Substance Misuse and Alcohol Current Service Westminster Drug Project as a lead provider with St Mungos and CNWL as partners Shared care model for GP practices. GPwSI to be appointed on one year pilot. Service due for (mandatory) retender following extension on a 1+1 basis. Issue for Primary Care Recent GP survey – showed GPs wanting help with treating patients with complex needs, more training and better communication with Hackney Recovery Service – how do GPs want to be involved in the service design and commissioning? Alcohol identification and brief advice and Audit C – do GPs feel engaged in this, can we do better in the early intervention? Key group with high rates of substance misuse – offenders, homeless, those with mental illness – how can we work differently/in a more joined up way?

Sexual health Recent/current commissioning GUM services: clinics at Clifden, Ivy, John Scott and new clinic at 80 Leadenhall New sexual health e-service (www.shl.uk) - order tests online, self-sample at home, get results in 3 days GPs - continue and extend existing sexual health services (Confed) Issues: Access to GPs for contraception (covered by GMS; contraception an additional service, but all GPs are opted in) Not currently a focus for CCG contract management Needs consistency between practices and across the system (e.g. OHC script length) Potential to create further efficiencies (e.g. through technology) System fragmentation Question of “who pays?” is leading to some services and pathways being unfunded Is this something that integrated commissioning can address? (Sexual health and gynae are in separate workstreams; HIV commissioning is partially outside the local system)

Long Term Conditions What else should be improved for better outcomes? Congratulations on achieving the LTC contract targets for 2017/8. The targets for 2018/9 have been nearly agreed with the GP Confederation; Heart Failure coding, minor shifts only. Hepatitis B dropped. Hypertension prevalence: Outcomes still worse for black ethnicities and prevalence low against modelling. This year check BP for 30-40 year olds, next year possibly individual practice prevalence target, based on new Public Health practice profile? Work on Atrial Fibrillation. Spirometry: New training requirements coming, bid for training money and consider a hub model, prevalence targets for COPD and asthma. Diabetes: Pilot for DIRECT trial implementation, Outpatient Transformation Programme, Amputation audit to report. Group consultations What else should be improved for better outcomes?

Make Every Contact Count Smoking, Alcohol, Exercise, Diet, 5 to Thrive. Part of all NHS contracts, culture shift for all staff Bid for training Publicity on resources.   Ideas for how to make this effective? What else should be improved for better outcomes?