Come to our local listening post events
Our listening post events are usually held in Gravesend and linked with our governing body meetings. They provide an opportunity for anyone interested in health to come and give their views and ask questions directly to the CCG’s governing body members in attendance.
We publicise upcoming dates of the governing body meetings and associated listening posts on our homepage under ‘events’ so please check here for venue details and start times.
Getting answers to your questions about health commissioning
Informal Listening Post session for comments or questions from members of the public are held regularly by the CCG, where there is an opportunity to discuss any queries with key members of the board. Themes raised by attendees at our previous listening posts included:
- Mental health
Depending on the nature and level of detail provided, the CCG may not be able to answer all questions in full on the day of the listening post, however each query is passed on to the relevant lead and responded to in a timely way.
Where appropriate, listening post responses are posted on the CCG website for everyone’s information. Your feedback is important and valuable so, if you have an interest in local health, it is worth getting involved.
Read questions and answers from previous listening posts below
May 2019 Listening Post
Q1: How soon after an eye cataract removal operation, can a patient expect follow up care and attention?
A: For routine cataract surgery it is standard for patients to receive a call from their clinical team two weeks after the procedure. The first follow up appointment is scheduled to take place six weeks after surgery as that allows tine for any swelling to go down so that the patient can be assessment for glasses if required. Patients are followed up sooner if there is any cause for concern during the initial phone call.
Q2: Do our doctors still use the Body Mass Index (BMI) to assess the fitness of their patients?
A: BMI is not an indicator of fitness. It is used in conjunction with a range of other facts to indicate if a patient is at a higher risk of common conditions.
Q3: How should leg ulcers be treated at home?
A: A patient’s treatment will be decided in line with the protocols and patient pathways for wound care. This will be set out in the patient’s treatment plan and care will be delivered wherever is appropriate, sometimes this will be in the patients home.
Q4: Are patients now expected to inject themselves with clot busting drugs after surgery? Would people with dementia have to do it or a member of their family?
A: Yes, if they are able to. Often this can be carried out by a partner or family member who would be shown how to do this in the hospital or at the first appointment after discharge. This is a common, routine straight forward practice and many patients prefer to self-inject rather than having to attend appointments elsewhere.
For patients with dementia or other conditions meaning it is not possible for them to inject themselves then arrangements would be made for a family member, carer or suitable professional to do this.
Q5: What is the state of play for urgent care?
A: In Swale, there is a lot of ongoing work since halting the procurement. The CCG is mapping and looking at detailed analysis of work and options on how to deliver this service. The results from this as well as future engagement events will be shared in due course.
Q6: Will the CCG be superseded by a new organisation?
A: There will be one CCG covering Kent and Medway by March 2020. The 8 current CCGs will be superseded by this new organisation. In parallel, Integrated Care Partnerships (ICP) will be formed alongside the three new Primary Care Networks in Swale.
Q7: Will you be coordinated with NHS Medway CCG?
A: Yes, our PCNs will be in one ICP with NHS Medway CCG.
Q8: Are there any thoughts on supporting Patient Participation Groups (PPGs)?
A: We are planning a north and west Kent and Medway PPG event to be held in the next few months. We plan on having a representative from National Association for Patient Participation (NAPP) and the Care Quality Commission (CQC) and also discuss PPGs going forward under the Primary Care Networks.
Q9: It is Carers Week in early June, will you add details on the CCG website?
A: Yes we will ensure that there are updates with information on support.
Q9: When are you going to do something about the closure of Warden surgery? It is badly affecting the whole of eastern Sheppey patients.
A: We are meeting with the Parish Council and have also started negotiations for the mobile unit to be located in the area part of the week.
March 2019 Listening Post
There were no questions raised at this Listening Post.
January 2019 Listening Post
Q1: (Relating to creating an Urgent Treatment Centre in the Swale area) What is going to be done about concerns over transport issues across the island and Sittingbourne?
A: From previous engagement about urgent care, the CCG is aware of the local population’s concerns about transport issues. We will be sure to consider these issues in the review of the Urgent Treatment Centre service specification, and will bring our findings to the Health Overview Scrutiny Committee (HOSC) in March, when we will be discussing with HOSC how we will be moving forward with engagement on an Urgent Treatment Centre in Swale. The CCG is committed to ensuring the needs of the local population are considered.
Q2: What wasn’t suitable with the urgent care procurement?
The CCG approached the market and found that the services specified were unaffordable. The CCG is now reviewing the specification and previous engagement, which may lead to a public consultation. The Director of Strategic Transformation, who is leading on the Urgent Care review, said that data will help with identifying preferred options and she will ensure she attends the next Listening Post to provide updates and will look to attend both Dartford Gravesham and Swanley CCG’s Patient Participation Group Chairs meeting and Swale CCG’s Patient Liaison Group meeting.
Q3: What’s the take up of the walk-in centre’s mobile service that visits Asda and Sainsbury’s in Sittingbourne and Tesco in Sheerness – it doesn’t seem very busy?
A: We will review the number of attendances at both the mobile service and the walk-in centre’s base as part of the service specification review.
Q4: Will the CCGs consider holding the Listening Post in the evening so it is more accessible?
The Listening Post takes place from 12.30pm to 1.30pm, which is immediately after the Governing Body meeting attended by the executive team. The subsequent Listening Post provides an opportunity to informally question the executives on the spot about NHS local services. Members of the public who are unable to attend in person can raise questions formally in writing before the meeting which can then be put to the executives during Listening Post.
As there were only a few members of the public, it was suggested that the CCG consider the cultural issues around getting more interest in attending future Listening Posts. The CCGs will consider this along with other suggested alternatives that include holding Listening Posts at the Primary Care Commissioning Committee meetings.
Q5: Why were the Governing Body board papers not available on the website until the weekend?
The board papers are normally due one week in advance of the Governing Body meeting. The papers were delayed on this occasion by 24 hours as two critical papers were late coming in. The CCG normally sends a copy of the papers to the local council ahead of the meeting and the CCG offered to include the enquirer on the mailing list.
Q6: Where should public go to find out which GPs and pharmacies are in the area?
This information is on the Health Help Now website and app, where you can put in your postcode to find the GP practices and pharmacies closest to you.
In addition, the CCG website has a ‘Contact Your GP’ webpage which includes the address and telephone number of local GPs. The Communications and Engagement team are looking to update this webpage and include GP website links where possible. The NHS website provides a list of local GPs within a postcode area. The list includes the telephone number, address, number of registered patients and other services provided.
The CCG has a ‘Stay Well – Pharmacy’ webpage which has a link to the NHS website where people can access a list of local pharmacies by providing a postcode. The list includes the telephone number, address and opening times.
Q7: Could the Health Help Now App link be included as well?
The CCGs will ensure that the Health Help Now link is included as well for both the ‘Contact Your GP’ and ‘Stay Well – Pharmacy’ webpages. It was then informed by an attendee that there are differences on the information provided depending on what mobile you use. When searching on the app via the website and android mobiles there is a full list of all services, whereas using an Apple mobile narrows it down to the nearest services. The CCGs have raised this with the provider and will share their response as soon as possible.
Q8: Why has the Sheppey Community Hospital information on their website not been updated since 2013 and still has Kent Community Health NHS Foundation Trust listed as the provider instead of Virgin Care?
The CCGs investigated. It appears that there is not a website for the hospital specifically and that providers list the services offered at the hospital. There is a link to Virgin Care and another link for Kent Community Health NHS Foundation Trust.
November 2018 Listening Post
Q: Over 75% of CCGs have made Freestyle Libre available on prescription since this became possible on 1 November 2017 and they are reporting positive impacts in all aspects of diabetes care. Over the past year I have been given several different dates for a decision to be made by the Dartford, Gravesham and Swanley CCG and I am still waiting for a decision to made. My question is, when will a decision be made regarding the availability of the Freestyle Libre on prescription.
Have the CCG made GPs aware that the Freestyle Libre is available on the NHS on prescription for every patient for whom it is clinically appropriate and that the CCG cannot prevent GPs from prescribing it if a patient needs it?
A: The CCGs acknowledge that a commissioning decision regarding the availability of Freestyle Libre has been prolonged in the absence of any national guidance. CCGs have a duty to make sure that patients get the best support and treatment available whilst ensuring that the limited funds we have available are spent on those areas that are most clinically effective.
NHS England (NHSE) have now announced that Freestyle Libre blood glucose monitoring will be made available to all patients who meet the inclusion criteria set out by NHSE, from April 2019. Eligible patients will be able to receive this on prescription from their local GP or diabetes team helping them to better manage their blood sugar levels.
Should you wish to find out further information on NHSEs decision, please follow the following link: https://www.england.nhs.uk/2018/11/nhs-to-provide-life-changing-glucose-monitors-for-type-1-diabetes-patients
GPs will not prescribe Freestyle Libre in the first instance. A consultant in a specialist setting such as a hospital would initially prescribe Freestyle Libre for a patient who meets the nationally-agreed criteria. A GP would then continue prescribing Freestyle Libre once it has been initiated by a consultant. This process is being introduced locally prior to April 2019.
Q: Having indicated that the X-PERT Course would become available in this CCG I now find that is not the case. So, when will the X-PERT Course be available in our area, please?
DGS CCG were successful in a bid, along with other CCGs to improve attendance at structured education via transformation funding.
Q: The X-PERT Course is approved by NICE and is more cost-effective than DESMOND. Diabetes UK have produced a number of reports recommending the CCGs run a range of Diabetes Courses, so why don’t you?
A: Our current commissioned programme DESMOND has the same outcomes as X-PERT. Diabetes UK are highly committed to ensuring that people with diabetes receive high quality education at diagnosis and on an ongoing basis. There are different types of education available of varying quality. Both DESMOND and X-PERT meet the quality standard required by NICE and we do not promote one course over the other. The DESMOND programme has been shown to support weight loss and smoking cessation, improve peoples’ understanding of diabetes and reduce depression at 12 months although, as with most programmes, evidence suggests that the programme needs to continue for improvements to be sustained longer. As an organisation we are less concerned over which education programme is commissioned – as long as it meets the NICE standards – and are more interested in ensuring the availability to all people eligible and encouragement to attend these valued courses.
Up until now, the CCG have not been able to fund a range of diabetic courses, particularly as there is no evidence to suggest that one is more clinically effective than the other. We are however, very pleased to have been part of a Kent and Medway wide bid to improve attendance at structured education. This means that in the future, there will be a range of structured education on offer to patients across Kent and Medway.
Q: Presumably now having had the chance to make comparisons with other local CCGs such as Medway and Bexley; it would be interesting to see how this CCGs ‘Complications & Mortality’ statistics, compare with Medway & Bexley areas.
DGS CCG use a range of data to improve services. The Right Care and National Diabetes Audit (NDA) data that we use are in the public domain. DGS CCG are aware of the need for improvement around diabetes and continue to work with a range of stakeholders to co design services to better suit the needs of our diabetic population. We are currently scoping out a potential community model and are working with providers to co design this to ensure that patients get the support they need in the right place at the right time.
January 2018 Listening Post
Questions and answers
Q1: Some of the members of the public attending asked questions relating to the care of specific patients. These questions related to a lack of support when people are discharged from hospital in Swale.
A: We have a good system in place in Swale for supporting patients when they are discharged from hospital if they need it. Ward staff should determine whether a patient is likely to need support on discharge and refer to the integrated discharge team if it is required. An assessment then takes place. The amount of support will vary according to individual patients’ needs.
Any patient who feels the appropriate procedures haven’t been followed, or that the right care hasn’t been put in place should contact the hospital the patient was in. This can then be investigated.
Q2: How is the news about Carillion going to impact on us locally?
A: Carillion staff were providing NHS related services at Darent Valley Hospital in Dartford, Gravesham and Swanley until the company went into liquidation. This was mainly support services such as porters, cleaning and maintenance.
The CCG was notified a couple of days before Carillion went into liquidation that this was highly likely and worked with Darent Valley Hospital to ensure contingency plans were put into place to make sure the services provided by Carillion staff continued. The Carillion staff at Darent Valley Hospital have been taken on by a new provider who has assured them they will continue to be employed and paid.
Carillion did not provide staff for services in Swale.
Q: Did CariIlion have the contract because Darent Valley Hospital is a PFI hospital?
A: Services at the hospital are commissioned by The Hospital Company which is a private company. The Hospital Company was responsible for awarding the contract to Carillion and has also been responsible for putting contingency plans in place.
Q: Are health MOTs offered by pharmacists charged to the NHS?
A: Pharmacies are commissioned by NHS England so we would need to check that with them. We are making enquiries with NHS England.
Q: If I’m entitled to a free flu injection and I get it through my local pharmacy, who pays for that?
A: The CCG in the area where you are registered with a GP pays for the flu jab. Details will be taken by the pharmacy and the charge is passed on to the relevant CCG.
Q: What’s the latest news on the Sustainability and Transformation Partnership in Kent and Medway and what does that mean for Swale?
A: The latest position with the STP was discussed at our January Governing Body and the papers and presentation are available here. You can read more about what the Sustainability and Transformation Partnership means for Kent on its website.
There is a proposal for a transitional strategic commissioner for Kent and Medway to be put in place in shadow form from April 2018. There is a possibility this arrangement could then be made permanent from April 2019, but significant work is required before the CCGs can consider this.
NHS Swale and Dartford, Gravesham and Swanley CCGs have agreed the proposal for the transitional period, and other CCG governing bodies will make a decision on the same in the next few weeks (late January/early February). Other CCGs across Kent and Medway need to approve this before it is taken forward.
The arrangements for the senior management arrangements for the strategic commissioner for the transitional period were discussed at our Governing Body and approved.
Local CCGs will continue to commission NHS services in their area, and will be the decision making bodies about the strategic commissioning function during the transitional period. All eight CCGs in Kent and Medway remain sovereign organisations that hold the decision making power. Swale CCG and DGS CCG will remain and retain its powers and responsibilities unless it delegates its power elsewhere.
We are planning further engagement with the public and stakeholders and providers and our staff as these transitional arrangements develop.
In April 2019, if this plan moves forward, local commissioning organisation will continue to exist, as well as the strategic commissioning organisation.
* Health Secretary Jeremy Hunt has currently (Jan 2018) paused the development of Accountable Care Organisations nationally and we await further guidance on this and how it might impact on local plans to develop the STP.
Q: Local authorities need to be engaged with the STP to ensure rehabilitation and prevention is addressed. What is the NHS doing to make this happen?
The STP plans involve health and social care working together in a more joined up way and we hope that as it progresses, local authorities will get more involved.
Q: What area does Swale CCG cover?
Swale CCG covers some of the area covered by Swale Borough Council, but its boundary finishes in Teynham. Canterbury and Coastal CCG covers the rest of the Swale Borough Council area towards and including Faversham area.
Q: There seems to be pressure on some patients to vacate hospital beds. Why is this?
Evidence shows patients recover faster when they are mobile and in their own homes.
Therefore we encourage patients to be mobile as soon as possible when in hospital.
There is pressure on the NHS which means we need to free bed space in hospitals as quickly as possible, but we would and do not make patients go home until they are well enough to do so. Some patients require support when they leave hospital and if this is the case, they are assessed and the appropriate support services are arranged before they leave hospital. Some patients are transferred from an acute hospital to a community setting before going home. We usually try to ensure we put community services in place as a first step if needed rather than transferring to a residential home.
Some patients at the end of life, are transferred to a hospice.
Q: I hear Virgin Care at Sittingbourne Memorial Hospital has overspent its budget. If this happens, what happens next? Does the NHS give them more money?
A: We have a block contract with Virgin Care for the services it provides in Dartford, Gravesham and Swanley and Swale. This is a type of contract used in the NHS which agrees an amount the provider will be paid for services regardless of how many patients it treats.
Virgin Care has a seven year contract which started in September 2016. The block contract means if the provider overspends , the additional costs are picked up by the provider. However, there are some services Virgin Care is providing in addition to the main contract, with the agreement of the CCG, which they have been paid an additional amount for – for instance catering services at Sheppey.
Q: If Virgin have a block contract and beds are empty in their hospitals, are they winning financially?
A: Due to the nature of health service delivery, beds are not occupied 100% of the time, for instance for cleaning and preparing for another patient to be admitted. Currently, it’s unusual for hospitals to have many empty beds for anything other than a short period of time. Block contracts allow for this.
Q: Does the CCG get an increased budget every year to provide services?
We do get extra money each year, which is known as growth money. The money we receive is based on a projection made by NHS England and the Treasury of our registered GP population. Any funding for additional growth over and above this can take up to four years for the CCG to receive.
Q: What is Medway Hospital building next to its A&E?
A: This is part of Medway Hospital’s changes to its Emergency Department.
December 2017 Listening Post
Questions and answers
Q1: I have read complaints on an NHS website about people regularly turning up at a GP surgery at Sheppey Community Hospital and being turned away without an appointment. It would seem more sensible for the receptionist at the surgery to signpost people to the Walk in Centre in the same building. Could the surgery be encouraged to do this?
A: We can assure members of the public that GP surgeries are encouraged to signpost patients who are unable to obtain a GP appointment but who need one urgently to the Walk in Centre. There are two GP practices based at Sheppey Community Hospital: DMC and Minster Medical Centre. We have reminded Minster Medical Centre to signpost patients to the Walk in Centre in the same building if appointments aren’t available and have reiterated this message to DMC. However, DMC run a GP surgery and the Walk in Centre so we have emphasised that any signposting to the Walk in Centre should only be done if an appointment cannot be offered by the DMC GP surgery and where it is appropriate to do so.
Q2: There are signposting problems at Sheppey Community Hospital and Sittingbourne Memorial Hospital. Can this be resolved?
A: Our Swale Patient Liaison Group has raised this issue and we have been working with the providers of services at the hospitals, and NHS Property Services who manage the building, to try to rectify this. We understand new signposting will be put in place soon.
Q3: Parking is still an issue at Sittingbourne Memorial Hospital – for consultants, patients and residents – and this is likely to worsen when the hospital becomes an Urgent Treatment Centre. Is the CCG planning adequately for this risk?
A: The parking issue has been raised at our urgent care engagement events and via our roving roadshows which were held throughout the summer.
The planned urgent treatment centres for Swale will be sited in the existing minor injuries units at both Sittingbourne Memorial Hospital and at Sheppey Community Hospital. The Walk in Centre GP service which is currently provided at Sheppey Community Hospital will be part of the Urgent Treatment Centre at Sheppey.
In terms of the Sittingbourne Memorial Hospital site, we are aware that there have been concerns over the parking and we have raised this with NHS Property Services, who manage the estate. In September they were undertaking a review of the parking, in conjunction with Swale Borough Council, and we have requested feedback on the outcome of that review. This has not yet been received by the CCG but a further request has now been made to obtain this information. It is hoped that this will support the staff and patients using the centre to be have access to parking spaces as required. We are also aware that there is a need to review transport links to ensure that public transport can provide accessible access for patients in the area to the community hospitals and this will be raised through the Kent and Medway Sustainability and Transformation Partnership.
Q4: Community transport remains a concern for people on the Island to get to Sheppey Community Hospital and elsewhere. Some services for Sheppey patients are now in Margate and Littlebrook. What more can be done to provide better bus routes, at least to Sheppey hospital from elsewhere on the island?
A: We are aware of the transport issues for people on the Isle of Sheppey and frequently work with local authorities and voluntary organisations to try to resolve this. We have worked with the Swale Patient Liaison Group and funded a leaflet about transport which can be accessed online. We have also distributed hard copies around Swale.
We are continuing to consider how we can support a solution to this issue,but sadly it’s not an easy problem to solve.
Q5: Patients are aware that there is shortage of both Parkinson’s and MS nurses on the Isle of Sheppey. Could the CCG explore the possibility of nursing posts being created to support both Parkinson’s and MS, as both illnesses are similar?
A: The CCG is aware of a service capacity issue with regards to the Parkinson’s Nursing Service provided by East Kent Hospitals University Foundation Trust and is in discussion with the Trust to resolve the problem. In the meantime, the CCG has ensured there are interim arrangements in place to ensure people have access to the specialist team when they need it.
The CCG is looking into the MS nursing arrangements as we were not aware, prior to this enquiry that there were concerns around availability of this nursing care. The CCG is grateful therefore for this feedback.
Q6: People with mental health conditions are being supported in the community but this puts an additional burden on GPs to support them. There is concern that GPs are not adequately prepared for this or have insufficient capacity e.g. they do not have the RIO mental health computer system, many may not understand the requirements of mental health patients. Does more need to be done to gear-up GPs to take on this additional load and if so what should be done and by whom?
A: When patients are accepted for treatment by the community mental health team at KMPT, it is explained that it is the aim of the service to help them to understand their condition and how to take control and manage this independently.
When the patient is ready to be discharged from this service, the team works with the patient and other health professionals to develop a care plan to support the patient when they are discharged back to the GP. Other services are in place to support the patient as well as their GP. These include primary care mental health specialist nurses, primary care social care, the wider Live Well Kent service and IAPT services (Improving Access to Psychological Therapies). Live Well Kent has seven contracted ‘delivery partners’ in Swale and more than 100 ‘network partners’ to support mental health and wellbeing.
When a person is discharged, their GP is informed and a full discharge letter with a plan is provided. Some service users do not need any other follow-up and are transferred directly to the GP. If the GP requires further advice, KMPT Consultants are accessible for consultation any time during working hours and the GPs currently access them when they need their support.
The GP remains involved in the person’s care even when under the care of KMPT. The service user can access KMPT to enable extra support and expertise for a period of time, as a person would if they were to need support for a specialist physical health condition. That person would see the specialist for a period of time and once treatment is complete then care is transferred back to the GP with recommendations and advice from the specialist service.
KMPT does offer a fast-track referral option back into the service if needed.
GPs do not have access to KMPT’s Rio software, but most GPs have a basic knowledge of common and secondary care mental health problems. KMPT provides training for GPs as requested by them, and there is a programme of educational sessions in place. The CCG also requests that a variety of secondary services carry out training sessions during monthly GP-focused protected learning time.
Patients transferring from secondary services to primary care is not additional work for GPs, but part of the existing remit of a GP practice’s service.
Q7: Is there parity of esteem in the STP planning? It seems with only 9% of funding continuing to go to mental health, that this could remain a problem in the new STP structure?
A: NHS Swale CCG’s lay member for Patient and Public Engagement has raised this with the Sustainability and Transformation Partnership’s Patient and Public Advisory Group. The Sustainability and Transformation Partnership is planning a conference to look at the importance of mental health in the new STP structure in March 2018.
Q8: Breastfeeding: It seems people need to go to Margate or London to get support with breastfeeding. Could this not be provided through the existing Medway service provided by Medway Community Healthcare (MCH)? Two specialist breastfeeding clinics are also planned to be closed down in the area. Breastfeeding clinics are also used by some mums to help with postnatal depression. What can be done to stop the two clinics from closing and also enabling Swale patients to go to Medway rather than Margate/London?
A: Breastfeeding support is available for mums locally but the specialist services, for instance for babies under six months which are tongue-tied, are provided out of area. Breastfeeding clinics are commissioned by Kent County Council and any queries and concerns about the future plans for breastfeeding services should be directed to KCC. You can find out more about their services on their website: https://www.kent.gov.uk/social-care-and-health/health/breastfeeding
Q9: Speech and language services are only offered in Swale on a Tuesday afternoon. Can this be expanded to provide enough of a service?
A: Our clinics are planned to meet the requirement of existing and anticipated caseloads and the provider of speech and language services has not made the CCG aware of any additional need. However, we are working with the provider to determine if there have been any changes to provision. Should demand increase we will work with the provider to develop additional capacity if required.
Q10: Are there opportunities for breastfeeding organisation PSB CIC, to engage and come on to the provider list so that they can be a point of referral for GPs etc?
A: Kent County Council commissions breastfeeding services and any queries regarding these services should be directed to KCC.
Q11: The GB papers were difficult to find on the website for the last meeting. Can this be resolved for future meetings?
A: We aim to publish the papers for our Governing Body meetings in public on our website a week before the meeting. We’d like to apologise if the papers could not be found. Here is a link to the place they are located: https://www.swaleccg.nhs.uk/about-swale-ccg/meetings/governing-body-meeting-papers/.
Q12: Two GP surgeries on Sheppey have told a working patient in their 50s that although they are in need of knee replacements, they are not entitled to this until they retire. This does not seem to make sense. Can we clarify that there is no such stipulation.
A: Joint replacement operations are performed in the vast majority of cases for pain which originates from the joint, limits the patients’ ability to perform normal daily activities, disturbs sleep and does not respond to non-surgical measures, most commonly due to osteoarthritis. Patients should be referred for consideration of total joint replacement when all conservative means have failed to alleviate the patient’s pain and disability, which should be significantly interfering with their activities of daily living and their ability to sleep.
Referral for specialist assessment should only be considered if the patient has:
- Moderate to severe pain not adequately relieved by an extended course of non-surgical treatment (such as adequate doses of analgesia, weight control and physical therapies), and
- clinically significant functional limitation resulting in diminished quality of life, and
- radiographic evidence of joint damage
Our referral policy, which GPs are aware of, states that the condition should be managed through painkillers, anti-inflammatories, exercise and physiotherapy where appropriate. Also advice can be given on walking aids, home adaptations, curtailment of inappropriate activities and general counselling on the potential risks and benefits of joint replacement surgery.
Underlying medical conditions should have been investigated before referral.
Q13: Many GPs do not offer Choose and Book. But some GPs are making too many referrals to London at great and unnecessary expense to the CCG, only to find local hospitals have to pick up problems later when the patient comes back home. What more can be done to make sure GPs offer Choose and Book but also do not ‘over’ refer to London.
A: We are working with GPs to ensure a consistent approach to offering Choose and Book (which is now known as E-Referral) and also London referrals.
Q14: It is understood that Ruby Ward at Medway Hospital, which was previously kept open after the closure of the A-Bloc in order to serve dementia patients, is now supporting psychotic patients. This seems a change from the original intentions and could be a problem for patients if the proper systems are not in place. Can this be checked?
A: Ruby Ward continues to treat older adult patients with organic and/or functional conditions (including psychosis). The ward is not, and has not ever been, a dementia-only ward.
September 2017 Listening Post
Questions and answers
Community infant feeding support
Q: A resident raised a query about the peer support breastfeeding contract, stating that it is due to change and identifying that midwives will provide support in the first two weeks and health visitors will provide support after that. This means that there may be no specialist breastfeeding service for the first two weeks. It was asked whether tongue-tie services will eventually be accessible locally. The enquirer stated that currently the service is only accessible via King’s College Hospital and is only offered to babies that are breastfed. Babies that have tongue-tie and are not able to breastfeed and have had to be bottle-fed may lose entitlement to access services at King’s College Hospital as there is no pathway for bottle-fed babies.
A: The CCG confirmed that KCC is responsible for leading Public Health in Kent, and is the lead commissioner for breastfeeding services. The CCG understands that KCC is reviewing the current pathway before proceeding to consultation and it was advised that queries are raised to KCC directly to ensure that these valuable insights and views are considered as part of this consultation. The KCC direct web link was provided to enable this feedback to be recorded: https://consultations.kent.gov.uk/consult.ti/InfantFeeding/consultationHome
Health and Wellbeing for the Elderly
Q: Overall funding issues for the NHS and the Community Mental Health and Wellbeing Services tender were raised and it was asked if a mental health and wellbeing practitioner for older people would be funded and placed at one of the future urgent treatment centres.
A: Consultations that are run by Kent County Council (KCC) are shared with the CCG for comments. There is no direct link for a Health and Wellbeing service to be provided in the future Urgent Treatment Centres, but there may be public health, mental health, addiction and mental health and wellbeing services implemented in the centres in future. The CCG also has responsibility for frail patients needing to access urgent and emergency care. As part of the proposed local care model, a care navigator 24-hour helpline will aim to come together in 2019. NHS 111 now has pathways now for under 5s and over 75s to go direct to clinicians. Details of the next urgent care engagement event were shared.
Q: The transport support at home package across Kent was referenced, it was raised that some service users have experienced difficulty accessing transport and there was a concern about the eligibility criteria that may restrict access to those who are not terminally-ill.
A: The CCG confirmed that there are clear access criteria for transport and it is for planned care and not just cancer care. Full details around the transport eligibility criteria and alternative options were provided: http://www.km-pts.co.uk/
Q: It was asked whether the CCG ever compares statistics with Bexley as recommended by Diabetes UK and whether the CCG has data to compare
A: The CCG does take part in the National Diabetes Audit and were one of the best performing areas in the country this year. 100% of practices in the Dartford, Gravesham and Swanley area completed the audit and were the first in the country to achieve this. The completion of this audit will result in the CCG and local GPs being able to identify needs and supports early diagnosis of diabetes.
The CCG has not previously compared itself to other CCGs but, now we have good data, we will be using this to do the comparisons to other local and national CCGs.
Q: A local resident asked why the CCG is not running X-pert diabetes courses for type 1 and 2
A: In terms of diabetes courses, the CCG commissions two gold standard, NICE accredited structured education courses. These are DAFNE (Dose Adjustment for Normal Eating) for Type 1 and DESMOND (Diabetes Education and Self-Management for Ongoing and Newly Diagnosed) for Type 2. At the beginning of the year, we were successful in a bid for National Transformation Funding in conjunction with CCGs across Kent and Medway. The funding will be used to increase attendance at such courses and to enable patients to choose from a menu of options which will include the X-Pert programme.
New flu vaccine
Q: A question about how well will we combat the new flu strain was raised and whether this is being promoted.
A: Yes, this has been talked about at the Governing Body and all GPs will be made aware. There will be a communication campaign for healthcare professionals and public to promote and prompt getting vaccinated. There is a national flu campaign led by Public Health England via local authorities including Kent County Council. The CCG is supporting and promoting key messages to local stakeholders including staff, GP members and to the public via a number of communications channels.
November 2017 Listening Post
Q: What work has been carried out in relation to children and mental health as their GP practice is keen to engage with younger people about mental health?
A: The CCG shared the annual report summary which details the work that has been carried out with young people on the good mental health matters campaign.
A presentation was shared following the meeting along with a link to the Kent Local Transformation Plan for Children, Young People and Young Adults’ Emotional Wellbeing and Mental Health and information about the Mind and Body programme, the Good Mental Health Matters campaign and resource, and work on suicide prevention.
A listening post attendee expressed an interest in starting a parent support group for those who have children with mental health issues and hopes to invite key speakers.
The CCG provided the above information along with contact details for the ADHD support group that gives talks to parents, along with contacts for We Are Beams (previously known as the Parents’ Consortium) and North West Kent Council Voluntary Services. The deputy chair of the CCG (a local GP), provided information about the Parents’ Support Alliance.
Out-of-hospital care and care closer to home
Q: What are the bed capacity figures locally at the moment
A: Director of Commissioning and Performance, explained that figures vary but that around 27 per cent of acute beds that have patients in them that no longer benefit from being in a hospital bed. It is a significant issue and every three days in a hospital bed can be counter-productive and compromise 10 per cent effectiveness to recovery. The plan is to address the 27 per cent that can be cared for in a better place for their needs. There are no plans to increase hospital beds at the moment and the challenge for the CCG is to have more services out of hospital.
Engaging with the public about local health services
Q: An attendee introduced the service which utilises media to feed information communities online and requested information on how the CCG engages with the communities and the representative asked about local engagement projects the CCG has undertaken.
A: We have a Communications and Engagement Strategy and we also work closely with PPGs to use as a two way forum for best practice to formal consultations. The CCG engages in many ways and this includes face-to-face meetings at CCG roadshows, online surveys, listening posts, planned events, via social media (Twitter/Facebook) and through our Health Network and list of stakeholders which includes voluntary and community organisations. The group were sent links to join NHS Dartford, Gravesham and Swanley and NHS Swale CCGs Health Networks and other links to the other Kent clinical commissioning groups.