicable

Engagement

Engagement documented in report.

Equality Impact

Analysis

No equality impact assessment is required for this report.

Report History and

Key Decisions

Not Applicable

Next Steps Not Applicable

Appendices

Not Applicable

The Patient Voice Report (November 2018)

This paper covers work undertaken over the past two months, relating to: 1. Camden Patient and Public Engagement Group (CPPEG) 2. Business Plan Objective E: Work jointly with the people and patients of Camden to shape the services we commission.

1. Camden Patient & Public Engagement Group (CPPEG) Since the last Governing Body meeting the CCG has held one CPPEG operational meeting and one Patient Participation Group (PPG) forum meeting. Key themes and issues arising are described below:

1.1 CPPEG operational meeting (11/09/2018) CCG Committee reports CPPEG committee representative reports and the Governing Body Patient Voice report were discussed, approved and disseminated to PPGs for information, which can be accessed here.

Locally commissioned primary care services (from April 2019) Vanessa Cooke, Senior Commissioning Manager – Primary Care, updated CPPEG on the CCG plan to ensure that locally commissioned services continue to evolve beyond March 2019. The presentation is here. The key messages were:

Camden CCG commissions 13 locally commissioned services (LCSs). The contracts and associated investment for most of these services ends in March 2019 and the

CCG therefore needs to review current provision and develop future commissioning plans The CCG will continue to invest in locally commissioned services, however this will have to be

achieved in the context of a very challenging financial position in Camden. A working group has been established to review the options for local enhanced services (need,

value and affordability) and identify what will be commissioned for 2019/20 and beyond. The CCG will work with key stakeholders (for example Camden practices and their Federations,

Local Medical Committee, Healthwatch Camden, patient representatives, Public Health and others) to develop plans that are robust and achievable.

The CCG will work with stakeholders to ensure the case for investment recognises and responds to the very challenging financial position in Camden. In particular the CCG will ensure value for public money by ensuring any investment is clearly linked to achievement of key outcomes.

CPPEG members welcomed the update and the plans for linking investment to the achievement of key outcomes. Concerns were expressed in relation to pressures placed on general practice but recognised the financial challenge in which the CCG has to manage.

Care Navigation and Social Prescribing Tom O’Gorman, Project Manager, Camden CCG and Monica Riveros, Services Manager - Age UK Camden gave an update on the CCG plans for updating the provision of care navigation and social prescribing in Camden. The presentation is here. The key messages were:

What is changing and why? A new model of social prescribing has been developed, which:

• Takes the best practice and learning from existing services • Implements a consistent, outcomes focused model of social prescribing • Establishes clear and simple pathways • Reduces duplication and improves coverage • Provides a clear social prescribing offer • Aligns with other social prescribing services

The aim is to • enable people to access care and support in the right place and at the right time • To help residents to identify their needs and access support at an earlier stage to prevent escalation • enable residents to access more support within their local communities • improve patient experience of care • support more residents from ‘hard to reach’, ‘marginalised’ and BME communities with issues that they want resolving or community activities that they want to do

CPPEG members welcomed the update and felt reassured by (a) the investment given to support the care navigation and social prescribing in Camden and (b) the work with local voluntary sector groups in supporting the delivery of the services through Age UK Camden, Voluntary Action Camden and Wish Plus.

Review of adult elective orthopaedic care in North Central London Rhona Hobday, Programme Manager and Colin Beesting, Communications & Engagement Lead from North London Partners gave an update on plans to review services across Camden, Islington, Barnet, Enfield and Haringey. The presentation is here. The key messages were:

About North London Partners (NLPs) in Health and Care Our sustainability and transformation partnership (STP), brings together health and care

commissioners and providers across five boroughs We work together to provide joined-up health and care across the area All partners are united behind a clear set of priorities, based on the needs of local people

About the review NLPs think there may be opportunities to improve adult elective orthopaedic surgery in North

Central London by consolidating services onto fewer sites We are undertaking a review of these services to see if these improvements can be achieved The review has been established by North London Partners in Health and Care A review group led by local clinicians is coordinating the development of how this kind of care could

be delivered in the future Clinical commissioners will make decisions on where and how this happens

What we want to achieve Improve outcomes and experience for patients Improve quality and efficiency of services by reducing unwarranted variation Make efficiencies as a consequence of these improvements; value for money

The benefits for patients Less time spent in hospital Much less risk of operations being cancelled and shorter waiting times for an operation Improved clinical outcomes

CPPEG members welcomed the proposals, the focus on improving patient outcomes and the opportunity being given for patients and the public to give feedback thought meetings and a survey. CPPEG also asked that representatives from NLPs return to update members on what is the next steps after feedback has been collated across the 5 CCG catchment areas.

Chair of CPPEG (proposal for changes to the term of office) Martin Emery, Communications and Engagement presented the proposal for changing the terms of office for the role of chair of CPPEG. The presentation is here. The key messages were:

Current status A PPG member can be elected as Chair to serve 2 terms (a term currently stands at 1 year).

Proposal It was proposed that that the terms of office change from 1 year to 2 years and a PPG member if

elected can be elected for 2 terms. The main reason for the proposed change to the length of term is to give elected chairs time to become comfortable in the role.

CPPEG members supported the proposal for the change to the terms of office.

Table 1:

You Said We Did

CPPEG committee reports: Approved.

Locally commissioned primary care services (from April 2019): CPPEG members welcomed the update, the opportunities to give feedback and invited

Camden CCG has: disseminated reports to PPGs and the public via the patient newsletter, social media and made available on the public website.

Camden CCG has: disseminated the presentation to PPGs via the patient newsletter and social media.

representatives from the primary care team back to CPPEG to update progress made at the November operational meeting.

Care Navigation and Social Prescribing: CPPEG members welcomed the update and felt reassured with the investment given to local voluntary sector groups working together to deliver social prescribing to patients within general practice and other public settings.

Review of adult elective orthopaedic care in North Central London: CPPEG members welcomed the proposals, the focus on improving patient outcomes and the opportunity being given for patients and the public to give feedback.

The CCG will continue to work with key stakeholders (for example Camden practices and their Federations, Local Medical Committee, Healthwatch Camden, patient representatives, Public Health and others) to develop plans that are robust and achievable.

Camden CCG has: raised awareness of the refreshed service via social media, public website and the patient newsletter.

The difference that this will make: The CCG shows its commitment to work with local voluntary and 3rd sector groups to deliver services for patients in Camden ensuring that links to local communities is strengthen ensuring partnership work in embedded.

Camden CCG has: helped promote the opportunities for patients and the public to give feedback via the public website, social media, patient newsletter and other local avenues such as Voluntary Action Camden’s weekly e-newsletter.

The difference that this will make: Camden CCG has also linked NLPs to local groups such as Camden Disability Action and Camden Carers Service to ensure that people from ‘Seldom Heard Groups’ have the opportunity to give feedback and assist with the design of potential changes to services.

1.2 Camden Patient Participation Group (PPG) Forum meeting (08/10/2018) Forum meetings occur bi-annually and give an opportunity for general practice PPG members to hear about and engage with the work of the CCG and partner organisations. The October forum meeting was attended by 46 PPG members from 21 general practices and chaired by Camden CCG’s Head of Communications and Engagement, Simeon Baker.

Transformation of Healthcare in North Central London and Camden Presentation 1 (a): North Central London – Sustainability and Transformation Partnership (STP) achievements and future direction. The presentation given by Will Huxter, Director of Strategy, North London Partners (NLPs), can be viewed here. The main messages from the presentation were as follows:

Ambitions of the STP NLPs are a partnership of the NHS and local authorities (across Camden, Barnet, Enfield, Islington

& Haringey), working together with the public and patients where it’s the most efficient and effective way to deliver improvements.

Maximise out of hospital care, build resilient and well supported communities, reduce health inequalities, improve the health and wellbeing of the local population.

Achievements were listed in relation to o Integrating neighbourhood services; connecting hospitals with primary care (it is faster and

safer for patients to get home from hospital); extended GP access across North Central London; improved NHS 111 service; new maternity community hub at Harmood’s Children’s Centre in Kentish Town; and a new women’s psychiatric intensive care unit at Camden and Islington NHS Foundation service opened in November 2017.

Continuing to improve our plans Work with all our partners and public to design plans Ensure plans are clinically led and evidence based Communicate with our stakeholders and communities about the changes ahead Agree plans across organisations and ensure these contribute to financial sustainability Continuing to explore scope for NCL working and greater impact To underpin this, we will be doing more work to understand the financial challenge to help us

strengthen our approach to transformation for 18/19 and beyond

The PPG attendees welcomed the presentation and the time given to answer questions that were raised from the audience. Some attendees asked that future slides were more accessible to read on the screen and handouts supporting the presentation were copied 1 slide to 1 page. Attendees also asked through the feedback survey that NCL and CCG staff across all boroughs relay what services will be reconfigured or discontinued to meet the financial challenge of sustaining local services. Attendees through the feedback survey also asked for the STP plan which has been disseminated and can be found here.

Presentation 1 (b): Camden Local Care Strategy (LCS) The presentation was given by Sally MacKinnon, Director of Transformation, Planning & Delivery Camden CCG. The presentation is here. The key messages were:

Delivering joined-up care, closer to home o More care provided within the community, including more specialist services o Primary care and community services working together as one service o The voluntary sector is better integrated into the system o The workforce works flexibly to support people when and where they need help

Investing in prevention and supporting people to look after themselves o Prevention is a core part of all services o People know how to help themselves and maintain a healthy lifestyle o Services are easy to understand and access

Examples where given to what does this mean for patients in the future? o Planned Care - Introducing tele-dermatology which will use technology to get

specialist advice on dermatology conditions, for patients being seen in primary care o Primary Care Mental Health - More mental health support will be delivered in primary

care rather than secondary care. The aim is to have a more responsive and preventative model that supports people with mental health problems.

o For patients with complex needs who are cared for by lots of different people, we are continuing to develop a more joined up approach between all these professionals so that they work more as a team

The PPG attendees welcomed the presentation and the plans to deliver joined up care closer to home, investment in prevention and supporting people to look after themselves and examples of what changes will mean for patients in the future. Suggestions given from the feedback survey asked if patients who have been affected by the changes could present at future events which would strengthen the case for change.

Patient Participation Group (PPG) success stories Presentation 2 (a): Hampstead Group Practice PPG The presentation was given by David Green (Hampstead Group Practice PPG Chair). The presentation is here. The key message were as follows:

Success of the PPG is dependent on the close collaboration between the PPG and the practice partners and manager. PPG meetings are held three times a year, consisting of two parts. In the first part the PPG members meet alone to review the agenda, feedback received from patients and prepare what they want to discuss with the practice. For the second part two partners join, together with the practice manager and other staff members as appropriate.

Routine agenda items cover (patient feedback from comments book, Friends & Family Test results since the last meeting, NHS patient surveys, practice news, including staff and premises issues, local hospital and CCG issues).

Focused Actions Changes Things - dialogue in the meeting on each of these issues leads on to decisions about what the practice will do and what the PPG will do. The meetings, including the commitments on future action by both practice and PPG, are minuted and the progress on the action points reviewed at the subsequent meeting.

Overall, the collaborative approach which has developed, which requires commitment from both sides, has, we believe, served both patients and practice well

Presentation 2 (b): Park End Surgery PPG The presentation was given by Connie Smith (Park End Surgery PPG member). The presentation is here. The key messages were as follows:

Patient Access – PPG initiative to improve patients registering online to access the GP practice.

Two members of PPG attended Surgery – morning surgeries after opening rush to promote awareness. Surgery staff provided PPG with registration letters and simple instructions about

registering to give to patients who were in waiting room. PPG members also talked with patients who filled in registration letters if they wanted to.

Surgery staff processed registration letters whilst patients were in their appointments and PPG members gave completed letters to patients as they returned to waiting room after their appointments. Patients left surgery with all the information and registration details to start using Patient Access.

Outcome achieved – patient uptake of online access to the surgery has increased dramatically which is one of the best performing for access in Camden.

Attendees welcomed the success stories and agreed to disseminate the success stories to their PPG colleagues at upcoming meetings. Comments given in the feedback survey ranged from “It shows that PPGs can make a difference” to “PPGs may not always be representative but we help and make a difference which supports hard-pressed practice staff”.

Presentation 3: Commissioning Plans 2019/20 The presentation was given by Debbie Hawkins, Head of QIPP, Planning, Monitoring, Transformation, Planning and Delivery. The presentation is here. The key messages were:

Annual planning cycle (July-September: develop intentions, October-March financial and delivery planning and prioritisation, after April implementation of plans).

In relation to system changes and sustainability 4 areas where referenced: o Integrated Models (e.g. Integrated care model, Adult Community Services

Reconfiguration, Federations / Primary care resilience, Integration Primary Care and Acute (e.g. clinical advice and guidance).

o Prevention (e.g. embedded within commissioning plans, mental health awareness training, making every contact count, preventing falls in older adults and reducing childhood obesity).

o Enablers (e.g. Health information exchange, estates and workforce strategy and provider collaboration)

o Value-for-money / re-commissioning (e.g. pathology, diagnostic and imaging services, medicines optimisation, halt growth in acute spend / new contract forms)

The PPG attendees welcomed the presentation and the explanation of the commissioning cycle and direction of travel for 2019/20. Suggestions given from the feedback survey asked if clarity could be given at future meetings to what would be changed and stopped as the CCG had to ensure that services were sustainable moving forward.

Presentation 4: Self-care for people in Camden The presentation was given by Eli Collis, PPG member, Gray’s Inn Medical Centre and Martin Emery, Communications and Engagement Team, Camden CCG. The presentation is here. The key messages were:

To reduce pressures on A&E, General Practice and Pharmacies the CCG in partnership with other local providers are hosting self-care workshops with patients to address the pressures that services are facing to reduce avoidable consultations. The dates for the workshops were handed out to attendees to share with family, friends and PPG members to encourage attendance at the workshops.

PPG attendees welcome the presentation and agreed to share the dates and reasons for the workshops with families and PPG colleagues.

Presentation 5: Pointers for future PPG forum meetings Kathy Elliott, Vice Chair Camden CCG gave the presentation (to view click here). The Key messages were:

Interim survey results suggested in order of importance the following topics to be. o Performance of Local NHS Providers (acute, community & mental health), Self-care,

Camden Local Care Strategy, NCL Sustainability & Transformation Partnerships, PPG success stories, GP Neighbourhoods, Social Prescribing and CQC inspections of general practices.

PPG members asked that the above topics be presented and discussed at future forum and CPPEG public meetings.

Table 2:

You Said We Did

North Central London – Sustainability and Transformation Partnership (STP) achievements and future direction Attendees welcomed the presentation, the achievements and future steps for the STP.

The majority of attendees asked that future slides were more accessible to read on the screen and handouts supporting the presentation were copied 1 slide to 1 page. Attendees also asked through the feedback survey that NCL and CCG staff across all boroughs clarify what services will be reconfigured or discontinued to meet the financial challenge of sustaining local services.

Camden Local Care Strategy (LCS) The PPG attendees welcomed the presentation and the plans to deliver joined up care closer to home, investment in prevention and supporting people to look after themselves and examples of what changes will mean for patients in the future.

Suggestions given from the feedback survey asked if patients who have been affected by the changes could present at future events which would support the case for change. PPG success stories: Attendees welcomed the success stories and agreed to disseminate the success stories to their PPG colleagues at upcoming meetings.

Comments given in the feedback survey ranged from “It shows that PPGs can make a difference” to “PPGs may not always be representative but we help and make a difference which supports hard-pressed practice staff”. Self-care for people in Camden: PPG attendees welcome the presentation and agreed to share the dates and reasons for the workshops with families and PPG colleagues

Camden CCG will: disseminate the presentation to the public via the patient newsletter, public website and social media.

Camden CCG will: invite representatives from NLPs to a future CPPEG operational meeting to update members on developments made in progressing the STP.

The difference that this makes: Local patients and the public will be kept at the heart of maintaining the patient voice in monitoring progress and development of the STP.

Camden CCG will: disseminate the presentation to the public via the patient newsletter, public website and social media. Camden CCG will: invite representatives from the CCG to a future CPPEG operational meeting to update members on developments made in progressing the LCS.

Camden CCG will: look to design case studies and stories of patients who have been affected by the LCS and potentially presenting at future public meetings.

The difference that this makes: Local patients and the public will be kept at the heart of maintaining the patient voice in monitoring progress and development of the LCS.

Camden CCG will: disseminate the presentation to the public via the patient newsletter, public website and social media; develop a page on the public website listing the PPG success stories and also promote through the GP newsletter.

The difference that this makes: (a) promote the difference that PPGs can make to encourage membership within practices and (b) inspire PPGs with ideas to assist practices to improve the patient experience.

Camden CCG will: disseminate the presentation to the public via the patient newsletter, public website and social media.

2. Business Plan Objective E: Work jointly with the people and patients of Camden to shape the services we commission The following summarises other key engagement activity undertaken by the CCG over the last two months to support Objective E:

Mental health The Communications and Engagement team, in collaboration with colleagues at Islington CCG, supported the mental health commissioning team and Camden & Islington NHS Foundation Trust to promote and host consultation events in relation to St Pancras Hospital Site redevelopment. The consultation ran from 6th July to 12th October 2018 and over the last 3 months we have held three public events and two drop-in sessions, along with outreach and engagement with local service user groups and the community. The evaluation report of consultation responses will be published by the end of November.

On World Mental Health Day 10th October 2018, the UK Government hosted the first ever global ministerial summit to drive global action on mental health. Camden, uniquely amongst local areas, was asked to host a stand for delegates explaining our CAMHS offer with the support of the Communications and Engagement Team. Camden Council, the CCG and the Tavistock and Portman Foundation Trust used the opportunity to showcase our core CAMHS service including our trailblazing work on service integration using the THRIVE model; our extensive work to improve mental health in schools and our innovative Minding the Gap project to improve transitions for young people moving from CAMHS to Adult Mental Health services and reach those not accessing traditional services.

Accessible Information Standard (AIS) Support visits (Healthwatch Camden) The Communications and Engagement team and Local Medical Committee have supported Healthwatch in visiting local general practices to ensure that practices are meeting AIS standards with a special focus on patients who have learning disabilities and sight problems with registration forms and annual health checks being provided in easy read and large print. The last practice will have received the support visit by the end of October.

It is important to note that the AIS project won a Healthwatch England Network Award at the annual conference in October. There were 170 entries from local Healthwatch all over England and Healthwatch Camden finished 2nd.

Medicines Management The Communications and Engagement team are supporting the Medicine Management team in responding to the national NHSE guidance on reducing prescribing of over-the-counter (OTC) medicine for minor and short-term health concerns. A local Equality Impact Assessment is currently in progress and the findings will be reported back to the Medicine Management Committee by the end of the year.

Citizens Panel (CP) A self-care survey and adult orthopaedic review of services have recently been completed and the results will be disseminated to CPPEG for information.

Self-care workshops The Communications and Engagement team are supporting Community Matters promote self-care workshops which are facilitated by a local GP and Pharmacist in Camden. Uptake of the workshops have improved dramatically with the assistance of a PPG member. Self-care attendees will receive a take-away pack full of resources to manage health and well-being. The feedback from sessions delivered so far has been very positive.

A quote from an attendee: “It is not often I'm glad to be a Camden resident, but this sort of workshop really makes it worth it- it has been really useful”

Self–care notice boards are also being introduced in a number of local general practices and with a virtual notice board also under development for the CCG public website and links will be forwarded to general practices to signpost patients to. The purpose of the notice boards will be to signpost people to help them manage their health and well-being and to access General Practices, Accident & Emergency and Pharmacies appropriately.

Transformation and Delivery The Communications and Engagement team are supporting the refresh of the communications and engagement plan for the Local Care Strategy which will be rolled out in the autumn.

Children and Young People Staff (Fitzrovia Youth in Action) and young people will be attending the November CPPEG operational meeting to give feedback on what is good and could improve in healthcare for young people in Camden. An update on actions will be given in the next Patient Voice report.

Voluntary Sector - Strategic Partners Neighbourhoods The Communications and Engagement team are working in partnership with the Lead Community Partnership team at Camden Council to establish and strengthen existing relationships with directly funded council groups to connect them to the work of the CCG. Visits will be made with the following groups over the next 3-6 months to strengthen and embed relationships (Abbey Community Centre, Kingsgate Community Association, Sidlings Community Centre, Hampstead Community Centre, South Hampstead and Kilburn Partnership (SHAK), Highgate Newtown Community Centre, Castlehaven Community Association, Kentish Town City Farm and much more). Updates will be given in upcoming report and the patient newsletters.

The Vice Chair of Camden CCG with the support of the Communications and Engagement Team met with the Chair of Voluntary Action Camden (VAC). It was beneficial to understand her interests (for example health and wellbeing) and challenges (for example the impact from austerity). Going forward VAC indicated that they would welcome input into a ‘future horizon scanning event’; introducing the CCG Chair and Vice Chair to a small group of the smaller Camden voluntary sector groups (first steps have been taken to organise this); and to champion the new social prescribing/ care navigation initiative.

Musculoskeletal (MSK) Services at University College London Hospitals (UCLH) NHS Foundation Trust The Communications and Engagement team have supported UCLH MSK Patient Director in hosting a patient event on the 17th October raising the profile of the service to local patients and their carers.

3.0 Looking ahead The following activity is currently planned for November/December 2018:

CPPEG operational meeting (06 November)

General Practice Summit meeting (07 November)

Citizens’ Panel Winter Pressures / Cold Weather Planning event (November)

CPPEG open meeting (11 December – St Pancras Hospital, Conference Centre)