Wandsworth PCT

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.

Andrew Craig, PEC Lay Representative, has produced a feedback briefing from the PCT’s Professional Executive Committee Meeting held with the PCT Management Team on 16^th March 2010.    

• Dental Mystery Shopping
• St. Georges Hospital A&E  GP referrals
• Minor Oral Surgery update
• Out of hours Services

To read his report please click here March 2010 Lay Member PEC Feedback

Your comments on these and other lay issues in connection with PEC discussions are very welcome and Andrew will feed them into the next PEC meeting or other appropriate channel at the PCT.  

At it’s recent Board Meeting NHS Wandsworth selected St George’s Hospital Trust as its preferred organisation to take on the Wandsworth Community Services as it separates from the Primary Care Trust.

The PCT also received a detailed report of the events leading up to the voluntary liquidation of Secure Healthcare, the social enterprise providing healthcare services to inmates of Wandsworth Prison.  In discussing the report, it was recognised that it was difficult to balance the financial risk of accepting a tender from an untried organisation, against the improvement in services such an organisation might achieve.

To read the full report click below:

Notes from the Wandsworth PCT Board, 2nd December

A&E and ‘Urgent care’ are at the top of the list of topics in this feedback from the November meeting of the PEC committee with the NHS Wandsworth Management Team. Londoners are very keen – rather too keen – on using their A&E departments. Emergency and unplanned hospital admissions are running about 9% ahead of the planned provision. 7pm is the peak time which strongly suggests, writes Andrew, that is the time when GP should be offering walk in services. People going to A&E are saying they cannot see their GPs then. Do the younger residents of Wandsworth who come from parts of Europe where hospital is the first stop and primary care facilities like GPs are not the norm, understand how things work here? Andrew calls for a look at ways of changing the ways many of us are using A&E departments to make sure we all know that there are lots of places other than A&E to get urgent treatment.

Will the Primary Care Scorecard help?

Soon you will be seeing a table that ranks GP performance in a way that will be intelligible and useable for members of the public. This will be the ‘Primary Care Scorecard’ which will make comparisons between local GP practices. Andrew hopes that the final version of the scorecard will show both individual practices who are poor performers and areas of service where particular practices are performing poorly. He calls for action by the PCT to decommission consistently failing practices, tell their patients why and find them alternatives which offer better quality service.

Are You Ready to Share?

There is a system whereby your records can be shared over something called the EMIS Web System. This makes your medical records available when you are being treated in an emergency when looking at your GP medical notes or hospital records may not be possible. You will be asked for your consent for this sharing by your GP (if you have not been already). You have the right to take a look at them before they are uploaded to check their accuracy. The PEC committee are going to do a Privacy Impact Assessment to make sure that this is all in the patients’ interests.

Next Meetings

Andrew Craig reports in his capacity as the Lay Member on the PEC committee which regularly meets with the Wandsworth PCT management. The PEC meets again on 1st December and the NHS Wandsworth Board on 2nd December. This is a public meeting and you can find information about time and place here.

The Wandsworth LINk wants you to be aware of the following important advice from NHS Wandsworth

At risk residents are urged to get the swine flu vaccine

The NHS is urging local residents to take up the swine flu vaccination. The vaccine is being offered first to people most likely to become seriously ill if they catch swine flu.

The priority groups for vaccination are:

· Adults and children between six months and 65 years of age in the current seasonal flu vaccine clinical ‘at risk’ groups. e.g. who have a long-term health condition, including chronic lung disease and heart disease;

· Pregnant women;

· People who live in the same house as someone whose immune system is compromised by disease or treatment, and

· People aged 65 and over in the current seasonal flu vaccine clinical “at risk” groups.

NHS Wandsworth’s Joint Medical Director, Dr Dave Finch said: “We know that for the majority of cases swine flu is a mild illness, but for some people, mostly with other existing health problems, it can be more serious. The vaccine is our best line of defence against swine flu, and I urge everyone in the priority groups to take up the offer of being vaccinated. Your GP will contact you to let you know if you are in one of the at-risk groups.”

Residents in the priority groups who are not registered with a GP can arrange to have their free swine vaccination at Tooting Walk-in Centre by calling 020 8700 0505.

Clinic times are:

Wednesday 11, 18 and 25 November 4pm – 7pm

Thursday 12, 19 and 26 November 7am – 10am

Saturday 14, 21 and 28 November 5.30pm – 8pm

Dr Finch continued “We are seeing increasing numbers of cases in the local community and the number of people catching the illness may rise as we move into the winter season Being vaccinated against swine flu is voluntary but the NHS wants to protect as many people in the community as possible. ”

The swine flu vaccines have under-gone a series of stringent tests to be granted a licence by the European Medicines Agency and have undergone extensive trials involving thousands of people.”

One of the best things that everyone can do to protect themselves and others from swine flu and ordinary seasonal flu is to follow good basic hygiene, said Dr Finch, especially covering your nose and mouth when coughing or sneezing, placing used tissues in a bin and remembering to wash your hands frequently with soap and water to reduce the spread of the virus.”

The swine flu vaccination will not protect you against seasonal flu so if you are at-risk it is important to have both vaccinations.”

For more information on swine flu, visit www.nhs.uk or call the Swine Flu Information Line on 0800 1 513 513.

NHS Wandsworth Changes Plans

Although NHS Wandsworth have consulted on polyclinic developments across the borough, it is likely that several of the new polyclinic hubs which were planned to bring a wide range of services together on a single local site will not now be developed. Of greatest concern are the changes to the plans for north Wandsworth and Battersea. The key hub for this area was going to be a new comprehensive primary care centre in Grant Road which would have provided primary healthcare and an urgent care centre with a wide range of diagnostic equipment on site.

Use of existing and other planned facilities

The new centre is not now likely to be built, with local residents having to rely on facilities contained within St John’s Therapy Centre and the new primary care centre to be opened next year under the railway arches at Clapham Junction.

Will the new services offer what is needed?

The key question is whether there will now be the complete range of healthcare services provided on a single site near Clapham Junction to offer a real alternative to local A&E services for residents needing urgent care. The review of polyclinic developments across the whole Borough will be reported to the PCT Board at the beginning of December 2009.

What is the Wandsworth LINk doing about this?

Wandsworth LINk representatives, as part of their campaign to seek improvements to local health and social care services, will be trying to ensure that NHS Wandsworth comes up with a plan for urgent care services in north Wandsworth and Battersea which will match the facilities available to residents of other parts of the Borough at hospitals such as Queen Mary’s Roehampton and St George’s.

If you have comments on this development, please use the comment box.

The theme of working together for improved services crops up more than once in this the latest report from the PEC committee meeting with the management team of NHS Wandsworth. This is personal feedback from our PECMAN Andrew Craig in his role as the Lay Member on the PEC (Professional Executive Committee).

Better Integration = More Effective Commissioning

The discussion on how best to provide the services needed by drug and alcohol users identified the important point that ‘drug and alcohol services should be considered together for commissioning purposes in close liaison with the local authority.’ Andrew added his own view saying:

“I welcomed the emphasis on better integration and more effective commissioning of these services. The Local Strategic Partnership should be the forum to address the wider non-health issues around drug and alcohol problems as it could involve more stakeholders including the police and courts service. Insight from service users was an essential part of the intelligence the PCT must obtain in order to improve its competencies in this area.”

The benefits of the PCT and Wandsworth Council working together came up again in a discussion about children’s service and how a joint initiative could be established using pooled funds from both local government and health care organisations.

Unprecedented Response – reliable basis for decisions

The South Wandsworth Consultation in which we as a LINk were very much involved had seen an unprecedented level of response from a good cross section of people in the borough.  This means that the information is a reliable basis for future decisions about the service.

In the light of this successful consultation, it is a shame that work going on to decide where future savings could be made did not involve frequent service users. Andrew makes the point that the PCT’s

“customer insight was inadequate to the scale of the decisions we needed to take and this had to be addressed through our engagement efforts. Service users and the general public had to be brought on board with the rationale for this thinking. If they were not, the risk was considerable that reasonable intiatives to achieve efficiency would be misunderstood and rejected by the very people who should be helping to identify them.”

Better Data, Lower Score but Better Service

NHS Wandsworth had collected better information on its drug services which showed things to be worse than had been previously thought and meant they got a lower score on some of the Government’s targets. However the better data means better provision since managers now have a better understanding of what the needs are and how they might be met. Congratulations to the NHS Wandsworth for risking the consequences of getting low marks on central government targets in favour of better local service in the long run.

To view the PEC October 2009 Report document in full, please visit our Health & Social Care page.

The Wandsworth Carers Conference – for those who look after an adult in Wandsworth and are not paid for the care they give.

10.30am to 3pm Tuesday 6th October at the Civic Suite Wandsworth High St., SW18 2PU

The LINks will have a stall at this event where Carers are invited to come and have a ‘speed date’ with the people responsible for providing support and services for carers in Wandsworth. These senior professionals from the Council, Health and Mental Health Services will be there to answer your questions about the plans they have made for action and improvement in these area.

National Carer in Chief will be there

Dame Philippa Russell Chair of the Government’s Commission for Carers will be there to give the keynote address.

Free lunch, Entertainment and Other Treats

Meet your fellow unpaid carers and don’t forget to come and tell us what we should be saying on your behalf to the bigwigs. No need to ‘speed date’ us – we’ll be sticking around.

NHS Wandsworth is running some diabetes focus groups in September/ October to give patients an opportunity to have their say about the diabetes services and to inform and influence future service planning.  Come along and be asked about:

1) Access:

Did you get the right information? How was the service delivered?  What was your experience of the GP service and of hospitals? Could you get to the clinic easily?

2) Attitudes of the Staff you meet – doctors, nurses, reception staff

How would you describe their dealings with staff? What effect did your relations with staff affect the service you got and what suggestions do you have to improve things?

3) Pathway of Care:

What does this mean to you? Has this approach to care improved things for you?

Anything else on your mind? Bring it up at one of the meetings. Check with the group organiser that your views will be treated in confidence and not associated with you or any other individuals in any report.

The Meetings

They will be about 2 hours long and about 6-8 people are expected at each. Snacks will be provided and travel expenses will be reimbursed.

The dates, places and times are:

1. 15th September – Balham Park Surgery – 2-4pm

2. 16th September – Queen Mary’s Hospital in the Richmond Room – 1-3pm

3. 21st September – Balham Park Surgery – 10am to 12noon

4. 22nd September – Doddington Health Centre – 10am to 12noon

5. 24th September – Doddington Health Centre – 10am to 12noon

6. 9th October – Queen Mary’s Hospital in the Barnes Room – 10.30am to 12.30pm

Sign up by contacting Sue Fleming on 020 8812 7946

Queen Mary’s Hospital in Roehampton are looking for a volunteer to take part in their regular inspections.

Join PEAG and do PEATs

These inspections are called Patient Environment Action Team (PEAT) inspections and assess a range of factors including standards of maintenance, décor, furnishings and cleanliness to help bring about improvements to the patient environment.

Queen Mary’s carries out 3 “mini-PEAT” inspections and one PEAT inspection every year through a group called the Patient Environment Action Group (PEAG). The PEAG meets every 3 months, and volunteers will be expected to take part in each meeting and inspection (i.e. 8 sessions per year).

The hospital is looking for volunteers who have a keen interest in the patient environment and experience, and are able to report back to the LINk (verbally and in writing). They will cover all expenses that you incur when taking part in this role and can provide additional support in the form of basic training (giving background on PEAT inspections).

The deadline for submission is the 4th August, applicants to supply a short personal statement (no more than 200 words).

Please note if there is an insufficient response, they will defer an appointment until October so there will be another chance to get involved.

If you are interested in this opportunity please contact Tom Magill on 0208 812 7642 or Tom.Magill@wpct.nhs.uk.