NHS London, along with all other Strategic Health Authorities, was abolished as part of the reform of the NHS that the Health and Social Care Act introduced on 1st April 2013. The Greater London Authority is the only body now capable of providing a strategic overveiw of NHS services in London. Items of London-wide interest will be posted in this section of the website.
- Patient choice of access options eg via telephone, email or skype.
- Easier making of appointments – with more use of on-line services.
- A named GP for each patient, with flexible length appointments up to four weeks ahead.
- Routine surgery opening hours 8am - 6.30pm Monday to Friday and 8am - 12 noon Saturdays.
- Access to primary care 8am to 8pm every day in the local area for urgent unscheduled care.
- Same day access to a GP for consultation on urgent conditions.
Networking of GP practices: (From Hillingdon CCG Board papers April 2014) North West London has been awarded £5m from the Prime Minister’s Challenge Fund, matched by £5m from NW London Clinical Commissioning Groups and Health Education NW London. This £10m non-recurrent funding is for networking GPs across 39 networks and development of lay contribution to NHS service redesign.
- This launch is billed as an ‘opportunity for everyone with an interest in these issues to have their say in shaping a sustainable NHS for Londoners’.
- Based on NHS England’s expectations of patient demands and flat financial growth, there is likely to be an ‘affordability gap’ of £4bn in London by 2020. Particular pressures are due to:
- Since 1990 the increase in life expectancy in London is one year higher than national average
- About 80% of premature deaths are due to alcohol, smoking, poor diet, lack of exercise
- Birth rate in London is increasing by 3% per year
- Based on 2011 census, the amount of Londoners over 65 years of age is set to increase by 19%
- 1 in 5 early adolescents in London are at risk of obesity
- Acute sexually transmitted diseases in London are 50% higher than in any other region
- London’s hospitals are becoming increasingly unsustainable both clinically and financially due to the drive for seven day working and specialist teams utilising expensive technology. It notes three factors to combat these challenges: transforming primary care; integration of health and social services; consistent services seven days a week.
a. London Health Board: When NHS London was abolished on 1st April 2013, there was no strategic authority to take an overview of NHS services in London. That gap was addressed by the London Councils, the Mayor of London and key health partners by them agreeing to establish a London Health Board, which has now met twice, in May and September 2013. It does not meet in public but its papers can be seen on its website at: www.londonhealthboard.org.uk The Board meets four times per year.
Its membership comprises five Leaders of London’s Local Authorities, the Mayor, four Mayoral appointees, five senior representatives from the Health Sector in the capital - NHS England, Public Health England, the London-wide Clinical Commissioning Council representing London CCGs, a Director from one of the London Academic Health Sciences Networks, ·and the London Clinical Senate. The Board is chaired by Boris Johnson, the Mayor of London.
In May the Board agreed three priorities for the next year – improving primary care, enhancing the patient experience, particularly through digital access to information, and improving mental health services. The September Minutes are not yet published but it is addressing the financial pressures of CCGs in outer London, which is noted here in Section 2: Update on Community Voice Activities.
b.· London Health Commission:· The Mayor of London is setting up this independent Commission, led by Lord Ara Darzi, to investigate the provision of health and care services in the capital, in support of the work of the London Health Board. It will focus on three key areas. Firstly whether the needs of London’s diverse population are adequately understood by government and reflected in allocation formulae. Secondly it will assess the sustainability of the capital’s healthcare services. Thirdly, it will consider how London’s health research institutions can be best supported.c. Public Health England (London Region): This went live on 1st April 2013. Its role is to protect Londoners against hazards to their health, support them in enjoying good health at each stage of their lives, and to enable them to access health services that meet their needs. Key topics are sexual health, tobacco control, mental health, workplace health, early years and health inequalities
Dr Susan LaBrooy, Medical Director of “Shaping a Healthier Future Programme”, spoke to The Community Voice, of which Ruislip Residents' Association is a member
- She started by noting that the “Shaping a Healthier Future Programme” has a strong clinical basis. North West London has always had good NHS healthcare, but changes are now essential as we have an ageing population, young people with chronic conditions now live into old age, and new treatments prolong patients’ lives. She noted that many new treatments and drugs are expensive, or need clinicians with specialist expertise, quoting transplant surgery and cyberknife as examples.
- Centralisation of some services is already saving lives in North West London, such as heart, stroke, trauma, and vascular centres.
- To afford the provision of modern healthcare, all services must be cost effective. Sometimes mergers are appropriate in providing a bigger patient pool, to justify bigger and better services. Northwick Park and Ealing Hospitals hope to merge later this year. Chelsea and Westminster and West Middlesex Hospitals are considering that possibility. Close collaboration is another option, such as Royal Brompton Hospital working with its neighbour, Chelsea and Westminster Hospital.
- The “Shaping a Healthier Future Programme” has had wide scrutiny, with contributions from the London Clinical Senate, and the Royal Colleges, also substantial public consultation with 250 meetings in which over 5,000 people were involved plus 17,000 consultation responses, including responses in 421 languages other than English.
- The Joint Committee of Primary Care Trusts, in collaboration with the eight North West London Clinical Commissioning Groups, decided on 19th February 2013 to adopt the preferred model of care. The audience was reminded about the details – Hillingdon, Northwick Park, St Mary’s, Chelsea and Westminster and West Middlesex would remain major hospitals with enhanced A&Es, but other hospitals would lose their A&Es. All acute hospitals would have 24/7 Urgent Care Centres.
- Delivering that option will centralise access to senior clinicians, and develop specialist skills. It will improve local access to services and support people with long-term conditions. It will also integrate care between NHS and social care. Ultimately it will save lives and improve patients’ experiences.
- Dr LaBrooy indicated proposed enhancements at Ealing Hospital and Charing Cross Hospital to serve local people. She also spoke about the proposal for community hubs throughout the area to support the out of hospital strategy and to improve community healthcare services.
- By 2017-18 an additional £190m per year will be spent on out of hospital care, with a focus on integrated care and rapid response teams enabling patients to avoid hospital admission, improved discharge from hospital arrangements, the 111 telephone advice service to direct patients to appropriate care, readily accessible 24/7 Urgent Care Centres, enhanced services for psychiatric and dementia patients, and better end of life care.
- GP leaders in North West London have pledged to support patients to take care of themselves and to provide both good primary care services and access to properly maintained up-to-date services in hospitals with highly trained specialists, available 24/7 to support patients needs.
Dr LaBrooy then answered a wide range of questions. She was thanked on behalf of the audience by the Vice Chairman, Donald Edwards, which was endorsed by loud applause.
The review was cririticised by the Independent Reconfiguration Panel, which concluded that the plans developed by the review were based on "flawed analysis of incomplete proposals".
The new review, ordered by Mr Hunt, has adopted the panels' recommendation to consider children's heart services alongside those for adults. A meeting on 21st June saw NHS England's Medical Director, Sir Bruce Keogh, and Policy Director, Bill McCarthy, agree with the ten trusts covered by the original review to produce an "implementation plan " on child and adult heart surgery by the end of July.
Based on an aricle in Health Service Journal 5.7.2013
The Joint Primary Care Trusts took their decision today on the outcome of “Shaping a Healthier Future”, their proposal for changed health services in NW London, which had been subject to months of preparation and consultation in 2012.
The JPCTs billed their meeting as an all day event, and such it was, from 9.30am to 5.50pm, almost an hour longer than planned, and with only two short comfort breaks in the whole of the day.
Every aspect was looked at in detail with a pause after each section for Board Members to ask questions and discuss options. They looked at clinical issues, financial issues, value for money, public transport, public consultation, equality issues. The Business Case ran to two full volumes. All eight Chairmen of the CCGs were present in the afternoon and each gave a summary of their own CCG’s views.
The outcome was largely as planned but with some concessions. The preferred Option “A” was agreed, so there will be five major hospitals with 24/7 A&Es, urgent care centres, trauma, emergency surgery, intensive care, paediatric in-patients and maternity services – Chelsea & Westminster, Hillingdon, Northwick Park, St Mary’s, West Middlesex. They all require major investment to meet their roles.
Transfer of responsibilities: NHS London is in the process of handing over its functions to the NHS Commissioning Board London Region, in preparation for its abolition on 1st April 2013. Planning is well underway.. A legacy document is being prepared, as is required from all NHS organisations that are handing over their functions to new organisations..
Clinical Commissioning Groups: CCGs take over from PCTs on 1st April 2013. Authorisation of the London CCGs is at different stages. Some were authorised in December 2012. (Later in January the CCGs in Brent, Ealing and Harrow became authorised but Hillingdon CCG must wait until 7th March 2013). All 32 London CCGs have appointed clinical Chairs. Of their Chief Accountable Officers, only one is a GP and two are public health doctors. Other Board Members are being appointed.
Finances: At month 8 the forecast outturn position for London was a surplus of £147m which was £31m above plan. However four provider trusts were not meeting their planned position for that month and four PCTs too, including Hillingdon PCT. PCTs were still assessing retrospective claims for NHS Continuing Care - the estimated additional cost not already included in PCT forecasts was £14m.