Covid-19: QPARA Community Support Network
QPARA has made arrangements to make sure that vulnerable people, those self-isolating and those with symptoms of Covid-19 get the support they need with shopping for necessities etc. during the crisis. These arrangements are to fill in any gaps not met by the local and street level initiatives which have sprung up across the area.
We distributed a flyer to all households in the area in March offering help via street based Zone Reps and have provided them with the following updates by email:
QPARA Health Action Group
QPARA’s Health Action Group monitors local health issues.
QPARA is affiliated to Brent Patient Voice (BPV), an entirely independent volunteer body, who aim to hold the Clinical Commissioning Group and providers to account, and hold public meetings with expert speakers on current NHS topics.
BPG’s chair at March 2019 is Robin Sharp, who leads QPARA’s Health Action Group.
Robin has written a clear explanation of how the NHS operates in Brent for QPARA.
The NHS in Brent in 2019
99% of patients don’t care how the health service is run. They just want an appointment with their GP if they feel unwell or good hospital treatment if their condition can’t be dealt with by their GP.
However when, as now, funds are tight it does matter where they go to, what facilities are closed or opened and if new initiatives actually work.
Setting the scene
After a huge amount of Parliamentary fuss the Health and Social Care Act 2012 (the “Lansley” reforms) set the NHS landscape in statute, though not in stone. Ever since 2014 the NHS England leadership under Simon Stevens has been trying to “work around” the legislation to impose another more centralized pattern. But the basic law has not changed.
The NHS is divided into two types of organization: the commissioners and the providers, that is those who lay down the rules and control the money and those who provide frontline medical treatment. There are also trainers and regulators, while local government is responsible for public health and adult social care.
Giving the orders: the Commissioners
Locally It is now nearly 6 years since the NHS Brent Clinical Commissioning Group (CCG) came into being. The CCG pays for routine hospital treatment and community healthcare provision, including GPs. This leaves hospital specialist services such as cancer care to be paid for centrally by NHS England – but they also decide on the overall total for Brent CCG to distribute.
The CCG comprises the 56 GP Practices in Brent and since September 2018 is chaired by Dr MC Patel, a Wembley GP, with Sheik Auladin as Managing Director. A Governing Body (GB), which meets mostly in public and has a majority of GPs on it, directs the affairs of the CCG. The Chair and others respond to questions from the public submitted in advance for 30 minutes before each GB session.
The CCG engages with the public mainly through its Health Partners Forum. This meets three times a year and has quick fire presentations and table discussions on current CCG initiatives.
Since December 2018 the Brent CCG has delegated upwards important decision-making and budgetary functions, e.g. for acute care, to the North-West London Collaboration of CCGs covering 8 boroughs in the north-west of the capital. This “half-merger” aligns with the long-standing controversial plan, Shaping a Healthier Future, to reduce 9 acute hospitals to 5 and with the more recent NHS-imposed Sustainability and Transformation Plan (STP) designed to save money and promote more central control.
Caring for patients: the Providers
The front line of healthcare providers consists of the 56 GP practices already mentioned. In Brent over 380,000 people are registered with these practices (more than the estimated population!) and there are around 2,300 patients for each full-time equivalent doctor, as compared with a London average of 1,600. No wonder getting an appointment can be hard.
Most GP practices have full- or part-time nurses, some with special expertise, as well as access to pharmacists, phlebotomists and the like. There are also a variety of clinics, mainly at the Willesden and Wembley Health Centres, provided either by NHS hospital trusts or by private healthcare providers who have contracts from the CCG. What the GPs do, along with these clinics, is known in the NHS as “Primary Care”.Most practices engage with their patients through PPGs – Patient Participation Groups, normally chaired by a patient.
Last but definitely not least are the hospitals. They provide acute care, as commissioned by the Brent or other CCGs, and spend the lion’s share of the NHS money. This is known as “Secondary Care”. All acute hospitals are now grouped together into “Trusts” as medical, financial and administrative units. Thus most patients from the Queen’s Park area who need emergency or planned admission to a hospital go to the Imperial College Healthcare Trust whose nationally known hospitals are St Mary’s Paddington, Charing Cross, Western Eye and The Hammersmith. The majority of Brent patients needing hospital care go to Northwick Park, which is the main site of the London North West University Healthcare Trust. Some others go to the Royal Free.
What is actually going on
First we need to be aware that under the NHS and in London we receive some of the best and most efficiently provided healthcare in the world. Even if the staff are reasonably paid they mainly work under too much pressure, not helped by significant shortages.
In spite of encouragement of healthier lifestyles and fitness manias, more people than ever want GP appointments and end up at or in hospitals. The money provided won’t quite pay for this. Hospitals have some key targets such as that all but 5% of people with severe emergencies should be sent home safely, or given a bed, within 4 hours. For around 2 years now both Imperial and London NW Trusts have been missing this key target by miles: generally 25% of patients in major A&E facilities are waiting for more than 4 hours. Most of the remaining critical targets are being missed to a greater or lesser extent. The knottiest problem is returning people who have completed treatment but need care packages, to their homes or elsewhere in order to free up beds for new patients.
The broad response of the NHS nationally to these pressures is to try to shift more care from the Secondary, hospital sector, to Primary Care. This was the message of the first national plan produced by Simon Stevens, called the 5 Year Forward View. Now boosted by the £20.5 billion extra wrenched by the Prime Minister from a reluctant Treasury last summer we have the NHS Long Term Plan which is supposedly agreed for five of the next 10 years, starting in 202 – if you follow that.
Under this plan the “away from hospitals” mantra is flagged as the Primary Care Network initiative, which is already being promoted by the CCG in Brent. If it takes off it will affect the way our GP practices deliver care to patients locally. Groups of practices are being created in order to share specialist support staff such as nurse practitioners, phlebotomists, pharmacists and perhaps yet another “p”, physiotherapists. Details as to how these will be allocated and accessed are still scanty – but it seems to be the shape of things to come.
Altogether more obscure and more risky is the other big organizational brainchild of the NHS chief. Currently renamed as the “Integrated Care System” (ICS), it is an elaborate contractual web bringing together Secondary and Primary Care providers, to address a specific slice of the patient population in an area covered by an STP. In theory dissolving the boundaries between the silos in which hospitals and GPs work is a great idea (practised in the US on a fairly small scale and at around twice the cost of healthcare provision in the UK). However the concept is untested in the different environment of the UK and there is the risk that if one of the various partners in an ICS fails to deliver the resulting litigation will benefit not patients but lawyers. ICS has not yet come to NW London.
Commentators and campaigners are not convinced that any of these new ideas are reducing, or are likely to reduce, the continually increasing demand for hospital care, even if extra posts for groups of GP practices will be welcome when and if delivered.
A public voice on what the NHS is doing
In Brent the CCG-run Health Partners Forum, already mentioned, is one opportunity for members of the public to say what they think.
HealthWatch Brent is a government-funded consumer voice on health and social care issues. It has a budget of around £150,000 pa and employs staff who sit on some CCG boards and committees and interact with the public via surveys etc.
Entirely independent is the volunteer body, Brent Patient Voice, who aim to hold the CCG and providers to account, and hold public meetings with expert speakers on current NHS topics – see www.bpv.org.uk.
Many from the QPARA area are patients at the Lonsdale Medical Centre, where a newly refreshed PPG is chaired by Deborah Unger, also of QPARA. Contact firstname.lastname@example.org, you would like to get involved.
Clinical Commissioning two years on
It is now two years since the NHS Brent Clinical Commissioning Group (CCG) came into being. The CCG allocates about two-thirds of the NHS budget in Brent for routine hospital treatment and community healthcare provision. The rest comes from NHS England who commission GPs and hospital specialist services such as cancer care.
The CCG is comprised of the 67 GP Practices in Brent and is chaired by Dr Ethie Kong, a Harlesden GP, with Sarah Mansuralli as the Acting Chief Operating Officer. A Governing Body which meets mostly in public and has a majority of GPs on it directs the affairs of the CCG.
Two notable features of the new CCG were to have doctors in charge and to involve patients much more closely in governance through an Equality, Diversity and Engagement (EDEN) Committee. The EDEN Committee included 8 community representatives and 5 elected chairs of Locality Patient Participation Groups (PPGs). For governance purposes Brent CCG has been divided into 5 Localities, which are meant to include the GP practices within a recognised geographical area, though this concept has already been significantly eroded.
In Queen’s Park we are in the Kilburn Locality. The Kilburn PPG, chaired by Robin Sharp and with technical support from the CCG, has met bi-monthly with an attendance averaging around 20 people. There have been informative presentations both from CCG and Hospital Trust clinicians and administrators on unfolding plans. These have been met with probing and reasoned challenges from members. Several QPARA members take part. QPARA people have also been active in helping to revive the Practice PPG at Lonsdale Medical Centre.
How far have the new structures worked? As far as having GPs in charge is concerned the jury is still out. A major problem is that pressures on GPs are huge, so even where they have allocated time for CCG governance they are finding it hard to master the committee work and associated papers.
Sadly the initial enthusiasm of the CCG for involving patients has seemingly disappeared. The EDEN Committee has been abolished and there is now no commitment in the revised constitution to supporting the Locality PPGs, though in practice some help may still be extended.
In response to these moves leaders of the Locality PPGs and others have formed a new independent body to bring together the separate Locality and Practice PPGs and other patient groups and individuals to speak to the CCG, the hospitals, Brent and the GPs on behalf of patients. We are called Brent Patient Voice (BPV). For news and information about what we are up to please go to www.bpv.org.uk .
BPV members have played an active role in giving evidence to the Mansfield Commission set up by four local authorities including Brent to scrutinise the implementation of Shaping a Healthier Future, the NHS plan for re-organising hospital provision and community services in NW London. This has included the controversial closure of the A&E Departments at Central Middlesex and Hammersmith Hospitals, which was followed by poor performance against waiting time targets by Northwick Park Hospital in particular.
For most of us healthcare means treatment by GPs and hospitals.
However, for the last twenty years, decisions on how to allocate
NHS funds have been taken by
Primary Care Trusts (PCTs) under a process known as commissioning. From 1st April, PCTs are out and GP-led area-based Clinical Commissioning Groups (CCGs) take over
In Brent the CCG is made up of the 67 GP practices in the borough. It is chaired by Dr Ethie Kong, a Harlesden GP, and has as full-time
Chief Operating Officer Jo Ohlson, an NHS administrator. Key decisions are delegated to a Governing Body, most of whose members are local doctors elected by their peers. The CCG is required to
consult and involve patients in planning services which it will do through Patient Participation Groups (PPGs), one for each of the five Brent localities.
In Queen’s Park we are in the Kilburn Locality. The PPG, of which I am currently chair, is open to any patient registered with a practice in Kilburn. We meet every two months, with some twenty people attending our March meeting. We are consulted on health priorities and implementation plans by the CCG.
Brent Council is also now responsible for public health. They partner the CCG in supporting a Health and Wellbeing Board.
The Council is also charged with setting up an independent watchdog known as Healthwatch.
Will we notice any difference? We should see a trend towards more services located in the Community rather than in major hospitals and there should be better communication and consultation. Look out
for the new HUB scheme under which extra appointments and doctor capacity will be located at a selected practice in the Kilburn area.
In a few years’ time we may begin to know if the new doctor-led and patient-involving NHS can deliver better care and better
health than its predecessors. I believe that it is possible if it can be much more open about success and failure.
This article by Robin appeared in the May 2013 QPARA newsletter.