Patient and Public Engagement

Annual Report 2014/2015

Name of CCG: Enfield Clinical Commissioning Group

Name of person who completed this report: Laura Andrews, Patient and Public

Engagement Manager

Internal sign off obtained from: Patient and Public Engagement Committee on 3

September 2015. The draft report was then circulated to all Governing Body members

for comments. Approved by Chair of Enfield CCG and the lay Chair of the patient and

Public Engagement Committee. The report will be formally ratified at the Governing

Body meeting on 14 October 2015

Healthwatch statement completed by: Deborah Fowler, Chair, Healthwatch Enfield

Date submitted to regional team:

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Contents Introduction ............................................................................................................................................ 2

SECTION ONE - Context Setting ...................................................................................................... 2

Vision for Engagement .................................................................................................................... 5

Structure and Resources ................................................................................................................ 7

SECTION TWO: Developing the Infrastructure for Engagement and Participation ................. 10

Processes ........................................................................................................................................ 10

Networks .......................................................................................................................................... 13

Structures ........................................................................................................................................ 14

Partnerships .................................................................................................................................... 15

SECTION THREE- Engagement and Participation Activity......................................................... 16

SECTION FOUR- (Meeting the Individual Participation Duty) .................................................... 19

SECTION FIVE- Forward Plans for 2015-16 ................................................................................. 22

SECTION SIX - Healthwatch Statement ........................................................................................ 24

Appendix A: Commissioning Cycle.................................................................................................. 26

The Engagement Cycle ..................................................................................................................... 26

Appendix B: Quality and individual participation ............................................................................. 0

Appendix C: PPG training ................................................................................................................... 0

Appendix D: Engagement log ............................................................................................................. 0

Appendix E – Collective and Individual Participation duty activities 2014/15 ........................... 13

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Introduction

We are pleased to present our second Annual Patient and Public Engagement

Report. This report describes how we discharged our statutory responsibilities for

patient and public participation as described in the Health and Social Care Act 2012

during the period 1 April 2014-31 March 2015.

SECTION ONE - Context Setting

About Enfield Clinical Commissioning Group

Enfield Clinical Commissioning Group (CCG) is a clinically-led organisation and all 49 GP practices in the London Borough of Enfield are members of the CCG. Our GP member practices have signed up to a Constitution which sets out the governance of the organisation and explains how all the practices collectively work together for their patients to buy the best quality health services. The CCG commissions most health services that GPs refer on to including hospital, community and mental health services. GP practices in Enfield also work closely together in four localities and each geographical area elects two GPs onto our Governing Body. The Governing Body is the executive team that leads our organisation and develops the strategies that will deliver our vision and corporate objectives. The elected GPs lead a Governing Body that includes NHS managers, a secondary care doctor, a nursing representative, lay members, other clinicians, a practice manager, partner organisations and patients. Our organisation serves a London borough that has a growing and changing population and diverse health needs. In this section we would like to introduce you to our borough and the local population that we commission services for. Enfield CCG is coterminous with Enfield Council. We commission health services for more than 326,000 residents in Enfield and we have three main local providers:

Barnet, Enfield and Haringey Mental Health Trust (including Enfield Community services). We are lead commissioner for this Trust.

The Royal Free London Hospitals NHS Foundation Trust (on 1 July 2014 Barnet and Chase Farm Hospitals became part of the Royal Free London NHS Foundation Trust). We are the lead commissioner for the Chase Farm site.

North Middlesex University Hospital NHS Trust. Following the merger of Barnet and Chase Farm Hospitals with the Royal Free London Hospitals NHS Foundation Trust on 1 July 2014 and following the implementation of the Barnet, Enfield and Haringey Clinical Strategy in December 2013, we now commission the majority of hospital services from the North Middlesex Hospital.

We also hold NHS contracts with a range of other acute, community and mental health providers ensuring that a wide range of services are available to support the needs of our diverse population and to support the delivery of choice under the individual patient participation duty.

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We work closely with NHS England who in 2014/15 were the lead commissioners of primary care services. CCGs have an important role under the Health and Social Care Act in helping NHS England to improve the quality of local primary care services. During 2014/15, Enfield CCG, in partnership with the other CCGs in North Central London, applied to NHS England for level 3 primary care co-commissioning responsibilities. This means that later in 2015 we will start to have more influence over the development of primary care in Enfield and can build further on the legacy of the NCL primary care strategy, which was a three year investment programme that ended in March 2015. Although we won’t have the contractual or financial control over the development of new primary services or be involved in performance management, level 3 co-commissioning will allow us greater control in primary care decision making, in particular, strengthening our role in improving quality. Patients and stakeholders tell us that good access to high quality primary care is a very important issue for local people. As a GP-led organisation, we know the impact that good primary care can have on maintaining and improving people’s health and believe that Enfield CCG taking on co-commissioning responsibilities is a very positive step towards improving local services. We also work closely with other four CCGs in North Central London (Barnet, Camden, Haringey and Islington) to plan and improve services together when there are benefits across a bigger population. This includes this includes delivering stakeholder engagement together where appropriate. This year we have worked on larger scale projects together with other CCGs such as planning to commission an integrated GP OOH/111 service across NCL, and this includes planning communications and engagement activities together. Enfield place Enfield is the most northerly London borough and it’s also one of the largest in terms of size (31 square miles). It’s also the greenest borough in London as two thirds of Enfield is open space or designated green belt land, with a wealth of country and urban parks, farmland and fields. Enfield is often called a borough of two halves, divided by the A10 running north-south and the A406 running east to west. The geographical location of these roads provides the grid to understanding Enfield’s population distribution. Not only do most of the population live to the east of the A10 and south of the A406, but deprivation and health problems are also more concentrated in these areas. Enfield is a borough with a significant level of high deprivation. Enfield has the highest number (23,210) of children living in poverty within London. It is the 14th most deprived of the 32 London boroughs and the 64th most deprived local authority district in England out of 326. 32.8% of children under 16 years live in poverty, ranking 6th worst in London and 10th worst nationally. The three Edmonton wards, in the South East, are all within the most deprived 10% of wards in England, whilst 12 of Enfield’s twenty-one wards are in the most deprived 25% of wards in England. The population is also growing faster in the deprived wards. Overall, the proportion of Enfield’s population who are living within the most deprived 10% of areas throughout the country as a whole has increased from 7.0% to 10.3%.

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Enfield people Enfield is an ethnically diverse borough with over 154 languages spoken in schools and over 60% of the population recorded as being non-white. The current population is 326,700 (ONS mid-year 2014 population estimate). The Office of National Statistics (ONS) predicts the population of Enfield will grow by an average of 1.40% per year, and by 2020 the population will be 355,200 which is 7.15% growth from 331,500 in mid-year 2015. The ONS estimates the growth will become gradually slower towards 2020. In contrast, the Greater London Authority (GLA) estimates lower numbers, but predicts that the population will be gradually rise towards 2020 and the highest rise years of growth will be 2017 and 2018. Enfield’s population is also shifting in terms of age. Ages 55-59 and 85+ are rising the most at an average of 3.79% and 3.73% per annum respectively. 20-24 age-group and 45-49 age-groups are predicted to be shrinking by an average of -0.47% and -0.71% per annum (ONS).The proportion of under 15s (21.2%) is higher than both England (17.7%) and London (19%) averages. Our health and wellbeing challenges Our diverse community faces significant health and wellbeing challenges. These challenges can begin before they are born and they can accumulate throughout their life. We are committed to improving the health and wellbeing of people in Enfield throughout their lives. Some of our main challenges to achieving this are:

• There are differences in life expectancy between different areas of Enfield. In the areas of higher deprivation, men live 8.7 years less, and women live 8.6 years less.

• Enfield has largest number of children in poverty in London and the 3rd highest infant mortality rate in London.

• We have a high number of obese and overweight children. • Our population is growing, placing more demand on local services. • We have an ageing population which will need more support in daily living due to

physical frailty, chronic conditions or multiple impairments and significant support from health and social services.

• There is significant variation in the rates of mortality between wards. The largest numbers of deaths in are due to circulatory (cardiovascular) diseases (32%), cancers (29%) and respiratory diseases (14%).

• The rate of employment in Enfield is 67.0%. This is the eleventh lowest rate in London - well below the London average of 69.5% and the England average of 71.1%. Further detailed information about Enfield and the health needs of our population can be found in the Joint Strategic Needs Assessment (JSNA). Our diverse population with their changing health needs presents us with significant challenges in mass communications and engagement. To overcome the challenges of communicating with such a large audience we work closely with local partners and the voluntary sector to ensure our corporate messages and engagement are disseminated across as many channels as possible. We segment our approach to communications and engagement as described on page 13 of our Communications and Engagement Strategy. We have also mapped our stakeholders as an organisation (p12 of our Communications and Engagement Strategy).

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We also take a bespoke approach to communications and engagement planning for programmes of work that focus on improving service, mapping stakeholders and developing activities that match the needs of each project. This ensures we get patient groups and representatives of those health conditions involved in shaping our plans. Going forwards we promise to continue to develop more creative and innovative engagement approaches to get everyone in our community more involved in the CCG.

Vision for Engagement

Enfield CCG continues to work closely with local people to ensure that health

services in Enfield are high quality, good value for money and meet the needs of

people living in our borough. Although our strategic plans for improving health

services will always be based primarily on the health needs of our population, NHS

priorities and clinical evidence, we want patients and stakeholders to become more

involved individually and collectively in helping us to commission local NHS services.

We believe that empowering patients to understand more about their NHS and

increasing patient involvement in designing the health services they use will lead to

better health outcomes for our local population. We also want people to make

positive and informed choices about their health and enable them to select

appropriate services aligned to their needs.

We are also committed to working with our partners to create a sustainable health

economy in which people feel empowered to influence the health and wellbeing of

their community and demand high standards of care with a focus on quality and

safety.

We have listened to what local people, clinical colleagues, partners and other stakeholders have told us about the aspirations of our community and our member practices in developing our corporate vision. “We are committed to commissioning services that improve the health and wellbeing

of the residents of Enfield borough through securing of sustainable whole systems

care.”

Enfield CCG recognises that engagement is one of the key enablers to deliver this vision and states: We will do this by:

Working in partnership with individuals and patient groups to ensure they are central to our work.

Ensuring we work in an open and transparent way with our public and all partners.

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The Communications and Engagement Team plays a strategic role in helping to

ensure our organisation delivers high quality communications and embeds

engagement across all our work.

We know that to achieve the very best health for local people, we need to listen, understand and hear what they are saying about their needs and their current experience of local services and reflect that feedback in all that we do to improve services. We also want to ensure that the services we commission are fair, equitable and do not disadvantage particular communities or groups. Our vision for engagement describes the principles of how we will deliver the

statutory collective and individual participation duties in the Health and Social Care

Act 2012.

“We are committed to delivering the highest standards of communications and

engagement and putting the patient voice at the centre of our organisation.

At every stage of our commissioning cycle we will work to ensure that the services

we plan, buy and monitor are all coordinated and tailored to the individual needs and

preferences of patients, their families and carers - delivering a patient centred NHS.

We are committed to an open and active dialogue with our community. We will

always be honest about the challenges we face and ask patients, partners and our

stakeholders to help us find the best way to improve local health services and get

better value for money.

We aspire to develop more creative and innovative methods of engagement to get

our whole community involved in the NHS and improving their health and wellbeing.”

Appendix A shows how we embed our participation duties in our commissioning

cycle. An example of how we have delivered this vision of a patient centred NHS this

year is through our Integrated Care Strategy. A case study for this piece of

engagement can be found in section three.

Details of key outcomes are given in Section 2, Individual Participation, Section 3

Engagement and Participation Activity and Appendices D- Engagement log and E-

Collective and Individual Participation duty activities 2014/15.

We also use The Consultation’s Institute’s definition of consultation to define the

principles of how we will deliver our statutory requirements to consult under the

Health and Social Care Act 2012.

“Consultation is the dynamic process of dialogue between individuals or groups,

based upon a genuine exchange of views with the objective of influencing decisions,

policies or programmes of action.”

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Structure and Resources

During the year 2013/2014 Enfield CCG directly employed an in-house

communications and engagement team of three, all of whom work full time. This

Team provides comprehensive in-house internal and external communications and

engagement services for Enfield CCG as well as strategic and professional advice to

the organisation on communications, engagement, media, reputation management

and public affairs.

The Head of Communications and Engagement reports to the Director of Quality and

Integrated Governance, whose portfolio also includes: quality, governance,

safeguarding and patient experience. Our team works to the principles described on

pages 10-11 of our Communications and Engagement Strategy.

During this year, along with 12 other CCGs in north and east London, we also

purchased some communications support from North and East London

Commissioning Support Unit (NEL CSU) via a service level agreement (SLA) which

dated from April 2013. The service lines purchased during this year were:

Freedom of Information (FOI) service - This service line manages all FOI

requests. Enfield CCG’s Communications Manager operationally manages

this service line, giving final operational approval and tracking performance.

Media and reputation management - This service line provided a press office

function. Enfield CCG’s Communications Manager operationally manages this

service line, giving final operational approval and tracking performance.

Public Affairs This service line manages MP correspondence (non-

complaints) as well as the Joint Strategic Health Overview and Scrutiny

Committee (JHOSC) in North Central London on behalf of Barnet, Enfield and

Haringey CCGs. There was some resource in 2014/15 for consultation, which

was not required. Enfield CCG’s Patient and Public Engagement Manager

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operationally manages this service line, giving final operational approval and

tracking performance.

Strategic Communications - This service provided additional support for

communications across organisations such as the Barnet, Enfield and

Haringey Clinical Strategy. The Head of Communications and Engagement

operationally managed this service line.

Web and Marketing - This service provides the web technical and hosting of

the CCG’s website and intranet. There is also a marketing team which Enfield

used to plan and deliver a Choose Well campaign and App in partnership with

Barnet and Haringey CCGs. The Communications Manager operationally

manages this service line.

During this year, there was an opportunity for Enfield CCG to review the SLA with

the CSU. Following the review of the SLA, the following service lines were

decommissioned: public affairs, media management, strategic communications,

marketing, and media and reputation management. Operationally, most parts of the

standard operating procedures for these services were already being delivered in-

house. These services were transferred back to Enfield CCG on 1 January 2015.

Enfield CCG decided to renegotiate a smaller bespoke support service from NEL

CSU which delivered the following services to the end of last financial year:

FOI, which formed part of the CSU’s new core offer

Web technical support and hosting of the CCG’s website as this offers value

for money and a service that cannot be delivered in-house.

JHOSC support in recognition of the fact that this committee reviews work

programmes undertaken by one or more CCGs and therefore is best

delivered at scale.

Out-of-Hours media support – This was purchased as a time limited contract

while the services transferred back in-house bedded-in. Going forwards our

team will manage this service alongside the in-hours media function.

Additional services purchased from NEL CSU with SLAs

Equality and Diversity service – This was originally commissioned as a

specialist service line from communications and engagement and remains a

separate contract. This service provides specialist knowledge and operational

capacity that is unavailable in-house. This service was therefore

recommissioned in 2014/15.

In March 2015, an SLA was set up with NEL CSU to deliver communications

and engagement on proposals to commission a joint GP Out-of-Hours and

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NHS 111 service when the current contracts come to an end. This programme

of work is led strategically by Enfield CCG who commissioned the

communications and engagement piece for the CCGs across NCL. This

additional SLA recognises how important it is to resource the communications

and engagement function to support large programmes of strategic change. It

also demonstrates the importance of consistent communications and

engagement planned activities across the North Central London.

The decision to decommission the majority of the CSU’s communications services

has released some funding that was planned to be used to recruit a band 4

Communications and Engagement Assistant that can help with routine administrative

tasks, events and basic online content uploading. This will improve the capacity of

the team to deliver communications and engagement activities and to undertake

more innovative and strategic work. The recruitment for this post began in the

financial year 2015/16 with the hope that it will be filled by the end of summer 2015.

The decommissioning of the CSU does not translate to any non-pay budget being

transferred back to Enfield CCG. The communications and engagement activities

that are delivered annually in line with constitutional requirements (three GP

membership and three Patient and Public Engagement events) are funded via a

central corporate budget. Bespoke communications and engagement activities that

support commissioning programmes or projects are funded by the commissioner for

that area through a budget line approved in the Project Management Office (PMO).

This year, the team was supported by a small budget of £10,000 which was originally

given to CCG’s by NHS England in March 2014 to support engagement activities.

This money was invested broadly across a number of areas to support

communications and engagement. This included:

Sponsoring National Association of Patient Participation (N.A.P.P.)

membership for every Patient Participation Group (PPG) in Enfield that

wanted to join. N.A.P.P. membership and the resources it provides will

support the ongoing development of individual PPGs and the network.

Training sessions for PPG representatives including: developing aims,

objectives, vision and mission statements, governance and minute taking. The

training was selected by patients and well received. It has supported the

development of their PPGs and learning has been shared across the network.

Appendix C shows how the PPGs used the developed their own aims,

objectives, vision and mission and developed a statement of how they want to

work together. The CCG’s approach to encouraging PPGs to develop their

own statement, similar to our own Constitution, was highly acclaimed by PPG

representatives from other areas.

Purchasing equipment to support the team and the delivery of events.

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Funding a corporate patient and public engagement event that met the

individual participation duty by focusing on how we can plan person centre co-

ordinated care.

Specialist training from Enfield Voluntary Action for the Head of

Communications and Engagement focusing on managing volunteers. The

Patient and Public Engagement Manager also attended a course on recruiting

volunteers through social media.

Funding corporate membership of The Consultation Institute. This has given

the CCG access to resources that can support ongoing learning and

development such as webinars, briefings and an online knowledge base. We

also have access to an advice line, which we used once during this year. We

also block purchased training places to support the team’s continuous

professional development (CPD). Courses attended during this year included:

The Law of Consultation and Consultation Essentials. We have more courses

booked for 2015/16 and the Head of Communications and Engagement and

Patient and Public Engagement Manager will achieve a certificate of CPD.

SECTION TWO: Developing the Infrastructure for

Engagement and Participation

Processes

Collective Participation

In our first year as a CCG our first priority was to establish the engagement structures that were laid out in our Constitution. During our time as a shadow organisation, Enfield CCG had adapted the model CCG Constitution to ensure that it reflected the needs of our local population and also our ambitions to be an innovative CCG who is committed to including patients in our membership organisation. Enfield CCG has a particularly democratic constitution in many areas and set up a strong governance process that gave patients a voice in our organisation. Our Patient and Public Engagement Committee was formally established in April 2013 and is one of the five sub-committees of the Governing Body. The PPE Committee meets bi-monthly and has a strategic role in developing patient engagement and participation across the CCG as well as monitoring equality and diversity. The terms of reference for the PPE Committee are available on our website. The PPE Committee is chaired by the Lay Member for PPE and members include two other Governing Body members – the Director of Quality and Integrated Governance and the Practice Manager Governing Body Representative as well as the Head of Communications and Engagement, PPE Manager along with representatives from Public Health, Healthwatch Enfield and during this year, two interim Patient Participation Group representatives.

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During this year the PPE Committee received delegated responsibility from the Governing Body to progress the recruitment process of an elected PPG representative. It also discharged other key functions in line with its terms of reference such as: reviewing work programmes against participation duties, the publishing of Equality Information and advising on key partnership work such as engagement for the Better Care Fund.

During our second year as a CCG we have continued to improve and develop our processes for engagement. We recognise the importance of embedding engagement throughout our organisation’s work and at every stage of the commissioning cycle. This is reflected in our annotated commissioning cycle diagram (Appendix 2) which underpins our planning for our corporate PPE events, which happen three times a year. We use You Said, We Did feedback to show how we have used the comments given at each PPE event to shape our projects and influence our future strategy.

The Communications and Engagement team provides a bespoke service to advise

commissioners on how best to communicate and engage with GP members,

stakeholders and the public on the wide range of issues and improvement

programmes. We have a wide range of operational tools available such as: website,

intranet, Twitter, Smart Survey and stakeholder e-bulletins that can be used to target

audiences with updates about the CCG. We also share updates from our partners

such as NHS England. For larger projects focused on service improvement – such

as our Transformation Programme, the Communications and Engagement Team

work with project leads to develop bespoke communications and engagement plans

using a standard corporate template. This ensures that a stakeholder analysis is

undertaken at the project initiation phase, key messages developed, risks assessed

and activities mapped to ensure delivery of the work programme. Part of this

specialist advice service involves testing the level of engagement needed and

whether a consultation needs to be planned into the project timeline. Advice on

Communications and Engagement at the beginning stages of the project is

complemented by an equality impact assessment (EIA) and Quality Impact

Assessment (QIA). All three documents are reviewed as the projects develop.

This year, some of the examples of how we have met our collective participation duty

include:

Delivering the cycle of corporate events described in our Constitution including: 6 Governing Body meetings in public (one in each locality) and three patient and public engagement (PPE) events.

Targeting hard to reach groups like our Turkish community (Turkish Cypriot Luncheon Club), blind and visually impaired patients (Enfield Vision) and deaf services users (Enfield Deaf Image Group). We visit these groups to talk to them about the CCG, health promotion and find out more about their needs. An example outcome of these meetings is that we developed an audio version of the Choose Well Campaign to support members of Enfield Vision.

Attending community events including: the Enfield Town Show and the Edmonton Festival.

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Providing speakers for partner or voluntary sector events including our Governing Body GPs presenting at the Over 50s Forum winter health fair, Enfield Carers Centre and the Enfield Racial Equality Council.

Planning and delivering joint events with Enfield Council including: engagement on the Better Care Fund and Integrated Care as well as a careers fair with sixth form students focused on jobs in health.

There are many more examples in Appendix D which is our corporate engagement

log.

Individual Participation

The CCG has clear responsibilities in relation to commissioning for quality, informed

by the NHS Constitution (2011):

To ensure that services we commission are safe, effective, provide good

patient experience and continuously improve

To secure health services that are provided in an integrated way, working

in partnership with the Local Authority

To actively seek patient feedback on health services and engage with all

sections of the population with the intention of improving services

As a membership organisation, working with NHS England, support

primary medical and pharmacy services to deliver high quality primary

care

The charts in appendix B describes how we monitor quality and the individual

participation duty delivered through providers during the commissioning cycle.

The key ways we monitor our contracts and services locally across the three quality

domains are:

• Our early warnings system – designed for reporting concerns from our GP members based on feedback from their patients. Our system has been adopted by other CCGs.

• Providers send us patient experience reports that are discussed at the Clinical Quality Review Groups (CQRQ).

• Our patient enquiries service and our communications inbox or telephone numbers, which often receive comments, complaints and concerns.

• Feedback from Healthwatch Enfield • Monitoring Twitter. We have a standard response for complaints or feedback

received. • Collecting feedback directly from patient groups • Monitoring feedback on national websites such as NHS Choices, Patient

Opinion and other public comments • Viewing feedback from patient forums such as the Maternity Services Liaison

Committee (MSLC), the North Middlesex University Hospital Focus Group, Parent and Young People Participation Group.

• Evaluation of services we commission such as the Older People’s Assessment Unit (OPAU) at Chase Farm, falls programme and tele-health

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using semi-structured interviews, surveys or complaints/compliments received.

Key outcomes included:

• Of 38 early warning quality alerts received in 2014/15, 13 (43%) arose directly from patient feedback to the GP. Themes and trends are reported to the CCG Clinical Reference Group and escalated to the Governing Body as necessary through the Quality and Safety Report.

• The views of patients have led to improvements such as: greater GP involvement in the falls programme and the selection of a tele-health provider.

• We met with a relatives and carers group of The Oaks, an adult ward at BEH-MHT which cares for people with mild to moderate dementia, depression and psychotic illnesses, provided additional feedback and insight to support a visit.

• Improved quality of care from individual providers. For example, the Care Home Assessment Team (CHAT) has worked with a number of care homes to improve the standard and quality of nursing care in Enfield

• BEH MHT Care Homes Assessment Team works closely with LBE’s and Enfield CCG’s Safeguarding Teams and Enfield’s safeguarding procedures (which include CQC involvement) to identify and address any provider concerns

• Any quality issues identified or raised during via the quality alerts process go to the quality meeting for the contracts the CCG manages.

• More partnership working with TDA, CQC, and NHS England on quality issues.

Networks

Enfield CCG has an extensive list of stakeholders and takes a proactive approach to

networking.

We run three corporate PPE events around our commissioning cycle. These events

are open to the all our stakeholders and members of the public. The events are

accessible to everyone – and we are pleased to provide BSL translators at these

events for our deaf community who regularly attend as well as accommodating any

other needs as requested. The objective of these events is gathering feedback on

our commissioning plans and supporting quality improvements. A report is prepared

after every event and attendees become part our stakeholder network, receiving

email updates. Based on feedback we have received from patients, these events are

now clinician led and group work focused. Outcomes from these events have

included: patient feedback on our Procedures of Limited Clinical Effectiveness Policy

and on the quality outcomes we should focus on.

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We work closely with patient groups and networks around service improvements.

This involves a range of activities including: patients attending focus groups or

steering groups as expert patients. It also provides patient experience data gathered

through these methods or surveys that can be used to support service

improvements. Example outcomes from such activities included: patient involvement

in our Patient Experience Tracker project which has provided GP member practices

with a tablet device and the opportunity to gather live patient experience data.

We host a network for our GP member practices’ Patient and Participation Groups

(PPGs). During this year the group was jointly chaired by the interim PPG

representatives. The group sets their own agendas. Action notes are taken by CCG

staff and circulated to network members. The PPG network reports in to the PPE

Committee and up to the Governing Body. Outcomes have included: PPGs getting

involved in promoting Choose Well and European Antibiotic Awareness Day as well

as sharing best practice. The network also advised the CCG on the recruitment of

the elected PPG representative.

Structures

Enfield CCG takes a proactive approach to engagement, building it in to all of our

work. The Communications and Engagement team ensure that structures are in

place to support engagement work and that activities are planned, monitored and

outcomes reported. Examples of this approach include:

The Communications and Engagement team support the bi-monthly Governing Body

meetings which are attended by a number of members of the public. Written

questions can be submitted in advance and the Communications and Engagement

team supports the delivery of written answers to any questions asked, as well as

hosting a tea and coffee session with patients before the meeting. The Governing

Body meetings are an important way for the public to be kept up-to-date on the work

of the CCG and the organisation welcomes participation in these meetings.

We hold an Annual General Meeting (AGM) as required by our Constitution at which

we present our Annual Report and Accounts. Our Constitution requires that we have

attendance from our GP membership to approve the Annual Report and Accounts

and we also advertise the event to the public and send invitations to our

stakeholders. Last year we developed a plain English summary Annual Report and

Accounts for stakeholders which received very positive feedback and will produce

the same type of document for discussion this year. The format for our AGM is

presentation led, but in our first year we had a vibrant questions and answers

session on our challenges and future plans.

The CCG also held many other patient events during 2014/15 which focused on

particular projects or key work programmes including integrated care and service

redesign. These workshop style meetings enabled patients to hear about proposals

at an early stage and commenting on the plans. They also offered an opportunity for

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expert patients to become more involved in long-term projects and taking the plans

forward by sitting on steering groups and taking on an advisory role.

Patients and Healthwatch Enfield were also involved in commenting on key

publications including: the Equality Information and our summary Annual Report and

Accounts and patient questionnaires for the Community Services improvement

programme. The CCG is committed to being open and transparent about our plans

and we believe that seeking patient feedback on how we can best have an open

dialogue with our community will enhance our engagement.

The Communications and Engagement team works with commissioners and project

managers to design bespoke programmes of communications and engagement

using a corporate template. This ensures that projects utilise the existing

engagement structures such as weekly e-newsletters to GP member practices, the

website, intranet and Twitter. It also ensures that managers understand that activities

and outcomes must be recorded to enable reporting up to the PPE Committee.

Our website, intranet and Twitter are a key communications channels. We have over

2,000 followers on Twitter since starting our account on 1 April 2013. Our followers

include key stakeholders such as providers, partners, local MPs, Councils and

voluntary sector partners as well as members of the public. We use Twitter to

promote our organisation but we also retweet other organisations when they have

news, healthy lifestyle information or campaigns that we feel would benefit our

patients. We regularly review our website and intranet statistics for trends. We use e-

communications channels to have an active dialogue with harder-to-reach

communities such as the young and working adults. For example, the Patient

Experience Tracker project which purchased tablets for practices allows people to

complete a questionnaire giving real-time feedback on patient experience. We also

use Smart Survey to create online surveys and are planning to expand the use of

this as other features are added to this product in 2015/16.

Partnerships

Locally we have a very vibrant and engaged population and we are very committed

to hearing people’s views on the NHS and how we can improve it. At Enfield CCG

we believe we have built strong partnerships with our local stakeholders as

evidenced by our 360 stakeholder survey results for 2014 commissioned by NHS

England. We have developed an action plan so that we can respond proactively to

the comments in the report.

We work very closely with key partners including Enfield Council and local NHS

providers to improve local health and social care services and to ensure the long-

term sustainability of our health economy. This year we have worked with Enfield

Council on the Better Care Fund engagement. We have also worked closely with

Enfield Council on the Joint Health and Wellbeing Strategy, Joint Strategic Needs

Assessment and delivering our joint plans for integrated care.

16

We have also worked in closer partnership with other CCGs in North Central London

to develop our strategic plans for transformation, planning improvements to services

together when there are benefits across a bigger population. We have taken key

steps towards co-commissioning primary care with the other CCGs in partnership

with NHS England which will be further developed during 2015/16. An example of

this partnership engagement work across NCL is the joint commissioning plans for

GP OOH/NHS 111 under which a patient reference group has been set up.

SECTION THREE- Engagement and Participation Activity Enfield CCG regularly undertakes activities to meet the collective engagement duty.

This duty places a requirement on CCGs to ensure public involvement and

consultation in commissioning processes and decisions. It includes involvement of

the public, patients and carers in:

planning of commissioning arrangements which might include consideration of

allocation of resources needs assessments and service specifications.

proposed changes to services which may impact on patients.

In this section, we will focus on examples that show how we have approached

delivering the collective duty across a number of key areas.

During 2014/15 we began engagement on three major contracts that the CCG plans to procure – community services, musculoskeletal services and NHS 111 and GP Out of Hours Services. Enfield CCG works in line with our local Procurement Policy, which requires patient involvement and also uses specialist support from the procurement team at North and East London Commissioning Support Unit (NEL CSU). Improving Community Services Objective: Our current provider is BEH-MHT. We engaged on moving towards procuring a contract that is delivered around populations – not traditional service lines. This means that community services can focus on delivering outcomes based care for both episodic and long-term conditions. Activity: We worked up proposals for an outcomes based commissioning approach in partnership with Healthwatch. We developed a patient questionnaire to benchmark experience of current services and also to explain how we think services could be better delivered around population groups in the future. Who was involved? We distributed questionnaires to the public at corporate events, community events and promoted it through our website and Twitter. The questionnaire was designed to be answered by patients who have been receiving long-term care from community services, or episodic care. Outcomes and impact: Patients widely supported our approach to segmenting population groups. We will use the outcomes from this survey to further develop our

17

commissioning plans moving forwards, influencing our strategy and commissioning intentions for this important service. In the meantime, we have invested more in community services to reflect some of the survey feedback. More information about this engagement work can be found on our website. NHS 111 and GP Out-of-Hours (GP OOH) services Objective: Currently, the five CCGs have a single 111 provider –London Central & West Unscheduled Care Collaborative (LCW) and two GP OOH providers: Barndoc for Barnet, Enfield and Haringey and Care UK for Camden and Islington. The five CCGs plan to commission an integrated NHS 111 and GP OOH service in the future. Enfield CCG is the lead organisation for this piece of work across North Central London. Activity: Together the five CCGs have delivered a mixture of local events and collective public engagement such as questionnaires. Outcomes: A five borough patient reference group, including Healthwatch and campaign groups started meeting in March 2015. More information about this engagement work can be found on our website.

Service planning, design, redesign and decommissioning

Patient involvement is an important part of our service redesign programme. We routinely involve patients throughout the commissioning cycle and have patient representation on projects where possible.

Examples in 2014/15 include:

Integrated Care for Older People

Objective: Planning a new Integrated Care System for older people with Enfield

Council. Maintaining independence and self-direction is a key element of the

integrated care programme and was the focus of the last PPE’s event presentation

about the integrated care network.

Activity: The CCG has been working closely with stakeholders on developing the

plans and organised a public event in March 2015. Enfield CCG and Enfield Council

hosted this event which was about updating patients on their plans and engaging

them on how we could develop better services. This event was also supported by

updates on the development of integrated care at our Patient and Public

Engagement Events in 2014/15. We have used public events to talk to patients

about integrated care, but we also have a regular dialogue with user groups and the

voluntary sector which has helped us to understand the needs and aspirations of

older people.

18

Outcomes: In December 2013, the Older People’s Assessment Unit at Chase Farm Hospital

opened in line with the Barnet, Enfield and Haringey Clinical Strategy to support

older people with their urgent care needs. We receive excellent feedback from

patients who have used the unit. Following patient feedback a new community

transport service was commissioned to help older patients get to the popular Older

People’s Assessment Unit at Chase Farm Hospital

Ensuring a truly person-centred approach in which patients had choice and control is a key element of the integrated care programme and ongoing patient engagement helps us to continue to develop these values. Patients have told us what good services would look like in terms of outcomes.

Improving Respiratory Services Objective: Improving rapid access for patients with respiratory problems in the community. Activity: We held co-design meetings with patients and local groups such as Breathe Easy Enfield to find out more about patients’ needs. We also worked with Enfield Community Services as the current service provider to build a complete picture of the current pathways and patient experience. Outcomes: Patients helped us to understand what they would need from a rapid access service and the outcomes they would like. A new direct access telephone service was commissioned that helps patients who are having breathing problems access care fast, supporting them to manage their condition at home, improving their wellbeing and confidence in managing their condition.

Commissioning Intentions

Objective: We have a statutory responsibility to engage with patients about our commissioning responsibilities and we want patients to work with us on our ambitions to design services around them and their health needs. Activity: We worked with our stakeholders to develop and explain our commissioning intentions at: Patient and Public Engagement events – example agenda, The Health and Wellbeing Board, Governing Body meetings. Key outcomes: Feedback from these events helped us to better understand the aspirations of our community for their health and wellbeing and how they would like local health services to be delivered in the future. Patients helped us to shape and develop our Commissioning Intentions. Improving our Patient and Public Engagement Events

Objective: We hold three patient and public engagement events a year in line with our Constitution.

19

Activity: We hold these events in a central location. We advertise the events publically and we send invitations out to our stakeholder lists including: voluntary sector groups, patient groups, providers, Healthwatch Enfield, partners and members of the public who have signed up for email updates. Outcomes: This year we changed the format of these events. In our first year, our events always had presentations on the CCG and the new NHS. Based on stakeholder feedback and now that there is a better understanding of the new system and responsibilities, we now make sure that our PPE events are clinically-led and focus on group work. Our GP Governing Body members each have a portfolio as a clinical commissioner and they update the Governing Body on progress in these areas, as well as leading discussions on their area at public events. We have responded to feedback that our Commissioning Intentions and other documents should be written in plain English. We also now explain to our stakeholders where commissioning intentions fit with national priorities – e.g. we focused part of a PPE Event and had other meetings with patients about the Five Year Forward View and our five year plan. We also clearly explain when we are developing intentions with other partners or boroughs, such as the Better Care Fund plans with Enfield Council or our NCL commissioning plans.

SECTION FOUR- (Meeting the Individual Participation Duty) This duty requires CCGs to ensure they commission services which promote the

involvement of patients across the full spectrum of services. This duty requires

collaboration between patients, carers and professionals, recognising the expertise

and contribution made by all.

Enfield CCG is committed to redesigning and commissioning services that enable

patients to take control of their health through individual participation in their care

planning. Enfield CCG wants to put patients in control of their health and support

them to achieve outcomes that improve their wellbeing. This section provides some

examples of how we met the individual participation duty this year.

Developing outcomes based commissioning for a new musculoskeletal

(MSK)service

Objective: There is a wide range of pathways for MSK and entry points into the

system. Enfield CCG has ambitions to move to a lead provider model to encourage

services to work closer together. Self-management tools will also play a much bigger

role in the new pathways with an expert patient programme planned to promote self-

care and pain management.

Activities: We have worked with clinicians and patients to map current pathways

and understand their individual journey and experiences through them. We used

interviews and questionnaires to collect this information. Later in the project we used

20

a patient focus group to review the anonymous patient data and help us work up

outcomes that will enable better individual participation in care planning.

Outcomes: New patient centred outcomes have been developed through

engagement. We have now have five outcomes that we believe can represent

people’s individual goals for recovery and we want patients to feel empowered by

working in partnership with clinicians to deliver better health and wellbeing for

themselves. We believe this will deliver better quality services for patients requiring

episodic or long-term care.

The ability of patients to manage their conditions, including our expert patients

programme participants, will be monitored by a patient questionnaire. Patient

satisfaction with the new system will be measured by a patient and carers

satisfaction survey.

Enabling Continuing Healthcare patients to manage their personal health

budget

Objective: Helping patients who receive Continuing Healthcare (CHC) funding to

understand their rights to a personal health budget and to provide them with support

if they would like to manage it.

Activity: Since 1st April 2014 every individual eligible for CHC funding who lives in

the community are informed by letter of their right to have a personal health budget.

An indicative budget assessment is undertaken for all Individuals who request a

personal health budget. My Support Broker has been commissioned to work with

individual/family/carers and works in conjunction with them to understand their needs

and complete a support plan. Once all parties agree support plan is signed off by the

CCG’s CHC team and monies are released. The patient’s support plan is reviewed

after three months and then annually or if needs change as in line with the CHC

framework.

Key outcomes: The support plans are shaped and owned by the individual CHC

patient. All parties were signed up to the support plan. Each patient is supported in a

manner that meets their needs and enables them to take full responsibility for their

own care management. We believe that this has improved individual participation for

patients and their experience of receiving NHS CHC.

Working with providers to deliver individual participation

Objective: We work with providers using the levers provided by the standard NHS

Contract and other local quality indicators to continuously improve patient

experience.

Activity: We undertake a wide range of activities both through contract management

and through governance as well as quality and safety measures to regularly monitor

21

provider data. We have a positive dialogue with providers about continuously

improving quality but we also vigorously challenge when we believe services could

be improved. Our regular activities with providers are

Key outcomes: An example of this work is improving the quality of care from

individual providers. For example, our local Care Home Assessment Team (CHAT)

team has worked directly with a number of care homes to improve the standard and

quality of nursing care in Enfield.

Meeting the collective and individual participation duties: Recruiting an

elected Patient Participation Group Representative to our Governing Body

When our GPs designed our Constitution they were embedded the values of patient

and public engagement in the governance of our organisation by extending the

concept of membership from local GP practices to the member Patient Participation

Groups. Clause 21.2 of our Constitution formally extends the concept of membership

to our member practices’ Patient Participation Group and allows us to co-opt an

elected PPG member to our Governing Body.

By June 2014 all our member practices had PPGs. Practice Managers were

supported by our GB Practice Managers lead and were given a toolkit to help setup

and manage the group. During 2013/14 we recruited two interim PPG

representatives through an advert and interview process. The successful candidates

signed a one year voluntary contract and sat on the CCG’s Governing Body and

PPE Committee as well as helping us to start up our PPG network.

Our PPG network met quarterly during 2014/15. Chairs, members and practice

managers and staff that support PPGs all attend this meeting. The network was

supported by NHS England engagement funding in its first year and money has been

spent on training for PPGs including: developing mission, vision, aims and objectives

and developing governing documents as well as sponsored membership of the

National Association of Patient Participation.

During the year the PPG network shared good practice and strengthened their

working relationships with each other and their practices. Guest speakers presented

to the networks on topics of interest such as: primary care estates and Care.data. A

short verbal update on PPG network development was a standing item at both the

Governing Body and PPE Committees throughout this year.

During 2014/15 the PPE Committee planned for the recruitment of the elected PPG

Body representative. The Committee reviewed and updated the process used for

advertisement and selection of the interim PPG representatives. This included

revising the role description and voluntary agreement based on the learning of the

interim representatives as well as updating the recruitment pack. It was agreed that

the recruitment process should be an application form and interview before the

22

candidate was put forward for election. The PPE Committee also discussed a

proposed voting process for the PPGs.

The PPE Committee received delegated responsibility from the Governing Body in

November 2014 to proceed with the election. It was agreed by the PPE Committee

that the Electoral Reform Services would manage the process independently from

Enfield CCG, in line with other elected Governing Body posts. The election

recruitment pack, role descriptions and voluntary descriptions were all discussed

with the PPG network who were able to amend the documents and comment on the

process. The PPG network agreed that each PPG should get one vote and that

groups would meet to agree which candidate to vote for. The election process was

an online, first past the post system. Provision was made for postal votes if the

person asked to vote on behalf of their PPG did not have an email address.

Two candidates came forward for election from two different localities. Having

successfully completed the application process, each candidate was invited for

interview. The CCG invited two PPG representatives from other London boroughs to

sit on interview panel. The patient representatives gave an independent view to

Enfield CCG about the role. Following the interviews, both candidates were put

forward for election.

The majority of PPGs in Enfield took part in the election process and Electoral

Reform Services confirmed the appointment of Litsa Worrall. Litsa took up her new

role as elected PPG representative in May 2015. The role is three year appointment

in line with other elected Governing Body positions.

More examples of how we met the individual and collective participation duties are

available in appendix E.

SECTION FIVE- Forward Plans for 2015-16

We are proud of what we have achieved in 2014/15, but we are an ambitious and

innovative organisation that always strives to deliver more. Here are some of our

forward plans for 2015/16.

• The CCG plans to support its PPG network to develop further now that the

elected representative is in post. This will include funding four network

meetings a year. We will consider whether training or further support could be

offered again to members of the network in 2015/16.

At the first meeting chaired by the elected representative in May, the PPGs

were encouraged to produce a work plan and choose their own priorities for

the year. This included core work such as sharing best practice and raising

awareness of PPGs but also some further collaboration around: reducing do

23

not attends, promoting public health messages and working with practices on

their falls registers.

The CCG plans to develop a more formal approach to recruiting and

managing volunteers. The Head of Communications and Engagement and the

Patient and Public Engagement Manager are attending specialist courses run

by Enfield Voluntary Action.

The CCG plans to develop a voluntary and community stakeholder reference

group in 2015/16 to provide early support and feedback on the development

of strategic change programmes.

The CCG has invested in corporate membership of the Consultation Institute,

along with buying specialist training courses which will be used to develop

the Communications and Engagement Team and other senior leaders in the

organisation.

Continuing the programme of three PPE events a year to inform and support

engagement on the development of the CCG’s strategy and commissioning

plans.

To continue with targeted engagement on service redesign. Increase patient

involvement with steering groups and procurement.

Developing more You said, We did outcomes from engagement.

Continuing to develop the website and Twitter.

Reviewing the 360 degree survey results, segmenting the responses and

developing a targeted action plan by September 2015 which will be shared

with CCG staff, PPE Committee and Governing Body.

Continuing and developing further GP-led engagement, (as requested by

patients).

We will continue to engage on our Commissioning Intentions and we will

consult on any plans that involve substantial changes to the delivery of

services.

Developing a programme of visits of hard to reach groups. Continuing to

respond to requests for visits to patient groups.

Carry out an annual review of Communications and Engagement Strategy

and work plan by September 2015.

The Communications and Engagement Team will continue encourage all

teams to report engagement activities that they undertake and these are

24

recorded in an engagement log that is regularly viewed by the PPE

Committee.

Operational and strategic support across the organisation will continue to be

provided by a very experienced in-house team of three communications and

engagement professionals. We aim to recruit a Communications and

Engagement Assistant to strengthen the team’s capacity following the

decommissioning of communications services from NEL CSU.

SECTION SIX - Healthwatch Statement

Healthwatch Enfield and Enfield CCG have a strong working relationship that

enhances the work of both organisations in promoting the interests of patients.

Enfield CCG are responsive to formal reports that we submit to them and to

informal issues that we raise with them. We are able to feed in intelligence from

local people to help inform the CCG’s understanding of the services that local

people receive from its providers. Equally, the CCG trusts Healthwatch Enfield

with confidential information, where necessary, for example, having

representation from Healthwatch in North Central London on the NCL Urgent Care

Programme Board.

Enfield CCG has pursued its ambition of having an elected PPG Representative on

its Governing Body and it has been good to see it supporting the development of a

functioning PPG network. Although it is still early days for the PPGs and for the

PPG network, it is an area of activity that has considerable potential.

During the year, Enfield CCG has successfully adapted its set-piece engagement

events in response to feedback, securing better attendances and more meaningful

engagement. In other work, they have now started to show how feedback has

influenced services, for example in the development of a community transport

service for patients of the Older People’s Assessment Units as well as the selection

of a telehealth provider. They also established a Patient and Public

Representation Group to advise on NCL’s re-procurement of Out of Hours and 111

services.

Importantly, Enfield CCG have also begun to develop more of a whole-organisation

approach to engagement, with the PPE Committee now at least made aware of

clinical engagement work led by other parts of the organisation. We hope that this

will develop over time into a role that also seeks assurance on the effectiveness of

all engagement work. This is part of a move towards a more holistic approach to

engagement by the Committee that is very welcome and which also involves a

growing focus on outcomes and impact and will hopefully embrace relevant

aspects of the individual participation duty in due course.

25

We are pleased to see the progress that Enfield CCG has continued to make in its

approach to patient and public engagement in 2014-15. We are confident that

their strong commitment to this work will ensure that it continues to develop and

starts to yield more tangible results over time.

26

Appendix A: Commissioning Cycle

The Engagement Cycle

The Engagement Cycle shows clearly how we plan to engage with patients and the

public, explaining where and how people and groups can contribute and how their

views will be used by the CCG to improve services and make commissioning

decisions. Each box on the engagement cycle shows the ways we will involve the

public at every stage of the commissioning process.

Appendix B: Quality and individual participation

Example 1: Quality in the Commissioning Cycle using the CCG Early Warning Process

CCG Objective:

To improve

transparency and

reporting for quality,

safety and patient

experience (including

duty of candour).

Identify gaps is service

provision

(Radiology early warning

alert on delays in receipt of

x-ray results in General

Practice

Intelligence used to escalate

to the trust for further

investigation into turnaround

times.

Decide Priorities & Service

Redesign

Investigation subsequently

prompted a review of

Standard Operating

Procedure for Turnaround of

x-ray results

Outcome

This led to the CCG review of

the CCG’s commissioning

arrangement for this service to

identify were contractual

monitoring needs strengthening

through the use of the national

contract

Monitor & Manage

Performance

Escalated for further

discussion through contract

and assurance that delays

were not adversely

impacting on patient

outcomes management

Identify gaps in

Quality via review of

services.

Data sources –

safety, effectiveness

and patient/staff

feedback

Triangulate both

qualitative and

quantitative to give a

full picture of quality

Timely and accurate

quality data flows

Review provider

performance data

Information sharing

Contract Quality Review

meetings

Escalation and contract

levers for

underperformance

Provider quality visits

Example 2: Complaint Feedback

Enfield CCG Corporate Objective

Maintain and improve the quality of health

services our citizens receive and ensure a

strong focus on quality as services change

Quality Objective (Directorate

Objective)

To improve transparency and

reporting for quality, safety and patient

experience (including duty of

candour).

Activity

Utilised patient’s complaint feedback to identify early quality and safety issues. Complaint related to: Funding request for children requiring intensive Physiotherapy intervention Whilst investigating the complaint the Head of Children’s Commissioning was informed that there are a number of other children who have similar clinical needs

Outcome

Concerns about funding for additional capacity were subsequently raised with the Director of Quality at ECCG and the Head of QIPP and Service Redesign. It was agreed that the service provider should provide a business case for CCG scrutiny. The business case being prepared by the Trust to request funding to support this client group will inform commissioning intentions.

Appendix C: PPG training

Feedback from Patient Participation Group (PPG) training

session: 19 June 2014

Enfield Clinical Commissioning Group (CCG) is committed to supporting the

development of member practices Patient Participation Groups (PPGs). The CCG

has been working with PPGs to develop a network. As part of this work, Enfield CCG

commissioned a training session from Enfield Voluntary Action to support groups to

develop and collaborate for the benefit of patients. The training package that was

selected was “Agreeing Aims, exploring visions and setting objectives”. This training

package was put forward to the meeting of the PPG Chairs and it was agreed that

this was a good choice of training course at their May meeting.

On the 19 June, a small group of PPG representatives from six local practices came

together for the training, which was tailored to meet the needs of PPGs. The PPG

representatives decided that they would like to work together to design a generic set

of aims, visions and objectives to discuss and refine with their PPGs and also to

share with other PPGs that couldn’t make the training session.

What are aims?

The session began with a definition of how to set group aims. Aims help to explain

the overall mission and vision. Usually the aims are a set of statements that define

the detail behind the overall mission and vision of the group.

The group agreed that they would like to work together to design the aims of a PPG.

The group came up with five aims of a PPG:

1. To work with the GP practice and patients to improve patients’ health.

2. To engage and communicate with patients.

3. To help GP practices improve the services that they offer to patients.

4. To empower patients to have a voice.

5. To enable the GP practice to support patients with particular health needs and

outreach to community groups where needed.

Mission statement

A mission statement summarises the purpose of the group. An effective statement

should be able to tell the story of your group and share your ideals in less than 30

seconds.

We looked at the five aims that the group had just developed together. Each

participant was asked to write one word from the aims on a post-it note that was the

most significant to them. The choices were:

1

We used these key words to design our mission statement:

Enfield PPGs empower all patients to have a voice through supporting involvement,

representation and communication with their GP practices and Enfield CCG to

develop and enhance services.

Vision

The group then discussed how we could design a vision for PPGs. A vision should

capture the perfect situation, so should describe what you would achieve if you

deliver your mission and overcome any challenges you may face. You will always

strive to achieve this perfect situation so it can be as powerful and challenging as

you wish to make it.

Our vision:

Through working with patients and the practice team we develop an efficient,

effective and welcoming GP practice where patients become equal partners in their

care.

Values

Values are descriptive statements that emotionally connect with what drives you,

what you believe and what you are prepared not to tolerate. We discussed some

universal values such as honesty, passion and commitment as well as looking at

some examples from the charity sector. We also looked at the NHS Constitution

which describes the principles and values of the NHS, along with the rights and

responsibilities of staff and patients.

We developed our values together:

We believe in mutual respect between patients and the practice team. This

includes a commitment to removing barriers to communication by reducing

and explaining jargon.

We believe in collaboration. Clinicians will enable and educate patients to take

responsibility for their own health by listening and respecting their opinions.

We want a committed, compassionate and caring NHS for staff and patients.

Learning from comments, complaints, concerns and compliments.

The Elevator Pitch

The aim of an elevator pitch is to come up with a short summary statement that you

can use to speak to someone in the time it takes to take a ride in a lift/elevator. Plan

Empower Communication Involvement Voice Support

2

your pitch so you can state clearly what your group does, what the challenges you

are trying to address, what you are aiming to achieve and why the other person

should join or help you. Be persuasive and passionate! Each group came up with an

elevator statement.

Designing outcomes

We went back to our aims and discussed how we could achieve them. We came up

with some activities and outcomes for each aim.

1. Work with the practice to improve patients’ health

Conduct and act upon patient surveys

Work with patient support and community groups

Share good practice throughout the network

2. Engage and communicate with patients

Promote membership of the PPG

Develop patient reference/virtual groups for members who can’t make

face to face meetings and involve them through newsletters, surveys

etc.

Use iPlato (CCG purchased SMS system) to send text messages to

patients

Encourage people from different backgrounds to join the PPG

Provide information in other languages or formats (this could be

enabled through networking)

Develop great networking skills

Advertise PPGs through the Enfield Voluntary Action (EVA) volunteer

centre

Develop links with the voluntary and community sector services

Look into new advertising opportunities – e.g. community centres,

supermarkets, places of worship.

3. Help practices to improve their service

Conduct patient surveys and use the feedback to develop new and

improved services

Collect data on specific health issues to improve services

Collect information on services and patients’ communication needs to

improve accessibility

Support innovation – especially around exploring technology e.g.

patient consultations using Skype and text messaging for appointment

or test result reminders

Use technology to support PPG communications e.g. .e-newsletters,

conference calls, webinars

3

4. To enable patients to have a voice

Work towards the PPG being representative of the practice

demographics

Consider meeting at different times or alternative venues

Promote good practice amongst PPGs – share what works

Use the link with Laura Andrews at the CCG to raise issues that can’t

be dealt with

Use the option of the current interim and later elected PPG

representative on the Governing Body to raise issues and champion

PPGs

Next steps

Participants agreed that this was an enjoyable and productive training session. The

group produced together aims, a mission, vision and values for a PPG. We also

came up with lots of ideas about how we can achieve our aims, including practising

writing an “elevator pitch” that we can use to recruit new members.

The next steps are to share the outcomes of this training session at the next PPG

network meeting in September 2014. At this next meeting, we will also review a list

of other training opportunities that could be funded by the CCG to support the PPG

network development.

Appendix D: Engagement log

Enfield CCG’s Patient and Public Engagement Activity Log 1 April 2014- 31 March 2015

Key:-

ECCG Corporate Patient and Public Engagement Events organised by ECCG Engagement Team

ECCG Engagement Team invited to attend

Patient Participation Group Events organised by ECCG Engagement Team

PPE Engagement Events/meetings organised by ECCG Colleagues

Patient and Public Engagement Activity for year 1 April 2014- 31 March 2015

Date of activity

or dates

activity ran

from and to

Type of activity

e.g. Meeting,

focus group,

deliberative

event, online

discussion,

online

Target audiences

e.g. Local patient

groups, public,

stakeholders, public,

disease specific

groups

How were participants

informed (invited, media

release, advertisements,

flyers, online)

Key themes identified/ areas

covered

Number of

attendees /

number of

hits or users

1

3 April 2014 Attending their

Luncheon club in

Edmonton

Enfield Turkish Cypriot

Association

Contacted via e-mail and

telephone

What is the CCG; Enfield and its

health challenges; chose well

campaign; NHS 111- translation

services; hospital bed for home;

PPGs; breast screening; diabetes

35-40

older men &

women-

Turkish is

first language

8 April – 11

June 2014

MSK Patient

Engagement

MSK patients attending

community clinic

appointments (ECS),

acute appointments

(NMUH/BCF) and

attending community

meetings (Over 50’s

forum)

Face to face contact with

project manager. Surveys

conducted at meetings, as

well as distribution of

event flyers for the MSK

patient workshop

Surveys conducted at meetings, as

well as distribution of event flyers for

the MSK patient workshop

8

appointments

attended

16 April 2014 Respiratory Co-

Design meeting

Public, partners and

key stakeholders,

voluntary sector

groups. (Breathe Easy)

patient rep

Email / Telephone Update on the current service

Look into successes and

development needs from a provider’s

perspective

Discuss what could be changed

within the systems

Agree next steps

21

Ongoing

engagement

via website and

Online

engagement

Public, partners and

key stakeholders,

voluntary sector

Website, intranet, twitter Information on Call to Action and Call

to Action London available and linked

to on e-channels; Chose Well

twitter

followers:

894 as of

2

twitter groups. Campaign

03/04/14

As part of the

integrated care

programme

(Older People’s

Assessment

Unit)

1. Patient satisfaction questionnaires

Patient care &

engagement as

part of service

evaluation process

Patients over 65s

/carers

At point of service

attendance,

questionnaires were

completed

Feedback on patient centred co-ordinated care was effective

Treated with dignity and respect was acknowledged by 99% of patients

A multi-disciplinary approach to care was identified as been effective and accessible to patients

Time spent in total to be seen or assessed by all staff needed slight improvement

Overall satisfaction with care/ treatment provided was very good

20 May 2014 Patient

Participation

Group Network

meeting

All members of PPGs

in Enfield

Advertised in local papers,

website, twitter; emails to

PPG chairs; summer

events

Welcome and feedback from the last meeting (you said, we did)

Explaining the role of CCGs and the new NHS system

Locality working in Enfield

Group work including your feedback on how we can support you to work

20-25

3

together

An update from NHS England on Care. Data

How PPGs are involved in CQC inspections

Training, future meetings and any other business

5 June Cardiology co-

design follow up

workshop

Public, partners and

key stakeholders,

voluntary sector

groups. (Heart throbs)

patient rep

Email and face to

face/telephone

Map current services; discuss key

issues and what the good looks like

25

10 June Patient and Public

Engagement

Public, partners and

key stakeholders,

voluntary sector

groups.

Advert, Website, intranet,

twitter

Corporate Update including 5 year plan

Royal free Acquisition update

Transformation Programme- overview of projects

Commissioning for Quality

Workshop on developing quality Outcome measures

Panel question time

30+

17 June 2014 Attending Enfield

Volunteers

Organisers

Network

Representatives from

voluntary and

community sector

Invited by EVA What was a CCG

New structures in NHS

Enfield and its health priorities

Ways of being involved in the work of Enfield CCG

10

23 June MSK Patient

Engagement

Workshop

MSK patients, carers Website, intranet, 3rd party

organisations, Posters,

Flyers, ECCG visits to

Gather patient opinion on the current

service and the proposed outcome

measures.

11

4

trusts and ECS

01 July 2014 Respiratory Co-

design meeting

Public, partners and

key stakeholders,

voluntary sector

groups. (Breathe Easy)

patient rep

Email, telephone - Review current ‘as is’ system

- Validate work undertaken so far

on respiratory co-design

- Agree what we need to change

- Next steps

15

24 July 2014 Cardiology Co-

design 2nd

workshop

Public, partners and

key stakeholders,

voluntary sector

groups. (Heart throbs)

patient rep

Emails, telephone Second workshop session provided:

- Recap on previous workshop

- Group plenary – What are

they key service changes that

are being proposed?

- Plenary – How should the

service delivery model look in

the new world?

This well attended session helped

identify a raft of

service/commissioning options and

enhanced commissioning dialog

between both, GPs, acute secondary

care consultants, community

services and patients.

27

1 consultant

1 specialist

heart failure

nurse

7 GPs

1 practice

manager

1 voluntary

sector/

patient rep

26 July to 27

July

Edmonton

Summer Festival

held at Pymmes

Public Advertised in local papers,

website, twitter

Met with over 100 local residents and

provided information on :

200+

5

Park Edmonton Choose Well Campaign

NHS 111

Dental out of hours services

Joining PPG

Participating in service

transformation work being carried out

by ECCG

Engagement on Improving

Community Services

13-14

September

2014

Enfield Town

Show

Public Advertised in local papers,

website, twitter

Met with over 300 local residents and

provided information on:

Choose Well Campaign- particularly

services available at Chase Farm

Hospital

NHS 111

Dental out of hours services

Joining PPG

Participating in service

transformation work being carried out

by ECCG

Engagement on Improving MSK

300+

6

Services

26 September

2014

Patient

Participation

Group Network

meeting

All members of PPGs

in Enfield

Advertised in local papers,

website, twitter; emails to

PPG chairs; summer

events

Primary Care estates

PPG Elections

Setting up of PPGs

General networking

Choose Well

25

1 October 2014 Over 50s

International Older

people’s Day

Members of the Over

50s Forum

Advertised by over 50s

Forum

Keeping warm and well

Choose well

PPG participation

Volunteering to support service

changes

100+

6-12 October

2014

Cardiology Patient

Engagement

Cardiac patients Face to face consultation

within trusts Patient opinions on the services within Enfield

Recommendations for improving the service

Future engagement opportunities

38

22 October

2014

Patient and Public

Engagement

Event

Public, partners and

key stakeholders,

voluntary sector

groups.

Advert, Website, intranet,

twitter

Vision for Enfield

Annual Report and Accounts

How to provide feedback

Commissioning Intentions

Commissioning for Outcomes

Primary Care including Medicines Management

Urgent Care

30+

7

Integrated care for older people

People with Long Term Conditions

Children and Young People

Mental Health

13 November

2014

Cardiology Patient

Engagement

Cardiac patients,

carers, family members

Organised through ‘Heart

Throbs’ Patient opinions on the services within Enfield

Recommendations for improving the service

Presentation of outline plans for cardiac services

Future engagement opportunities

40

20 November

2014

Clinical Workshop Consultants from main

providers of acute

dermatology and

community services

across North Central

London, GP Clinical

Leads, Commissioning

Leads from all 5 NCL

CCGs, representative

from British Association

of Dermatologists and

Patient Representative

from PPG

Email/Telephone/ via

British Association of

Dermatologists

Provision of dermatology services across NCL (acute, primary care and community)

Proposal to develop consistent clinical model for integrated community provision

Feedback on how best to:

a. Deliver an integrated model and mange rising demand for acute services

b. Deliver better care in primary care for patients

c. Improve knowledge & expertise in primary care

d. Support patients to manage their conditions better

27

8

18 December

2014

Carers Forum Carers This was one of their

regular meetings

What is a clinical commissioning group

Enfield: its health challenges and working together

Choose the right treatment- Choose well Campaign

30

19 December

2014

Patient

Participation

Group Network

meeting

All members of PPGs

in Enfield

Advertised in local papers,

website, twitter; emails to

PPG chairs;

You said we did

PPG Elections update and review

5 Year Forward View

Medicines Management

35

Stakeholder’s Engagement Activity for year 1 April 2014- 31 March 2015

Date of activity

or dates

activity ran

from and to

Type of activity

e.g. Meeting,

focus group,

deliberative

event, online

discussion,

online

Target audiences

e.g. Local patient

groups, public,

stakeholders, public,

disease specific

groups

How were participants

informed (invited, media

release, advertisements,

flyers, online)

Key themes identified/ areas

covered

Number of

attendees /

number of

hits or users

15 January

2015

Patient

Participation

Group Network

meeting

All members of PPGs

in Enfield

Advertised in local papers,

website, twitter; emails to

PPG chairs;

PPG Elections Process update

Networking and developing working together

15-20

22 January Heads of Sixth Heads of Sixth Form in Invited to attend this Role of CCG

Enfield and its health challenges

20-25

9

2015 Form meeting Enfield meeting Choose Well

How to become involved

Careers in the NHS

29 January

2015

Patient and Public

Engagement

Event

Public, partners and

key stakeholders,

voluntary sector

groups.

Advert, Website, intranet,

twitter; email to

stakeholder list

5 year Forward View Workshops on:

Primary Care Improvement/CO-Commissioning

NHS 111 and Out of Hours

Mental health

Clinical and Cost Effectiveness

2 February

2015

Enfield Vision

monthly meeting

Enfield Vision members ECCG invited to attend

their monthly meeting

What is a CCG and its role and responsibilities

Enfield and its health challenges

Choose Well Campaign

The Transformation Programme in particular Ophthalmology Services Redesign Project

Information the CCG provides

How GPs access leaflets

How can they get involved

15-20

20 February

2015

Over 50s Forum

Winter fair

Organised by Over 50s

Forum

Used Over 50S newsletter

and media

Choose well Campaign

Cutting the waste of prescription medicines- how can you help

Five year forward View and The Forward View into Action: Planning for 2015/16

Summary of the Annual Report and Accounts 2013/14

Glossary of Terms

Engagement events information for NHS 111/ GP OOHs services

50-60 people

attended the

stall, but

about 200+

people

attended

10

plus FAQs

Keep Warm Keep Well

European Antibiotics Awareness- Get Well Soon without antibiotics

Advanced Care planning and Power of Attorney

Engagement events information for Sharing Health & Care-

Forms for people to volunteer to help with the transformation programme

20 February

2015

Carer and Patient

Lasting Power of

Attorney and

Advance Decision

Talk and patient

engagement on

suite of

information leaflets

on advance care

planning

Local patients and

carers, in particular

those making end of life

choices about care,

and those suffering

from degenerative

conditions

E-mail GP Bulletin, Tweet,

provider patient networks,

leaflets, hard copy to GPs

voluntary orgs, and

nursing homes

Lasting Power of Attorney – how to, and FAQ’s

Advance decisions – how to refuse treatment, how to make a valid advance decision

23 attendees

23 February

2015

Carer and Patient

Lasting Power of

Attorney and

Advance Decision

Talk and patient

engagement on

suite of

information leaflets

on advance care

Local patients and

carers, in particular

those making end of life

choices about care,

and those suffering

from degenerative

conditions

E-mail GP Bulletin, Tweet,

provider patient networks,

leaflets, hard copy to GPs

voluntary orgs, and

nursing homes

Lasting Power of Attorney – how to, and FAQ’s

Advance decisions – how to refuse treatment, how to make a valid advance decision

6 -10

attendees

11

planning

3 March 2015 NHS 111/GP

OOHs

engagement event

Local patient and public

engagement

Media; website;

engagement events

Details of the joining up of the

proposed NHS 11 Service and GP

out of hours services to enable them

to work better

8

3 March 2015 BME Health

Seminar

Arranged by Enfield

Racial Equality Council

Chair presented

Commissioning for health

presentation

Areas covered were:

The NHS – roles and responsibilities

Enfield health challenges

Budgets

How do we ensure equality and diversity in our commissioning

NHS Constitution

Choose Well Campaign

Primary Care Strategy Achievements

Engaging with stakeholders in the redesign of services

Access to healthcare for asylum seekers

Access to translation services

Joining PPGs Details about the NHS11/GP OOHs engagement event the evening of 3 March was given

60+

6 March 2015 NHS 111/GP

OOHs

engagement event

Local patient and public

engagement

Media; website;

engagement events

NHS 111/GP OOHs proposal for

integration

TBC

12

10 March 2015 Carer and Patient

Lasting Power of

Attorney and

Advance Decision

Talk and patient

engagement on

suite of

information leaflets

on advance care

planning

Local patients and

carers, in particular

those making end of life

choices about care,

and those suffering

from degenerative

conditions

E-mail GP Bulletin, Tweet,

provider patient networks,

leaflets, hard copy to GPs

voluntary orgs, and

nursing homes

Lasting Power of Attorney – how to, and FAQ’s

Advance decisions – how to refuse treatment, how to make a valid advance decision

15 attendees

Feb –Mar 2015 Provider

engagement in

development of

patient information

leaflets on

advance care

planning

Patients and carers

through LPA talks.

Acute, community and

mental health providers

through email and face

to face meetings. GP’s

through GP bulletin

GP bulletin, email and

face to face meetings with

providers

Review of suite of information leaflets to agree content and design for providers to adopt- 3 trusts have requested the information leaflets once signed off to make available to their patients and carers on dementia, stroke wards etc.

100-200

17 March 2015 Carers Forum Carers Invite to attend by Carers

Forum

NHS organisations

Primary Care Services provided by GPs

Feedback on GP services

Joining PPGs

20

13

Appendix E – Collective and Individual Participation duty activities 2014/15

Domain 2: Collective Participation Duties

NHS Commissioners to ensure public involvement and consultation in commissioning process and decisions which includes

involvement of the public, patients and carers in: commissioning activities, planning of proposed changes to services monitoring, insight

and evaluation.

What activity has been undertaken to involve patients and the public in each of the following areas of CCG’s

business and focusing particularly on the period since April 2014, for each how is this being demonstrated in

outcomes?

Domain 2 Activities Objectives associated

with each activity

Outcome realised or planned from each

activity

Procurement Range of patient engagement

exercises to enable their input

into the redesigning of

community services in to key

populations and development

of the service specifications

To gain public opinion on

CCG populations and get

input into key elements of

service specifications for

those populations

Populations agreed by public and some

new additions made to specifications for

populations as well as confirming other

elements within specification

NHS Enfield is leading the work

across North Central London to

explore a potential merger of

NHS 111 and GP OOH

services, which are currently

Explaining the current

geographical use of NHS

11 and the types of calls

currently received.

Commissioning a single integrated service

across a wider geographical area

Developing our commissioning intentions.

14

separately commissioned with

one provider for NHS 111 and

two for GP out of hours – (one

provider for Barnet, Enfield and

Haringey and the other GP

OOH provider covering

Camden and Islington)

A NHS 111 and OOHs patient

and public reference group and

stakeholder and patient

engagement has been set up

as part of the procurement

strategy. There are 4/5 reps for

each borough.

Attending patient group

meetings such as the BME

Health seminar and the Over

50s Forum in Enfield

to explain the potential options

for the new service.

Discussing details of

potentially joining up NHS

111 and OOH services by

commissioning a new

contract.

Meeting with patient

groups on request.

Being open and

transparent about service

redesign and seeking

public participation to

shape those plans.

Gathering patient feedback on current

services and opportunities for

improvement

Developing a new service specification for

GP/111 and OOH

Developing an area of the website focused

on GP OOH and NHS 111 procurement

http://www.enfieldccg.nhs.uk/about-

us/nhs-111-and-out-of-hours-gp-

services.htm

15

We have also discussed the

proposed procurement at public

meetings and PPE events

Procurement MSK stakeholder engagement

as part of the procurement

strategy – two month

engagement exercise,

communications and

engagement plan in place.

MSK co-design follow up

workshop

To give patients face to

face contact with project

manager, conduct patient

surveys and distribution

of events flyers for MSK

patient workshop

Through the patient

engagement, the CCG

looked to gather

information regarding:

demographic Information and how patients use 111

The patient experience of diagnosis and treatment of their condition

levels of satisfaction with

Gathering patient feedback on current

services and opportunities for

improvement.

The MSK surveys have been completed

by forty one patients in Enfield.

It is apparent from the feedback that the

current service is deemed as good by

patients who have been given care for

their MSK condition. Despite this, the

feedback shows that there are several

areas in which this can be revised and

improved in order to improve patient

experience of the MSK services in Enfield.

This feedback was used to shape the

service redesign.

16

the service(s)

how the service can be improved

Gather patient opinion on the current service and the proposed outcome measures

Several key themes were identified when

discussing the proposed outcome

measures.

These included:

• Care closer to home • Need for more effective

communication between healthcare professionals and patients

• Need for greater lifestyle support and self-management information available for patients

• Multidisciplinary teams to support patients at a local level is important

Contract and

service

monitoring

Friends and family test at local

maternity units.

Daily survey conducted that is

reported monthly to

Easily administered

survey via kiosks and

questionnaires.

Measuring patient

experience of maternity,

ante-natal and delivery

Survey results inform staff training and

practice.

Provides valuable feedback to maternity

teams/ individuals on the quality of care

17

management, staff and

commissioners.

services

Benchmarked with other maternity units

A number of “insight and

learning” visits to provider

services to walk the pathway

including Older Peoples

Assessment Unit, Urgent Care

Centres, A&E, Ambulatory care

with discussion with patients as

part of the process

To understand patient

experience as part of

better understanding of

the overall model of care

for particular populations

and service areas

Clinical and managers attend these visits

which assure the quality of locally

commissioned services.

Service planning,

design and

decommissioning

Public engagement in the

development of Better Care

Fund (BCF) plans

To give an update on

progress BCF plan

submission and Plan

implementation.

To give an update on the

current service,

successes and

development

opportunities, and to

General updates on the plans at

Governing Body and PPE meetings.

Engagement largely delivered through

individual schemes within plan. PPE

committee gave overview.

18

discuss what could be

changed in system and

agree the next steps.

Service planning,

design and

decommissioning

Respiratory co-design meetings

• Review current ‘as is’ system

• Validate work undertaken so far on respiratory co-design

• Agree what we need to change

• Next steps

To give an update on the

current service,

successes and

development

opportunities, and to

discuss what could be

changed in system and

agree the next steps.

21 stakeholders and patient group

(Breathe Easy) gave views on:

• key issues impacting on the current service

• what would a good service look like in terms of outcomes

• identification and prioritisation of key initiatives

• These views were used to influence service redesign and prioritisation of initiatives

Service planning,

design and

decommissioning

Integrated Care System Public

Events March 2014 & March

2015

OPAU Sharing Health and Care workshop March 2015

Public-facing Integrated Care Factsheets created and now available to public; tested at

To discuss development

of integrated care and

OPAU and to elicit

patients’ views about their

current experience and

vote on outcomes that

were important to them.

Their views were

incorporated into the

outcomes for the

Views on outcomes became part of the

formal monitoring of Integrated Care and

individual Service Specifications with a

view to monitoring these outcomes in

2015/16. The OPAU patient feedback was

designed to improve practice in the unit

The views of individuals were also fed

19

workshops

Various evaluations of integrated care services which included patient feedback, e.g. falls programme, Tele-Health Services etc.

Patient Experience Tracker

project

Programme in its

Business Plan.

The views of individual

patients through surveys

and semi-structured

interviews were an

important element of the

evaluation of services.

Other objective is to

improve public knowledge

of integrated care,

progress and impact

Including patients in the

design of a questionnaire

for GP practices.

back to professional service design

workshops, e.g. falls management, rapid

response etc. with a view to influencing

service re-design, e.g. in the patient

wanting to tell their story to as few people

as possible. This in turn influenced

commissioning intentions

The views of individuals in evaluations

influenced service re-design, e.g. the need

for greater GP involvement in the falls

programme and more coordination, or the

selection of a Tele-Health provider

Patients designed the questionnaire

Service planning,

design and

decommissioning

Edmonton Summer Festival The CCG had a stall at

this large community

festival. Our stall focused

on:

Talked to over 100 local residents.

Promoted Choose Well leaflet and App.

20

NHS 111

Choose Well Campaign

Dental OOH services

How to engage with the CCG

Engagement on improving community services through a questionnaire

Joining Patient Participation Groups

Volunteering

Promoted NHS 111 and dental OOH

services.

Recruited volunteers

Surveyed opinions on community services

and value based commissioning.

Passed on details to member practices of

patients interested in joining PPGs (with

patient’s consent)

Enfield Town Show

The CCG had a stall at

this large community

festival. Our stall focused

on:

NHS 111

Choose Well Campaign

Dental OOH services

How to engage with the CCG

Talked to over 300 local residents.

Promoted Choose Well leaflet and App.

Promoted NHS 111 and dental OOH

services.

21

Engagement on improving community services through a questionnaire

Joining Patient Participation Groups

Volunteering

Promoting MSK service redesign

Recruited volunteers

Surveyed opinions on MSK services and

outcomes based commissioning.

Passed on details to member practices of

patients interested in joining PPGs (with

patient’s consent)

Visits to patient groups

including: Over 50s Forum,

Enfield Racial Equality Council,

Enfield Carers Forum,

To promote

understanding of the role

of the CCG, to open

discussions on the

strategy of the CCG to

seek groups views on our

strategy.

Raised awareness of the CCG and its role

in commissioning most local health

services.

Gave opportunity for patients to comment

on the CCG’s strategy and encouraged

people to become more involved.

Commissioning

intentions

The September 2014 PPE

event outlined the six

transformation programmes

and the 5 year Strategic Plan

To explain what

commissioning is and the

process of developing

intentions to our wider

Promoting better understanding of the

CCG’s high level commissioning intentions

and how we intend to get the best value

for our local resources and transform local

22

Reports and Presentation the

Health and Wellbeing Board

Five year Plan

Governing Body meetings

Patient participation Group

Network Meeting

Patient and Public Engagement

events 5 year forward view

community.

To present the initial

commissioning intentions

to a range of audiences

to:

• Inform stakeholders of potential plans

• Receive feedback and opinions on intentions

care pathways.

Broad support for most commissioning

intentions.

Feedback supported:

• Greater patient responsibility • More community based services • Specific proposals around urgent

care, dementia, long-term conditions services

Feedback did not support wholesale

tendering of services

Strategy

development

Joint MH Strategy 2014/2019 Healthwatch members of

the Mental Health

Strategy Implementation

Positive support for mental health strategy

and primary care projects.

23

Primary Care Strategy

Implementation Board (PSCIB)

Meetings (ended March 2015)

Steering Group, service

user representation on

the Partnership Board

PCSIB gave oversight of

the projects within the

programme and their

delivery into mainstream

services, and progress

against key programme

objectives

Further development of strategies and

action plans for projects within mental

health and primary care.

How does the CCG transparently and systematically monitor and act on patient feedback, especially in identifying

and addressing quality concerns across all sectors? And focusing particularly on the period since April 2014, how

has service quality improved as a result of this?

24

Monitor feedback

on services and

patient

experience data

Providers are asked for regular

patient experience reports

through work plans for Clinical

Quality Review Groups.

The Commissioning Support

Unit (CSU) also offers theme

and trend reports benchmarked

against other providers in North

East London.

The CCG also has in place an

early warning system for

reporting concerns based on

patient feedback to GPs. These

are reported through the CCG

GP intranet and website

Other methods of gathering

and monitoring feedback

include:

• Patient enquiries and

For Barnet, Enfield and

Haringey Mental Health

Trust (BEHMHT), for

which the CCG is lead

commissioner, this falls

within a quarterly clinical

quality and safety report.

The views of individual

patients through surveys

and semi-structured

interviews are an

important element of the

evaluation of services.

Patients and service

users are given a variety

of options for feeding

back their views on local

NHS services. The

feedback is monitored

and responded to in a

4 of 6 BEH-MHT’s corporate values are

patient specific

Of 38 early warning quality alerts received

in 2014/15, 13 (34%) arose directly from

patient feedback to the GP. Themes and

trends are reported to the CCG Clinical

Reference Group and escalated to the

Governing Body as necessary through a

Quality and Safety Report

The views of individuals are monitored and

triangulated. For example complaints and

concerns data can be triangulated with

Healthwatch and PPG feedback to

investigations and to help with challenging

providers as a commissioner.

Responding to concerns of families and

carers where they are not complaints.

25

communications inboxes • Complaints and

concerns can also be received via general email inboxes, Twitter and telephone.

• Feedback provided on NHS Choices, Patient Opinion and other public websites.

• Healthwatch Enfield feedback

• Feedback from patient groups e.g. Enfield Vision and Enfield Over 50s Forum

• Twitter • Feedback of PPG

network • Various evaluations of

integrated care services which included patient feedback, e.g. falls programme, Tele-Health Services etc. from surveys, semi-structured interviews, complaints/compliments.

• Maternity Services Liaison Committee (MSLC)

• North Middlesex

number of different ways

e.g. complaints and

feedback through Twitter

are responded to on an

individual basis

Feedback on NHS

Choices, Patient Opinion

and other public websites

is used to research and

triangulate other quality

information.

Patient/Focus groups are

used where service

information needs to be

gathered based on recent

individual experience of a

specialist service.

Forums for young parents

to provide feedback on

Involving mothers and organisations (e.g.

NCT) in maternity issues.

Ongoing forum for users and senior

26

University Hospital Focus Group

• Labour Ward Forums • CAMHS forum • Parent and Young

People Participation Group

• Patient Voice events • Draft Joint

Commissioning Strategy for child and adolescent mental health and emotional wellbeing

services

Forum to discuss issues

with organisations

providing services locally.

Forum to discuss issues

with head teachers

maternity staff to discuss maternity and

other hospital issues.

Ongoing forums for users and senior

maternity staff to discuss maternity issues.

Ongoing forum to discuss CAMHS issues

FNP achieved Your Welcome Standard

(NHS accreditation for improving services

for young people

Held two events

Services users provided their views on

IAPT, CAMHS, children’s centre and

maternity services. Feedback to services.

For example, informed breastfeeding

practices

Held events with other organisations

27

Meet with group of Head Teachers and

separate interviews where required

Act on patient

feedback,

especially

identifying and

addressing

quality concerns

across all sectors

Thematic analysis: this provider

also reports thematic analyses

on patient experience every six

months to demonstrate how it

has acted upon patient

feedback; next is scheduled at

the Clinical Quality Review

Group for July 2015. The CCG

uses its early warning system

to escalate to providers as

necessary for escalation and

resolution of concerns arising

All teams discuss complaints

received during their team

meetings and reflect upon how

the issues raised can be used

BEHMHT has reported

that it uses a variety of

methods for identifying

and responding to quality

concerns raised by

patients and will be

incorporating this into its

six monthly patient

experience thematic

analyses

Complaints management

example – a “My Care

Coordinator” has on

occasion not attended to

a patient at home at the

times agreed; Trust

The CQRG for BEHMHT was assured

January 2015 that FFT has been

implemented across the Trust since 1

January 2015 and almost all services have

started collating the feedback and will act

on comments received to improve

services. Further reporting anticipated

through the Clinical Quality Review Group

(CQRG) in due course

28

to improve the services that

they provide; e.g. delays in

processing referrals and

reporting back to referrers

within 48 hours:

• Using formal and informal routes

• 1:1 discussions with patients

• Contract meetings • Quality meetings • Quality accounts • CQUIN

ensuring that this issue is

addressed with the staff

member in supervision to

ensure that all service

users are visited as

agreed and not

inconvenienced

In all but one early

warning alert, they have

been investigated and

resolved. In the remaining

case, contractual

assurance and evidence

is awaited prior to formal

closure (relating to North

Middlesex Hospital)

Oaks Carers Group –

relatives/carers group

provided additional

feedback and insight to

support a visit

To address issues about

quality raised about

providers through formally

agreed QA and

safeguarding processes

Improved quality of care from individual

providers. For example, CHAT has worked

with a number of care homes to improve

the standard and quality of nursing care in

Enfield

Enfield CCG participated in

Haringey’s insight and learning

To ensure that services

investigate concerns

BEHMHT Care Homes Assessment Team

works closely with LBE Safeguarding

29

visiting to North Middlesex

Hospital’s discharge lounge

visit. There was a patient

representative as part of the

visit group.

Patients are also spoken to

about their care during these

visits

Integrated Care: Concerns

identified amongst key

providers follow individual

agencies’ quality assurance

mechanisms, e.g. OPAU at

Chase Farm QA process

governed by Royal Free

London Foundation Trust QA

process

We review the Healthwatch

Enfield Enter and View reports

which are taken to our Q&S

using their own internal

processes, and where

necessary collaborate

with other organisations

on investigations and

collaborate with wider

safeguarding or provider

concern arrangements

Gathering a wider and

independent view of

quality issues

Team and Enfield’s safeguarding

procedures (which include CQC

involvement) to identify and address

provider concerns

Any quality issues identified or raised

during via the quality alerts process go to

CQRQ

Improved quality of care

Preventing poor quality care

30

Committee

You also list a

number of

programme

specific events,

with outputs

identified. Can

you demonstrate

similar activity in

14/15 and

impacts on

outcomes?

IRIS Domestic Violence training

sessions, newsletters to GPs

and posters and leaflets for

patients.

Our Primary Care Strategy

funded a patient experience

tracker project. We purchased

equipment for practices and

patients helped us to design

the questionnaire. We also

visited PPGs on request to talk

to them about the project.

MSK co design follow up

workshop and MSK market

testing day. MSK patient

engagement workshop.

Cardiology Co-design

workshop x 2. Cardiology

To help GPs increase

identification of patients

experiencing domestic

violence. Raising

awareness with patients

that GP practices are DV

aware and providing a

signposting service .

To encourage live

reporting of patient

experience data. To

support practices in

getting ready for the

Friends and Family Test.

To encourage openness

and transparency of data

– practices were

encouraged to discuss

survey results with their

PPGs and put them up on

Identified service and commissioning

options, and enhanced the dialogue

between providers and patients.

Workshops have supported us in

understanding priorities for patients when

they use services and by holding provider

focused workshops, we have been able to

shape our

Enfield Carers Centre asked us to tell

them what to expect from their GP

practice. This talk was led by one of our

GP Governing Body members and

explained the differences between the

levels of services offered in primary care

locally.

We developed an audio version of Choose

Well to meet the needs of the blind and

partially sighted.

31

patient engagement events

Respiratory co design meeting

A programme of outreach visits

have continued during 2014/15.

These included: Enfield Vision,

Enfield English Turkish Cypriot

lunch events and visits to the

Carers Centre. Topics for the

presentations are agreed with

the community to suit the

needs of users

their noticeboards.

Aim to improve capture

rates of patient

experience feedback,

encouraging patient

engagement in improving

services, embedding

effective communication

systems between staff

and patients

Patient awareness of

project

To raise awareness of

Enfield Health

Challenges, choose well

campaign, NHS 111

translation services,

hospital beds for home,

PPGs breast screening

and diabetes

Enfield Carers Centre asked us to tell

them what to expect from their GP

practice. This talk was led by one of our

GP Governing Body members and

explained the differences between the

levels of services offered in primary care

locally.

32

Update on MSK

pathways, test

assumptions and

outcome measures with

local stakeholders.

Looking at commissioning

model

How has service

quality improved

as a result of

this?

Integrated care To improve the quality of

care from individual

providers

For example, a number of care homes with

whom CHAT works have demonstrably

improved their standards of care and

addressed provider concerns as part of a

joint approach between CQC, LBE and

CHAT

You describe in

your 13/14 report

the setting up of

the governance

structures, in

particular the

PPE Committee,

PPGs and

networks; and

Our PPE Committee,

established in March 2013 is

one of the six sub-committees

of the Governing Body. It meets

bi-monthly, reporting back to

the Governing Body and its

terms of reference describe

how it oversees

communications, engagement

To discuss and share with

stakeholders, patients,

key elements of CCG

work in strategic direction

and individual service

changes.

Gather general patient

opinions on services

Every event generates feedback that can

be used by the CCG. We report this

feedback in a You said, we did format.

Stakeholder feedback is used to develop

plans such as Enfield’s Better Care Fund

Plan

33

three annual

events around

the

commissioning

cycle. How have

these developed

and can you

demonstrate

positive

outcomes on

CCG activity by

engagement and

feedback through

these channels?

and equality and diversity

strategically.

We hold three patient and

public engagement events a

year around our commissioning

cycle. These events focus on

the strategic priorities for the

organisation such as

developing commissioning

intentions and feedback on key

programmes of work such as

developing urgent care

services and integrated care.

These three key public meeting

are supported by a range of

engagement visits to a wide

range of voluntary sector and

patient groups.

We hold an Annual General

Meeting as required by our

Constitution at which we

within Enfield.

Recommendations for

improving the service

Identifying future

engagement opportunities

Building strong

relationships with

stakeholders, partners

and our community.

Transparency and

openness

Being a listening

organisation that puts

patients at the heart of

our work

Building our reputation as

Outcome of PPE events reported back to

PPE Committee and Governing Body

Events help us to understand our priorities

might be different from patients. The

integrated care events not only helped us

to map pathways for older people with

frailty, but also helped us to understand

the role that patients would like the

voluntary sector to have.

Collecting feedback from each event to

continuously improve the format – e.g. our

stakeholders told us that they would like

our PPE events to be clinically-led and

more informal so we have changed to a

focus group approach.

Allowing patients to set the agenda and

recommend topics.

34

present our Annual Reports

and Accounts and discuss our

achievements and challenges

with our stakeholders.

Our Constitution extends the

concept of membership to our

member practices Patient

Participation Group. Clause 22

allows us to co-opt an elected

PPG member to our Governing

Body. During 2014 we recruited

two interim PPG

representatives who sat on the

Governing Body, PPE

Committee and helped us to

develop our PPGs.

By June 2014 all our member

practices had PPGs. Practice

Managers were supported by

our GB Practice Managers lead

and were given a toolkit to help

setup and manage the group.

We have also developed a

the local leader of the

NHS.

Supporting our member

practices to develop

active PPGs

Designing and delivering

an election process for a

PPG representative

Recruiting volunteers to work on service

redesign programmes

Delivering an elected PPG representative

to our Governing Body – achieved in May

2015.

Developing a patient-led PPG network.

Developing a governance structure that

delivers a feedback loop from PPGs to

their elected representative to the

Governing Body and back.

We believe we are the first CCG in the

country to have an elected PPG

representative.

35

strong PPG network which

meets at least quarterly.

Chairs, members and practice

managers attend this meeting

and it’s a forum to share good

practice. The network has been

supported by NHS England

engagement funding in its first

year and money has been

spent on training for PPGs

including: developing mission,

vision, aims and objectives and

developing governing

documents

We developed an election

process and governance

structure for the recruitment of

the elected PPG

representative. The election

was managed independently by

Electoral Reform Services.

Every PPG had one vote. Two

candidates came forward for

election from two different

localities and we now have an

36

elected Chair and Vice Chair.

Domain 2: Individual Participation Duties

NHS Commissioners must promote the involvement of patients and carers in decisions which relate to their care or treatment, including

diagnosis, care planning, treatment and care management. This duty requires CCGs and commissioners to ensure that the services

commissioned promote involvement of patients in their own care including: personalised care planning, shared decision making, self-

care and self-management support information with targeted support.

Self-management Integrated Care: Maintaining

independence and self-

direction is a key element of the

integrated care programme and

was part of the last public event

presentation about the

integrated care network

Integrated Respiratory Service

co-design meetings: Objectives

include to bring care closer to

home and empower patients to

self-manage conditions.

Range of engagement for

development of MSK: services

will be commissioned to embed

self-management tools within

The objective was to

ensure that individuals

considered their own

responsibilities in terms of

managing their condition

Update on the current

service:

Look into successes and

development needs from

a provider’s perspective

Discuss what could be

changed within the

systems

This view was generally accepted by most

participants, but the caveat they may need

help from professionals and informed

others to do so.

The evaluation of Tele-Health suggested

remote monitoring was able to improve

individuals’ health outcomes and ability to

understand their condition better and how

to manage it

MSK: Key themes from patient

engagement:

• Care closer to home • Need for more effective

communication between healthcare professionals and patients

• Need for greater lifestyle support and self-management information available for patients

37

the pathway, and an expert

patient programme to promote

self-management. The ability of

patients to manage their

conditions will be monitored by

a patient questionnaire. Patient

satisfaction will be measured

by a patient and carers

satisfaction survey. Patient

centred outcomes have been

developed through

engagement

MSK Patient workshops

April – June 2014 held on

the proposed outcome

based service model with

patients who have, or are,

using current service.

With the objective to:

• talk through each outcome statement with the patient representatives to get their views

• To explore what each outcome statement means more directly for the patient (sub-outcomes)

• To identify any other outcomes the patient representatives feel are important

• To get an indicative scale of importance for each of the outcome statements

• Multidisciplinary teams to support patients at a local level is important

Resulting in a set of patient outcomes,

validated by patients that commissioners

can use to develop measures for measure

MSK service delivery across streamlined

patient pathways

38

Shared decision

making

Integrated Care: Ensuring a

truly person-centred approach

in which patients had choice

and control is a key element of

the integrated care programme

and was part of the last public

event presentation about the

integrated care network

The objective was to

ensure the system and

professionals operating

within it saw individuals

not as passive consumers

of healthcare, but as at

the heart of care planning

and delivery.

This was done by

consulting with patients

on this, and other issues

and feeding these views

directly into action-

learning professional

workshops around which

to design elements of the

system

This view was generally accepted by most

participants and was identified as an

important, but not the most important,

outcome people wanted from the

integrated care network (see Aiii).

Shared decision making and care planning

are fundamental parts of all specifications.

Personalised

care planning

and personal

health budgets

1. Commissioning Mysupportbroker to undertake support plans/finance management

1. The objective was to ensure that the process would be managed effectively by

1. Mysupportbroker were able to

utilise their expertise to ensure a smooth

process for individuals requesting PB

2. All eligible individuals were made

39

2. Since 1st April 2014 every individual eligible for CHC funding who lives in the community are informed by letter of their right to have a personal health budget

3. An indicative budget assessment is undertaken for all Individuals who request a personal health budget

4. Support broker in conjunction with individual/family/carers meet to understand full needs and completes support plan

5. Once all parties agree support plan is signed off by CHC and monies are released

6. Support plan is reviewed after 3 months then annually or if needs change as per the CHC framework

people who have experience of support planning against individual needs and personal budget allocation

2. To ensure all eligible individuals were aware of Personal Budgets in line with government guidance.

3. The objective was to ensure an indicative budget based on the individuals needs was available for the individual at the start of the support planning process

4. The objective was

aware in line with government timeframes

3. Both the individual and the Support

Broker had good understanding of the

expenditure framework they were able to

utilise

4. The support plan was shaped and

owed by the individual

5. All parties were signed up to the

support plan

6. Individual is supported in a manner

that meets their needs and enables them

to take full responsibility for their own care

management

40

to ensure that the individual/family/carers had full input into the support planning process, and met all their holistic needs

5. The objective of sign off is to ensure that health needs are appropriately met and supported within the support plan, and the whole package is sustainable and fit for purpose

6. The objective is to ensure the plan is robust and meets the needs of the individual

Personalised Working with voluntary To follow similar best Met with each family to discuss personal

41

care planning

and personal

health budgets

sector partners, Enfield

Disability Action and

disability parent group Our

Voice

practice processes

already in place for adults

in CHC services

budgets.

Ran an awareness event in April 2015

MCA Advance care

planning talks x 3 and

consultation on advance

care planning leaflets

To raise awareness of

LPA and advance care

planning and develop

patient information

leaflets

50 patents attended and were given

access to specialist speakers from OPG

and Compassion in Dying, patients were

linked into CiD patient engagement

activity. Feedback on leaflets used to

improve leaflets and FAQs for patients

developed from questions asked. Patient

survey on events gave feedback on

reasons for attendance and success of

events.

Domain 2: Collective and Individual Participation Duties

How is

information

technology,

including social

media, being

used to improve

engagement

Enfield CCG started their

Twitter account in April

2013. The Twitter account

was created as a new

account, rather than

renaming the former Enfield

PCT account

To reach a wider

audience through social

media including harder to

reach groups such as

young people and the

working age population

50 patents attended and were given

access to specialist speakers from OPG

and Compassion in Dying, patients were

linked into CiD patient engagement

activity. Feedback on leaflets used to

improve leaflets and FAQs for patients

developed from questions asked. Patient

survey on events gave feedback on

42

activity

We promote events and key

developments on our

Twitter account which has

1.936 followers.

This includes: promoting

PPE events, patient

surveys, special events

such as the MCA Advance

care planning talks. We also

retweet health advice from

NHS Choices and health

awareness messages to

promote people’s

understanding of different

conditions. Wherever

possible we link to a trusted

source of information so

people can find out more

e.g. promoting awareness

of womb cancer and risk

factors and linking to the

Womb Cancer Trust. We

also promote NHS providers

and their campaigns e.g.

NHS Blood and Transplant

or our local providers

We use Twitter to link to our

To support NHS partners

To raise awareness of

health conditions, support

available and promoting

healthy lifestyles to

support our patients to

self-manage their health

To raise awareness of

LPA and advance care

planning

To encourage people to

attend events

To promote news and

updates

To support partners with

campaigns and raising

awareness of local

services

reasons for attendance and success of

events.

Patients are directed to the right place

quickly to feedback on their experience

43

website and post real time

updates of interest to our

community such as:

pharmacy opening times

over holiday periods and the

appointment of our PPG

elected representative.

We take part in social media

campaigns jointly with

partners e.g. mental health

awareness week with BEH

MHT.

We have a standard

process if we receive

complaints or feedback

through Twitter.

The CCG website hosts

information on how to make

a complaint or give

To drive traffic to our

website using Twitter

To build our

organisation’s reputation

as the local leader of the

NHS and raise our profile

To raise awareness of

complaints and informal

patient enquiries. To

explain the new NHS

system

44

feedback to the NHS. The

section includes an

explanation of the new NHS

system and where to

complain to

What benefits

can be

demonstrated

from this?

Our Twitter account has

attracted 1,936 followers and

our tweets are regularly

retweeted by subscribers.

We plan to increase our use of

social media to attract more

volunteers to feedback on

service redevelopment issues.

Our Patient and Public

Engagement Manager will be

attending a specialist course

run by Enfield Voluntary Action

on this issue.

The Patient and Public

Engagement Manager will also

be undertaking specialist social

To increase our Twitter

followers

To increase the number

and diversity of our

volunteers.

This is regularly monitored and has been

reported in to the PPE Committee.

To be engage younger users in particular

45

media courses focused on

engagement and consultation

later in 2015

To learn best practice

To use our training package with the

Consultation Institute to strengthen the

skills of our in-house team.

How is the CCG

systematically

and transparently

holding providers

to account for

patient and

public

engagement and

what

improvements to

care have been

made as a result

of this

accountability?

Providers are asked for regular

patient experience reports

through work plans for Clinical

Quality Review Groups. For

Barnet, Enfield and Haringey

Mental Health Trust

(BEHMHT), for which the CCG

is lead commissioner, this falls

within a quarterly clinical quality

and safety report.

Thematic analysis: BEH MHT

also reports thematic analyses

The CCG is assured that

the provider is collecting

intelligence on patient

experience , is

subsequently acting upon

that patient feedback

(especially identifying and

addressing quality

concerns across all

sectors) and can

demonstrate improvement

GP satisfaction

The satisfaction rate for patient experience

feedback January 2014 - December 2014

for BEHMHT was 91% including all Trust

services. Positive feedback substantially

outweighs negative feedback

BEHMHT has reported that it uses a

variety of methods for identifying and

responding to quality concerns raised by

patients and will be incorporating this into

its six monthly patient experience thematic

analyses

46

on patient experience every six

months

Quality account – CCG

providing formal feedback

which is published in the

annual Trust quality account.

CQRQ monitoring of friends

and family test feedback and

performance issues.

The NCL CCG Quality Leads

meeting reviews provider

patient experience and

complaints benchmarking

report.

Monitoring implementation of

the Friends and Family Test.

Provider complaints

benchmarking report is

questionnaires regarding

the hub access for crisis

home resolution

treatment team (CHRTT).

As a result of feedback,

CHRTT improved their

communications

processes to GP

practices.

Themes and trends

demonstrating early

warnings identified

through complaints and

addressing any quality

concerns and feedback.

Thematic Analyses

demonstrate how

providers have acted

upon patient feedback;

the next for BEHMHT is

scheduled at the Clinical

Quality Review Group

(CQRG) for July 2015

Complaints handled in line with NHS

Complaints regulation e.g. acknowledged

within 3 working days and response

agreed with complainant

Almost all services have started collating

the feedback as of 1 January 2015 and will

act on comments received to improve

services. Further reporting anticipated

through the Clinical Quality Review Group

in due course

Helping to provide assurance on how

providers are handling complaints and

implementing complaints regulations

47

produced by the CSU PEET

Team and reviewed at the CCG

quality leads meeting.

CCG assured through the

Clinical Quality Review

Group (CQRG) that this

has been implemented

across the Trust from 1

January 2015 as was

planned. Service line FFT

data will be monitored

through the Trust’s

quarterly deep dive forum

Regularly reviewing

complaints across the

sector and benchmarking

providers

What plans does

the CCG have in

place for the

further

development of

engagement and

participation in

The CCG has developed a

Communications, Engagement

and Consultation Toolkit to

support programme managers

deliver their project

communications. The Toolkit is

internal only, and has been

tested with programme

Developing systems and

processes for

communications,

engagement and

consultation.

The Toolkit has been developed with the

support and comments of commissioning

managers.

It will be launched as a final, internal only

document in summer 2015

48

2015/16?

managers. It supports all levels

of engagement and also

supports managers to prepare

for HOSC and JHOSC.

The Toolkit includes

appendices which programme

managers can use to support

the development of project

plans and also develop with the

support of the Communications

and Engagement Team.

The Toolkit will is being

developed and the next version

will include visual flow charts

The CCG will continue to

deliver three main PPE events

a year and supported this with

a programme of other events

and visits, tailored in line with

corporate priorities and the

needs of our community.

Developing best practice

49

The CCG plans to further

develop its PPG network now

that the elected representative

is in post. At the first meeting

chaired by the elected

representative in May, the

PPGs were encouraged to

produce a work plan and chose

their own priorities for the year.

This included core work such

as sharing best practice and

raising awareness of PPGs but

also some further collaboration

around: reducing do not

attends, promoting public

health messages and working

with practices on their falls

registers.

The CCG plans to develop a

more formal approach to

recruiting and managing

volunteers. The Head of

Communications and

Engagement and the Patient

Enfield CCG wants to

further develop the PPG

network to be patient-led

and develop a work plan

through co-production.

Patient-led engagement. Peer education

50

and Public Engagement

Manager are attending

specialist courses run by

Enfield Voluntary Action.

The CCG plans to develop a

stakeholder reference group in

2015/16 to provide early

support and feedback on the

development of strategic

change programmes.

The CCG has invested in

membership of the

Consultation Institute, along

with buying specialist training

courses which will be used to

develop the Communications

and Engagement Team and

other senior leaders in the

organisation

Better support for

volunteers including

developing role

descriptions based on

the appendix in the

Communications and

Engagement Toolkit

More formal support and training where

necessary for volunteers

51

More engagement with

patient groups.

Learning best practice,

understanding wider

public sector issues and

techniques for

engagement and

participation

Ensuring training and

development for the team

and the CCG is up to

date.

Setting up a panel approach to get

feedback early on in the planning cycle.

20 specialist training courses have been

purchased. Courses already attended by

the Communications and Engagement

team include the Law of Consultation and

Consultation Essentials

52

What steps have

been taken to

ensure that plans

are robust (e.g.

level of

governance

approval,

evidence of

funding and/or

other resource

commitment)?

Governance for engagement

activities is supported by:

oversight by the PPE

Committee, operational

leadership by the Director of

Quality and Governance and

the Lay Member for PPE. The

PPE Committee has a direct

line of report to the CCG

Governing Body.

Operational support across the

organisation is provided by a

very experienced in-house

team of three communications

and engagement professionals.

The Communications,

Engagement and Consultation

Developing the role of the

PPE Committee in

overseeing engagement

across the organisation

Developing the skills of

the experienced in-house

communications team

PPE Committee monitors activity and

assures the Governing Body

Potential commissioning of specialist

support where required

53

Toolkit has been developed to

further support staff’s

knowledge and understanding

of the importance of planning

communications and

engagement activities.

The Communications and

Engagement Team encourage

all teams to report engagement

activities that they undertake

and these are recorded in an

engagement log that is

regularly viewed by the PPE

Committee.

Developing policies and

protocols to support good

practice

Ensuring that all activities

are reported and

evaluated

Ensuring project managers are using the

same planning processes and that

communications and engagement plans

are developed for all projects.

Increasing the range and diversity of

engagement activities.