North London Partners in health and care

STP Newsletter - April 2018


STP news: successes and achievements

We are committed to being open and transparent about the work we are doing across health and social care as a partnership of 21 organisations in North London. By sharing this newsletter we are demonstrating this commitment in a real and meaningful way. We encourage you to forward this newsletter to your teams and more broadly within your organisation. 

Digital Programme Update – Contract announcement

One of the key strategic aims of North London Partners is digital transformation, to help meet the needs of our local population.  The five CCGs bid to NHS England for funding on behalf of the local system, and in mid-March we were informed that the North London Partners’ bid for investment in digital transformation has been successful. NHS England agreed the full amount of the bid, totalling £8.9m over three years.    Following sign-off by each of the CCG Governing Bodies and a period of commercial discussion, we have signed a contract with Cerner as our supplier and strategic partner to enable digital transformation across the whole of the STP including the Global Digital Exemplar. They have significant experience in this field across the NHS including within London.    This is a significant moment for the STP and for the digital programme, and I would like to thank everyone from across all the partners in the STP who has contributed to this success. We are reviewing clinical and care representation on the Digital Board, who will manage the programme, to ensure that we have the appropriate leadership from across the STP. 

The next months will see the ramp up of the programme team working for Geraldine Wingfield-Hill, as our Digital Programme Director, as well as stakeholder launch events across North Central London.  

Planned Care Update - Clinical Advice and Navigation Service Launched

We’re pleased to announce that the first wave of Clinical Advice and Navigation has been launched across NCL, with all acute trusts in NCL now providing advice and guidance from January 2018. GPs are able to ask local acute consultants a question where they are unsure if a patient needs to be referred to secondary/specialist care. 

There is significant evidence that enabling communication between GPs and specialists can support management of patients in primary care, and avoid unnecessary hospital appointments for patients. Clinical Advice and Navigation builds on previous versions of advice and guidance offered by acute trusts with some of the main differences being:

  • A response given within 2 days
  • The use of the Electronic Referral System to monitor implementation
  • An integrated solution across NCL 

The benefits of Clinical Advice and Navigation include:

  • Improved patient experience
  • More efficient and effective advice and guidance for GPs
  • Managing demand for Outpatient services
  • Streamlining of patient pathways 

Primary care colleagues can access the service through the current ERS and the range of services and providers can be found here. More specialties will be added in the second wave of implementation by December 2018. 

A number of GPs who have already used the service have been impressed by the speed and content of response. A communication plan is being developed that will utilise a range of media to support the implementation across NCL. 

The key message is: if you are unsure, it’s best for you and your patient to ask before making a referral. For more information, please contact your local CCG lead or the NCL CCG lead: Marco.Inzani@nhs.net 

Health and Care Closer to Home Case Study - Working together to tackle high blood pressure in south-west Islington

High blood pressure affects around 40% of the world’s population aged over 25 years. Also known as hypertension, the condition is estimated to be implicated in approximately half of deaths caused by stroke or cardiovascular disease. 

The impact of this is that we’re seeing men and women with the condition with a total life expectancy that’s respectively 5.1 and 4.9 years shorter at 50 years of age. In the south-west of Islington, between April 2016 and March 2017, the NHS saw 29 patients admitted to hospital following a heart attack or stroke. Although levels of patients diagnosed with hypertension in the borough are at 13.9% of the population, they’re estimated to be significantly higher at 25.5%, suggesting we are still to diagnose patients living with hypertension. 

With symptoms that are rarely noticeable, hypertension if untreated increases the risk of serious problems such as a heart attack or stroke. As a result, cases often have to be picked up opportunistically and are largely dependent on patients attending regular health checks. Adding to this the fact that clinical coding of the condition in general practice is often inconsistent, leading to little or no treatment, means that for many the risk of complications is much higher. 

Faced by the challenge of undiagnosed patients and the need to effectively manage these cases, a group of GP practices in south-west Islington has come together to tackle the problem. 

Through the creation of shared patient registers and by working with the Islington GP Federation, this group of practices has been able to run centralised search and reports, enabling them to identify potentially undiagnosed cases of hypertension. Following this, the specially trained “super admin” clinical assistant then screens the patient notes, coding them as appropriate and helping to free up clinician’s time. As a final step the screening and coding is validated by a GP Clinical Lead from the Islington Quality Improvement Support Team (QIST). 

The result of this approach where practices are collaborating and teaching staff new skills is that to date, 107 patients in the south-west of Islington have been identified as having hypertension. With each of these patients now receiving appropriate monitoring and an annual follow up, there is great potential to reduce the number of strokes, heart attacks and hospital admissions. 

Cancer Update – One-stop shops across NCL

New ‘one-stop shops’ designed to speed-up cancer diagnosis and help save lives are being rolled-out in three of our local Trusts: the Royal Free London, North Middlesex University Hospital and University College London Hospitals. The rapid diagnostic and assessment centres, designed to diagnose cancers early in people who do not have ‘alarm symptoms’ for a specific type of cancer, will catch cancer early and speed up diagnosis for people with cancer. 

People with vague, non-specific symptoms, such as unexplained weight loss, appetite loss or abdominal pain are often referred multiple times for different tests for different cancers, but these new Multidisciplinary diagnostic centres (MDCs) will help end this cycle. If a GP or other healthcare professional suspect cancer, they will now be able to refer to a one stop shop where all the necessary investigations can be done under one roof. Each MDC has a dedicated team of clinicians, including nurse specialists, who can provide a fast-track diagnostic service for patients who are traditionally difficult to diagnose. 

Some patients will receive a definitive diagnosis or all clear on the same day, while others will need to undergo further assessment, but can generally expect a diagnosis within two weeks of their first appointment. Those diagnosed with cancer can be referred on to specialists, while those with benign conditions receive appropriate treatment and tailored advice about prevention. 

The pilot MDC programme is run by UCLH Cancer Collaborative and is part of the national Accelerate, Coordinate, Evaluate (ACE) Programme jointly funded by Cancer Research UK, Macmillan Cancer Support and NHS England. 

For more information about the MDC pilots visit http://www.uclh.nhs.uk/cancercollabMDC 

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