NHS North West London is introducing a plan to improve same day access to primary care for patients.

The approach will lead to the introduction of ‘same day access hubs’ across North West London from April. This is where patients can contact their GP surgery either online or by telephone and may be directed to the same day access hub for triage to the right service for their needs. The approach will evolve over time but ultimately, patients may have telephone, online, video or face to face contact with staff at the hub, who will direct them to the right place for their care.

Where appointments are not available with their own GP or alternate service (e.g. pharmacy) they may be directed to a neighbouring practice. Hubs can be either physical or virtual and will usually be managed through the local PCNs, with each hub including a senior GP. All clinical decisions will have a senior clinical decision making and GP lead, with support from a multi-disciplinary team.

This approach ensures patients needing primary care services that day are more likely to be looked after in the quickest way.

Primary care access is the issue most consistently raised by North West London residents we speak to about health services. 

Dr Genevieve Small, Harrow GP and Medical Director, Primary Care NHS North West London, explains the thinking behind SDA and answers some of the concerns expressed by our stakeholders and residents following recent news coverage. The full video can be seen HERE. 

Alongside talking with stakeholders, NW London will also hold a residents’ forum in March, details of which will be shared widely in the coming weeks, alongside its ongoing engagement in boroughs.

The Anchor Programme, in partnership with West London Alliance, organised the NW London ICS Employment Expo this month with a focus on direct recruitment and career information sharing to the Core20Plus population. 

A total of 724 people attended and 77 people were offered jobs on the day, 23% of whom are from our most deprived communities. Potential candidates also had the opportunity to have their health checks on the day to support health improvement. A team from Active Successful Engagement ran an engagement stall and over 40 individuals filled out the questionnaires as part of our co-production work to address inequalities faced by black men at an increased risk of prostate cancer.  

Population Health Management (PHM) Academy specialist training for our business intelligence / analyst colleagues is due to start in the next few weeks. This is part of a planned curriculum for skills development over the next year with a focus on priority areas such as data visualisation, predictive modelling and evaluation. Co-production training for our first cohort has commenced.

 A workshop with public health oral health leads and engagement with dental commissioners has informed the development of a high-level work plan for improving young people’s oral health. A key priority of our Integrated Care Partnership, this has been tested with programme boards and will be developed into a system-wide action plan. 

System partners are continuing to work together to respond to the measles outbreak in NW London, testing new models of reaching out to communities and offering vaccines in different settings. Learning from this response will help inform future work to improve the uptake of childhood immunisation across NW London. 

The government has published next steps following its consultation on proposals to create a smoke-free generation. This looks to raise the legal age of sale for tobacco products and includes measures to make vaping less attractive to young people. 

The Cost-of-Living campaign on the NW London ICS website  is now live. The site now includes information on free prescriptions and the cost of living crisis hubs; which provide more information on eligibility for benefits to relieve cost of living pressure. 

The Social Welfare Legal Advice (SWLA) working group is working through how best we can deliver SWLA provisions to our communities most in need, supported by Bromley-by-Bow due to their experience in this area. 

The digital inclusion gap analysis has been completed; we used research and local insights to understand the different barriers that people from the inclusion groups face when accessing digital health services, and gathered proposed solutions to tackle the barriers. 

These barriers and solutions are being shaped into recommendations through co-production sessions that have been taking place across Kensington and Chelsea, Brent and Hounslow. Early findings from the sessions highlight a need for training on NHS digital services, using community and NHS settings.

NW London and Rethink Mental Illness have been shortlisted for a Health Service Journal (HSJ) Partnership Award in the category of ‘Best Mental Health Partnership with the NHS’. 

The judging panel was held this month and winners are set to be announced at an awards ceremony in March.

Over the coming months NW London will be re-procuring its Suicide Postvention Service; this will be an expansion of the current service offer, extending the service to children and young people and opening beyond next of kin and immediate family.  The service will include colleagues, friends and witnesses of those who have taken their own life; ensuring also that more inclusive support is provided to communities.

Imperial College Health Partners (ICHP) held a workshop with around 50 stakeholders from across the ICS – including clinicians, operational leads, Experts by Experience, and VCSE colleagues – to shape the delivery of the children and young people’s crisis component of ‘Mission 3’. 

Break-out discussions were held to agree the definition of ‘crisis’, and to consider how care pathways can be improved to reduce crisis episodes and improve outcomes and experiences. Initial outputs from the workshop will be shared with stakeholders in March. 

Work is underway with educational specialists to develop a proposal to secure funding from NHS England to deliver the Partnerships for Inclusion of Neurodiversity in Schools (PINS) project in Harrow and Hillingdon in 2024/25. 

If successful, the project will involve the development of a small project team to include clinical, educational, and project support to work with 40 primary schools in partnership with Parent Carer Forums to improve outcomes for neurodivergent pupils.

The system flow team has been working with partners across the ICS to support the roll out of the OPTICA dashboard. OPTICA is contributing to better understanding of our discharges and enabling us to track patient pathways; we are now using OPTICA data in the ICB for the monitoring and management of discharge performance. We have started the rollout with local authorities which means better-shared oversight of live discharge data and improved operational planning.

The NW London team have secured a single provider for the NW London provision of wheelchairs for all but one (Hounslow) of the NW London boroughs.  This has been a long and challenging process but we have awarded the contract to AJM who are already established in NW London and have begun the process of mobilisation.

Kingston Hospital NHS Foundation Trust and Hounslow Richmond Community Healthcare Trust are developing a Strategic Case related to their future organisational configuration – an assumed acquisition of Richmond by Kingston Hospital. This case is currently going through NHS England’s assurance processes. 

Prior to that merger, the Hounslow services will be separated - this means that we have to quickly find a provider to deliver community services to our Hounslow residents. This will be a complete lift and shift of our current provision with no expected changes. We have published the first PIN and now are reviewing the outcomes before obtaining executive sign off to proceed with the procurement process and will keep you up to date with how this progresses over the next few months.

MyHealthLondon platform has just launched and all residents in NW London can now access any of the five eLearning courses available, as well over 100 pages of helpful information regarding their condition. This platform is for people who are living with a heart or circulation condition, and residents who have some of the factors that could lead to cardiovascular issues (eg hypertension). It's also for family, caregivers, and the healthcare professionals looking to support this cohort of patients.

The ICS brought together clinicians and operational managers involved in women’s health to support the development of the local strategy and plans in this area. The insights that came out identified some further areas where changes could provide significant impact and improvement for our population in accessing health and their outcomes.

The overall performance assessment of the ICS in February 2024 is rated as red. This is based on a higher number of people getting infections compared to plan and patients experiencing long waits for ambulances, in emergency departments, for planned treatments and moving to the right care setting. 

The ICB does benchmark well to other ICBs in a number of areas including 2-hour urgent rapid response times, diagnostic waiting times, theatre utilisation and patient experience scores. 

Following the Strategic Commissioning Committee’s approval of the revised Estates Strategy, the ICB Estates team’s work with ICB Programme Teams, Boroughs, Trusts, local authorities and a number of other key ICS stakeholders continues in earnest to develop an underpinning delivery plan over the next 5-10 years. It is intended that much of this activity will be completed by the end of this financial year.

Work also continues with local authorities and NHS stakeholders to inform the eight local Infrastructure Delivery Plans (IDPs), ensuring alignment to our overarching strategic ICS priorities, inequalities projections and population needs. 

ICB Estates continue to work with partners and local authorities to review available and expiring s106 (a developer contribution) and CIL (Community Infrastructure Levy) funding. So far, significant sums are in the process of being bid for, secured and allocated to estates activity. This will be key to supporting an array of estates-related projects over coming years. This quarter, the focus is on securing Neighbourhood CIL funding to support primary care initiatives across RBKC.

The team is also working closely with the regional London Estates Delivery Unit (LEDU) to progress supported FY 24/25 London Improvement Grant (LIG) schemes through the due diligence process. The grant offers funding for GP practices to improve the condition of premises as aligned to the Estates Strategy and Six Facet Condition Survey recommendations. It is expected that due diligence reviews should conclude by April 2024. 

Following Executive approval, HQ estate rationalisation activity is underway across NW London boroughs. A hub and spoke HQ model across MBR, Heart of Hounslow and Sudbury Health Centres continues to be progressed mobilised subject to ongoing consultation activity. Bi-weekly working groups have now been stood up from w/c 19th February with key Borough and ICB business area representatives. These discussions will focus on co-designing new space, change management and staff support, decant activity, dilapidations and operational readiness. 

The Estates team continue to explore opportunities with ICS stakeholders to repurpose existing space to improve service offerings and accessibility to healthcare for communities, whilst reducing vacant and unused bookable at Heart of Hounslow, St Charles, The Meadows, Alexandra Avenue, Willesden Centre for Health, Feltham and other locations.

Work continues to expand primary care offerings at Grand Union Village Health Centre, Ealing, and at the refurbished old vinyl factory in Hillingdon. Both projects are set to complete by quarter three of the next financial year. Work also continues on the Chiswick Health Centre Rebuild in Hounslow, which will offer over 2,348 sqm of multi-service healthcare in improved, fit-for-purpose and compliant premises.

As part of Ealing’s Integrated Neighbourhood Team (INT), a mapping exercise was undertaken to identify services to imbed as part of each locality. It became apparent various services shared the remit of care navigation in the borough. As a result, the INT is launching “Ealing Care Navigation Network” in March to bring together the following six services in a face-to-face workshop:

• Care Coordinators (Ealing Community Partners);
• Social Prescriber Link Workers (Primary Care Networks);
• Mental Health link workers (MINT);
• Dementia link workers (Dementia Concern);
• Link workers (Specialist Older Adult Mental Health Services); and
• Recovery workers (RISE).

The aim of this new forum is to explore gaps and overlaps between the services, in order to build and strengthen relationships, develop community of practice, improve integration, streamline pathways and share learning. The network will aim to meet on a quarterly or bi-annual basis, to ensure services are working together seamlessly.

Ealing cancer working group is now established to help meet the Core20Plus5 ambition of at least 75% of cancers being detected at stage 1 or 2 by 2028. The working group pulls together stakeholders including Ealing and Hounslow CVS, LNW Trust, Macmillan, ICB & RM Partners all working separately on early cancer detection, awareness and increasing screening uptake. 

We have created a working group to compare and share data and join forces to avoid duplication of efforts, such as practices hearing from multiple stakeholders their screening uptake is low. 

Alongside our NW London GP Cancer Bulletin, we hope to share the news of what resource and support is available and the work of each of the stakeholders to better support patients and stakeholders achieve the same desired outcomes. 

In addition, our Macmillan partners are working with our engagement team with events and the recruitment of local cancer champion volunteers in areas of deprivation, local communities, faith groups, and many more. 

We also have celebrated the work done so far by ManVan and Lung Health Checks launching recently with close monitoring of the activity, outcomes and learning. 

Ealing BBP has submitted a bid for ‘urgent and emergency care (UEC) demand prevention for frailty including dementia’. As a partnership we have been working with our care homes to understand where we can provide more targeted support to ensure more integrated responses when someone in a placement is unwell, or where there is a risk of a placement breaking down for any reason.

We have opted to submit a bid for this unique opportunity to receive dedicated support to test cutting-edge innovations which address challenges of long length of stay (LoS); discharge process optimisation; and urgent and emergency care (UEC) demand prevention for frailty including dementia.

If successful we will be working with Imperial College Health Partners (ICHP) and will be supported with additional resource and capabilities to test and implement innovative technologies, look at the current pathways, and care models, with the aim of enabling more days at home. We will know the outcome of the bid by the first week of March. 

Ealing borough held its regular Health and Care Residents Forum at the beginning of February as part of our programme to ensure we are engaging with all of our residents across the seven towns in Ealing. 

February’s meeting was held as a virtual/face-to-face hybrid in the south of the borough. Each forum aims to cover a specific range of topics from all of our partners having presentations from each of the key areas Health, Care and Voluntary sector. 

This month we had an informative presentation from Healthwatch and their roll in assessing services focusing particularly on their recent care home audit. This was alongside engagement Community-based specialist palliative care and the future development of the Older Adults, Disabilities and Long-Term Conditions Partnership Board and how lay partner representation is improving. The forum was well attended and formed part of an on-going and continuous conversation with our residents.

Hillingdon has started offering blood pressure testing stations and blood pressure monitor machines loaned to libraries. 

This is providing access to BP testing in non-medical environments and attracting people who are using the libraries as warm hubs. The scheme went live in January in three library sites; Central Uxbridge Library, Botwell Green Library and Ruislip Manor Library. 

Hillingdon has seen its cervical cancer screening performance improve from 56.8% to a high of 64% which is 8% higher than the North West London average. 

This increase is linked to the RM Partners Clinic Lead attending all six PCN meetings sharing performance data and giving detailed instruction on how to access data on screening dashboards. In particular, the advice was to target more difficult to reach groups who engage less with screening, for example BAME groups, or people with learning disabilities. 

The dementia diagnosis rate in Hillingdon is 68.7% which remains 3.5% higher than the North West London average. The Hillingdon Dementia Alliance is working together to improve waiting times for assessment and diagnostics and offering support to carers.

As a result of a very successful acute respiratory hub at the Alexandra Avenue Health and Care Centre Harrow, Dr Clare Andrews, Paediatric Registrar has been invited to deliver a presentation to showcase the work at the RCPCH conference in March. 

In the winter of 2022/23 Streptococcus rates resulted in overwhelming levels of demand on Urgent & Emergency Care (UEC) and General Practice. The Hub delivered high-quality urgent care in the community, reducing demand on local services. In addition, the hub facilitated collaborative working and learning between professional groups. The hub saw 3377 patients over 100 days from 21st December 2022 to 31st March 2023.

A comprehensive review of admissions at the front door of the system is underway so that we are able to consider short, medium, and long-term strategies to reduce avoidable admissions and A&E attendances. A Steering Group has been established with partners from BBP, ICB, Local Authority, CLCH, LNWHUT, LAS, and Primary Care to reduce avoidable admissions.

An update was presented to the Bi-borough Health & Wellbeing Board as part of the item launching the Health & Wellbeing Strategy citing integrated neighbourhood teams (INTs) as the delivery vehicle for the transformation required to deliver upon a number of the aims within the Bi-Borough’s 10-year strategy.

INT Leadership Teams have been established for North (K&C and Queens Park & Paddington) INT and South (K&C) INT with confirmed membership, terms of reference and meeting schedules. In Westminster our Demonstrator Programme Board has now transitioned into its INT Leadership Team. These leadership teams report into a Bi-Borough INT Steering Group which provides strategic direction and will act as a point of escalation, where required.

Each INT has initial high-priority areas which will allow new ways of working to be tested with learning shared between INTs as we move forwards. Some of these areas include: 

• Children, Young People and Families
• My Care My Way – Integrated health and social care system for older adults
• Older Adults Mental Health
• People with Long Term Conditions
• Octopus Network and Navigation Roles

There are also several cross-cutting enabler work streams which will support all three of our INTs which, where possible, will be delivered as ‘Once for Bi-Borough’: 

• Workforce,
• Population Health Management and Inequalities,
• Co-Production,
• Organisational Development, and
• Digital.

In order to support the development of INTs and establish a common understanding across our residents and staff we have developed a guide to INTs which seeks to build on workshops and wider engagement in order to set out our vision and principles for INTs .

The gujde also highlights some of the excellent examples of integration that already exist across the Bi-Borough. We have published The Bi-Borough Guide to Integrated Neighbourhood Teams: An introduction for residents and professionals on our Bi-Borough website.

Screen, detect, protect’ is a Bi-borough programme aiming to improve our residents’ uptake of cancer screening services. The Bi-Borough Community Chest has agreed to support voluntary sector and community based solutions that target specific communities within Westminster and RBKC to remove barriers and reduce inequities in cancer screening.

The community chest has funded nine projects: 

• Homeless health peer advocacy and support to access
• Recruitment of community health champions within specific communities experiencing lower uptake of screening
• Addressing specific barriers to access through community led events, both in person and virtual engagement events
• Production and distribution of cohort/community appropriate educational material (easy read, local dialects), creating videos utilising service users and representative community presence
• Peer support model for people with learning disabilities
• Free transport service to and from screening appointments
• Poster and radio campaigns with targeted reach into identified community groups

The projects are running from January to June 2024 and aim to reach approximately 10,000 residents across our two boroughs.