1. Tower Hamlets managed practice networks John Robson GP Reader QMUL NHS Tower Hamlets networks

2. Tower Hamlets in numbers 36 GP practices 150 GPs, 300 nurses, 100 health care assistants Tower Hamlets in numbers 2000 staff 250,000 people twice size of Cambridge

3. NHS Tower Hamlets networks Health needs How networks change provision and impact Scaleable Key levers Outline

4. NHS Tower Hamlets networks Welcome to Tower Hamlets

5. Newham Barking Redbridge Waltham Forest Hackney City Tower Hamlets East London Diabetes belt 1 in 20 have T2 diabetes NHS Tower Hamlets networks

6. Where we are today Male life expectancy 2002-9 NHS Tower Hamlets networks

7. The story 4 yrs top in UK and London bottom quartile UK spend & performance £2m Diabetes CVD ImmunisationCOPD 2008

8. 36 practices in 8 local area networks 8 6 5 * 1 2 3 4 5 6 8 9 10 7 11 12 15 13 16 14 17 18 19 24 21 22 20 23 25 26 27 28 29 30 31 32 Pop: 28,956 Pop: 23,868 Pop: 38,529 Pop: 33,948 Pop: 25,549 Practice Networks 33 35 34 36 NHS Tower Hamlets networks

9. Care Packages 2010 2009 Diabetes CVD cardiovascular Immunisation COPD chronic pulmonary disease

10. NHS Tower Hamlets networks Success Childhood Imms 1st in London Diabetes 1 st in 2012 National Diabetes Audit CVD - BP and cholesterol control 1 st QOF Statins 1 st nationally COPD Spirometry/MRC rating 1st QOF

11. Resources for local complexity Network manager Performance dashboards MDTs Target support Outreach Practice managers Clinical leads Finances collective target Admin problems Target resources Educational needs Peer to peer learning Nurse Forum NHS Tower Hamlets networks

12. Priority, Guidance and Audit Education: in-practice facilitation

13. NHS Tower Hamlets networks VISUALISING CHANGE Diabetes HbA1c by network Spitalfields Thameside NHS Tower Hamlets CCG

14. NHS Tower Hamlets networks Network/practice monthly RAG red amber green chart CVD Target Net workABASCSLHGW %Count% % % % % new MI reviewed in 4 weeks post discharge 67.0% 574/7505/10 603/5 80% 1003/3 1005/5

15. Network - practice engagement NHS Tower Hamlets networks

16. Did we make a difference? NHS Tower Hamlets networks

17. % T2 diabetes all 8 care processes Tower Hamlets National diabetes audits 2008-12 NHS Tower Hamlets networks TOWER HAMLETS Bottom 25% Diabetes network care package 1 st in E&W

18. Equity: age, ethnicity, deprivation NHS Tower Hamlets networks

19. Inclusive & area based Inclusive: 3 rd party providers & practice federations Based on LA local boundaries Local community and Integrated Care

20. NHS Tower Hamlets networks Widespread interest EVALUATE DISSEMINATE & PUBLISH Directly influenced Newham clusters and federation: Camden, South Wales, Waltham Forest Scotland to Torbay Generalisable

21. Natural experiment Tower Hamlets vs Newham & Hackney NHS Tower Hamlets networks Blood pressure control CHD (QOF)

22. Natural experiment Tower Hamlets vs Newham & Hackney Blood pressure control CHD (QOF) NHS Tower Hamlets networks

23. % Coronary heart disease: cholesterol <5mmol/l QOF no exceptions

24. NHS Tower Hamlets networks Impact 10% increase in antihypertensive and statins 3m people with CVD diabetes 40% reduction in events 3000 CVD events and death every year Impact

25. NHS Tower Hamlets networks Myocardial infarction mortality under 75 years per 100,000 DSR ONS

26. NHS Tower Hamlets networks Key points Key levers

27. Review & recall IT Decision Prompts Act Belief Motivate Guideline Education Comparative Feedback Incentives

28. NHS Tower Hamlets networks Key points Priority setting – choose carefully for maximum (evidence based) achievable impact Engage stakeholders – consultants, prescribing advisors, LMC, nurses, practice managers – GP champions Project or network managers IT systems VISUALISE Performance - dashboards Key levers

29. NHS Tower Hamlets networks What happened next? Extended scope Atrial fibrillation, Cancer early diagnosis, Integrated care +++ Networks as providers Took over failing practice scaleable Entire CCG federated provider network

30. NHS Tower Hamlets networks What happened next? Entire CCG federated provider network

31. NHS Tower Hamlets networks Networks are a step change