1. Annual General Meeting
27 September 2018

2. Welcome and panel introductions
Dr Andrew Murray, Chair of NHS Merton CCG

3. Housekeeping

4. Agenda 2.05 – 2.15pm Review of the year 2017/18
James Blythe, Managing Director, NHS Merton CCG Sarah Blow, Accountable Officer, NHS Merton CCG, NHS South West London Alliance
Making a difference to patients
2.15pm – 2.20pm Social prescribing pilot extended
Dr Mohan Sekeram, GP lead for social prescribing
2.20pm – 2.25pm Improving access to GPs
Dr Andrew Murray
2.25pm – 2.30pm Care home pilot
2.30pm – 2.40pm Finance Report
Neil McDowell, Finance Director, NHS Merton CCG
2.40pm – 2.45pm Looking Forward
James Blythe, Managing Director, NHS Wandsworth CCG
2.45pm – 3pm Questions and closing remarks

5. Review of the year 2017/18
James Blythe – Managing Director Sarah Blow - Accountable Officer

6. What we set out to do

7. Challenges
Working with St George’s hospital to reduce waiting times (referral to treatment within 18 weeks)
St George’s University Hospitals NHS Foundation Trust took the decision to suspend referral to treatment reporting in June 2016 due to significant concerns over the quality of data.
An extensive programme of waiting list validation has taken place since then. In February 2018, the trust introduced a new patient pathway management system and is working towards the standards required to return to formal reporting.
We commissioned additional capacity for two of the most challenged specialties to treat long-waiting patients. Significant progress has been made and we continue to monitor closely. We also supported the introduction of a system to highlight services with limited capacity and suggest alternative providers with shorter waiting times.

8. Challenges
Primary care mental health services (IAPT): working to increase referrals and access to services
We are working to make it easier for people to access talking therapies across Merton. We recently launched a service offering one-to-one online appointments with a therapist – including evenings and weekends.
Continuing Healthcare: working with new provider to clear backlog
We changed the provider of this service and brought in simplified assessment and decision-making processes that ensure people receive funded care where eligible and more regular reviews of their needs

9. How we performed Overall rating of “good” from NHS England
Strong performance:
- appropriate prescribing of antibiotics in primary care
- provision of high quality care for adult social care
- more people benefiting from bookable GP appointments (8am-8pm, 7 days a week)

10. How we performed

11. How we have been transforming care
In 2017/18 we:
Moved to electronic, rather than paper based, referrals, helping patients make informed choices and speed up access to care
Completed the implementation of two 8 to 8 GP access hubs
Implemented care co-ordination for people with complex needs, linking GPs, community services and social care
Introduced new joint evaluation and discharge management pathways with social care colleagues to ensure patients secured the help they needed to leave hospital in a timely way
Piloted, evaluated and extended our social prescribing approach, linking GP services to community based wellbeing support

12. South West London Health and Care Partnership
NHS, local councils and the voluntary sector in south west London strengthening our commitment to work together to deliver better care for local people
In November 2017, we published The South West London Health and Care Partnership: One year on for discussion Commitment to champion children and young people’s mental health and wellbeing Developing Merton’s Health and Care Plan to be published in March 2019 We will be hosting a Merton Health and Care Event in November 2018

13. South West London CCGs
Committees in Common agreeing collective decisions including funding for the transformation of primary care for 2018/19
£4.58 million NHS England funding for this implementation providing 18,000 extra appointments each month
Cancer care to improve cancer care for local people by focusing on:
 Early and timely diagnosis and treatment
 Improving uptake of bowel screening
 Increasing screening uptake for people with learning disabilities
Collective approach to staying well this winter to increase flu vaccine uptake and reduce pressure on A&E across south west London as a whole

14. Future plans Continued focus on integrating health and social care
Improving mental health support
Improving access for children and young people to mental health services
Work with providers to transform outpatient hospital services
Support access to extended GP services
Working more closely with Merton CCG and other south west London CCGs
Focus on clinical quality routine monitoring for all services we commission

15. Making a difference to patients
… through social prescribing
Dr Mohan Sekeram – GP lead

17. Social prescribing pilot extended
‘Social prescribing addresses people’s physical and mental wellbeing and has been shown to both improve patients’ quality of life and reduce pressure on other NHS services.’

18. Social prescribing pilot extended
Last year results:
Average increase in overall wellbeing score of 0.7
Average number of GP appointments reduced from 11.9 to 8.
Average number of A&E appointments reduced from 1.4 to 0.7.
This year:
Focus is on ‘upscale’- challenge ( two practices to 13)
All East Merton practices ( 9)
Four West Merton practices
Referrals from primary care
Now access through Improving Access to Psychological Therapies (55% referrals in pilot)
Looking at Connect Physio / Case management / London Fire and Safe

19. Social prescribing pilot extended
Evaluation
Qualitative – Healthy dialogues ( + Med3 )
Quantitative –Secondary care data
HLP video – eight short films ( flagship for London)
Future
Link with voluntary sector and local authority
Support the voluntary sector so resources cope with demand
Digital platform.

20. Making a difference to patients
… through improving access to GPs and care home pilot
Dr Andrew Murray

21. Improving access to GPs
At the start of the year we announced that we are funding up to 50,000 more GP appointments across Merton with the help of significant extra funding secured from NHS England
Across all practices more appointments are available: 
during normal surgery hours of 8am to 6.30pm Monday to Friday and
during extended hours up until 8pm Monday to Friday
on Saturday mornings 
We have also put in place two new GP hubs which provide extra appointments in the evenings, at weekends and bank holidays. 
The hubs are located at the Wide Way Medical Centre in East Merton and The Nelson Health Centre.

22. Care home pilot
A six month pilot delivered enhanced primary care input in two nursing homes in Merton (Eltandia and Fieldway).
The goal was to provide more coordinated, proactive care for the residents, the majority of whom have complex health needs and are living with severe frailty.
At its core was improved integration of the workforce and a focus on personalisation of care.
Positive feedback was received from professionals and residents/ their next of kin.
Across the two care homes there was a 28% reduction in London Ambulance Service conveyances during the pilot period compared to the equivalent 6-month period from the previous year.
Drawing upon the learning from the pilot, work is now underway to develop a model across all care homes in Merton.

23. Finance report
Neil McDowell, Finance Director

24. How we were funded in 2017/18
Funding given based on our weighted population of 196,000 (calculated by NHS England)
Number of people actually registered with a GP closer
to 224,000
Allocated £282.7 million (including funding for primary care delegated commissioning)
This is equivalent to £1,262 per person
We ended the year in a break-even position, i.e. we spent all of the £282.7m allocation.

25. Our financial targets
Maintain financial stability Fair and effective use of resources Investment made in mental health in line with our growth allocation Stay within running costs of £20 per head of population

26. How we spent the money

27. Looking ahead
James Blythe, Managing Director

28. Merton Health and Care Together
There are opportunities for improving local healthcare services by greater collaboration between organisations involved in planning and delivering care
As a result Merton Health and Care Together has been established. This programme involves Merton CCG, Merton Council, Merton Voluntary Services Council and the main health and social care providers in the borough.
Patients and stakeholders are seen by a range of primary care, mental health, community, hospital, social care and wellbeing services. People tell us that different services need to work more closely together to deliver better outcomes and experience for patients.
Merton Health and Care Together is about providing integrated, responsive, personalised services that help people to stay well and independent for longer.
It will form the basis of our Local Health and Care Plan – overseen by the Merton Health and Wellbeing Board. These plans will provide clear and detailed actions to address local challenges and will be published in 2018.

29. Merton Health and Care Together

30. The Wilson Health and Wellbeing Campus
Services at the Wilson will include:
Wellbeing services to help people stay healthy and well – social prescribing
Bookable GP appointments from 8am – 8pm, seven days a week
Adult mental health services
Children’s development centre
Community café
X-ray and other diagnostics
Physiotherapy and podiatry
Subject to planning, building work will commence in late 2019 with opening in 2022

31. Improving Healthcare Together 2020-2030

32. Closing remarks and questions
Dr Andrew Murray