Quarterly Meeting Notes

June 2010

Venue: Lighthouse West London

Theme: Access to Primary Care

Ziaur Rahman – BME Health Forum Chair, welcomed all to the meeting and introduced the first Item.

Item 1:

Good Practices for Access and Well-being programme – Launch of the Final Report

Isis Amlak – Programme Coordinator

Isis outlined the background to the programme.

• 18 month pilot programme
• A unique approach to working with communities in delivering health care
• Funded by NHS Westminster and NHS K&C
• It was delivered by 6 community groups
• Evaluation process was done by Shared Intelligence
• The coordination was done by the Migrants and Refugee Communities Forum.

The key objective of the programme was to work with patients and service providers together to improve access.

Model

We need to look at a community development approach. We need to go to communities to work with them to develop services together.

We need to use Cultural Brokerage. In other words we need to respect self determination, respect community differences. Communities should determine their own needs and we need to use their knowledge and expertise to develop services.

What we did

• We found 6 community groups via a tender process to work on the programme
• We produced the Good Practice Guide to Interpreting (in 6 languages) that discourages the use of children or family members as interpreters.
• We developed Fact cards (in the 6 languages) giving information on GPs, Dentists, Mental Health Services, PALs, Screening services and more.

Surveys

We conducted two Questionnaires as part of the evaluation process. 300 at the beginning and 300 at the end.

Key Findings from Surveys

• There was a significant increase in knowledge 

What worked

• The support of the Access Facilitators. Funding was offered to each of the organisations to employ them fulltime. The project would not have worked without a fulltime employee to take on this role. They were given training and learnt a lot about the NHS that they did not know before. 

What didn’t work

• Working with GP and receptionists. We did not manage to successfully engage with and work with GP practices

So how do we get GPs to work with us on a project like this? Our main finding regarding this is that with GPs time is a key issue. We need to present them with something immediately practical and not time consuming to work with. Being able to offer money would also help but this is not a model we would be keen to promote.

Recommendations (a selection from the report ‘Good Access in Practice’)

• All stakeholders should work together to develop a model of governance of primary care services that is based on the Canadian Community Health Centre (CHC). 

• In addition to developing a CHC model, commissioners should ensure BME communities are actively involved in all service developments, at all stages from inception to evaluation. 

• Stakeholders should use a community development approach for engagement with BME communities. 

• Commissioners should adopt a Cultural Brokerage approach. 

• BME Access Facilitators should be recruited. 

Q&A

Lev Pedro (KCSC) commented on the timeliness of the project when considering the current drive for the polysystem approach to delivering services in K&C, for example. We need to use this piece of work to influence the polysystem approach – we need to send the report to commissioners.

Question: What will happen next?

Answer: We want to continue the work with the community groups. (Ziaur Rahman, QPBA). There will be a response to this report from the Chief Exec of NHS Westminster at the next Quarterly meeting. There is also work being done in Westminster as well on the polysystem approach – or GP led commissioning. There are discussions on how we can use this model. (Brian Colman).

Comment: It’s very hard to work alongside GPs – if this problem can be resolved this will be key.

Response: Yes this is a key issue. We must find a way to work together much more strategically by working collaboratively (Lev Pedro, KCSC).

There are models to look at for example, Luton Health Centre and Bromley by Bow (Isis Amlak).

Question: With the GPs you did work with, did they not offer you suggestions as to how to work with GPs better?

Answer: Yes. The main point they highlighted was the issue of time. If something was offered to them which meant investing more of their time they would be unlikely to respond. We would have to approach them with something very simple.

Item 2

GPAW Access Case studies dramatised by MRC’s ESOL and Drama group

Item 3

Dental Report Update – An update on ‘Commissioning World Class Dentistry – a race equality impact assessment’

Agnes Olagunju (Deputy Head of Primary Care Commissioning NHS Westminster)

This study was commissioned in 2009. 60 interviews were conducted, 51 BME residents, 7 Dentists and 2 Commissioners.

Themes

One of the main points that came out of the study was that there was a disparity between what we think we know and what is the reality in terms of the experience of BME communities and Dentists.

Reported different treatment experience

• More extractions over more expensive band 3 treatment like crowns, bridges.
• Over 40% not happy with the treatment they received.

6/7 dentists never use interpreters – where as respondents preferred formal interpreters

Underestimation of the link between smoking and oral health

Recommendations:

Four main recommendations came out. We have not addressed them all but we are starting to.

Interpreters

We have had more and more requests for interpreters – we are on the way to changing the habit of dentists using interpreters. The message is out there to dentists that they can book interpreters too.

How are we going about this?

• Quality indicators included in new contract
• New literature presented to all practices in March
• Follow up at contract monitoring visits – a point about how you communicate with those who don’t speak English well is included in Performance Management.

Ethnic Monitoring

Patient Surveys:

• Communication and problems with cultural barriers is now part of patient surveys.

• Ethnic Monitoring is included – but not compulsory at the moment. (Less than half will fill this part out at the moment. However we need to educate people gradually that this section is about improving services to meet needs of all.)

Private Treatment

This is a grey area. There is always confusion as to where NHS stops and Private starts.

Complaints need to be made where patients are not sure if they have been given the correct treatment or if they have been unnecessarily encouraged to go for private treatments where NHS was available.

The Care Quality Commission will be registering all dental practices from April 2011.

Capacity

• Two new dental practices – one in Baker Street and one in Victoria
• Increased capacity from existing practices – Have trained dental nurses so that some of the work can be handed over to them so time is increased for dentists.
• Provision of Oral Health sessions in schools

Q&A

Question: When it comes to dentures – it is all too often the case that people are issued them on the NHS and then do not use them because they are of poor quality.

Answer: We are moving towards a national decision to encourage implants as opposed to dentures.)

Item 4

Voluntary Sector Funding Review

John Dimmer (Policy and Partnerships Manager, Westminster City Council)

• We are trying to achieve a stronger and more sustainable relationship for the future.

• There will be no grants offered this year; however some grants have been extended for 3 months of the next year.

• There will be a big consultation in the summer and a decision will be made finally in December.

Westminster Compact

• Agreed in 2004 
• Framework for developing closer partnerships 
• Shared principals 

Development and sustainability - We are shifting towards a commissioning approach by the council much like the NHS.

Does the grant process fit into this?

There is a fundamental shift in the political landscape.

Consultation

This will be on the relationship between Councils, NHS and voluntary sector.

We see the Voluntary sector as a big partner. We need to look at the overall contribution of the voluntary sector – to acknowledge what it provides.

What next?

• Please give feedback by 22^nd October.

• There will be 4 big consultation events over the summer and the decision will be made in December. It is important that you attend.

Item 5

Major Health Campaign

Sue Nelson

NHS Westminster has asked for a world class public health campaign to tackle

• Smoking
• Obesity
• Harmful drinking

The main drive is to empower residents with the relevant information and tools to tackle these problems.

One of the main reasons for the Campaign is that for people born between 2004 and 2008 there is a 15.6 year gap in life expectancy for men born in the most deprived 10% of the borough and the least deprived 10% of the borough.

Also NHS Westminster is currently ranked 151 out of 152 PCTs, where 152 equals the largest life expectancy gap in the country.

There are 2 stages:

1. Research and planning stage
2. Implementation

Stage1. Consists of four work streams

W1 – Health needs assessment

W2 – Local insight – this is where we have consulted and involved the BME Health Forum to get insight from local communities, including in depth discussions with BME groups to assess local attitudes and habits regarding smoking, healthy eating and harmful drinking.

W3 – Proposals and Plans for implementation

W4 – Evaluation – including equality impact assessment

Timeline

• Local insight report including resident surveys is due ode completion on 23^rd August 2010
• Health Needs assessment report is due on 10^th September 2010
• Final evaluation plan is due at the end of September 2010
• Final Implementation plan is due in mid October 2010
• Delivery will run from October 2010 until April 2013 and beyond.

Some of the initial findings

• Around 2/3 of responses were from women and around 2500 were returned from households with children under 16 
• Harmful drinking appears to rise with income 
• Levels of physical activity do not appear to be influenced by income/deprivation, although this seems to be linked with diet and smoking 
• Obesity reported to be a particular issue for people from African, Caribbean, Arabic and Bangladeshi communities 
• Health risks from Shisha use not widely appreciated or advertised 
• Drinking ‘hidden’ in Arabic and Bengali communities 
• Stress experienced by those with uncertain immigration status said to be contributing to drinking/ smoking/ poor diet 
• Lack of motivation can prevent engagement even when free services are provided 
• Muslim women need women-only exercise facilities 
• Service need to be local, non-judgemental and not too structured 
• Bottom-up services delivered by the community work best 

Q&A

Comment: Regarding the point about 2/3 of responses being from women – it should be noted that in different communities it will be different. For example in Arabic communities it will be predominantly men who would respond.

Question: Regarding the above point, is there a breakdown available in terms of ethnic background of respondents? 

Answer: Yes this is monitored and is available as well

Comment: Regarding the last point about Bottom-up or ‘Ground-up’ services delivered by the community – the benefits of working with communities are not just in the evaluation and delivery of services but also in the designing and developing of services.

Comment: About £1 million has been earmarked for this project. My concern is that there should have been more of a partnership approach in the way that the work has been done – not just little pots of money handed out to community groups for their contribution to the research.

Question/ comment: I have heard that strategies around equality and diversity are changing and it is very worrying.

Answer: In the Department of Health the 2 key priorities are still inequalities and prevention. It is in the strategy of the Department of Health.