Patient and Public Engagement Event 30 October 2019

Patient and Public Engagement Event 30 October 2019 1 -4 pm 1

Housekeeping • • • No fire alarm is planned today. If you hear the alarm, please follow the CCG fire warden who will help you to evacuate. Please turn your mobile phones off or put them on silent Please help yourself to refreshments throughout the event Feedback forms will be emailed to you after the event and a small number of printed copies are available Please tell us what you what think of today’s event on the feedback form and tell us about topics you would like to see at future events. 2

Agenda 1: 00 pm-1: 30 pm Sign in, refreshments and networking 1: 30 pm-1: 40 pm Welcome Kevin Sheridan, Lay Governing Body member for Patient and Public Engagement 1: 40 pm-2: 00 pm 2: 00 pm-2: 15 pm 2: 15 pm-2: 20 pm - 2: 35 pm-3: 10 pm 3: 10 pm-3: 45 pm - 4: 00 pm Enfield CCG corporate update Dr Mo Abedi, Chair Commissioning Intentions Stephen Wells, Senior Programme Manager Immunisation and staying well in winter Raste Fatah, Primary Care Project Support New Approaches to Diagnosing Long Term Illnesses Philippa Mardon, Deputy Director Transformation, Performance & Delivery NHS Long Term Plan Graham Mac. Dougall, Director of Commissioning Primary Care networks Riyad Karim, Interim Head of Primary Care Commissioning Questions and Answers session with the Governing Body Thank you and event closes Kevin Sheridan, Lay Governing Body member for Patient and Public Engagement 3

Enfield CCG Update Dr Mo Abedi, Chair

Finance update • For 2019/20 as at month 6, the CCG is reporting to plan for both year to date and forecast outturn against our planned deficit of £ 15. 4 m. The QIPP efficiencies required to deliver this is around £ 15 m per plan and any slippage needs to be mitigated through compensating new schemes or other financial efficiencies. • Looking ahead to 2020/21, the CCG is working to an indicative gross transformation programme of £ 17 m with a particular local focus on long term conditions in order to foster financial sustainability. • Alongside this there will be transformation schemes informed through the Medium Term Financial Strategy that is currently being developed across the NCL footprint. All transformation will need to phased and supported by investment/reprovision arrangements. • As well as contractual agreements with acute providers, success on delivery will require a continued integrated approach to patient care across involving primary care, mental and community health and voluntary sector. The plan is expected to improve the patient journey and/or maximise the use of finite resources. Primary care has a pivotal role to play in how services are shaped going forward.

Annual Report and Accounts 2018/19 • The CCG held its AGM (Annual General Meeting) on the 18 September 2019. At the AGM, the CCG presented the highlights, achievements and financial performance for Enfield and across North Central London for 2018/19. The Annual Report and Accounts were approved by the Members that were present. • The Annual Report and Accounts are available for review on the CCG’s website: https: //www. enfieldccg. nhs. uk/Downloads/Annual. Reportand. Accounts/Enfield %20 Annual%20 Report%20 and%20 Accounts%202018 -19. pdf

Enfield GP extended access service • From 1 October 2019 the weekend walk-in service activity has been transitioned into the current GP extended access service, in line with the national model of care. • Patients are required to request a GP hubs appointment via their own GP practice directly during core opening hours, or via NHS 111 weekday evenings, weekends and bank holidays when the practice is closed. • If an Enfield patient walks in to one of the four Enfield GP access hubs are now offered a same day booked appointment instead, or redirected to another service if clinically appropriate. • Any out of area patients who walk-in at an Enfield GP hub are redirected to NHS 111. • From 2020/21 extended access services will be transitioned to the new Primary Care networks who will receive

Enfield GP extended access service

Chase Farm Urgent Care Centre • The Urgent Care Centre (UCC) at Chase Farm Hospital (CFH) opened in January 2013. The UCC was open from 9 am-9 pm, 365 days of the year. • In January 2015, the CFH UCC opening hours extended from 8 am-10 pm. The extension to the opening hours has continued. • The Royal Free London has approached commissioners about the possibility of reducing the opening hours of the Chase Farm UCC by one hour with the last patient being booked at 9 pm, citing low attendance figures. • Enfield CCG decided to undertake an engagement exercise, as the main users of this service are Enfield residents. A report of this public engagement went to the CCG’s Governing Body https: //www. enfieldccg. nhs. uk/Downloads/Board. Papers/2019/ECCG%20 GB%20 Pape rs%20 -%20 September%202019. pdf • Enfield CCG Governing Body supports the continuation of operating hours to 10 pm and we continue to commission the interim Barndoc GP cover in place. • We will be shortly meeting with Royal Free team to discuss an agreeable way forward.

NCL Change Programme NHS Long Term Plan – NCL response currently being finalised based on feedback from a range of stakeholders - North London Partners website https: //www. northlondonpartners. org. uk/ourplan/draft-response-to-the-nhslong-term-plan-in-north-central-london. htm • Local integrated care partnership • NCL Integrated Care System Local clinicians working with local people for a healthier future

NCL Change Programme Proposed merger of NCL CCGs A report on the CCG merger went to the Enfield CCG Governing Body meeting in public on 18 September 2019, page 105. https: //www. enfieldccg. nhs. uk/Downloads/Board. Papers/2019/ECCG%20 GB%2 0 Papers%20 -%20 September%202019. pdf – Application approved by NHS England Improvement – Draft NCL CCG Constitution – An early priority for the new CCG will be to develop and agree a Communications & Engagement Strategy - including to set out how the CCG and its borough-based teams will continue to engage and work with local partners, patient representatives and the public. We will very much value feedback from these groups in the development of this strategy. Local clinicians working with local people for a healthier future

Adult Elective Orthopaedic Services Review Enfield engagement meeting Colin Beesting, Communications & Engagement Lead

What might change in future? • We are recommending changes to planned care for bones, joints and muscles (known as ‘elective orthopaedic surgery’) for adults. • This includes routine hip and knee replacements and other surgery of hips, knees, wrists, shoulders and ankles. • Any changes will affect residents of Barnet, Camden, Enfield, Haringey and Islington. 13

Timeline…what’s happened so far 1 February 2018… • Joint Commissioning Committee (JCC) of the five NCL CCGs signed off the mandate for the adult elective orthopaedic services review August – October 2018…. • Carried out a desktop equalities review to identify impacted groups • Engaged patients, residents and other stakeholders on the draft case for change and rationale for the review. Five clinical design workshops to establish the model of care. December 2018… • JCC approved the design principles for a new model of care and received the feedback from the engagement on the draft case for change January 2019… • JCC approved the overarching timeline, revised governance and accepted the recommendation around final contract form May 2019 the JCC… • Agreed the Clinical Delivery Model and Options Appraisal Process and issued them to providers for them to submit options July 2019… 14 • Carried out the options appraisal process

Next steps Validating our plans: over the autumn an NHS England assurance process will test all aspects of our proposals. This will start with a review of the clinical case for change and proposed model of care by the London Clinical Senate; Joint Health Overview and Scrutiny Committee: we went to the JHOSC in late September to have an early conversation about the consultation process and approach; Preparing for public consultation: as our plans evolve we will involve partners and stakeholders in contributing to the development of our approach to the consultation; Formal decision-making: this is planned to take place in early December, with clinical commissioners asked to approve both the preconsultation business case and decide whether or not to launch the consultation; Public consultation: aiming to start in December 2019

Public consultation – plans in development Our proposals are a change for patients in north central London, who need elective orthopaedic care We plan to consult with affected parties to inform the next stages of the review and continue ongoing engagement with local residents, staff and stakeholders who could help to further improve the model and its implementation Prior to consultation a transport analysis and health inequalities and equalities impact analysis will be completed and published alongside the consultation document The plan is to begin a 12 -week consultation in December Plans are at an early stage, and we welcome your views and feedback to improve them further

We need your help We are planning for a consultation and would like to talk to your networks: • Would you like to be involved in feeding back on proposals? • Do you organise a group that would like a visit from the programme team? • Can you distribute information to members? Send information to: iuliana. dinu@nhs. net 17

Questions Local clinicians working with local people for a healthier future

North Central London CCGs System Intentions for 2020/21 Stephen Wells, Senior Programme Manager, Directorate of Transformation, Performance & Delivery 19

NCL Medium Term Financial Strategy 2020/21 The NCL system has commenced work to develop joint priorities, for 2020/21 and beyond through development of the Medium Term Financial Strategy (MTFS) and the North London Partners draft submission for implementing the NHS Long Term Plan. The NCL system partners have collectively agreed to operate within the framework of the MTFS principles, which are to: q Focus on what is best for the population, rather than taking an institutional approach; q Work to the system benefit and seek to support the collective commitment to reduce system costs and to ensure that any unintended consequences of that for individual organisations are mitigated; q Develop a single local delivery plan for the year for both commissioners and providers to deliver our operating plan and contracts; q Recognise that we cannot deliver a collective balanced plan for NCL in 2019/20 and that we need to develop an NCL medium term financial strategy that both maximise income into NCL and the London system, sets out a system cost reduction programme, and produces a balanced plan over three years with the active support of all providers and commissioners; q To establish contracts for 2019/20 that act as a milestone for delivery of the mediumterm financial strategy; 20

NCL System Intentions for 2020/ 21 (1) The System Intentions for 2020/21 consist of the following: • Provider Contracts - CCG intentions for 2020/21 provide a focus on the development of local tariffs to support existing and future service developments, including service changes or notice on the cessation of services by CCGs and Trusts; • Mental Health Liaison – commitment to continue the pooled provider and commissioner budget in 2020/21; • NHS England Specialist Commissioning in relation to mental health and acute specialist services – specialist providers will identify areas of impact as part of annual contract & planning round for 2020/21; • Same Day Emergency Care - to discuss the Urgent Care Centre service model at Chase Farm Hospital as per the national urgent & treatment centre designation and ensure the model of care is primary care facing and supports a move towards preventative healthcare; • Urgent Treatment Centres – ensure future designation is in accordance with national requirements and delivered as part of the NLP Long Term Plan ambition; 21

NCL System Intentions for 2020/ 21 (2) Optical Coherence Tomography (OCT) Clinic - North Middlesex University Hospital and the Commissioners are evaluating a proposal to introduce a new pathway, which is more appropriate for patients detected with a diabetic related eye disease. Pathology NCL Right Test Right Time programme To review GP Direct Access Pathology, in line with the Right Test Right Time programme, following implementation of Phase 1 & 2 and development of Phase 3, in 2019/20. To improve productivity, reduce duplication of diagnostic testing and enhance diagnostic pathways in pathology through: q Streamlining test electronically, q Supporting appropriate ordering communications systems (t. Quest/ Sunquest), q Implementation of clinical protocols to ensure only appropriate tests are undertaken, q Reducing orders for unnecessary / duplicate pathology tests, q Improving patient experience, q Supporting improvements in electronic data sharing across the pathway in line with Health Information Exchange and other standardised processes. 22

NCL System Intentions for 2020/ 21 (3) GP Direct Access Pathology In line with the NLP CCGs GP Direct Access (GPDA) strategic case for change and the NCL STP diagnostics programme stream we expect to jointly agree a strategic commissioning direction for GPDA for the next 3 -years, informed by the NHS Long Term Plan and the NCL medium term financial strategy which will include: q Quality Improvement – identification of priority areas to improve the quality of service delivery, building on the NCL Right Test Right Time programme to support demand management initiatives with GP practices across NCL CCGs; q Identifying areas for cost improvement aligned to the NHS Long Term Plan and the NCL STP transformation programmes (at care pathway level) to support development of care outside of the acute hospital setting and the development of the integrated care partnerships; q Progressing the development of a “single NCL CCGs” contractual agreement for GPDA going forward; 23

Enfield CCG System Intentions for 2020/ 21 Community Phlebotomy Procurement of a community phlebotomy service in Enfield for early 2020; Muscoskeletal Services Development of First Contact Practitioner and Self-Referral Physiotherapy Service and to consolidate direct access physiotherapy service is aligned with the MSK First Contact Practitioner single point of access; Community Cardiology Enhanced Triage and Diagnostic Hub To implement the agreed model of care to triage GP requests for cardiology and ensure appropriate tests are undertaken in primary care. To commission a 9 -month pilot of the agreed service model with local acute providers; Gastroenterology and development of Reference Assessment Service (RAS) Seeks to agree the development of the gastroenterology service including the reference assessment service (RAS) at North Middlesex University Hospital for the clinical triage of patients at the front door of the hospital; Wound Care Dressings To review the provision of repeat wound care dressings undertaken by the Urgent Care Centres provide by North Middlesex University Hospital and to re-direct patients requiring a repeat wound dressing to primary care, during normal working hours in 2020/21; 24

Enfield CCG System Intentions for 2020/ 21 (2) Mental Health & Community Services Integrated Care and Primary Care Networks (PCNs) Informed by the strategic direction and emphasis on integration around PCN configurations, the emergent borough based partnerships are actively working towards models of care that wrap community physical and mental health care services around patient cohorts to improve quality and experience of care. In this regard, we are encouraging all providers to collaborate with PCNs in the interests of integrated care delivery. Neurological Development Disorders Service - Autism Spectrum Disorder and ADHD NCL commissioners have decided to commission an NCL wide service. As such notice is given on existing ADHD provision. NCL commissioners will propose the new commissioning model for go live in April 2020. Complex Care q In order to optimise bed use, Barnet, Enfield and Haringey CCGs propose to devolve their commissioning budgets for Inpatient complex care to BEH MHT. We are looking to put in place recurrent sustainable arrangements that negate the need for Out of Area Placements rehabilitation beds; 25

North Central London Service Developments 2020/21 NHS Long Term Plan The draft North Central London response to the NHS Long Term Plan which incorporates the systems response to deliver financial balance by 2022/23 known locally as the MFTS can be found at: http: //www. northlondonpartners. org. uk/ourplan/the-nhs-long-term-plan. htm This response covers: Maternity services Integrated community based health care Reducing pressure on hospital services More choice and control over health and more personalised care Planned care Improving mental health outcomes Moving to integrated care systems everywhere Focus on prevention A strong start in life for children & young people Learning disabilities and autism Workforce – NHS Peoples Plan Delivering digitally-enabled care across the NHS 26

Questions Local clinicians working with local people for a healthier future

Immunisation and staying well in winter Raste Fatah, Primary Care Project Support 28

New Approaches to Diagnosing Long Term Illnesses Patient & Public Input Discussion 29

Background • Whilst called the National Health Service, it’s historical focus has been to provide care to those who are injured or unwell • Causes of illness by infectious disease have largely been eradicated in modern societies • However, complex Long Term Conditions, such as diabetes and heart disease are increasing across the UK and the rest of the modern world • These conditions are complex and costly to treat once established, and have a significant negative impact on peoples lives • Sadly, they are on the increase due of worsening lifestyle choices and environmental factors as well as genetic complications 30

The impact In Enfield: • These conditions negatively impact peoples lives (and their families) • Around 89, 000 people have a long term condition • Around 32% of these people have more than one condition • Life expectancy can be six-years less than the national average • An estimated 48% of our hospital admissions relate to these conditions • An annual cost of £ 67 m to Enfield is estimated • These costs are expected to increase by around 18% by 2029 31

What are we working on • In Enfield we are working on new approaches to Long Term Conditions • A major part of this is identifying those at risk, early diagnosis and supporting people to prevent the onset of disease before they become unwell • We intend to launch initiatives that: • Identify people who need extra support • Diagnose those who may have a long term condition earlier • Introduce new treatments that help people to stay healthy • Enable people to manage their own health and conditions • It is critical that we include people like you in these projects and the 32 design of new services

Questions 1. How many of you have a long-term condition? 2. Were you diagnosed: • In hospital? • By your GP? • Privately? • Other? 3. Do you believe you could have been diagnosed earlier? 4. How did you feel when you received your diagnosis? 5. How could your diagnosis experience and the immediate time after be improved? 6. What impact has the long term condition had on you? 7. In what ways could you be better supported now? 8. Have you, or would you, seek support from others with similar conditions? 9. How would you feel about using technology (phones, apps) to improve your treatment? 10. Do you feel able to use modern technologies, such as smartphones, apps, wearable devices, smart-TVs? What could be done to help you with this? Finally How do you think patients can help us with this work? 33

NHS Long Term Plan - What does it mean for Enfield? Graham Mac. Dougall, Director of Commissioning 34

Primary Care Networks Riyad Karim, Interim Head of Primary Care Commissioning 38

Primary Care Networks video https: //www. youtube. com/watch? v=W 19 Dt. Esc 8 Ys

Enfield GP Practices and Primary Care Networks, July 2019

Enfield’s emerging PCN Landscape • West Enfield Collaborative PCN – Population 40, 447 – Clinical Director: Dr Rizwana Noor • Enfield Care Network PCN – Population 100, 095 – Clinical Directors: Dr Sanjay Patel, Dr Mohammad Choudhry and Dr Harry Grewal • Enfield Unity PCN – Population 158, 030 – Clinical Directors: Dr Sarit Ghosh, Dr Ujjal Sarkar and Dr Chimere Aka • Enfield South West PCN – Population 45, 286 – Clinical Director: Dr Yogasankaran Arjuna

Recap - The NHS Long Term Plan (LTP) § The NHS Long term Plan was published in January 2019 setting out how the NHS will: § make sure everyone gets the best start in life § deliver world class care for major health problems § support people to age well How: Ø Primary care networks as the foundation for Integrated Care Systems Ø Preventing ill health and tackling health inequalities Ø Supporting the workforce Ø Maximising opportunities presented by data and technology Ø Continued focus on efficiency

Recap - the new GP contract Addresses nine goals, including: § addressing workload issues § developing Primary Care Networks (PCN) § improving Quality and Outcomes Framework § joining up urgent care services § using of digital technologies § delivering new services § providing more certainty about funding for 5 years § setting up a new clinical negligence scheme

Primary Care Networks – Working at Scale § Groups of GP practices working more closely together, with other primary and community care staff and health and care organisations, providing integrated services to their local populations. § 30, 000 – 50, 000 Patients § Wider range of services for patients § Staff recruitment and retention § Managing financial and estates pressures § Integration with wider health system § Involve local community from the start, working together to design and develop services and support

Questions Local clinicians working with local people for a healthier future

Panel questions and answers session Ask us anything! 47

Key dates for your diaries Governing Body Meetings 18 December 2019 1: 30 -3: 30 pm 18 March 2020 1: 30 -3: 30 pm Meetings take place in the Committee Room at Holbrook House, Cockfosters Road, Barnet, Herts, EN 4 0 DR NCL Joint Commissioning Committee 05 December 2019 2: 30 pm - 5: 00 pm Committee Rooms 1 and 2, Civic Centre, High Rd, Wood Green, London N 22 8 LE Patient and Public Engagement Meetings 2020 To be confirmed. Patient Participation Group (PPG) network meetings For Chairs and members of PPGs and staff at member practices who support patient groups only. Thursday 5 December 2019, 6 -9 pm, Dugdale Centre, Please email enfccg. communications@nhs. net to be added to our stakeholder list and be notified of news and events. All events are advertised on our website: www. enfieldccg. nhs. uk; Twitter @Enfield. CCG and in local newspapers.

How you can get involved • • 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 or a North Central London CCGs meeting – dates are advertised on our website, on Twitter and in the Enfield Independent Follow us on Twitter @Enfield. CCG Sign up to our mailing list - we will add your email address from the sign-in sheet to our list OR contact enfccg. communications@nhs. net Contact us if you would like someone to attend your voluntary or community group meetings Visit our website www. enfieldccg. nhs. uk NHS England Participation opportunities: https: //www. england. nhs. uk/participation/get-involved/opportunities/

Proposed move of Moorfields Eye Hospital’s City Road services – Request for feedback on draft summary of consultation findings A draft summary of consultation findings, prepared by independent evaluators, is now published and open for comment. The independent analysis of the survey responses tells us that 73% of responses agreed with the proposed new centre and 73% agreed with St Pancras as the preferred site. A final outcome report will be published in November, which will inform a decision-making business case for consideration in determining if the proposed move should go ahead. This decision is due to be taken in December 2019. You can download a copy of the findings summary here https: //oriellondon. org. uk/consultation-documents/ or contact the consultation team by emailing moorfields. oriel@nhs. net or calling 020 7521 4684. All comments on the proposal should be returned to the consultation team by Wednesday 6 November.

Thank you for attending today’s event For more information www. enfieldccg. nhs. uk Follow us on Twitter @Enfield. CCG Contact: enfccg. communications@nhs. net 0203 688 2814 51