How we’re improving health services in west Hertfordshire
We have made real strides in our work to transform services this year – particularly our Your Care, Your Future ambitions to provide patients with more joined-up care closer to where they live.
Below are just a few examples of these new-style services. Some common themes throughout are that all services have established local clinics where patients see specialist qualified staff working in the community. Patients are referred by their GP and the new community-based staff then
assesses the patient’s needs, working out with them, what would be the best treatment, providing this in the community where possible.
Further details are available in the full Annual Report and Accounts.
During 2018/19, Herts Valleys CCG’s performance was measured against a range of indicators contained in the NHS England’s CCG improvement and assessment framework (IAF).
Results are available to view at My NHS.
Key points on our performance in west Hertfordshire can be found on our annual report.
Strengthening the organisation
Following an external review and listening to feedback from stakeholders we have taken action to strengthen our leadership, internal processes and governance to put the CCG in better shape to move forward. Improvement actions have included:
- Strengthening our finance, business intelligence and contracts functions
- Tighter governance arrangements including establishing a finance and performance committee
- Strengthening our workforce through training and development for senior managers and improving staff appraisals.
Community gynaecology service
The enhanced community gynaecology service supports patients aged 16 years upwards. The service is provided for the CCG by the Community Gynaecology Partnership, which includes teams of specialist GPs and consultant gynaecologists linked to different local hospitals.
Patients are referred into the community gynaecology service by their GP. From there the service works hard to ensure that patients are seen by the right person in the right place first time, for their particular gynaecological issue.
The service has clinics in all four of the west Hertfordshire localities.
Community Integrated Musculoskeletal (MSK), Rheumatology, Pain and Postural Stability service
Integrated diabetes service
The Herts Valleys integrated diabetes service has been in place since April 2018. This innovative service provides the majority of diabetic patients with the treatment they need in their local community rather than in hospital and ensures their care is
West Hertfordshire Hospital NHS Trust (WHHT) is the lead provider for this integrated service working in partnership with Hertfordshire Community Trust (HCT), Hertfordshire Partnership Foundation Trust (HPFT), and Herts One GP Federation.
You can find out more about this service here.
Nutrition and dietetics
The new Herts Valleys integrated nutrition and dietetic service for children and adults went live in November 2018.
Hertfordshire Community NHS Trust (HCT) is the lead provider and the service is provided in partnership between the NHS and the voluntary sector.
The new service supports a wider range of patients who have difficulty with eating or maintaining a good diet as well as carers and healthcare services including local GPs, care homes and hospices. This is achieved by providing specific clinical services and through social support, education and training so that patients feel more able to manage their diet and nutrition themselves.
Ear, nose and throat (ENT) service
A new service launched on 4 February 2019 for patients in west Hertfordshire with ear, nose and throat (ENT) problems. It aims to make sure that more people receive expert diagnosis, treatment and supportclose to where they live rather than having to travel to hospital for their appointments.
The community ENT service is provided by Communitas Clinics Limited. Communitas are working closely with local GPs to deliver the new service.
A new community ophthalmology service provided by Community Health & Eyecare Limited (CHEC) launched in January 2019. Patients referred to Community Health & Eyecare Limited are booked into community clinics or hospital eye services where appropriate, or returned back to their patient’s GP or optometrist with a management plan.
Their referral centre includes a consultant-led team. Clinics are delivered from a GP practice or accredited optometrists in each locality.
Healthharmonie is running a community dermatology service on a pilot basis for all ages. The pilot service started in February 2019 and will run for 18 months.
In early 2020, the CCG will invite bids for a community dermatology service across all four localities – informed by the pilot service.
GP direct access ultrasound service
The procurement process was completed in December 2018 and the service was available from April 2019.
People needing an ultrasound now access the new service at a designated local GP surgery rather than in hospital. We hope to halve waiting times for patients needing an ultrasound and also be more convenient for patients as they will no longer need to travel to hospital.
The service is provided by Physiological Measurements Ltd.
Older and frail people: Frailty and falls prevention
Approximately one in ten west Hertfordshire residents over 65 are living with frailty. There will be 60,000 more over 65s in west Hertfordshire by 2035 - a 66% increase.
We are working with partners to transform the way we deliver services to support frail patients.
GP practices are starting to proactively identify patients with moderate frailty who would benefit from further support so that they can be looked after in the community and so that we can help prevent further decline, including falls.
Transforming adult community health services
Central London Community Healthcare NHS Trust (CLCH) will be providing a new community health service for adults across west Hertfordshire starting on 1 October 2019.
Since announcing that CLCH would be providing the new service, following a detailed procurement exercise, we have been working with them and the current provider, Hertfordshire Community NHS Trust, to ensure a smooth handover for patients and staff.
The new model will work towards creating a fully joined-up service. Services such as community nursing and therapy, rehabilitation and end of life care will work more closely with GP services, mental health, social care and voluntary services to provide more coordinated patient care. We want staff and patients to be aware that they should not expect changes initially; we are keen to make sure there is real continuity. At the same time, there will a new model developing which will work at a neighbourhood level and will tie into local networks including primary care networks.
The new service we are commissioning will include:
- a greater focus on advice and support so that patients can look after themselves and stay healthy and get support early on so that their health doesn’t deteriorate to a point they need hospital or residential care.
- greater use of technology to enhance services and support.
- targeting resources to tackle health inequalities.
There will be increased investment in existing and new services, such as leg ulcers and phlebotomy, in line with our Your Care, Your Future ambitions to strengthen community provision.
The launch of the new service on 1 October 2019 is the first stage of a longer development to transform services over the seven years of the contract and we will involve staff, patients, and other providers as the service develops.
Our vision for urgent care
Accident & Emergency (A&E) attendances were higher this year than last, not only in west Hertfordshire but across England. This year we developed a plan to deal with this across the health and social care system. The plan provided for additional beds to meet the demand throughout the winter period. It also featured support to get patients back to their homes rather than have an extended stay in hospital. Part of the plan included placing a GP at the entrance to A&E at Watford General Hospital to assess and triage patients as they entered the department so that they were seen more quickly.
We developed a new urgent care strategy and this means that we will:
- Use technology to identify in real time any pressure points across the Hertfordshire and west Essex health and care system.
- Join-up computer systems across Hertfordshire and West Essex STP.
- Develop primary, community and hospital services that work all together to reduce emergency attendances and admissions.
- Consider placing an urgent treatment centre at Watford General Hospital as the first point of call for patients attending A&E. This would further help to triage patients and reduce pressure.
- Planning to develop the minor injuries unit at St Albans City Hospital into an Urgent Treatment Centre.
Mental health and learning disabilities
We received significant recognition for our work in two areas of mental health services. In December 2018, we, with local partners, were successful in our bid to become a trailblazer site for Mental Health Support Teams, working with schools to strengthen support for children and young people with mental health issues.
In July 2019, our pilot Improving Access to Psychological Therapies (IAPT) service, focusing on caring for the emotional wellbeing of people living with diabetes, became regional champion at the prestigious NHS70 Parliamentary Awards.
We continue to work closely with our partners to improve the health of people with a learning disability.
With support from community learning disability nurses and the GP lead for learning disabilities, GP practices have successfully increased the number of annual health checks for people with a learning disability that have been completed from 64% in 2017-18 to 74% in 2018-19. Annual health checks for people with a learning disability mean that GPs find out about health conditions sooner and can treat them more effectively and more swiftly.