To receive a report from Vince McCabe, Interim Director of Commissioning, Enfield CCG.
Vince McCabe, Interim Director of Commissioning Enfield Clinical Commissioning Group introduced this report on Enfield Care Closer to Home and highlighted the following:
· The update paper provided details of the objectives and deliverables that are being aimed for from the programme.
· The paper is a snapshot of a very detailed, complex but long scale piece of work. There will be many more opportunities for the Health Scrutiny Panel to feed in.
· This is joint work with Enfield CCG, the local authority, partners in health and social care, voluntary sector, Enfield Health (Community Services in Enfield) and the GP Federation.
· The three main drivers for the programme are :
o Improving access to primary care
o Further develop the Care Closer to Home Integrated Networks (CHINs)
o Further develop the Quality Improvement Support Teams (QISTs)
· The QIST look at unwarranted variation in health needs or services and provide support to individual GP practices.
· This programme is at a very early stage in the process; the three locality-based primary care access hubs are operating as detailed below. The walk in service is operating 8am-8pm on weekends and bank holidays. Already we are seeing increases in usage already especially over the weekend. Full details are below:
o Carlton House Surgery, 28 Tenniswood Road, Enfield, EN1 3LL (18:30 to 20:00 Monday to Friday and 08:00 to 20:00 on Saturday, Sunday and all Bank Holidays)
o The Woodberry Practice, I Woodberry Avenue, Winchmore Hill, N21 3LE (18:30 to 20:00 Monday to Friday and 08:00 to 20:00 on Saturdays and Bank Holidays)
o Evergreen Primary Care Centre, 1 Smyth Close, Edmonton, N9 0TW (18:30 to 20:00 Monday to Friday and 08:00 to 20:00 on Saturday, Sunday and all Bank Holidays)
o Walk in appointments in the North East at Eagle House Surgery, 291 High Street, Ponders End, Enfield EN3 4DN commenced in December 2017 08:00to 20:00 Saturdays, Sundays and all Bank Holidays)
· The GP Federation also known as Enfield Healthcare Co-operative Limited is the clinical hub and will deliver and work in partnership with a wide range of services including GP, Statutory health and social care and third sector. All GP’s in the borough are signed up to this.
· The Integrated Locality Team (ILT) has been in Enfield for a while and will help provide the building blocks for Care Closer to Home.
· The aim is that those working in the 4 localities will know the local area and the local people. They will include virtual teams that can target those most at risk with access to multi-disciplinary teams such as GP’s, District Nurses and social workers.
The following questions/issues were raised:
Q: What is planned for the North East where there is currently no locality based primary care access hub and what has occurred following the review of this?
A: The review is still on-going; there is currently a walk in centre in the area. It is still unclear what will be in the North East; feedback is being reviewed from GP’s and the Walk in Service.
Q: Following concerns that had been raised on waiting times where a GP practice had taken on all patients from another practice. How can GP practices be prevented from taking on more patients than they appear to have either the resources or capacity to deal with?
A: John Pearce at the CCG works with GP practices part of this includes reviewing statistics and the quality of work. The next meeting of the Health Scrutiny Panel has GP access as a main agenda item. The new ways of working with CHINs and QISTs should allow practices to work together and highlight issues; this will enable a mechanism for discussion in the form of a peer review as to why a practice maybe struggling. The CQC have the ultimate authority regarding patient numbers, however a detailed peer review and local knowledge was felt to be the best way to pick this up.
Q: Is the single phone number implemented and is this advertised?
A: Yes and this is advertised through the Health and Well Being members, libraries, Children’s Centres, A & E and GP practices. The telephone number 111 will also direct to these services if that is what is appropriate
Q: How will the localities be governed?
A: Each locality will put forward 1 GP to represent their area and they will be responsible for ensuring delivery of all services that the locality has signed up for.
The recruitment of carers was discussed as a potential issue. The programme will include embedding the third sector within the localities. There are also workforce issues amongst GP’s, can be difficult to recruit and retain GP’s in certain areas where population is very large. Over the course of the next 5 years many GPs are due to retire. NHS London will be running a big campaign to recruit from overseas to fill the gap that will be created before the training of new GPs can catch up.
There will be more need as people age, the public health paper details the difference between living in good and bad health. Many people will need access to primary care when their GP is not open. It was noted that those with serious illness should always go to A & E.
There was a query as to whether ambulances could refer to these hubs. Ambulances are aware of the hubs but there are very complex safety rules around what they can and cannot do.
A member of public praised the patient engagement event that took place before Christmas, where in excess of 100 people were present to provide their views. There was also praise on personal experience at one of the hubs used and the service that had been received.
It was felt that communication between hubs and patients has some teething problems particularly with understanding of what can be done at a hub (both from staff and patients).