Embed Size (px)
Citation preview
Thursday 4th June 2015
CCG Clinical Commissioning Forum
Hackney Council Public Health Estate Based Interventions: Community Kitchens Programme
Henry Muss
Public Health Officer - Community & Partnerships
June 2015
1. The Problem: Obesity
2. How Hackney Compares Nationally
X – Excess Weight 10-11yr / Y Fruit & Veg 5 a day
Southwark
Richmond Upon
Thames
3. Community Kitchens
To improve residents knowledge & confidence around
preparing healthy nutritious food, on a budget, tackle
obesity and reduce social isolation
9 Underutilised estate based “Community Kitchens” in
the Borough
Phase 1- Two Kitchens: Apr/Jun 2014 - 2 local providers
commissioned to deliver 3 months of FREE six week
programme of classes aimed at families with kids and
adults in Community Halls on estates
Phase 2- Sep/Mar 2015 - expanded to a further six
kitchens in Community Halls on estates offering cook &
eat classes
4. Locations & Diabetes Prevalence
Banister House
New Kingshold
5. Community Kitchens - Evaluation
• 6 month evaluations carried out at two sites – 42
participants filled in pre/post and 6 month questionnaires
• 18% very confident at cooking prior to the class, 85% of
them were feeling very or fairly confident after the course
“My attitude has changed: I realised I was very set
in my ways giving the children the same foods over”
Participants who said would change their eating habits: 88.89%
“One of the best things is meeting new people”
6.Whats next – Refer patients to your
nearest community kitchen
Location Venue Contact
Woodberry
Down Redmond Centre [email protected]
Upper
Clapton Lea View House 0208 442 4266
Homerton
Banister House
Community Centre
k
Stoke
Newington
Somerford Grove
Community Centre 020 7033 8506
Lower
Clapton
Nye Bevan Community
Centre
Manny_epton@helping
hackneyhealth.org
Well Street
New Kingshold
Community Centre 07885 629384
Haggerston
Fellows Court Community
Centre [email protected]
07455 737 747
Wick Kingsmead Estate [email protected]
07824-641927
Hackney
Downs
Nightingale Estate
Luncheon Club
les.moore@commonresourc
e.net
020 7254 4593 Contact provider directly or
[email protected] / 020 8356 6326
Family & Adult courses start next week!
End6
/
5
/
2
0
1
5
Dr Gary Marlowe
Planned Care Board
Developing a community gynaecology
service
The current service provision – HUH service at the Ivy
Service offer Service details Conditions treated
• Consultant led – HUH
• One day a week –
capacity for 7 patients
• Complex contraception
and gynaecology advice
• Currently suspended due
to long term sickness
absence of the consultant
• 6 week waiting times
• Patients usually only seen
once – maximum of 2
appointments before
onward referral to HUH is
standard
• Scan to aid diagnosis
available
• Menorragia
• Irregular bleeding
• Intermenstral bleeding
• Post coital bleeding
• Amenorrhoea
• Menopause
• HRT
• PMT
• Difficult IUD/ IUS removal
and insertion
• Norplant removal
• Complex contraception
Proposal for new service model
Service offer Service details Conditions treated
• Integrated model –
two tier service. Tier
1 within practices and
on behalf of other
practices. Tier 2
Consultant led
intermediate ‘one
stop service’
supported by General
Practitioners and/or
senior nurses
• Integrated with Pelvic
floor/Continence
service
• One stop approach
• Service capacity
increased to
daily clinics
• One stop
approach - 37
hours per week
• Evening
appointments
considered
• Assessment
within 4 weeks
Tier 1 –Primary Care Service
• IUCD / Pessaries
• Insertion / removal of IUCD for menorrhagia conditions only
(not contraceptive services)
• Insertion / removal of shelf / ring pessary (for the treatment
of vaginal prolapse)
Tier 2 – Consultant led service
• Heavy Menstrual Bleeding Assessment including menstrual
disorders and persistent inter-menstrual bleeding
• Chronic Pelvic Pain Assessment (thresholds to be
discussed and agreed )
• Irregular bleeding to include (Post Menopausal/Inter-
menstrual/post coital (after STIs have been ruled out))
• Oligo Amenorrhoea
• Vulvar Dermatoses, Polycystic Ovarian Syndrome and
benign Ovarian cysts
• Fibroids and Cervical Polyps
• Urogenital prolapse and Female Urinary Incontinence
• Complex menopausal care
Continued
Service offer Service details Conditions treated
• Over age of 16 and
registered with GP
practices in City and
Hackney
• Regular GP
education and
training sessions
which includes up-
skilling techniques
• No GA/IV sedation
Assessment, diagnosis and treatment for:
• Dyspareunia
• Complex Coil fittings/removals
• Endometrial Biopsy
• Menopause Management
• Menorrhagia
• Ovarian Cysts (functional)
Plus the following investigations and procedures:
• Ultrasound scan
• Hysteroscopy
• Flexible cystoscopy for gynaecological conditions
• Pipelle endometrial Biopsy
• Cervical polypectomy
• Biopsy of genital skin lesions
• Insertion / removal of IUCD for menorrhagia (ie
not contraceptive services) - complex
• Insertion / removal of shelf / ring pessary (for the
treatment of vaginal prolapse) - complex
• Bartholin cyst/word catheter
Next steps
• The GP group at our initial workshop will act as a reference group throughout this
development
• Views on the model proposal from GP members and HUH invited to finalise and
agree the service specification
• Patient feedback – generally patients appreciate the community option though
further work will be undertaken in refining the service specification
• Model and cost the service, capacity and agree an appropriate % shift in acute
activity from secondary care
• Agree community price
• Agree the non –recurrent investment and the shift from secondary care to secure
the service on a recurrent basis
End6
/
5
/
2
0
1
5
City & Hackney IBS pathway
The Problem…IBS affects 15% of the population
Why primary care is the best place for IBS pts:Long term continuity of care
Discourage healthcare seeking behaviour
Referrals increase anxiety (delays, multiple tests)
Some investigations associated with morbidity
Costs to NHS
40-60% of Gastro clinic referrals nationally
=> Functional GI disorders
C&H Gastro Referrals 2013 -2015
80
100
120
140
160
180
200
220
Ap
r-12
Ma
y-1
2
Ju
n-1
2
Ju
l-1
2
Au
g-1
2
Se
p-1
2
Oc
t-1
2
No
v-1
2
Dec
-12
Jan
-13
Fe
b-1
3
Ma
r-13
Ap
r-13
Ma
y-1
3
Ju
n-1
3
Ju
l-1
3
Au
g-1
3
Se
p-1
3
Oc
t-1
3
No
v-1
3
Dec
-13
Jan
-14
Fe
b-1
4
Ma
r-14
Ap
r-1
4
Ma
y-1
4
Ju
n-1
4
Ju
l-1
4
Au
g-1
4
Se
p-1
4
Oc
t-1
4
No
v-1
4
Dec
-14
Jan
-15
Fe
b-1
5
Ma
r-15
Nu
mb
er
of
att
en
ds
GP ref 1st OP
Homerton IBS Referrals Audit
Sept – Nov 2014: 30 patients diagnosed with IBS
Results
19/30: referral letters good/excellent; 11/30: poor
6/30: no work-up prior to referral
Can some of these patients be adequately investigated and managed in primary care?
Services to help GPs investigate & manage these patients in primary
care
IBS pathway
GP IBS training afternoons
Calprotectin pathway
Direct access endoscopy (DAFS, DACS, OGD)
Community dietician service trained in IBS management (including FODMAP diets)
Primary care psychology
IBS - Diagnosis
IBS – Management Options
Further Info &
Resources
End6
/
5
/
2
0
1
5
Hackney Frequent Attenders Project
Wayne Gillon | Clinical Lead Occupational Therapist
First Response Duty Team & Lead, Hackney Frequent Attenders Project
Background
• 2 year project Commissioned by City & Hackney CCG Urgent Care Board
(until 31 March 2016)
• Lead is Wayne Gillon (Clinical Lead Occupational Therapist in A&E)
• Report to City & Hackney CCG Urgent Care Program Board
Target Group
• Any patient 18+ who attends A&E five times or more in any month
• or Any patient 18+ who attends A&E three times or more in any week
• or Any patient 18+ who is at risk of becoming a frequent attender to A&E
Who and How much?
‘10 attendances in a 12 month period’ (NHS Scotland)
5881 attendances
‘Top 10’ ave.71 attend’s
~6%of A&E
Attend’s
Cost ????
325 frequentattenders
2014
FA Comparison 13/14 to 14/15
Aims
• To reduce target group’s attendances to A&E and London Ambulance Service
calls
• Develop and share action plans with:
– registered GP − London Ambulance Service
– out-of-ours services − community teams
• Ensure GP’s are aware of their frequent attenders
• Encourage GP registration of unregistered frequent attenders
• Ensure appropriate input of mental health and substance misuse services
• Recommend new pathways or service change to CCG Urgent Care Board
Initial vs. Following Months
52% reduction at
1 month
66% reduction at
2 months
Task List
• Email sent to all GP surgeries with 2014 FA information
• Bi-monthly FA meetings held
• Pathways established with for homelessness, asthma, learning
difficulties
• Three GP surgery meetings attended
• Four further GP meetings planned
• Discussion with GP’s re: new FA’s
• Patient assessments in ED & home visits if required
• Case conferences held for complex FA’s
• Regular liaison with HPM and LAS
Strategic Developments
• Weekly reporting
• Dressing changes clinic
• Homeless FA’s pathway
• FA diagnosis on EPR chronic problem list
• 12 on-going FA Care Plans for ED staff
• HFAP engagement part of GP contract 15-16
• Adherence to RCEM guidance on FA’s (Aug 2014)
What does it all mean?
Every patient 18+ who attends A&E either 5 times in one month or 3 times
in one week is:
• Known to the Frequent Attender lead
• Contacted by the Frequent Attender lead (HV if appropriate)
• Discussed with their GP if appropriate (or encouraged and helped to
register with local GP)
• Discussed with any community teams involved
• Action plan put in place to address their individual needs
• A&E attendances monitored for at least 3 months
• Discussed at bi-monthly clinical discussion meeting
• NB: Excluding dressing changes and sickle cell
End6
/
5
/
2
0
1
5
City and Hackney Autism Service
What is Autism? Autism is a lifelong developmental condition
Triad of impairments:
• Difficulty with social communication
• Difficulty with social interaction
• Difficulty with rigidity and repetitive behaviours
The condition is characterised by its diversity.
Autism as a term is used to cover autism, Asperger
syndrome and atypical autism. (NICE guidelines)
“Once you’ve met one person with autism you’ve met
one person with autism” (Dr Lorna Wing)
Think Autism: Fulfilling and Rewarding Lives
Key government strategy for adults with autism
Focus on supporting and tasking local authorities to
improve services for adults with autism
Recognition that these service users are underserved
A significant number of adults with autism suffer
social isolation and economic exclusion.
City and Hackney Autism Service
Diagnostic service for adults (18+) in City & Hackney
Open referrals system through CHAMHRAS
Multidisciplinary team: Consultant Psychiatrist;
Operational Lead; Senior Practitioner (SW);
Psychologist; Administrator.
Person centred approach
Increase awareness of autism across City & Hackney
Diagnostic service
Follow best practice and NICE guidance
We use the AQ10 diagnostic test
We provide assessment, brief intervention and advice
We will be implementing a group in the near future
Service users who have a learning disability should
be referred to the Learning Disability Service
Contact City and Hackney Autism Service
Email: C&[email protected]
Margherita Tanzarella: 07816230480
Leda Veloso: 07939678592
See leaflet for details on how to make a referral.
Resources• Ambitious about Autism:
http://www.ambitiousaboutautism.org.uk/page/index.cfm
• National Autistic Society : http://www.autism.org.uk/
• NHS website: http://www.nhs.uk/conditions/autistic-spectrum-disorder/Pages/Introduction.aspx
• NICE: National Institute for Health and Clinical Excellence : Autism: recognition, referral, diagnosis and management of adults on the autism spectrum: http://www.nice.org.uk/guidance/cg142
• SCIE : Social Care Institute for Excellence: Improving access to social care for adults with autism: http://www.scie.org.uk/publications/guides/guide43/
• Talk About Autism : http://www.talkaboutautism.org.uk
• Think Autism : Fulfilling and Rewarding Lives, the strategy for adults with autism in England; an update: https://www.gov.uk/government/publications/think-autism-an-update-to-the-government-adult-autism-strategy
Thank you for listening.
Any questions?
End6
/
5
/
2
0
1
5
INTEGRATED ASTHMA SERVICE
• New Service extension from existing ACERS
team commenced end January 2015
• Primary aim of the service is to impact and
reduce attendances in Emergency
department/unplanned admissions for adult
patient with asthma within City and Hackney
CCG boundaries
INTEGRATED ASTHMA SERVICE
Aims:
• To provide patients with targeted education
improving poor knowledge and poor self-
management of asthma
• Follow up difficult to reach patients in the
community, using telephone triage, home
visits, community clinics as appropriate
INTEGRATED ASTHMA SERVICE
• To provide education and support for
clinicians in City & Hackney primary care
facilities through clinical meetings, teaching
sessions and/or 1:1 teaching
• Undertake visits to practices to identify and
review complex asthma patients within
primary care setting where appropriate,
acting as expert in treatment and education
INTEGRATED ASTHMA SERVICE
• First draft of pathway for Overnight Medical
Unit (OMU)completed with David Wilson (ED
consultant)
• Liaison with Dr. Bronwen Williams – GP to
outline asthma pathway for primary care use
• Detailed adult asthma audit for 2014 in
Hackney
• Commencement of community based asthma
clinic at St. Leonards at end of April
INTEGRATED ASTHMA SERVICE
• Represented Homerton University Hospital at
NICE Asthma Management Scoping Exercise
• Planning commenced for 1-2 day educational
meeting for practice nurses with City &
Hackney CCG with ACERS
• Liaison with Confederation/CEPN’s and wider
multi-disciplinary team
• Fluctuating caseload currently >50 patients
End6
/
5
/
2
0
1
5
COMMUNITY NURSING
Sickle Cell & Thalassaemia
MODELS OF CARE
HOLISTIC CARE
Team works beyond traditional model of care which looks at see,
treat & Discharge
Explore self management and patient responsibility to encourage
informed choices
Nursing goes beyond the disease and considers the patient as a
whole
THE TEAM…
We are a cradle to grave service, unlike other services which are adult
or child specific
Social care liaison team; which provides benefits & financial advice,
assistance with social care issues, psychology support, bereavement
support, Outreach, raising awareness amongst families, local communities
and health care professionals
Specialist nursing team; Promote self management, Disease
Management, Complex case management, collaborative working
CARE DELIVERY
Care is proactive
Delivered by a team on a wider scale
Integrated across time, place and conditions
Care is multi faceted and can be delivered in groups settings, nurse
led clinics, telephone, email, etc
Actively promoting self management and patient responsibility
IMPROVING PATIENT
OUTCOMES
Improving service provision- liaising with other services to improve
patient access
Making services more accessible to patients; Raising awareness,
keeping patients informed; Service Newsletter, 24 hour helpline, Support
Groups, social networking; Facebook and twitter
Nurse Led clinics, hydroxyurea, therapy clinics, Patient Review
Nurse Prescribers
Integrated team, social care drop in sessions, multi site working
Adequate and appropriate skill mix-all nurses with the same skills;
Apheresis training, nurse rotation programme, nurses familiar with
adult and paediatric processes
Liaison with the MDU to improve patient experience
MDM’s within the community focussed on Case management
patients with complex needs and comprehensive goal setting
Engaging in Network activities to improve patient outcomes and
experiences
Exploring Alternative Therapies
Patient & Family activities
End6
/
5
/
2
0
1
5
