Meetings

LAY MEMBER’S HEADLINE FEEDBACK FROM THE NHS WANDSWORTH PROFESSIONAL EXECUTIVE COMMITTEE (PEC) MEETING WITH THE MANAGEMENT TEAM ON 13 JULY 2010

These headlines are for rapid briefing purposes about the lay/user issues arising in the meeting. It is not a full report from the meeting.

PEC and PCT Board papers are available on the NHS Wandsworth website: www.wandsworth.nhs.uk   contact  Sandra Allingham on 020 8812 7740 or e-mail sandra.allingham@wpct.nhs.uk

The contents of this briefing note are for information only and are solely the responsibility of Andrew Craig, PEC Lay Member, including errors and omissions. They do not necessarily represent the views of the PEC or NHS Wandsworth.

Items for Discussion

Performance Area Presentation – Screening

Breast screening: The target is for 70% of women aged 53-70 to have received screening for the early detection of breast cancer over the last three years. In 2010/11, the target will be extended to include all women aged 47–73. 

Local performance was consistently underachieving (63%) compared to other sector PCTs (London average 65.1%; Islington 66% highest).  Issues of  venues, sites and times and list cleaning were being pursued to improve this.  Language issues are sighificant factor. A pictorial version of the invitation was being trialled.

There is significant patient opt out and also professional doubt about effectiveness in early detection and intervention for breast cancer.  This could be an example of chasing targets not in the patients’ best interest and spurious in terms of improving the health of the population.   Not part of current GP contract, so GPs less likely to be asked about it than cervical screening.  And patient information usually not transferred to EMIS patient records. 

General view that changes won’t take local performance up to 70%.  Breast screens done privately  (probably about 1%) not counted for the target as not quality assured. 

Cervical screening:  The 2010/11 target is for 80% of women aged 25-49 to have had a technically adequate smear within the last 3.5 years and 80% of women aged 50-64 to have had a technically adequate smear within the last 5 years.

Local performance (68% and 74.5% for the respective groups) improved by 2% this year, but consistent underperformance issues are the same as for breast screening.  Data reconciliation has revealed large inconsistencies in patient lists ( reflecting our highly mobile and diverse population).

For both types of screening, PEC agreed that there must be much more engagement with the target community to find out what kind of service they would use and where it should be offered.

My conclusion from this is that the NHS is underperforming because it is trying to promote uptake of a product that many customers don’t recognise as something they need and should want. Women called for screening are not “patients” and are unlikely to respond to top down services that take no account of language, culture, convenience and other consumer factors.  We do not know what kind of service women would like to have and until there is reliable user-led intelligence, it will not be possible to commission something more appropriate.  Tinkering with the existing model is futile and wastes resources.  Getting this right presents a big opportunity for the NHS, Wandsworth Council  and Third Sector bodies to work together in an engagement exercise with a public health objective. This fits the new White Paper’s approach to public health. It is astonishing that data collection at practice level is still so fragmented.  

Naitonal GP Survey – Practice Nurses

Wandsworth’s results for patient satisfaction with access to and services from nurses in general practice are getting worse.  PEC agreed the final version of a practice nurse developmehnt strategy aimed at improving the situation. This includes better performance measures than the national survey questions. Performance data is not understood in practices and by individual nurses in the practices and this must be remedied.   

Nursing outside of hospital remains disjointed and nurses employed by GPs are professionally isolated.  The new practice nurse strategy will help, but it cannot overcome a problem whose cause is inherent in the way these practitioners are employed by GPs as private businesses.  We need a primary care nursing service that is not just confined to GP practices.  In my view the practice nurse task model is a dinosaur and impedes innovation. An alterantive is to employ primary care nursing staff through Healthcare Federations as legal entities and not through individual practices and arrange professional development and leadership across Wandsworth. Another option to consider is the  “chambers” approach where nurse employees own their own business as a mutual society and contract services to practices (and to GP commissioning consortia in future).  That would require a solution to the NHS pensions issue but there are strong signals from government that this model would be supported.  

Quarter Four GP Survey Results

PEC discussed the access to primary care results.  London and all South West London sector PCTs are underperforming in most areas.  Wandsworth is poor in practice nurse and  out of hours areas.   Government has announced that the specific target of seeing a GP within 48 hours will be abolished.

Because of the importance of providing information to patients to enable informed choices, PEC agreed that this information should be put on the PCT website in a clear and accessible way relating to individual practices.  This would enable people to choose a GP practice or switch from a poorly performing one.  PEC also agreed that the PCT should ask patients if this was the kind of data they wanted, what will they do with it,  whether it helped them make choices and whether they would recommend others to use it.    

 Implementing Coalition Government Policy

The Chief Executive provided information based on a recent briefing with NHS London and London PCT CEOs.  The following issues were highlighted:

The mismatch between having to achieve management savings quickly compared to the requirements of the legislative timetable to have changes completed by 2013 is a serious complicating factor and will make the PCT’s job more difficult in managing change and retaining its skilled staff to enable the transition to GP commissioning and closer work with the Council.

Commissioning consortia will be statutory organisations with an accountable officer (CEO) and geographical responsibilities.  Consortia will be in shadow form from from 4/11.  No mention of Boards in the accountable structure (consortia CEOs will be accountable upwards to the NHS CEO in England).  

Re-negotiation of GP contact will be simultaneous with setting up of consortia.  Providers will take most assets with them required for provision of services (et Queen Mary’s Hospital, health centres);  only assets requried for commissioning would remain with GP consortia.

The NHS Commissioning Board from 2012 will commission all primary care and maternity care.  GP consortia will not commission GP (primary)  care, for obvious conflict of interest reasons, but would take an interest in quality and effectiveness (how this would happen has not yet been specified).  Some SHAs will turn into offices of the NHS Board by 2012.  

Public health,  wellbeing and health improvement – will essentially transfer to local government  as a core cabinet level responsibility to be integrated with social care. In London this could mean the Mayor taking control of them.  Directors of Public Health would be employed by Councils not the NHS.  Overview and scrutiny arrangements will change.  London would have a public health focus.

Healthwatch nationally and locally would relate to the Care Quality Commission and absorb the LINk.  Local Healthwatch would be Council funded and accountable.   See the diagram at the end of this report.

Monitor would become the universal healthcare economic regulator.  All NHS Trusts would have to become Foundation Trusts or merge with viable FTs. Private patient income cap will be removed.  Social enterprise and employee ownership models are being heavily promoted and incentivised.

Independent health care sector will play a role mainly in market testing rather than mainlyin service provision.  

Key documents for the White Paper Liberating the NHS launched on 12/7are grouped on the Department of Health website and are essential reading www.dh.gov.uk/en/Healthcare/LiberatingtheNHS/index.htm 

 David Nicholson, CEO of NHS England, letter to CEOs of NHS organisations 13 July outlining stages and pace of transition www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_117406.pdf  stresses  four key change principles: subsidiarity, co-production,    clinical ownership and leadership, and system alignment.  The message is the need to understand the NHS as a system of services linked by common principles of access, equity and quality, not a monolithic organisation of buildings and 1m+ employees.

NHS England Governance Model in White Paper Liberating the NHS July 2010

 Next Meeting of the NHS Wandsworth Board: Wednesday 28^th July 2010 in the Richmond Room, Queen Mary’s Hospital, commencing at 09h30.

 Next Meeting of the PEC: 09h30 on Tuesday, 14^th September 2010.

If you are a Carer and want to advise the new Government about what help and support is important to you to live your life, now is your chance to speak up.

See our poster for the two events on the 8th and 16th September 

If you are interested in attending, please call Daniel at the Wandsworth Carer’s Centre on 0208 675 0811

Topics include an update on LINks work over the past 12 months and the work plan for the coming year, a discussion on the implications of the NHS White Paper, plus an opportunity to take part in local consultation activities.

This meeting is open to anyone with an interest in local health and social care services, including voluntary groups, service users, carers and the wider community.

Speakers at the meeting:

• Roy Benjamin, Chair of LINk Merton on our work and priorities

• Peter Jenkinson, Trust Secretary at St Georges Hospital Foundation on plans to create a foundation Trust

• Helen Bainbrige, NHS Sutton and Merton on the new PCT equalities scheme

The meeting will take place at Grenfell Housing and Training, 16-20 Kingston Road, South Wimbledon, SW19 1JZ.

To book your place, call 8685 1771 or e-mail justin@mvsc.co.uk

A meeting for managers of organisations providing any type of care and support for adults will take place at Wandsworth Voluntary Sector Development Agency on 17th August 2010 at 10am. This is an opportunity to discuss the switch to personalised services, implications for provider organisations and opportunities to find joint solutions with other providers.

There has been a huge amount of interest in this meeting and there is now a waiting list. If you would like to register your interest please contact Wandsworth Voluntary Sector Development Agency on 020 8875 2846.  

Wandsworth Voluntary Sector Development Agency, 170 Garratt Lane, SW18 4DA

Please see poster for more details

The Mayoral Community Reception at City Hall

Monday 5^th July 2010, 6.30pm – 8.00pm 

The Mayor of London’s forthcoming Mayoral Community Receptions at City Hall are designed to bring Londoners together to celebrate the capital’s diversity, and encourage greater community cohesion and improved integration in this city. These receptions will also honour those who make their area or neighbourhood a better place to live, and will very much encourage community participation and civic engagement.

The inaugural event will bring together those living in the Assembly Constituencies of Lambeth/Southwark and Merton/Wandsworth, and will be held on Monday 5 July 2010 at City Hall from 6.30pm to 8.00pm.

The Greater London Authority (GLA) is keen to invite an array of community organisations and leaders from faith, elders, women’s, LGBT, minority ethnic groups in Wandsworth.

If you would like to represent your organisation at this event, please contact:

Richard Reddie

Senior Co-ordinator,

External Affairs,

City Hall,

The Queen’s Walk,

London, SE1 2AA
Tel: 020 7983 6527
Email: Richard.Reddie@london.gov.uk

www.london.gov.uk

LAY MEMBER’S HEADLINE FEEDBACK FROM THE NHS WANDSWORTH PROFESSIONAL EXECUTIVE COMMITTEE (PEC) MEETING WITH THE MANAGEMENT TEAM ON 13 APRIL 2010

Self-Referral Physiotherapy Service Update

The PEC has been supportive of self-referral to physiotherapy.  A successful pilot is running in West Wandsworth (through Queen Mary’s) and a pilot is soon to start in Central Wandsworth (through Wandsworth  Medical Centre at the top of Garrett Lane).   Self referral will be a recognised referral route and will be imbedded into the referral pathway.  There will be a further report on developments in 3 to 4 months.

I welcomed this development, having raised the issue some months ago about self-referral to therapists.  We need to understand the user feedback/evidence  in the West Wandsworth pilot.   This is a good focus for  shifting services, if the community service is robust enough and seeing the right people and changing user behaviour about where they might choose to go and what services they can access. 

Ethical Framework for Priority Setting

This is a draft framework to facilitate the decision making process around priorities, especially in a time of financial restraint and competing demands for funding.  The NHS Constitution has been referenced in compiling it and it reflects the legal and ethical duties of the PCT.   PEC welcomed this tool and it was agreed that when it was fully fledged, it would be used to revisit earlier decisions made about funding obesity (bariatric) surgery and funding for fertility (IVF).    There is an aspiration to share this process with Local Authority councillors (Health OSC in particular) and officers. It can support the new LCCBs (Local Clinical Commissioning Boards).  The June meeting will consider an amended version including weightings for value for money, feasibility and service fit. 

I welcomed this approach to decision making and support sharing the process in a public seminar.  Planned differences in services are acceptable – even desirable – when they reflect evidence based decisions about health needs of the local populations.

Cancer Prevention Action Plan

Cancer and CVD (cardiovascular disease) are the two main causes of death locally.  The mortality rate for cancer is rising and as currently set, the local target (reflecting previous unmet targets) to reduce cancer deaths is not achievable.  Wandsworth is the worst performer in the sector for cancer deaths in people under 75.  Smoking is the greatest cause of cancer locally and the PCT is not doing enough to achieve stop smoking targets.  Reducing smoking  would be the most cost effective thing the local NHS could do to reduce deahs and make savings from smoking-related problems.  Performance on colorectal cancer was also cause for concern locally and there was unsatisfactory uptake of the national bowel cancer screening initiative. Other key areas of activity in the cancern prevention plan included:

• raising awareness and needs assessment
• smoking cessation
• obesity control
• increasing physical activity
• alcohol reduction,
• cancer screening – breast, cervical and bowel
• sun protection and early detection of skin cancer
• HPV vaccination.

Obviously the public’s awareness and willingness to come forward for screening and when symptoms are suspected or detected is essential for success in any prevention programme.   Steps have been taken to address gaps in the PCT’s understanding of how local people understand cancer, eg about skin cancer risks and testicular cancer in younger men. Social marketing aimed at high risk groups is the main tool used to discover user-focused views and a tendering exercise to appoint a company to undertake this work is nearing completion.  

GP Performers List Update

PEC discussed the issue of strengthening language competency for GPs, including those providing out of hours services, and other health care professionals.  The General Medical Council registration procedure did not offer sufficient assurance and as EU/EEA qualified doctors were not required to demonstrate competency in English, it was up to local processes to do this. The PCT’s letter to applicants for the Performers List had been strengthened about language proficiency and the Primary Care Support Service was putting in place a language test. Patients have a right to assume that a doctor who comes to see them at home is competent in English. There was a problem with locums who were not on the Performers List who come from agencies.  The PCT’s out of hours contract (currently with Harmoni) would also be strengthened as part of the current rewriting of the specification prior to re-tendering.  Local GPs using agencies for locums will be advised only to use agencies that require standards of English testing.  The same would be applied to nurses and therapists employed through agencies.  PEC agreed it was essential to assure the public on this issue.

I support this move and would encourage any patient or carer who has had an unsatisfactory experience with a clinician having poor command of English, whatever the setting,  to tell the PCT about this.  

Other Business

It was announced that contracts had been terminated with the folowing three GPs and that they had ceased to trade.  Patients of these practices had been informed and been offered allocations to other practices. 

Dr Daud Khan  87 Northcote Road; Dr Mohamed Sultan and Dr Jawed Ali   138-140  Mitcham Road

 PEC and PCT Board papers are available on the NHS Wandsworth website: www.wandsworth.nhs.uk   contact  Sandra Notridge on 020 8812 7740 or e-mail sandra.notridge@wpct.nhs.uk

Next Meeting of the NHS Wandsworth Board: 

Balham Park Surgery, 236 Balham High Road,  not the Town Hall, starting at 09h30 on Wednesday 28^th April.

Next Meeting of the PEC: 09h30 on Tuesday, 11^th May 2010.

Last night at the open meeting at South Thames College each of the Battersea parliamentary candidates from the three main political parties were asked their view of the current proposed polyclinic hub services for Battersea.

Jane Ellison (Conservative) felt that the current “portacabin” solution in Grant Road was a far cry from what was promised by NHS Wandsworth after the expensive consultation in 2008.  She still felt that a replacement hub on the NHS-owned Bolingbroke Hospital site would have been the best solution.

Martin Linton (Labour) pointed out that the “portacabin” solution was only temporary whilst the permanent base for the GP health centre under the arches was prepared.  He also reiterated NHS Wandsworth commitment to achieving the comprehensive hub on the Grant Road site: a promise made by NHS Wandsworth after referral of their current plans to the Council’s Health Committee by Wandsworth LINk.

Layla Moran (Liberal Democrat) saw the long-term solution being the creation of local health boards which would take over the running of local health services.  Local people would then be able to determine what happened in their own area.

Roger Appleton

Chair Wandsworth LINk

LINk Elections- nominate now

On Monday 18th January 2010 between 6p.m. and 8.30 p.m. the LINk will be holding a meeting at which we will elect a new Executive Committee member to fill the vacant place on the Executive. All members of LINk are invited to take part in this election.

Under the current agreement the elected candidate will serve for the remainder of the vacant term i.e. until January 2012. (It should be noted that the term served by an elected member is currently under review)

All current members will receive a letter or email depending on their specified preference and pack in the post detailing how they can nominate and vote. Alternatively all relevant documents are available here:

• nomination for election form
• appointment of proxy form
• nomination and voting procedure

Nominations

Any member who has signed up as a LINk member by 12 noon on Monday 21st December 2009 can stand for election. This is also the deadline for receipt of nominations for election to the Executive Committee.

You do not need a proposer or seconder- you can nominate yourself and fill in the statement in support of the nomination and declaration of interest.

 
How you can vote….

• In Person on the night – Monday 18th January 2010

• By appointing another person to act as your proxy.

• By Post – This must be requested by 12 noon on Monday 4th January 2009, from the Host (Wandsworth Care Alliance). The vote must then be completed and returned to the Host office by 12 noon on Friday 15th January 2010.

 
What if I am not a member but would like to vote?

If you would like to register as a member and in turn take part in these elections then please click here.
If you would like any additional information or assistance completing the nomination form or with voting arrangements, please ring the Host at WCA on 02085 167 767 or email sarah@wandcareall.org.uk and someone will be pleased to assist you.

Just a reminder that our next meeting is open to the public and starts with an Executive business meeting from 6 pm on Monday 23rd November at York Gardens Library, Battersea, followed at 7.15 pm by refreshments and a presentation and open discussion about being discharged from hospital and the difficulties that can arise. You can see the full set of papers for this meeting here.

If you would like to make any comments on what we are going to talk about, please get in touch with Sarah at Wandsworth Care Alliance by noon on Monday 23rd November. You can reach her on 020 8696 1709 or by email sarah@wandcareall.org.uk

We look forward to seeing you.

Come and join our Open Discussion at the LINk Executive Committee meeting Monday 23rd November.

Wandsworth LINk will be holding its Executive Committee meeting on 23rd November at 7.30 at York Gardens Library, Battersea, Lavender Road, London, SW11 2UG. There will be a presentation on Hospital Discharge and care planning, followed by an open discussion. Please do come along and share your views.

Click here to view the agenda and minutes from the previous Executive Committee on 28th September.