1. Annual General Meeting
Wednesday 26 September

2. Welcome and panel introductions
Dr Nicola Jones, Chair of NHS Wandsworth CCG

3. Housekeeping

4. Agenda 3.05 – 3.15pm Review of the year 2017/18
James Blythe, Managing Director, NHS Wandsworth CCG Sarah Blow, Accountable Officer for NHS Wandsworth CCG, NHS South West London Alliance
Making a difference to patients
3.15pm – 3.20pm Supporting your GP practice
Dr Nicola Jones, Chair, NHS Wandsworth CCG
3.20pm – 3.25pm Planned care
Dr Nicola Williams, Joint Clinical Lead, Battersea Locality
3.25pm – 3.30pm New community services
Dr Caroline Scott, Clinical Lead, and Claire Ratnayake, Director, Wandsworth GP Federation
3.30pm – 3.40pm Finance Report
Neil McDowell, Finance Director, NHS Wandsworth CCG
3.40pm – 3.45pm Looking Forward
James Blythe, Managing Director, NHS Wandsworth CCG
3.45pm – 4.00pm Questions and closing remarks
Dr Nicola Jones

5. Review of the year 2017/18
James Blythe – Managing Director, Wandsworth CCG
Sarah Blow – Accountable Officer, Wandsworth CCG
(part of the NHS South West London Alliance)

6. What we set out to do

7. The main challenges we faced
Working with St George’s hospital to reduce waiting times (referral to treatment within 18 weeks)
St George’s University Hospitals NHS Foundation Trust took the decision to suspend referral to treatment reporting in June 2016 due to significant concerns over the quality of data.
An extensive programme of waiting list validation has taken place since then. In February 2018, the trust introduced a new patient pathway management system and is working towards the standards required to return to formal reporting.
We commissioned additional capacity for two of the most challenged specialties to treat long-waiting patients. Significant progress has been made and we continue to monitor closely. We also supported the introduction of a system to highlight services with limited capacity and suggest alternative providers with shorter waiting times.

8. How we performed

9. South West London Health and Care Partnership
NHS, local councils and the voluntary sector in south west London strengthening our commitment to work together to deliver better care for local people
In November 2017, we published The South West London Health and Care Partnership: One year on for discussion Commitment to champion children and young people’s mental health and wellbeing Developing Wandsworth’s Health and Care Plan to be published in March 2019 We will be hosting a Wandsworth Health and Care Event in November 2018

10. South West London CCGs
Committees in Common agreeing collective decisions including funding for the transformation of primary care for 2018/19
£4.58 million NHS England funding for this implementation providing 18,000 extra appointments each month
Cancer care to improve cancer care for local people by focusing on:
 Early and timely diagnosis and treatment
 Improving uptake of bowel screening
 Increasing screening uptake for people with learning disabilities
Collective approach to staying well this winter to increase flu vaccine uptake and reduce pressure on A&E across south west London as a whole

11. Future plans Continued focus on integrating health and social care
Improving mental health support
Improving access for children and young people to mental health services
Work with providers to transform outpatient hospital services
Support access to extended GP services
Working more closely with Merton CCG and other south west London CCGs
Focus on clinical quality routine monitoring for all services we commission

12. Making a difference to patients…
…through supporting your GP Practice
Dr Nicola Jones

13. Access to primary care
Improving access to primary care is both a national and local priority, however there are some key challenges involved in delivering this:
Workforce: Inability to recruit to key staff groups including GPs and practice nurses, and a significant number of staff coming up to retirement age
Financial: Funding hasn’t kept pace with demand and rising costs of provision
Demand: Patient expectations, increasing frailty and complexity, shift of care from hospitals
Infrastructure: Practices operating out of poor estate, fragmentation in IT systems and limited investment.
In 2017/18 and 2018/19, results from the national GP patient survey indicated that patients in Wandsworth have a better experience of accessing primary care services than the London average. However we know that there is more we can do.

14. Meeting the challenges
We have introduced around 5,000 additional GP appointments per month as part of a newly funded 8am-8pm access contract, this includes funding for practices to offer patients an urgent appointment within four hours where it is deemed clinically appropriate
The CCG is continuing to make use of innovative IT solutions to improve access, including increasing the use of patient online, and rolling out e-consult and direct booking from A&E and NHS 111
Developing primary care at scale – supporting practices to work together collaboratively (where it makes sense to do so) to become more sustainable and resilient in the face of current challenges, this includes:
Consideration of scaling up back office functions and utilising collective purchasing power
Piloting the introduction of clinical pharmacists, physicians assistants, social prescribing and care navigators in GP practices as well as training existing staff to work in different ways
Improving recruitment and retention with a range of schemes aiming to make Wandsworth a great place to work for primary care staff.

15. Making a difference to patients…
…through planned care
Dr Nicola Williams

16. Planned care programme
We are working together with GPs, patients and St George’s Hospital to look at the whole patient pathway for planned care.
Our aims:
Patients are seen in the right place, at the right time with the right information
Clinical capacity is balanced with patient demand
The right thing to do for patients is the easiest thing for everyone to do.
Broadly, the planned care programme has three themes:
Developing primary care – success will only be possible if we have robust and sustainable primary care. We need clear pathways which are easy to follow and readily available so GPs can support patients in their communities with advice and guidance from specialists.
Explore where there may be appropriate alternative services to going to the hospital. Some patients could be better supported in the community.
Changing the current outpatient model of care – improve triage to ensure appropriate tests are done prior to the patient’s first appointment, offer virtual clinics and open access follow up appointments (patient attends when they need to be seen), as well as group education.

17. Meeting the challenges
In 2017/18 we:
Established individual GP practice visits to review patients with diabetes - advice from a consultant, pharmacist and specialist nurse
Introduced clear new patient pathways in ear, nose and throat, dermatology, neurology, urology, gynaecology and gastroenterology
Rolled out a single effective commissioning policy across the whole of south west London so its clear for GPs and all hospitals have to work with the same criteria
Offered a range of clinical and non-clinical educational events for GPs and other practice staff
Set up hot clinics and a community migraine clinic to support neurology patients.
Into 2018/19:
A gastroenterology clinical assessment and triage pilot has started, which sees much closer working between primary and secondary care. Initially this is being delivered within gastroenterology, hepatology and general surgery. There are plans to roll the model out to further specialties
All GP practices across Wandsworth can now offer anti-coagulation warfarin monitoring and DOAC Initiation
Teledermatology services to enable the virtual review of semi-urgent lesions are expected to start in November
Intermediate ear, nose and throat services are expected to start across south west London in January.

18. Making a difference to patients…
…through new community services
Dr Caroline Scott and Claire Ratnayake

19. New community services
Since October 2017, Wandsworth Community Adult Health Services have been provided by Central London Community Healthcare NHS Trust (CLCH), a community trust working across 10 London boroughs, including Merton CLCH were procured and are overseen by Battersea Healthcare Community Interest Company as part of the Multi-speciality Community Provider (MCP) model Following procurement the staff vacancy rate within the community adult health services has fallen from 30% to 13% From March 2018, CLCH have been using a new clinical record system which allows improved information sharing and referrals between primary care and the community services.

20. Finance Report
Neil McDowell
Finance Director

21. How we were funded in 2017/18
Funding given based on our weighted population of 348,000 (calculated by NHS England)
Number of people actually registered with a GP closer
to 395,000
Allocated £480.9 million (including funding for primary care delegated commissioning)
This is equivalent to £1,217 per person
We generated a surplus of £4.1 million (or £2.2m after adjusting for exceptional, one-off items)

22. Our financial targets Maintain financial stability
Fair and effective use of resources
Investment made in mental health in line with our growth allocation
Stay within running costs of £19 per head of population
Our accounts were submitted on time and with an unqualified opinion

23. How we spent the money
In 2017/18, we were responsible for a budget of £476.8m that we used to pay for hospital,
primary care, community and mental health services for people living in Wandsworth.

24. Looking forward
James Blythe
Managing Director

25. Looking forward Local health and care plans
Following the publication of the STP refresh in November last year, we are now in the process of developing local health and care plans for each borough which we hope to publish in March These local plans will outline the priorities and plans in each borough to improve health and care.
Based on the JSNA and what residents have told us we have agreed the following areas of focus with the Health and Wellbeing Board.
Theme
Area of focus
Start Well
Childhood obesity
Children’s and young people’s mental health
Risky behaviours
Live Well
Integration of physical and mental health approaches
Chronic disease management – diabetes
Age Well
Health and social care integration
Dementia
Social isolation and carers

26. Wandsworth Joint Strategic Needs Assessment: The Wandsworth Story
Key headlines:
Wellbeing
Risky behaviours
Complex needs
Ageing population
Mental Health and Wellbeing

27. What residents tell us
Continuity of care remains a priority for people in Wandsworth, with a particular reference to ongoing support for managing long term conditions such as diabetes.
Accessibility of services is very important to people in Wandsworth, particularly for services they have to use regularly.
People reported significant support for better integration of health and social care services. Services do not always feel person centred and did not always take into account the background and preferences of the individual.
People in Wandsworth place a lot of value in therapy support, and other specialist input. However people did report concerns about the capacity of these teams and their ability to recruit and retain good staff.
People are very positive about the move towards services encouraging wellbeing and independence.
Mental Health is a clear priority for people in Wandsworth. Access to mental health services was raised as a concern, particularly for services for common mental health issues.

28. Wandsworth’s health and care plan will ….
Address the developing health and care needs of the local population
Outline the local vision for health and care and the health and care model being developed
Identify and address the clinical, financial, workforce and sustainability issues in the borough so that we can take a system-wide approach to our collective challenges
Identify what it means to start, live and age well in the borough and the actions that will be taken to ensure the vision for each is met
Outline what the local system will do to support the SWL health prevention priority of Children and Young People’s Mental Health
Allow partners to shape the developing plans including through their organisational governance structures
Be owned by the local NHS, Wandsworth Council and the local voluntary sector

29. Questions and closing remarks
Dr Nicola Jones, Chair