primary care commissioning committee · primary care commissioning committee part i meeting:...

Primary Care Commissioning Committee Part I – 2.30pm – 3.30pm Wednesday 28 August 2019 Committee Rooms, 4th Floor Unex Tower, 5 Station Street, London E15 1DA

Agenda

No Time Item Action Required

Page Presenter

1. Administration and updates

1.1

2.30pm

Welcome, introductions and apologies Chair

1.2 Declarations of interests Monitor Chair

1.3 Minutes of previous meetings:

29 May 2019

Approve Page 2 Chair

1.4 Action log Monitor Page 7 Chair

1.5 Primary Care Networks Update Information Verbal J Mazarelo

2 Discussion Items

2.1 2.50pm GP Patient Survey Results Information Page 8 J Mazarelo

2.2 3.00pm Update on Practice Core Opening Hours Decision Page 57 A Goodlad/ L Hutchinson

2.3 3.10pm Newham Health Report Information Page 62 L Greco

3. Any other business

3.1 3.25pm AOB

3.2 Next meeting: 2.30-3.30pm Wednesday 25 September (discussion meeting), Committee rooms 4th Floor, Unex Tower, 5 Station Street, London E15 1DA

2.00-4.00pm Tuesday 1 October 2019 – North East London Primary Care Commissioning Committee in Common, Venue to be confirmed

Primary Care Commissioning Committee Part I meeting: 2.30-3.30pm Wednesday 29th May 2019

Committee rooms, 4th Floor, Unex Tower, 5 Station Street, E15 1DA

Minutes

Voting members present:

Ellie Robinson Lay Member for Patient and Public Engagement (Acting Chair)

Nadeem Faruq GP Board Member, NCCG

Fiona Smith Registered Nurse, NCCG

Steve Collins Chief Financial Officer

Non-voting members present:

Jenny Mazarelo Associate Director Primary Care, NCCG

Fiona Hackland Head of Commissioning, Public Health – Adults, LBN

Alison Goodlad Head of Primary Care Commissioning, NELCA

Leonardo Greco Healthwatch Newham

In Attendance:

Yusuf Olow (minutes) Interim Committee Officer, NCCG

Susan Masters Lead for Health and Adult Social Care, LBN

Sally Burns LBN-Public Health Consultant

Apologies:

Selina Douglas Managing Director, NCCG

Lorna Hutchinson Assistant Heath of Primary Care, NELCA

Chetan Vyas Director of Quality and Safety

Phil Horwell Lay Member for Remuneration, NCCG (Chair)

Satbinder Sanghera Director of Governance and Partnerships, NCCG

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No Item

1.1 Welcome, introduction, apologies for absence and declarations of interest

CV sent his apologies and there were no declarations of interest.

1.3 Minutes of last meeting

The Chair requested clarification that the agreement letter relating to the proposal for the establishment of a North East London Primary Care Commissioning Committee in Common. AG confirmed that the letter had been sent before the April meeting.

The Chair also requested clarification on the five-year framework for GP Contract Reform 2019-2023. J Mazarelo responded that this had been superseded by the guidance that published by NHSE on 29th March 2019.

The Committee agreed that the minutes of the meeting held on Wednesday 27th March 2019 were approved as an accurate record of the meeting.

1.4 Action log

Review of Roma Community Access to Primary Care

This was considered at Item 2.3

Commissioning Intentions – New Transitional Team

This was considered in Item 2.1 in the part 2 agenda.

The other actions were no due.

1.5 Application to vary PMS Agreement-Change of Name

Presented by Alison Goodlad

Dr N Bhadra’s Surgery is the registered name on PMS Agreement for services, however following Dr Bhadra’s retirement it was no longer relevant. The GP’s who have succeeded the contract have requested that the practice name be change to ‘The Manor Park Practice.’

Cllr Masters suggested that the name could confuse patients, as there are several practices in the Manor Park area. The Committee noted that, whilst it was unfortunate that they were not more specific, this was not grounds for rejecting the application.

The Committee agreed to the application to change the name of the practice.

1.6 Establishment of Primary Care Networks

Presented by Jenny Mazarelo

By 15th May 2019, the CCG received proposals for 10 PCTs. Five were approved and five required further discussion and work. However, NHSE have stated that unless all 10 proposals are approved then none of the PCTs will come into operation on 1st July 2019 as anticipated.

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Following questioning, J Mazerelo disclosed that the issues with the five proposals that were not approved were considerable but not insurmountable. J Mazarelo also clarified that the issues related to geography and not capability.

J Mazarelo suggested that, once the issues have been resolved, a virtual sign off will be required as the June meeting will be too late. If the issues have not be resolved, there is an agreed escalation mechanism with final escalation to the General Practitioners Committee and NHSE. However, J Mazarelo said that this would be an extreme measure that should be avoided if possible.

The Committee noted the update and asked to be kept informed.

2. Discussion Items

2.1 Update on Practice Core Opening Hours

Presented by Alison Goodlad

There is a requirement or CCGs to review core hours which are 8.00am-6.30pm, Monday-Friday. There was a requirement under the contract for practices to meet the ‘reasonable needs’ of patients however, this was never formally defined. To assist decision making a survey, the NHSE engaged patients and a set of bullet points were drawn up showing what services patients expected to be able to access during core hours.

A Goodlad noted that there had been an improvement in the number of GP practices that are opened in North East London. However, surgeries had to improve advertising to let patients know that they are opened for longer.

A Goodland highlighted two surgeries that were non-compliant. Dr Krishnamurthy Practice was previously closed on Thursday afternoons. However, there were questions in regards to whether or not patiens could obtain urgent advice. A Goodlad also noted that Boleyn Road Practice was still closed on Thursday afternoons and total weekly opening hours are less than 45 hours.

An update would be given in three months’ time. Prior to contractual enforcement action being taken, a comprehensive assessment of arrangements and legal advice will be taken. The Committee will be notified if contractual enforcement action is taken.

The Committee thanked those in NHSE who worked on this issue and noted the update.

Action: A Goodlad to report back on Practice Core Opening Hours in August 2019.

2.2 Community Minor Surgery – Update on Service Specification Presented by Jenny Mazarelo

In September 2018, the Committee received a report on the stock take of minor surgery arrangements. A community minor surgery service was commissioned and an updated service specification was requested to ensure there was no omissions from the DES specifications.

The matter will be considered by the Commissioning Committee in June, and one of the options being considered is to decommission the community service meaning patients would access the primary care additional service or the minor surgery DES.

F Smith questioned if the some of the specifications are available among the primary care additional services or DES, highlighting the example of the lymph node excision biopsies. F Smith also added that

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there was no information on the number of operations that take place on relation to the individual specifications.

Dr Faruq noted that there were three levels of DES noting that level three treatments which consist of incisions and excision was carried out by only three GPs within the borough. Dr Faruq was concerned that unless more GPs carried out these procedures and supporting infrastructure provided then it would likely be carried out by hospital trusts at greater expense. Dr Faruq also stated that any decommissioning of services would likely result in greater hospital trust involvement.

Action: The Committee requested that these concerns be passed to the Commissioning Committee.

2.3 Review of Roma community access and other seldom heard groups to primary care

Presented by Jenny Kezia

The Roma Support Group produced a report measuring the outcomes of Roma communities’ access to primary care services. A survey was undertaken in 2017 and, following the survey, a workshop was held for practices and the feedback from practices was positive. However, there was insufficient evidence that it had had a positive effect on the Roma and J Kezia also included other seldom heard groups.

J Kezia suggested that desktop research be undertaken of the data already gathered identifying any gaps in information. Digital and face-to-face research will used where information is missing or limited. Following this, a plan of action will be drawn up. It was expected that that it would take three months to complete the work.

In regards to funding, S Collins noted that there had been no figure stated though the Committee was being asked to agree funding. J Kezia responded that she had a meeting with Intelligent Health and it was hop that the research could be carried out by them within the existing contract. J Kezia said she would return to the Committee with full costings for the Committee to approve. F Hackland asked for additional information on the communities being targeted to ensure that none are missed.

Regarding reporting, J Kezia reports to Satbinder Sanghera who then reports to the Quality, Performance and Finance Committee.

Action: J Kezia to return the QPF Committee in August with the outcome of her Desktop research.

3. Any Other Business

3.1 Leonard Greco gave a brief update on the outcome of engagement with patients with physical disabilities and learning disabilities undertaken by Healthwatch Newham. The report will be published next month and it would be circulated to the Committee in time for the next meeting.

Patients with physical disabilities did not realise they could ask for a 20 minute appointment. Patients also reported that GPs often tended to bring the discussion back their main condition even if that was not the purpose of the appointment. In addition to this, GPs changed medication without explaining why, and for those with sight issues they only discovered the medication had changed due to different side effects.

J Mazarelo stated that Justin Roper and herself, as the mattes related to their remit would investigate and meet with Leonardo Greco.

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The Committee expressed concern and requested that the report added to the agenda for the next meeting.

Action: L Greco to circulate Health Newham Report, which will be considered at the next meeting.

3.2 Next meeting: Wednesday 26th June 2019 (discussion meeting)

2.30pm-3.30pm Committee rooms 4th Floor, Unex Tower, 5 Station Street, London E15 1DA

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Action

referenceMeeting date Action Owner Deadline Update

PCCC94 29/11/2017

Review of Roma Community access to Primary Care

The proposal for roll out of this training across Newham GP

practices to be discussed by the Committee early 2018.

S Sanghera May-19Review presented to meeting on 29 May 2019. See action

PCCCx below

PCCC108 10/09/2018Revised AQP Minor Surgery specifcation to be reviewed by PCCC to

ensure no Directed Enhanced Service omissions.L Sibbons May-19

Revised specification presented on 29 May 2019. Feedback

reflected in updated service specification to be presented to

Commissioning Committee in October 2019

PCCC111 31/10/2018

Strategic Estates Plan

Strategic Estates Plan approved by PCCC on 31.10.18 on an annual

review cycle J Kelder Nov-19 Not due

PCCC112 31/10/2018

Commissioning Intentions - New Transitional Team

J Mazarelo to discuss the Newham Transitional Team cohort of

patients with S Sanghera as part of the Roma Community/hard to

reach groups as part of the CCG Strategy

J Mazarelo May-19 On Part 2 agenda

PCCC119 29/05/2019Practice Core Opening Hours

Update to be presented to August meetingA Goodlad Aug-19 On agenda

PCCC120 29/05/2019

Community Minor Surgery

Concerns regarding decommissioning of all but two procedures to

be raised with Commissioning Committee with regard to future

commissioning arrangements

J Mazarelo Sep-19Update to be presented to the Commissioning Committee on 5

September 2019

PCCC121 29/05/2019

Review of Roma community access and other seldom heard

groups to primary care

Outcome of desktop review to be presented to Quality Performance

and Finance Committee

J Kezia Aug-19Review underway and to be presented to QPF (or equivalent) in

September 2019

PCCC121 29/05/2019 Health Newham report L Greco Aug-19 On agenda

item 1.4 - 28 August 2019 Primary Care Commissioning Committee - Action Log Part I

Highlighted items represent a recommendation to close action

1 7


Title National GP Patient Survey Results

Agenda item 2.1

Author Jenny Mazarelo, Deputy Director of Primary Care, WEL CCGs

Presented by Jenny Mazarelo, Deputy Director of Primary Care, WEL CCGs

Contact for further information

Jenny Mazarelo, Deputy Director of Primary Care, WEL CCGs

T: 020-3688-2156 / E: [email protected]

This paper is for ☐ Decision ☐ Monitor ☐ Discussion ☒ For Information

Action required To note the latest national GP Patient Survey results for Newham CCG published in July.

Executive summary

The GP Patient Survey (GPPS) is an England-wide survey, providing practice-level data about patients’ experiences of their GP practices. Ipsos MORI administers the survey on behalf of NHS England.

The slide pack attached at Appendix 1 presents some of the key results for Newham CCG and is based on the 4,381 questionnaires returned completed from the 23,197 sent out, representing a response rate of 19%.

The survey questionnaire measures patients’ experiences across a range of topics, including:

- Local GP services

- Making an appointment

- The patient’s last/most recent appointment

- Overall experience

- Health

- When the GP practice is closed

- NHS Dentistry

- Questions about the patient

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There are three main ways in which the results can be used and interpreted to improve GP services:

• Comparison of a CCG’s results against the national average allowsbenchmarking of the results to identify whether the CCG is performing well, poorly, or in line with others.

• Considering questions where there is a larger range in responses amongpractices or CCGs highlights areas in which greater improvements may be possible, as some CCGs or practices are performing significantly better than others nearby.

• Comparison of practices’ results within the CCG can identify practices within aCCG that seem to be over-performing or under-performing compared with others. The CCG may wish to work with individual practices: those that are performing particularly well may be able to highlight best practice, while those performing less well may be able to improve their performance.

These first two areas will be considered in more detail at the first Primary Care Commissioning Committee meeting in Common on 1 October 2019.

Supporting papers Appendix 1: GP Patient Survey Results for Newham CCG – July 2019.

Next Steps/ Onward Reporting

Where has the paper been already presented?

This report has not been presented to a previous Committee or Forum

How does this fit with NHS Newham CCG strategic Priorities?

To commission and develop GP services that are modern, accessible and fit for the future in caring for our residents

We will ensure we plan, design, and commission accessible high quality services for our residents with our residents

We will improve access to, and, the quality of, Primary Care

Risk BAF.07.01 Failure to effectively deliver a primary care strategy that is adequately resourced to service Newham residents

Equality impact N/A

Stakeholder engagement

Individual Primary Care Networks and individual practices whose results reflect under-performance compared with other practices. Practice Managers Forum – 4 September 2019 Practice Council – 27 September 2019

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Financial Implications

Newham CCG faces a significant financial challenge in 2019/20 and is undertaking a range of measures to ensure sustainability including the 2019/20 QIPP program.

This report presents issues that may have financial consequences. These are yet to be fully determined but if not already embedded in budgets or reserve provision, a further Board decision would be required to release any additional expenditure commitment.

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2


Overall experience of GP practice

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3

83%

10%

Overall experience of GP practice

33%

42%

15%

6% 4% Very good

Fairly good

Neither good nor poor

Fairly poor

Very poor

Q31. Overall, how would you describe your experience of your GP practice?

National

6%

Good

Poor

%Good = %Very good + %Fairly good

%Poor = %Very poor + %Fairly poorBase: All those completing a questionnaire: National (760,037); CCG 2019 (4,317); CCG 2018 (4,272); Practice bases range from 38 to 119; CCG bases range from 2,377 to 8,129

CCG’s results Comparison of results

76%Good

Poor

CCG

74 76

10 100

10

20

30

40

50

60

70

80

90

100

2018 2019

% Good % Poor

CCG’s results over time

Practice range in CCG – % Good Local CCG range – % Good

LowestPerforming

HighestPerforming

47% 91%

LowestPerforming

HighestPerforming

74% 88%

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4

Overall experience:how the CCG’s results compare to other local CCGs

Comparisons are indicative only: differences may not be statistically significant

74%

88%

Percentage of patients saying ‘good’

Base: All those completing a questionnaire: CCG bases range from 2,377 to 8,129 %Good = %Very good + %Fairly good


The CCG represented by this pack is highlighted in red

Results range from

to

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Overall experience: how the CCG’s practices compare

Percentage of patients saying ‘good’

Base: All those completing a questionnaire: Practice bases range from 38 to 119



Results range from

to 47%

91%


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Percentage of patients saying ‘good’ CCGPractices National

Base: All those completing a questionnaire: National (760,037); CCG 2019 (4,317); Practice bases range from 38 to 119


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Percentage of patients saying ‘good’ CCGPractices National



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Local GP services

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15%Very easy

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68%

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Ease of getting through to GP practice on the phone

Q1. Generally, how easy is it to get through to someone at your GP practice on the phone?

32%

Easy

Not easy

Base: All those completing a questionnaire excluding 'Haven't tried': National (742,537); CCG 2019 (4,223); CCG 2018 (4,165); Practice bases range from 39 to 110; CCG bases range from 2,324 to 7,930

58%Easy

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%Easy = %Very easy + %Fairly easy %Not easy = %Not very easy + %Not at all easy

Practice range in CCG – % Easy Local CCG range – % Easy

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23% 91%

LowestPerforming

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52% 83%

CCG’s results Comparison of resultsCCG’s results over time

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Ease of getting through to GP practice on the phone: how the CCG’s practices compare

Percentage of patients saying it is ‘easy’ to get through to someone on the phone

Base: All those completing a questionnaire excluding ‘Haven’t tried’: National (742,537); CCG 2019 (4,223); Practice bases range from 39 to 110 %Easy = %Very easy + %Fairly easy



CCGPractices National

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Ease of getting through to GP practice on the phone: how the CCG’s practices compare

Percentage of patients saying it is ‘easy’ to get through to someone on the phone

Base: All those completing a questionnaire excluding ‘Haven’t tried’: National (742,537); CCG 2019 (4,223); Practice bases range from 39 to 110 %Easy = %Very easy + %Fairly easy




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12

34%

49%

14%4%

Very helpful

Fairly helpful

Not very helpful

Not at all helpful

89%

18%

Helpfulness of receptionists at GP practice

Q2. How helpful do you find the receptionists at your GP practice?

11%

Helpful

Not helpful

Base: All those completing a questionnaire excluding ‘Don’t know’: National (751,111); CCG 2019 (4,305); CCG 2018 (4,270); Practice bases range from 39 to 114; CCG bases range from 2,359 to 8,065

82%Helpful

Not helpful

81 82

19 18

0

10

20

30

40

50

60

70

80

90

100

2018 2019

% Helpful % Not helpful

%Helpful = %Very helpful + %Fairly helpful %Not helpful = %Not very helpful + %Not at all helpful

Practice range in CCG – % Helpful Local CCG range – % Helpful

LowestPerforming

HighestPerforming

59% 98%

LowestPerforming

HighestPerforming

81% 92%


NationalCCG

22


13

0%

10%

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E

Helpfulness of receptionists at GP practice:how the CCG’s practices compare

Percentage of patients saying receptionists at the GP practice are ‘helpful’

Base: All those completing a questionnaire excluding ‘Don’t know’: National (751,111); CCG 2019 (4,305); Practice bases range from 39 to 114 %Helpful = %Very helpful + %Fairly helpful




23


14

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

DR

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AM

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TH

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Helpfulness of receptionists at GP practice:how the CCG’s practices compare

Percentage of patients saying receptionists at the GP practice are ‘helpful’

Base: All those completing a questionnaire excluding ‘Don’t know’: National (751,111); CCG 2019 (4,305); Practice bases range from 39 to 114 %Helpful = %Very helpful + %Fairly helpful




24


15


Access to online services

25


16

51%

31%

19%

12%

32%

44%41%

15%

7%

40%

0

10

20

30

40

50

60

70

80

90

100

Bookingappointmentsonline

Ordering repeatprescriptionsonline

Accessing mymedical recordsonline

None of these Don't know

CCG

National

Awareness of online services


Per

cent

age

awar

e of

onl

ine

serv

ices

offe

red

by

GP

pra

ctic

e


Q4. As far as you know, which of the following online services does your GP practice offer?

Practice range within CCG

26


17

Online service use

25%

10%7%

70%

15% 16%

4%

76%

0

10

20

30

40

50

60

70

80

90

100

Booking appointmentsonline

Ordering repeatprescriptions online

Accessing my medicalrecords online

None of these

CCG

National

Per

cent

age

used

onl

ine

serv

ices

in p

ast 1

2 m

onth

s

Practice range within CCG


Q5. Which of the following general practice online services have you used in the past 12 months?


27


18

77%

30%

Ease of use of online services

Q6. How easy is it to use your GP practice’s website to look for information or access services?*

23%

Easy

Not easy

Base: All those completing a questionnaire excluding 'Haven't tried': National (259,817); CCG 2019 (1,838); CCG 2018 (1,628); Practice bases range from 12 to 73; CCG bases range from 929 to 3,006

70%Easy

Not easy

%Easy = %Very easy + %Fairly easy %Not easy = %Not very easy + %Not at all easy

Practice range in CCG – % Easy Local CCG range – % Easy

LowestPerforming

HighestPerforming

41% 92%

LowestPerforming

HighestPerforming

66% 79%

25%

45%

19%

11%Very easy

Fairly easy

Not very easy

Not at all easy

69 70

31 30

0

10

20

30

40

50

60

70

80

90

100

2018 2019

% Easy % Not easy

*Those who say ‘Haven’t tried’ (52%) have been excluded from these results.


NationalCCG

28


19


Making an appointment

29


20

14%

52%

9%

36%

Yes, a choice of place

Yes, a choice of time orday

Yes, a choice ofhealthcare professional

No, I was not offered achoice of appointment

62%

36%

Choice of appointment

38%

Yes

No

Base: All who tried to make an appointment since being registered excluding ‘Can’t remember’ and ‘Doesn't apply’: National (593,075); CCG 2019 (3,322); CCG 2018 (3,301); Practice bases range from 31 to 94; CCG bases range from 1,902 to 6,085

64%Yes

No

63 64

37 36

0

10

20

30

40

50

60

70

80

90

100

2018 2019

% Yes % No

Q16. On this occasion (when you last tried to make a general practice appointment), were you offered a choice of appointment?

Practice range in CCG – % Yes Local CCG range – % Yes

LowestPerforming

HighestPerforming

36% 87%

LowestPerforming

HighestPerforming

57% 74%

%Yes = ‘a choice of place’ and/or ‘a choice of time or day’ and/or ‘a choice of healthcare professional’


NationalCCG

30


21

Choice of appointment: how the CCG’s practices compare

Percentage of patients saying ‘yes’ they were offered a choice of appointment

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

LUC

AS

AV

EN

UE

PR

AC

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OA

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Base: All who tried to make an appointment since being registered excluding ‘Can't remember’ and ‘Doesn’t apply’: National (593,075); CCG 2019 (3,322); Practice bases range from 31 to 94





31


22

Choice of appointment: how the CCG’s practices compare

Percentage of patients saying ‘yes’ they were offered a choice of appointment

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

DR

T L

WIN

RO

YA

L D

OC

KS

ME

DIC

AL

PR

AC

TIC

E

E12

ME

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AL

CE

NT

RE

NE

WH

AM

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AN

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ION

AL

PR

AC

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ST

AR

LA

NE

ME

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AL

CE

NT

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ES

K R

OA

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ICA

L C

EN

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TH

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ZA

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RA

CT

ICE

Base: All who tried to make an appointment since being registered excluding ‘Can't remember’ and ‘Doesn’t apply’: National (593,075); CCG 2019 (3,322); Practice bases range from 31 to 94





32


23

67% 74%

67%

25%

8%Yes, and I accepted anappointment

No, but I still took anappointment

No, and I did not takean appointment

Satisfaction with appointment offered


LowestPerforming

HighestPerforming

39% 89%

LowestPerforming

HighestPerforming

62% 77%

Base: All who tried to make an appointment since being registered: National (711,867); CCG 2019 (3,977); CCG 2018 (3,940); Practice bases range from 36 to 110; CCG bases range from 2,251 to 7,502

63 67

37 33

0

10

20

30

40

50

60

70

80

90

100

2018 2019

% Yes % No

Q17. Were you satisfied with the type of appointment (or appointments) you were offered?

6%

25%

8%No, took appt

20%

Yes, took appt

No, took appt

Yes, took appt

No, didn’t take apptNo, didn’t take appt

%No = %No, but I still took an appointment + %No, and I did not take an appointment


NationalCCG

33


24

Satisfaction with appointment offered: how the CCG’s practices compare

Percentage of patients saying ‘yes’ they were satisfied with the appointment offered

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

TH

E S

UM

MIT

T P

RA

CT

ICE

TH

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RA

CT

ICE

ALB

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NT

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Base: All who tried to make an appointment since being registered: National (711,867); CCG 2019 (3,977); Practice bases range from 36 to 110




34


25

Satisfaction with appointment offered: how the CCG’s practices compare

Percentage of patients saying ‘yes’ they were satisfied with the appointment offered

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

WO

OD

GR

AN

GE

ME

DIC

AL

PR

AC

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E

ST

AR

LA

NE

ME

DIC

AL

CE

NT

RE

DR

T L

WIN

NE

WH

AM

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AN

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AL

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ER

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K R

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ICA

L C

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ZA

D P

RA

CT

ICE





35


26

16%

8%

22%

11%8%

20%

9% 10%

23%

14%8%

12% 10% 10%

21%

12% 11%

29%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Got anappointment fora different day

Called an NHShelpline, suchas NHS 111

Went to A&E Spoke to apharmacist

Went to orcontacted

another NHSservice

Decided tocontact my

practice anothertime

Looked forinformation

online

Spoke to afriend or family

member

Didn’t see or speak to anyone

CCG

National

What patients do when they are not satisfied with the appointment offered and do not take it

Of t

hose

who

dec

lined

an

appo

intm

ent,

perc

enta

ge w

ho w

ent o

n to

do

som

ethi

ng e

lse

Base: All who did not take the appointment offered (excluding those who haven't tried to make one): National (34,350); CCG 2019 (286)

Q19. What did you do when you did not take the appointment you were offered?


36


27

67%

19%

Overall experience of making an appointment

22%

40%

19%

11%

9% Very good

Fairly good


Fairly poor

Very poor

Q22. Overall, how would you describe your experience of making an appointment?

Practice range in CCG – % Good Local CCG range – % Good

16%

Good

Poor

LowestPerforming

HighestPerforming

27% 92%

LowestPerforming

HighestPerforming

57% 75%


%Poor = %Very poor + %Fairly poorBase: All who tried to make an appointment since being registered: National (705,310); CCG 2019 (4,009); CCG 2018 (3,955); Practice bases range from 37 to 108; CCG bases range from 2,244 to 7,482

62%Good

Poor

60 62

21 19

0

10

20

30

40

50

60

70

80

90

100

2018 2019

% Good % Poor


NationalCCG

37


28

Overall experience of making an appointment:how the CCG’s practices compare

Percentage of patients saying they had a ‘good’ experience of making an appointment


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

BO

LEY

N R

OA

D P

RA

CT

ICE

E12

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ALB

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38


29

Overall experience of making an appointment:how the CCG’s practices compare

Percentage of patients saying they had a ‘good’ experience of making an appointment


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

LIB

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39


30


Perceptions of care at patients’ last appointment

40


31

Perceptions of care at patients’ last appointment with a healthcare professional

Base: All who had an appointment since being registered with current GP practice excluding 'Doesn't apply': National (717,030; 715,282; 717,062); CCG 2019 (4,031; 4,024; 4,017)

CCG’s resultsNationl results % Poor (total)

CCG results

% Poor (total)

%Poor (total) = %Very poor + %Poor

Q26. Last time you had a general practice appointment, how good was the healthcare professional at each of the following

35% 40% 39%

45%44% 42%

13% 10% 13%4% 3% 4%3% 3%

Giving you enough time Listening to you Treating you with care and concern

Very good Good Neither good nor poor Poor Very poor

National results

% ‘Poor’ (total)

CCG results

% ‘Poor’ (total)

Very poor

Very good

4% 4% 4%

7% 6% 6%

Giving you enough time Listening to you Treating you with care and concern

41


32

Perceptions of care at patients’ last appointment with a healthcare professional

Base: All who had an appointment since being registered with current GP practice excluding ‘Don’t know / doesn’t apply’ or ‘Don’t know / can’t say’: National (637,385; 705,397; 706,338); CCG 2019 (3,513; 3,854; 3,852)

CCG’s resultsNationl results % Poor (total)

CCG results

% Poor (total)

Q28-30. During your last general practice appointment…

48% 56% 51%

40%36% 40%

12% 9% 9%

Felt involved in decisions about care andtreatment

Had confidence and trust in thehealthcare professional

Felt their needs were met

Yes, definitely Yes, to some extent No, not at all

National results

% ‘No, not at all’

CCG results

% ‘No, not at all’

No, not at all

Yes, definitely

7% 5% 6%

12% 9% 9%

Felt involved in decisions about care and treatment

Had confidence and trust in the healthcare professional

Felt their needs were met

42


33

41%

34%

24%

Yes, definitely

Yes, to some extent

No, not at all

86%

24%

Mental health needs recognised and understood

14%

Yes

No

Base: All who had an appointment since being registered with current GP practice excluding ‘I did not have any mental health needs’ and ‘Did not apply to my last appointment’: National (284,999); CCG 2019 (1,964); CCG 2018 (1,866); Practice bases range from 22 to 66; CCG bases range from 852 to 3,542

76%Yes

No

76 76

24 24

0

10

20

30

40

50

60

70

80

90

100

2018 2019

% Yes % No

Q27. During your last general practice appointment, did you feel that the healthcare professional recognised and/or understood any mental health needs that you might have had?

%Yes = %Yes, definitely + %Yes, to some extent


LowestPerforming

HighestPerforming

56% 96%

LowestPerforming

HighestPerforming

76% 89%


NationalCCG

43


34


Managing health conditions

44


35

30%

38%

32%Yes, definitely

Yes, to some extent

No, not at all

78%

32%

Support with managing health conditions

22%

Yes

No

Base: All with a long-term condition excluding ‘I haven’t needed support’ and ‘Don’t know / can’t say’: National (292,168); CCG 2019 (1,497); CCG 2018 (1,391); Practice bases range from 12 to 54; CCG bases range from 773 to 2,655

68%Yes

No

Q38. In the last 12 months, have you had enough support from local services or organisations to help you to manage your condition (or conditions)?


LowestPerforming

HighestPerforming

35% 93%

LowestPerforming

HighestPerforming

67% 82%

64 68

36 32

0

10

20

30

40

50

60

70

80

90

100

2018 2019

% Yes % No



NationalCCG

45


36

Percentage of patients saying ‘yes’ they have had enough support to manage their condition(s)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

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Base: All with a long-term condition excluding ‘I haven’t needed support’ and ‘Don’t know / can’t say’: National (292,168); CCG 2019 (1,497); Practice bases range from 12 to 54


Support with managing long-term health conditions:how the CCG’s practices compare




46


37

Percentage of patients saying ‘yes’ they have had enough support to manage their condition(s)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

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Base: All with a long-term condition excluding ‘I haven’t needed support’ and ‘Don’t know / can’t say’: National (292,168); CCG 2019 (1,497); Practice bases range from 12 to 54


Support with managing long-term health conditions:how the CCG’s practices compare




47


38


Satisfaction with general practice appointment times

48


39

23%

41%

18%

9%

10%Very satisfied

Fairly satisfied

Neither satisfied nordissatisfied

Fairly dissatisfied

Very dissatisfied

65%

19%

Satisfaction with appointment times

18%

Satisfied

Dissatisfied

Base: All those completing a questionnaire excluding ‘I’m not sure when I can get an appointment’: National (696,898); CCG 2019 (4,008); CCG 2018 (3,981); Practice bases range from 35 to 106; CCG bases range from 2,254 to 7,543

63%Satisfied

Dissatisfied

62 63

20 19

0

10

20

30

40

50

60

70

80

90

100

2018 2019

% Satisfied % Dissatisfied

Q8. How satisfied are you with the general practice appointment times that are available to you?*

%Satisfied = %Very satisfied + %Fairly satisfied

%Dissatisfied = %Very dissatisfied + %Fairly dissatisfied

Practice range in CCG – % Satisfied Local CCG range – % Satisfied

LowestPerforming

HighestPerforming

31% 88%

LowestPerforming

HighestPerforming

58% 72%

*Those who say ‘I’m not sure when I can get an appointment’ (2%) have been excluded from these results.


NationalCCG

49


40

Satisfaction with appointment times: how the CCG’s practices compare

Percentage of patients saying they are ‘satisfied’ with the appointment times available

Base: All those completing a questionnaire excluding ‘I’m not sure when I can get an appointment’: National (696,898); CCG 2019 (4,008); Practice bases range from 35 to 106

0%

10%

20%

30%

40%

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60%

70%

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90%

100%

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Q8. How satisfied are you with the general practice appointment times that are available to you?



50


41

Satisfaction with appointment times: how the CCG’s practices compare

Percentage of patients saying they are ‘satisfied’ with the appointment times available

Base: All those completing a questionnaire excluding ‘I’m not sure when I can get an appointment’: National (696,898); CCG 2019 (4,008); Practice bases range from 35 to 106

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

SA

NG

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Q8. How satisfied are you with the general practice appointment times that are available to you?



51


42


Services when GP practice is closed

• The services when GP practice is closed questions are only asked of those who have recently used an NHS service when they wanted to see a GP but their GP practice was closed. As such, the base size is often too small to make meaningful comparisons at practice level; practice range within CCG has therefore not been included for these questions.

• Please note that patients cannot always distinguish between out-of-hours services and extended access appointments. Please view the results in this section with the configuration of your local services in mind.

52


43

52%

16%

3%

46%

16%

13%

6%

6%

63%

25%

5%

37%

12%

8%

17%

5%

I contacted an NHS service by telephone

A healthcare professional called me back

A healthcare professional visited me at home

I went to A&E

I saw a pharmacist

I went to another general practice service

I went to another NHS service

Can't remember

CCG National

Use of services when GP practice is closed

Base: All those who have contacted an NHS service when GP practice closed in past 12 months: National (139,476); CCG 2019 (990)

Q45. Considering all of the services you contacted, which of the following happened on that occasion?

53


44

52%48%

It was about right

It took too long

48%

Time taken to receive care or advice when GP practice is closed

66%

34%

About right

Took too long

Local CCG range – % About right

Base: All those who tried to contact an NHS service when GP surgery closed in past 6 months excluding ‘Don’t know / doesn’t apply’: National (130,757); CCG 2019 (895); CCG 2018 (914); CCG bases range from 382 to 1,433

LowestPerforming

HighestPerforming

52% 74%

52%About right

Took too long

Q46. How do you feel about how quickly you received care or advice on that occasion?

51 5249 48

0

10

20

30

40

50

60

70

80

90

100

2018 2019

% About right % Took too long


NationalCCG

54


45

36%

54%

10%

Yes, definitely

Yes, to some extent

No, not at all 10%

Confidence and trust in staff providing services when GP practice is closed

91%

9%

Yes

No

Local CCG range – % Yes

Base: All those who tried to contact an NHS service when GP surgery closed in past 6 months excluding ‘Don’t know / can't say’: National (134,437); CCG 2019 (931); CCG 2018 (937); CCG bases range from 398 to 1,487

LowestPerforming

HighestPerforming

86% 95%

90%Yes

No

88 90

12 100

10

20

30

40

50

60

70

80

90

100

2018 2019

% Yes % No

%Yes = %Yes, definitely + % Yes, to some extent

Q47. Considering all of the people that you saw or spoke to on that occasion, did you have confidence and trust in them?


NationalCCG

55


46

23%

38%

19%

11%

9%Very good

Fairly good


Fairly poor

Very poor

21%

Overall experience of services when GP practice is closed

69%

15%

Good

Poor

Local CCG range – % Good

Base: All those who tried to contact an NHS service when GP surgery closed in past 6 months excluding ‘Don’t know / can't say’: National (134,770); CCG 2019 (954); CCG 2018 (944); CCG bases range from 395 to 1,501

LowestPerforming

HighestPerforming

56% 77%

61%Good

Poor

5461

22 21

0

10

20

30

40

50

60

70

80

90

100

2018 2019

% Good % Poor

%Good = %Very good + %Fairly good %Poor = %Fairly poor + %Very poor

Q48. Overall, how would you describe your last experience of NHS services when you wanted to see a GP but your GP practice was closed?


NationalCCG

56

Primary Care Commissioning Committee 2.30pm – 3.30pm Wednesday 28 August 2019 Unex Tower, Station Street, Stratford, London E15 1DA

Title Update on Practice Core Opening Hours

Agenda item 2.2

Author Abdul Rawkib, Senior Primary Care Commissioning Manager, North East London Commissioning Alliance (NELCA)

Presented by Lorna Hutchinson, Assistant Head of Primary Care, North East London Commissioning Alliance (NELCA)


Abdul Rawkib, Senior Primary Care Commissioning Manager, North East London Commissioning Alliance (NELCA)

Email: [email protected]

Tel: 020 3688 2121

This paper is for ☐ Decision ☐ Monitor ☐ Discussion ☒ For Information

Action required For Decision: The Committee is asked to approve the recommendation regarding next steps

Executive summary

The report asks the Committee to make note of the progress of core hours opening in Newham and approve the recommendation to take contractual actions, included as part of next steps.

Supporting papers N/A


Issue Boleyn Road Practice a contractual Breach Notice for failing to complywith core opening hours as per GMS/PMS regulations.

Consider undertaking financial sanctions in the event that Boleyn RoadPractice fail to comply with core opening hours. Exact financial penalty willneed to be fair and proportionate and will need to be determined by financecolleagues.

57


No previous presentation to any previous meetings/forums


• Strategic Priorities– To commission and develop GP services that are modern, accessible

and fit for the future in caring for our residents

• Outcomes– We will ensure we plan, design, and commission accessible high

quality services for our residents with our residents– We will improve access to, and, the quality of, Primary Care– We will clearly be able to demonstrate how we have improved

outcomes for our residents

Risk Non-compliant practice will be classified as an outlier. Registered patients from this practice will not be in receipt of equitable healthcare services.

Equality impact Consultation has taken place nationally with various patient groups in relation to what patients classify as being ‘reasonable needs’ for patients during core hours opening. Further engagement will need to be undertaken locally with practice PPGs that are non-compliant with core opening hours.




N/A

58

1. Introduction and Background

1.1

1.1.1

1.1.2

1.1.3

1.1.4

Background

At the Newham Primary Care Commissioning Committee (PCCC) meeting which took place on 29 May 2019, an update was provided to the Committee on practices that were closed half day during core opening hours. Core opening hours are described within the General Medical Services (GMS) and Personal Medical Services (PMS) Regulations as 08:00 – 18:30, Monday to Friday, excluding weekends and bank holidays.

Newham CCG wrote to all practices in February 2019 requesting that all practices are compliant with core opening hours from 1 May 2019. The letter to practices in February acknowledged the sub-contracting arrangements that some practices already had in place with Newham GP Co-Operative Limited to provide cover during core hours. However it was deemed that the sub-contracting arrangements in place with Newham GP Co-Operative did not satisfy the obligations under the GMS contract or PMS Agreement. Therefore the reasonable needs of patients were not being met during core hours.

Following the 1 May 2019 deadline, there were a total of three practices that remained non-compliant with core opening hours:

Dr Krishnamurthy Surgery

Newham Medical Centre Boleyn Road Practice

At the PCCC meeting in May it was agreed that the above practices will be followed up and further advice would be sought from NHS England regarding what contractual action can be undertaken against non-compliant practices. This was in order to ensure that any enforcement action taken against a non-compliant practice was in line with national directives.

2. Progress Update

2.1

2.1.1

2.1.2

Report on Actions following May PCCC Meeting

Following the PCCC meeting in May, a ‘mystery shopper’ exercise took place in June 2019 with the three non-compliant practices highlighted above. An additional practice - Dr Knight & Ashar was added to the list following reports from other service professionals of the practice not answering telephone calls on a Thursday afternoon. Findings from the ‘mystery shopper’ exercise detailed below:

Practice Name Outcome

Dr Krishnamurthy Surgery Compliant – practice no longer closed half day on a Thursday afternoon. New opening hours reflected on NHS Choices.

Newham Medical Centre Compliant – practice no longer closed half day on a Thursday afternoon. New opening hours reflected on NHS Choices.

Boleyn Road Practice Non-compliant – practice continue to be closed half-day on a Thursday afternoon and remain resistant to complying with core hours opening.

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2.1.3

2.1.4

2.1.5

2.1.6

2.1.7

2.1.8

2.1.9

Dr Knight & Ashar Practice Compliant – practice have confirmed they are open on a Thursday afternoon. This is reflected on the practice website and eDEC submission.

Based on the above, Boleyn Road Practice is the only practice for being non-compliant with core opening hours in Newham. It was originally envisaged that this would be addressed via the Primary Care Network (PCN) Direct Enhanced Service (DES) published in April 2019, whereby it clearly stipulates that no member PCN practice should close half-day without prior approval from the Commissioner.

Furthermore, guidance from the NHS England National team has stated that, ‘if a practice participating in the PCN DES does close half a day on a weekly basis without prior written approval and without appropriate sub-contracting arrangements in place, they will be in breach of the DES, as will the PCN practices.

The commissioner can then take the appropriate action as outlined in the DES specification (Paragraph 4.6.1 of the Network Contract DES Specification).

4.6.1. states, ‘where a commissioner is not satisfied that a PCN is delivering extended hours access in accordance with the requirements of this Network Contract DES Specification then it may withhold payments’.

Annex B, B1.4. states, ‘if the PCN or PCN member GP Practice (s) do not satisfy any of the above conditions, commissioners may, in appropriate circumstances and acting reasonably, withhold payment of any, or any part of, an amount due under the Network Contract DES that is otherwise payable to the PCN.

Boleyn Road Practice were initially in discussions to join Newham Central PCN, however this failed to come to fruition. LMC representatives have also been involved in discussions with this practice in relation to PCN membership and being compliant with core hours opening, however these discussions have also been unsuccessful.

Considering that Boleyn Road Practice is not a member of a PCN does limit contractual levers being enacted through this route, as the guidance mentioned above would not be applicable to Boleyn Road Practice.

In the case of Boleyn Road Practice, the Commissioner could determine financial sanctions for breaching the core contract requirements in which case the principle for calculating the financial sanction would have to be fair and proportionate (In the case of non-compliance with the DES Extended Hours requirements, the basis of this can be calculated from the £1.95 p/p)

Poor patient access is one of the areas which further strengthens the case to undertake enforcement action against this practice. Below is a breakdown of how the practice has performed in relation to GP appointment times based on the national GP Patient Survey for the last two years:

Q. How satisfied are you with the general practice appointment times that are available to you?

2018 2019

Boleyn Road Practice 32% 45%

Newham CCG average 62% 63%

National average 66% 65%

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There has been a slight increase in the satisfaction rate for appointment times for Boleyn Road Practice from 2018 to 2019, however the practice is still significantly below the CCG and national average. In addition, the CQC have also highlighted poor patient access during core opening hours in the recently published June 2019 report.

3. Recommendation

3.1

3.1.1

Recommendation and Next Steps

Any contractual action taken against Boleyn Road Practice will need to be in line with national and local guidance. The national guidance is quite limited in relation to practices that are closed half day and not part of a PCN. However this does not impede taking any contractual action based on what is already in motion across other North East London CCGs. In this particular instance the Committee are asked to support the following:

Issue Boleyn Road Practice a contractual Breach Notice for failing to comply with coreopening hours as per GMS/PMS regulations.

Consider undertaking financial sanctions in the event that Boleyn Road Practice fail tocomply with core opening hours. Exact financial penalty will need to be fair andproportionate and will need to be determined by finance colleagues.

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Title Healthwatch Newham Long Term Plan Engagement - May 2019 Report

Agenda item 2.3

Author Leonardo Greco, Healthwatch Newham, Manager

Presented by Leonardo Greco, Healthwatch Newham, Manager


Leonardo Greco, Healthwatch Newham, Manager

T: 020 3828 8246

E: [email protected]

This paper is for ☒ Decision ☐ Monitor ☐ Discussion ☐ For Information

Action required Make a decision:

Recommendation/Action:

Learning Disability GPs and practice staff to have bite-sized training/guidance to remind them

of the challenges and barriers that people with learning disabilities may face and to better support such patients in their healthcare.

This could be through always arranging double appointments; printinginformation about conditions in Easy Read for patients to take away.

Nursing staff or health care assistants to be available to answer questionsand provide information about conditions or procedures.

GP/nurses to explain and remind patients of cancer screening services atannual health checks and other appointments and provide information for patients in Easy Read other languages to take away.

To explore whether wellbeing and prevention programmes, such as thosefor diabetes, have staff with awareness or training to support people with learning disabilities, which would help them participate in the group and in the exercises.

To develop healthy eating and weight sessions for participants with learningdisabilities, with guidance from nutritionists and on weight management and exercise programmes.

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Physical Disability

GP staff to actively offer extended appointments to patients with disabilities or long-term complex conditions.

GPs to be reminded to listen to the patient first of all and focus on the main issue they are presenting regardless of their disability.

GPs should clearly explain any change in medication or the brand of medication. This is vitally important for people with visual impairments.

GP/nurses to explain and remind patients of cancer screening services and provide information for patients in accessible formats on symptoms and screening.

Executive summary

The report asks committee to review the recommendations made following the LTP engagement and implement action to address concerns of patients with physical and or learning disability.

Supporting papers

Appendix A: Long Term Plan Engagement - May 2019


An update on the progress of the implementation to be provided at future meetings as required. The report will be presented to the September Health and Wellbeing Board and be published on the Healthwatch Newham website




Strategic Priorities • To commission a Newham-based integrated health and care system which

delivers high quality services for the residents of Newham, in accordance with statutory requirements

• To commission and develop GP services that are modern, accessible and fit for the future in caring for our residents

Outcomes

• We will have a borough based Integrated Care System that is utilised, understood and valued by our residents

• We will ensure we plan, design, and commission accessible high quality services for our residents with our residents

• We will improve access to, and, the quality of, Primary Care • We will support our entire CCG workforce to deliver what we need to for our

residents • We will promote equality as a commissioner of health services and as an

employer

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Risk As a paper from an external organisation, this is not applicable.

Equality impact This report relates to Newham residents with physical and or learning disability covered under the Equality Act 2010 and equality duties.


“No previous presentation to any previous meetings/forums”


As a paper from an external organisation, this is not applicable at this stage’

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Long Term Plan Engagement

May 2019

Introduction Healthwatch England secured funding to ensure local Healthwatch can support public engagement on

the NHS Long Term Plan and contribute to the development of a local plan in the East London Health

and Care Partnership.

Methodology Healthwatch Newham delivered two focus groups with semi‐structured questions, with people with learning disabilities and people with physical and sensory impairments. The engagement was delivered over April and May 2019.

Key Findings The following are the key findings and recommendations.

Patients with learning disabilities or disabilities need to be informed about GP extendedappointments. This will help patients explaining their ill‐health and understand treatment and save GP time in the long‐run.

GPs should explain medication to patients, including changes, how and when to take it and howand when to use repeat prescriptions. We have consistent feedback that this does not happen, leading to confusion and problems later on.

Patients responded positively to social prescribing and Newham Self‐Care Programme and hadideas about how this can work well for people with learning disabilities and people with disabilities.

There needs to be improved communications about awareness of cancer symptoms andscreening. Some patients are not presenting to GPs with symptoms or do not feel listened to, resulting in late presentation or other health complications. We recognise that nationally, NHS and Public Health staff have experienced challenges with the IT screening systems, we think this emphasises why local information and contacts are vital in informing Newham residents and helping them seek medical help when needed.

Patients had good feedback on individual GPs and pharmacists which will be shared with theseproviders and Newham CCG.

Findings Summary Focus Groups Summary of Findings

The focus groups where attended by 21 participants, 12 with learning disability and 9 with physical

disability.

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Please note that not all participants answered or were involved in all questions. The numbers below

reflect the number of participants that contributed to each question/ discussion point.

Adequacy of service and support received from health services: To start the sessions, we asked a general question about people’s overall experience of health services and whether these have met their needs:

Participants with learning disabilities: 3 – were happy with the service received

2 – found the support inadequate and staff rude

2 – like their GP, while 1 found them rude an unhelpful

Physical disabilities participants:

GPs will allow 1 condition only to be discussed per appointment.

None of the participants with physical disability were aware they could ask for an extended 20‐minute appointment.

GPs tend to focus on their main condition or disability, even if that is not the issue that they arepresenting. 3 participants with visual impairments/blindness said this happens with their GP,which takes up time during the appointment unnecessarily.

GPs and Pharmacists do not explain when medication or the brand of medication is changed. Thisis difficult for blind/visually impaired patients, as they cannot see the packaging, and will onlyrealise the change was made after they experienced the side effects.

Participants agreed that having multiple conditions did not make receiving support easier, in factin some instances it hinders the process.

Participants with learning disability found it difficult and uncomfortable to attend tests and scansas they had to undress and did not aware of the process.

Awareness of Newham Self‐Care Programme

No participants had heard of the Self‐Care programme.

3 – found their pharmacist helpful

1 – physical disabilities (visually impaired) participant is unable to do their own diabetes prick

test and found the pharmacy charges them to complete it, when this should be free.

Once explained, participants with physical disabilities thought the self‐care programme would

be helpful, however, the scheme would need to:

Have staff that are available and can enable the patient to make an appointment.

Have a private room for the sessions.

Provide reassurance about confidentiality.

Have a good knowledge of Newham’s community and health services.

Have staff that have good medical knowledge for people with long‐term or complexconditions. Staff would need to know detailed medical information. One example wasgiven of a patient that can’t digest certain food but would like to know if they can takeliquid vitamins. They would not want to visit a GP for this but are not sure where to go tofind out. This is it the type of thing a pharmacist could advise on.

Social Prescribing

Participants with learning disability enjoyed taking part in activities provided by local

organisations and groups, such as outings, dance and exercise classes.

Physical disability participants thought social prescribing is a good thing and could include

services such as:

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‐ Diabetes blood‐sugar finger prick tests to be provided in community settings as well as pharmacies (for people with disabilities or visual impairments that cannot do it themselves)

‐ Prove healthy eating recipes that are easy to do for people with visual impairments and disabilities.

‐ Activities in locations that are easy to get to. ‐ Personal trainers that are free of charge or at a reduced rate with better support and

adaptations for people with disability – participants felt that current gym sessions that are supposed to be for or adapted for people with disabilities are not well run. Staff do not understand the disability and what someone can do or not do; sometimes they are left alone with equipment and the participant feels unsafe or cannot control/stop the equipment (e.g. treadmill) if they are left alone.

‐ Information should be available in different formats as residents use all different types, such as Braille, Large Print, on CD or online (the latter can be accessed by ‘Read Aloud’ software).

‐ Life coaches or wellbeing support.

Cancer Screening

Some of the participants with learning disabilities did not at first seem to understand what

the term cancer meant. After further explanation, they were aware of cancer and what it

involves. It’s important that things are explained clearly to help people understand and

remember.

None of the participants recalled being asked by their GP whether they had cervical screening (smear tests), breast cancer, including mammograms and other screenings, except for one participant with learning disabilities.

o This is most concerning for participants who are blind or visually impaired as they may

miss text or letter reminders.

Participants with learning disabilities seemed to have considerable issues with and concerns around tests in general including blood tests, since they do not seem to be aware of how the tests are conducted and what they involve.

Participants with learning disabilities said it would help to have someone visit their groups to explain various procedures including cervical screening, bowl cancer test, mammograms etc, what they are, what they involve and what to expect, to make it easier for them to attend.

Participants with visual impairments stated that they will not be able to see possible signs of cancer such as blood in urine/stools; making it extremely important that they are made aware of other signs and have regular checks.

Participants with physical disabilities said that the lack of support makes their conditions worsen, increasing costs in the long run. For instance, around how to use self‐test kits and being able to pick up on possible signs of cancer

Cervical Screening

Participants with learning disabilities said it would not help to bring a friend or relative to their cervical screening, because they would not be allowed in during the test and “you will have to do it alone”

3 participants with learning disabilities had a smear test and found it uncomfortable.

o 1 found the nurse helpful,

o 1 had a very bad experience and they would not go again,

o 1 said they would go again although she didn’t like it, because she understood why it was important.

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3 said they would not attend an appointment for cervical screening.

Participants thought it might be helpful to have someone with them, but thought this person would have to wait outside and could not be there in the room or beside them whilst the test was done.

Bowel cancer

None of the participants with learning disabilities were aware of the kit to test for bowel cancer and did not recollect ever having received it.

When the process was explained, many did not want to talk about it and seemed to find the process uncomfortable and not something they would do.

1 physical disabilities participant could not use the bowl cancer home test kit and had to press for a colonoscopy, and felt this delay exacerbated their symptoms and caused ongoing health problems.

Mammogram/checking one’s own breasts

No participant could recollect being invited to or attending a mammogram. Some participants were over 50.

No participant said it had been explained to them how they could check their own breasts.

Recommendations Learning Disability

GPs and practice staff to have bite‐sized training/guidance to remind them of the challenges and barriers that people with learning disabilities may face and to better support such patients in their healthcare.

This could be through always arranging double appointments; printing information about conditions in Easy Read for patients to take away.

Nursing staff or health care assistants to be available to answer questions and provide information about conditions or procedures.

GP/nurses to explain and remind patients of cancer screening services at annual health checks and other appointments and provide information for patients in Easy Read other languages to take away.

To explore whether wellbeing and prevention programmes, such as those for diabetes, have staff with awareness or training to support people with learning disabilities, which would help them participate in the group and in the exercises.

To develop healthy eating and weight sessions for participants with learning disabilities, with guidance from nutritionists and on weight management and exercise programmes.

Physical Disability

GP staff to actively offer extended appointments to patients with disabilities or long‐term complex conditions.

GPs to be reminded to listen to the patient first of all and focus on the main issue they are presenting regardless of their disability.

GPs should clearly explain any change in medication or the brand of medication. This is vitally important for people with visual impairments.

GP/nurses to explain and remind patients of cancer screening services and provide information for patients in accessible formats on symptoms and screening.

Healthwatch Newham will share details of the feedback on different GPs with the GP and

Newham Clinical Commissioning Group, to help improve the service for patients. Healthwatch

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Newham will share the good practice shown by GPs and pharmacists and share the challenges

some patients have with particular services.

Healthwatch Newham will liaise with the groups, different cancer charities and NHS staff with

the aim to improve trust with NHS services and increase the knowledge and usage of cancer

symptoms, screening and services.

About Healthwatch Healthwatch Newham is part of a national network led by Healthwatch England, which was

established through the Health and Social Care Act in 2012, to give service users of health and social

care services a powerful voice both locally and nationally. We are the independent voice for people’s

views on Newham services, both good and bad. We listen to local people and feedback patient

experience and liaise with local commissioners and decision makers, in order to improve services.

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