Haringey CCG public meeting - Thursday 19 October 2017

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Haringey CCG public meeting - Thursday 19 October 2017
Haringey CCG
public meeting
Thursday 19 October 2017

Primary care services update
Improving access
to primary care services

 More evening and weekend GP appointments
Patients can now access more evening and weekend
appointments, due to the opening of three primary care
‘hubs’ in GP practices across Haringey. The opening of
these hubs is improving access to primary care for Haringey
residents, by offering appointments at more convenient
Hubs supplement the core offer that GP practices already
provide by offering appointments 8:00am to 8:00pm
Saturday and Sunday and 6:30pm-8:30pm weekday evenings; however, opening hours vary
between the sites. Anyone who is registered with a GP in Haringey can access the appointments
at any of the hubs.
Patients will see a local GP or healthcare professional who may or may not be from the practice
they are registered with. The GP or other professional will have access to the patient’s medical
record to ensure that they offer the best possible care and support. More information about these
hubs are available on the CCG’s website: http://www.haringeyccg.nhs.uk/ccg-news/more-

 Opening new and bigger practices
In addition to improving access by offering more appointments, Haringey CCG is looking at ways
to invest in primary care premises to make sure that patients receive the best care in modern,
fit for purpose buildings. We have been given provisional funding to build three new practice
locations in Haringey, which will be able to offer a wider range of services and have the capacity
for more patients to use them.
Improving access through online services
Haringey CCG is working closely with GP practices to offer more online services to patients.
This includes booking appointments online, ordering repeat prescriptions and accessing medical
records. This will make accessing appointments and other services much more convenient for
patients. Online services will be offered in addition to telephone and face-to-face services, and will
not replace them.

What is going to be different?
 Care in your community
Haringey’s health and social care professionals are already working together in various ways to
provide services closer to, and sometimes within, the homes of local people.
Haringey CCG is keen to build on the integrated work already taking place between health and
social care and the voluntary sector to improve quality and access to primary care services.
Our proposed model for primary care will focus on more joined-up working and person centred
care. GP practices across the borough will work together, along with social care and the voluntary
sector, in small clusters called Care Closer to Home Integrated Networks, to provide a range of
services. These services will be focused on the needs of the local population.
Within these networks, there will be a number of healthcare professionals working together,
including Doctors, Specialist Nurses, Pharmacists and Social Workers. They will be able to share
information and link together better to improve the health and wellbeing of Haringey residents.
Patients, particularly those with long term conditions, such as cancer, heart disease and Chronic
Obstructive Pulmonary Disease (COPD), will receive care that is centred on their individual needs.
By joining health and social care together with primary care, patients can be treated quickly and
will be able to access the most appropriate care for them; improving their health and wellbeing
The aim of this network is to ensure prevention and early intervention, so that residents are
looked after in their community, rather than being admitted for long stays in hospital.
Haringey CCG
public meeting
Thursday 19 October 2017

SEND (Special Educational Needs
and Disabilities) update
The 2014 Special Educational Needs and Disabilities (SEND) Reforms place a duty on agencies to
work together across education, health and care for joint outcomes for children and young people
with additional needs and disabilities. In Haringey this work is coordinated through the SEND
Reforms Group and the key areas of work in which the CCG is involved are outlined in our Joint
Commissioning Strategy for SEND 2017-2019.

    What we’re doing/ have done in this area
•    We are currently reviewing our policy and processes for children’s continuing care to ensure that support
     to those children and young people with the most complex needs is timely, and coordinated.
•    We are reviewing specialist therapies for children and young people with disabilities with an initial focus
     on speech, language and communication services.
     Our next stakeholder event is on
     Wednesday 29th November 2017,                                    Wednesday
     9.30am-12.30pm in the Council Chamber,
                                                                     29th November 201
     Haringey Civic Centre, 255 High Road,                                                                  7
     Wood Green, London, N22 8LE.
     To attend please contact Amanda Jefferson on
     HARCCG.Info@nhs.net / 020 3688 2704 by Friday 24th November 2017.
•    We are currently reviewing equipment services across health, education and social care to look at how
     these can be commissioned and delivered in a more coherent and transparent way.
•    We are working with providers across health to ensure and monitor involvement within the Education,
     Health Care Plan process within prescribed timescales.
•    We are working with the Council and providers to improve transition arrangements for children and
     young people approaching adulthood

    What’s going to be different for people?
We are aiming to develop a comprehensive offer of support, accessible in our local community, that enables
high aspirations for all our children and young people. We want support to be provided at the earliest
opportunity in a fair and equitable way. In order to do this we ensure we have an engaged and confident
local workforce who will work together with the person and their families.

The Joint Commissioning Strategy for SEND will be implemented over the next two years. Significant work is
already happening, and will continue to 2019.
Haringey CCG
public meeting
Thursday 19 October 2017

NHS 111 and GP out of hours
service update

Introduction                                                               NHS 111
The 111 telephone number is available 24 hours a day, 7 days
a week, 365 days a year, and calls are free from landlines and
mobile phones. People can call 111 when they need medical help or advice for conditions
that are urgent but not life-threatening, and they will be directed to the service most
appropriate for their health needs.
GP out of hours services are available so that people can access primary care, for urgent health
problems, when their GP surgery is closed at night or over the weekend. People access GP out of
hours by also dialling 111.
Following a three-year pilot of NHS 111, a new integrated 111 and out of hours service for north
central London (Barnet, Camden, Enfield, Haringey and Islington) began operating in October
2016. The service combines the existing NHS 111 and GP out of hours services into a single
integrated service to deliver streamlined and improved urgent care for all residents of Barnet,
Camden, Enfield, Haringey and Islington.

 Why did we integrate the NHS 111 and GP out of hours services?
Combining the two services means patients get the right help they need more quickly, spend less
time being passed between different parts of the NHS, and will not have to repeat their story
multiple times. For example, more people will find they can get clinical advice or book urgent
appointments directly through 111, instead of being asked to hang up and call again.

 What happens when I call 111?
                             The NHS 111 health advisors ask callers for their details and some
                             information about their symptoms. The health advisors will assess a
GP out                       caller’s symptoms using a clinical tool called ‘NHS Pathways’. At the
of hours                     end of the assessment the caller will be directed to the service that
                             is most appropriate for their symptoms or, if appropriate, will be
                             provided self-management advice.
The new service
• Gives patients direct access to clinical advice from a nurse, paramedic, pharmacist or GP
--   Is more fully integrated with local healthcare services enabling:
--   Direct appointment bookings into other services, including home visits
--   Timely transfer of relevant information about each patient to those involved in the patient’s
--   Better access to patients’ medical histories
--   The immediate dispatch of an ambulance, if needed.
--   Easy access to the out of hours GP service, if needed

Callers whose symptoms indicate the need for a referral to a GP outside of their normal GP
surgery opening hours, will be booked directly into a primary care hub, which offers evening and
weekend GP appointments, or the out of hours GP service.

 Recent service developments
• Dedicated clinicians dealing specifically with activity coming in from London Ambulance
  Service and care homes through dedicated telephone lines.
• Pharmacists managing queries about medicines such as dosage and side effects, which helps
  to free up GP capacity.
• North Central London’s service is one of the first to enable a caller with a mental health need
  or a crisis to be transferred from a clinician directly to their local mental health crisis team.
• NHS 111 online application (App) pilot. The app which can be accessed from any mobile
  device is another way for patients to get safe, accurate health information and advice on
  the appropriate services for their needs. At the end of July 2017 there had been 13,195
  downloads of the application, 15,000 completed interactions with the App, of which 8,000
  queries were completed online. The NHS 111 app can be downloaded from the App store
  from an Apple device or the Play store from an Android device.

 Next Priorities
• Further developing technology to enable patient record sharing, so that when a patient
  agrees, their record can be accessed by a GP wherever the patient is seen.
• Other improvements will take place gradually as the new service works behind the scenes to
  improve the way it links to other urgent care teams - such as district nurses, end of life care
  and rapid response services.
NHS services
for elderly people
living in Haringey
                                                                      Progress 2016-17
People living in Haringey have told us that
                                                                      In the past year we have
their priorities for the care of older people                                                  achieved the
(people aged over 65 years old) are:
                                                                              reduction in people aged
    1. Loneliness and social isolation                              1.4%      over 65 being sent to ho
    2. Leaving hospital                                                      reduction in the rate of
                                                                  11.9%      due to falls in people ag
    3. Accessing NHS services                                                65 per 100,000.
                                                                                                      ed over

    1. Loneliness and social isolation
•    Agreeing to adopt the model of local area coordination in order to strengthen communities and promote
     the independence of local residents
•    Sessions held regarding services for carers which will aim to reduce their social isolation
•    Over 400 socially isolated people supported home from the voluntary sector run service ‘home from

    2. Leaving hospital
•    A 98% increase in the number of people receiving reablement from the London Borough of Haringey
     within the same community reablement service resource
•    A 3.6% reduction in the rate (per 100,000 people) of delayed days for the transfer of care (discharge)
     from hospital
•    Supporting people to leave hospital, when safe and appropriate to do so, and continuing their care
     and assessment out of hospital. Known as Discharge to Assess is now being implemented at North
     Middlesex University Hospital with plans to roll it out across North Central London.
•    Transforming the delivery of bed based intermediate care with step-down beds in Protheroe House. This
     service won a national housing award.

    3. Accessing NHS services
•    Provided more support to people with dementia to access appropriate services
•    Provided more support for people at the end of life in care homes with an advance care planning
•    Delivering self-management support to 221 local residents to help people better manage their long term
•    Helping people improve their health and wellbeing through care planning and care coordination mainly
     delivered in people’s homes via the Locality Team (see figure 1: A case study) overleaf.
The experience of Mrs Gray, supported by the Locality Team

                               1.   Mrs Gray, 76 year old
             Identify          2.   Mobility significantly impaired due to fall and hip replacement
                               3.   Complex history with physical and mental health problems
                               4.   Lives in a supported living flat
                               5.   Frequently calls 999 and attends A&E

             Care              1.   Holistic assessment and care planning
             planning          2.   Medication review to improve pain relief
             and support       3.   Link to mental health and befriending services
                               4.   Education and alternative support for emergencies

             Improved          1.   Increased independence with mobility and personal care
                               2.   Improved mental wellbeing
             wellbeing         3.   Personal goals achieved
                               4.   Well aware of support in community
                               5.   Less inclined to call emergency services.

Priorities 2017-18
Some of our priorities for the next year include improving the Discharge to Assess

    1. Loneliness and social isolation
•    Local area coordinators employed and working in Northumberland Park and Hornsey Central
•    Improvements to carers assessments and support offer
•    Transformation of The Haynes into a dementia hub to link people with dementia and their carers into
     community and social activities

    2. Hospital discharges
•    Implement discharge to assess in all hospitals used by people in Haringey, with focus on North Middlesex
     Hospital and Whittington Hospital
•    Meet our targets for 17 people being discharged from hospital a week through Discharge to Assess
•    Increase the number of people assessed for Continuing Health Care in the community rather than in
•    Improve the efficiency of patients discharged from hospitals into care homes with ‘Trusted Assessors’
•    Communicate all the changes with hospital discharges to all staff and patients in Haringey

    3. Accessing NHS services
•    Working closely with the council and the voluntary and community sector we are developing local
     systems of care, Care Closer to Home Integrated Networks (CHINs). These networks will provide care for
     the local population based around groups of GP practices. In West and Central Haringey the integrated
     networks will begin by focusing on care for the frail elderly, including care home residents.
Haringey CCG
public meeting
Thursday 19 October 2017

Child and Adolescent Mental
Health Services (CAMHS) update
Haringey CCG commissions a broad range of Child and
Adolescent Mental Health Services (CAMHS) and perinatal
mental health services from a number of providers including:
•   Barnet Enfield and Haringey NHS Mental Health Trust
•   Tavistock and Portman NHS Foundation Trust
•   Royal Free London NHS Foundation Trust
•   Open Door
•   Mind in Haringey
•   The Whittington Hospital NHS Trust
•   Camden and Islington NHS Foundation Trust
These services deliver interventions such as counselling, psychotherapy, psychological therapies
and psychiatry for Haringey families.

 What we’re doing/ have done in this area
In 2015 the Department of Health published Future in Mind: Promoting, protecting and
improving our children and young people’s mental health and wellbeing. This allocated
additional funding for CAMHS and required each area to publish a local CAMHS Transformation
Plan for how it would spend this funding on improving outcomes for children and young people,
this is a five year plan to 2021. Haringey’s plan is available to download on the CCG’s website –

So far we have:
• Established a new service ‘Choices’ for families that offers a one-off conversation around
  mental health via self-referral with telephone follow up to ensure the appropriate support was
• Developed a participation strategy with Public Voice that provides a template for engagement
  with parents and children and young people in the design and development of services.
• Invested in post-diagnostic support for families who have accessed the paediatric
  neurodevelopmental and social and communication clinics.
• Increased mental health support to those within the Youth Justice Pathway.
• Expanded services for Children in Care to support those who have experienced multiple
  placement moves and are unable to access their local CAMHS
• Invested in IT infrastructure with our main providers to improve outcome and data monitoring
• Provided additional resource to support pathways experiencing long waits
• Worked with young carers to improve awareness of young carers and their emotional support
  needs with professionals across the borough
• Trained staff across social care and education in mental health
• Worked with Public Health to support the needs of vulnerable children in schools and
  have established Emotional Wellbeing Coordinators in schools and better mechanisms for
  communication between CAMHS and schools.
• Established peer support for children and young people and for parents/carers of children and
  young people with mental health needs.
• Introduced processes for identifying those with learning disability/autism with challenging
  behaviour or mental health issues at risk of inappropriate admission to inpatients or residential
  settings so that multi-agency Care, Education and Treatment Reviews can be convened to step
  up community support.
• Introduced a more coordinated child sexual abuse/assault service which incorporates mental
  health support and advocacy.

What we are working on:
• Improving transition pathways between CAMHS and adult mental health services and social
• Developing out of hours crisis response services
• Improving support for Children and Young People with learning disabilities and/or autism
  who have mental health difficulties and/or challenging behaviour including positive behaviour
• Understanding how we can meet the needs of communities who are under-represented in
  current CAMHS services
• Working with the Mayor’s Office for Policing and Crime to build on the current developments
  around child sexual abuse in line with the outcomes from the 2014 pathway review for
  children and young people who have experienced sexual abuse: https://www.england.nhs.uk/

 What’s going to be different for people?
There will be improved access to CAMHS through reduced waiting times and a broader range of
community locations and appointment times. There will be an embedded approach to mental
health across the children’s and families workforce to better support mental health and emotional
wellbeing. There will be better joint working between different services and organisations which
will mean better, more coordinated care and services.

The CAMHS Transformation Plan is a 5 year plan. Investment and improvements in the system are
already happening, but will continue to March 2021.
Haringey CCG
public meeting
Thursday 19 October 2017

Mental health services update

What we’re doing / have done in this area
We have a new pilot service offering talking therapies
for people with diabetes or breathlessness who also are
feeling anxious or low in mood. This is a joint project with
Islington which we aim to expand across North Central
London and extend to other physical health conditions,
such as chronic pain.
We have increased the capacity of the Barnet, Enfield,
Haringey ADHD assessment and treatment clinic, and
are beginning a wider review of support and treatment
around ADHD and Autism.
We have extended the services provided by Mind in
Haringey as part of our preparation for a new contract with the voluntary sector, which has
improved access to social, practical and motivational support for people with significant mental
health conditions.
We have successfully implemented a 2 week “referral to treatment” waiting time standard for
people having their first experience of psychosis, and invested more in their treatment, including
family therapists.
We are also working in partnership with the rest of North Central London NHS to introduce new
services for people who are acutely ill, including a psychiatric intensive care ward for women, a
service for women who are pregnant or have recently given birth and are experiencing severe
illness, and an inpatient rehabilitation service in Enfield for adults requiring extended support
before returning home.

 What’s going to be different for people?
People with severe mental health problems will start to see improved access to treatment of
physical health conditions and better co-ordination with their mental health treatment.
People with long term physical health conditions will have better access to psychological support
to improve their overall wellbeing.
People facing social and practical issues which are causing deterioration in their mental health will
see improved access to support via their GPs or specialist mental health services.
People in acute illness – and particularly women – will see improved access to care and less risk of
being hospitalised out of London.

Many changes have already happened, though several – such as the talking therapies for people
with diabetes – have only just started and are still growing.
New ways of working in primary care and better integration of physical and mental health is a long
term approach which will continue to develop over the next 3 years.
We are agreeing the timetable for our voluntary sector changes at the moment, but aim to have
new services in place no later than July 2018.
Haringey CCG
public meeting                                                   Thursday 19 October 2017

Prevention initiatives
that keep people healthy
Although people in Haringey are living longer than ever, these extra years of life
are not always lived in good health.
The main reason people live in poor health is because they have one or more long-term
health condition. Long-term conditions can be both physical health conditions like stroke,
heart disease or diabetes or mental health conditions like depression. Many of these long-term conditions
are preventable and Haringey CCG is working with Haringey Council and other partners on a number of
initiatives that prevent long-term conditions and help people to stay healthier for longer.

What are we doing in this area?
 Below are some examples of local initiatives to prevent
 physical ill health in Haringey.

Haringey stroke prevention initiative                     Trust and Embrace UK. Staff and volunteers in these
                                                          organisations have been trained to deliver awareness
General practices in Haringey are doing targeted          raising and testing for high blood pressure in at risk
work to identify people with high blood pressure and      groups, such as Black Africans and in areas with high
atrial fibrillation (a kind of irregular pulse rhythm),   levels of deprivation.
which are two of the most important risk factors for
stroke. So, for example when people over the age
of 65 go for their annual flu jab, they may also have     NHS Health Checks
a pulse check to look for atrial fibrillation. In the     NHS Health Checks consist of a comprehensive
first year of the scheme, more than 10,000 blood          assessment of cardiovascular risk, including blood
pressure and pulse checks were carried out, resulting     pressure, pulse, physical activity and smoking status,
in more than 2,000 additional diagnoses of high           followed by appropriate lifestyle advice, treatment
blood pressure and nearly 300 additional diagnoses        of conditions and referral to support services such as
of atrial fibrillation.                                   smoking cessation.
                                                          We continue to deliver NHS Health Checks through
Community blood pressure checks                           GP practices in Haringey, mainly in the east of the
In October 2017 we are beginning a two year               borough.
programme of blood pressure checks in community           In addition, we deliver NHS Health Checks in
locations, such as libraries, community centres           community settings through Tottenham Hotspur
and community events. We are working with                 Foundation as part of the One You integrated
Tottenham Hotspurs Foundation, Bridge Renewal             wellness service.
Below are some examples of local initiatives to prevent
 mental ill health in Haringey.

Mental Health and Wellbeing in                             Sustainable Employment Devolution
schools                                                    Pilot
We commissioned Young Minds to deliver mental              Haringey is building on good things happening
health and emotional wellbeing training to all             in the borough such as the Individual Placement
schools in Haringey and this programme has been            and Support initiative for people with mental ill
going on for the last few years. Staff are being           health – a programme that assists people to find
trained on how to recognise mental and emotional           and maintain suitable employment. We are now
problems including effects of bullying and self-           designing a new project in collaboration with GPs,
harm. This has been a very successful programme.           the mental health trust, employers and JobCentre
                                                           Plus to help people who are in employment but
Project Future                                             experiencing mental ill health to maintain their
This project is supporting young people at risk of
offending and/or offenders with their mental health
problems. This project is based in Tottenham and
                                                           Time Credit
over the last two years, has helped over 100 young         http://www.justaddspice.org/
people. Over 40% of those supported through                We commissioned Spice UK to provide time credit/
Project Future have found employment or are back           time bank initiatives for people with mental ill
in education.                                              health and the project is a real success. So far, over
                                                           500 hours were earned by people volunteering in
Bruce Grove Youth Service                                  a range of community activities. As a reward, the
                                                           volunteers can spend back these hours on a range
Bruce Grove Youth Service is introducing an
                                                           of community activities and also on cinema or
inspiring new research project in conjunction with
                                                           theatre trips or an activity of their choice that would
Community Links.
                                                           improve their wellbeing.
More Than Mentors is a six week mentoring
programme by young people for young people,                Thinking Space
supporting them to be happy, healthy and
confident. We want to build up emotional strength          Tavistock and Portman NHS Trust are facilitating
and the ability to deal with life’s difficulties through   community discussions across the borough aimed at
peer mentoring. Young People aged 16 to 19 will            building community resilience. Many communities
have a fantastic opportunity to train and gain a           organise themselves around their specific support
recognised qualification and then work and support         needs. There are currently a number of community
other young people to think about what they                thinking spaces taking place regularly such as:
would like to change and improve at school and in          mothers’ coffee morning, women’s wellbeing,
their personal lives.                                      Being a man in Haringey and a general group every
                                                           Tuesday evening. For more information and how to
                                                           join, please contact JCampbell@tavi-port.nhs.uk
Haringey Welfare Hubs
Haringey is co-locating Citizens Advice Bureaux            Mental Health First Aid training
services in GP practices across Haringey including
Queenswood Practice and Bounds Green practice.             Mind in Haringey is commissioned by Public Health
Two advisers from Haringey Citizens Advice Bureaux         to deliver Mental Health First Aid (MHFA) training
provide weekly advice sessions in participating            to all frontline staff and residents, which helps to
practices and give support to clients with mental          raise awareness around mental health. Anyone
health problems, stress or long-term conditions on         who lives or works in Haringey is eligible for free
a one-to-one basis. Clients are either referred by         training. More info: http://www.mindinharingey.
their GPs and other practice staff or they self-refer      org.uk/mental-health-first-aid-training.asp#.
to the service. The majority of advice issues relate to    Vxoo91Jf1LM.
benefits and debt-related issues.                          In addition, Department of Health is funding Youth
                                                           Mental Health First Aid training for all schools
                                                           across England including Haringey schools.
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