NHS managers question viability of polysystems rollout

Posted on February 8, 2010. Filed under: News stories, Polyclinics | Tags: |

Pulse | By Ian Quinn | 8 February 2010

Exclusive: NHS managers have raised serious doubts about the viability of controversial plans to group GPs in polysystems and transfer hundreds of thousands of hospital cases to them.

Documents uncovered by Pulse demonstrate concerns within at least one PCT that some of the so-called polysystems being launched by NHS London could end up costing more money than they save.

The revelation comes with the BMA urging GPs to attend a rally at its headquarters on 25 February – where GPC chair Dr Laurence Buckman will be one of the key speakers – as it spearheads the battle against the ‘unproven’ polysystems model.

A report reveals NHS Westminster, meeting two days before NHS London unveiled plans for more than 100 polyclinics across the capital, claimed the policy of having groups of GPs practices serving up to 80,000 patients, based around major ‘hub’ buildings, was not practical in large areas.

Areas including Paddington, Queens Park and the northern half of central London do not have ‘sufficiently sized premises’, it said.

The report also raises fears over the affordability of the polysystems proposals.

‘A key principle in designing each polysystem is that it costs less than the existing service and delivers savings,’ it adds.

‘This requirement has a fundamental impact on the feasibility of delivering certain elements… It will be essential sufficient activity and funding can be diverted from A&E to the new service to make it financially viable,’ says the report, adding: ‘This may not be achievable in certain parts of the PCT.’

The report claims there is also a danger of polyclinic buildings threatening each other’s viability.

Neighbouring Kensington and Chelsea PCT is developing a major polysystem hub at St Charles Hospital, which Westminster claims means its cross-border plans ‘would not make sense from a service or economic perspective’.

The development of polyclinics in London has been fraught with controversy, with the economic crisis forcing a massive scaling back of the original plans put forward by Lord Darzi and now fears growing over the viability of the hub-and-spoke model.

A report by NHS Hillingdon reveals the evidence for its polyclinics strategy was branded as ‘weak’ by NHS London itself, which said it lacked evidence of affordability and how GP practices would work together, as well as ‘justification’ of the chosen sites.

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PMS funding diverted to pay for ‘polysystems’

Posted on February 4, 2010. Filed under: News stories, Polyclinics | Tags: |

Pulse | By Ian Quinn | 4 February 2010

Exclusive: NHS managers are planning to scrap growth funding for PMS practices across London and use the cash to fund a new network of 100 ‘polysystems’ – the successors to Lord Darzi’s polyclinics.

Plans unearthed by Pulse show trusts plan to make huge savings by denying growth money to practices in the capital, and have earmarked it to finance their latest policy drive rather than pay off deficits.

Polysystems are designed to serve populations of up to 80,000, working around polyclinic hubs many of which may be run by private providers.

The Department of Health’s policy implementation arm, NHS Primary Care Commissioning, has lent its backing to a policy developed by controversial PCT NHS Camden to finance polysystems using PMS cash.

An NHS Camden policy document posted on the PCC website as a model for other trusts sets out plans in which ‘the PMS growth money will be taken out and invested in the polysystem’.

At a meeting of PCT and DH representatives, PCC endorsed the Camden model and urged trusts to use ‘contractual levers’ to squeeze money out of PMS.

It said: ‘NHS Camden has conducted a PMS review and illustrated how to reinvest into a 40% shift from acute medicine to a primary care polysystem.’

NHS North Central London – a group of five PCTs including NHS Camden – plans to move 87,291 outpatient appointments into polysystems in 2011/12, which it claims will save more than £20m a year.

Elsewhere, PMS practices in NHS Newham have been served with breach-of-contract notices after refusing to sign up to plans to cut funding (see left).

NHS London last week announced potential sites for more than 100 polyclinics across London, with care coordinated around each in a polysystem. But it admitted there was a high risk of local and national opposition jeopardising the plans, which will dramatically reduce the number of singlehanded practices and require those GPs who take part to extend their opening hours.

Dr Chaand Nagpaul, GPC negotiator and a GP in Stanmore, Middlesex, said: ‘Polysystems are being imposed on GPs as a political imperative rather than being led by clinicians. It’s the antithesis of the rhetoric we were given in the Darzi report. Just taking money from PMS practices to fund them is a highly crude approach that can only serve to further alienate GPs.’

The BMA is staging a rally at its headquarters on 25 February to protest against NHS London’s plans, and is strongly opposing the polysystem drive.

Dr Kevin O’Kane, chair of the BMA’s London regional council, said: ‘Polysystems are being used to bring in multinational companies and increase competition. This will enable them to replace small practices.’

LEGAL FIGHT TO SAVE CONTRACTS

GPs fighting against NHS plans to slash the terms of their PMS pay have been threatened with breach-of-contract notices.

Dr Surendra Dhariwal, a GP in Newham, east London, heads up a group of more than 30 PMS practices who have consulted lawyers in an effort to stop NHS Newham bringing in new targets and cutting the funds per patient.

Dr Dhariwal said: ‘The attitude of the PCT is totally alien. All the PCT staff who negotiated the first PMS contract and understood its benefits have now left.’

FROM POLYCLINIC TO POLYSYSTEM

Networked polyclinic: A hub-and-spoke model with various GP practices linking to the hub for specialist services. Hub premises could be an existing GP practice, a private provider, a new-build or a new existing building.
Hospital-based polyclinic: To be based at the front of the hospital, with a network of care operating from community locations.
Same-site polyclinic: Services such as GP practices provided from the same building. The GP practices could run independently or merge.

Source: NHS London report

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Polysystems launched in NE London

Posted on January 4, 2010. Filed under: News stories, Polyclinics | Tags: , |

Nursing in Practice | Press Association | 4 January 2010

North-east London GPs are to get the power to decide how and where healthcare budgets will be spent, as a primary care trust becomes the first in the country to hand over its commissioning function.

NHS Redbridge has disbanded its three practice-based commissioning clusters and replaced them with five polysystems to represent the interests of the borough’s 51 general practices.

In a move that could eventually give family doctors control of a £400m budget, the new polysystems are designed around a “hub and spoke” model, with each covering a distinct geographical area.

At the “hub” is a multipurpose polyclinic, which will offer a range of services, including outpatients and diagnostics, surrounded by local hospitals, pharmacies and surgeries to make up the “spokes”.

Each polysystem is run by a board of local GPs, who may be given responsibilities to commission services and meet targets from the Department of Health and NHS Redbridge.

Local GP Narinder Sharma, Clinical Director for Loxford Polysystem, said: “Health needs vary from area to area and being able to focus the appropriate resources on specific areas as well as anticipate future health trends is a great step forward.”

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Redbridge: polyclinic strategy mapped out

Posted on December 19, 2009. Filed under: News stories, Polyclinics | Tags: |

Ilford Recorder | NHS Redbridge | 19 December 2009

FOUR polyclinics at the heart of future healthcare in Redbridge could be developed in the next four years.

NHS Redbridge says it is pleased with the impact Loxford Polyclinic has had since it opened in April and has released details of the remaining four super surgeries, which it hopes will be running by 2013.

Work begins next year on the Seven Kings polyclinic system, linking health centres and medical surgeries with polyclinics, and a surgery could be developed on the King George Hospital site, Barley Lane, Goodmayes.

Health officials will look at systems in Wanstead, Fairlop and Cranbrook in 2011, 2012 and 2013, but have not decided in which order.

Research will be done to gauge needs in the communities, which will be compiled with social and economic information.

NHS Redbridge’s borough managing director Conor Burke said: “The proposed changes to services in outer north east London echoes this approach, suggesting the majority of urgent healthcare needs could be out outside hospitals in a polyclinic setting.

“Our five polysystems will increasingly be able to direct funding where they think it is best used in their neighbourhood, while still ensuring we meet national quality standards.”

The Wanstead polysystem could have a clinic at South Woodford Health Centre, High Road, South Woodford, and the Fullwell Cross Health Centre, Tomswood Hill, Barkingside, is the preferred option for Fairlop.

There is no obvious site for Cranbrook yet.

Loxford’s polyclinic has enticed nearly 1,000 new patients to register with GPs.

The spokesman said: “The lessons we’ve learned will prove invaluable when it comes to opening the remaining four polyclinics.

“One of Loxford’s strongest assets is the work of its community panel and this input will be replicated in the planning of the other clinics.

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NHS Westminster: GP-led Health Centres & Polyclinics

Posted on December 15, 2009. Filed under: GP-led health centres, Polyclinics, Providers, Reports/papers | Tags: , |

NHS Westminster | Committee Report | Health Consultations and Service Development | 15 December 2009 [word]

GP-led Health Centres

The introduction of GP-Led Health Centres is a nationally driven initiative to extend access to primary care services in response to the findings of Lord Darzi’s review that notes access as a significant concern for patients and service users.

The minimum services specified by the Department of Health for the GP led health centres were as follows:

  • Core GP services
  • Open 8am to 8pm 7 days a week
  • Bookable GP appointments and walk-in services
  • Registered and non-registered patients.

London PCT’s were asked to commission at least one GP-Led Health Centre by March 31st 2009.

In 2008, NHS Westminster initiated a programme of work to procure 2 GP-Led Health Centres for the north and south of the borough in areas of highest health need.  Unfortunately in the Victoria/Pimlico area difficulties were encountered in finding suitable premises for this new service and therefore we have not been able to proceed. We remain committed to providing extra GP services in the south of the borough and are currently exploring all available options to ensure that we deliver the best services possible for local people.

The contract for the GP-Led Health Centre in the north of the borough was awarded to Malling Health LLP and premises for the service have been identified in Queens Park.

A temporary premises solution has been secured while the permanent location is being made fit for purpose.  The GP led health centre opened in this temporary location on 26 October 2009.  The service is called Malling Health at Westminster.  The practice is open for patients 8am – 8pm, 7 days a week at Woodchester Square, W2.  The practice is adequately staffed with clinical and administrative personnel.  The Practice is expected to move into the permanent premises by June 2010.

Whilst in the temporary location, Malling Health will be operating under the same contractual arrangements as they will in the permanent location, including the provision of the full range of services within their contract.

Polyclinics

NHS Westminster is consulting with residents in two areas on the development of new Polysystems for the provision of out-of-hospital and primary care services. The two areas have been designated as Queen’s Park and Paddington – which covers Queen’s Park, Harrow Road, Westbourne, Bayswater, Lancaster gate and Hyde Park – and Central Westminster – which covers Bryanston & Dorset Square, Marylebone High Street, The West End, Abbey Road, Maida Vale, Little Venice, Regent’s Park, Church Street.

A polysystem is simply a network of community health services – clinics, health centres and GP surgeries – which all work together to care for patients.  It can organise for patients to get the care they need more efficiently, support patients in getting more care nearer to home and reduce the number of trips patients have to make into hospital.

GPs will be able to offer tests, appointments and treatment more quickly and conveniently.  It will also be easier to get an urgent appointment or go to a walk-in service near to home or work.  It can offer more health services in a community setting.  Examples include:

  • urgent care and walk-in services
  • diagnostics such as blood tests, x-rays and ultrasounds
  • community nursing
  • physiotherapy, occupational therapy and podiatry
  • minor surgery
  • hearing tests and hearing aid fitting
  • obstetric and maternity appointments
  • support to help with a long term condition
  • outpatient clinics
  • mental health clinics
  • sexual health clinics.

It will offer these services alongside the traditional community health services (GPs, NHS dentistry and pharmacies) and well-being services from the local authority from housing and benefits advice to debt counselling or support in getting back to work.  When a GP surgery becomes part of a polysystem, patients will still see their own GP as before.  In addition, they will also be able to see the other GPs and healthcare professionals that are part of the network.

NHS Westminster is running two separate consultations, one in each proposed polysystem area.  The proposals have been developed by local Practice-Based Commissioning Clusters in partnership with NHS Westminster to reflect local needs and experience.  Although the NHS London policy of developing polysystems is being implemented by NHS Westminster, it is important that each one is tailored to the needs and views of local residents, patients, stakeholders, GPs and other professional clinical staff.

All stakeholders on the NHS Westminster database will be contacted in the relevant areas and invited to contribute to the consultation.  NHS Westminster will also be offering stakeholders the opportunity to attend meetings to discuss and listen to local views.  Online questionnaires and response mechanisms are also being made available and consultation materials will also be available online, in GP practices and other NHS facilities as well as in libraries.

Feedback from the consultations will be collated and analysed.  Separate reports will be created for consideration by the NHS Westminster Board and will be made available online and in a feedback document to stakeholders and respondees to the consultation.

The NHS Westminster Board will then consider the responses to the consultations in developing the service specification and implementation plan.

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NHS Westminster – Update on GP Led Health Centre, Polysystems and Dental Practices

Posted on November 24, 2009. Filed under: GP-led health centres, Providers, Reports/papers | Tags: , |

NHS Westminster | Board Meeting | 24 November 2009 [pdf]

Introduction
Following the discussions at the last Board, this paper provides an update on key developments within primary and community care in Westminster.
Queens Park GP Led Health Centre Summary Update

Karen Clinton, Assistant Director, Primary Care Commissioning | 3 November 2009

Temporary solution

The GP Led Health Centre opened on 26 October 2009. The service is called Malling Health at Westminster. The practice is open for patients 8.00am – 8.00pm, 7 days a week, from temporary premises situated at Woodchester Square. The practice is adequately staffed with clinical and administrative personnel. NHS Westminster met the Department of Health target to open the GP Led Health Centre by 31 October 2009.

Permanent solution
  • Malling Health and their agents, GPI, have agreed the Heads of Terms (HoT) with Genesis Housing.
  • The rent has been agreed between NHS Westminster and GPI and the rental level is supported by the District Valuer.
  • The planning application for the permanent premises was submitted on 1 October 2009. The process will take 8 – 12 weeks in total. Taking into account the planning process and the work required to make the premises operational, the contractors have advised that the building will be ready for occupation in April 2010. A project plan for delivery of the permanent solution is in development.
  • Dr Thomas Reichhelm, Medical Director for Malling, has met with Dr Srikrishnamurthy, who is located directly opposite the Genesis building.
  • Progress is now being made by Malling Health to integrate into one of Westminster’s PBC clusters.

Significant Risks
  • The planning cycle for “change of use”, from retail to clinical, may take longer than the estimated 8 weeks and could impact upon the building work required to make the premises habitable.
  • The building work may hit unforeseen problems that could delay the opening in April 2010.

Polysystems Update

Simon Hope, Assistant Director, Strategic Commissioning | 3 November 2009

Context

The PCT is progressing development of 3 Polysystems across Westminster. Polysystem boundaries are broadly aligned with the 3 largest PbC clusters and design of Polysystem service models is being led by PbC clusters, supported by the Polysystem Programme Team.

Detail regarding development of each Polysystem is detailed below including the latest position in terms of cost and timescale for implementation:

South

The project is at implementation stage and work is underway to develop the South Westminster Centre, which is the identified system hub. A programme of minor refurbishment is due to begin, and discussions are underway with a range of service providers which will be commencing provision of new clinics in the Centre during the coming months. These include; Improving Access to Psychological Therapies (IAPT), Dermatology, Musculoskeletal services and Diabetes.

A marketing and communications plan is being drafted to include engagement with key stakeholders including clinicians and local residents, regarding the further development of the polysystem.

Discussions with the Victoria Commissioning Collaborative Cluster, regarding arrangements for management of the Polysystem, associated resources and governance arrangements between the Polysystem and the PCT are at an advanced stage.

To date, there has been new investment in the Polysystem of £280,000, to fund minor refurbishment and IT infrastructure costs. Further significant investment will be required in order to facilitate extended hub opening hours, building management, and commissioning of an on-site Urgent Care Centre. Specific detail of costs will depend on the respective service models and procurement routes selected. Savings to be accrued from the Polysystem, linked to development of redesigned community-based services, are being calculated using the Commissioning Support for London (CSL) framework, which is being relaunched in November. Detail will be included in the next Board update.

Central

Following a workshop with the Central London Healthcare Cluster, a design report has been produced which highlights a significant range of areas where further work is required in order to finalise the service model.

The Cluster’s preference is for a largely federated system, with services provided in a range of locations and integration achieved via its planned Clinical Co-ordination Centre.

The major focus to date has been in relation to the model for commissioning community-based Urgent Care services. The model put forward by the Cluster proposes multiple practice-based sites, providing integrated planned and urgent care by current primary care providers, 12 hours a day, 7 days a week. The PCT is assessing the affordability of this option and whether it meets Healthcare for London requirements.

In addition to scoping the potential for development of a number of practice-based sites for urgent care provision, the project has PCT Management Team approval to work with Central London Community Healthcare (CLCH) to develop an integrated planned and urgent care service at the Soho Centre for Health, by integrating the PMS practice and the Walk-In service already commissioned there.

Work is ongoing to identify potential locations for other Polysystem services. The cluster is keen that, as far as possible, services are hosted by GP practices and is developing criteria which potential host sites will be required to meet.

An engagement process with local stakeholders is due to commence during November, the findings of which will be incorporated into the final service model which should be complete by February 2010. The timescale for implementation will be dependent on the model, as will the requisite investment and planned savings over time.

North West

Following a workshop with the Queens Park and Paddington Cluster, a design report has been produced which highlights a significant range of areas where further work is required in order to finalise the service model.

The Cluster’s proposal is for development of the Queens Park Medical Centre (QPMC) as a polysystem hub, working with the GPs in the centre to deliver an integrated model of planned and urgent care services. The Project Team is assessing the affordability of the urgent care element of this model, linked to the likely footfall of patients through the service and the close proximity of other urgent care services at the planned GP-led Health Centre on Harrow Road, and also at St Charles Hospital in NHS Kensington and Chelsea. If affordability and return on investment of the urgent care element of the model cannot be demonstrated, work to develop the QPMC as the hub will continue, with a range of other services being located there.

An engagement process with local stakeholders is due to commence during November, the findings of which will be incorporated into the final service model which should be complete by February 2010. The timescale for implementation will be dependent on the model, as will the requisite investment and planned savings over time.

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NHS Redbridge is asking residents for their views on a proposed ‘polysystem’ for Wanstead and Woodford

Posted on November 3, 2009. Filed under: News stories, Polyclinics | Tags: |

Guardian – Redbridge News | By James Ranger | 3 November 2009

RESIDENTS across Wanstead and Woodford will be able to give their views on how they receive their healthcare in the future.

NHS Redbridge will be asking for opinions on polyclinics across the borough, following the recent opening of the Loxford Polyclinic.

The clinics, which offer a range of services to patients, are part of a wider ‘polysystem’. The NHS are proposing setting up a Wanstead polysystem, which would include a broad range of healthcare services for patients in the Snaresbrook, Wanstead, Woodford and South Woodford areas.

NHS Redbridge say the new Loxford Polyclinic has been successful due to the input the community had in the run-up to its opening through the Loxford community panel, which continues to give feedback to the NHS.

The healthcare authority is also looking for residents input for proposed polysystems for Cranbrook, Fairlop and Seven Kings.

Residents wishing to put their views across should contact Amy Burgess, Community Engagement & Equalities Officer, on 020 8926 5048 or email amy.burgess@redbridge.nhs.uk.

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Four new polyclinics planned for Redbridge

Posted on October 30, 2009. Filed under: News stories, Polyclinics | Tags: |

Yellow Advertiser | By Peter Henn | NHS Redbridge | 29 October 2009

REDBRIDGE will be the first borough in the country to implement a radical change in the way people receive their healthcare. 

NHS Redbridge, which provides GP services to residents in the borough, is set to follow up on the success of Loxford Polyclinic, in Ilford, by establishing four further units. The Loxford Polyclinic opened earlier this year. 

The Trust is planning to set up polyclinincs in Cranbrook, Fairlop, Seven Kings and Wanstead wards, which will serve a population of around 50,000 people each. 

Health bosses claim the new way of working will mean people will be treated for the majority of ailments in their own area. 

NHS Redbridge’s borough managing director, Conor Burke, is ‘confident’ the polysystems were the way forward. 

He said: “We know people want easier access to health services in terms of both journey times and opening hours. 

“We are leading the country in what is a very innovate approach to healthcare.” 

Dr Narinder Sharma, clinical director for Loxford Polysystem, wants to establish a ‘seamless’ service for patients near their homes. 

He said: “The vision of the polysystem is to bring more services out of the hospital and into the heart of the community with local clinicians working with secondary care colleagues and stakeholders.” 

The news comes as the Trust announced it will transfer control of its £400million budget to health professionals. 

The scheme will see GPs call the shots about how and where health cash is spent, and will be responsible for commissioning services and meeting Department of Health targets. 

* The PCT is calling for people to come and join the panels, which will help shape the way healthcare is provided in their area. 

The Trust is currently looking for people to join the panels for the Cranbrook, Fairlop, Seven Kings and Wanstead polysystems. 

For more, call Amy Burgess on 020 8926 5048 or e-mail amy.burgess@redbridge.nhs.uk

Email: redbridge@yellowad.co.uk

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Closing A&E just doesn’t add up

Posted on October 29, 2009. Filed under: News stories, Polyclinics | Tags: |

Ilford Recorder | 29 October 2009

THERE are worrying inconsistencies in the information from NHS Redbridge and Barking, Havering and Redbridge University Hospitals Trust (BHR) in proposing the closure of King George’s A&E.

Heather O’Meara, for example, from NHS Redbridge, claims that 200 people from Redbridge in an eight-week period used the Loxford polyclinic for urgent treatment who might otherwise have used King George A&E.

But this figure (averaging just 25 per week, all of them self-selected as minor cases) is not significant in the context of the sustained high caseload seeking A&E care at KGH and Queen’s Hospital over the past decade and more.

In the past full year the BHR Trust dealt with 177,000 first attenders at A&E – equivalent to 3,400 per week.

The 200 who attended Loxford polyclinic between 8am and 8pm was less than one per cent of the Trust total in the same period.

According to Ms O’Meara, 76,000 people attended KGH A&E last year – the Loxford polyclinic caseload is equivalent to less than two per cent of these.

Incidentally, BHR also admits that KGH is its only hospital meeting waiting time targets for A&E, while Queen’s lags behind.

But more significant are the very large numbers of local patients who require emergency admission to hospital. The most recent full-year figures show almost 50,000 emergency admissions to Queen’s and King George – NONE of which could be properly treated in Loxford polyclinic.

Given the evident chronic pressure on beds at Queen’s, where red alerts run for weeks at a time, and the persistent above-average and increasing bed occupancy in the BHR Trust, it seems unwise – and even dangerous – to close the KGH facility for emergency admissions, and run the risk of swamping both Queen’s and Whipps Cross with cases they are not resourced to handle.

It is impossible not to conclude that the “clinical” arguments wheeled out by trust and PCT bosses are a smokescreen to divert attention from the real reason for these changes – the trust’s disastrous £105million cumulative deficits.

DR JOHN LISTER

Director 

London Health Emergency

GPs ‘back axing of hospital A&E’

Ilford Recorder | NHS Redbridge | 25 October 2009

GPs IN REDBRIDGE are backing plans to axe King George Hospital’s A&E department, it was claimed this week.

In a meeting at the Barley Lane, Goodmayes hospital on Monday, health chief Heather O’Meara told the Recorder clinicians, including doctors, nurses and midwives, support the proposals.

And Ms O’Meara, who is sector chief executive for outer north east London, which is driving the changes, stressed the plans were different to the ill-fated Fit For the Future proposal in 2006.

“This process has been absolutely clinically driven from the beginning. It’s not being management led,” she said. 

The proposals by Health for North East London are the result of regular meetings by six working groups made up of medical staff. 

Stephen Burgess, who is leading the urgent surgery clinical working group, said: “I think there’s a view that the care people are getting within north east London is not as good as it could be.

“The public perception of an A&E and what it actually does is very different. Only 15 per cent of the people we see are actually ill or injured enough to need admission to hospital.”

The remaining 85 per cent are already starting to consider going elsewhere, such as to a polyclinic for emergency treatment. 

Ms O’Meara, who is also chief executive of NHS Redbridge, added: “Within the first eight weeks of Loxford Polyclinic opening, 200 people presented there, who would have been emergency patients.”

One thousand people also registered with a GP at the polyclinic, many of them for the first time.

Mr Burgess added: “This is not about the closure of King George Hospital and not about not having urgent care.

“There will be a 24/7 facility at King George where things like diagnostics, blood tests and rapid blood tests will be carried out.”

Since 2006, heart patients have been taken to the London Chest Hospital, Bethnal Green and stroke and trauma victims to Queen’s Hospital, Romford. 

Patients with other injuries are taken to their nearest A&E.

Ms O’Meara added: “Ten per cent more people survive a heart attack if they are taken straight to the specialist hospital and we want to deliver the best healthcare outcomes for Redbridge.”

Dr Hector Spiteri, Redbridge GP and Clinical Director for Seven Kings Polysystem, said yesterday (Weds): “The Health for North East London proposals have been developed by local doctors and are all about improving the care we provide to our patients.

“These plans will help us medical practitioners do more to enable people to live healthy lives and significantly improve health outcomes across north east London.” 

KGH looks set to hold on to its rehabilitation services and outpatient services such as chemotherapy, securing the future of the hospital’s Cedar Centre, built with the help of funds raised by Recorder readers.

The 14-week consultation is due to begin in November but the plans will be tested by the Joint Committee of PCTs and the Department of Health.

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A picture of health as GPs take the ‘polysystem’ lead

Posted on October 26, 2009. Filed under: News stories, Polyclinics | Tags: |

Public Service | NHS Redbridge | 26 October 2009

Clinicians will increasingly call the shots about how and where money is spent in the local health economy, says Conor Burke, borough managing director for NHS Redbridge primary care trust

NHS Redbridge (NHSR) is moving ahead with a phased handover of its commissioning function that could eventually see clinicians in east London gain control of an annual budget of up to £400m. NHSR’s decision reflects its Rich Picture, a map capturing the organisation’s five-year vision of bringing healthcare closer to people’s homes.

The borough’s three practice-based commissioning clusters were replaced by five “polysystems” earlier this year following more than a year of intense negotiation between the trust and health professionals. The new GP-led network of care professionals will have designated budgets and eventually be responsible for commissioning services and meeting statutory health targets set by NHSR and the Department of Health.

It reflects the organisation’s move towards providing better access to health services closer to home, as well as taking it a step closer to becoming a world-class commissioner.

The polysystems will:
• Promote the health and wellbeing of all the people in the community
• Maximise independence and quality of life for people with long-term conditions
• Improve services for people with non-critical acute care needs.

The decision to introduce the polysystem model is being driven by a commitment to give GPs the power to design and deliver services that improve health outcomes as well as patient experience.

The Royal College of GPs (RCGP) reinforces the need for a federated approach to primary healthcare with teams and practices working together to improve services in its paper The Future Direction of Healthcare: a roadmap.

Each polysystem covers a distinct geographical area of the borough comprising 50,000 people and is managed by a polysystem board made up of local clinicians.

Clinicians’ intimate understanding of their communities will help them design and deliver healthcare measures that not only address current need, but anticipate future trends such as the rise in diabetes and obesity.

NHSR recognises that the polysystem boards have little or no direct experience of commissioning services and will provide the necessary training and support via a Clinical Commissioning Board (CCB) made up of the five polysystem clinical directors and PCT officers. The transfer of commissioning duties will be phased in with the CCB monitoring the poly- system boards’ performance over a number of years.

Health practitioners will also be shown how to analyse their performance and to identify trends where appropriate resources need to be targeted.

The fledgling polysystem boards’ first challenge is looking at ways of reducing the number of first outpatient referrals made by GPs. There has been a 36 per cent increase in referrals in the past three years, with huge variations in referral rates between different practices. One practice made 400 per cent more cardiology referrals than a neighbouring practice, incurring an additional £130,000 in annual costs.

The referral management scheme aims to reduce first referrals for outpatient appointments by 30 per cent by April 2010, making a £3m saving. Several specialist areas have already been highlighted where referrals are noticeably high, including ophthalmology, dermatology, trauma and orthopaedics.

NHSR has introduced a savings incentive framework to encourage both GPs and polysystem boards to meet the challenge. The distribution of savings would be divided among GPs and polysystems to reinvest in their local community and NHSR.

Polysystems will play a key role in bringing the organisation’s Rich Picture to life by treating the majority of patients’ needs in the community, saving unnecessary hospital appointments. The polysystems will operate on a hub and spoke model with a polyclinic at the heart or hub of each polysystem with surrounding surgeries, pharmacies and hospitals forming the spokes that radiate out into the community offering a seamless level of healthcare.

The first polyclinic opened in April 2009. Loxford Polyclinic in south Ilford opens seven days a week and offers more than 20 services including GPs, an in-house pharmacy, healthy living café and a variety of services more traditionally based in hospitals, including diagnostics and outpatient appointments.

A unique point is the inclusion of community groups on the premises, with some 15 community and voluntary groups based at the polyclinic, offering advice, support and information on services including benefits, employment, housing and domestic violence.

The creation of polysystems also has the potential to save the NHS money at a time when it faces severe spending restrictions. Better access to healthcare and raising awareness of the need to adopt healthier lifestyles logically reduces the need for treatment, especially in illnesses aggravated by poor diet and lack of exercise.

GP-led services

Health Service Journal | YOUR IDEAS AND SUGGESTIONS | 29 October 2009

GPs will increasingly call the shots about how and where money is spent in the local health economy, writes Conor Burke.

NHS Redbridge is moving ahead with a phased handover of its commissioning function that could eventually see clinicians in east London gain control of an annual budget of up to ₤400m.

NHSR’s decision reflects its Rich Picture, a visual map capturing the organisation’s five year vision of bringing healthcare closer to people’s homes.

The borough’s three practice based commissioning clusters were replaced by five polysystems earlier this summer following more than a year of intense negotiation between the primary care trust and health professionals.

The new GP-led network of care professionals will have designated budgets and eventually be responsible for commissioning services and meeting statutory health targets set by NHSR and the Department of Health.

It reflects the organisation’s move towards providing better access to health services closer to home as well as taking it step closer to becoming a world class commissioner.

The polysystems will:

  • Promote the health and wellbeing of all the people in the community
  • Maximise independence and quality of life for people with long-term conditions
  • Improve services for people with non-critical acute care needs

The decision to introduce the polysystem model is being driven by a commitment to give GPs the power to design and deliver services that improve health outcomes as well as patient experience.

The Royal College of GPs reinforces the need for a ‘federated’ approach to primary healthcare with teams and practices working together to improve services in its paperThe Future Direction of Healthcare: a roadmap.

Each polysystem covers a distinct geographical area of the borough comprising of 50,000 people and is managed by a polysystem board made up of local clinicians.

Clinicians’ intimate understanding of their communities will help them design and deliver healthcare measures that not only address current need but anticipate future trends, such as the rise in diabetes and obesity.

NHSR recognises that the polysystem boards have little or no direct experience of commissioning services and will provide the necessary training and support via a specially convened clinical commissioning board made up of the five polysystem clinical directors and PCT officers.

The transfer of commissioning duties will be phased in, with the board monitoring the polysystem boards performance over a number of years.

Practitioners will also be shown how to analyse their performance and identify trends where appropriate resources need to be targeted.

The current governance arrangement will see the five polysystem boards report to the clinical commissioning board who, in turn, report to the PCT board.

The fledgling polysystem boards’ first challenge is looking at ways of reducing the number of first outpatient referrals made by GPs.

There has been a 36 per cent increase in referrals in the past three years with huge variations in referral rates between different practices.

One practice made 400 per cent more cardiology referrals than a neighbouring practice incurring an additional £130,000 in annual costs.

The referral management scheme aims to reduce first referrals for outpatient appointments by 30 per cent by April 2010 making a £3m saving.

Several specialist areas have already been highlighted where referrals are noticeably high including ophthalmology, dermatology, trauma and orthopaedics.

NHSR has introduced a savings incentive framework to encourage both GPs and polysystem boards to meet the challenge.

The distribution of savings would be divided among GPs and polysystems to reinvest back in to their local community and NHSR.

Polysystems will play a key role in bringing the organisation’s Rich Picture to life by treating the majority of patients’ needs in the community, saving un-necessary hospital appointments.

The polysystems will operate on a hub and spoke model with a polyclinic at the heart or hub of each polysystem with surrounding surgeries, pharmacies and hospitals forming the spokes that radiate out into the community offering seamless healthcare.

The first polyclinic opened in April 2009.

Loxford Polyclinic in south Ilford opens seven days a week and offers more than 20 services including GPs, an in-house pharmacy, health living café and variety of traditionally hospital based services, including diagnostics and out-patient appointments.

A unique point is the inclusion of community groups on the premises.

Up to 15 community and voluntary groups are based at the polyclinic, offering advice, support and information on services including benefits, employment, housing and domestic violence.

The creation of polysystems and devolution of commissioning functions to their respective polysystem boards also has the potential to save the NHS money at a time when it faces severe spending restrictions.

Better access to healthcare and raising awareness of the need to adopt healthier lifestyles logically reduces the need for treatment, especially in illnesses aggravated by poor diet and lack of exercise.

Source: Conor Burke is borough managing director for NHS Redbridge

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Labour welcomes plans for a polyclinic in Harrow East

Posted on October 12, 2009. Filed under: Polyclinics, Press/News Releases | Tags: |

Labour Matters | By Harrow Labour | NHS London | 12 October 2009

Good news for residents of Queensbury and Edgware Wards in Harrow East. 

Proposals are being considered for a new polyclinic in Mollison Way to replace the former surgery in South Parade. This follows a campaign by local Labour councillors. In addition, there is a further proposal to make Belmont Health Centre in Kenton Lane into a polyclinic.

Labour Councillor Margaret Davine said: “These are really exciting and beneficial developments for residents living in Harrow East and puts paid to all the ill-informed campaigning against polyclinics.

GP Services available from 8 am to 8 pm, seven days a week, will clearly be more convenient for lots of residents. The absolutely crucial thing is what it is going to provide for people – it will open up whole areas of treatment and provisions according the needs of the local communities.

It is however crucial that as promised in April this year that NHS London conducts a thorough and wide ranging consultation that engages people and help them understand how the new system will benefit patients and impact on their health and well-being. It is also important that all stakeholders are listened to and able to feed back their views, ideas and concerns. We want what is right for Harrow and for its residents.

It is important to remember the proposals are not simply to introduce some polyclinics but to develop a poly-system for East Harrow using ‘Hub and spoke model’ which will include and support all GPs who want to be involved.”

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