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Plenary-minutes-5th-May-09

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					                                                                          C    L   H

              Central London Healthcare Ltd
        53 New Cavendish Street, London, W1G 9TQ, Tel: 0207 486 2231, Fax: 0207 487 1500,
                              www.centrallondonhealthcare.co.uk

           Notes of 30th Plenary held on 5th May 2009
              at Paddington Green Health Centre
Present:
Neville Purssell (NP) (Vice Chair)            – Paddington Green Health Centre
Chatsuda Chierakul (GP)                       - Cavendish Health Centre
Kazimierz Bninksi (GP)                        - Harley Street Surgery
Sarah Freedman(GP)                            - Imperial College Health Centre
Denise Johnson (Centre Mgr)                   - King’s College Health Centre
Maria Angeles Corcuera (GP)                   - Lanark Medical Centre
Cara Ruggeri (Admin)                          - Lanark Medical Centre
Hugh Wright (GP)                              - Maida Vale Medical Centre
Sawsam El-Khadem                              - Maida Vale Medical Centre
Andy Goodstone (GP)                           - Marylebone Health Centre
S. Nazeer (GP)                                - Mayfair Medical Centre
Selwyn Dexter (GP)                            - North West London Medical Centre
Victoria Froome (GP)                          - Paddington Green Health Centre
Rishi Chopra (GP)                             - Paddington Green Health Centre
Chris Bark (GP)                               - Soho Medical Centre
Steven Charkin (GP)                           - St John’s Wood Medical Centre
Jasna Bibic (PM)                              - The Connaught Square Practice
Husna Martin (GP)                             - The Randolph Surgery
Laila Abouzekry (GP)                          - The Third Floor Medical Centre
Aseem Kashif (GP)                             - The Third Floor Medical Centre
Edward Leigh (GP)                             - Wellington Health Centre

Central London Healthcare staff: Sanja Todorovic (ST) (Office Manager); Kate
Meadowcroft (Polyclinic Implementation Project Manager))
Guest speakers from St. Mary’s Hospital: Dr. Mando Watson (Consultant Paediatrician); Dr.
Dalbir K. Sohi (Paediatrician Registrar); Dr Tagore Charles, Dr Stephen Goldring.

Apologies: Dr. S. Wong, Dr J. Amakye, Dr. G Ahmed, Dr. S. Honey, Jeanette Creaser.

1. Neville Purssell (NP) chaired the plenary and welcomed the four guest speakers from St.
Mary’s Hospital paediatric unit. Drs Watson and Sohi led a thought-provoking presentation
on “Integrated Paediatric Services in West London”.

Dr. Watson explained that - since her appointment at St Mary’s eight years ago - a
particular focus has been to develop more integrated ways of working with GPs and
community nursing staff, with an emphasis on educating primary care teams to manage
less complex conditions at the practice level.


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                               Registration number: 06135803, Registered: UK
The Outreach Paediatric Clinic run by Dr. Sohi at Paddington Green Health Centre (PGHC)
is an example of this approach. The once-monthly clinic sees 5 patients (mostly new
referrals) for a 30 minute consultation each.

Dr. Sohi considers the main benefits of the clinic to be:

       A more familiar environment – this means that the patient and accompanying family
        member(s) are more relaxed
       The opportunity for face-to-face consultant / GP discussion and information sharing
       Consultant access to patient’s electronic medical record

Dr. Sohi explained that the clinic is scheduled immediately prior to the regular clinical
meeting at PGHC, which provides the opportunity for a detailed consultant/ GP discussion
of each patient’s care. Whilst the GP may have useful knowledge about the patient and
their family background that contributes to the care decision, the consultant will give clinical
insights that can inform not only the current case but also future GP referral patterns (ie. the
GPs acquire additional knowledge to be able to manage a particular condition themselves).

NP noted that the Outreach Clinic addressed a previously unmet demand for joint Primary
and Secondary care input – including the need for reassurance and guidance in some
cases. This was reflected in the fairly high discharge rate of 51% in comparison with the
Outpatients discharge rate of approx. 30%.

Dr Watson stressed that the opportunity for clinical discussion with GPs was essential to the
Outreach project, believing that successful collaboration only happens when there are
sufficient points of contact between all healthcare colleagues involved a patient’s care.

The department’s philosophy of multiple agencies working together to address each child’s
needs was supported by several new services including:

       Paediatric Short Stay Unit (PSSU) – provides very flexible approach to length of
        patient stay
       Rapid referral clinics (ie. not A&E but fast track access to consultant for urgent
        cases)
       Email enquiry service: paediatrichotline@imperial.nhs.uk
       Consultant telephone hotline Monday to Friday, 12.00-14.00 – tel. 07810 794 718
        (eg. for GPs to ask specific referral questions)
       Outreach paediatric clinics (so far only at PGHC but there are plans to expand
        programme)

Dr Watson announced that the department is now preparing to pilot additional Outreach
clinics across Westminster – and preferably across an entire PBC cluster in order to test out
methods of delivering outreach services to a variety of practice types. The project will
hopefully incorporate an academic study of the clinical outcomes (funding is currently being
sought for this)

NP/Dr Watson clarified that collaboration with the Outreach clinic project would probably
have a cost-neutral impact in terms of a practice’s referral spend. After any set-up costs,
the ongoing spending involved would be on travel, education and administration. It is
unknown whether practices’ total paediatric referral spend would go down or remain
relatively stable – this is because, whilst additional referrals would be generated by the new

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                               Registration number: 06135803, Registered: UK
service, the collaborative working style would be expected to lead to the earlier discharge of
more patients back into primary care.

CLH practices were invited by Dr Watson to consider if they were interested in
hosting a clinic, or linking up with 1 or 2 other practices to do so.
(ST will email an Expression of Interest form to all practices.)

2. CLH Update

Following a re-run of last month’s AGM (see attached) NP updated members on:

      Incentive Scheme 08/09 – All submissions should have been received by 30th April
       09. These will be analysed and practices will be notified about the amounts to be
       paid as soon as possible. The Board are preparing next year’s scheme and
       would welcome practice feedback about which parts of last year’s scheme
       were most and least helpful, and any changes they would like to see in future.

      The Board needs a new GP member and NP encouraged anyone with an interest
       in developing and implementing CLH’s PbC agenda to put their name forward or
       contact Ruth O’Hare or himself for further information.

      Update on Polysystem plans: In accordance with national targets, NHS
       Westminster is to working get four polyclinics up and running in the near future.
       South Westminster are already being consulted about a polyclinic site, and polyclinic
       planning is in process for Queen’s Park and Paddington. The CLH PbC cluster
       covers two “polyclinic” areas – Central North and Central East Westminster. NHS
       Westminster has approved the implementation of a federated “polysystem” or hub
       and spoke model for both areas. In Central North Westminster (CNW), Brampton
       House has been identified as the “hub” site where “core” services and diagnostics
       will be delivered. Core services include an Urgent Care Centre that will be open 8am
       to 8pm, 365 days a year with access to a rota GP, nursing staff etc. Some enhanced
       services will also be located at the Brampton House “hub” (eg, community cardiology
       and MSK clinics). Other new and expanded services will be available at a variety of
       GP practice “spokes”. In view of these plans, CLH practices should begin to
       consider their hosting and/or delivery capabilities and interests.

       NHS Westminster has agreed that CLH will lead on the strategy and management for
       the two polysystems in their area. However NHS Westminster will tender for all
       additional/ redesigned services to be delivered in accordance with the “any willing
       provider” commissioning model. A more detailed plan for the CNW polysystem
       implementation is not yet available but the principle is established that it will build on
       the foundation of existing GP practices.

       To ensure effective integration of the polysystem’s enhanced service provision into
       CLH practices, it is vital that GPs prepare to work together more closely both with
       each other and secondary care colleagues.


The next Plenary will be held on Tuesday, 2nd June 2009, 18.30-21.00 at Paddington
Green Health Centre.


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                               Registration number: 06135803, Registered: UK

				
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