Wandsworth PCT

report by Roger Appleton

The financial challenges facing St George’s Hospital were set out clearly in a report considered by the Council’s Adult Care and health Overview and Scrutiny Committee recently.  Although the trust achieved financial balance in 2010/11, it did not achieve its savings target and this failure has contributed to its decisions to delay its application for Foundation trust status.  In the current year, the trust faces a double problem of anticipated reduced demand for its services amounting to some £15 million pounds in income, alongside the challenge of achieving its own savings target of a further £38 million.

Under questioning from the LINk representative, the Trust confirmed that it had faced some self-inflicted problems during the past year with reduced clinical activity because of Consultant unavailability but promised that this problem would not recur during the current year.

Much of the anticipated reduced demand in the current year relates to treatment for non-Wandsworth patients but the Trust still could face a problem of having to re-expand its services in an unplanned way during the year if the planned demand reductions do not take place and more patients are admitted than were expected.

As well as these financial challenges, it appears that the pressure on the A&E services at St George’s remain and it is not clear that the alternative walk-in arrangements put in place by NHS Wandsworth have had a significant impact of attendances at A&E.  The LINk will take this up with NHS Wandsworth at its next meeting.

NEWS RELEASE

Date of issue: 6^th May 2011

David Astley has announced his decision to step down as chief executive of St George’s Healthcare NHS Trust in south west London.

Since he joined St George’s Healthcare in December 2006 the trust has become a major trauma centre, a hyper-acute stroke unit and, in October 2010, successfully integrated with community services Wandsworth. In addition, St George’s Healthcare was named `Large trust of the year` by Dr Foster Intelligence for 2009.

Speaking about his decision David said: “I had always planned to retire from the NHS when I reached the age of 60 which is now just two years away. The board’s recent decision to delay our foundation trust (FT) application to April 2013 has led me to consider my position.  It is important that the trust has a chief executive who can drive the organisation forward to achieving its goals for 2013 and beyond. Therefore I have taken the difficult decision, in the long-term interests of the trust, to step down. I am immensely proud of what has been achieved during my time at St George’s Healthcare although none of this would have been possible without the support, hard work and dedication of colleagues from across the organisation.”

Naaz Coker, chair of St George’s Healthcare, said: “On behalf of the trust board I would like to thank David for the valuable work he has done over the past four years. David has decided to step down now to allow a new leader to take St George’s forward as a foundation trust. David is very well respected by his colleagues and will be missed at the trust and we all wish him well for the future.”

Ruth Carnall, chief executive of NHS London, said: “David’s leadership over the past four years has been instrumental in the transformation of many of St George’s services. The trust is now amongst the best in the country for its care of stroke patients, heart disease and major trauma. With his support, a number of the trust’s leading doctors have also been involved in clinically-led reforms to improve health services across the capital.”

The trust has started the process of appointing a new chief executive and, in the meantime, Patrick Mitchell, chief operating officer, will act up in an interim capacity.

On Monday night, the Council’s Adult Social Care Overview and Scrutiny considered a report on the out-of-hours GP services provided by Harmoni.  NHS Wandsworth recently extended Harmoni’s contract for the second time, arguing that Harmoni was achieving good results on all of its performance indicators.  Results from the recent GP Survey tell a different story, with local patient satisfaction scores being lower than both the London and national average in every case.  More than one half of all respondents were unhappy about how quickly Harmoni provided care and a similar percentage were unhappy about the quality of the care they received.  The Councillors questioned why NHS Wandsworth was extending the contract given these levels of dissatisfaction.  Full details are available at http://www.wandsworth.gov.uk/moderngov/mgConvert2PDF.aspx?ID=13588

Roughly two thirds of England’s population is now covered by ‘pathfinder’ GP consortia following the acceptance of a further 31 groups onto the scheme.

Health minister Andrew Lansley said the varying shapes and sizes of the groups piloting GP commissioning showed there had been a ‘truly bottom-up response’ to his reforms.   A number of consortia from the second wave have now merged, meaning the total number of pathfinder consortia is now 177, according to the DoH.

But  Dr James Kingsland, the DoH’s national clinical network lead, admitted little information had been fed back about the programme so far.

Pathfinders by region

Pathfinders by wave

East of England

Cam Health Integrated Care       

Geographical area:  Cambridge

Number of practices: 8
Population size: 72,564

East and North Herts GPCC

Geographical area:  East and North Hertfordshire

Number of practices: 50

Population size: 463,692

Luton GPCC

Geographical area:  Luton

Number of practices: 32

Population size: 210,447

West Norfolk PBC Consortium 

Geographical area:  West Norfolk

Number of practices: 22

Population size: 156,021

South West Essex Federation of GPs

Geographical area:  Thurrock and Basildon

Number of practices:  34

Population size: 179,170

South Essex Managed Care Consortium LLP

Geographical area:  Wickford and Basildon

Number of practices: 10

Population size: 51,268   

East Midlands

North Derbyshire

Geographical area:  North Derbyshire

Number of practices: 31
Population size: 230,000

Crescent

Geographical area:  South East Leicestershire & Rutland

Number of practices: 33
Population size: 311,000

North and West Leicestershire

Geographical area:  North and West Leicestershire   

Number of practices: 49
Population size: 360,000

Nottingham West Consortium

Geographical area:  12

Number of practices: Broxtowe locality, which encompasses Beeston, Chilwell, Bramcote, Stapleford, Kimberley and Eastwood
Population size: 93,000

Newark and Sherwood Health

Geographical area:  Market town of Newark and surrounding villages extending to Sherwood and A1 border with Lincolnshire

Number of practices: 14
Population size: 115,231

Erewash

Geographical area:  13

Number of practices: The towns of Ilkeston and Long Eaton including surrounding villages
Population size: 102,000

Corby           

Geographical area:  Corby

Number of practices: 6
Population size: 67,124   

Skegness and Coastal    

Geographical area:  Skegness and Coastal

Number of practices: 7
Population size: 72,000

London    

The Federation      

Geographical area:  Sutton & Merton

Number of practices: 32

Population size: 262,557

Wandsworth           

Geographical area: Wandsworth

Number of practices: 46

Population size: 370,366

Lambeth Commissioning Collaborative         

Geographical area:  Lambeth     

Number of practices: 52

Population size: 377,624

Richmond & Twickenham GP Consortium

Geographical area: Richmond & Twickenham

Number of practices: 32

Population size: 197,524

United Medical Consortium (UMC)

Geographical area:  Barking & Dagenham (part of)

Number of practices: 15

Population size: 71,098   

Havering First Consortium         

Geographical area:  Havering (part of)

Number of practices: 27  

Population size: 108,994 

Havering Premier

Geographical area:  Havering (part of)

Number of practices: 22

Population size: 143,416

Camden Commissioning Consortium

Geographical area:  Camden

Number of practices: 39  

Population size: 224,450

Hillingdon

Geographical area:  Hillingdon

Number of practices: 49

Population size: 273,256

Barking & Dagenham Quality Healthcare Commissioning Consortia (BDQHCCC)   

Geographical area:  Barking & Dagenham (part of)

Number of practices: 26

Population size: 123,000 

Newham Commissioning Group (NCG)

Geographical area:  Newham (part of)

Number of practices: 11

Population size: 68,199

North West

Lancaster Morecambe Carnforth Garstang Practice Based Commissioning Consortium   

Geographical area:  North Lancashire

Number of practices: 13  

Population size: 160,000

Wylde Commissioning Consortia

Geographical area:  North Lancashire

Number of practices: 21  

Population size: 157,000

South Cheshire Commissioning Consortia (SCCC)           

Geographical area:  South Cheshire

Number of practices: 16  

Population size: 164,000

Warrington  

Geographical area:  Warrington

Number of practices: 28  

Population size: 208,000

Ashton Wigan and Leigh with 5 consortia: (62 Practices)

ALPF Health Commissioning Consortium     

Geographical area:  Ashton Leigh and Wigan

Number of practices:

Population size: 90,832   

TABA Consortium

Geographical area:  Ashton Leigh and Wigan

Number of practices:

Population size: 45,127   

North Wigan Consortium                        

Geographical area:  Ashton Leigh and Wigan

Number of practices:

Population size: 54,946   

Wigan Commissioning Consortium

Geographical area:  Ashton Leigh and Wigan

Number of practices:

Population size: 75,998

United League Commissioning                        

Geographical area:  Ashton Leigh and Wigan

Number of practices:

Population size: 106,837 

South West

Swindon NHS Consortium: The Transitional Leadership Group

Geographical area:  Swindon

Number of practices: 30

Population size:  250,000

West Cornwall Commissioning Consortium

Geographical area:  West Cornwall

Number of practices:  23

Population size: 160,457 

Newquay Commissioning Consortium

Geographical area: Newquay, Cornwall

Number of practices: 3    

Population size: 28,000   

West Midlands

Nuneaton & Bedworth     

Geographical area: Nuneaton and Bedworth

Number of practices: 11

Population size: 40,000   

South Warwickshire Consortium

Geographical area:  South Warwickshire including Leamington Spa, Warwick and Stratford-upon-Avon

Number of practices: 36

Population size: 270,000

HealthWorks Commissioning Consortium

Geographical area: Birmingham and Sandwell

Number of practices: 13

Population size: 124,340

Intelligent Commissioning Federation

Geographical area: Heart of Birmingham (Ladywood, Aston and Sparkbrook areas of

inner city Birmingham)      

Number of practices: 29

Population size: 134,000

Yorkshire and the Humber

North Kirklees Health Alliance (NKHA)

Geographical area:  Kirklees

Number of practices: 31  

Population size: 183,000

Greater Huddersfield Commissioning Consortium (GHCC)

Geographical area:  Huddersfield

Number of practices: 41  

Population size: 237,000 

Rotherham Commissioning Executive                                               

Geographical area:  Rotherham

Number of practices: 41  

Population size: 255,500 

Closure of wards and loss of staff for a hospital already struggling to meet patient needs.

Wandsworth LINk was horrified to hear  that St. George’s hospital is due to close 3 wards and lose 500 staff, in a bid to make £55 million of savings in the next financial year. This decision was made without any prior consultation with the community or patients’ groups and at a time when the hospital’s services are already stretched to breaking point.

St. George’s has been failing to meet its targets to admit patients within 18 weeks of referral during the first months of 2010/11. They have also failed to meet their target of a waiting time of no more than 62 days for urgent cancer referrals. At LINk’s last meeting with the Trust, held on 12^th January, we were informed that the `Winter pressures` – increased numbers of very unwell patients – meant that A&E waiting time targets could not be met and there was overcrowding on the Wards and problems with maintaining single sex accommodation.

The government made a commitment that the current financial restraints would not apply to front line NHS services. Wandsworth LINk, is concerned that the loss of so many jobs will have “serious consequences” not only for the local community and London, but for patients across the south-east. LINk will be writing to St. George’s NHS Trust to seek the reasons for these drastic cuts and to challenge them on their failure to consult.

Note to editors:  The failure to meet targets was reported to Wandsworth Council’s Overview and Scrutiny Committee which met on Tuesday 15^th February Paper No 11-163

The Wandsworth LINk is a statutory body, funded by government, to monitor and bring about improvements in health and social care locally by involving local residents, patients and service users.  The LINk meets regularly with representatives of the Trust in order to ensure an exchange of information between the hospital and the community

Jenny Weinstein Chair Wandsworth LINk

C/o Wandsworth Care Alliance  3^rd Floor

Trident Business Centre

89, Bickersteth Rd

SW17 9SH

Tel: 0208 516  7767

THE PCT MANAGEMENT TEAM ON 11 JANUARY 2011

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.

Matters Arising

COPD and Pulmonary Rehabilitation Needs Assessment

Both of these related areas are being targeted for service redesign. The report stated that “patient and public Involvement is key to these projects and a patient group will be established to work with the clinicians to develop the proposals.” The PEC recommended that an “invest to save” model be used, reflecting the importance of COPD to the QIPP programme.

I asked that user engagement begin before the formulation of proposals – reflecting the government’s commitment to “nothing about us without us” – so that it would be clear that the redesign of the pathway reflected service users’ contributions. The national literature on patient views on these services should be used to test out local views.  Having one patient on the working group was tokenism and inadequate and must be reconsidered.

Items for Discussion

Teenage Pregnancy Performance Update

This subject is really about young people’s sexual health and wellbeing, not just teenage pregnancy.  Funding streams were coming to an end and there was a need to integrate activity with the local authority to get the right reach into the target group.  There was good evidence of service user input to this work.  Reliable data showed Wandsworth pregnancy rates falling, but the overall rate remained above the London and national averages. The rate of conceptions in young women under 18 was still the 10^th highest in London and 43^rd highest in England. 

Wards with the highest numbers of under 18 conception rates are: Queenstown; Nightingale; Latchmere with rates nearly three times that in low rate wards.  Numbers of conceptions are highest in Latchmere, Queenstown, Roehampton and Furzedown.  Black and minority ethnic groups had much higher probability of pregnancy than the white population and this had to be addressed in terms of vulnerability and aspirations from an equality point of view.  The emergency contraception pathway and access to it was not clear enough to young people.  A text service had been used for this, but it had been discontinued.   

I supported the integration with the local authority approach for strategy and funding and hoped that the action plan would be considered by the new Health and Well Being Board led by the Council at an early point.   This subject should be part of the Joint Strategic Needs Assessment.  Any communications method that increased awareness and access to emergency contraception had to be used with this target group.  We needed to understand why comparison boroughs like Westminster and Hammersmith and Fulham had achieved greater success than we had in Wandsworth.

Breastfeeding Update

Evidence was that breast feeding initiation rates were high immediately post birth, but in the 6-8 week period after that things broke down, especially for some groups of white mothers. The target for 2010/11 is that 75.7% of infants are recorded as being partially or totally breastfed by the GP practice at the 6-8 week check. Mothers from black and ethnic minority groups were much more likely to continue breast feeding. Locally, we were only just meeting this target and the evidence suggested performance was slipping as mothers were reporting not being advised by health visitors about breast feeding.   PEC agreed that this had to be a mainstream service and must not be left to a specialist.  The outcomes in the contract had to be tightened, including financial penalties for not meeting breastfeeding targets, rather than funding found for a specialist post.  

I expressed strong concern if the so-called “universal service” provided by midwives and health visitors locally seemed – on the basis of this report at least – to be failing where adherence to breast feeding was concerned. This is such a crucial issue that it cannot be left to a specialist to pick up the pieces.  The Health and Well Being Board should consider this as a public health priority and the message to Community Services Wandsworth needed to be strong that performance had to improve.

Items for Approval

TB Needs Assessment and Action Plan

Tuberculosis is a significant public health problem in Wandsworth, with the highest TB mortality rate in SW London and the biggest incidence (new cases per year) 29/100,000. Most cases occur in non-UK born ethnic minorities from sub-Saharan Africa (particularly Somalia) and the Indian sub-continent (India, Pakistan and Bangladesh).  This is reflected in the considerable geographical variation in incidence that is seen within the borough, with the highest rates occurring in Tooting, Earlsfield, Graveney, Roehampton, Furzedown and Latchmere.   

Drug resistance is an emerging problem within Wandsworth with 13% of culture-confirmed cases resistant to at least one anti-tuberculosis drug and 3.5% resistant to more than one drug in 2008. The problem is compounded by considerable stigma around TB in minority ethnic populations, which results in late presentation and poor treatment rates.  Against this, local providers are meeting local and national metrics for finding and treating cases. Universal BCG vaccination about to start.  Wandsworth Prison is included in the action plan as TB is a significant problem in that facility.

PEC agreed the action plan and recommended it to the Board

Reports for Information

Cancer Diagnosis Audit

This is another area where late presentation and delays in treatment make the problem much worse than it should be in terms of survival rates.  An audit across the sector showed: 46% of patients diagnosed with cancer had been referred via the two week wait rule (ie 56% FAILED to be referred within the required time; 47% of the audit patients were referred to secondary care after one visit to the GP surgery, ie for 53% it took MORE than one visit and in some cases many more.

The median average total pathway was shortest in breast cancer cases (27 days) followed by lung cancer cases which took an average of 27 days in total.  Colorectal cancer cases took 54 days on average whilst prostate cancer cases took longest of all at 64 days.  The biggest reason for the variance was patient delay, see below.

GPs participating in the audit identified that there had been 146 (22%) avoidable delays out of 704 cases.  Of these:

45 cases (31%) were due to the patient delaying presentation, investigation or hospital referral, 

34 cases (23%) were delayed due to the GP not initially thinking about diagnosis,

27 cases (18%) were delayed after referral to secondary care,

16 cases (11%) could have been referred earlier using the two week rule

14 cases  (9%)  were delayed due to communication problems between primary and secondary care and

10 cases (7%) were delayed due to other causes.

PEC agreed the action plan of the Cancer Network and recommended it to the Board.  The February PEC will receive a report based on interviews with the public analysing views about signs and symptoms of common cancers.

Open Space

I raised two issues

Comparative GP practice performance data.

Despite promising to produce it since July last year, the PCT has not delivered comparative GP practice performance data accessible to the public to facilitate choice and changes of GP practice. Work to make this suitable for the website was done by the comms department but never materialised.  Government has confirmed it is proceeding in the forthcoming HSC Bill with abolition of practice boundaries, so user friendly comparative information to enable choices and changes is essential.  It is not acceptable to the public to say that NHS London is doing this work – there is no sign of it on their website –  so the PCTs do not have to.   

PEC agreed that a “balanced score card” showing comparative performance of all Wandsworth GP practices by name will be completed in the next 4 weeks and put up on the PCT website.

Hospital discharge.  

Wandsworth LINk published its hospital discharge study in mid December based on patient and carer interviews.  This is important user-focused intelligence, so how will the existing and future commissioners take account of it?

Next Meeting of the NHS Wandsworth Board: Wednesday 26^th  January 2011 in the Richmond/Barnes Room at Queen Mary’s Hospital, London SW15.

Next Meeting of the PEC: 09h30 on Tuesday, 8^th February 2011.  I have given my apologies and there will be no Lay Member’s report from this meeting.

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.