Greenwich

Commissioning
Strategy
Transforming our health and
social care system 2018 to 2022
 Greenwich Commissioning Strategy Transforming our health and social care system 2018 to 2022

About Greenwich CCG Contents

NHS Greenwich Clinical Commissioning Group (CCG) is responsible for planning Foreword................................................................. page 4
and buying (commissioning) most of the health care services for people in the
Summary.................................................................. page 5
borough of Greenwich. This includes hospital services, GP practices, mental health
services and community care. We are also responsible for monitoring how well 1. About this strategy............................................. page 8
these services are provided. 2. What are the challenges?................................. page 10
Our mission is to secure the best possible health and We also have a new executive leadership team. A new 3. Our ambition for Greenwich............................ page 24
care services for the population that we serve, specifically Managing Director joined the CCG in September 2017,
in primary care settings and in hospitals as necessary. with responsibility for day-to-day leadership of the 4. Our four priority areas..................................... page 32
In doing this, we will work with patients and the wider organisation and to ensure that people in Greenwich
public to develop the services that we offer, reduce continue to receive high quality local health care. We 5. A financially sustainable system...................... page 42
health inequalities and improve health outcomes. appointed a new Chief Officer of the South East London
Commissioning Alliance, covering all six south east 6. From strategy to action.................................... page 44
We are a clinically-led organisation. Our Governing London CCGs, who is also the STP Lead for
Body is led by a Clinical Chair and comprised of GP Our Healthier South East London.
References............................................................. page 44
clinical commissioners elected by the CCG membership,
a secondary care doctor, a registered nurse, three More details about the organisation, our Governing Appendix 1 – Engagement report....................... page 46
lay members (representing the public interest), a Body, and the way we work are available at
representative of the local authority as well as executive [Link] Appendix 2 – Equality and
directors. The function of the Governing Body is to equity impact assessment form........................... page 47
ensure strong and effective leadership, management
and accountability.

General Practices 1. Abbey Wood Surgery 22. Greenwich Health GP Access Hub 43. Thamesmead Health Centre
45
and major health 2. All Saints Medical Centre 23. Greenwich Health GP Access Hub 44. Thamesmead Medical Associates
44
service locations 3. Bannockburn Surgery 24. Greenwich Peninsula Practice (Gallions Reach Branch)
22
in Greenwich 43 4. Basildon Road Surgery 25. Lewisham and Greenwich NHS Trust 45. Thamesmead Medical Associates
1
(Queen Elizabeth Hospital) (Gallions Reach)
24 52 38 5. Blackheath Standard
26. Manor Brook 46. The Hill Surgery – Coldharbour Hill
10 12 6. Briset Corner Surgery
20
50 27 29 Branch
3 4 7. Burney Street 27. Market Street Health Centre (Oxleas)
54 19 47. The Hill Surgery – Primecare
35 28. Memorial Hospital
18 51 55 8. Burney Street – Wallace Centre (Eltham) Branch
49 58 Branch Surgery 29. Mostafa
42
8 2
41 48 30 48. The Trinity Medical Centre
7 59 25 34 9. Campus Surgery – Primecare 30. Mostafa (Branch)
21 49. The Wallace Centre
37
5
53
(Eltham) Surgery 31. New Eltham Medical Practice
GREENWICH 50. Triveni
10. Clover Health Centre 32. New Eltham Medical Practice (Branch)
33 51. Triveni (Branch)
26 28 11. Coldharbour Hill
56 33. Plumbridge Medical Centre
52. Valentine Health Partnership
12. Conway 34. Plumstead Health Centre (Branch)
13 (Ferryview)
LEWISHAM 57 13. Conway (Branch) 35. Plumstead Health Centre
39 53. Valentine Partnership
6 15 BEXLEY 14. Eltham Medical Practice 36. Primecare (Eltham) (Ferryview Branch)
40 17 15. Eltham Medical Practice (Branch) 37. Primecare (South Street) 54. Vanbrugh Group Practice
Key
14/16 32 16. Eltham Palace 38. Royal Arsenal Medical Centre 55. Waverley
Hospital
Community Hospital
23 17. Eltham Park Surgery 39. Sherard Road Medical Centre 56. Waverley (Branch)
GP Access Hub
9
18. Fairfield (Branch)
57. Westmount Surgery
General Practice 40. Sherard Road Medical Centre
19. Glyndon 58. Woodlands Surgery
General Practice Branch 41. St Marks
Health Centre 20. Glyndon (Branch) 59. Woodlands Surgery (Branch)
42. St Marks (Branch)
(Community Services) 31
21. Goldie Leigh Hospital
11
36

47 BROMLEY
2 NHS Greenwich Clinical Commissioning Group 46 [Link] 3
 Greenwich Commissioning Strategy Transforming our health and social care system 2018 to 2022

Foreword Summary
I am delighted to endorse the new Greenwich This commissioning strategy sets out bold ambitions for transforming health and care
Commissioning Strategy Transforming our Health services in Greenwich. Continuing without significant change is not an option. If we do
and Care System 2018 to 2022. nothing, we will need far more hospital beds to meet current demand, and this is neither
feasible nor sustainable. Instead, we want to focus on providing more services closer to
The launch of this strategy, along with our recent ‘Good’ rating from home and ease pressures on other parts of the system. Achieving this relies on effective
NHS England is a hugely positive milestone in our journey from not too
collaboration between primary, community-based and secondary care, as well as with
distant challenges including financial turnaround and special measures.
the Royal Borough of Greenwich and the voluntary sector. It means crossing provider
Creating this strategy has been a process of collaboration and engaging and sector boundary lines, to build effective local health and social care systems. Only by
with local people and partner organisations who have participated working as a system, across Greenwich and with our neighbouring boroughs, can we
in developing a comprehensive, integrated commissioning strategy
achieve real health, quality and efficiency gains for our population.
for Greenwich.
This strategy makes frequent mention of integrated care how services are organised and delivered’. It is this
This is part of a longer journey for health and social care locally,
pathways and systems. According to NHS England, ‘for objective that underpins our strategy1. Achieving it means
and across south east London. The test will be putting this strategy health, care and support to be ‘integrated’, it must be investing in primary and community care, including in the
into action, and the CCG has already made sound plans to do that person-centred, coordinated, and tailored to the needs primary care workforce and infrastructure. We have already
in our commissioning intentions for 2019/20. and preferences of the individual, their carers and family. begun this journey and we have the building blocks needed
It means moving away from episodic care to a more holistic to continue it over the next three years, and beyond.
It is evident that everyone wants the best for local people and local approach to health, care and support needs, that puts the
services. We are working towards a shared purpose of health and needs and experience of people at the centre of
wellbeing for Greenwich people, with high quality, effective and
Strategy at a glance – health and care services in Greenwich
sustainable health services. This strategy provides the vision to
achieving our shared purpose.
Greenwich population
Dr Krishna Subbarayan Maximise prevention
Patients, carers and service users
Chair and self-care
• Live Well Greenwich

Increasing levels of need

Primary care • Community cohesion
GPs, pharmacies, dentists,
optometrists, Live Well Greenwich Strengthen community-
based care
Community-based care • Resilience
(Oxleas), children and adult • Support for marginalised /
social care (disabilities, mental health, vulnerable people
older people, residential, rehab)
• Integration of services
(e.g. children’s centres)
Acute care
(Lewisham and Greenwich
Hospital Trust), adult High quality acute services
mental health and child and when really required
adolescent mental health • Working across south east
(Oxleas), specialised care London on care models
and productivity

1
[Link]/ourwork/part-rel/transformation-fund/
4 NHS Greenwich Clinical Commissioning Group [Link] 5
 Greenwich Commissioning Strategy Transforming our health and social care system 2018 to 2022

Our plan on a page

Our High levels of High prevalence of Fragmentation of Cancer is one of
challenges deprivation, inequality mental health issues planned care. GP the main causes of
and unemployment and learning disability workforce shortages premature death and
– mental health the and estate not fit for living with ill-health
biggest cause of poor purpose. Financial
health in Greenwich challenge across the
and gaps in service system – savings of more
provision than £14m needed

Our • To prevent ill-health and increase health and wellbeing, intervene early to avoid hospital admissions,
plans for and to streamline service provision
transformation • To develop an integrated care system for Greenwich, in collaboration with social care,
public health, providers and community and voluntary sector organisations
• To provide the wrap-around health and social care needed by people living with a physical and
mental health condition
• To invest in a wide range of primary care services, working at scale, across four Local Care
Networks, which are responsive to local people
• To engineer shifts away from expensive hospital services to primary and community-based care closer
to home. A frailty care pathway, better end of life care, integrated care hubs, and the highest quality
urgent care should all help in reducing unnecessary hospital attendances

Our four To prevent illness To strengthen To better meet the To improve the
priorities and help our population local support for people needs of frail older prevention, detection
for the next to live well with mental illness, people with care and treatment of
three years including children and closer to home, an cancers for our
young people integrated urgent care local population
system, and stronger
community-based care

The impact • Children get the best • We see better mental • Frail people receive • Uptake of screening
of our plans possible start in life health and wellbeing safe, high quality for cancers
by 2022 • Improvement in for both children interventions in the • Improvements in the
life expectancy, and adults community factors associated with
particularly for women • Decrease in A&E • Fewer hospital an increased cancer
• Reduction in alcohol attendances for attendances and risk (e.g. smoking,
consumption and mental health issues admissions for frail alcohol, diet)
smoking • Reduction in out of people • Increased public
• Increase in children area treatments • Hospital interventions awareness of cancer
and adults who are a • Services are joined up only when necessary symptoms and
healthy weight and well-coordinated and for the shortest the need for early
periods diagnosis
• Better mental health • Unnecessary
and wellbeing, and hospital admissions • Greenwich population • Consistent access
early identification of and inappropriate benefits from to high quality care,
children’s educational discharges fall enhanced community timely diagnosis and
and communication provision and treatments
• Fewer people with
needs improved access • Increase in cancer
learning disabilities
• More people nearing survival rates from
• Reduction in diabetes in the justice system
the end of life can  one to five years
and other long-term
die at home or in
conditions • Improved patient
the community with
experience scores 
multidisciplinary
support

6 NHS Greenwich Clinical Commissioning Group [Link] 7

 Greenwich Commissioning Strategy Transforming our health and social care system 2018 to 2022

1. About this strategy

Our role is to use NHS funds to meet the needs of the people living in Greenwich Our strategy is also set in context of other strategic plans for Greenwich and south east London, including:

in the best possible way. This strategy sets out our plans for commissioning, in T
 ransforming Primary Care in London: H
 ealthy Greenwich, Healthy People. Places,
partnership with others, health and social care services for the next three years. A Strategic Commissioning Framework (2018) people and services: working together to
improve health and wellbeing in Royal

South East London: Sustainability and
Our objectives, agreed by the CCG Governing Body in January 2018, are: Greenwich (2015)
Transformation Plan (2016)
and, as part of this, P
 rovider plans – Lewisham and Greenwich
To commission safe, sustainable, efficient and affordable services to meet the health and NHS Trust, and Oxleas NHS Foundation Trust
Our Healthier South East London
wellbeing needs of the population of Greenwich and reduce health inequalities with an
additional focus on the urgent and emergency care system improvement along the pathway G
 reenwich Transformation Plan for Children V
 oluntary sector plans – METRO GAVS
and Young People’s Mental Health and Greenwich (‘How the voluntary sector
Wellbeing: 2015-2020 (2017) supports the health & social care sector
To ensure the CCG’s position recovers to meet its financial and governance duties
in Greenwich’)
and performance standards

To nurture and support primary care to be resilient and thrive

To strengthen productive relationships with partners and the public to work as a

Working in partnership
health and care system
The development of this strategy has been led by NHS Greenwich CCG, working
To actively engage with our communities to improve their experience of healthcare
in partnership with the Royal Borough of Greenwich. Our commitment to improving
health and wellbeing, reducing health inequalities, and ensuring everyone has equal
access to the health services they need, can only be achieved through close working
To play an active and influential role in shaping South East London (SEL)
and London-wide commissioning. with the council and its social care and public health functions.

These objectives are reflected in this commissioning strategy and This is a clinically-led, multi-partner strategy.
the four priority areas that we will focus upon over the next three Transformation across the system requires everyone to We will work to ensure that this strategy aligns with
years. We began consultation about these priorities in March 2018 work together. We work closely with our main NHS Lewisham’s approach, with a view to building resilience
with local GPs, our partners, patients and the public. Their feedback providers: Lewisham and Greenwich NHS Trust and Oxleas and driving transformation across the wider system.
is reflected in this strategy. NHS Foundation Trust (our main community and mental
health provider). We also commission primary care from We regularly engage with Healthwatch Greenwich and
In creating this strategy, we have been mindful of national other community groups, residents, patients and carers,
policy, and we recognise that we may have to adapt the a range of providers, including our 35 GP practices, and
work effectively with Greenwich Health GP federation. to make sure that patients are at the centre of our
strategy in light of long-term commitments set out in the commissioning decisions. Our partners in the voluntary
NHS 10 Year Plan. This strategy has been informed by We are working closely with Lewisham CCG to provide sector (represented by METRO GAVS) will continue to play
the following policy documents in particular: an integrated approach across our respective areas as a vital role in supporting delivery of our strategic aims.
part of the South East London Commissioning Alliance.

N
 HS Five Year Forward View Mental Health Five Year Forward View
(NHS England, 2014) (NHS England, 2016b)
Next Steps on the NHS Five Year Integrated Urgent Care Service Specification
Forward View (2017a) (NHS England, 2017b)
2018/19 planning guidance

The NHS Cancer Plan (NHS England, 2000)
G
 eneral Practice Forward View
A
 chieving World-Class Cancer Outcomes:
(NHS England, 2016a)
Taking the strategy forward (NHS England, 2016c)

8 NHS Greenwich Clinical Commissioning Group [Link] 9

 Greenwich Commissioning Strategy Transforming our health and social care system 2018 to 2022

Figure 1. The health of the Greenwich population

2. What are the challenges? Our population Deprivation

78th/326
To improve the health and social care outcomes for our local population we 291,194
must respond to changes in the population, our population’s health and the people were registered with a Greenwich GP Greenwich ranks 78th out of 326 local authorities of
the most deprived in England, our rank has improved
health system. Several of the challenges we face are common across England, Greenwich population by age since 2010
however we have challenges that are particular to Greenwich, such as high levels
of deprivation, inequalities and unemployment. 23%
Of our population live within the most deprived
2 in 10 under 16 7 in 10 16-64 1 in 10 over 65
areas nationally
2.1 The health needs of Greenwich Some people live in more densely populated areas
than others

Greenwich has a young and very diverse population. It is next biggest cause of preventable deaths in the borough. Population change
2747
estimated that there are just under 283,500 people living
in Greenwich, and almost 1 in 4 of our population are
The biggest burden on morbidity (poor health) is mental
ill health, followed by musculoskeletal health conditions
14,900
Is the estimated increase in population over the period
under 19 years (compared to 1 in 5 in England). With new such as back pain, arthritis and other joint conditions.
of this three year strategy …this in an increase of 5%
building in the borough and changes in the housing stock,
we expect there to be further growth in the numbers Our population is more diverse than England’s overall With the population of over 65s set to increase 7%
of families and young people living in Greenwich. Our population, with around 2 in 5 people from a Black over the next three years
population is likely to grow by nearly 15,000 people in and minority ethnic background (compared to 1 in 7
in England). The two biggest ethnic groups are black, 11325 As the number and proportion of older people
the next three years.
Asian Caribbean/African and South Asian/Chinese. More increase so does the need and service use.
Just over 1 in 10 of our population is over 65 years diversity is seen in our children, young people and Population density per sq km by ward, mid-2014 estimates
(compared to just under 1 in 6 for England), however this young adults, and over the next decade our older
proportion is set to increase over the next 10-15 years population will also become more ethnically diverse. White British 46%
Ethnicity
(Greenwich Public Health, 2018). The population of over White Irish 2%
Nearly a quarter (23%) of our population live within the Overall our area has a more diverse population
65s is set to increase by 7% over the next three years. Other White 11%
most deprived areas nationally. Overall, Greenwich ranks than England but similar to outer London
The growth in the number of older people will mean an White & Black
increase in the proportion of the population living with 78th out of 326 of the most deprived local authorities in 2 in 5 of our population are Black Caribbean/African Caribbean 2%
more complex conditions and health and social care England. We know that people living in deprivation are and South Asian/Chinese. More diversity is seen in White &
needs. The major causes of death in Greenwich are cancer more likely to suffer certain health conditions and require our children, young people and young adults Black African 1%
and cardiovascular diseases, especially heart attacks social care. There is a high prevalence of mental health Greenwich ethnic break-down based on 2018 White & Asian 1%
and strokes, although overall death rates from these issues and learning disability in Greenwich, which, if population projections Other Mixed 2%
conditions are improving. Respiratory diseases, including poorly managed, can impact on other health services. Source: GLA population projection profiles, 2016  Indian 3%
chronic obstructive pulmonary disease (COPD), are the Pakistani 1%
Over the next 10 years population increases Bangladeshi 1%
will be greater in our BAME groups Chinese 2%
Diversity varies between age groups with increasing Other Asian 6%
diversity in older age groups over the next decade Black African 15%
Black Caribbean 3%
Other Black 2%
Other Ethnic Group 2%

10 NHS Greenwich Clinical Commissioning Group [Link] 11

 Greenwich Commissioning Strategy Transforming our health and social care system 2018 to 2022

Our population’s health

Life expectancy Healthy life expectancy Avoidable deaths Lifestyle indicators
On average, women in Greenwich live 3.1 years more Healthy life expectancy is the average number of years we There is a strong
than men. The overall difference in life expectancy can expect to live in good health. Whilst men and women Greenwich has the 6th highest rate of
link between
between the most affluent and most deprived areas are living longer, there is a gap between how long we live years of life lost alcohol related hospital admissions in
is 4.6 years for females and 6.9 years for males. and how long we live in good health. Potential years and deprivation London (613 in every 100,000 people)
of life lost (PYLL)
Fewer than 1 in 5 (16.9%) of our adults
6000 smoke, 8.9% of mothers smoke at
79.3 years 82.4 years 60.7 years 58.5 years 5000 time of delivery
4000
3000
More than 3 in 5 (63.8%) of Greenwich
2000
The life expectancy gap between Years lived in poor health: adults are overweight or obese.
1000
most deprived and most affluent: 0
2006 2007 2008 2009 2010 2011 2012 2013 2014
Greenwich PYLL (Male) Greenwich PYLL (Female)
4.6 6.9 24.1 18.6 London PYLL (Male) London PYLL (Female)

years years years years

Potential years of life lost (PYLL) is a measure of the
Female Male Female Male
number of years of life lost by every 100,000 adults
aged 20 and over dying from conditions which are
usually treatable by healthcare. PYLL has decreased for
women and men with rates now lower than London.

26.8%
Of our 10-11 year old children are obese

Mortality Prevalence of disease

Cancer, cardiovascular disease GP reported numbers of people with long term conditions
and respiratory disease are the
leading causes of premature and 40,000
35,000
avoidable mortality.
30,000
25,000
20,000
15,000
Under 75 10,000
respiratory mortality
5,000
Under 75 respiratory
mortality (preventable) 0
Under 75
cancer mortality
Under 75 cancer Hypertension Coronary heart Stroke (all ages)
mortality (preventable)
Depression (18+) disease (all ages) Atrial fibrillation
Under 75 CVD mortality Cancer (all ages)
Diabetes (17+)  Mental health (all ages)
Under 75 CVD
mortality (preventable) Asthma (all ages) Chronic obstructive Heart failure (all ages)
0 20 40 60 80 100 120 140 160
Chronic kidney pulmonary disease Dementia (all ages)
per 100,000 (COPD) (all ages)
disease (18+)

There is a gap between the reported disease and estimated levels of disease,
in some cases this is considerable.

12 NHS Greenwich Clinical Commissioning Group [Link] 13

 Greenwich Commissioning Strategy Transforming our health and social care system 2018 to 2022

Figure 2, below, provides a summary of some of the are getting worse (such as life expectancy). It also shows The Director of Public Health for Greenwich reports that there • The impact of austerity on employment (particularly
main areas in which health is poorest in the borough improvements in outcomes where the impact affects small have been improvements over the last five years, notably for those with mental illness and those with disability)
and some of the associated factors (such as poverty and numbers of the population (such as late HIV diagnosis) educational attainment, particularly in early development, • The impact of austerity on housing, with more
obesity) when compared with England. It shows where versus impact on large numbers (for example, under 75s among more deprived children. The prevalence of smoking families living in temporary accommodation
improvements are being seen (for example, in early deaths deaths from cancer). within the borough has continued to decline (prevalence is
from cardiovascular diseases), as well as where outcomes now 16.9%), and there are fewer young people smoking We will work with the Royal Borough of Greenwich and
or drinking alcohol, more cases of HIV are diagnosed early, the Health and Wellbeing Board to address these and other
fewer cases of people dying prematurely from preventable challenges. We recognise we need to focus our energies on
Summary of status of key health outcomes cardiovascular disease, and improvements in life expectancy preventing ill-health and on early diagnosis of disease, and
that this means taking a holistic, system-based approach.
and their determinants in Greenwich for men in particular. The biggest challenges are:
This is core to our ambition for Greenwich for the next three
• Poorer healthy life expectancy, particularly
years (see priority one, page 32).
for women
Summary of status of key health indicators in Greenwich

2.2 The Greenwich health system

Improving

Male life expectancy

Killed & injured on England’s roads Diabetes prevalence

Under 75s mortality rate Children in poverty

Late diagnosis HIV The Greenwich health system BOX A: GPS SPREAD THINLY
from liver disease (persons)
is under pressure.
Under 75s death from cancer (all persons) Greenwich practices

Tuberculosis (TB) incidence GP workforce shortage

Under 75s death from
cardiovascular disease (persons)
Like many parts of the country, we have a shortage 15 GP practices
of qualified GPs. The impact of this is felt acutely
Population vaccination Branch surgeries
in Greenwich, as our GP population is dispersed
coverage – HPV* 35
(see Box A, right), which leads to a lack of resilience
Adult obesity and limits the primary care services we can offer.
Childhood obesity % people aged 16-64 in employment Greenwich Health GP federation2 is an integrated • 21 of our 35 practices have one or two partners
network of all 35 Greenwich GP practices and • B
 ranch surgeries – open for limited hours and
Under 18 conception rate Gap in life expectancy between has been working ‘to realise efficiencies and disperse GP resource
Greenwich and England (females) create synergies and economies of scale’. Levels
of collaborative working will need to increase RETIREMENT TIMEBOMB
Adult smoking rate Male healthy life expectancy
significantly however, to support delivery of
primary care services over the coming years Greenwich GPs
Suicide rates Population vaccination Female life expectancy and manage the workforce shortage.
112 40
Worsening

coverage – shingles
Infant mortality Female healthy life expectancy We intend to give greater attention to providing
primary care at scale, whilst making sure services are
responsive to local people. We also need to expand
Low Impact High the primary care workforce to provide a wider range 10
of care options for patients, and enable GPs to Aged <60yrs Aged >60yrs Aged >70yrs
focus attention on those with complex needs. Such
expansion also reflects changes in the way newer • O
 ne third of Greenwich’s 162 GPs are at
Worse than England Similar to England Better than England generations of GPs prefer to work, including a rise retirement age
in part-time working and more salaried doctors and
long-term locums. Section 3 sets out our aspirations right skills and experience is increasingly difficult
Figure 2. Health in Greenwich for the primary care workforce and for primary care across the country and this position is mirrored in
Source: NHS Greenwich [Link] at scale (page 28). NHS organisations across Greenwich. There are
significant shortages of clinical staff, most notably
Updated March 2018 from PHOF [Link] Workforce nurses, paramedics and some medical specialists.
Workforce is a top concern for the NHS, with staffing Demand for services, and in turn, demand for staff
*less than previous year’s England target
challenges now as pressing as the financial challenge. to deliver services, has grown more quickly than the
Recruitment and retention of enough staff with the pipeline of new staff. These pressures are having a

2
[Link]
14 NHS Greenwich Clinical Commissioning Group [Link] 15
 Greenwich Commissioning Strategy Transforming our health and social care system 2018 to 2022

direct impact on the ability of trusts and primary care in general practice have been found to be in short Estate Greenwich. The Board leads work across Greenwich to
to deliver safe and sustainable high-quality care. supply (Ipsos Mori, 2017). Greenwich has just 97 improve and protect mental health and wellbeing for the
We are part of The London Health and Care Estates Strategy
practice nurses (three of whom are advanced nurse population. People with lived experience of mental health
The NHS is not training enough healthcare developed by the London Estates Board (2018); it is the first
practitioners) and 28 healthcare support workers. problems are equal partners in the leadership of this
professionals to be self-sufficient, meaning that it London-wide estates strategy for health and care.
work, together with the statutory sector and community
relies on EU and other international staff to ensure NHS England’s Ten Point Action Plan for General
Much of the estate in Greenwich requires improvement to and voluntary groups. We will work with the Board to
safe staffing levels and will need to continue to do Practice Nursing seeks to help nurses and health
support our growing population. Taking primary care as transform pathways, including improving equity of access
so for the foreseeable future. Tougher language tests care support workers to demonstrate their
an example, many practices are small and branch surgeries to mental health services, providing care closer to home
introduced in 2016 for European Economic Area nurses contribution to reducing the gaps identified in the
are not always held in suitable premises. Two Community and supporting networks that people with mental health
registering to work in the UK have made recruitment Five Year Forward View (the health and wellbeing
Health Partnership buildings in the borough, Eltham problems already have. We will work with Oxleas NHS
and retention of overseas staff more difficult. Similarly gap, the care and quality gap, the funding and
Community Hospital and Garland Road Medical Centre, Foundation Trust and other local mental health providers
pay restraint up until 2018 and increasingly pressurised efficiency gap). It includes raising the profile of
are inefficiently utilised. The provision of community and to improve the range of services on offer to Greenwich
working conditions further adversely impact on general practice nursing, increasing the number
primary care estate does not align with the areas of high residents. Priority two details our plans to strengthen
recruitment and retention. of pre-registration placements in general practice,
deprivation, which undermines our ability to address local support for people of all ages with mental illness, but
establishing inductions and preceptorships, and
Providers locally have made sustained improvement health and social care inequalities. particularly for children and young people – see page 34.
improving access to ‘return to practice’ programmes
in tackling workforce challenges by reducing
(NHS England, 2017c). Working at scale could We are committed to making efficient use of our existing Planned care
agency spend, developing new and more staff (for
support Greenwich practices to offer initiatives, estate, to make positive investments in areas of deprivation,
example, development of the nursing associate Fragmentation and inconsistency in the planned care
such as preceptorships, and offer opportunities to and to incentivise services to locate to areas of greatest
role and furthering apprenticeship opportunities) system is a problem. Too often, local residents often
strengthen the nursing workforce. need. This may involve exploring how to integrate the 62
and strengthening links with local universities. The face lengthy waiting times for services. The Referral to
NHS in Greenwich in 2022 will be looking after Access to primary care community pharmacies in Greenwich with NHS 111, out Treatment (RTT) standard requires 92% of patients to
more patients and we are therefore going to need of hours and other urgent care provision. Our 2018 Estates be treated in 18 weeks from referral. Achieving this was
Access to primary care is the most common cause of
to continue to improve productivity and grow our Strategy aligns with this clinical commissioning strategy, particularly challenging in 2016/17 (NHS Greenwich CCG,
complaint, according to Healthwatch Greenwich,
frontline workforce, especially in priority areas of and supports transformational change, with more primary 2017a) and in 2017/18 (NHS Greenwich CCG, 2018).
including problems getting appointments,
nursing, mental health, urgent and primary care. and community care provided closer to home. Lewisham and Greenwich NHS Trust has not met the
information and communication issues. Its GP
Achieving this will require more training, with fast Access Report identified big differences in patient target, and we will continue to work closely with the trust
track options, more recruitment, better retention and Mental health provision
registration practice across the borough, with many to ensure that it is able to achieve the target next year.
greater return to practice after time out from the While mental ill-health is the biggest cause of poor During 2017/18, a small number of Greenwich patients
people experiencing problems in registering with a
workforce. Similarly, we will also need to ensure better health in Greenwich, we do not yet have a comprehensive waited more than 52 weeks for treatment, each month.
local practice (Healthwatch Greenwich, 2017a). This
job planning, e-rostering and a focus on staff health network of mental health support in the borough. Mental
became more problematic when the two walk-in
and wellbeing. It will also require greater flexibility as health and learning disability services have historically had Healthwatch Greenwich (2017b) has highlighted problems
centres in Greenwich were replaced by GP access
roles and places of work evolve in line with changes to a low profile, there is a lack of out of hours urgent and with discharge arrangements at Queen Elizabeth Hospital,
hubs in late 2016, which required patients to be
medicine and the shape of health care. crisis care for children and young people, including a lack including a high rate of readmissions, inappropriate use
registered with a Greenwich GP to be able to get
of Tier 4 inpatient beds. Greenwich has 70% more mental of the discharge lounge, inadequate information around
Taking primary care as an example, we need to an appointment. This is thought to have resulted
health admissions than 10 similar CCGs and it is clear we medication and how to access support after discharge.
nurture other health care professionals to help meet in increased pressure on the local A&E. Greenwich
need to be doing more as a system to prevent crisis and Lewisham and Greenwich NHS Trust responded positively
demand and deliver primary care services. General is ethnically diverse and issues around access are
avoid admissions. The impact of drug and alcohol misuse to the recommendations made by Healthwatch but there
practice nurses are an essential component of the particularly pronounced for residents for whom
is particularly pronounced within Greenwich. Demand for is more to be done to ensure that patients spend the
general practice workforce. However, the recruitment English is not their first language.
assessment and diagnosis services for autism has grown shortest time possible in hospital. We are committed to
and retention of general practice nurses is an issue. reducing lengthy hospital admissions and to avoiding
significantly and there is a waiting list of more than
The workforce is ageing – with predictions that a third delayed discharges. Whilst Greenwich performs well in
2.5 years.
of the workforce may retire by 2020 (The Queen’s terms of avoiding delayed discharges, we are mindful
Nursing Institute, 2016) – and placement and training We will work with the Greenwich Mental Health and
of the impact that delays can have on patients and the
Wellbeing Partnership Board to address the wide range
wider health system. NHS Benchmarking (2018) has
of issues that affect mental health and wellbeing in
found that 45% of delayed transfers of care are in the
85+ age group. The reason for delay for this cohort is

16 NHS Greenwich Clinical Commissioning Group [Link] 17

 Greenwich Commissioning Strategy Transforming our health and social care system 2018 to 2022

that the patient is awaiting a care home placement Cancer care NHS Foundation Trust. In order to improve this number, The CCG achieved its financial duties for 2017/18. The
(29% of cases), a care package in their own home we need to continue to work with our commissioner and 2017/18 Annual Accounts show a surplus of around
Cancer is one of the main causes of people dying
(18%) or awaiting family choice (19%). provider colleagues across south east London. £0.7m, which is in line with the CCG’s financial target for
prematurely and living with ill-health in Greenwich
the year (NHS Greenwich CCG, 2018). This is a result of
Outpatient provision has changed little whilst other (see Box B right). More cancer patients in Greenwich are Our commitment to improving the prevention, detection
sustained determination by our local and south east London
service transformation has been underway, and we need diagnosed when their cancer is at a later stage than in and treatment of cancers is reflected in our decision to make
contracting and finance teams, the efforts by all in the
to make sure that patients attend hospital for follow-up other parts of Europe. This is the main reason why people this one of our top priority areas for the coming three years
CCG to develop our savings schemes and support from
appointments only where this is clinically necessary. in the UK have poorer short-term survival rates after – see priority four, page 41.
our providers in implementing them.
receiving their diagnosis than people who live elsewhere
There is underuse of mechanisms designed to support the
in Europe. BOX B: CANCER AT A GLANCE The CCG budget for 2018/19 is around £419.8m. Our
planned care pathway, such as GP referral management
systems and acute direct access services (for diagnostics financial plan for 2018/19 is to deliver in-year financial
Our performance against the national cancer standards
Greenwich residents are more likely to have cancer: balance, contingent on the delivery of significant Quality,
and pathology). However, we need to go further than requires improvement. We measure cancer waiting times
the way we access planned care, to explore new ways • Every year about 900 Greenwich residents are Innovation Productivity and Prevention (QIPP) savings of
performance against eight specific measures. We met the
of providing planned care. Currently, services are not newly diagnosed with cancer around £14.6m (around 3.5% of the overall 2018/19
national target for five of the eight measures in 2017/18:
commissioned around the person, and patients end • Our borough has higher cancer rates than London budget) and to manage other key financial risks.
cancer 2-week wait, breast cancer symptom 2-week wait,
up with multiple care plans. This reflects how different boroughs with similar levels of deprivation – we We will build on the success we have had over the last
cancer 31-day definitive treatment, cancer
players in the system have conflicting priorities. There have the 6th highest rate out of the 32 London two years to turn around our financial position.
31-day sub treatment – surgery, cancer 31-day sub
are insufficient staff to deliver services and inflexibility treatment – drug (NHS Greenwich CCG, 2018). CCG areas Funding for the CCG’s programme of expenditure is
of current roles and responsibilities. Residents living in the most deprived parts of anticipated to remain flat in real terms over the planning
Our provider hospitals have found it difficult to meet the
We want to reduce fragmentation and increase Greenwich have poorer outcomes: period into 2022. It is anticipated that similar size QIPP plans
62-day cancer wait target. This standard measures the
coordination, with simpler, more streamlined pathways. • People living in the most deprived 20% of areas in will be required in 2019/20 and onwards. Financial savings
wait from an urgent GP referral for suspected cancer to
System-wide transformation is needed to shift more the borough are signifciantly more likely to die from plans of a similar size are being implemented across all
first treatment and covers all types of cancer. Over the last
services into the community, and for health and social cancer than those living in the least deprived 40% local health and social care organisations. We need to work
year, an average of 75.4% of people with an urgent GP
care to be more joined up, with the patient at the centre. of areas together across our organisations to deliver the scale of
referral had their first treatment for cancer within 62 days
The image produced by The King’s Fund, figure 3, shows Greenwich residents are more likely to die change needed and enable best use of public resources.
of referral – the standard is 85%. This standard has proved
the wide range of sectors and services that deliver care and from cancer:
particularly challenging when patients are referred from Section 5, page 42, sets out our plans for a financially
support in community settings. These aspirations will be
one trust, usually Lewisham and Greenwich NHS Trust, to a • Cancer accounts for about a third of all deaths sustainable system. This includes using available levers to
reflected in our commissioning intentions for the coming
tertiary provider (a specialist centre), such as King’s College of people in Greenwich, with an annual death incentivise change, as well as introducing new contractual
years. Section three details our plans to commission
Hospital NHS Foundation Trust and Guy’s and St Thomas’ rate that is higher than both London and England arrangements that support partnership working across
integrated care pathways, closer to home.
– we have the 9th highest mortality rate out of CCGs and integrated models of care. The financial challenge
the 32 London CCG areas means we must be innovative in designing solutions that
Figure 3. Survival rates are poorer in Greenwich offer long-term sustainability and in designing these we will
Reimagining community consult and engage with stakeholders.
ndary acute care • One year survival rates in Greenwich in 2011
services. Charles et al (2018). Seco
were (66%), compared to England (68%) and Section 3 sets out our ambition in tackling these challenges.
The King’s Fund
London (69%) – although, by 2016/17, our one Our plans for transformation build upon the successful
Community
year survival rate had increased to 70.9% projects that embody the type of community-based, multi-
health services Co
t ph m
m Source: Royal Borough of Greenwich (2016) agency working needed to support system change – see
en
me

ar successes to build upon, page 22. They also align with the
re
e

Inp ealth c
nta
un cy
car

Ur

m
ca

national direction of travel, with respect to primary care at

ity

atie

Financial pressures
lh
a
ary

ary care
Prim scale and federated and network arrangements. Importantly,
servic ce

Com tal

nt
Terti

Our commitment is to improve the quality of care and

an

our plans recognise that we are a system within a wider

men lth
es

hea

munit
Ambul

patient experience, and to meet the changing needs of the

are

system – as shown in figure 4, below – and this will enable

Patient population; we need to achieve these objectives in ways that future resource flow. We need to address fragmentation
y

are financially sustainable. Commissioning services within of providers and of commissioning, and to wrap services
Family/
a tight financial envelope is a challenge across the health around residents. The ‘system of systems’ seeks to address
carers
and social care sector. The CCG incurred a deficit of £3.8m the following simultaneously: for all commissioned services
in 2016/17, which in part reflected a large and unforeseen
tor

to work as efficiently as possible, to facilitate integration

rise in the costs of funded nursing care and an obligation
Soc

sec

NHS services within boroughs across health and social care, and to enable
to make a payment of £1.8m to Lewisham and Greenwich
ial

ary

integration across providers in areas such as elective care

ca

NHS Trust in respect of transitional support following the

nt

with greater network provision delivered at a local level.

re

lu

dissolution of South London Healthcare NHS Trust (NHS

Vo

Wider services Greenwich CCG, 2017a). In short, we were unable to deliver

Em a 1% surplus or to operate under our resource revenue limit.
erg ols
ser ency Housing Scho
vice
s
18 NHS Greenwich Clinical Commissioning Group [Link] 19
 Greenwich Commissioning Strategy Transforming our health and social care system 2018 to 2022

General practice at scale is at the core of the south east London system of systems for integrated care

Other London South West London

Some STPs and
Sustainability and Sustainability and Kent, Surrey and Some boroughs,
boroughs outside of SEL such as Greenwich
receive tertiary services Transformation Partnerships Transformation Partnership Sussex populations and Bexley, share
from relevant providers emergency services
within the Integrated from the same hospital.
Care System (ICS) Other boroughs are
Tertiary provision (highly specialised acute / mental health) coterminous with
their emergency
department
The interface between Networked secondary care / episodic care
secondary care and
mental health, and
local care partnerships Chronic care delivery Chronic care delivery Chronic care delivery
(LCPs), should have
a local focus (based
on population
segmentation) A&E 1 A&E 2 A&E 3 A&E 4

Lambeth Southwark Bromley Lewisham Greenwich Bexley

LCP LCP LCP LCP LCP LCP
At scale general
practice, coterminous
with borough boundary
and covering the whole
borough population

Local Care Networks (developmental) Primary Care Home / 1. King’s

2. PRUH 3. UHL 4. QEH
become LCPs (one or more dependent clusters (of multiple GP St Thomas’
on borough likely to cover a practices) to provide
population of c.250-350k enhanced personalised and
preventative care for the
Includes: primary care, community local community. Likely STP clinical programmes STP enabler
services (physical and mental), social to cover a population of programmes
care, housing, leisure and secondary care c. 30-50k
provision (e.g. chronic care / new models A&E Cancer CBC Mental Planned CYP Maternity Digital Estates Workforce
of outpatient care) health care

Figure 4. A system of systems We recognise the importance of working with other commissioners and with providers of
services to improve health and care for the populations we jointly serve. This means collaborating
STP as the organising function to manage the resources available to us. The King’s Fund (2015) has called this approach
‘placed-based systems of care’. Our strategy seeks to act at every level in partnership with others:

• At populations of 30,000 to 50,000, by supporting • At multi-borough level, in partnership with Bexley 

multidisciplinary working in primary and community care and Lewisham to ensure areas like unscheduled
• At general practice level, by supporting federated care work effectively
working at greater scale • At SEL level, by working in synergy with other
• At borough level, through local care networks that commissioners to support re-designed pathways
will over time work as partnerships across multiple providers
20 NHS Greenwich Clinical Commissioning Group [Link] 21
 Greenwich Commissioning Strategy Transforming our health and social care system 2018 to 2022

2.3 Successes to build upon

Barnfield Well Community and more joined-up working at grassroots level. There There are plans to launch additional community clinical Live Well Greenwich is system-wide change to embed
is an improved environment, with a play area and open hubs to expand MSK coverage across Greenwich to enable prevention at individual, community and population levels.
The Well Communities programme is a community
spaces, which has improved community safety and pride greater patient choice of locations and care closer to home. In addition to an online Greenwich community directory
development programme targeting disadvantaged
in the environment. The borough has invested £14 million MSK practitioners (senior physiotherapists) will soon be and the Live Well Line telephone support service,
communities with high health needs. The aim is for
in the area, and local funding supported the development supporting GP surgeries across the borough by seeing Live Well Coaches (LWCs) provide one-to-one intensive
disadvantaged communities and local organisations to
of the Barnfield Hub. In all, 786 residents participated in patients who would normally require a GP appointment. interventions, supported by community volunteers.
work together to improve health and wellbeing, build
Well Communities activities: 85% reported an increase
community resilience and reduce inequalities.
in healthy eating, 72% reported an increase in healthy Greenwich Time to Talk (IAPT) A network of LWCs are embedded in primary care and use
physical activity; and 80% reported feeling more positive. Time to Talk is part of a national motivational approaches and social prescribing to address
Barnfield has a population of 2,290, living in 811
programme called Improving wider social and economic needs. On average, clients have
dwellings, of which 71.5% are social housing. The
population has many young families, across a range of Greenwich Musculoskeletal Service Access to Psychological Therapies two appointments with a LWC, and outcomes data place
The Greenwich Musculoskeletal (MSK) Service comprises (IAPT). It is for people with mild 97% at least in the early stages of change and the majority
cultural groups (African, Caribbean, East European, Irish,
community hubs and local providers that offer support problems of anxiety or depression (62%) at the action stage. Feedback from clients and GP
English, Scottish, Somalian and Vietnamese).
and treatment for patients with musculoskeletal issues. who are motivated to work to practices has been very positive. By focusing on frequent
Five themes were identified for Barnfield: mental Some patients are offered virtual consultations through change the problem. Oxleas attenders in primary care, telephone triage and a whole
wellbeing, open space, physical activity, healthy activity, a Physioline service where a physiotherapist will carry out NHS Foundation Trust, our systems approach, the LWCs are having a real impact
culture and tradition. Initiatives included a DIY Happiness a musculoskeletal assessment over the telephone and main provider of mental health by finding solutions to complex problems.
workshop for women, cookery club, Barnfield community provide advice, exercises and guidance. Patients continue services, has a team of therapists
website, and a play area. METRO GAVS Greenwich
to have access to face to face physiotherapy assessments based in Eltham, who can see patients at other centres
by local providers, and the local hubs provide more throughout the borough. The voluntary sector is playing
The programme has led to several positive outcomes, a vital role in supporting the
including an improved relationship between the choice as to the location for treatment. Some patients
have access to clinics provided by an Extended Scope Greenwich Time to Talk offers free psychological health and social care system
community and the local authority, better co-ordination, treatment as recommended by the National Institute for in Greenwich. METRO GAVS
Practitioner or a GP with a special interest at the main
clinical hub in Eltham Community Hospital. Both carry out Health and Clinical Excellence (NICE) guidelines for anxiety is central to this. It is providing
specialist musculoskeletal assessments on patients and and depression. This is mainly cognitive behaviour therapy strategic leadership in representing and building the
can request diagnostics or provide injection therapy or (CBT) and counselling, to help people feel more able to capacity of the voluntary, community and faith sector in
ultrasound guided injections, where needed. cope with problems. The service offers support for people the Royal Borough of Greenwich. It provides a range of
over 16 (there is a specific service for 16 and 17 year olds). ‘capacity building’ support and training to local voluntary
Consultant clinics are held at Eltham Community Hospital and community organisations as well as support to
for rheumatology, orthopaedics and pain management, Live Well Coaches the sector to get its voice heard.
supported by consultants from Lewisham and Greenwich Online Telephone Face-to-face
NHS Trust. This service has enabled rapid access to METRO GAVS has a strong working relationship with the
access support support
consultants for very complex patients, allowing them local authority, police and the NHS, which is enabling the
to be seen closer to home. co-production of new services and policies to become a
reality. The sector can reach parts that the NHS cannot,
as well as supporting Live Well Greenwich, and other
initiatives that rely on the input of voluntary sector
organisations. Its onus, as reflected in this strategy,
Live Well
is on prevention, and working together to achieve this.
Greenwich Live Well Live Well Champions
Community Line Greenwich Line Coaches and Volunteers

22 NHS Greenwich Clinical Commissioning Group [Link] 23

 Greenwich Commissioning Strategy Transforming our health and social care system 2018 to 2022

3. Our ambition for Greenwich 2018 to 2022

We will reduce health inequalities by taking a preventative, proactive approach. We will demonstrate effective clinical leadership. We recognise that the challenges
We will distribute resources in ways that lessen health inequalities and support initiatives we face require whole system solutions, which rely on strategic leaders across health and
that identify and eliminate discrimination. This includes being clearer about the outcomes social care (including the Royal Borough of Greenwich, and Lewisham and Bexley CCGs)
we expect the services we commission to demonstrate with respect to health inequalities. working together with users and providers of services to co-design pathways and make
We will focus particularly on the health needs of black and minority ethnic communities best use of available resources.
and ‘hard to reach groups’.

We will be outcome-focused in commissioning high quality services. We will

We will demonstrate accountability to the local population and our partners
work to deliver better health outcomes for the population of Greenwich, by focusing
through robust governance arrangements. We will ensure that our systems have
on evidence-based solutions that improve the quality of care, the patient and carer
sufficient capacity and capability to monitor outcomes effectively and provide us with
experience, and deliver the greatest health benefit. We will focus on outcomes for the
information to understand the value we are achieving on behalf of the people
whole population and key groups.
of Greenwich.

We will seek to add value, and to minimise waste and inefficiency. We recognise
the tight financial context in which high quality services are to be commissioned. We will
demonstrate clear and credible plans that meet the financial challenges. We will improve At the heart of our ambition is a focus on prevention, living well and self-care.
collaboration to harness economies of scale to best use available resources, including closer We want to drive an expansion of primary and community-based care, and for
integration with social care, public health and other partners, and delivering primary care acute-based hospital care to require a smaller share of resources.
at scale.

We will know that we are achieving our ambition when:

• We see improvements in health and wellbeing in the population of Greenwich, including an

We will work collaboratively with our partners to develop modern integrated
increase in healthy life expectancy, a reduction in health inequalities, and more people engaged
commissioning arrangements. We will maximise resources by taking an integrated,
in their own health and wellbeing
whole-system approach to commissioning, where incentives are aligned, and clinical
care pathways are simplified. • Better patient experience is reported by users of health and social care
• We achieve financial balance and can work effectively with our partners to plan future investment
• We commission services in ways that meet the needs of our local population and demonstrates
efficiency and impact
• We show a system-based approach to working with our partners
We will listen to those we serve. We are committed to involving local people to make
sure there is a patient voice in the decisions we make. Our commissioning intentions will
Our ambition, and the four priorities that flow from it, align with the five priorities
be informed by local views about what is working well, and what could be improved.
identified by the Sustainability and Transformation Partnership (STP) for south east London,
which are as follows:

Developing consistent and high-quality community-based care and prevention

We will engage local people in improving their own health and wellbeing.
We need to support people to be healthy and free from disease and the burden of Improving quality and reducing variation across both physical and mental health
ill-health. For those with long-term conditions, we will help them to maintain active and
healthy lives. For those with acute illness or injury, we will increase understanding of Reducing cost through provider collaboration
self-help and support people to receive advice in the community as far as possible.
We will encourage self-management of conditions wherever possible to reduce Developing sustainable specialised services
avoidable hospital admissions and to increase confidence in self-care.
Changing working relationships to deliver the transformation required

24 NHS Greenwich Clinical Commissioning Group [Link] 25

 Greenwich Commissioning Strategy Transforming our health and social care system 2018 to 2022

We intend to become more strategic in our commissioning, Our aim is to consult with patients and providers, to
3.1 Integrated care Greenwich focusing on the planning and funding of new models
of integrated care using evidence-based approaches.
ensure their involvement in the planning, procurement
and monitoring process. For example, we will work
It is likely to involve the use of longer term, with voluntary and community groups in shaping the
The health system cannot continue to deliver services in the current way. The outcome-based contracts. structure of integrated services. We will ensure that the
NHS Five Year Forward View (NHS England, 2014) and General Practice Forward Communication and engagement for integration is key
development of provider services enables effective use
of the voluntary sector to support access for hard to
View (NHS England, 2016a) are clear that the future focus must be on promoting to driving greater transparency, by working collaboratively reach or seldom heard communities.
wellbeing and preventing ill-health. This affects all health, social care and voluntary with key stakeholders, including provider organisations.

sector services, including primary care. As commissioners, it means we need to work Figure 5. A patient-based
integrated care system
collaboratively with all providers to change pathways and support population-based for Greenwich
services. We will do this by having aligned budgets, underpinned by new contract
models to ensure shared incentives are in place to deliver the best outcomes.
We are part of the South East London Commissioning have modern, integrated commissioning arrangements
Alliance – which recognises our role as a system within with a variety of partners along similar lines to our
the bigger SEL system. We cannot make decisions in current arrangements for the Better Care Fund. Acute care (LGT) Inpatient mental
isolation to other parts of the wider system and need • Inpatient health care (Oxleas)
to take a ‘SEL perspective’ if we are to bring about Integrated care systems (ICSs) are emerging across the
country to take the lead in planning and commissioning • Emergency
transformational change. The next three years will see
closer working with commissioners in neighbouring care for their populations. Our local integrated system for
localities, particularly where we commission services Greenwich seeks to be a sustainable and accessible health Community mental

In mi
on d

Co
g
is te
and care system which will support people to maintain health services (Oxleas)

in

te ss
m
from the same acute trusts (Lewisham and Bexley CCGs

m ra

gr io
Ou oni is tio sigh

ste ion prin urc rk

and improve their mental and physical wellbeing, live

m teg
Community

at ni
si
with respect to Lewisham and Greenwich NHS Trust,

o o
tc tor sion n o t

w
M omm ifica ver

ov f n ples s

ed ng
o ci e
Co In

om in

tifi an f r me
independently and access high quality care when they health services (Oxleas)

C ent m o
and Bexley CGG with respect to Oxleas NHS Foundation

es g o g i nee

a
Id ntio ing s fr

s
Id ste

sig d
need it. We are at an early stage of development in this

e
fra re nte d

er ee
Trust). We have begun to work with Lewisham CCG to

e
Sy

ht
m so nt

in nit com

o
work in Greenwich, and we have good relationships

ew ur ion
f

d
develop our approach towards integrated care, including Public health

ng Mo ut
or ces an
in f

te or
O
with our partners.

en n
Sy at
exploring areas where we can begin to work together

m
Voluntary and

c
across the geography of Greenwich and Lewisham. We anticipate that integrated care will cover the whole community
services

ni
population of Greenwich in the long term, starting with

io
We support further integrated provision through local

pr

iss
urgent and emergency care. Over the next three years we Schools

in

m
providers working together through their own joint Residential

cip

m
Co
les
approach. We have a good relationship with our local GP will focus on the priority areas identified by this strategy, placements
federation, Greenwich Health. Some NHS providers are and particularly mental health (priority two), including adults and Home
children and young people, and frail people (priority children care GPs 999
also working together to deliver integrated care locally Housing Youth
through local care partnerships, for example integrating three). We want to move from a hospital-focused system
provision
to one that has the patient at its centre, as shown by Childrens
mental health and acute provision.
figure 5. and family
centres Adults and children Transport
As well as working with other NHS organisations, we will
in Greenwich
continue to work with the Royal Borough of Greenwich,
to develop joint or integrated commissioning across Pharmacy 111
the health and social care sector. Our vision is to

• Population health & care management information system

Enablers • Communications and engagement, finance
• Estates, strategic IT
• Workforce development providers/commissioners

26 NHS Greenwich Clinical Commissioning Group [Link] 27

 Greenwich Commissioning Strategy Transforming our health and social care system 2018 to 2022

3.2 Primary care at scale 3.3 Local Care Networks

Key to achieving our vision for integrated care is providing primary care at scale. It is Investment in community-based care is essential to transform our system and
primary care that will enable us to make transformational change happen. We will be move towards lower cost, higher value care delivery. To this end, we will continue
commissioning primary care organisations that have the capacity to provide services at scale. to support the development of four local care networks (LCNs); multi-disciplinary
Continuity of care is important to patients and has been associated with lower mortality networks that work at scale to improve access, as well as manage the mental and
rates (Periera Gray et al, 2018). Some services will best be provided at a GP practice level, physical health of their populations. The LCNs will draw together primary care at
some by practices working at scale (for example, networked practices covering a scale with other community-based provision to provide care at neighbourhood level.
population of 30-50,000) and some, such as social care, on a borough wide basis.
Fully operational LCNs will deliver our new model of We will continue to focus on the following: diabetes;
care and the full vision of the Primary Care Strategic prevention; case management; reablement; medicines
Working at larger scale has been found to improve As delegated commissioners of primary care services,
Commissioning Framework (SCF). The LCNs will support management; reduction in variation; and end of life care.
sustainability in core general practice through operational we will use our primary care Commissioning Intentions
practices to shift the focus to prevention, facilitated by In addition, LCNs will provide a full range of community-
efficiency and standardised processes, maximising income, to incentivise new ways of working. In pursuing primary
Greenwich Health GP federation. We will give emphasis based services, including: support to patients to manage
enhancing the workforce, and deploying technology care at scale we will align our approach with the rest of
to adopting population-based budgets and risk-based their own health, prevention, improved access to general
(Rosen et al, 2016). It can also support a more sustainable London, guided by London-wide strategy intended to
contracts, and fully integrating information management practice, and support for vulnerable people.
primary care workforce by broadening skills, creating role strengthen general practice collaboration in London.
and technology across organisations and pathways. It
flexibility and role enhancement through peer support The ultimate aim is for LCNs to integrate the entire
We will work with Greenwich Health and our 35 GP will mean removing barriers to professional roles and
(ibid). Additionally, working at scale can enable general community-based system and drive transformation. The
practices to develop the concept of primary care at responsibilities, through joint education and training
practice to deliver extended services, with benefits not availability of more community-based care will enable
scale. Central to our approach will be our four Local between primary and community care providers. The
only for primary care, but for the wider health system. us to achieve simpler, more streamlined planned care
Care Networks. implementation plan will outline how changes will take
In short, we believe that primary care at scale is crucial pathways, to consolidate acute services and engineer
place and there will be further discussion at that stage.
to achieving the shifts we seek from hospital-based care shifts in activity to new models of primary and community
to community and primary care. We will strike a balance BOX C: LEWISHAM ‘SUPER PARTNERSHIP’ The minimum that LCNs should encompass is: all GPs care. As part of this, LCNs will help us to achieve greater
between working at scale and ensuring services are working at scale, community pharmacies, specialist teams consistency of access to high quality and safe planned
responsive to local people. Five practices in Lewisham are merging to become one working in the community, voluntary and community care services, to manage demand for planned care and
Many GP practices are now collaborating with other super partnership that will become the second largest sector, community nursing, social care, community mental ensure that outpatient referrals are made only where
practices, often to achieve efficiencies and to offer registered list size in London. The merger is designed health teams, community therapy, community-based appropriate. The pathway is not operating as planned and
extended services in primary care – Box C highlights to enhance patient experience and create benefits for diagnostics, and patient engagement groups. feedback we received at the listening events highlighted
an example within Lewisham. Increasingly, Greenwich staff and local commissioners. that one element that needs improving is for GPs to
Our vision is to establish long term condition (LTC) receive more training on how to use the system. We
practices are looking to create ‘nested’ structures, to Initially the five PMS contracts will remain as separate hubs within our LCNs, to improve the quality of care will work with GPs to ensure more effective use of the
allow different functions to be performed at the most contracts, which the new entity holds in trust, allowing for people with LTCs by increasing access to community referral management system. We will also improve access
appropriate scale, including deliberately designing the practices to benefit from the integration of clinical based multi-disciplinary services. This will require GP to planned care services by working with our partners to
small clinical core teams for care where continuity is and access services and systems. At a later stage it practices collaborating with each other, and with other align provision across boroughs, with the aim of making
important. Greenwich Health GP federation is already is envisaged they will move to one PMS contract or health and social care providers, the third sector and service provision more consistent and to improve clinical
taking an ‘at scale’ view of primary care across the consider the new voluntary Multispecialty Community community assets. transitions from primary to secondary care and between
patch. For example, the federation is working with Provider contract. Further practices are expected to join
local GPs to provide extended access to primary care at all service providers.
the super partnership model over time.
evenings and weekends and developing the ‘hub’ model
to deliver public health services. We need to build on Working at scale requires a completely new business
these developments and drive primary care at scale, as a model, and both clinical and non-clinical capacity to
cornerstone of our plans for integrated care. develop, consult and implement it. As part of the
business case for the merger, seven day, 8am to 8pm
We anticipate that primary care working at scale will
access was proposed.
provide the foundations for new integrated care systems
across London, which will bridge the traditional provider- We will look to learn from the super partnership model
commissioner boundary to provide for the care needs of and from other experiences of neighbouring areas in
whole populations. Primary care at scale will be at the the delivery of primary care at scale.
heart of transformation.

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3.4 Primary care workforce BOX D: PHARMACISTS IN PRIMARY CARE

Greenwich Health GP federation and Lewisham

Initiatives are already underway to address the GP workforce shortage in Greenwich, and Greenwich NHS Trust’s pharmacy is launching
including offering mentoring for new GPs and a retainer scheme for GPs who do not a new service development in September 2018.
More than 10 hospital pharmacists (6.5 whole
want to work full-time. time equivalent) will work in 22 of Greenwich’s
GP practices – serving a population of 200,000.
The general practice workforce in some parts of the Community pharmacists can also provide an alternative
country is expanding to include physician associates triage point for many of the common ailments dealt The pharmacists will rotate between the GP
working under a GP’s remit, paramedics employed by GPs with by out-of-hours services and A&E departments practices and the trust’s pharmacy to support
to undertake home visits, pharmacists managing groups (Smith et al, 2013). interface working and improve the patient journey
of patients with long-term conditions, advanced nurse across the health system. They will be trained
practitioners supporting patients with minor ailments, Medical Assistants are being trained nationally to work to prescribe and will work to support medicines
and mental health therapists. Feedback from Greenwich in primary care. Greenwich is part of a joint bid to optimisation and release some pressure from GPs.
patient groups has highlighted the benefit of expanding increase the number of GPs through an international
the skillmix in primary care in our locality. recruitment and retention initiative. We have advanced
nurse practitioners and practice nurses, but the numbers
To support primary care at scale, we will invest in are relatively low.
expanding the primary care workforce. Pharmacists in
primary care are being introduced during 2018/19 to Live Well Coaches are one example of new roles
support GPs, reduce demand for appointments, promote effectively integrated into the primary care workforce
self-care, and support medicines management initiatives – see page 23 for further details. Front-line primary
(including reducing medicines wastage and medicines care staff will be trained in care navigation. MSK
optimisation) – see Box D. Community pharmacists can physiotherapists in primary care are being championed
also play a vital role in supporting people with long through our MSK contract. Introducing new roles into
term conditions and to help optimise use of medicines. primary care will be an ongoing programme,
supported by Health Education England.

3.5 Primary care estate

An estates strategy for south east London is in draft, and a Greenwich estates
working group has been set up with key stakeholders to ensure we are planning
for the future.
Our estates plan will support our ambitions for more We will work with the Royal Borough of Greenwich
community-based care, including the rationalisation of to improve the ability of our community and primary
inappropriate estate. We want to ensure comprehensive care health workforce to use their own transport to
primary care and where branch surgeries are unable carry out their roles. We are also working closely with
to do this we would want to review this in the context the local authority on the footprint of further housing
of the estates strategy. We will encourage greater GP developments where demand will be for primary and
networking arrangements and primary care working at community services. Engagement on the estates strategy
scale through our estates plan. for Greenwich will take place in 2018/19.

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Other priorities for joint work include: • Maternity services, health visitors, social care, adult
4 Our four priority areas • Preventing diabetes, by improving uptake rates for the
mental health services and Children’s Centres to work
closely together to share data, ensuring those who
National Diabetes Prevention Programme by increasing
need additional support receive appropriate, timely,
primary care referrals
The four priorities we have chosen for the next three years seek to shift the focal and culturally sensitive help. The pooling of budgets for
• Improving health protection arrangements, including
point from expensive hospital services to community-based care closer to home. improving immunisation uptake rates through primary
these services will encourage innovative commissioning
and induce a culture of joined-up working
We want to get upstream, to prevent ill-health as much as possible, intervene care, improving cancer screening uptake rates, and
• The health and early years workforce to receive high
early to avoid hospital admissions, and to streamline service provision. The primary continued rollout of the latent tuberculosis programme
quality training in infant mental health and attachment
in general practice.
objective is to improve health and wellbeing for the Greenwich population. as standard, in order for practitioners to understand
Getting it right from birth parent-infant relationships and the services required
This will have a secondary gain in making best use of limited resources. when difficulties arise.
Greenwich Children and Young People Plan
2017-2020 Greenwich has been leading a tri-borough commissioning
4.1 Priority one: To prevent illness We will work with our partners to support this plan,
which has four priorities:
initiative on perinatal mental health and will continue this
activity over the next three years. This will be developed
and help our population to live well • Strong foundations for children from disadvantaged
through a single integrated service model based at Queen
Mary’s hospital, with links into the three boroughs locally.
backgrounds – including fewer admissions to hospital The service will provide specialist input in line with NICE
Our first priority is to prevent illness and enhance wellbeing Our prevention plans and A&E, improved parental mental health, fewer evidence, including on psychotropic medication.
and healthy living, in collaboration with the Royal Borough of neonatal mortalities and stillbirths, and increased
Our plans for prevention reflect the areas indicated,
Greenwich, the Health and Wellbeing Board, and community uptake of immunisations Children in hospitals
as follows:
and voluntary sector organisations. This means getting it right • Supporting disadvantaged boys and engaging We want Greenwich children and their parents to be
from birth and giving children from all backgrounds the best • Reducing alcohol, through using levers, such as CQUINS well with men supported in managing a child’s long-term condition in
possible start in life, supporting them to live healthy and active (Section 5, page 42, explains this term), to embed alcohol
• Healthy relationships, tackling violence and exploitation primary and community-based care through our local care
lives, and to minimise ill-health and disability in older age. screening, and support the roll out of the digital alcohol
• Children with special educational needs and disabilities networks rather than in an acute setting. In addition, we
We will focus upon the delivery of the existing strategies that identification and brief advice programme (IBA) in primary care
– including more children having antenatal checks at 10 want to support children and their parents to manage the
have been developed by us and by our partners and be driven • Reducing smoking through using levers, such as CQUINS, to
weeks, and early identification of speech, language and everyday healthcare of their children without the need
by the insights provided by our public health colleagues (for embed smoking screening and specialist advice across all our
communication needs. For example, children with autism to attend A&E. We will achieve this by providing more
example, as highlighted in the annual report of the Director providers in primary care, community care and acute settings
need an early identification process where appropriate community-based services for children and making sure that
of Public Health for Greenwich).
• Promoting healthy weight, including through creating a pilot services are wrapped around the child in order to parents and children can better access primary care. We
Live Well Greenwich programme for Tier 3 weight management for children achieve the best possible outcomes. will develop our children and young people implementation
• Improving mental health and wellbeing through Primary based on the prevention cycle with in-reach clinics, care for
We will support the continued development of Live Well
Care Plus (see page 35) and by supporting broader initiatives 1001 critical days long term conditions based in primary care, supported by
Greenwich, empowering people to find the support they
through the Thrive Greenwich programme. Priority two The Greenwich Child and Young People Plan 2017-2020 access to specialists, diagnostics and sign posting for children
need to look after themselves, including telephone help (Live
focuses on our plans for mental health commits to providing all children and young people in and young people and their parents.
Well Line) and face to face support (Live Well coaches; for
further details see page 23). We will work with our partners • Promoting a healthy workforce, through embedding Make Greenwich with the best possible start in life, particularly
to increase the expertise and help people can access to make Every Opportunity Count (MEOC), securing opportunities to during their first 1001 days. The 1001 critical days manifesto We will know that we are achieving
the best use of all these resources. This will include training promote work as a health outcome, and developing the highlights the importance of intervening early in the 1001 our vision when:
(Making Every Opportunity Count (MEOC)) for front line Care Navigator workforce as part of Live Well Greenwich critical days between conception to age two to enhance
• Children get the best possible start in life
staff, partners and residents in the community to help them • Sharing best practice and identifying possible areas outcomes for children (Durkin et al, 2016). For example, the
manifesto’s vision provides for: • There is improvement in life expectancy,
to recognise when someone might need help and signpost for collaboration in our commissioning of public
particularly for women
them to a range of support services. health services, such as health visiting, sexual health • Vulnerable families, or those experiencing difficulties,
and smoking cessation • We see reductions in alcohol consumption
to be able to access specialist services which promote
South East London Commissioning Alliance parent-infant interaction
and smoking
• Working together to implement public health campaigns,
A prevention board will be established which will work such as Stoptober and Change for Life, amplifying the • There is an increase in children and adults who
• A range of services to be in place in every local area to
alongside the community-based care board. The focus public-facing messages across south east London and are a healthy weight
ensure that parents who are at risk of or suffering from
of this board will be to roll out the ‘vital five’ areas of reducing duplication of work at borough level • We see better mental health and wellbeing, and
mental health problems are given appropriate support
prevention across south east London to ensure that each early identification of children with educational
at the earliest opportunity
health and care system addresses these risk factors more and communication needs, including autism
systematically and effectively. These are: • All parents to be able to access antenatal classes which
address both the physical and emotional aspects of • There are reductions in diabetes and other
• Smoking • Mental health • Hypertension parenthood, and the baby’s wellbeing and healthy long-term conditions
• Alcohol • Obesity social and emotional development.

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We will work with our partners to develop the mental

4.2 Priority two: To strengthen local support for health workforce, to ensure that staff have the skills to
identify mental health issues (and particularly those with
BOX E: PRIMARY CARE PLUS (PCP)

people with mental illness, including children complex presentations) and take appropriate action at
the first point of entry into a service, whether an adult,
The Greenwich PCP service was first introduced in
September 2015, providing a specialist in-reach
and young people child or young person. We will address mental health
inequalities, including targeted activities at specific groups
mental health liaison service to primary care providers
in the borough. It is a community-based, single
(for example, we will develop a specialist perinatal mental point of access to mental health services. It takes an
Our vision for the commissioning and delivery of mental • Adults and older adults learning disabilities –
health service). integrated approach, incorporating services necessary
health and learning disability services in Greenwich is to including transforming care for people with learning
for maintaining good mental health and wellbeing,
increase wellbeing, prevent ill-health, and to improve disabilities and autism who have a mental illness or
Mental health services for children including social care, housing and employment
people’s quality of life. Our strategy, in tandem with whose behaviour challenges services
the national direction, is to provide the wraparound
and young people (CYP) support, and voluntary sector support.
• Children and young people mental health –
health and social care needed by people living with a including new models of care (led by the South There is concern over the growth of mental health The service will map to GP opening hours and provide
physical and mental health condition. To achieve this London Partnership) such as availability of alternatives problems amongst young people. We will support a single point of access for all referrals to Oxleas
aim, we will continue to work with Greenwich Mental to inpatient care Greenwich’s Child and Adolescent Mental Health Services Mental Health Services (specialist care services) from
Health and Wellbeing Partnership Board, Royal Borough (CAMHS) Transformation Plan (NHS Greenwich CCG, primary care.
of Greenwich, Oxleas NHS Foundation Trust, GPs, We will continue to develop these pathways over the 2017b), which outlines the following local priorities:
and community and voluntary sector organisations, to next three years. Urgent referrals will be telephone triaged within 24
coordinate services across health and social care. • Helping CYP and families to access appropriate hours, and if needed, individuals will receive a same
At our listening events we heard that better signposting support and to build capacity across children’s services day face to face assessment from the crisis service.
We will undertake integrated commissioning with the is needed and inaccurate communications around
• Increasing awareness amongst Black, Asian and Routine referrals to PCP will be triaged within
Royal Borough of Greenwich, supported by staff jointly mental health services is an issue. Central to our plans is
minority ethnic CYP two weeks. New referrals will be directed to the
appointed to the CCG and the local authority. We will Primary Care Plus (PCP) – see Box E, page 35 – which is a
work with Oxleas NHS Foundation Trust, our provider of community-based single point of access to mental health • Improving outcomes for CYP with suspected appropriate treatment pathway (psychosis, ADAPT
acute and community mental health services, to shift the services that wraps around the patient, with all services eating disorders [anxiety, depression, personality disorder and trauma],
focus more firmly into community provision. We want to brought into one operating arrangement. The PCP model • Developing the breadth and volume of support early intervention, older adults or memory services) for
ensure people with mental illness are properly supported places emphasis on holistic care and on mental health programmes for parents full assessment or treatment, as necessary.
to stay well in the community, and that the support they pathways that put the patient at the centre. • Improving significantly urgent and emergency The PCP team will have a full-time consultant
need is available locally. mental health care
We will work to raise the profile of mental health services, psychiatrist, and a multidisciplinary team comprising
We have identified four transformation pathways by tackling stigma and integrating mental health with • Improving mental health care for CYP within the a team manager, community psychiatric nurses,
for 2018/19: physical health services. We will meet the national Mental youth justice system occupational therapists, psychologists and social
Health Investment Standard, which requires CCGs to • Addressing the difficulties that CYP face when workers. PCP staff will have expertise in social
• Community mental health – including developing increase investment in mental health services in line with transitioning to adult services or back to primary care. inclusion (including employment and housing issues),
a holistic primary care health and wellbeing support their overall increase in allocation each year; this will help with an emphasis on early intervention (for example,
pathway as an alternative to admission and secondary to bring parity with physical health. Our plans for CYP for 2018/19 include improving the 24 hour Home Treatment Team).
care support, and developing the Primary Care urgent and emergency care pathway, meeting national
Plus model access targets, increasing scrutiny of transitions in care, PCP staff will also provide regular teaching at
reviewing the community eating disorder service, and borough-wide primary care events.
• Crisis – including expanding provision of the
Crisis Resolution and Home Treatment Team, refreshing the Greenwich CAMHS Transformation Plan.
Source: Healthy London Partnership (2017).
suicide prevention, and a dedicated 24/7 crisis line We want to work towards joint commissioning of mental
health services, between the Royal Borough of Greenwich
and the CCG, to address the challenges around transitions
from children to adult services.

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Adult mental health services

4.3 Priority three: To better meet the needs
• Providing care closer to home and alternatives
to admissions
We will strengthen alternatives for admission for those
needing immediate support, by shifting care closer to
home. The Greenwich Improving Access to Psychological
• Supporting the uptake of annual physical
health checks of frail people with care closer to home, an
Therapies (IAPT) service has one of the best recovery rates
in London and regularly delivers against its access targets
• Supporting use of personal health budgets to enable
people with a learning disability to live in their own integrated urgent care system, and stronger
for entering treatment.
homes or with their families, rather than in institutions.

We will align our activities with the national Transforming

community-based care
In line with the Five Year Forward View (NHS England,
Care Programme for people with learning disabilities and We will place a much greater emphasis on promoting of hospital (Department of Health, 2014). Integration across
2014) we will expand the IAPT programme as first-line
autism who have a mental illness or whose behaviour independence, dignity and choice, with care shifting away providers and with social care will also be a real enabler
treatments for people experiencing depression and
challenges services, with the aim of more people living from institutions (i.e. hospitals) towards community and for change. We envisage staff delivering services through
anxiety. This will include:
in the community, with the right support, and close home-based support. Our vision is to commission more new integrated roles that span organisations. We will work
• Increasing the access rate from 15% to 16.9% to home. Greenwich is one of six boroughs in the SEL healthcare services closer to home rather than in acute with our partners to agree joint workforce plans focused on
in 2018/19 Transforming Care Partnership with a commitment to hospitals. We want to work with service users, their families securing the right skills to best support patients.
• Maintaining a minimum of 50% recovery rate for working across organisational and borough boundaries, and carers, to design services that achieve this aim.
We will undertake risk stratification to focus the work of
all service users particularly where we can deliver more or better outcomes
through joint initiatives.
Frailty and older people the developing multi-disciplinary community hubs, which
• Implementing a long term conditions pathway As we face an ageing population, so the number of people will enable staff to target services at those most at risk (for
• Developing a payment by outcomes mechanism living with more than one long-term condition will rise. example, through falls management, diabetes care, and
with Oxleas NHS Foundation Trust.
We will know that we are achieving improved support to care homes).
Currently, 44% of people over 75 now live with more than
our vision when: one long-term condition, and around 10% of people over
Learning disabilities • We see better mental health and wellbeing for 65 are living with frailty, a distinctive health state related to Figure 6. Our principles for frailty care in Greenwich
both children and adults the ageing process (Royal College of General Practitioners
People with learning difficulties often fall through the Centred around the holistic needs of the
• We see a decrease in A&E attendances for mental and British Geriatrics Society, 2016). In Greenwich, there is
net, and equity of access into planned care is an issue. service users and their carers, involving them
health issues also frailty in the younger population (aged 18 to 64).
Our vision includes supporting people with learning in all decisions while providing simpler access
disabilities by: • We see a reduction in out of area treatment We will plan and commission services to cover the and a shared care plan
• Services are joined up and well-coordinated whole frailty trajectory, from keeping people healthy
• Reducing the number of people receiving treatment
and independent to supporting them in hospital, Is personalised and tailored to changing
outside of Greenwich • Unnecessary hospital admissions and
built around three pillars: health as well as social needs, covering
• Improving the crisis and acute care response inappropriate discharges are reduced
• There is a decrease in people with learning • Ageing well and staying well both planned and reactive needs, and
• Contributing to the local housing strategy empowering self-care
disabilities in the justice system • Extending primary and community support
• Integrated care in acute settings and beyond
Has a clear point of accountability (both for
Our principles for frailty care in Greenwich clinical & non-clinical outcomes) with a core
are set out in figure 6. team that reflects users’ needs and helps
We want to invest in well-designed schemes to provide coordinate their care
treatment, rehabilitation and reablement at home or in the local
Is supported by a number of local operational
community. This approach should particularly benefit frail older
whole systems bases where joint teams
people and those living with dementia. We want to reflect a
work on a day to day basis coordinating care
person-centred approach, including supporting improvements
and tracking outcomes
in the availability of district and community nursing to help
people with dementia receive better care, closer to home. To
this end we will agree joint plans with our partners for how Helps coordinate the services (via the base)
frail and older people are to be supported in their own homes as needed from different organisations, on
and we will seek to maximise the contributions of voluntary, behalf of service users and their carers
community and social enterprise organisations.
Transforming primary care sits at the heart of our plans
Is brought together by shared cultural
here – see primary care at scale, section 3.2. This aligns with
values and ethos, organisations working as an
national policy for primary care and providing those living
Integrated Partnership that is commissioned to
with complex health and care needs more personalised,
deliver a single set of outcomes and is enabled
proactive care to keep them healthy, independent and out
by shared systems and incentives

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End of life care toolkit they need to identify patients living with frailty and The key characteristics of Primary Care from an appropriate team of health and social care
refer them into their local integrated care hub. The hub Home include: professionals. As part of the development of Integrated
We intend to better support people nearing end of life
team will then work with the patient, their GP and other Care Hubs, we will ensure that there are appropriate
to be cared for and to die in their preferred place of care, • An integrated workforce, with a strong focus on
professionals already known to the patient, to understand processes in place to alert the Hub should one of their
which is usually their home, or other community-based partnerships spanning primary, secondary and
the patient’s needs and develop a care plan which focuses patients attend a local urgent care centre or require an
settings such as a care home or sheltered housing. To social care
on planned and coordinated support for that individual. unplanned admission. We will improve management of
achieve this, we will continue to work with our partners,
This will mean an annual discussion with a GP and • A combined focus on personalisation of care with frequent attenders to A&E and those who have repeat
including Greenwich and Bexley Community Hospice and
Healthcare Assistant for some patients and a monthly improvements in population health outcomes admissions, and we will work to reduce significantly
Lewisham and Greenwich Trust, to commission planned
appointment with a GP, social worker and geriatrician • Aligned clinical and financial drivers through a unified, patients being re-admitted to hospital within 30 days.
24/7 provision of community support, with advance
for others. capitated budget with appropriate shared risks Lewisham and Greenwich NHS Trust has already begun
care planning, co-ordination of care and effective
and rewards work to develop its plans for integrated discharge,
multi-disciplinary team working. The hubs will adopt a case management approach to and we will support the trust with this work.
support patients living with frailty to remain happily The key benefits for patients are a single integrated and
Central to our aim to improve end of life care are our
plans to further embed the skills and tools needed to
independent for longer and reduce unplanned admissions multidisciplinary team, working to provide comprehensive Our approach to community services
to hospital. The key benefits for patients include access and personalised care to individuals. Working at this scale We will focus on adopting preventative approaches,
identify individuals as they approach the end of their
to a single integrated and multidisciplinary team, who ensures everyone within the team knows everyone else such as health trainers embedded in GP surgeries, social
lives. Early identification will help to ensure that these
will work together to personalise care and a single point and the patient has a more consistent experience of care, prescribing, Care Navigators (Age UK), housing and debt
patients receive the proactive support they need and have
of access into the healthcare system as needs change or similar to having a named GP. management. These and other measures, including health
their wishes and plans for their care clearly documented
urgent support is required. checks, early falls assessment, and preventative support in
and shared across organisational boundaries. We remain
committed to promoting the use of Coordinate My
Urgent care care homes will aim to avoid the need for emergency and
The integrated care hubs, and improvements to wider
Care (CMC), a clinical system where information about The number of patients attending A&E is increasing, as urgent care. Working with our local authority and with
pathways of care for people living with frailty will
a patient’s wishes and care can be stored and shared are unplanned admissions. Our first objective is to reduce community and voluntary sector organisations, we will
adhere to the six principles that guide the frailty model
between healthcare providers, with the aim of increasing demand for urgent care through prevention and early adopt a holistic health model.
of care development in Greenwich. These principles were
the number of patients with a CMC record over the intervention – a frailty care pathway, better end of life
developed in early 2018 by a collaborative of over 100 We will expand the range of services available in the
next three years. In addition to improving the quality care, and integrated care hubs should all help in reducing
health and social care professionals in Greenwich and community, including diagnostics, respiratory and cardiology
of life for Greenwich residents in their final days, these unnecessary hospital attendances. We also need to ensure
describe our ambition for frailty care in Greenwich. services, pain management, MSK, and dermatology.
plans will help to avoid unplanned visits to A&E and that the Greenwich population has access to the highest
hospital admissions. Primary Care Home quality urgent care.
Community pharmacists working closely with GPs will also
The development of integrated care hubs is a first step We will work to the new national 111 specification across support people’s self-management of their conditions and
Integrated care hubs towards our longer-term ambition to introduce Primary undertake medication reviews and provide access to urgent
neighbouring areas, with full implementation by April 2019.
We want to introduce integrated care hubs in Greenwich Care Home into Greenwich. Primary Care Home is an The 111 service will be provided by a multidisciplinary clinical medicines. We will be informed by the Pharmaceutical
as part of our drive to strengthen and coordinate primary innovative approach to strengthening and redesigning team, with one senior GP available 24/7. We will integrate Needs Assessment for Greenwich, for 2018-2021 (Royal
care around the needs of patients living with frailty. primary care. Developed by the National Association of GP out of hours and 111 to become Integrated Urgent Care Borough of Greenwich, 2018), which examines the services
Primary Care, the model brings together a range of health Clinical Assessment Service (IUC CAS). It is expected that provided by the existing 62 community pharmacies located
The integrated hubs will bring together a range of
and social care professionals – drawn from GP surgeries, more than 50% of all calls to NHS 111 will involve a clinical within the borough and maps these against the needs
health and social care professionals, drawn from primary
community, mental health and acute trusts, social care consultation over the phone. of the local population. An extended primary care team
and secondary care, to work together to personalise,
and the voluntary sector – to work together to provide will be able to broaden the offering to patients and free
coordinate and enhance preventative care for their local We will move to the national specification for Urgent
enhanced personalised and preventative care for their GPs to focus on those with complex needs. NHS England
population. An agreed approach to risk stratification Treatment Centres, which will serve as clinical advice service
local community. has commissioned a new pilot from November 2018
will provide health and social care professionals with the hubs, and provide a single point of access for care homes. called Digital Minor Illness Referral Scheme (DMIRS) across
London. Patients with minor illness or conditions that can
When patients are discharged from the urgent care
be self-managed with advice from the local community
system, we want to ensure that frail people and those
pharmacies will be referred from NHS 111 to participating
with long term conditions receive continuity of care
Greenwich pharmacies.

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Greater use of technology

We will seek to harness technology to enhance
BOX F: TELEHEALTH CARE SYSTEM 4.4 Priority four: To improve the prevention,
access to services from home and increase self-care
and self-management of conditions. Greenwich was an
Greenwich CCG launched a new Telehealth Care
System in the 12 care homes for the elderly in
detection and treatment of cancers for our
early adopter of Wi-Fi in general practice, which benefits
both staff and patients, by enabling more mobile working
Greenwich. The telehealth system collates the results
of vital observations undertaken by staff and then
local population
and for practices to offer patients on-line services.
calculates the National Early Warning Score (NEWS).
E-consultations will be piloted in Greenwich during Tipping the balance against cancer (Royal Borough of • Improving early diagnosis of lung cancer, increasing rates
In doing so, the system helps staff to recognise early
2018/19 with the aim of all practices offering alternatives Greenwich, 2016) emphasises that we need to act across of smoking cessation, and introducing virtual clinics
deterioration signs in their residents and informs the
to face-to-face appointments by the end of 2018. the whole cancer pathway, from preventing cancer • Increasing uptake of existing screening programmes
appropriate response (such as increased monitoring,
Box F provides details of our new telehealth care system. developing, to supporting earlier diagnosis to increase the for bowel cancer and supporting the roll-out of Faecal
calling a GP, 111 or other service), leaving 999 for
chance of successful treatment and ensuring that people Immunochemical Test (FIT)
We will also be looking at how technology can support life-threatening emergencies only.
have access to the highest quality treatment. It involves a
multi-disciplinary team-working in primary care and partnership of organisations and people, including the local Details of our local cancer actions and initiatives are
GPs can remotely review the patient’s observations
enable best use of the GP workforce. For example, authority, our provider trusts, the voluntary and community contained in our local cancer plans and outcome framework.
and discuss results with staff before deciding whether
using tools such as Skype to enhance health care in care sector and local residents. For example, reducing smoking, See also, details of our plans for end of life care, page 38.
the patient requires a GP visit. The digital pad (see
homes as well as home care, by enabling GPs to interact which has a clear association with many cancers, requires a
image, below), enables photographs to be taken.
with patients, facilitated by other health and social care multi-agency approach, from smoking cessation services to
staff. Other examples may include: home or portable One GP reported: “I was able to see the pictures very reducing the amount of cheap tobacco sold locally. Nearly
diagnostics; smart assistive technology that can help clearly and the evidence of cellulitis”. The patient
We will know that we are achieving
one in 10 cancers in the UK are caused by unhealthy diets,
people with disabilities or long-term conditions perform was treated on the basis of the pictures and progress our vision when:
and a co-ordinated systems approach has a greater chance
tasks or activities; and digital therapeutics, such as was monitored at the next routine visit. This saved of improving diet for everyone in Greenwich. • There is an increased uptake of screening for cancers
computerised cognitive behavioural therapy (Gretton an additional visit to the patient and avoided delay
and Honeyman, 2016). Through our Local Cancer Steering Group and Bexley • Improvements are seen in addressing the factors
in starting treatment.
Greenwich and Lewisham (BGL) Cancer Collaborative associated with an increased cancer risk, including
We will incorporate into pathway design the need Locality group we will work with the SEL Cancer Alliance smoking, diet, alcohol, physical activity and healthy
for full IT interoperability between providers, integrated to improve patient outcomes from cancer through better weight, the sun and sunbeds
information sharing and coordinated flows of information. prevention of cancers, early detection through screening, • Increased public awareness of cancer symptoms
GP practices in the borough are not on the same system and improved public awareness of cancer symptoms (South and the importance of early diagnosis
and IT problems are experienced that can impact on East London Cancer Alliance Delivery Plan). This will require
patient care and could hinder working at scale. • Patients report consistent access to high quality
continued education for primary care teams, including
We need to invest in better IT systems that provide care, timely diagnosis and treatments in a location
on lifestyle interventions to reduce the risk of cancer,
a platform for modern clinical practice and meet that best suits their needs
recognising the symptoms, and best supporting people living
the needs of our local population. with cancer, reflecting national and local strategy for cancer • There is an increase in the number of Greenwich
(NHS England, 2000; Royal Borough of Greenwich, 2016). people who survive cancer for 1-5 years
Improved access to primary care We will know that we are achieving
We will also work to ensure that patients have access to • Improved scores in the national cancer patient
In addition to strengthening community-based provision, our vision when: experience survey
timely diagnosis and treatments in a place that best suits
we will improve access to primary care. Two GP Access • Frail people receive safe, high quality interventions their needs (for example, lymphedema treatment services),
Hubs were commissioned in 2016/17, with three-year in the community and to improve patient experience throughout the cancer
funding. Patients can now see a GP seven days a week
• There are fewer hospital attendances and pathway. We will ensure that Greenwich achieves all eight
from 8am-8pm. Further work is needed to review the
admissions for frail people waiting time standards for cancer, including the 62-day
utilisation of the hubs and to increase access to the
referral-to-treatment cancer standard.
population who use urgent and emergency care services • Hospital interventions only happen when
inappropriately. We will pay particular attention to equity necessary and for the shortest periods of time We will also pursue initiatives specific to
of access for primary care services and ensure that services Greenwich, including:
are targeted at patient groups in greatest need. We will • The whole Greenwich population benefits from
invest in care navigation and better signposting to ensure enhanced community provision and improved • Tackling inequalities by reducing variations in
that all Greenwich residents are directed to the most access to primary care cancer incidence and mortality, and by increasing
appropriate source of assistance for their needs. • More people nearing end of life can die at home public awareness and uptake of screening in social
or in the community, if this is what they choose, groups where this is low
supported by multidisciplinary teams • Supporting people living with, and beyond, cancer
• Reviewing pathway issues and barriers
(for example, around radiology)

40 NHS Greenwich Clinical Commissioning Group [Link] 41

 Greenwich Commissioning Strategy Transforming our health and social care system 2018 to 2022

Figure 7. Summary of final budgets for 2018/19 to 2022/23

Summary of Final Budgets
5 A financially sustainable system 2018-19 2019-20 2020-21 2021-22 2022-23
£’000s £’000s £’000s £’000s £’000s

We need to do things differently; working with our partners, we will plan and Allocation 1.51% 3.36% 2.44% 2.44%
Programme 380,618 386,365 399,347 409,071 419,032
commission services in ways that reflect our ambitions in this strategy. It is only by
Running Costs 6,119 6,211 6,420 6,576 6,737
engineering shifts into community-based and primary care that we can develop a Primary Care 38,618 39,201 40,518 41,505 42,516
financially sustainable system. NHSE Transfers (1,988) (2,018) (2,086) (2,137) (2,189)
Total RRL 423,367 429,760 444,200 455,016 466,096
Section 2 highlighted the financial challenges faced
Spend
across the system. Pressures on the system are expected BOX G: COMMISSIONING FOR VALUE
to continue to rise at a faster rate than funding, and we Acute (220,521) (236,812) (245,041) (252,851) (260,865)
must deliver efficiency savings of around 3.5% of the We will use the following levers to commission high Mental Health (50,457) (51,219) (52,940) (54,229) (55,549)
budget for 2018/19 alone. This section outlines our quality services: Community (31,689) (32,798) (34,566) (34,066) (33,472)
plans to achieve this over the next three years. Continuing Care (19,998) (20,998) (21,232) (21,408) (21,583)
QIPP – Quality, Innovation, Productivity and
We will continue to work to deliver the NHS 10 Point Prevention programme to transform Greenwich CCG Prescribing (37,839) (39,731) (40,175) (40,507) (40,838)
Efficiency Plan (NHS England, 2017a), which includes through quality care improvement and savings. The Primary Care (38,618) (39,201) (40,518) (41,505) (42,516)
a range of measures from clamping down on aim is to deliver a better service on a tighter budget. Other (15,710) (15,383) (15,333) (15,239) (15,144)
temporary staffing spend and getting best value
QOF – the Quality and Outcomes Framework Running Costs (6,118) (6,211) (6,420) (6,576) (6,737)
from medicines and pharmacy, to freeing up hospital
beds and reducing unwarranted variation through is designed to drive ongoing improvements in Contingency (2,117) (2,149) (2,221) (2,275) (2,330)
the Getting It Right First Time (GIRFT) programme3. standards and reward GPs for providing patients Total Spend (423,067) (444,502) (458,447) (468,657) (479,035)
We will also implement learning from the Carter Review with good quality care. For Greenwich CCG it is Assumed QIPP 3.50- 15,042 16,657 17,063 17,618
(2016), regarding the productivity and efficiency of designed to ensure that all patients receive a 3.75% from 2019/20
non-specialist acute hospitals, which account for half high level of treatment.
In Year (Surplus)/Deficit 300 300 2,411 3,423 4,679
of the total health budget. Some of the levers we will use CQUINs – Commissioning for Quality and Innovation
to commission high quality services are outlined at Box G. In addition to stimulating development of at scale providers to deliver extended access, we will invest to stimulate
framework supports improvements in the quality of
implementation of the 10 high impact actions to free up GP time (see Box H).
Figure 7, page 43, sets out the forecasted financial services and the creation of new, improved patterns
position for the CCG from 2018/19 to 2022/23. The of care.
BOX H: 10 HIGH IMPACT ACTIONS TO RELEASE TIME FOR CARE
intention is for the CCG to deliver a 1% in-year surplus
(£4.7m) by 2022/23 and a cumulative 1% surplus by 1. Active signposting: Provides patients with a 5. Productive work flows: Introduce new ways of
the end of 2021/22. In order to achieve this financial first point of contact to direct them to the most working to enable staff to work smarter, not harder.
performance, QIPP of between 3.5% and 3.75% appropriate source of help, including web and 6. Personal productivity: Support staff to develop their
(£15.0m to £17.6m) will need to be delivered on an app-based portals to provide self-help and self- personal resilience and learn specific skills that enable
annual basis over the period. The delivery of a cumulative management resources as well as signposting. them to work in the most efficient way possible.
1% surplus is a key financial target for CCGs.
2. New consultation types: Introduce new 7. Partnership working: Create partnerships and
The CCG has produced a Financial Recovery Plan which communication methods for some consultations, collaborations with other practices and providers in
sets out the financial position in greater detail. such as phone and email, improving continuity and the local health and social care system.
convenience for the patient, and reducing clinical
contact time. 8. Social prescribing: Use referral and signposting to
non-medical services in the community that increase
3. Reduce Did Not Attend (DNAs): Maximise the wellbeing and independence.
use of appointment slots and improve continuity by
reducing DNAs. Changes may include redesigning the 9. Support self-care: Take every opportunity to support
appointment system, encouraging patients to write people to play a greater role in their own health and
appointment cards themselves, issuing appointment care with methods of signposting patients to sources
reminders by text message, and making it easy for of information, advice and support in the community.
patients to cancel or rearrange an appointment. 10. Develop quality improvement (QI) expertise:
4. Develop the team: Broaden the workforce to Develop a specialist team of facilitators to
reduce demand for GP time and connect the patient support service redesign and continuous
directly with the most appropriate professional. quality improvement.

3
[Link]
42 NHS Greenwich Clinical Commissioning Group [Link] 43
 Greenwich Commissioning Strategy Transforming our health and social care system 2018 to 2022

6 From strategy to action

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strategy and to set out and agree a detailed implementation and align our current strategy. During the autumn of 2018 people living with severe mental illness (SMI) in primary care. reports/Greenwich%20Annual%20Report%20and%20
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There will be an action plan that supports this strategy. We
NHS England. (2017a). Next Steps on The NHS Five Year reports/Annual%20reports/Annual%20Report%20
will hold a series of meetings and events with our partners, Greenwich Health and Forward View. [Link]/publication/next- and%20Accounts%[Link] (accessed 11/06/18).
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accountable to the Health and Wellbeing Board. This group NHS England. (2017b). Integrated Urgent Care Service Wellbeing: 2015-2020. [Link]/
intentions over the next three years, which will provide a
comprises representatives of the CCG and the Royal Borough Specification. [Link]/urgent-emergency- News-Publications/Documents/Greenwich%20
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of Greenwich, as well as Lewisham and Greenwich NHS care/nhs-111/resources/ (accessed 11/06/18). CAMHS%20LTP%20Refresh%20Jan%[Link]
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 Greenwich Commissioning Strategy Transforming our health and social care system 2018 to 2022

Royal Borough of Greenwich. (2016). Joint Strategic Smith J., Picton C., Dayan M. (2013). Now or never: Shaping The Great Get Together on 30 June brought the CCG • Recovery College annual celebration
Needs Assessment. Greenwich Population Profile. pharmacy for the future. The report of the Commission of together with many members of the public, and provided • Coldharbour Tenants and Residents Association (TRA)
[Link]/app/uploads/2015/08/ future models of care delivered through pharmacy. Royal sound networking opportunities with other organisations.
Demography_JSNA-[Link] (accessed 11/06/18). Pharmaceutical Society. [Link]/resources/ The CCG stand focused on several key messages, including • Women’s shed Mycenae House
reports/now-or-never-shaping-pharmacy-for-the- asking people to participate in a survey monkey about • Migrant Hub
Royal Borough of Greenwich and NHS Greenwich CCG.
future (accessed 26/06/18). clinical commissioning plans. • Queen Elizabeth Hospital patient user group
(2015). Healthy Greenwich, Healthy People. Places, people
and services: working together to improve health and South East London Cancer Alliance. Delivery Plan Update: The online and paper survey monkey tested the emerging • All day outreach at Tesco Woolwich
wellbeing in Royal Greenwich [Link]. Early Diagnosis and LWBC priorities Update to the London priorities and enablers with the general public in June and • Outreach with service users and volunteers of WSUP,
uk/Get-Involved/Documents/Greenwich_Health_and_ Cancer Commissioning Board (24 May 2018) July with a total of 173 people completing a full survey. A a grass-roots drop-in project tackling homelessness,
Wellbeing_Strategy_2015-[Link] (accessed 11/06/18). shorter open-answer survey was used in an all-day outreach
The Queen’s Nursing Institute. (2016). General Practice vulnerable housing, recovery from illness and
Royal College of General Practitioners and British Geriatrics Nursing in the 21st Century: A time of opportunity. session at Tesco Woolwich. Over 50 people completed the
social isolation.
Society. (2016) Joining up care for older people with frailty [Link]/wp-content/uploads/2016/09/gpn_ shorter survey, highlighting common issues such as waiting
[Link]/about-us/news/2016/november/ c21_report.pdf (accessed 09/08/18). times, access and availability of services. Feedback with each group is planned between October
[Link] and December and will provide opportunity for further
Thrive LDN. (2017). Are we OK London? [Link]. The next stage of the Greenwich Big conversation involved
(accessed 11/06/18). engagement. Most participants completed either a survey or
[Link]/wp-content/uploads/2017/12/T1536-THRIVE- further engagement and outreach with individuals and
feedback form, and many gave the CCG permission to keep
FINDINGS_REPORT.pdf (accessed 11/06/18). groups. Materials were tailored for each audience. Many
in touch. A multi-channel campaign is planned to feedback
of the outreach and events included presentations and
and formally launch the full and summary strategy. Where
completion of the surveys, some were led by the individual
Appendix 1 – Engagement report and their desire to be heard on particular points, some
included a short two question survey, and some a longer
direct feedback may not always be possible, for example
where we engaged on the street, in Tesco Woolwich and
with users of homeless services, the planned multi-channel
conversation with an individual. All were fed back to the
Public engagement Greenwich Commissioning of the public together to discuss and deliberate future campaign will offer the greatest possibility of reaching those
commissioning team. These contacts include:
Strategy Transforming our Health and Social Care healthcare needed in Greenwich, within the context of who have participated.
System: 2018 to 2022 NHS England policy, financial constraints and increasing • Learning disability week outreach with service The Greenwich Big Conversation has provided a great
demand on services. users and champions
The approach to public engagement around the clinical opportunity to build and widen CCG networks and
commissioning strategy and commissioning plans has The discussion and feedback at these events helped shape • Governing Body strategy engagement session relationships, and our engagement will continue.
been to build relationships with community and voluntary the direction of the strategy, and a number of priority areas • NHS 70th birthday outreach at the Woolwich Centre Our approach is to continually involve local people,
sector partners who represent specific communities, and to and enablers were identified. Conversations progressed particularly those who are seldom heard, throughout our
and on General Gordon Square
undertake outreach with the public. Engagement around around these priorities although public engagement was commissioning plans and the Greenwich Big Conversation
restricted during the pre-election period between the end • Workshop on commissioning plans and draft is one step in a longer journey.
the strategy has taken place in different settings across the
of March to early May. During this time, engagement strategy at Charlton House
borough through a series of outreach, presentations and
conversations. This approach allowed us to reconnect with focused on developing models with partner organisations, • Workshop with the Nepalese community
existing stakeholders, and reach out to new, wider and with three frailty workshops bringing together over 100
more diverse individuals and groups. people from partner organisations. Healthwatch Greenwich

Communications about events and opportunities to

participate were targeted through the CCG website and
participated in the first of these workshops.
In May and June, the CCG reached out to a range of
Appendix 2 – Equality and equity impact
assessment form
social media (including over 10,000 Twitter followers), organisations including Healthwatch Greenwich, Age UK
partner organisation communication channels, direct email Bromley and Greenwich, and MENCAP. The draft clinical
of existing stakeholder networks and hand delivery of flyers commissioning strategy was presented to the June Health
and surveys to groups who prefer printed materials. and Wellbeing Board meeting, where members agreed to
This is a checklist to ensure relevant equality and equity aspects of proposals4 have been addressed either in the
create a Greenwich Health and Wellbeing Executive Group
Much of the engagement around the commissioning main body of the document or in a separate equality and equity impact assessment (EIA)/ equality analysis. It is not a
which will be instrumental in progressing transformation
strategy was branded the Greenwich Big Conversation. substitute for an EIA which is required unless it can be shown that a proposal has no capacity to influence equality.
across the system.
This took place between March and August 2018 and The checklist is to enable the policy lead and the relevant committee to see whether an EIA is required and to give
involved local people and representatives, member The CCG facilitated a workshop with the METRO GAVS assurance that the proposals will be legal, fair and equitable.
practices, staff, and key partners working together to Health and Wellbeing Forum, which is made up of
develop and finesse the clinical commissioning strategy. community and voluntary services and organisations in Equality Impact Checklist Yes/ Explain how you have considered
Over 350 members of the public directly had their say, and Greenwich. This helped us to forge new links with seldom No impact and any valid legal and/or
the programme provided many more opportunities to see heard groups and communities and contacts made during justifiable exception
the CCG brand and spokespeople, and to discuss priorities the session have been followed up. Additional invitations
1. Does the proposal affect one group more or less
and ambitions for the future. were issued to Practice Participation Groups (PPGs), and
favourably than another on the basis of:
several representatives joined the workshop, adding
The first three Greenwich Big Conversation events in valuable debate and discussion. The themes from the Age - Consider and detail (including the source of any no This document refers to targeting
March involved 167 delegates from across the borough. discussion and workshops have been threaded through evidence), across age ranges of old and younger people, approaches both towards children and young
A whole day workshop brought together community our commissioning plans, and feedback for each discussion including safeguarding, consent and child welfare. people as well as those who are frail and/or
and voluntary sector partners with commissioners and point will be shared at the September METRO GAVS elderly
providers, and two shorter workshops brought members Health and Wellbeing Forum.
4
A generic term for any policy, procedure or strategy that requires assessment.
46 NHS Greenwich Clinical Commissioning Group [Link] 47
 Greenwich Commissioning Strategy Transforming our health and social care system 2018 to 2022

Disability (including learning disabilities, physical no The strategy recognises the particular The goals and outcomes of EDS2
disability, sensory impairment and mental health needs of those with learning disabilities Description of outcome Yes /no
problems) - Consider and detail (including the source and particular consideration is documented Better health 1.1 Services are commissioned, procured, designed and delivered to meet the health yes
of any evidence), on attitudinal, physical and social on pages 33 to 36 outcomes needs of local communities
barriers.
1.2 Individual people’s health needs are assessed and met in appropriate and yes
Sex - Consider and detail (including the source of any no Priority One of the strategy considers the effective ways
evidence) on men and women (potential to link to differences in life expectancy for men and
1.3 Transitions from one service to another, for people on care pathways, are made yes
carers below). women
smoothly with everyone well-informed
Gender and gender re-assignment - Consider no Page 24 states the ambition for Greenwich
1.4 When people use NHS services their safety is prioritised and they are free yes
and detail (including the source of any evidence), on CCG to lessen health inequality and
from mistakes, mistreatment and abuse
transgender and transsexual people. This can include eliminate discrimination
issues such as privacy of data and harassment. 1.5 Screening, vaccination and other health promotion services reach and yes
benefit all local communities
Marriage or civil partnership - Consider and detail no Page 24 states the ambition for Greenwich
(including the source of any evidence), on people with CCG to lessen health inequality and Improved 2.1 People, carers and communities can readily access hospital, community health or yes
different partnerships. eliminate discrimination patient access primary care services and should not be denied access on unreasonable grounds
and experience 2.2 People are informed and supported to be as involved as they wish to be in yes
Pregnancy and maternity - Consider and detail no Page 24 states the ambition for Greenwich
(including the source of any evidence), on working CCG to lessen health inequality and decisions about their care
arrangements, part time working, infant caring eliminate discrimination 2.3 People report positive experiences of the NHS yes
responsibilities. 2.4 People’s complaints about services are handled respectfully and efficiently yes
Race - Consider and detail (including the source of no Page 24 states the ambition for Greenwich A representative 3.1 Fair NHS recruitment and selection processes lead to a more representative yes
any evidence) on different ethnic groups, nationalities, CCG to lessen health inequality and and supported workforce at all levels
Roma gypsies, Irish travellers, language barriers. eliminate discrimination workforce 3.2 The NHS is committed to equal pay for work of equal value and expects yes
Religion or belief - Consider and detail (including no Page 24 states the ambition for Greenwich employers to use equal pay audits to help fulfil their legal obligations
the source of any evidence), on people with different CCG to lessen health inequality and 3.3 Training and development opportunities are taken up and positively evaluated yes
religions, beliefs or no belief. eliminate discrimination by all staff
Sexual orientation (including lesbian, gay bisexual no Page 24 states the ambition for Greenwich 3.4 When at work, staff are free from abuse, harassment, bullying and violence from yes
and transgender people) - Consider and detail CCG to lessen health inequality and any source
(including the source of any evidence), on heterosexual eliminate discrimination
3.5 Flexible working options are available to all staff consistent with the needs of the yes
people as well as lesbian, gay and bi-sexual people.
service and the way people lead their lives
2. Will the proposal have an impact on lifestyle? yes Priority One in the strategy aims to prevent
3.6 Staff report positive experiences of their membership of the workforce yes
Consider and detail (including the source of any illness and help our population to live well
evidence) e.g. diet and nutrition, exercise, physical Inclusive 4.1 Boards and senior leaders routinely demonstrate their commitment to promoting yes
activity, substance use, risk taking behaviour, education leadership equality within and beyond their organisations
and learning. 4.2 Papers that come before the Board and other major Committees identify yes
3. Will the proposal have an impact on social yes Priority One in the strategy aims to prevent equality-related impacts including risks, and say how these risks are to
environment? – (Consider and detail (including the illness and help our population to live well be managed
source of any evidence) e.g. social status, employment 4.3 Middle managers and other line managers support their staff to work in yes
(whether paid or not), social/family support, stress, culturally competent ways within a work environment free from discrimination
income Carers and general caring responsibilities. Policy Author Signature: Virginia Morley Date: 15.08.2018
4. Will the proposal have an impact on physical yes Priority One in the strategy aims to prevent Date: 15.08.2018
environment? e.g. living conditions, working illness and help our population to live well Equalities Lead Signature: Date: 15.08.2018
conditions, pollution or climate change, accidental (Carol Berry)
injury, public safety, transmission of infectious disease.
5. Will the proposal affect access to or experience of yes Page 27 of the strategy states our ambition
services? e.g. Health Care, Transport, Social Services, to focus on outcome-based commissioning
Housing Services, Education. of high quality services We aim to design and implement policies, procedures and functions to meet the diverse needs of our service users,
population and workforce, ensuring that they receive good access, outcome and experience. We have developed and
By using evidence and insight to assess and grade our equality performance, NHS Greenwich can generate instigated a rolling Equality Impact Assessment Programme for this purpose and also to ensure that it complies with the
much of the information we will require to demonstrate compliance with the Public Sector Equality Duty general duties referred to in the Equality Act 2010. Policies, procedures and functions of the CCG are impact assessed
(PSED). The checklist is to enable the policy lead and the relevant committee to see if a particular policy by Equality, Health Inequality, Quality and Privacy. Risk assessments are completed, and any mitigations of negative
or project will provide the relevant evidence to assist NHS Greenwich CCG meet the set-out EDS goals to impacts are monitored. Full Equality Impact Assessments will be undertaken if impact cannot be mitigated and the
achieve better outcomes for patients and staff. recommendations will be used to inform new proposal, projects and business cases.

48 NHS Greenwich Clinical Commissioning Group [Link] 49

 020 3049 9000 and ask for @NHSGreenwichCCG
the engagement team
[Link]@[Link]
NHS Greenwich CCG, The Woolwich Centre,
35 Wellington Street, London SE18 6ND [Link]

If you would like this document in an alternative format please

contact the communications team on 020 3049 9000 or email
[Link]@[Link]

Thank you to Sally Williams September 2018