Patient and Public Engagement Event 9 September 2015

Patient and Public Engagement Event 9 September 2015

Patient and Public Engagement Event 9 September 2015 Dugdale Centre Thomas Hardy House 39 London Road Enfield EN2 6DS Agenda 10:00-10:10am Welcome - including introduction for new GB members Teri Okoro, Lay Member for Patient and Public Engagement Dr Mo Abedi, Chair of the Governing Body 10:10-10:30am Our Commissioning Intentions 2016-17 Graham MacDougall, Director of Strategy and Partnerships 10:30-10:40am Introduction to the group work sessions Paul Jenkins, Chief Officer 10:40-12:10pm

Three workshops each lasting 30 minutes and Urgent Care, GP Out of Hours and NHS 111 Clinical lead: Dr Hardeep Bhupal, Management Lead: Graham MacDougall, Facilitator: Claire Kapoor Medicines Management Clinical lead: Dr Mo Abedi, Management Lead: Paul Gouldstone, Facilitator: Jenny Mazarelo Child and Adolescent Mental Health Services (CAMHS) Clinical Lead: Dr Fahim Chowdhury, Management Lead: Michelle Guimarin, Facilitator: Clare Wright 12:10pm

Group feedback GP lead for each table 12:20pm Thank you and event closes Teri Okoro, Lay Member for Patient and Public Engagement 12:30:1:00pm Governing Body members and CCG staff are available to talk to you 2 Welcome Dr Mo Abedi, Chair of the Governing Body Teri Okoro, Lay Member for Patient and Public Engagement 3 Housekeeping No fire alarm is planned today. If you hear the alarm, please make your way outside Please turn your mobile phones off or put them on

silent The toilets are on this floor You have a local GP and an NHS manager on each of your tables. They are here to lead the group work sessions there are three. Please help yourself to refreshments throughout the morning. Local clinicians working with local people for a healthier future 4 Local clinicians working with local people for a healthier future Our Vision We are committed to commissioning services that improve the health and wellbeing of residents of Enfield borough through the securing of sustainable whole system care Our Strategic Goals Enable the people of Enfield to live longer fuller lives by tackling the significant health inequalities that exist between communities

Provide children with the best start in life Ensure the right care in the right place, first time Deliver the greatest value for money for every NHS pound spent Commission care in a way which delivers integration between health, primary, community and secondary care and social care services 5 Listening to you Your feedback is important to us today. We want to work closely with our stakeholders and local people to develop our plans for the future and today we are going to focus on our commissioning plans for the next year. We would like you to get more involved in the CCG. You can: Attend a Governing Body Meeting dates are always advertised on our website, Twitter @EnfieldCCG and in the Enfield Independent Join your GP practices Patient Participation Group (PPG) ask at your practice. All 49 member practices have a PPG. We have an active PPG network and an elected PPG representative Litsa Worrall who sits on the Governing Body. Sign up to our mailing list contact [email protected] Volunteer to be a patient representative and help us improve services for local patients Visit our website www.enfieldccg.nhs.uk for more information

Follow us on Twitter @EnfieldCCG You also have some post-it notes on your tables, please use these to jot down any extra questions or comments for us and add it to the feedback wall. We will ask you to fill in a feedback form about todays event. Please tell us what you what topics you would like to talk about at future events. Local clinicians working with local people for a healthier future Our Commissioning Intentions 2016/17 What are our commissioning intentions? Our draft Commissioning Intentions for 2016/17 focus on: Primary Care and Prevention Integrated Care for Older People Unscheduled, Urgent and Emergency Care workshop on urgent care Planned care and long-term conditions Children, Young People and Maternity workshop on child and adolescent mental health services (CAMHS) Mental Health, Continuing Healthcare and Learning Difficulties Medicines Management workshop on prescribing Quality Community Services Today we are focusing our workshops on the Commissioning Intentions highlighted

above. You can also read our draft Commissioning Intentions document online at www.enfieldccg.nhs.uk If you have any comments on the other areas we are not covering today, we would love to hear your views. Please email [email protected] 7 Commissioning Intentions What we have done 2015/16 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.

14. Implemented Integrated Locality Teams Developed new models of care for older / frail people Re-commissioned the Older Peoples Assessment Unit (OPAU) at North Middlesex University Hospital to an Ambulatory Unit. Delivered and assured Better Care Fund investment plan Improved Access to Psychological Services (IAPT) access and recovery rates Improved dementia diagnosis in primary care Implemented Care Homes Assessment Teams (CHAT) Reducing unplanned admissions for over 65s (-8%) Liaison Mental Health services on both acute sites 24/7 Implemented on-line support networks for IAPT, Cognitive Behavioural Therapy (CBT) and 1-1 counselling (Big White Wall / Silver Cloud / IESO) Continued to develop the Community Intervention Service for our learning disability patients

Commissioning two urgent primary care hubs Early booking research with East London University Co-located IAPT and substance misuse services with maternity servicers to improve perinatal mental health What we intend to do in 2015/16 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Crisis Resolution Home Treatment Teams: part of review of adult emergency care pathway Liaison Mental Health Services: reviewed with NCL

CCGs to review models across NCL. National requirement for 24/7 local mental health services by April 2017 Recovery Houses as part of Barnet Enfield and Haringey Mental Health Trust procurement Community and inpatient rehabilitation services District Nursing services Post-acute care enablement and Triage and Rapid Elderly Assessment Team (PACE and TREAT) OPAU Integrated Locality Teams Memory clinics as part of dementia review/prevalence Paediatric Assessment Unit (PAU) and paediatric urgent and emergency care pathways 8 Key Commissioning Intentions 2016/17 1. Develop integrated services for older people across all health and social care

providers including voluntary sector services 2. Commission local hubs for long term conditions including: Chronic Obstructive Pulmonary Disease (COPD), Diabetes and Heart Failure. 3. Commission extended hours urgent primary care services including urgent care hubs in Enfield and procure an integrated 111 and Out-of-Hours services across the 5 CCGs of North Central London 4. Redesign services including dermatology, cardiology, ophthalmology to ensure more streamlined delivery for patients 5. Maximise resources for Child and Adolescent Mental Health Services. Our 2015/16 priorities are: eating disorders, psychological therapies and perinatal mental health 6. Implement mental health Crisis Concordat action plan aimed at ensuring a consistent, co-ordinated approach to adults having mental health crisis. 7. Ensure clinical and cost effectiveness of medicines management and prescribing budgets. 8. Further develop outcomes based commissioning. In particular, commission elective musculoskeletal services Local clinicians working with local people for a healthier future 9 Group work

Each session lasts 30 minutes 10:40-11:10am 11:10-11:40 noon 11:40-12:10 pm Medicines Management Led by Dr Mo Abedi, Chair of Enfield CCG and Paul Gouldstone, Head of Medicines Management, Facilitator Jenny Mazarelo This workshop will focus on how we can reduce prescribing costs for antibiotics (to reduce antibiotic resistance) and on medicines available over the counter. Urgent Care Led by Clinical lead: Dr Hardeep Bhupal, Management Lead: Graham MacDougall, Facilitator: Claire Kapoor This workshop focuses on how we can improve local urgent care services. Child and adolescent mental health services (CAMHS) Led by Clinical Lead: Dr Fahim Chowdhury, Management Lead: Michelle Guimarin, Facilitator: Clare Wright This session looks at our strategy for improving local CAMHS services Local clinicians working with local people for a healthier future

10 Medicines management Main Issues: Increasing Antibiotic resistance - GPs will continue to reduce antibiotic prescribing. Patients should not expect antibiotics when they have colds, coughs, sore throats and ear infections. Self care and treatment for minor ailments e.g. hay fever, cough and cold remedies - patients will be expected to visit a pharmacy and buy medicines or may be able to receive free medicines from pharmacy as part of minor ailments scheme. This improves access to GP appointments. Stopping prescribing of vitamins where there is no evidence of clinical benefit. This would save over 70k a year which could be used to provide other services. Working with hospitals to ensure they use most cost effective medicines to enable maximum number of patients to be treated. 11 Cost of Over the Counter (OTC) medicines on

prescription In 2014-15 Enfield CCGs member GP practices prescribed medicines costing 36.8 million which is around 10% of the CCGs budget Over 91,000 was spent on antihistamines which could have been bought OTC. Over 407,000 was spent on painkillers which could have been bought or a more cost effective preparation prescribed. Over 40,000 was spent on OTC nasal sprays for hay fever or colds. Over 12,000 was spend on OTC Haemorrhoid treatments. Over 48,000 was spent on multivitamin, minerals and antioxidants vitamins which have limited clinical value and could have been bought OTC.

Over 86,000 was spend Omega 3 and other fish oils - this is no longer recommended to be prescribed post heart attack except for hypertriglyceridaemia, and can be bought OTC. Over 93,000 was spend on Gluten Free products 12 Comparative cost of gluten-free vs gluten containing foods 13 Medicines management questions Antibiotic resistance is increasing which is very dangerous for individuals and public health. How can we ensure that antibiotics are prescribed only when necessary and that patients shouldnt expect them? How do patients feel if their GP stopped prescribing products which could be easily bought OTC with the support of pharmacists, who can

offer expert advice on medicines? This would save money which could be invested in other services and would also free up GP time. Cost of prescribing multivitamins, minerals and antioxidants which could be bought over the counter Cost of investing in a new neuronavigator post. This is a therapist who supports patients with brain injuries and complex strokes 48,748 50,000 14

Improving child and adolescent mental health services (CAMHS) Enfield Council and NHS Enfield CCG are keen to engage with children, young people and families, the providers of mental health services, and other stakeholders on a draft CAMHS strategy. The strategy is based on national evidence and policy direction and has a local Enfield focus. Strategy is focused on parity of esteem treating mental health with equal importance to physical health 50% of mental health problems are observed by the age of 14 Fewer than 25-35% of young people are needing emotional and mental health support are receiving it. Key areas for improvement proposed by the strategy

Promoting resilience, prevention and early intervention Preventing/responding to crisis and self harm Improving access to effective support a system without tiers Care for the most vulnerable Accountability and transparency Developing the workforce 15 Improving child and adolescent mental health services (CAMHS) questions What services for vulnerable young people would be the most effective? (Our definition of children and young people includes: children with learning, disability or physical illness, children who are homeless, LGBT, young offenders or children of prisoners, children involved in gangs, looked after children or adopted children, substance misusing young people, homeless, experienced violence and abuse or severe neglect, sexually abused and/or exploited.) What would make the most difference in improving services to young people and their families? What would be effective ways of raising awareness of mental health and

emotional problems? 16 Improving child and adolescent mental health services (CAMHS) - Priorities for investment There is increasingly complex presentations to CAMHS. What would your priorities be to maintain and to improve services? Crisis Self-Harm Early Years work

Early intervention (when symptoms first appear) Public information/Raise awareness about mental health Generic CAMHS services Web based solutions e.g. web sites where young people can communicate their problems and seek counsellor/therapists assistance. 17 Unscheduled, emergency and urgent care Clare Kapoor Programme Lead and Dr Hardeep Bhupal Clinical Lead NCL NHS 111 and GP Out-of-Hours re-procurement Ensure right care, first time The five NCL CCGs (Barnet, Camden, Enfield, Haringey and Islington) will procure a single, integrated NHS 111 and GP Out-of-Hours (OOH) service for their collective population. Urgent and Emergency Care Review To deliver the best possible health care and outcomes to patients requiring it on an urgent basis, at any time of the day or night, within available resources. North Central London CCGs have agreed to undertake a joint review of

system wide urgent and emergency care provision for the populations they are responsible for across the boroughs. We will be undertaking a review of urgent care services in Enfield. 18 Unscheduled, emergency and urgent care questions How do you access urgent care? Where do you prefer to access urgent care? What areas do you think we should review? 19 Group feedback 20 Key dates for your diaries Governing Body meetings in public

Annual General Meeting 30 September 2015 1-2pm and Governing Body Meeting 2:30-3:30pm West Lodge Park Hotel, The John Evelyn Suite, Cockfosters, EN4 0PY (to consider the report of the outcomes of the July engagement activity on the north central London CCGs commissioning intentions to procure an integrated NHS 111 and out-ofhours service). 14 October 2015 3-5pm Dugdale Centre Thomas Hardy House, 39 London Road, Enfield, EN2 6DS Patient Participation Group (PPG) network meeting For Chairs and members of PPGs and staff at member Practices who support patient groups only. Tuesday 22 September 2015 7.00-9:00pm (6.30pm refreshments) Dugdale Centre Thomas Hardy House, 39 London Road, Enfield, EN2 6DS Patient and Public Engagement meeting For all Enfield residents and local stakeholders 6 January 2016 1-4pm Dugdale Centre, Thomas Hardy House, 39 London Road, Enfield, EN2 6DS All events are advertised on our website: www.enfieldccg.nhs.uk Twitter @EnfieldCCG and in the local press. Local clinicians working with local people for a healthier future 21

Ask us anything! Local clinicians working with local people for a healthier future 22 Thank you for attending todays event. For more information www.enfieldccg.nhs.uk Follow us on Twitter @EnfieldCCG Contact: [email protected] 0203 688 2840 Local clinicians working with local people for a healthier future 23

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