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

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

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

NHS Tower Hamlets networks Welcome to Tower Hamlets

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

Where we are today Male life expectancy NHS Tower Hamlets networks

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

36 practices in 8 local area networks * Pop: 28,956 Pop: 23,868 Pop: 38,529 Pop: 33,948 Pop: 25,549 Practice Networks NHS Tower Hamlets networks

Care Packages Diabetes CVD cardiovascular Immunisation COPD chronic pulmonary disease

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

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

Priority, Guidance and Audit Education: in-practice facilitation

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

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

Network - practice engagement NHS Tower Hamlets networks

Did we make a difference? NHS Tower Hamlets networks

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

Equity: age, ethnicity, deprivation NHS Tower Hamlets networks

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

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

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

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

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

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

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

NHS Tower Hamlets networks Key points Key levers

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

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

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

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

NHS Tower Hamlets networks Networks are a step change