North London Partners in health and care

NCL Clinical Advisory Group update

NCL’s Clinical Advisory Group (CAG) was established back in April to provide clinical oversight and assurance to ensure that the service adjustments being put in place meet the needs of the system, are safe and don’t have any unintended consequences.  The CAG is chaired by Dr Jo Sauvage, NCL CCG Chair, and Dr Chris Streather, Group Medical Director, Royal Free London and has representatives from NHS providers, GPs and London Ambulance Service.

In the last month the CAG group has endorsed proposals on the following topics:

Early Medical Abortion by remote consultation

The British Pregnancy Advisory Service (BPAS) has been working to make sure that women have access to Early Medical Abortion care during the pandemic, with a focus on telemedicine to minimise risk and maintain a timely provision of abortion as an essential service for women. ‘Pills By Post’ launched in April this year to provide nurse and midwife-led consultations over the telephone or video call, with medication posted to a woman’s home address where she was suitable for treatment. The new pathway guidance is that services are via remote consultation – over the phone or video with limited in-clinic care. Ultrasounds are made available to women only when necessary.

BPAS have completed an evaluation of ‘Pills By Post’ and found that remote consultation and provision have supported abortion providers to protect staff and clients from the impact of Covid-19, while enabling women who are unable to leave their houses the only possible option for ending their pregnancy. Unlike other healthcare services over the period, the numbers of clients have increased, waiting times decreased, and satisfaction maintained at high levels, with 97% of clients satisfied or very satisfied. The average gestation for treatment across the BPAS service has reduced from 8.1 weeks at the end of March to 6.8 weeks by mid-May.

NCL GPs can refer patients using the existing referral process.

Discharge referral form

Over the past few months NCL’s partners have rapidly mobilised the National Discharge Requirements for Covid and have made operational practices more consistent across the system. There are now new ways of working across NCL’s single points of access for discharge that are underpinned by a common set of discharge principles that all SPAs will meet, including:

  • Home first – prioritising supporting people to return home before considering other options
  • Early discharge planning and same day discharge
  • Monitoring and responding to system demand and capacity
  • Multi-disciplinary working
  • Improved support and outcomes for care home residents by ensuring smooth discharge from hospital

This month CAG has endorsed these system principles and a single discharge referral form for use across NCL. This approach will:

  • Enable better patient flow through and across the system
  • Prevent Delayed Discharges
  • Allow swift transfer of MO patients out of the hospital into the community for assessment
  • Improve reporting consistency

For more information contact Wolfie Smith, email

Direct Access Imaging

Restarting GP Direct Access imaging services in North Central London is a priority so that high-urgency patients can receive their scan in a timely manner. GPs across NCL are now able to refer patients into these services using NHS provider trusts and some independent sector capacity.

Implementation of infection prevention and control measures and requirements for social distancing within providers has led to reduced capacity of approximately 35% in imaging, so it is crucial to ensure that services are not overwhelmed with requests. Advice has been provided to GPs that these services should be requested on the basis of clinical need/prioritisation to support care for those patients for whom an imaging diagnostic is essential. GPs have also been asked to reprioritise historic direct access referrals to help ensure patients on existing waiting lists are treated in clinical priority order. 

There is a generic inbox for all applications for proposed service changes to be submitted for consideration by NCL CAG:

There is a generic inbox for all applications to be submitted for consideration by NCL CAG: