Haringey CCG public meeting - Thursday 19 October 2017
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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 times. 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- gp-appointments-for-haringey-residents-at-evenings-and-weekends/27076 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 outcomes. 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 Introduction 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. Timescales 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 care -- 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 following: (people aged over 65 years old) are: reduction in people aged 1. Loneliness and social isolation 1.4% over 65 being sent to ho spital 2. Leaving hospital reduction in the rate of injuries 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 hospital’. 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 facilitator • Delivering self-management support to 221 local residents to help people better manage their long term conditions. • 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 hospital • 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 Introduction 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 – www.haringeyccg.nhs.uk. 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 offered. • 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 care • 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 support • 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/ london/2014/11/02/review-of-pathway-cyp/ 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. Timescales 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. Timescales 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 Introduction 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 employment. 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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