Patient and Public Engagement Event Getting the best value for every NHS pound

1. Patient and Public Engagement Event Getting the best value for every NHS pound Wednesday 20 July 2016 Green Towers Community Centre, 7 Plevna Road, Edmonton N9 OBU

2. Welcome 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 • There is a disabled toilet on this floor. The main toilets are downstairs on the ground floor • You have a local GP and an NHS manager on each of your tables. They are here to lead the group discussions. We have three group work sessions today. • Please help yourself to refreshments throughout the event. Local clinicians working with local people for a healthier future

4. Listening to you • Your feedback is important to us today • We want to work closely with local people to develop our plans • Today we are going to focus on our plans for the next year • We will ask you to fill in a feedback form (in your pack) about today’s event. Please tell us what you what think of today and tell us about topics you would like to see at future events. • We would like you to get more involved in the CCG: • Join your GP practice’s Patient Participation Group (PPG). Ask your practice if you can join. We have an active PPG network and an elected PPG representative Litsa Worrall who sits on the Governing Body • Volunteer to be a patient representative and help us improve services for local patients forms are available. • Attend a Governing Body Meeting – dates are advertised on our website, on Twitter and in the Enfield Independent • Follow us on Twitter @EnfieldCCG • Sign up to our mailing list – contact communications@enfieldccg.nhs.uk • Visit our website www.enfieldccg.nhs.uk Local clinicians working with local people for a healthier future

5. Agenda 10:00am-10:05amWelcome - including introduction for new GB members Teri Okoro, Lay Member for Patient and Public Engagement 10:05am- 10:20pm CCG Financial Position and future commissioning plans Rob Whiteford, Chief Finance Officer 10:20am-10:40pm Introduction to the group work sessions Teri Okoro, Lay Member for Patient and Public Engagement 10:40am-12:40pmThree workshops each lasting 40 minutes GP Governing Body Members and CCG commissioners lead discussions on: Repeat Prescribing- Dr Jahan Mahmoodi and Paul Gouldstone Paediatric Assessment Unit - DrMo Abedi and Claire Wright Future of Primary Care GP Services – Dr Janet High and Deborah McBeal 12:40pm-12:55pmPanel questions and answers Your opportunity to ask any questions to our panel of clinicians and NHS managers 12:55pmThank you and event closes Teri Okoro, Lay Member for Patient and Public Engagement Local clinicians working with local people for a healthier future

6. CCG Financial Recovery & Future Commissioning Plans Rob Whiteford, Chief Finance Officer

7. 2017/18 2016/17 2015/16 The Financial Challenge – Now and Next Year McKesson Service Auditor SBS Service Auditor Assurance from various business partners / service providers as well as internal sources of assurance (management and Internal Audit) Actual In-Year Deficit £14.4m Internal Audit Capped In-Year Deficit £7.7m SBS Service Auditor No In-Year Deficit £0m Internal Audit Assurance Framework CSU Service Auditor McKesson Service Auditor Control Self Assessment 8

8. Financial Position and QIPP • Planned 16/17 deficit of £14.9m including £9.9m QIPP programme • NHS England rejected 16/17 plan of £14.9m deficit and required an additional £7.2m of QIPP opportunities – a deficit of £7.7m • Due to scale of current QIPP programme, difficult decisions are necessary • We want to engage to quickly identify and implement clinically led opportunities Local clinicians working with local people for a healthier future

9. Financial Position and QIPP

10. Progress on additional QIPP of £7.2m £1.8m Risk Rated £7.2m Required QIPP £3.6m Schemes Identified • Schemes include: • Complex Care • Medicines Wastage • Re-procurement of CSU Services • POLCE reduction • Clinically led change through RightCare

11. Areas of focus for savings Our Right-Care Programme Our RightCare opportunities are £10.3m per annum, and £1.3m in 2016/17

12. Other savings opportunities • Vacancy freeze in corporate departments • Shared posts with Barnet as opportunities arise • Contribution from partner CCGs • RightCare – clinically led schemes • We need to deliver £5.4m recurrently in 2016/17 from these initiatives. • Do this and achieve our QIPP of £12.0m in 2017/18 we are in recurrent balance Local clinicians working with local people for a healthier future

13. North Central London’s Sustainability and Transformation Plan • Every health and care system has been tasked with producing a multi-year Sustainability and Transformation Plan (STP) – to become sustainable and deliver the NHS Five Year Forward View – better health, better patient care and improved efficiency • North Central London partners are collaborating to develop and agree a plan – includes clinical commissioning groups, hospitals and local authorities • The plan will provide access to transformation funding Our financial plan for 2016/17 was initially a deficit of £14.9m, which was subsequently altered to £7.7m by NHSE

14. Strategic aims and objectives To develop a sustainable plan that improves health, improves patient care and improves efficiency. Ahigh level case for change is being developed that provides evidence that significant transformation to the delivery of healthcare services is needed over the next 2–5 years. From this initial evidence and engagement with senior leaders across all NCL health and care organisations, we have identified a set of priorities: Transforming urgent and emergency care Transforming care for those with severe and enduring mental illness (SEMI) Primary care transformation: developing an enhanced offer from primary care Optimising the use of the estate Prevention and self care: better health for North Central London Care for those with chronic complex needs Care for those in child and adolescent mental health services (CAMHS) To deliver against these priorities we are establishing a substantial programme of work. The programme will have strong clinical leadership and a strong clinical focus.

15. Feedback and Questions

16. Repeat prescribing Dr Jahan Mahmoodi, Clinical Director

17. Repeat prescribing can be defined as: “a partnership between the patient and prescriber that allows the prescriber to authorise a prescription so it can be repeatedly issued at agreed intervals, without the patient having to consult the prescriber at each issue.” In our financial position and with limited resources, we need to think carefully how we can best spend our budgets, and this year we want to think about how we can reduce wastage associated with repeat prescribing Local clinicians working with local people for a healthier future

18. Cost • Around 10% of the CCG’s budget is spent on GP prescribing. • In 2015-16 5.2 million items were prescribed by Enfield GPs at a cost of £37.8 million. • Over 95% of items dispensed are on free prescriptions • Repeat prescriptions accounted for more than half the items dispensed in 2015-16 Local clinicians working with local people for a healthier future

19. Quality and safety issuesin repeat prescribing • Medications are ordered on behalf of patients by pharmacies without the patient being contacted for confirmation are often over ordered or ordered too soon • Many patients who receive repeat prescriptions often end up with too much medicine and stockpile it at home. This medicine will eventually go out of date which is another risk to patient safety and it requires safe disposal through local pharmacies Local clinicians working with local people for a healthier future

20. What can GP practices, pharmacies and patients/carers do to improve safety and reduce wastage from the repeat prescribing process? • Proposal: • In the future, patients will be asked to confirm with their pharmacy or through their GP practices website what items they need every month rather than the items being automatically issued. GP surgeries will not accept repeat prescription orders from pharmacies without proof that the patient has requested the items. • What do you think of these plans? • How do think it would impact the way you or people you know order medicines? • How could the CCG help member practices educate patients if we recommended a change to this system? Local clinicians working with local people for a healthier future

21. Paediatric Assessment Unit (PAU)at Chase Farm Hospital Dr Mo Abedi, Chair Claire Wright, Head of Strategy and Children’s Commissioning

22. About the PAU at Chase Farm Hospital What does the Chase Farm PAU do? • Consultant led service that enables children aged 0-18 to be assessed, treated and observed by trained paediatric staff How do patients access this service? • Referrals to this service are made by the Urgent Care Centre (UCC) at the Chase Farm site, or by your GP or other services. The PAU is not a self-referral unit which means you cannot just turn up or make appointments directly What happens next? • In most cases a child or young person would be assessed and treated and sent home. However if a child or young person is deemed to be more appropriately seen in another setting then there is a transfer protocol in place from Chase Farm to the other hospital sites Clinical review of the PAU • A review of the PAU has taken place in line with last year’s commissioning intentions • The review was chaired by Enfield CCG’s Governing Body lead for children and involved clinical staff from the Royal Free Hospital, including clinicians who work in the PAU • The review group was asked to review the effectiveness of the current model in the context of the overall provision for children

23. Issues Range of urgent care services for children The PAU at Chase Farm is one of many options for children who need urgent care in Enfield. Other choices include: calling NHS 111, visiting your GP practice, attending the urgent care centres (at Chase Farm, Barnet or North Middlesex Hospital) or contacting GP Out of Hours services (via NHS 111), or in a life-threatening situation, visiting A&E (Barnet and North Middlesex). Patient choice Parents are given a choice of which PAU they would like to attend. There are more attendances at the other PAUs (at North Middlesex and Barnet Hospitals) Low attendance In the last year (2015) the majority (94%) of the children or young people who presented at Chase Farm’s Urgent Care Centre were seen and treated by the staff there without needing a referral to the PAU. Only a few (6%) of these patients needed to be referred into the Chase Farm PAU for observation and treatment and of those less than 1% were transferred to Barnet or North Middlesex Hospitals for further care.

24. Issues continued Staffing and skills The PAU at Chase Farm is staffed by a paediatric consultant and two nurses on rotas. The more patients that clinicians see, the more skilled they become. If clinicians can’t see the patient numbers recommended by their Royal College, then it’s likely that recruitment and retention of staff could become difficult in the future. All the PAUs provide clinical advice and guidance for Enfield GPs, however a limited number of GPs use this service. Cost The cost of the PAU service at Chase Farm is £409,000 per year. A PAU would usually be funded by the Payment by Results tariff (payment for each attendance) but for the Chase Farm PAU but this would not cover the cost of providing the service with the current levels of attendance. Enfield CCG is a financially challenged CCG. The NHS has limited funds and spending decisions impact on other services. Chase Farm redevelopment The Chase Farm Hospital site is being redeveloped by the Royal Free London NHS Trust. Enfield CCG as lead commissioner for the Chase Farm Hospital site has an opportunity to influence how children’s services are provided at this site in the future.

25. Your views Due to the low attendances at the unit the CCG is considering how the provision of children’s urgent care will work at the Chase Farm site in the future What are your thoughts on the issues raised by the review? • Range of urgent care services for children • Patient choice • Low attendance • Staffing and skills • Cost • Chase Farm redevelopment opportunities • Are there any other issues that we need to consider? Next steps We will be undertaking more engagement on this over the summer. Let us know if you want to get involved or have any suggestions for groups we can visit. Local clinicians working with local people for a healthier future

26. Future of Primary Care GP Services Dr Alpesh Patel, Primary Care Clinical Lead Deborah McBeal, Director of Primary Care Commissioning and Deputy Chief Officer

27. The Patient Offer • Your practice will be open during routine hours of 8 am – 6.30 pm Mondays - Fridays • You will have a choice of appointment including flexible length of appointment time appropriate to your needs – named/same doctor for continuity of care or with a GP/Nurse for rapid access for urgent problems • You will have access to extended opening hours of 8 am – 8 pm 7 days a week across Enfield • You will only need to make one contact to make an appointment - in person/by phone or on-line • You will have on-line access to view your medical record, order repeat prescriptions and make appointments • You will have access to a greater range of services nearer home, reducing the need to travel to hospital • You will be supported to self care and purchase medicine over the counter where this is available • You will be prescribed the most clinically and cost effective medicine • You will received care in safe and suitable premises that support your well-being • Your practice will identify patients who would benefit from co-ordinated health and social care with a named clinician and will proactively review you on a regular basis • Clinicians across local health and social care will have access to a sub-section of your medical record to provide seamless and co-ordinated care Local clinicians working with local people for a healthier future

28. Primary Care Work In Progress • IT • Digitalisation of records to free up practice space for clinical services • Integrated Digital Care Record • Patient online services • Electronic consultations • Estates • Local Estates Plan developed • Space utilisation surveys • Silverpoint opening in Autumn 2016 • Feasibility studies planned for Chase Farm, Alma and Ladders Wood regeneration areas • Potential new premises and extensions being scoped in all four localities • Workforce • General Practice Nurse programme – 5 new GPNs by February 2017, 8 new GPNs by February 2018 • Practice Nurse and Practice Manager mentoring schemes introduced • Workforce planning underway • Services • Integrated Commissioning scheme from July 2016 • AF and Pre-Diabetes scheme from October 2016 • GP See and Direct • 8am – 8pm / 7 day GP Service Local clinicians working with local people for a healthier future

30. Group feedback

31. Key dates for your diaries Governing Body meetings in public 28 September 2016 – time and venue to be confirmed Annual General Meeting 28 September 2016 1-2:30pm 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 6 September 2016, 6.30 – 9pm, Executive Suite, Dugdale Centre, Thomas Hardy House, London Road, Enfield, EN2 6DS Tuesday 6 December 2016, 1.30 – 4.30pm, Executive Suite, Dugdale Centre, Thomas Hardy House, London Road, Enfield, EN2 6DS Patient and Public Engagement meeting For all Enfield residents and local stakeholders. Wednesday 16 November 2016 2 - 5pm Wednesday 2 March 2017 2 - 5pm Venues and agendas to be confirmed nearer to the dates of the events. Please email communications@enfieldccg.nhs.uk to be added to our email and be notified of news and events. 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

32. Panel questions and answers session Ask us anything! Local clinicians working with local people for a healthier future

33. Thank you for attending today’s event For more information www.enfieldccg.nhs.uk Follow us on Twitter @EnfieldCCG Contact: communications@enfieldccg.nhs.uk 0203 688 2814 Local clinicians working with local people for a healthier future