Agenda item


To receive reports on GP Engagement, Screening Services and Antenatal Services from Dr Tha Han, Consultant in Public Health and Allison Duggal, Consultant in Public Health.


·         GP Engagement Presentation

·         GP Engagement Report

·         National Screening Programme Report

·         Cancer Screening Report

·         Antenatal Services Report


Reports were presented on the following :

  • GP Engagement – Dr Tha Han
  • National Screening Programme Roles and Responsibilities and Cancer Screening Update –  Dr Allison Duggal and Jo Murfitt
  • Antenatal Services –  Dr Allison Duggal 


Post meeting note – Dr Tha Han has pointed out that his presentation should have stated – Life expectancy gap is : 8.6y (F) and 7.4y (M)


GP Engagement

Dr Tha Han presented this report and highlighted

  • Despite improvements there remain significant health inequalities within the borough.  These inequalities are more pronounced within the 5 wards of Upper Edmonton, Ponders End, Enfield Lock, Chase and Jubilee.  Public health is focused within these wards and elsewhere to help to mitigate against health inequalities.
  • There is a variation in the primary care management of long term care conditions (i.e cardiovascular disease, cancer and respiratory problems) between GP practices.
  • It was thought high quality primary care was key to improving health outcomes and for lower dependency on the acute services and social care sector.
  • Enfield GP’s face huge challenges related to: a high level of long term conditions in the borough, problems of socioeconomic deprivation and the high population churn.
  • Enfield is one of the most deprived boroughs in London. In addition, NHS payment per registered patient to Enfield G.Ps, is the third lowest in London at £118.


He referred to a plan set out by the public health team to address issues, the aim of which is to reduce illness from preventable conditions and conditions modifiable by healthcare by collaborating with Health and Wellbeing partners. 

·         To reduce variation in clinical care of long- term conditions  among general practices across Enfield by raising awareness of best practice among GP’s

·         To improve management of long-term conditions already identified by local GPs, and also to improve identification and management of major diseases and risk factors in primary care

·         To improve access to effective community services.


The following questions/ issues were raised:

  • There appears to be a discrepancy in the health inequality data quoted from GLA for 2015 – Life expectancy gap: 8.6years (F) and 6.4years (M) between the worst and best ward life expectancy compared to those from Public Health England.
  • When asked how we could raise the issue of increasing the number of Enfield G.P’s, it was thought this should be discussed with NHS England.   Councillor Pearce said members were of the opinion that following the removal of some services from Chase Farm hospital there was insufficient primary care resources here in Enfield.   Jo Murfitt (NHS England) would report this comment back. She referred to the additional workload of GP’s and extra immunisations and appointments carried out by them.  It was thought that whilst the number of GP’s for Enfield was average for London, there may be a higher need as resources for Enfield was lower than it should be.
  • It was questioned what was being done to improve the prevention side of public health especially in relation to obesity and diabetes? It was pointed out that visits had been made to GP practices to give advice on how to promote healthy lifestyles.  Improvements have been seen in some areas such as in smoking cessation.  Also a number of areas where public health team were working with primary care and communities to improve hypertension (High blood pressure)
  • When asked for a GP’s view on the Council’s ‘Cycle Enfield’ Programme, this was generally viewed as a positive initiative as it promotes a healthier lifestyle although it was stressed that exercise needs to be combined with a good diet.  A good diet was key.
  • Allison Duggal referred to the work undertaken by the public health team who have responsibility for the child measurement programme. Letters are sent to make clear to parents what they can do to help set up good habits.  We are also carrying out a peer review with other boroughs to see if we can learn anything further about tackling child obesity.
  • When asked if there were more children in the borough who were overweight rather than under- weight,  it was stated that measurements had not yet began for the year, however, generally speaking the majority of children are at a normal weight.  We do have a large proportion who are overweight with some who are underweight.
  • It was asked why the NHS Payment per registered patient to Enfield G.Ps is third lowest in London at £118 and whether we can pursue this to increase the allocation for Enfield.  It was stated that there is a wide variation in the country.  It is a national payment issue and up to one third is related to performance and claims. It is a quite complicated system for example premises costs are included although the formula for using this is not a simple one.  The public health team are trying to help GP’s with the variation in performance and Enfield CCG with their claims e.g for premises renovations.
  • It was confirmed that a G.P is able to claim extra costs if they specialise in a particular area- such as in dermatology. They also get paid for carrying out immunisations however this is a relatively small allowance.
  • A suggestion was made that if we improved administration for G.P’s this may increase available funding. However a suggestion by GP’s to spend more time with patients to give clear healthcare messages need to be carefully considered because their time is precious and it may lead to a reduction in the number of appointments.
  • Dr Tha Han said it was important that G.P’s are able to learn lessons of best practice from each other, and this is something which we are encouraging.
  • Dr Allison Duggal referred to work being done to reduce obesity. This included using dieticians in the community to advise parents of very young children when they have issues about weaning/ fussy eaters etc.
  • A member of the public referred to patients who do not often attend their GP surgery, and said it would be useful if when they do attend - checks are carried out. This may include blood pressure and cholesterol tests.


National Screening Programme Roles and Responsibilities and Cancer Screening Update   Reports presented by Allison Duggal and Jo Murfitt (NHS England)


The first report by Dr Allison Duggal and Lisa Luhman set out the roles and responsibilities of Public Health England, NHS England, Local Government, CCGs and providers in planning, commissioning and delivering the national screening programme.


The following was highlighted:

  • Much of the screening programme is delivered by the NHS.
  • NHS England is responsible for commissioning screening programmes, which includes monitoring of services
  • Public Health England – responsible for setting policy through its National Screening committee. Includes advice on screening and immunisation.
  • Enfield’s Public Health team reviews screening performance and contributes to production of Joint Strategic Needs Assessment, which informs commissioning decisions.  It also gives public health advice to NHS commissioners and can produce health need audits and health equity audits.


The second report provided an overview of uptake, coverage and performance of Cervical, Breast and Bowel Screening for Enfield CCG registered patients.


The following was highlighted:

  • Enfield is performing above the London average for all three screening programmes
  • Nationally the number of women attending for cervical screening is declining
  • Enfield uptake for breast screening (70.4%) is just above national minimum standard
  • Enfield performs better for bowel screening than the London average for uptake and coverage, but is below the England average.


The following questions were raised:


Q: Councillor Abdullahi said he would like to see a breakdown of the data on cancer screening and immunisation, so that we know where to focus our attention and resources 


A: The data are not available broken down by ethnicity or geography, but are available by GP practice and this might be used as a proxy for geographic data.  It was noted that the data would not be 100% accurate because people are sometimes not registered with a GP.


Q: As public health is now a responsibility for the local authority, since the Health and Social Care Act of 2012 was introduced, do you think the new arrangements work in favour of the local population especially in light of the closure of some of the services at Chase Farm hospital?

Is it possible for public health to support/ work with Local authority to ensure issues are addressed?


A: When the new Act was implemented, the transition was complicated in determining who was responsible for what.  In terms of public health influence in the local area, I think it sits well with the Local Authority, as it enables us to address the wider determinants of health. An example of this would be the impact this has had on local Antenatal services.


Q: It appears that the cancer screening data figures look positive and there seems to be improvements relating to immunisation figures.


A: There had been problems with the data recording system for immunisation which appeared to show our immunisation coverage was much worse than was the case.  We need to do more work to encourage childhood flu immunisation as often children are ‘super spreaders’ – we are currently looking at 2 -6 year age group and for next year this would be for the 2 – 7 year age group.


Antenatal Services – report presented by Dr Allison Duggal.


This report set out some of the recent work undertaken by Enfield Public ealth to help and advise antenatal service providers in planning and commissioning good quality care to women. Also to address health inequalities in the borough. 


The following was highlighted:


·         The National Childbirth Trust was supported by Public Health to train breastfeeding peer supporters for different children’s centres.

·         A breast feeding App has been launched which provides information on support in Enfield, it shows where breastfeeding friendly premises are located.

·         Over last two years the proportion of expectant mothers being seen by 12 weeks 6 days of pregnancy has gradually increased.

·         A toolkit and video have been developed with faith groups to help to discuss early access to maternity services.  This is targeted at the African community as they often do not wish to access maternity services until later in pregnancy. 

·         A roadshow was held in Edmonton with DVD to promote early use of antenatal service and breast feeding – the road show was successful and feedback good.

·         Some members of the Parent Engagement Panel (PEP) have volunteered to work as community health workers to engage parents and families during pregnancy.

·         Obesity in Pregnancy -. Public Health is working with health trainer to provide specialist training in maternity, working with mothers who have a BMI of over 30. Workshops are to be held for affected pregnant women.

·         Learning event held for professionals and health workers by Public Health and Safeguarding Children’s Board to raise awareness of child deaths and particularly those related to Sudden Infant Death Syndrome and to promote safe sleeping.

·         Joint working arrangements are developing to improve engagement of pregnant women in relation to Enfield’s Hidden Harm Parental Substance Misuse service.

·         Ante-natal and new born screening performance data provided – and considered to generally be going well.

·         An infant mortality action plan is being prepared and will hopefully be developed into a strategy for the next financial year.


The following issues were raised:


Q: Do we have data giving age evaluation and details of how far into pregnancy women are when they first access maternity services?


A: Yes we do have this information. This is heavily influenced by a woman’s culture. We are trying to move the target time of a first visit from 12 wks. 6 days to an earlier target.


A member of the public thought it would be useful for girls to view a video/ DVD in school to see the consequences of drug/ alcohol misuse in pregnancy and implications of this on their baby.  It was also thought this should apply to boys / young men.


Q: Who is responsible for visual defects screening

A: The National Screening Committee has recommended this screening service, but the responsibility for commissioning this service would rest with NHS England. We are not aware of any plans to implement this screening service.  There are a number of times when a child would be assessed at school and health visitors do an assessment at 2 years of age. 


Q: Who determines that a person has necessary support when a baby is born?

A: A new mother would be seen by a midwife, then a few days later they will be seen by a health visitor who would look at issues such as bonding, baby wellbeing and check for conditions such as neonatal jaundice.  If someone was struggling the service would be strengthened.  It is the job of the health visitor to take a more holistic view and to signpost additional services should this be required. They would also give advice on immunisation especially on the MMR programme.


Q: Are there an adequate number of Health Visitors?

A: There was a push to train more midwives in 2012. Enfield has a good number of midwives and does very well in retaining them.


Dr Tha Han, Jo Murfitt and  Allison Duggal were thanked for their contributions


Supporting documents: