You said, we did 

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You said, we did 2018/19 report

The Greenwich Big Conversation patient and public engagement

The Greenwich Big Conversation took place between March and August 2018 and involved local people, member GP practices, staff, and partners working together to develop and refine the Greenwich commissioning strategy for 2018 to 2022. Hundreds of members of the public directly had their say through meetings, outreach, workshops and online and printed surveys, with many more opportunities for conversations and feedback

In September 2018 we launched the NHS Greenwich CCG Strategy which sets out bold ambitions for transforming health and care services in Greenwich. Whether you attended our events, met us during outreach, or you took part in our online survey, you have helped to shape this strategy which will guide our commissioning decisions from now until 2022.

The strategy set outs four priority areas for Greenwich:

  • Priority one: To prevent illness and help our population to live well
  • Priority two: To strengthen local support for people with mental illness, including children and young people
  • Priority three: To better meet the needs of frail people with care closer to home, an integrated urgent care system, and stronger community-based care
  • Priority four: To improve the prevention, detection and treatment of cancers for our local population
  • Priority five: To invest in GP and nurse services within neighbourhoods

In order to achieve these priority areas, we have outlined plans for transformation, which centre on:

  • Developing an integrated care system for Greenwich, in collaboration with social care, public health, providers and community and voluntary sector organisations
  • Investing in a wide range of primary care services, working at scale, across four Local Care Networks, which are responsive to local people

By working as a system, across Greenwich and with our neighbouring boroughs, we can achieve real health, quality and efficiency gains for our population. This means investing in primary and community care including in the primary care workforce and infrastructure. We have already begun this journey and we have the building blocks needed to continue it over the next three years, and beyond.

We would like to thank everyone who shared their views and experiences with us. We are also grateful to our voluntary and community partners and Healthwatch Greenwich and METRO GAVS who continue to work with us collaboratively to ensure health and care services are responsive to local need. Thank you to Royal Borough of Greenwich (RBG), and our other partners who have given their time and energy. Thank you also to the staff within the CCG whose enthusiasm and focus ensured we heard from a wide range of local people.

What did we talk about?

We asked people to give us their views on the following areas:

  1. Preventing illness and supporting people to live well
  2. Improving mental health including care for children and young people
  3. Improving care for frail people
  4. Improving services for people with cancer
  5. Investing in GP and nurse services within neighbourhoods









Priority area 1:

Preventing illness and supporting people to live well.

 

What did you tell us?

What are we doing?

1.

You would like to see the CCG tackle health inequalities.

Our focus is on prevention and living well from birth to death.

We have been working together with the Royal Borough of Greenwich (RBG) to assess the health challenges in the borough and our strategy aims to address these challenges. For more information, please visit the following link; https://www.royalgreenwich.gov.uk/downloads/dow nload/466/health_and_wellbeing_strategy

2.

You would like to see more education as this is a key of prevention agenda from birth to death.

With RBG we set up the ‘Live Well Greenwich’ programme to improve the wellbeing of residents with poor health. The programme offers advice face-to-face, over the phone and online. They can provide information on a wide range of issues that impact on health and wellbeing, including debt and finance, work and training, housing and social isolation.

‘Live Well Greenwich’ allow residents to access help and advice in a way that suits them. By offering this flexibility, the RBG is ensuring that residents can easily get the support they need to live well.

Residents can benefit from up to six 45-minute face-to-face sessions with Live Well coaches in selected community settings for signposting and support. The team are planning to extend the ‘Live Well’ coaches as they don’t yet have a practice based service across the borough. They are looking at how they can secure future resources to do this. The bid money will allow them to roll out further to another 10 GP practices.
For more information, please visit the following link; https://www.royalgreenwich.gov.uk/news/article/11 77/new_live_well_greenwich_service_offers_advic
e_in_person_on_the_phone_or_online

3.

You would like to see access to well-being services to prevent ill health.

4.

You would like to see us supporting people to look after their own health


Priority area 2:

Improving mental health including; care for children and young people.

 

What did you tell us?

What are we doing

1.

You would like to see more support for people with mental health conditions to engage with mental health services.

We are improving the link between physical and mental health support and liaison team in A&Es 24/7 and working towards no out-of-area placements for non-specialist care by 2021. We created a mental health A&E liaison nurse role in Queen Elizabeth Hospital emergency department so that people with mental health needs get the right support and services.
We also introduced an initiative to improve the mental health of people with diabetes through the ‘three dimensions for diabetes’ pilot. The overall aim is to integrate medical, psychological and social care for people with persistent and poorly controlled diabetes

2.

You would like to see increased investment in children and young adults’ mental health services and therapies for up to the age of 25.

We are working closely with the RBG and have a joint children and young people’s strategy which we launched in 2018. We plan to publish the CAMHS Transformation Plan refresh, which details the joint commitment (with RBG, Oxleas and partners) to deliver the best possible mental health and emotional wellbeing outcomes for Children and Young People.

3.

You would like to see early intervention and rapid access to services.

The RBG Families Information and Outreach Service offers help and advice on a range of issues that affect you and your family. The free service is open to anyone in Greenwich with children up to the age of 19 (or up to 25 for families with disabled young people). You can get information about:

  • Education and early years
  • School services
  • Children with disabilities
  • Benefits and work

For more information, please visit the following link; https://www.royalgreenwich.gov.uk/info/200234/ children_young_people_and_families/1980/famil ies_information_service

4.

You would like to see better access to healthcare for people with learning disabilities.

We have a Health Facilitator in the Community Learning Disability team to promote the health care neds of people with learning disability.

We have recruited an acute liaison learning disability nurse based at QEH

We are working closely with RBG and have a joint children and young people’s strategy which we launched in 2018

5.

You would like to see an improved access to Improving Access to Psychological Therapies (IAPT) with regards to perinatal health.

Greenwich, Bexley and Bromley CCGS, have secured funding from NHS England for 2018/19 to improve access to and experience of care of perinatal mental health services. The three CCGs are working on development and mobilisation of the programme.

We are working closely with the LA in implementing our social prescribing service across the borough to support people to access information and support on mental wellbeing.

6.

You would like to see improved support for children and young people have special needs and are falling through the gaps.

We have identified the gaps and have in place a transition team. We are working closely with the RBG at strengthening the processes, working towards transition planning for children from the age of 14.

7.

You would like to see more support for people with dementia living alone discharged to assess.

We commission the Memory Clinic through Oxleas. There is also Better Care Fund (BCF) work on targeting Black Minority Ethnic (BME) communities. There are also a number of voluntary organisations (Alzheimer’s Society, National Dementia Helpline, Dementia UK, The Carers Trust and Carers UK)
who offer support to people living with dementia.

8.

You would like to see the NHS work closely with universities to address students’ mental health issues.

The CCG reached out in June to engage with University Student Welfare to hear about issues facing students. We will continue the relationship as we know students have specific needs and we are keen to include them in planning local health
services.


Priority area 3

Improving care for frail older people

 

What did you tell us?

What are we doing?

1.

You would like to see more services for adults in the community to prevent loneliness
and isolation.

We are working closely with our partners to ensure:

  • Frail people receive safe, high quality interventions in the community
  • Fewer hospital attendances and admissions for frail people
  • Greenwich population benefits from better community services and greater access to primary care (GP) services
  • More people nearing the end of life can die at home or in the community with the right support

2.

You would like to see improved services for people living with Alzheimer/Dementia and Parkinson diseases and improved ways of
diagnosis.

3.

You would like to see the quality of
life for people with mobility issues improved.

4.

You would like to see improvements in long term conditions pathways.

Our focus is to be proactive in our interventions to prevent crisis which result in avoidable admissions particularly towards the end of life.

We want to improve pathways for those living with frailty by developing an approach to frailty which focuses on patients as people and addresses frustrations of patients and their families /carers.

We will support patients through their whole pathway to remain independent and enjoy life.

5.

You would like to see responsive services at the point of need and reduced waiting times where people deteriorate and require more complex care.

6.

You would like to see the beds at Eltham Community Hospital used effectively.

In July 2018, the comprehensive geriatric access service based in Eltham Community Hospital moved to Queen Elizabeth Hospital (QEH). 30 community beds at Eltham remain, covered by a geriatrician, with admission via the QEH Ambulatory Care Unit or via the step-down process for patients needing a bed after discharge from hospital. The referral pathway into the intermediate care rehabilitation beds at Eltham will remain unchanged with hospital or community referrals accepted.

7.

Support services for elderly frail people who are stuck in hospital due to lack of coordinated discharge and lack of community
provision.

We launched a new unit with Royal Borough of Greenwich to provide a community based, home- like environment where patients can have their continuing health and social care needs be
assessed prior to discharge instead of remaining in

 

 

hospital.

We also implemented telehealth in care homes and trained care home staff to manage complex cases, helping to reduce hospital admissions and London
ambulance callouts.

Priority area 4

Improving services for people with cancer

 

What did you tell us?

What are we doing?

1.

You would like to see Greenwich meeting the Cancer diagnosis to treatment national average - 60
days

Our focus for tackling cancer is on helping GPs and nurses to support people to reduce their risk of developing cancer, to refer and diagnose patients in a timely way, and to help people who are living with cancer access the best treatment and services.

In our strategy, we aim to do the following;

  • increase the uptake of screening of cancers,
  • improvements in cancer risk factors (for example smoking, alcohol consumption, diet, physical activity, sunburn)
  • better public awareness of cancer symptoms and the importance of getting an early diagnosis
  • Consistent access to high quality care, timely diagnosis and treatments
  • Increase in cancer survival rates for one to five years
  • Improved patient experience scores.

Screening: bowel cancer

  • Implementation of Feacal Immunochemical Test (FIT) program
  • Implement program to increase uptake of bowel scope screening
  • Implement pilot program for people with learning disabilities to utilise bowel screening

Screening: breast cancer

  • Develop and implement plan to increase attendance at mammograms

Screening: cervical cancer

2.

You would like to see proper palliative care options

3.

You would like to see health and social care professionals talk more to families about palliative care and
end of life

4.

You would like to see more work done around the prevention of cancers and other long term conditions.

 

 

  • Develop and implement plan to increase uptake of Human Papillomavirus Vaccine(HPV)
  • Sign up to text reminding service to increase uptake in cervical screening

 

Screening: increasing awareness

  • Improve use of social media avenues (use of Greenwich Health) – GP federation
  • Engage with Metro to create awareness among lesbian, gay, bi-sexual, transgender, queer (LGBTQ) groups
  • Engage with the Nepalese community
  • Engage with the BME community

Screening: educating practices

  • Obtain Cancer Research UK (CRUK) practice visit program for cancer awareness and monitor progress

Priority area 5

Investing in GP and nurse services within neighbourhoods

 

What did you tell us?

What are we doing?

1.

You would like to see more GPs to meet the healthcare need of the growing population.

We successfully bid with Bexley, Lewisham and Bromley CCGs to launch a recruitment programme for GPs through the NHS International GP Recruitment Programme to address the shortage of GPs in the Borough

Greenwich has a number of in-house support programmes that are delivered via the Community Education Provider Network to support new practitioners to Greenwich, and to help retain existing primary care clinicians. We are also working with our local GP Federation to look at ways of improving access to recruitment resources and are encouraging our practices to use a variety of healthcare professionals to deliver services to free up GP time so that they get to see the patients they really need to.

Practices adjust the length of appointment time dependent on the nature of the appointment – if a review of a person’s overall care plan is required, these appointments are longer than the normal appointment times.

2.

You would like to see improved availability of GP appointments and length of consultation.

3.

You would like to see the profile of pharmacists raised as this will help if people cannot get GP appointments.

Greenwich was a successful bidder for the GP Forward View initiative to introduce clinical pharmacists into general practice. There are the equivalent of 6.5 WTE clinical pharmacists in post supporting 22 practices in Greenwich.

You can consult a pharmacist in confidence so there is no need to queue at your GP. They can give health advice and help avoid a trip to the GP. For example; for conditions like a runny nose, cough or headache, hangover, grazed knee or sore throat. Pharmacy services are promoted in our stay well materials. For more information please visit the following link; www.nhs.uk/staywellpharmacy

4.

You would like to see GP practices open late and weekends.

GP evening and weekend appointments are available to everyone registered with a Greenwich practice at two GP access hubs in Thamesmead and Eltham. They are open Monday to Friday 4pm to 8pm, and Saturday and Sunday 8am to 8pm. Appointments can be booked through 111
or your GP practice

5.

You want to see Greenwich CCG work with all partners across Bexley and Lewisham to deliver equitable care so there is no post code lottery.

Greenwich, Bexley and Lewisham CCGs are working closely together and have formed planned and unplanned care boards to ensure that there is continuity across the three CCGs and our local trust – Lewisham and Greenwich NHS
Trust.