SUPPLEMENTARY AGENDA A meeting of the Governing Body Part I

Date: 11 January 2018 Time: 10.00 am - 12.03 pm Venue: Cantilever House, Eltham Road, London SE12 8RN Chair: Dr Marc Rowland

Enquiries to: Lesley Aitken Telephone: 020 7206 3360 Email: [email protected]

Voting Members

Dr Marc Rowland (Chair) Chair Dr David Abraham Senior Clinical Director Alison Browne Registered Nurse Dr Charles Gostling Clinical Director Anne Hooper Lay Member Dr Sebastian Kalwij Clinical Director Shelagh Kirkland Lay Member Dr Faruk Majid Clinical Director Dr Jacqueline McLeod Senior Clinical Director Professor Simon MacKenzie Secondary Care Doctor Dr Angelika Razzaque Clinical Director Tony Read Chief Financial Officer Ray Warburton OBE (Vice- Lay Member Chair) Martin Wilkinson Chief Officer

Non-Voting Members

Aileen Buckton Executive Director, Community Services, Lewisham Council Dr Danny Ruta Public Health Director, Lewisham Council Dr Simon Parton Local Medical Committee Chair Dr Magna Aidoo Healthwatch Lewisham Representative

Quorum

The Governing Body will be deemed quorate when a minimum of 7 members, 4 of which must be Clinical Directors, one must be either the Chief Officer or Chief Financial Officer and two must be independent members (Lay Members, Secondary Care Doctor or Registered Nurse).

A member who is present at Governing Body meeting and is conflicted by a particular agenda item will not contribute to the quoracy of the meeting for the duration of that agenda item.

Chair : Dr Marc Rowland Chief Officer Martin Wilkinson Order of Business

Members of the public are requested to give any questions to the Governing Body in relation to matters not on the agenda before the meeting in writing to the Board Secretary. These will be responded to, at the discretion of the Chair, at the designated time shown on the agenda

Time Item Papers Presented by 1. 11:40 Public Consultation: The future of the NHS 1 - 108 Dr David Abraham Walk-in Centre, New Cross and improving provision and access to primary care To approve the recommendations made

Date of next meeting: Thursday, 8 March 2018, 10.00 am

The Committee to agree that, if required, the public should be excluded from the meeting while the remaining business is under consideration, as publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted.

Chair : Dr Marc Rowland Chief Officer Martin Wilkinson Managing Conflicts of Interest: Governing Body, committees, sub-committees and working groups

1. The chair of the Governing Body and chairs of committees, subcommittees and working groups will ensure that the relevant register of interest is reviewed at the beginning of every meeting, and updated as necessary.

2. The chair of the meeting has responsibility for deciding whether there is a conflict of interest and the appropriate course of corresponding action. In making such decisions, the chair may wish to consult the member of the governing body who has responsibility for issues relating to governance.

3. All decisions, and details of how any conflict of interest issue has been managed, should be recorded in the minutes of the meeting and published in the registers.

4. Where certain members of a decision-making body (be it the governing body, its committees or sub-committees, or a committee or sub-committee of the CCG) have a material interest, they should either be excluded from relevant parts of meetings, or join in the discussion but not participate in the decision-making itself (i.e., not have a vote).

5. In any meeting where an individual is aware of an interest, previously declared or otherwise, in relation to the scheduled or likely business of the meeting, the individual concerned will bring this to the attention of the chair, together with details of arrangements which have been confirmed by the governing body for the management of the conflict of interests or potential conflict of interests. Where no arrangements have been confirmed, the chair may require the individual to withdraw from the meeting or part of it. The new declaration should be made at the beginning of the meeting when the Register of Interests is reviewed and again at the beginning of the agenda item.

6. Where the chair of any meeting of the CCG, including committees, sub-committees, or the governing body, has a personal interest, previously declared or otherwise, in relation to the scheduled or likely business of the meeting, they must make a declaration and the deputy chair will act as chair for the relevant part of the meeting. Where arrangements have been confirmed with the governing body for the management of the conflict of interests or potential conflicts of interests in relation to the chair, the meeting must ensure these are followed. Where no arrangements have been confirmed, the deputy chair may require the chair to withdraw from the meeting or part of it. Where there is no deputy chair, the members of the meeting will select one.

7. Where significant numbers of members of the governing body, committees, sub committees and working groups are required to withdraw from a meeting or part of it, owing to the arrangements agreed by the Governing Body for the management of conflicts of interest or potential conflicts of interest, the remaining chair will determine whether or not the discussion can proceed.

8. In making this decision the chair will consider whether the meeting is quorate, in accordance with the number and balance of membership set out in the CCG’s standing orders or the relevant terms of reference. Where the meeting is not quorate, owing to the absence of certain members, the discussion will be deferred until such time as a quorum can be convened. Where a quorum cannot be convened from the membership of the governing body, committees, sub committees and working groups owing to the arrangements for managing conflicts of interest or potential conflicts of interest, the chair may invite on a temporary basis one or more of the following to make up the quorum so that the CCG can progress the item of business:

a) an individual GP or a non-GP partner from a member practice who is not conflicted b) a member of the Lewisham Health and Wellbeing Board; c) If quorum cannot be achieved by a) or b) (above) a member of a governing body of another clinical commissioning group.

9. These arrangements will be recorded in the minutes.

Chair : Dr Marc Rowland Chief Officer Martin Wilkinson This page is intentionally left blank Item Number 1

A meeting of the Governing Body Thursday 11th January 2018

Supplementary Agenda Item: 16

Public Consultation: The future of the NHS Walk-in Centre, New Cross and improving provision and access to primary care

CLINICAL LEAD/S: Dr David Abraham, Clinical Director – Urgent Care Lead and Dr Jacky McLeod, Clinical Director – Primary Care Lead SENIOR RESPONSIBLE OFFICER: Martin Wilkinson, Chief Officer MANAGERIAL LEAD: Diana Braithwaite, Director of Commissioning & Primary Care CONTRIBUTORS: Dorothy Muir, Interim Primary Care Engagement Manager, Valery Lawrence, North East London Commissioning Support Unit, Simeon Baker, Communications & Engagement Lead, Lewisham Health & Care Partners, Ashley O’Shaughnessy, Deputy Director of Primary Care, Ian Ross, Associate Director Primary Care Transformation and Charles Malcolm-Smith, Deputy Director (Strategy & Organisational Development).

1. RECOMMENDATIONS: 1.1 The CCG has conducted and commissioned a comprehensive review and evaluation of the consultation responses and proposed alternatives. Based on this review the CCG is assured that the needs of patients currently attending the Walk-in Centre can be met by mainstream primary care, current and planned alternative services. The Governing Body is recommended to allow the extended contract for the NHS Walk-in Centre at New Cross to expire on 31st March 2018 and improve provision and access to urgent and non-urgent primary care services in Lewisham; (a) By continuing to increase use and capacity of the GP Extended Access Service; (b) To commission an additional outreach and walk-in service for rough sleepers in Deptford and New Cross.

2. SUMMARY: 2.1 On the 13th July 2017 the CCG Governing Body agreed to commence formal consultation on the future of the New Cross Walk-in Centre service and that the CCG Chief Officer was delegated to assure that the consultation plan included the key stakeholders that will be directly engaged and the supporting materials that will be used. 2.2 In line with the public sector duty to consult, pre-consultation on the proposal and the plans for formal public and stakeholder consultation were reviewed and endorsed by the Healthier Communities Select Committee on 20th July 2017. 2.3 The formal public consultation was launched on 8th August 2017 and concluded on 30th October 2017. Over this 12 week period the CCG conducted an extensive and transparent programme to support the formal consultation – engaging with patients, the general public, public bodies, key stakeholders including health care partners and the third sector. 2.4 On the 9th November 2017 the Governing Body was presented with; (i) a summary of the emerging key themes from the engagement activities on the formal consultation and the CCGs response; (ii) the headline results from the online survey; and (iii) seven areas for which additional assurance was required; I. Comprehensive review and evaluation of the consultation responses and proposed alternatives is completed and published; II. A review of the capacity, access and public awareness of the GP Extended Access Service;

1 | Page LCCG:GOVBODJAN2018 – WPage i C & P 1 C

III. The GP streaming and primary care access services at the Urgent Care Centre, University Hospital Lewisham are delivering against the commissioned model and requirements; IV. Development of services to support the most vulnerable (specifically rough sleepers) as agreed at the Homeless Summit – ensuring that services are clinically appropriate and accessible; V. Patient Advice Liaison Support (PALS) at the Waldron Health Centre is implemented during peak times to enable increased GP registration until March 2018; VI. Development of clear and simple messages on accessing primary care for the North of the borough; VII. A robust assessment of the capacity and capability of the GP practices located in the Waldron Health Centre. 2.5 The Governing Body was asked to defer its review and decision on the future of the NHS Walk-in Centre and improving provision and access to primary care until the 11th January 2018, whilst assurances were sought on the proposed services and an assessment of the alternative models was undertaken. Consequently, the Governing Body agreed to extend the contract for the NHS Walk-in Centre until 31st March 2018 over the winter period. 2.6 Lewisham & Greenwich NHS Trust confirmed on 9th November 2017 (See Appendix 1) that they welcomed the extension over the winter period as it enabled time for the alternative primary care services to develop, thus mitigating the impact on both acute sites. 2.7 The Trust confirmed that the clinical validation of the attendances at the Walk-in Centre undertaken by CCG clinicians provided the necessary assurance that the impact on the Trust if the Walk-in centre were to close post-winter would be minimal. 2.8 The CCG sets out it response to concerns with regard to any perceived impact on A&E to the Governing Body on 9th November 2017 and a summary is provided at Appendix 5. In applying the Pinchbeck methodology to the Walk-in Centre activity for 2016/17 (29,528 attendances), the estimated shift in activity to A&E Departments is between 5% and 10%. This would equate to an estimated 4 to 8 attendances per day to an a A&E Department, which could either be to the University Hospital Lewisham site or any other A&E Department located within reasonable and accessible proximity to the Waldron Health Centre – if the Walk-in Centre were to close. 2.9 The Trust has agreed to continue to work in partnership with the CCG to ensure that GP Streaming, Primary Care Access Services at the Urgent Care Centre and our Ambulatory Pathways are embedded and delivering effective services to our patients. 2.10 Post the conclusion of the formal consultation the CCG has continued to engage with local charities and key stakeholders on alternative models, specifically with regard to the homeless and undocumented migrants and with Goldsmiths College. 2.11 This report has been submitted outside of the formal dispatch date in order to enable sufficient time to address the 7 assurance areas submitted to the Governing Body on 9th November 2017, which underpin the recommendation not to re-procure a Walk-in Centre service when the additional contract extension expires on 31st March 2018.

3. CONFLICT OF INTEREST: 3.1 There is a conflict of interest for Dr Sebastian Kalwij, Clinical Director and Governing Body Member due to being a GP and partner at the Amersham Vale Training Practice. For the Amersham Vale Training Practice; (a) Of those attendances that could be attributed to a Lewisham GP, the Amersham Vale Training Practice patients are the second biggest users of the Walk-in Centre based on 2016/17 data; (b) The practice has a commercial arrangement with Goldsmiths College to register 2,000 international students; (c) Dr Louise Irvine, is Chair of the Save the Lewisham Hospital Campaign (SLHC) and is also a partner with the same practice; (d) All GP practices in Lewisham are shareholders in One Health Lewisham Ltd the provider of

2 | Page LCCG:GOVBODJAN2018 – WPage i C & P C2

the GP Extended Access Service. (e) The Amersham Vale Training Practice will be one of the alliance/partnership of GP practices in the Waldron Health Centre providing the pilot homeless service for rough sleepers. 4. CORPORATE AND STRATEGIC OBJECTIVES:  The General Practice Forward Review (GPFV) – April 2016  Our Healthier South East London Sustainability Transformation Plan – Community Based Care  CCG Primary Care Strategy  CCG Estates Strategy  Corporate Objectives 2017/18: Urgent & Emergency Care – Review access to Urgent Care to streamline the number of ‘front doors’, including the Urgent Care Centre, new integrated primary care and Integrated Urgent Care (formerly NHS 111) and the New Cross Walk-in Centre

5. CONSULTATION HISTORY: 5.1 In 2010, the Health Secretary set out four key tests against which NHS service reconfigurations (significant changes to services) have to be assessed. These tests were set out in the Revision to the Operating Framework for the NHS in England 2010/12. This requires reconfiguration proposals to demonstrate; i. support from GP commissioners; ii. strengthened public and patient engagement; iii. clarity on the clinical evidence base; and iv. consistency with current and prospective patient choice. 5.2 The CCG is a clinically led organisation and therefore, the proposals are from and have the support of GP commissioners as set out in our constitution1. We have engaged and consulted with members in 2016 and key stakeholders on our Primary Care Strategy – Developing GP Services on our model of integrated urgent and primary care and this has led to the review and proposals. Pre-consultation:  Clinical Directors, 2nd February 2017  Membership Forum, 8th February 2017  Governing Body, 9th March 2017  CCG Clinical Directors and Senior Management Team, 25th May 2017  Governing Body, 13th July 2017  Healthier Communities Select Committee, 20th July 2017  Public Reference Group, 27th July 2017  Membership Neighbourhood Meetings, August and September 2017 Formal consultation:  Public Engagement & Equalities Forum, 7th September 2017  Lewisham & Greenwich NHS Trust, 21st September 2017  Equality & Diversity Group, 21st September 2017  Overview & Scrutiny Committee, 31st October 2017  Healthier Communities Select Committee, 1st November 2017  Governing Body, 9th November 2017 5.3 The CCG has embarked on one of the most extensive consultations undertaken to date across

1 http://www.lewishamccg.nhs.uk/about-us/our- plans/our%20plans%20site%20docs/NHS%20Lewisham%20CCG%20Constitution%20v7%20April%202017.pdf

3 | Page LCCG:GOVBODJAN2018 – WPage i C & P 3 C

the entire borough. We believe that we are delivering against our statutory duty to consult as set out in section 14Z2 of the NHS Act 2006. More so, that we have gone further with a comprehensive engagement programme with our public, patients and the local authority. 5.4 Clinical case for the GP Extended Access Service has been set out both locally and nationally.

6. PUBLIC ENGAGEMENT:  A comprehensive public and stakeholder engagement plan and associated activities are located in Appendix 3.

7. HEALTH INEQUALITY & PUBLIC SECTOR EQUALITY DUTIES:  The Equality Impact Assessment was completed and published (on the website) as set out in the formal consultation document and a refreshed version is attached.  The EiA was reviewed by the CCG Equality and Diversity Group on 21st September 2017.

RESPONSIBLE MANAGERIAL LEAD CONTACT: Name: Diana Braithwaite; Email: [email protected]

Appendices 1. Lewisham & Greenwich NHS Trust – Response to the consultation 2. Consultation document 3. Consultation Engagement activities and plan 4. CCG Review of alternative models/proposals 5. CCG Response to key online survey messages 6. Communications & Engagement Plan for the North of the borough

Attachments A. BMG Research Report on the online survey B. Equality Impact Assessment

4 | Page LCCG:GOVBODJAN2018 – WPage i C & P C4

Public Consultation: The future of the NHS Walk-in Centre and improving provision and access to primary care 1. Context 1.1 The document sets out the CCG review of the feedback on the formal consultation the Future of the NHS Walk-in Centre and improving provision and access to primary care and addresses the assurance areas as requested by the Governing Body 9th November 2017. 1.2 The Five Year Forward2 Review confirms that a strengthened version of general practice is essential to the wider sustainability of the NHS. The General Practice Forward View3 (GPFV) published in April 2016, details a programme of investment and reform that will enhance primary care services and improve access to support patients in accessing care that reflects their needs. This improved model of GP services provision provides extended access to appointments, use of technology to provide e-consultations and easier access to advice and guidance. 1.3 The CCG adopted commissioning responsibilities for the NHS Walk-in Centre from NHS England in 2015, when the GP register was disaggregated from the Walk-in Centre. On the 1st January 2016 an extension to the contract was issued to the incumbent provider of the Walk-in Centre, located in the Waldron Health Centre for a period of 24 months. 1.4 Since this time primary and urgent care services has developed and access to GP provision has increased through the Urgent Care Centre, Integrated Urgent Care (formerly NHS 111), GP Extended Access, the Primary Care Assessment and GP Clinical Redirection and Streaming services. Similarly, the CCG has invested in alternative services such as Pharmacy First. 1.5 The outcomes of review of the Walk-in Centre and access to urgent and primary care are documented in the consultation documents (See Appendix 2). The service essentially serves residents in the North of the borough (Neighbourhood 1) and residents outside of Lewisham. Use of the service is likely to be more about convenience and this is reflected in the high usage by patients registered with one of the four practices located in the Waldron Health Centre and at the time of the CCG review the New Cross Health Centre. This is also supported by the review of the GP Extended Access Service where usage is lower amongst practices located in the Waldron Health Centre. 1.6 The CCG commissioned North East London Commissioning Support Unit (NELCSU) to conduct an independent review of the data to better understand usage of the Walk-in Centre by Lewisham residents. NELCSU were able to review attendances with postcodes provided directly by the Hurley Group for 2016/17 and 2017/18. 1.7 The NELCSU analysis confirmed the CCG review in that more than a third of the attendances to the Walk-in Centre can be attributed to non-Lewisham residents; 61 % of attendances to the Walk-in Centre were from Lewisham residents (includes both registered and potentially unregistered) and conversely 39% of attendances of residents who live outside the borough. This trend continues into 2017/18 where at month 9, 59% of attendances to the Walk-in Centre were from Lewisham residents and conversely 41% of attendances of residents who live outside the borough. 1.8 The initial review of activity data presented as part of this consultation demonstrated that some 28.6% (8,367) of all attendances to the Walk-in Centre in 2016/17 could not be attributed to any CCG. In order to attribute the attendance to a CCG the GP details are required. Therefore, for those attendances without these details the assumption is that these are attendances for people that may not be registered with a GP. However, these figures will always be highly inflated and this is unfortunately a commonplace issue with poor quality data for Walk-in Centres – because it is not linked to an individual’s medical record or NHS number. 1.9 The substantial clinical review of the Walk-in Centre activity, demonstrated that (excluding wound dressings) presenting conditions were for minor ailments and more specifically – for coughs, sore

2 https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf 3 https://www.england.nhs.uk/wp-content/uploads/2016/04/gpfv.pdf 5 | Page LCCG:GOVBODJAN2018 – WPage i C & P 5 C

throats and limb pain. Therefore, the majority of attendances presenting at the Walk-in Centre in 2016/17, a GP or Nurse appointment was not required and patients could have used alternative services or self-cared. 2. Recommendation 2.1 The CCG has conducted and commissioned a comprehensive review and evaluation of the consultation responses and proposed alternatives. Based on this review the CCG is assured that the needs of patients currently attending the Walk-in Centre can be met by mainstream primary care, current and planned alternative services. The Governing Body is recommended to allow the extended contract for the NHS Walk-in Centre at New Cross to expire on 31st March 2018 and improve provision and access to urgent and non-urgent primary care services in Lewisham;  By continuing to increase use and capacity of the GP Extended Access Service;  To commission an additional outreach and walk-in service for rough sleepers in Deptford and New Cross. 3. Pre-consultation 3.1 By way of a needs assessment and in line with best practice for reviewing Walk-in Centres (Monitor4: Walk-in Centre Review 2014), the CCG interviewed a sample of users of the Walk-in Centre to better understand why they used the service and what the CCG could do to better improve access to primary care. A series of interviews took place (9, 10, 11 and 15th January 2017, 7, 13 and 21st February 2017) to ensure that a representative sample of users and views would be reflected. 3.2 The main driver of patients choosing to use the Walk-in Centre was not being unable to get an appointment with their own practice. However, a significant number of patients perceived that they would be unlikely to get an appointment and therefore, went directly to the Walk-in Centre without contacting their own GP; 46% said they went directly to the Walk-in Centre because they did not think they would be able to get an appointment at their GP practice. 3.3 The CCG asked those interviewed in January and February 2017 what they would do if the Walk- in Centre was not available and 40% stated they would have used A&E if the Walk-in centre was not available and 27% would just wait and see their own GP. 3.4 At the point that these CCG led interviews place there were no other alternatives available, as the GP Extended Access Service was not launched until April 2017. 3.5 Of those interviewed, 82.2% of people reported that they would consider using another service, which offered bookable appointments at another location, if their own GP practice did not have appointments available. 3.6 On 13th July 2017 the NHS Lewisham Clinical Commissioning (LCCG) Governing Body approved the recommendation to formally consult on the future of the NHS Walk-in Centre and improving provision and access to primary care. 3.7 In line with the public sector duty to consult, pre-consultation on the proposal and the plans for formal public and stakeholder consultation were reviewed by the Healthier Communities Select Committee on 20th July 2017.

4 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/283778/WalkInCentreFinalReportFeb1 4.pdf 6 | Page LCCG:GOVBODJAN2018 – WPage i C & P C6

4. Formal Public Consultation 4.1 A formal and comprehensive public, patient and stakeholder consultation programme was developed to enable views and comments to be sought and was launched on 8th August 2017. The consultation ran for a period of 12 weeks and ended on 30th October 2017. This was to enable sufficient time for the public and stakeholders to provide a considered response (taking into account of the last four weeks of the school summer holidays) and to ensure consideration by the CCG of what if any impact there may be and take appropriate mitigating action. 4.2 Consultation documents were developed including a full detailed report with a questionnaire; posters, postcards and a summary were printed and distributed to all Lewisham GP practices, pharmacies, Walk-in Centre, electronic distribution by the North Lewisham Health Partnership. The consultation material was tested with the CCG Public Engagement & Equalities Forum. The consultation material was accessible online and paper copies were provided on request. The CCG also commissioned easy read, audio and Vietnamese versions. See Appendix 2. 4.3 There was a small error in the online detailed report, which related to the GP practices located in the Waldron Health Centre and this was corrected and the document resubmitted. 5. Comprehensive review and evaluation of the consultation responses and proposed alternatives 5.1 In line with best practice the CCG has reviewed the extensive list of proposed alternatives from the consultation as presented to the Governing Body on 9th November 2017. In total there were 20 suggested alternative models of delivery. Our review of the proposed alternatives demonstrated that a number of the alternatives are either already in place, in development or are being addressed. The CCG has reviewed its preferred model and as a consequence adopted the proposal for a homeless service for rough sleepers in Deptford and New Cross. Details of the review are located in Appendix 4. 5.2 During the consultation period the CCG received 3 phone calls relating to; (i) access to the Equality Impact Assessment; (ii) access to the consultation documents online and; (iii) clarification on whether the Waldron Health Centre was closing. All calls were returned and the information requested provided. 5.3 The CCG received 9 emails/letters during the consultation; including two from the Save the Lewisham Hospital Campaign (a response was provided to the campaign, published on the CCG website and later published on the SLHC website); representation was received from The Parish of S. Paul w. S. Mark, Deptford raising concerns about access primary care services to the homeless; formal representation from the 3 New Cross Ward Councillors (Cllrs) and Vicky Foxcroft MP opposing the proposals and a number of the concerns raised by the Cllrs were addressed as a part of the key themes to the CCG Governing Body on 9th November 2017 and the Healthier Communities Select Committee on 1st November 2017. 5.4 Formal representation was received from the Liberal Democrat spokesperson raising concerns about those who are not registered with a GP, the GP Extended Access Service, and the impact on A&E over winter and reflecting some of the concerns raised by the SLHC. 5.5 There was one representation on the inclusion of ‘transgender’ as a category in the questionnaire about gender stating that it was not yet a ‘gender’ itself, although our consideration was welcomed. The CCG apologised for this mistake. 5.6 A petition was presented on 9th November 2017 to the CCG Chair post the formal closing date of the consultation containing 915 signatures; 246 of these people who signed the petition were from outside of London and 38 were from outside of the UK. 5.7 The remainder of the responses reflected the key themes as presented to the Governing Body on 9th November 2017; GP Extended Access Service, ability to get an appointment with own GP, those not registered with a GP, the vulnerable and the impact of the proposal on A&E. 5.8 Post the closing date (30th October 2017) of the formal consultation representations were received from the Jenner Practice Patient Participation Group (PPG) opposing the proposals and 7 | Page LCCG:GOVBODJAN2018 – WPage i C & P 7 C

Goldsmiths College dated 13th December 2017 outlining their concerns with regard to students accessing urgent primary care and staff employed by the college. 5.9 A further third representation was received from the SLHC on 28th December 2017, which was acknowledged. 5.10 Public and Stakeholder Engagement 5.11 The evaluation of the engagement activities and programme along with the Equality Impact Assessment were submitted to the Governing Body on 9th November 2017 and were shared with the Overview and Scrutiny Committee on 31st October 2017 and the Healthier Communities Select Committee on 1st November 2017 and can be found at Appendix 3. The engagement programme consisted of in excess of 40 face to face outreach activities with various groups – to the diverse communities in Lewisham. This included drop-in sessions at the Waldron Health Centre and meetings with homeless charities, community development groups, community hubs, children’s centres, parents’ forums, patient participation groups, faith groups, local ward assemblies and students. 5.12 The CCG also embarked on a proactive and positive Social Media campaign led by representatives from the NELCSU. This included regular tweets with links to the online consultation encouraging people to take part throughout the 12 week period. All CCG attended engagement events and drop-in sessions were tweeted and retweeted. 5.13 Online Survey 5.14 The online survey was open to anyone to respond and received 1,768 responses. The headline figures from the survey were reported to the Governing Body on 9th November 2017. 5.15 The CCG commissioned BMG Research to provide an independent review of the responses to the survey. The full BMG report on the online survey is provided as a separate attachment. 5.16 The consultation responses demonstrated clear opposition to the proposal to close the NHS Walk-in Centre; when the contract was due to expire with 82% of respondents being unsupportive. Among the remainder, 11% of respondents supported the proposal and 7% answered don’t know. 5.17 Age/Ethnicity: Responses to the survey were reflective of all age groups. However, there were more responses from women than from men – 2/3rds of all responses were from women. In terms of ethnic group, respondents to the consultation were most commonly White British (53%), this is in line with usage of the service, where the majority of users identified their ethnicity as White British or White Other. 5.18 GP Registration: The majority of responses to the questionnaire were from individuals registered with a Lewisham GP. In total 13% of the responses were from individuals registered with the Amersham Vale Training Practice, 12% registered with the Jenner Practice. A further one in ten of the registered patients are registered with the Hilly Fields Medical Centre (10%), the New Cross Health Centre (9%) and the Hurley at the Waldron (9%). 5.19 In interpreting the findings it should be noted that the two Hurley Group practices (New Cross Health Centre and Hurley at the Waldron) directly promoted the consultation to their registered patients via a text message. This text message provided a direct link to the online consultation survey and not the consultation page or documentation. Consequently, the Hurley Group sent a second set of text messages directing their registered patients to the correct CCG consultation webpage. In order to ensure that all registered patients in Lewisham could equally participate in the consultation by being alerted through a text message, the CCG supported all practices to send text messages. Key messages from the BMG review of the online survey; 5.20 Usage of the Walk-in Centre within the last 12 months was significantly higher amongst respondents aged 16-34 and 35-54 years. This does not vary significantly amongst those registered with a GP in Lewisham and those who are not. Therefore, it does not appear that Walk- in Centre usage is not necessarily as a result of a lack of GP registration.

8 | Page LCCG:GOVBODJAN2018 – WPage i C & P C8

5.21 The majority of respondents to the survey had read the consultation document or leaflet. Among the individuals who have read the consultation document or leaflet three quarters understood the proposal to close the Walk-in Centre. Even with this supporting material 21% did not understand why the closure is being proposed. The remaining 3% answered don’t know. 5.22 Whether the respondents had read the consultation documentation or not, the majority (70% of all respondents) understood the proposal to close the Walk-in Centre; 5.23 Opposition to the closure is significantly higher among those who have read the consultation leaflet or document than among those who have not. 5.24 Individuals who are not registered with a GP in Lewisham are significantly more likely to disagree with the proposal to close the Walk-in Centre (93%) than those who do have local GP registration (81%). 5.25 There is also a clear variation in opinion based on prior usage of the Walk-in Centre. Among users, 89% oppose its closure. This proportion drops to 67% among non–users, with 21% of this cohort supporting the proposed closure. 5.26 People who are not registered with a GP may feel particularly vulnerable to the proposed changes. 5.27 The top five themes considered important for the CCG to know before making its decision were; (i) Closure will impact on the health of the community (27%); (ii) Poor waiting times/appointment systems (17%); (iii) Shouldn’t close services/make cuts (15%); (iv) Closures will put more pressure on other health services (13%); and (v) Consider the effect on vulnerable people (10%). 5.28 With regard to how access to primary care in Lewisham could be approved the responses were similar to the above; (i) Decrease waiting/improve appointments times (23%); (ii) Don’t close services/make cuts (23%); (iii) Have more staff available including GPs (17%); (iv) Have more available appointments (17%); and (v) Be more efficient and manage GP workload (16%). 5.29 Responses to the themes are located at Appendix 5.

6. A review of the capacity, access and public awareness of the GP Extended Access Service 6.1 Service: The GP Extended Access Service (GPEA) commenced in April 2017 to increase access to core general practice as a part of the GP Forward View (GPFV). The service is delivered by One Health Lewisham Ltd a federation of local GP practices in Lewisham. The service provides bookable appointments, 7 days per week, 8-8pm, 365 days per year and has access to patients full medical records (read and write access).The service provides face to face access to GPs and Nurses and video consultations. In 2017 the CCG commissioned 25,426 bookable appointments, which increases this year to 29,914. 6.2 The consultation on improving provision and access to primary care demonstrated that not only was there a lack of awareness of the new service, but that patients were not routinely offered this choice on contacting their local practice. 6.3 Capacity and Utilisation: A review of the current capacity of the service has indicated that the service remains underutilised; from April 2017 to November 2017 the utilisation rate of the available commissioned appointments was on average 67%. 6.4 The service relocated in November 2017 to a purpose built suite within the yellow zone at the University Hospital Lewisham, which enabled the service to provide appointments for children. This also meant that the service was able to increase the number of available nurse appointments. In 2017 the CCG commissioned 5,021 nurse appointments and in 2018 there will be 8,926 nurse appointments made available. The nurse appointments are currently underutilised. 6.5 A clinical audit of the presenting conditions for booking nurse appointments evidenced that the main reason was for dressings; 66% Dressings, 11% Suture/Bandage removal, 9% Injections, 7% Stiches/Wound check, 5% Ear syringing, 1%, Contraception and 1% Swabs. However, it is 9 | Page LCCG:GOVBODJAN2018 – WPage i C & P 9 C

possible to group a number of these conditions under the generic title of dressings, which would indicate that the majority of the nurse appointments were for dressing during the period of the audit. 6.6 NHS England, through the Healthy London Partnership, has developed a draft specification for GP Extended Access. A new national target is being discussed and will be agreed for the level of provision, type and length of appointment. The expectation will be that CCGs provide 30 minutes per 1000 registered population as a minimum. The level of appointment provision per 1000 is calculated by the number of minutes of extended access provision and dividing this by registered population/divided by 1000. 6.7 In Lewisham (based on the current two year contract) the service is delivering 20 minutes per 1000 registered population. It is also recognised that if the CCG embarks on a programme to encourage increased GP registration the GP Extended Access capacity will need to be reviewed. 6.8 The review will take place in partnership with One Health Lewisham Ltd, who will work with all GP practices in Lewisham, to support delivery of the national specification on appointment provision, type and length based on the GP registered population. 6.9 However, utilisation of the GP Extended Access Service remains extremely low amongst the four GP practices located in the Waldron Health Centre. The New Cross Health Centre has the lowest usage of the GP Extended Access Service in the North of the borough with a total of 4 appointments to the service from April 2017 to November 2017. 6.10 Throughout the consultation concern has been raised about possible difficulties in accessing the GP Extended Access Service by patients registered with GP practices in the North of the borough. A review of the usage of the service has shown that the Queens Road Partnership Surgery, Queens Road, New Cross Gate – is the highest referrer to the GP Extended Access Service in the North of the borough, with 1,036 appointments between April 2017 and November 2017. 6.11 GP Extended Access Service is well received by patients. In a recent survey (September to November 2017), 90% of users rated the service as very good or good and 89% of patients stated that they would recommend the service to a family member or friend. 6.12 Monitoring: A formal contract for the GP Extended Access Service was awarded to One Health Lewisham Ltd in March 2017 and the CCG monitors the performance through monthly contract meetings with the provider. The GP Extended Access Service is also subject to national monthly reporting to NHS England and regional reporting to the South East London Sustainability Transformation Partnership (STP). 6.13 Review of any additional GP Extended Access capacity and associated impacts will be monitored by the local CCG Primary Care Commissioning Committee and reported to NHS England. 6.14 Pan-London Campaign: The pan-London campaign to raise awareness of the GP Extended Access Services in London was launched on 20th November 2017. The campaign consisted of both internal and external digital approaches (online and radio), working with GP practices, local NHS Trusts and staff. 6.15 Local Campaign: Since the relocation of the GP Extended Access Service in November 2017, the CCG supported by the CSU (working in partnership with the provider) has embarked on an extensive campaign to raise awareness and increase utilisation of the service. This has included an article in the Lewisham Life (winter issue) and regular e- bulletins to their subscribers in November 2017. The CCG printed 73,320 redesigned leaflets, which were distributed to all Lewisham GP practices, pharmacies, dentists, community spaces and leisure centres. Healthwatch have also included articles about the service in regular e- newsletters throughout November 2017. There has been promotion though social media and on the NHS Lewisham & Greenwich Trust ‘intra and internet’ sites.

10 | Page LCCG:GOVBODJAN2018 – Page W i C & 10 P C

6.16 In addition, every primary school child in Lewisham received a copy of the leaflet in their school bag to take home, in November 2017. A bespoke video on the service will be launched on 9th January 2018 via social media. 6.17 In summary, there is recognition that where the local registered GP population increases the CCG will need to review the capacity of the GP Extended Access Service to meet the needs of our local population. However, the initial priority for the CCG will be to increase utilisation of current commissioned capacity.

7. The GP streaming and primary care access services at the Urgent Care Centre, University Hospital Lewisham are delivering against the commissioned model and requirements; 7.1 The Primary Care Assessment Pilot where a GP is located in the Urgent Care Centre, who sees and treats patients has been in place since October 2016 and has successfully redirected on average 10% of activity away from the A&E Department. This pilot was independently evaluated and has been extended. The GP streaming and clinical redirection commenced in November 2017 and provides streaming and redirection support for patients attending the A&E Department. The service is seeing on average 30-35 patients per day. Patients are either provided with support for alternative services, or clinically streamed to a number of pathways. This includes, advice to self-care, pharmacy, their own GP, the Primary Care Assessment pilot and the GP Extended Access Service. 7.2 The CCG continues to work in partnership with Lewisham & Greenwich NHS Trust to embed the respective pathways. For commissioners work will commence in February on developing proposals to consolidate and integrate the two GP services.

8. Development of services to support the most vulnerable (specifically rough sleepers) as agreed at the Homeless Summit – ensuring that services are clinically appropriate and accessible; 8.1 Homeless: The CCG set out its commitment to provide enhanced services for the homeless specifically those termed as rough sleepers/sofa services in Deptford and New Cross after identifying barriers of the GP Extended Access in its Equality Impact Assessment. Post the joint CCG and Lewisham Council Homeless Summit and continuing to engage with the local community, the CCG organised a second workshop on the 6th December 2017. 8.2 The workshop was attended by representatives from the three local homeless charities; Deptford Reach, Bench Outreach, the 999 Club, the Salvation Army, GPs from the Amersham Vale Training Practice and a representative from the Hurley Group. 8.3 The purpose of the workshop was to develop an agreed pilot service model, which would provide improved clinical outcomes for the homeless in Deptford and New Cross, ease of access, better integration with other services and support registration. The proposed model will provide walk-in access for this group of patients at the Waldron Health Centre in addition to outreach services by GPs located within the local homeless charities. 8.4 The proposed model will be tested with users at the local charities and commissioned from an alliance/partnership of Waldron Health Centre GPs Practices from March/April 2018. This will be a pilot service for a period of 18 months. 8.5 There is currently no data available on the number of homeless people who use the Walk-in Centre. A key performance indicator of this pilot will be to provide activity data to support assessment and evaluate the demand for these services. Management, performance and evaluation of this service will be overseen by the local CCG Primary Care Commissioning Committee.

11 | Page LCCG:GOVBODJAN2018 – PageW i C & P11 C

8.6 Undocumented Migrants: The Equalities Impact Assessment identified a potential impact for those who were using the Walk-in Centre as their default access to primary care, which included undocumented migrants. 8.7 There is no regulatory requirement to prove identity, address, immigration status or an NHS number in order to register as a patient and no contractual requirement for GPs to request this. All asylum seekers and refugees and those who are homeless, overseas visitors, whether lawfully in the UK or not, are eligible to register with a GP practice even if they are not eligible for secondary care (hospital care) services. 8.8 By the nature of their irregular immigration status undocumented migrants are unlikely to engage directly with the CCG. Lewisham Council’s Overview & Scrutiny Poverty Report (May 2016) refers to undocumented migrants as a ‘hidden population’ who do not appear in any official statistics. 8.9 Local refugee and migrant organisations provide support and advice to migrants regardless of their status. The CCG has continued to engage with these organisations to increase understanding of the numbers of people who may be facing barriers to access to primary care in Lewisham. It is acknowledged that such engagement requires time and sustained engagement. 8.10 The CCG met with the Lewisham Migrant & Refugee Network (LMRN) in November 2017. LMRN advised that people attending their groups were registered with a GP. If people were not registered they would refer them to the charity Doctors of the World, which provides a number of outreach clinics for unregistered patients and advocacy to support people to register. 8.11 LMRN were aware of existing resources to support people to register, such as the NHS England leaflet, Asylum seekers and Refugees How to Register with a GP and the Healthy London Partnership ‘My right to access healthcare’ cards. The CCG has provided cards and leaflets to LMRN for their drop in sessions in Deptford. 8.12 The CCG attended an engagement session with a LMRN Women’s Group on 12th December 2017. No personal identifiable data (PID) has been collated or included in any CCG reports. The aim of the session was to develop relationships with the group and to encourage them to share views, understanding of using GP services and urgent care Consultation on the Walk-in centre – including whether people currently use the service and know about alternatives to find out about any other health information needs and barriers to access. The session was attended by 12 people; 7 were Southwark residents and 5 were Lewisham. All were registered with GP practices in their respective boroughs. 5 people had previously used the Walk-in Centre, of whom 3 had used it in the last twelve months. Those who had used it in the preceding 12 months were resident in Southwark and had done so because their GPs had directed them there when they were unable to get an appointment at their own practice or they had gone directly to the Walk-in Centre. 8.13 Information was provided on GP Extended Access and Pharmacy First Services as well as Integrated Urgent Care (formerly NHS 111). LMRN has requested that the CCG deliver another session in 2018 and to include speakers on preventative and health screening services linked to women’s health. 8.14 As a result of the engagement with LMRN, the CCG met with Doctors of the World, a charity which provides treatment for undocumented or unregistered patients and supports people to register. Doctors of the World shared data for 2016 on the numbers of people with a Lewisham postcode that they had supported to register and in 2016 they supported 40 people to register However,15 people were not successful at the first attempt due to a number of ID related issues or an immigration status query. 8.15 The CCG attended the United Nations Migrant Day event in Lewisham on 18th December 2017. The CCG had a stall providing materials about primary and urgent care services including GP Extended Access Service and Use the Right Service. The CCG engaged with a number of advocacy organisations including Action for Refugees in Lewisham (AFRIL). 8.16 In addition to on-going engagement with individual community groups there will be additional opportunities to engage with migrant communities during planned borough-wide events for National Refugee Week, 18-24th June 2018. 12 | Page LCCG:GOVBODJAN2018 – Page W i C & 12 P C

8.17 Learning from our continuing engagement with local groups supporting undocumented migrants will be incorporated into support and training for GP practices in Lewisham. 8.18 Students: As part of the on-going engagement with local stakeholders the CCG met with Goldsmiths College on 28th November 2017. It is recognised in the Equality Impact Assessment that a rolling communications programme to support registration for students is necessary – this would be in addition to the commercial service commissioned by the college from the Amersham Vale Training Practice. The CCG has committed to working with Goldsmiths College early in 2018.

9. Patient Advice Liaison Support (PALS) at the Waldron Health Centre is implemented during peak times to enable increased GP registration until March 2018; 9.1 The CCG committed to providing Patient Advice and Liaison Support (PALS) to increase GP registration recognising the potential level of unregistered users of the Walk-in Centre and the barriers posed by the GP Extended Access Service. From the 30th October 2017 the CCG commissioned PALS support located at the NHS Walk-in Centre, New Cross and 19 sessions have been provided during peak times. This has included weekends and support over the festive period. 9.2 This dedicated resource assists people on how to register with a GP (including NHS Choices and completing GMS1 registration forms) and also provides information and education about other primary care services (e.g. GP Extended Access and Pharmacy First Services). Briefings on the support were provided to staff at the Walk-in Centre and with regular communication with reception staff. 9.3 Support and advice has been provided to more than 100 people. In all cases our PALS has contacted the chosen practice for the patient to ensure residence with catchment areas and any additional requirements. 9.4 However, the numbers of unregistered patients presenting has been very low and of those, the majority were from residents in neighbouring Southwark, followed by Tower Hamlets, Greenwich and Bexley boroughs. The emerging key themes are; (i) patients being turned away due to a lack of ID; and (ii) a lack of awareness of GP Extended Access Services in neighbouring boroughs. The CCG will be providing support and training to local GP practices in February 2018 and learning from the PALS sessions will be incorporated. 9.5 The CCG has committed to provide this support until the end of March 2018; however a full evaluation will be submitted to the Primary Care Commissioning Committee in February 2018, which will determine whether the support should be extended beyond the 31st March 2018.

10. Development of clear and simple messages on accessing primary care for the North of the borough; 10.1 The CCG has developed a bespoke Communications and Engagement Plan for the North of borough (Neighbourhood 1) – see Appendix 6. The driver for this plan was recognition that the majority of attendances that related to GP practices in Lewisham to the Walk-in Centre were for presenting conditions that did not necessarily require either a GP or a Nurse appointment. 10.2 The plan focuses on the needs of the community living in the north by publicising and promoting appropriate and alternative services and to assist in encouraging residents to use the correct service.

13 | Page LCCG:GOVBODJAN2018 – PageW i C & P13 C

10.3 The key messages for Neighbourhood 1 reflect the wider context of what could be achieved across the entire borough. The activity in the northern four wards of the borough (Brockley, Evelyn, New Cross and Telegraph Hill) can be considered as a pilot, but it is important that the effectiveness and outcomes of the campaign are measured and monitored to inform future work. 10.4 The campaign was launched on 18th December 2017 with a bespoke ‘Use the Right Service’, which encourages patients to use the best service for them in Lewisham, whether it be; self-care, the Pharmacy First Service, their own GP, Integrated Urgent Care (formerly NHS 111) or A&E. This has included printed materials, social media, web presence, engagement and events. 10.5 The key messages were jointly developed with Lewisham Health & Care Partners; Lewisham & Greenwich NHS Trust, South London & the Maudsley NHS Trust, Lewisham Council, One Health Lewisham Ltd and the CCG. 10.6 30,000 leaflets and posters have been distributed to schools, GP practices, libraries, leisure centres, community groups and transport hubs. 10.7 Work is underway to further publicise the Pharmacy First Service and a short film is being developed with Lewisham & Greenwich NHS Trust. 10.8 The campaign is on-going and will continue to monitor, evaluate and record the impact and providing progress reporting to the Primary Care Commissioning Committee.

11. A robust assessment of the capacity and capability of the GP practices located in the Waldron Health Centre 11.1 The CCG commissioned the Primary Care Foundation to work with four GP practices located in the Waldron Health Centre (Amersham Vale Training Practice, Clifton Rise Family Practice, Dr Batra and the New Cross Health Centre) on understanding capacity and capability and how practices could improve access. The assessment consisted of four components: i. Analysis of the activity to assess current systems and processes related to access. Current activity, staffing, skill mix as applied to activity, appointments process, appointments balance (same day to book ahead, triaging), telephone response and the list demography will be analysed and assessed and compared to local and national benchmarks; ii. We will also assess the practices use of web booking, use of alternative services (e.g. GP Extended Access Service and Pharmacy First), additional services provided above and beyond core PMS/GMS activity, and provision of any DES (e.g. Extended Access DES). Text messaging for patients and any use of electronic consultations. The practices telephony will also be analysed and assessed to give a measure of responsiveness and call volumes compared to clinical activity; iii. Analysis using the avoidable appointments tool of current clinical workflows in the practice and recommendations for the potential for each practice to utilise staff in a different way and inform future staffing development; iv. Demand & Capacity Modelling: Modelling on possible activity shifts. 11.2 The purpose is to give the practices a stocktake of current provision compared to best practice and identify areas for development and improvement as well as a longer term plan to improve their access and use of resources. 11.3 This work is about to conclude and practices have been provided with an action plan and the CCG has committed to working with practices through the Practice Resilience Programme. However, there is recognition from the initial findings that there are a number of interventions that all practices can implement to improve access and that patients registered with the practices using the Walk-in Centre come back to their own practices and therefore, activity shifts may be less significant than suggested.

14 | Page LCCG:GOVBODJAN2018 – Page W i C & 14 P C

11.4 Final outcomes will be submitted to the Primary Care Commissioning Committee. The CCG Chair, the Lewisham Medical Committee Chair and the Director of Commissioning & Primary Care will meet again with all four GP practices. 12. Financial Implications The Finance & Investment Committee will consider the financial implications associated with commissioning the Homeless Pilot for rough sleepers and increasing capacity of the GP Extended Access Service.

13. Equalities implications The Equality Impact Assessment was completed and published. The document was reviewed by the CCG Equality & Diversity Group. The document has been updated after review of the consultation responses and suggested alternative models.

15 | Page LCCG:GOVBODJAN2018 – PageW i C & P15 C

Appendix 1: Lewisham & Greenwich NHS Trust Response

University Hospital Lewisham Lewisham High Street London SE13 6LH Tel: 020 8333 3000

Web: www.lewishamandgreenwich.nhs.uk Email: [email protected]

Martin Wilkinson Chief Officer Lewisham CCG By email 9th November 2017

Dear Martin

Re: Future of the NHS Walk-in Centre, New Cross

In August you notified the trust that the contract with the current service provider of the Walk-in Centre in New Cross was due to expire on 31st December 2017 and that a public consultation had been launched on the 8th August regarding the future of this service.

Diana Braithwaite met with Lee McPhail in September to talk through the proposal to close the Walk- In Centre at New Cross with an offer to come and speak with the clinical teams and following this meeting the Lewisham and Greenwich Trust Engagement document was shared widely with the clinical and operational teams at University Hospital Lewisham (UHL) and Queen Elizabeth Hospital, Woolwich.

We also attended the Homeless Workshop on 18th October related to this cohort of patients who currently use the Walk-in Centre.

I understand that the Walk-in Centre is open 08:00-20:00 seven days a week and sees approximately 29,000 patients each year, 43% of these being Lewisham residents and a further 17.5% from neighbouring South East London Boroughs, including Greenwich. In addition there are nearly 28% of patients that could not be attributed to any CCG either because they were not registered with a GP or they do not live in the borough.

Whilst the majority of users of the Walk-in Centre are aged between 25 and 64 years old, 10% of all users are aged under 5 years old, with only 3.5% being over 65 years old. There is a large student population nearby and 4 hostels for homeless people that make up a proportion of the attendees at the Walk-in Centre.

Your Primary Care Strategy outlines the improvements in provision and access to urgent and non- urgent primary care services in Lewisham. The GP Extended Access (GPEA) service at UHL is currently underutilised but provision has been made to increase bookable appointments to 29,914 in 2018. You have put forward GP Extended Access as an alternative service to the Walk-in Centre for Lewisham residents.

16 | Page LCCG:GOVBODJAN2018 – Page W i C & 16 P C

Whilst we had initial concerns around the proposed closure of this service in December, we have been informed that on 9th November a decision was made to defer the potential closure and extend the contract for the Walk-in Centre until 31st March 2018. We support this and feel assured that the extension will allow the alternative primary care services time to develop, thus mitigating the impact on both our acute sites.

We will continue to work closely with you to support the changes and ensure that GP Streaming, primary care access services at the Urgent Care Centre and our Ambulatory Pathways are embedded and delivering effective services to our patients. In addition, the further detailed information regarding the clinical validation of the attendances at the walk-in centre has provided the necessary assurance that the impact on the trust of the closure of the walk-in centre post-winter would be minimal.

Yours Sincerely

Meredith Deane

cc. Tim Higginson Lee McPhail

17 | Page LCCG:GOVBODJAN2018 – PageW i C & P17 C

Appendix 2: Consultation Documents The full consultation is below can be found on the formal consultation page (http://www.lewishamccg.nhs.uk/get-involved/Pages/Have-your-say-Walk-in-Centre,-New-Cross.aspx) and a summary leaflet was also produced and distributed, along posters and pop-up banners.

18 | Page LCCG:GOVBODJAN2018 – Page W i C & 18 P C

19 | Page LCCG:GOVBODJAN2018 – PageW i C & P19 C

20 | Page LCCG:GOVBODJAN2018 – Page W i C & 20 P C

Appendix 3: Engagement Plan and Activities 1.1 The CCG acknowledges the need to find more innovative ways of reaching those in our community who do not traditionally engage with processes of this nature or the seldom heard and have visited local businesses – particularly those where we are able to access residents from Black Minority Ethnic backgrounds. 1.2 We have also been visiting local transport hubs (Lewisham, Catford, Forest Hill, Sydenham, New Cross and Gate stations) and the Lewisham Shopping Centre and we have supported all GP practices to send text messages to their patients on the consultation. 1.3 People of working age are the highest users of the New Cross Walk-in Centre. Therefore, the CCG has had a visible presence at key transport hubs and train stations in the borough during the morning rush hour. The CCG distributed 1,175 postcards to commuters, in addition to making announcements on the consultation. 1.4 This section sets out of a summary of some of the interventions and a list of engagement activities are located in Appendix 2; 1.5 Patient Participation Groups (PPG) The CCG supported the development of neighbourhood Patient Participation Groups (north, south west, central and south east) in 2015, working with the local GP Federation, One Health Lewisham. The CCG attended this borough-wide meeting with attendees representing the PPGs from Lewisham practices. A presentation of the consultation was given to the 40 people who attended the event. Attendees were asked to take part in a snap shot vote – using a coloured care voting system. Of those attending 30 took part in the vote; 19 supported the proposal; 3 did not; and 8 were unsure. The confidence levels varied with regard to getting an appointment with their own GP or the GP Extended Access service. 1.6 Local charities and voluntary organisations 1.7 Deptford Reach The CCG delivered a presentation to 12 people at the service with written materials to support discussion and 6 people completed paper surveys (who were all registered with GPs). There was positive feedback about the Enhanced GP Service for the homeless commissioned by the CCG. However, concerns were raised about those who attended the Walk-in Centre and might not be registered with a GP. There was a lack of knowledge about the GP Extended Access service. The view was that the homeless would be more likely to ask for appointments in person due to a lack of phone credit. 1.8 999 Club The CCG attended the 999 Club and spoke with people in small groups and individually.18 surveys were completed and all were registered with a GP. 14 service users responded and 4 staff and volunteers who lived in the borough and had used the Walk-in Centre. Concerns were raised again here about the ability to access the GP Extended Access service due to a lack of phone credit and having to travel to their GP to book an appointment at the Lewisham Hospital site. 1.9 Evelyn Parents Forum Evelyn Parents Forum is a local Deptford volunteer parent/carer community group. The CCG attended the Forum and spoke with 4 parents and 3 completed the survey. Although not concerned for themselves 2 parents expressed concerns for others about the proposed closure. There were strong concerns from 1 parent about for their own vulnerability with regard to probable additional travel costs and travelling to the Lewisham Hospital site on public transport from Deptford with sick children. 1.10 Stakeholders 1.11 Kaleidoscope Children’s Centre The CCG spoke with parents of children from across the borough and from diverse backgrounds at the Centre, engaging in total with 25 people and 16 completed the survey.

21 | Page LCCG:GOVBODJAN2018 – PageW i C & P21 C

People using the services at Kaleidoscope were overwhelmingly in favour of the proposal. Particularly, with regard to the benefits of having a fixed/booked appointment when travelling with a sick child – rather than a queue up and wait system. 1.12 Neighbourhood Community Development Partnership The CCG attended an event held by the partnership to provide information for community organisations, which was shared with 18 community organisations. There were a handful of members of the public were present. The purpose of attending this event was to utilise the existing community channels and network to inform people about the consultation and encourage participation. People at the event had not used the GP Extended Access service and were not aware that it offered appointments 8am-8pm, 7 days a week. Concern was expressed that people in the area (on the border of Southwark) were often forgotten in any health decisions. 1.13 Downham Health & Leisure Hub The CCG spoke with people at this community hub. This engagement was successful in reaching people of working age and diverse ethnicity. Of the 40 people, 6 completed the paper survey – with others agreeing to complete it online. The majority of those engaged stated that the Walk-in Centre was too far and some used the Beckenham Beacon Urgent Care Centre. The GP Extended Access service had been used by one person who had a positive experience of the service. More people here supported the proposal, however this was not unanimous. 1.14 Phoenix Green Man (South Lewisham) The CCG attended this Health & Well-being event, which was open to all residents and was attended by 70 people, who were mainly aged over 55 years. The CCG had a stall at the event and provided a short presentation to 21 people. Of those 21 people 4 had used the Walk–in Centre. None of those who the CCG spoke to were aware of the GP Extended Access service. During a show of hands vote, where 16 people voted; 11 did not support the proposal, 2 were unsure, 1 supported it and 2 were out of borough residents. 1.15 Local NHS Trusts and neighbouring Clinical Commissioning Groups The CCG wrote to all local NHS Trusts and neighbouring Clinical Commissioning Groups at the start of the consultation. The CCG met with representatives of Lewisham & Greenwich Trust to discuss the proposals and possible mitigations. The CCG received verbal reassurances on the mitigations and have requested a formal written response. 1.16 Save the Lewisham Hospital Campaign (SLHC) The CCG wrote to the campaign on 8th August 2017 and received a response on 29th September 2017, which outlined 8 specific areas of concern. A meeting was arranged with representatives of the campaign Dr Louise Irvine, Dr Tony O’Sullivan and Jane Mandlik, The CCG has provided a formal response to the areas of concern, which has been published here; http://www.lewishamccg.nhs.uk/get-involved/PublishingImages/Pages/Have-your-say-Walk-in- Centre,-New-Cross/SLHC_CCG_Statement_16102017.pdf A second response was received from SLHC on 30th October 2017, which included the following two recommendations; ‘1: We still believe there are grounds for delaying the closure of the WIC until suitable and improved services are in place for those who need them, easily accessible in time and place; and 2: These disadvantaged groups will not be able to use the GPEA service – to use the GPEA service a person must already be registered with a Lewisham GP practice. We think the WIC should remain open until adequate plans have been made to meet the needs of these groups of people, if and when the WIC closes.’ 1.17 Leegate Community Centre The CCG engaged with 8 people who had used the Walk-in Centre. Some expressed positive comments about the GP Extended Access service although they had not used it themselves.

22 | Page LCCG:GOVBODJAN2018 – Page W i C & 22 P C

Some valued the Walk-in service because they had attended in a crisis and believed they were treated better than at their own GP. Of the people we spoke to 3 supported and 4 opposed it and 1 person did not complete the question. There was less certainty about confidence levels in being able to book appointments using either their own GP or the Extended Access service, with half of people uncertain about answering the question. 1.18 Young Mayors Advisors The CCG met with 8 Young Advisors and provided information about the proposals. The young Advisors’ experiences of access to GP appointments was positive, with most reporting that they could get an appointment when they needed one. When asked about their views on the proposals 2 people supported the proposal, 2 were uncertain and 4 did not support the proposal. 1.19 Local residents, patients, NHS staff and users of the New Cross Walk-in Centre 1.20 Waldron Health Centre Drop-in Sessions The CCG organised a series of drop-in sessions at the Waldron Health Centre. These sessions were open to the public, patients, staff and included two people outside the Waldron Health Centre, who told us they were rough sleeping and who completed the survey. These rough sleepers were registered with a GP practice, which is commissioned to provide an Enhanced Service to the Homeless. However, they expressed concern at the potential loss of the Walk-in Centre in that it supported people who could not make appointments. Over these three initial drop-in sessions, 90 people were engaged with and 24 completed the survey with other agreeing to complete online. Although most people understood the requirement to address the needs of the entire borough and some people supported the proposal; the majority did not agree with the proposal. Reasons provided included proximity of the Walk-in and the potential impact on vulnerable people. From additional sessions held during the week commencing 23rd October 2017 at the Walk-in Centre and engaging with users of the service; 28 people completed a survey, of which 10 supported the proposal, 8 did not and 10 did not know. In addition, a number of people committed to complete the survey online. 1.21 Goldsmiths College Fresher’s Fair The CCG engaged with 300 students over the course of two days. Information of the consultation was made available with a brief explanation. The CCG attendance at the fair was also to encourage new students to register with a local GP register and explaining to overseas students the points of access to Primary Care in Lewisham. There was also a helpful conversation with a member of staff who is a first aider for the College about the proposals. 1.22 Lewisham Islamic Centre The CCG had previously engaged with the centre on the development of the GP Extended Access service. This session was mixed but predominantly men were in attendance. The three women in attendance abstained in voting activity. The CCG held a presentation and discussion session on the proposal. There was appreciation of why the changes were proposed, but with concerns about losing the walk-in element. The majority of people did not support the proposal. One person was very confident about being able to get an appointment and remainder were not so confident. There was concern about expressing confidence levels in a service they had not experienced – GP Extended Access. 1.23 Lewisham Shopping Centre The CCG had brief conversations with 92 people. This is where there were the highest awareness levels of the GP Extended Access service to date with more people in favour of the proposal. There were some very positive comments from people who had used the GP Extended Access service, with regard to its usefulness for working people and its caring staff. People registered with GP practices in the Sydenham area advised that they had been offered the GP Extended Access service, those registered in the New Cross area reported that they had not. 1.24 Elected Member of Parliament 23 | Page LCCG:GOVBODJAN2018 – PageW i C & P23 C

Representatives of the CCG (Dr David Abraham, Urgent & Emergency Care Lead, and Diana Braithwaite, Director of Commissioning & Primary Care) met with Vicky Foxcroft MP. Our local MP expressed concerns about students and access to primary care services for the most vulnerable, particularly the homeless and those residing in the UK without legal status. The CCG committed to providing our MP with updates during the consultation. 1.25 Local Ward Assemblies 1.26 New Cross and Evelyn Ward Assemblies The New Cross Ward Assembly was not well attended by members of the public. However, the CCG engaged with and had conversations with 10 people and 6 completed surveys. The Evelyn Ward Assembly was attended by 40-50 people. The CCG had a stall providing information and proactively engaged with those attending. Although people understood the need to avoid duplication of services and the requirement to support all people in the borough, the majority were concerned about the impact on vulnerable people and that people would simply attend A&E. 1.27 Telegraph Hill Ward Assembly The CCG were invited to attend the Telegraph Hill Ward Assembly and there were about 8 members of the public in attendance. Local residents posed a series of questions and were clear; as were the two ward councillors in attendance, that they did not support the proposals. A formal response opposing the proposals was received on 30th October 2017 from Cllr Joe Dromey on behalf of the New Cross Ward Cllrs and Vicky Foxcroft MP. 1.28 The GP practices located in the Waldron Centre The CCG (with the assistance of the Lewisham Local Medical Committee), in its capacity as a level 3 delegated commissioner met with the Amersham Vale Training Practice, Clifton Rise Family Practice and Dr Batra – all located in the Waldron Heath Centre. The purpose of these meetings was to engage with these GP practices as providers (and not commissioners) of core primary care services in the area.

24 | Page LCCG:GOVBODJAN2018 – Page W i C & 24 P C

CCG led Engagement to support the formal consultation on the future of the NHS Walk-in Centre and improving provision and access to primary care

DATE EVENT TYPE TARGET GROUP LOCATION OBJECTIVES STATUS

8.8.17 Meeting with Key stakeholder to reach Catford  Use update meeting to highlight the COMPLETED Healthwatch communities launch and ensure Healthwatch have materials to disseminate information about the consultation and encourage participation through their networks and at events. 30.8.17 Meeting Homeless people and Deptford Reach 34  To reach those identified in Equality COMPLETED people who are rough Speedwell Street Impact Assessment as potentially sleeping (as per the Deptford SE8 4AT impacted by proposals. Equality Impact  Providing people using a support service

Page 25 Page Assessment), vulnerable, with opportunities to hear about our including people with proposals and share their views. substance abuse issues 1.9.17 Drop-in People using the Walk-in Waldron Centre –  Providing people using Walk-in Centre COMPLETED Centre and other health Ground Floor meeting and other services at the Waldron Centre services room and foyer area with an opportunity to hear about the proposals ask questions and share their views. 5.9.17 Attendance at New Local Community and Mulberry Centre,  Providing people in North Lewisham with COMPLETED Cross Local Councillors Amersham Vale, New opportunities to hear about our assembly meeting Cross SE14 6LE proposals, ask questions and share their views. 6.9.17 Attendance at Range of voluntary, Lewington Centre,  Engaging key community organisations COMPLETED North Lewisham community and health Eugenia with extensive reach to disseminate Community organisations and Road, Silwood Estate, information about the consultation and Development members of the public Deptford. encourage participation through their meeting networks and at events. 8.9.17 Drop-in People using the Downham Health and  Providing people in South Lewisham COMPLETED facilities at Downham Leisure Centre , (including those living in areas of Health & Leisure Centre Moorside Road during deprivation) with opportunities to hear busy evening sessions about our proposals, ask questions and share their views. 9.9.17 Drop-in People using the Walk-in Waldron Centre –  Providing people using Walk-in and other COMPLETED

25 | Page LCCG:GOVBODJAN2018 – W i C & P C

Centre and other health Ground Floor meeting services at the Waldron Centre with an services room and foyer area opportunity to hear about the proposals and ask questions and share their views. 12.9.17 Drop-in People using the Walk-in Waldron Centre –  Providing people using Walk-in and other COMPLETED Centre and other health Ground Floor meeting services at the Waldron Centre with an services room and foyer area opportunity to hear about our proposals, ask questions and share their views 16.9.17 Health and People from across the Green Man Centre  Providing people with an opportunity to COMPLETED Wellbeing event borough attending a (Whitefoot Ward) hear about our proposals and ask Health and Well Being Bromley Road SE6 questions and share their views. event 2RP 18.9.17 Meeting Homeless people and 999 Club Deptford  To reach those identified in EQI as COMPLETED people who are rough Broadway SE8 4PA potentially impacted by proposals sleeping (as per the  Providing people using a support service Equality Impact with opportunities to hear about our

Page 26 Page Assessment) proposals and share their views. 19.9.17 Drop-in Parents with young Evelyn Parents forum –  Providing people who may not be able to COMPLETED children in highest area playgroup sessions attend other sessions, due to childcare or of deprivation in North 231 Grove Street, SE8 transport, with opportunities to hear Lewisham 3PZ about our proposals and share their views. 19.9.17 Drop-in Young people or Parents Kaleidescope  Providing people who may not be able to COMPLETED with children attending Children’s Centre, attend other sessions, due to childcare or borough wide hub for Rushey Green SE6 4JD transport, with opportunities to hear children’s health services about our proposals and share their views. 20.9.17 Meeting Lewisham CCG AGM King's Church, Lee SE3  Providing people with an opportunity to COMPLETED 9DW hear about our proposals and ask questions and share their views. 25.9.17 Drop-in Students who may not Goldsmiths College  Providing students in Freshers’ week COMPLETED be registered with a GP Lewisham Way SE14 with information about the future of the (as per Equality Impact 6NW Walk-in Centre, how to access primary Assessment) care in Lewisham and the need to register. 25.9.17 Meeting Patient Participation Lewisham Civic Centre  Providing PPG representatives from the COMPLETED Group representatives borough’s 39 practices people with an opportunity to hear about our proposals and ask questions and share their views. 26.9.17 Drop-in Providing students with Goldsmiths College  Providing students in Freshers’ week COMPLETED 26 | Page LCCG:GOVBODJAN2018 – W i C & P C

about access to primary Lewisham Way SE14 with information about the future of the care and the need to 6NW Walk-in Centre, how to access primary register with a GP (as care in Lewisham and the need to per the Equality Impact register. Assessment) 3.10.17 Attendance at Local community and 2000 Community  Providing people in North Lewisham with COMPLETED Evelyn Local Councillors Centre opportunities to hear about our proposals assembly meeting ask questions and share their views with a (GP) Clinical Director and Deputy Director of Commissioning. 4.10.17 Attendance at Get People in Lewisham Green Man Centre  Providing people from across the NOT COMPLETE: –On Lewisham being supported to gain Bromley Road SE6 borough with an opportunity to hear Event was scaled borough wide digital skills 2RP about GP-ON Line (AT lead) and share down by digital event our Consultation and share their views organisers. On-line on-line (DM lead). consultation materials were Page 27 Page previously circulated and organisers have been asked to re- circulate these to all Get- On groups in the borough. 5.10.17 Drop-in Young people or Parents Kaleidescope  Providing people who may not be able to COMPLETED with children attending Children’s Centre attend other sessions, due to childcare or borough wide hub for Rushey Green SE6 4JD transport, with opportunities to hear children’s health services about our proposals and share their views. 5.10.17 Visits to BAME BAME communities – to Catford & Bellingham  Reaching communities who have low COMPLETED businesses encourage participation rates of participation in the consultation. in the Consultation and  Having conversations with individual share information businesses to support them to generate awareness with their customers and providing easily portable materials. 10.10.17 Consultation Working age Lewisham Catford Train station  Providing information (postcards) about COMPLETED promotion patients (Equality Impact the consultation and GPEA to commuters Assessment – high users travelling from Lewisham in the morning of Walk-in) rush hour; to promote awareness of and At train stations and participation in the consultation. 27 | Page LCCG:GOVBODJAN2018 – W i C & P C

transport hubs 10.10.17 Drop –in People with current or Lee Community Centre  Providing people who have had may not COMPLETED history of mental health Leegate SE12 8RG be able to attend other sessions, due to issues using an childcare or transport, with opportunities advocacy service to hear about our proposals and share their views. 11.10.17 Meeting People from Lewisham Lewisham Islamic  Providing people with an opportunity to COMPLETED who are Muslim (seldom Centre, Rushey Green hear about our proposals and share their heard group) SE13 6NZ views. 12.10.17 Consultation Working age Lewisham Lewisham transport hub  Providing information (postcards) about COMPLETED promotion patients (Equality Impact – train station (DLR and the consultation and GPEA to commuters Assessment – high users bus on 18.10.17) travelling from or through the borough’s of Walk-in) at transport major transport hub in the morning rush hubs hour; to promote awareness of and participation in the consultation.

Page 28 Page 12.10.17 Drop-in People of all ages and Lewisham Shopping  Providing people with an opportunity to COMPLETED demographics using the Centre hear about our proposals and share their borough’s largest views. shopping centre 13.10.17 Consultation Working age Lewisham Forest Hill Train station  Providing information (postcards) about COMPLETED promotion patients (Equality Impact the consultation and GPEA to commuters Assessment) – high travelling from or through the borough’s users of Walk-in) major transport hub in the morning rush at transport hubs hour; to promote awareness of and participation in the consultation. 17.10.17 Consultation Working age Lewisham New Cross Gate –  Providing information about the COMPLETED promotion patients (Equality Impact transport hub Consultation and GPEA to commuters Assessment – high users travelling from or through the borough’s of Walk-in) major transport hub in the morning rush at transport hubs hour; to promote awareness of and participation in the consultation. 17.10.17 Visits to BAME BAME communities – to Deptford / New Cross  Reaching communities who have low COMPLETED businesses encourage participation rates of participation in Consultations. in the Consultation and  Having conversations with individual share information businesses to support them to generate awareness with their customers and providing easily portable materials. 17.10.17 Attendance at Local Community and Telegraph Hill  Providing people with an opportunity to COMPLETED Local Assembly Councillors Assembly hear about our proposals, ask questions 28 | Page LCCG:GOVBODJAN2018 – W i C & P C

Somerville Youth & and share their views. Play Provision 260 Queen’s Road SE14 5JN

18.10.17 Consultation Working age Lewisham Lewisham DLR and bus  Providing information about the COMPLETED promotion patients (Equality Impact station Consultation and GPEA to commuters Assessment – high users travelling from or through the borough’s of Walk-in) at transport major transport hub in the morning rush hubs hour; to promote awareness of and participation in the consultation 18.10.17 Meeting Homeless multi-agency NHS Lewisham CCG  Providing key stakeholders (statutory and COMPLETED summit – in response to Cantilever House voluntary organisations supporting previous engagement SE12 homeless people) with an opportunity to and Equality Impact share their views on additional Assessment findings needs/services. Page 29 Page 19.10.17 Consultation Working age Lewisham Sydenham Station  Providing information about the COMPLETED Promotion patients (Equality Impact SE26 5EU consultation and GPEA to commuters in Assessment – high users the morning rush hour; to promote of Walk-in) awareness of and participation in the at transport hubs consultation. 19.10.17 Drop-in Parents with young Abbotshall Healthy  Providing people with an opportunity to COMPLETED children Living Centre, Catford hear about our proposals, ask questions SE6 1SQ and share their views. 19.10.17 Drop-in Walk-in Centre Walk-in Centre  Providing people with an opportunity to COMPLETED hear about our proposals, ask questions and share their views. 21.10.17 Meeting Social housing tenants Diversity Day – Phoenix  Providing people with an opportunity to COMPLETED South Lewisham Green man hear about our proposals ask questions and share their views. 23.10.17 Drop-in People at risk of social Lee Community Centre  Providing people with an opportunity to COMPLETED isolation hear about our proposals ask questions and share their views. 23.10.17 Meeting Young people (14-23) Lewisham Young  Providing young people with an COMPLETED Advisors opportunity to hear about our proposals, ask questions and share their views. 24.10.17 Drop-in Walk-in Centre users Walk-in Centre  Providing people with an opportunity to COMPLETED hear about our proposals ask questions and share their views. 29 | Page LCCG:GOVBODJAN2018 – W i C & P C

25.10.17 Drop-in Walk-in Centre users Walk-in Centre  Providing people with an opportunity to COMPLETED hear about our proposals, ask questions and share their views. 26.10.17 Drop-in Walk-in Centre users Walk-in Centre  Providing people with an opportunity to COMPLETED hear about our proposals, ask questions and share their views.

Page 30 Page

30 | Page LCCG:GOVBODJAN2018 – W i C & P C

Appendix 4: Proposed Alternative Models from the Consultation The CCG has reviewed each of the alternative models proposed as a part of the suggestions to the online survey and provided responses. 1. Providing a  The CCG will be reviewing the capacity of GP Extended satellite GP Access Service in partnership with the provider of the service Extended One Health Lewisham Ltd to support delivery of the national Access specification on appointment provision, type and length based service in on the GP registered population. the  Providing a specific GP Extended Service for the north of Waldron borough at scale would not be equitable for patients registered Health with practices in the south of the borough as use of the Walk-in Centre; Centre (predominantly used by GP practices in the north) has demonstrated.  A centralised GP Extended Access Service at the University of Hospital Lewisham provides a more equitable co-located solution with the Urgent Care Centre for the entire borough and value for money underpinned by a single infrastructure. 2. A walk-in  The currently CCG commissions two GP practices who provide service for Enhanced GP services to the four hostels in Lewisham. the However, these services support those who are known to homeless; agencies and access the hostels. On completing the Equality Impact Assessment and the joint Homeless Summit with Lewisham Council; the CCG has committed to commissioning a pilot homeless service for rough sleepers for Deptford and New Cross located at the Waldron Health Centre. The intention is for the pilot for provide both walk-in and outreach GP services. 3. Getting GP  The majority of Lewisham practices are already extending their practices to opening hours to provide appointments at times outside of their extend their core contracted hours. This is funded through the national hours; ‘Extended Hours Direct Enhanced Service’. Your local practice will publish their current extended hours on their website or at the surgery.  Lewisham has also commissioned the GP Extended Access Service, which provided 25,424 GP and Nurse appointments in 2017 and will increase to 29,914 appointments this year – providing coverage 7 days a week, 8am-8pm and 365 days per year. 4. Re-  The local qualification for Personal Medical Services (PMS) introducing contract, which was implemented on 1st January 2018 same day stipulates the following for GP practices in Lewisham; appointmen ‘If clinically urgent, a patient is able to book an appointment on ts at the the same day’ and ‘Where it has been deemed that the patient GP has a clinical need to be seen on the same day, they will be practices; able to do so. Consultations could be face-to-face or on the

phone (or video phone) or at the locally commissioned Extended Access service, but will be provided by a GP or an appropriately skilled appropriately skilled health professional, as appropriate.’

31 | Page LCCG:GOVBODJAN2018Page – 31W i C & P C

5. Same day  Same day triage is currently carried out at many GP practices triaging at across Lewisham and the CCG will be working towards this GP being available at all practices to implement the local practices; qualification outlined above.  This will apply for both children and adults. If it is not urgent then the person may be given a routine appointment or advice on how to self-care a condition such as a cold or hay fever or signposted to the nearest pharmacy for over-the counter medicines. 6. Charge  There are no plans either locally or nationally to charge NHS patients patients for a same day GP appointment. £20 for a same day GP appointmen t; 7. Providing  Some GP practices in Lewisham provide walk-in appointments. walk-in Your local practice will publish details of the appointments on appointmen their website or at the surgery. ts at GP  Each year NHS Lewisham Clinical Commissioning Group practices; invests an ‘additional premium payment’ of £3.2m to GP 8. Clearer practices providing core services to patients. As a part of the appointmen local PMS Premium GP practices (effective from 1st January t systems; 2018) are required to undertake a self-assessment of their current access arrangements/approaches and to develop an action plan to address any areas of challenge.  Areas of focus to be included as part of the self-assessment and action plan are:  Use of Online services  Patient information on Practice website and NHS Choices  Use of telephone triage  Sign posting to alternative services  Receptionist training  Appointment mix  Review of Extended Hours Enhanced Service provision  Engagement with practice Patient Participation Groups to discuss challenges and potential solutions  Review referrals to the GP Extended Access Service 9. Increase  There are already a number of Clinical Pharmacists and Nurse the use Practitioners working with practices in Lewisham. Clinical  Lewisham has also been successful in securing national GP Pharmacist Forward View funding to support Clinical Pharmacists working or Nurse in practices. Practitioner s; 10. Provide  Sexual health services are commissioned by Lewisham Council STD test at and full details of the local services are available at GP https://www.lewisham.gov.uk/myservices/socialcare/health/sex practices; ual-health/Pages/default.aspx  Online requests for Chlamydia Home Testing Kits for patients aged between 16-24 years old can be made at

32 | Page LCCG:GOVBODJAN2018Page –32 W i C & P C

https://www.checkurself.org.uk/ 11. Fast track  Most GP practices in Lewisham will prioritise children and the service for elderly. the elderly and children; 12. Register  The CCG has committed to working Goldsmiths College on a student as rolling communications programme to support students to part of register with a locally. enrolling; 13. Provide a  From 31st March 2016 the national GP contract required all named GP patients (including children) to have a 'named accountable GP’. for each  The contract requires the ‘named accountable GP’ to take patient; responsibility for the co-ordination of all appropriate services required under the contract and ensure they are delivered to each of their patients where required (based on the clinical judgement of the named accountable GP). 14. Provide  All Lewisham practices offer patients the ability to book online appointments online as well as to request repeat prescriptions booking; and to view their own medical record. These online services’ are free and everyone who is registered with a GP practice can access the services.  In 2016/17, Lewisham CCG ran a successful campaign to encourage more people to sign up for the patient online services As a result of the campaign, in Lewisham has the highest percentage of practices in London with more than 20% of patients registered to use online services. 15. Provide a  There has been no evidence as part of the consultation and a diagnostic review of the presenting conditions, which are for minor centre at ailments that diagnostic services such as ultrasound and x-ray the are required. Waldron (e.g. ultrasound and x-ray); 16. Develop  The CCG is currently supporting alternatives to traditional GP more access including the CCG commissioned Pharmacy First alternative scheme which provides advice, treatment and medicines for care; common ailments from your local pharmacy.  The CCG will be launching its self-care programme in January 2018, which provides advice and support for residents; http://www.lewishamccg.nhs.uk/your- health/Pages/Selfcare.aspx  We are also working with local partners to support patients with more socially related problems through the preventative social prescribing project, Community Connections (delivered by Age UK Lewisham and Southwark in partnership with a number of voluntary sector organisations in Lewisham) and Safe and Independent Living (SAIL) programmes. 17. Expand  South East London Doctors Co-operative (SELDOC) is the GP SELDOC; out of hours provider for Lambeth, Southwark and Lewisham.

33 | Page LCCG:GOVBODJAN2018Page – 33W i C & P C

 SELODOC are also the current providers of the Primary Care Assessment Service Pilot based at the Urgent Care Centre, University Hospital Lewisham, which seeing and treating patients with urgent primary care needs. 18. Offer  Lewisham CCG is currently supporting patients to better self- wellness care and self-manage through programmes such as LEEP and (Lung Exercise and Education Programme) for COPD patients preventativ and DAFNE (Dose Adjustment for Normal Eating Programme) e groups; and DESMOND (Diabetes Education for Self-Management for On-going and Newly Diagnosed) for diabetic patients.  We are also implementing preventative programmes such as the Diabetes prevention programme for those at risk of developing diabetes). Since April 2017, over 300 Lewisham patients have been referred to the programme. 19. Turn the  Lewisham CCG is supporting practices to consider working Waldron more collaboratively to provide resilience and sustainability and Health in 2017/18 have provided direct funding to GP practices. Centre into  The Pilot Homeless Service for Rough Sleepers in Deptford one good and New Cross will be commissioned from an GP facility; alliance/partnership of GP practices located in the Waldron Health Centre.  We are also reviewing with local health and care partners all services located at the Waldron Health Centre with the aim of:  ensuring that the optimum mix of services is provided  maximising utilisation of the estate  supporting the integration of services 20. Develop  Lewisham has successfully secured funding to pilot video video or consultations and also online ‘symptom checker’ technology at Skype GP practices from the national GP Forward View. ‘Symptom consultatio checkers’ allow patients to enter queries and symptoms online ns; and for this to be transmitted securely to their registered GP practice, as well as signposting patients to information and/or alternative services as appropriate based on the information provided.  We are also currently piloting the use of video consultations in Lewisham as part of the GP Extended Access Service.

34 | Page LCCG:GOVBODJAN2018Page –34 W i C & P C

Appendix 5: Online Survey Top 5 – CCG Response

Theme CCG Response

(a) Closure will impact  There is little academic evidence to suggest activity on the health of transfers from Walk-in Centres to A&E Departments, the community when non co-located Walk-in services close. There has (27%); also been no reports to support this perception from (b) Closures will put neighbouring CCGs in south east London or elsewhere more pressure on in the country where Walk-in Centres have closed. other health  However, it is important to acknowledge as stated in the services (13%); Pinchbeck Study5 that geography to walk-in services plays a critical part in any shifts in activity. Any changes in services would have a greater impact on local GP practice services (particularly those located in the Waldron Health Centre) rather than on the A&E Department at University Hospital Lewisham site or indeed any other A&E Department located within reasonable and accessible proximity to the Waldron Health Centre E.g. Kings College Hospital (Denmark Hill), Guy’s & Thomas NHS Foundation Trust (Guy’s – UCC and St Thomas’ – A&E Department sites).  In applying the Pinchbeck methodology to the Walk-in Centre activity for 2016/17 (29,528 attendances), the estimated shift in activity to A&E Departments is between 5% and 10%. This would equate to an estimated 4 to 8 attendances per day to an a A&E Department, which could either be to the University Hospital Lewisham site or any other A&E Department located within reasonable and accessible proximity to the Waldron Health Centre – if the Walk-in Centre were to close.  Our local data supports the Pinchbeck Study, as it demonstrates that in 2016/17 less than 7% of the total number of attendances (29,528) after seeing a GP or nurse at the Walk-in Centre were referred to A&E; this equates to an estimated 5 attendances per day. There is no evidence to suggest that the referral to A&E would translate into an attendance to the University Hospital Lewisham site or any other A&E Department located within reasonable and accessible proximity to the Waldron Health Centre.  It is also important to reiterate that the substantial clinical reviews of presenting conditions to the Walk-in Centre, (excluding wound dressings) were for minor ailments and more specifically were coughs, sore throats and limb pain. Consequently, providing users of

5 http://eprints.lse.ac.uk/64503/1/__lse.ac.uk_storage_LIBRARY_Secondary_libfile_shared_repository_Content_SER C%20discussion%20papers_2014_sercdp0167.pdf

35 | Page LCCG:GOVBODJAN2018Page – 35W i C & P C

the Walk-in Centre in the north with support to access the right services is essential.

GP Appointments  The GP Extended Access GP Extended Access Service provided a further 25,426 bookable GP, Nurse (c) Decrease and Video consultation appointments per year for waiting/improve people registered with a Lewisham GP. appointments times (23%);  Each year NHS Lewisham Clinical Commissioning Group invests an ‘additional premium payment’ of (d) Have more £3.2m to GP practices providing core services to available patients. As a part of the local PMS Premium GP appointments practices (effective from 1st January 2018) are required (17%); to undertake a self-assessment of their current access (e) Poor waiting arrangements/approaches and to develop an action times/appointment plan to address any areas of challenge. systems (17%);  Areas of focus to be included as part of the self- assessment and action plan are: (f) Have more staff  Use of Online services available including  Patient information on Practice website and NHS GPs (17%); Choices (g) Be more efficient  Use of telephone triage and manage GP  Sign posting to alternative services workload (16%).  Receptionist training  Appointment mix  Review of Extended Hours Enhanced Service provision  Engagement with practice Patient Participation Groups to discuss challenges and potential solutions  Review referrals to the GP Extended Access Service

Financial  It is important that we spend our £477m annual budget Considerations effectively, which has competing priorities and commission the best healthcare for Lewisham (h) Shouldn’t close services/make  The CCG spends approximately £1m on the Walk-in cuts (15%); Centre year. We also pay GPs for their patient’s primary care. The majority of Lewisham residents using the (i) Don’t close Walk-in Centre are registered with a Lewisham GP. services/make Therefore, the CCG are paying twice for their care and cuts (23%); this is a duplication of resources.  The CCG has invested in GP Extended Access Service, GP Clinical Streaming and redirection and the Primary Care Assessment Pilot. Vulnerable  We conducted an Equality Impact Assessment and Communities identified protected and vulnerable groups who would be (j) Consider the impacted by the Walk-in Centre. effect on  The CCG will commission an additional enhanced vulnerable people primary care service for the rough sleepers Deptford (10%). and New Cross.  The CCG is committed to working with local charities supporting undocumented migrants and accessing primary care for these groups The CCG will provide

36 | Page LCCG:GOVBODJAN2018Page –36 W i C & P C

training and education to GP practices on registering this group.

37 | Page LCCG:GOVBODJAN2018Page – 37W i C & P C

Appendix 6: North Lewisham Communications & Engagement Plan

Communications & Engagement Plan

Messages for the north of the London Borough of Lewisham (Neighbourhood1) and Appropriate Services

Author: Simeon Scott Baker SRO: Martin Wilkinson Date: November 2017

38 | Page LCCG:GOVBODJAN2018Page –38 W i C & P C

Section 1

EXECUTIVE SUMMARY

The purpose of this plan is to develop a tailored message for the north of the London Borough of Lewisham, focusing on the needs of the community living in Neighbourhood 1, publicising and promoting appropriate services and to assist in encouraging patients to use the correct service.

The plan sets out the role of the communications & engagement team members and the core messages that should be used to promote the above stated aims.

The plan sets out a strategy for both external and internal communications and identifies key areas to get our message across and to measure the effectiveness of our communications and engagement techniques.

Specific issues to be dealt with include the following:

 Ensuring that users and patients know of alternatives and how, when and where to access them.  Promoting self-care, pharmacy services and use of the correct service  Looking at demographics in the wards in the north of the borough to enable us to measure our engagement and communication, and its effectiveness.  The possible closure of the walk-in centre at the Waldron in New Cross (but not the Waldron Centre as a whole).  Working with seldom heard groups, the wider community and users  Work with partners and stakeholders to ensure that one message is maintained, both internally and externally.

The key messages for Neighbourhood 1 sit in the wider context of what we hope to achieve across the borough.

The plan will lay out how we can best promote health and care services in the north of the borough and encourage users to access the best service for them.

 Include and involve our stakeholders at every opportunity.  Communicate and engage with our stakeholders in a systematic way.

This communications and engagement plan will contribute to the development of a wider Lewisham Health and Care Partners communications and engagement strategy which will seek to:

39 | Page LCCG:GOVBODJAN2018Page – 39W i C & P C

 Demonstrate our determination to achieve the best standards in communications and engagement, our intention to continue to involve patients in a way that genuinely and demonstrably leads to service improvement, and our commitment to making public engagement a driver for safe, high quality health services.  Demonstrate how communication and engagement contributes to achievement of our vision  Support organisations in achievement of their strategic objectives.  Provide a clear link between the overall priorities of the health and care in Lewisham, and our communication and engagement with residents, stakeholders, elected representatives, patients and service users.  Ensure effective communication and engagement with all our internal audiences, and promote the importance of effective communication amongst all of our staff.  Define SMART (Specific, Measurable, Achievable, Realistic and Timely) marketing and communications objectives which effect behaviour change and influence public opinion.

Why Communication is important

Communication activities should all be governed by the quality standards and approach defined in this plan. Communication is a part of everyone’s job. As well as caring for and treating people a key part of that is being able to effectively communicate with patients, and colleagues. Good teamwork is about passing on information. All managers also have a role to play in the bigger picture by disseminating and cascading information to staff.

The reputation that an organisation acquires is in large part down to how its staff communicate with patients, service users and visitors. Everyone working across health and care in Lewisham does that directly, in the place that matters most – at the point of treatment or care provision.

All health and care staff are communicators for Lewisham outside work as well as internally. Many staff also live locally and should be proud to be ambassadors for health and care in their communities. Staff who are confident in their role and positive about the organisations promote health and care services with everyone they come in to contact with.

40 | Page LCCG:GOVBODJAN2018Page –40 W i C & P C

Section 2 OBJECTIVES AND CORE MESSAGES

Introduction

There are a number of core themes that need to be promoted externally and internally across the health and care partners. These include a vision for a sustainable future that meets the needs of the local population, the quality of the services provided, the values that drive service delivery and the expertise of the staff, but which also focuses on the needs of specific areas within the borough; in this instance Neighbourhood 1.

Target audiences

All of the necessary messages and information about the CCG and its projects must be communicated to the following key audiences:

 Patients and the public  Staff  General Practitioners  The wider NHS  Partner agencies  The voluntary sector  Stakeholders  Elected Councillors and Members of Parliament  The media (as an important audience in itself and as a crucial vehicle to communicate with all of the above)  Seldom Heard groups  Lewisham & Greenwich NHS Trust membership list Objectives

 Explore, trial and measure the best (and some new) ways to communicate and engage effectively with the people of N1 and stakeholders.  Roll out a comprehensive ‘Use the Right Service campaign across Neighbourhood 1. Encourage and support patients and users to use the right and best service for them, whether it is self care, pharmacy service, GP, 111 service or A&E. Reduce the numbers of people using the wrong service.  Increase GP registration in the north of the borough and promote Extended GP Access, through both external and internal communications and engagement methods.  Publicise the ‘Pharmacy First’ scheme, offering advice to users on the how, when and where.

41 | Page LCCG:GOVBODJAN2018Page – 41W i C & P C

Core Areas

PRIMARY CARE IS OPEN - with a more user friendly name for the campaign

Eg: ‘NHS LOGO’ FEELING UNWELL? HELP US HELP YOU

USE THE RIGHT SERVICE (Flyers. Posters. Possible editorial in Lewisham Life on costs to NHS)

Advice and Guidelines for SELF CARE (Based on NHS Choices branding and NHS England guidelines)

PHARMACY FIRST (Supporting and building on the work that has already been done on the ‘Pharmacy First’ campaign.

NHS 111 (Tying in with the national January re-launch)

GPs & GP EXTENDED ACCESS (Communicating effectively both externally with users and stakeholders as well as internally with GP practice staff and other employees across health and care partners)

GP REGISTRATION (Simple messages providing information to the public on how, when and where)

TIE IN WITH NATIONAL MESSAGES (eg. Winter pressures, Use the Right Service, Christmas and New Year GP Access etc)

Key Points for Delivering our Messages

An accessible name for the campaign (using Primary Care Is Open only as a working name within the CCG and partners as it is now widely known and referred to).

Ensure that as much of our communication and engagement is as measurable as possible, including use of demographics, cross partner working, etc.

Specific Communications and Engagement Techniques including:

 Direct Mail  Leaflets  Posters

42 | Page LCCG:GOVBODJAN2018Page –42 W i C & P C

 School Bags targeting families  Paid, targeted social media  Co-ordinated partner wide strategy and implementation  Editorial  Videos for social media  GP Lists  Text messages sent from GP surgeries to their patients  Pharmacy First (with opening times for each approved pharmacy)  Transport hubs and stations targeting commuters  Goldsmiths  Lewisham Life and e-bulletin  Use the Right Service flyer and coordinated campaign  Internal communications to ensure that staff in the NHS in Lewisham as well as our partners are aware of what is going on and can communicate with one voice.

Exploration / Possible Pilot

We are keen to trial a strategy of working with gyms and fitness clubs in the north of the borough to engage them and their users in the health messaging that is important to their communities and there is an obvious connection between health, exercise and fitness with the prevention and self care message that we are working to get across to our communities. This would cover the key campaigns that are below in this document and include the following establishments:

Club Pulse, New Cross Glass Mill, Lewisham Wavelengths, Deptford Meridian Fitness, Deptford New Cross Martial Arts

Section 3

Communications and Engagement Action Plan for Neighbourhood 1

1. Messaging for north of the Borough of Lewisham (Neighbourhood 1)

The message for the north of the borough should focus on all the positive things that are being done for residents in the north of the borough:

 Although the consultation document on the walk in centre, and the subsequent ‘noise’ around this matter, has focused on what may close,

43 | Page LCCG:GOVBODJAN2018Page – 43W i C & P C

some seem to have forgotten what is being offered currently and in the future.  It is important to take control of the messaging on this issue using the following points:  The Waldron Centre is not closing and is a proposed site to become 1 of 4 possible Neighbourhood Care Hubs.  GP practices opening in the Waldron Centre.  A focus on the health and care needs of residents of the north of the borough with two major health and care campaigns being launched there at the end of this year 2017 (‘Choose the Right Service’ and ‘Pharmacy First’)  The focus is on providing the best care to users and is not about privatising or cutting services, indeed the service provision will be increasing across the borough.

 The NHS in Lewisham is working closely with residents, communities and seldom heard groups as part of the aim to make London the healthiest capital city, in line with NHS London mission.  New joined up working across health and care partners means that we can better engage with users and tailor a better service for all.  Health and Care Partners are working on increasing GP registration.  Increased access to GPs and primary care through GP Extended Access.

These key points should be emphasised to staff across all LHCP as part of an internal communications plan to staff and should be the key lines used in external communications with stakeholders, media and users.

2. Integrated communications on Use the Right Service

The proposal is to develop a Lewisham version of the below graphics to inform our campaign for ‘Choose the Right Service’, which can be rolled out in Neighbourhood 1 before the end of 2017, and can act as our pilot area for a wider whole borough campaign.

The first of the 3 ‘Choose Well’ images is the NHS Choices graphic. This is more magazine content than poster or leaflet but illustrates effectively the different choices and also acts to guide us as a CCG that we are in step with national campaigns:

44 | Page LCCG:GOVBODJAN2018Page –44 W i C & P C

The second of the 3 ‘Choose Well’ images is the from NHS Sheffield

The third is from Caen Medical Centre

45 | Page LCCG:GOVBODJAN2018Page – 45W i C & P C

We can quickly sign off a Lewisham version and distribute it in leaflet form in: GP Surgeries Pharmacies Waldron Stations Home Delivery School Bags (by 15th December) Social Media across partners Paid targeted social media Goldsmiths Voluntary Action Lewisham and other charities Gyms in N1 area Lewisham Life e-bulletin District Nurses and Carers direct to patients’ homes Community groups and local assemblies Councillors and MPs surgeries

Working with partners we can distribute posters to health centres, practices, LB Lewisham properties, Lewisham & Greenwich NHS Trust properties as well as working with Transport for London and rail companies to use poster space in stations.

Over the wider campaign an editorial and discussion part to the campaign, including articles on the costs of NHS care and services and the importance and benefits of using the correct service. The graphic below is an example and this can be built upon. It is important that we emphasise that this is an engagement activity with users and patients and their families – to offer the best possible care we need to also care for the resources that we have. More efficient use of NHS services means less waste, more efficiency and an improved service for patients.

46 | Page LCCG:GOVBODJAN2018Page –46 W i C & P C

2. Integrated communications on ‘Pharmacy First’

Pharmacy First is an important part of reducing pressure on other NHS services by providing advice, treatment and medicines for common ailments. Pharmacy First will only be effective if people know it exists, how and when to access the service and what times their pharmacies are open.

In partnership with CCG Medicines Management we are proposing the following action points for December 2017 and January 2018 in the north of the borough of Lewisham.

• Distribution of leaflets to local GP surgeries • Distribution of leaflets to local pharmacies • Distribution of leaflets to the local train station (New Cross) & school bags (by 15th December 2017) • Pharmacy First posters for GPs and pharmacies. • Permanent Pharmacy First banner on the Lewisham CCG home page • Revamp of the Pharmacy First information pages on Lewisham CCG Website. • Addition of Pharmacy First banner to the ‘Walk In Centre’ page on the Lewisham CCG website and publicity on partner sites and social media. • Targeted Social Media Campaign promoting Pharmacy First • Pharmacy First information is part of OTC Antimalarial presentation to Neighbourhoods, to be presented December/January • Inclusion of Pharmacy First information on ‘changes to prescribing’ post consultation media.

The list of Pharmacy First pharmacies in Lewisham is listed here: \\5lfsles03.lewishampct.nhs.uk\vol1\CHUSERS\SiBaker1\Pharmacies in Pharmacy First.pdf

However it is important that users know the times that these services are available and we propose to confirm opening times of each pharmacy by 5th December 2017 so that we are able to include this information in the campaign (in online publications so that it can be changed and adapted as necessary).

47 | Page LCCG:GOVBODJAN2018Page – 47W i C & P C

The Pharmacy First leaflets are already printed. The focus to this part of the campaign is effective distribution and tie in with online, social media and partner and stakeholder working.

This campaign can also be part of our trial work with gyms in the north of the borough.

Pharmacy First Leaflet:

48 | Page LCCG:GOVBODJAN2018Page –48 W i C & P C

3. Encouraging GP Registration and Access

Key Messages:  GP registration of residents means more people access health services correctly.  GP Extended Access Service at University Hospital Lewisham offers GP appointments 7 days a week from 8am – 8pm to those who are unable to get an appointment with their GP.  GP practices make the appointments.  Sharing of patient information between Extended Access Service and patient’s normal GP practice, but only with consent of patient.  SELDOC for out of hours GP or NHS 111

The GP Extended Access Service (with the correct new location) have now been printed. They need to be distributed and GPs and their practice managers advised accordingly. There is a significant piece of work to do around promoting this service and advising staff and users that it exists and how to access it. This needs to be considered to run in step with the campaigns for Self Care and Using the Right Service and Pharmacy First.

Action Points for N1:

A GP Registration Drive in Neighbourhood 1 with targeted mail (Feb 2018)

Paid social media targeted by postcode (Feb 2018)

Posters and leaflets in the local area. (Feb 2018)

Working with gyms and leisure centres to promote GP registration and access. (Jan / Feb 2018) Distribution of GP Extended Access Service piloted primarily in the north of the borough, in GP practices, NHS estate, charities, stakeholders, local assemblies, Community Connections, and community groups. (Dec 2017 – March 2018)

Information on websites and social media of CCG and Health and Care Partners on GP registration. (Jan / Feb 2018)

Tie in with the national campaign on GP access over Christmas and New Year. (Complete)

49 | Page LCCG:GOVBODJAN2018Page – 49W i C & P C

Work with Healthwatch to hold engagement event(s) on access to GPs / primary care.

(March / April 2018)

MEASURING

We will seek to measure the impact of our communication and engagement in the following ways:

 Mapping of targeted areas  GP registration increases by address  Engagement on social media  Interaction with charitable and community groups  Longer term changes in behaviour and use of services

CONCLUSION

The actions listed within this plan are achievable for the north of the borough in the months of December 2017 and January 2018 and this work will also be used as a pilot for wider engagement and communication in the wider borough during 2018. The communications strategy for Health and Care Partners is being developed and will focus on joined up working across the partners, the improved access and service to users, ever greater engagement with staff and stakeholders to enable them to understand and have more ownership of the changes in the landscape and of the increased joined up working.

50 | Page LCCG:GOVBODJAN2018Page –50 W i C & P C

51 | Page LCCG:GOVBODJAN2018 – PageW i C & P51 C This page is intentionally left blank

Research Report

Review of the on-line survey for the public consultation on the future of the New Cross Walk-in Centre and improving provision and access to primary care Prepared for: Lewisham Clinical Commissioning Group January 2018

Page 53 Review of the on-line survey for the public consultation on the future of the New Cross Walk-in Centre and improving provision and access to primary care

Prepared for: Lewisham Clinical Commissioning Group Prepared by: Steve Handley, Research Director Date: January 2018

Produced by BMG Research

© BMG Research Ltd, 2018

www.bmgresearch.co.uk

Project: 1432

Registered in England No. 2841970

Registered office: BMG Research Beech House Greenfield Crescent Edgbaston Birmingham B15 3BE UK Tel: +44 (0) 121 3336006

UK VAT Registration No. 580 6606 32

Birmingham Chamber of Commerce Member No. B4626

Market Research Society Company Partner

The provision of Market Research Services in accordance with ISO 20252:2012

The provision of Market Research Services in accordance with ISO 9001:2008

The International Standard for Information Security Management ISO 27001:2013

Investors in People Standard - Certificate No. WMQC 0614

Interviewer Quality Control Scheme (IQCS) Member Company

Registered under the Data Protection Act - Registration No. Z5081943

A Fair Data organisation

Cyber Essentials certification

The BMG Research logo is a trade mark of BMG Research Ltd.

Page 54 Table of Contents

1 Introduction ...... 1 1.1 Consultation Background ...... 1 1.2 Analysis and reporting ...... 1 2 Sample Profile ...... 3 3 GP Registration and Walk-in Centre usage ...... 5 4 Views on Closure Proposal ...... 8 4.1 Understanding of the proposal ...... 8 4.2 Support for the proposal ...... 9 4.3 Views on future service access ...... 14 4.4 Further considerations in relation to the proposed closure ...... 16 5 Views on access to primary care ...... 22 6 Appendix: Statement of Terms ...... 24

Page 55 Page 56 Introduction

1 Introduction

1.1 Consultation Background The contracts for the NHS Walk-in Service at the Waldron Health Centre in New Cross was due to expire on 31st December 2017. Lewisham CCG ran a formal public consultation on its future and improving provision and access to primary care for a 12 week period between 8th August 2017 and 30th October 2017. The proposal presented suggested that the Walk-in service be closed when the current contract expires. Alongside this the CCG would encourage increased use of the GP Extended Access Service, which is open 8am-8pm, 7 days a week. This service currently provides 25,426 additional GP and nurse appointments, a figure that will increase to 29,914 appointments in 2018. The proposal to close the Walk-in Centre is based on the judgement that this does not represent the best way to care for the people of Lewisham. This position is based on the following key points:  Less than half of the attendances for people who used the Walk-in Service last year could be identified as registered with a Lewisham GP.

 The majority of people who attend the Walk-in Centre do so for treatment that could either be provided by their own GP or practice nurse, by other services or advice and support to self-care.

 It is important for people to be registered with a GP so they can benefit from care that encourages healthy living, early detection of diseases and holistic care.

 Walk-in Centres mean that people can avoid registering.

 Walk-in Centres do not provide bookable appointments and do not have access to patient records, which supports continuity of care.

1.2 Analysis and reporting Responses to the consultation survey were provided to BMG Research for collation, and analysis. This written report, and accompanying data tables, is based on valid responses, i.e. if a respondent did not answer a question, or answered it incorrectly they were excluded from the analysis for that question. Responses to the open/free text questions have been reviewed and grouped into themes, in order to quantify the prevalence of particular viewpoints. This coded data is shown in the analysis, along with illustrative quotes to explain the opinions being expressed.

Page 57 1 Review of the on-line survey for the public consultation on the future of the New Cross Walk- in Centre and improving provision and access to primary care The data used in this report are rounded up or down to the nearest whole percentage. It is for this reason that, on occasions, tables or charts may not add to 100%. Where tables and graphics do not match exactly the text in the report this occurs due to the way in which figures are rounded up (or down) when responses are combined. Results that do differ in this way should not have a variance which is any larger that 1%. Throughout this report, the term ‘significant’ is only used to describe differences within groups that are statistically significant. These are differences that are proven to be real by use of the T-test. This consultation was open to both residents who reside in Lewisham and those who live elsewhere. Overall, the split in the data is 92% Lewisham residents and 8% non- residents. Given that this was an open consultation, no correction for this is made in the data. The analysis will draw out whether the views of these two groups differ. The survey also captured equalities data (gender, age, ethnicity religion & disability). It also asked individuals to state if they are a carer. Where significant differences in opinion are found between these groups, this is reported.

Page 58 2 Sample Profile

2 Sample Profile

The table below summarises the composition of the consultation responses. While views were captured from all age groups, it is notable that there is a skew towards female responses (66%), with only 30% of responses coming from men. In terms of ethnic group, respondents to the consultation were most commonly White British (53%).

Table 1: Profile of consultation sample % Number

Do you live in the borough of Lewisham?

92% 1629 Yes 8% 139 No Gender

30% 528 Male 66% 1142 Female 1% 13 Transgender 3% 49 Prefer not to say Age

<0.5% 1 15 or under 12% 200 16-24 15% 265 25-29 16% 274 30-34 14% 239 35-39 12% 210 40-44 7% 127 45-49 7% 118 50-54 7% 117 55-59 4% 75 60-64 5% 85 Over 65 1% 25 Prefer not to say Disability that affects everyday living?

16% 278 Yes 84% 1427 No

Page 59 3 Review of the on-line survey for the public consultation on the future of the New Cross Walk- in Centre and improving provision and access to primary care

% Number Ethnic group White English/Welsh/ Scottish/ Northern Irish/ 53% 900 British 3% 49 White Irish 0% 0 White Gypsy or Irish Traveller 16% 276 White other 5% 87 Black African 5% 87 Black Caribbean 2% 32 Other Black/ African/ Caribbean 3% 44 White & Black Caribbean 1% 13 White and Asian 4% 67 Other mixed multiple ethnic background 2% 33 Indian <0.5% 6 Pakistani <0.5% 4 Bangladeshi 1% 20 Chinese <0.5% 2 Vietnamese 2% 27 Other Asian 4% 67 Any other ethnic group Religion Christian ( includes all Church of England, 31% 524 Catholic, Baptist denominations) 3% 48 Muslim 1% 19 Jewish 1% 9 Hindu <0.5% 5 Sikh <0.5% 1 Tamil 6% 94 Any other religion or belief 58% 986 No religion Are you a carer?

15% 247 Yes 85% 1439 No

Page 60 4 GP Registration and Walk-in Centre usage

3 GP Registration and Walk-in Centre usage

Approaching nine in ten (88%) of consultation respondents are registered with GP practice within Lewisham. A further 9% are not, with the remaining 3% being uncertain. Drilling down to Lewisham residents, 92% are registered with a GP, 5% are not and 3% answered don’t know. Significant variations in GP registration are evident by age. The 84% of 16-34 year olds who are registered with a Lewisham GP is significantly below the registration level in older age groups. This finding also reflects itself in a variation by ethnicity. Registration is lowest among mixed race respondents (77%), a group who have a younger age profile than other ethnic groups.

Figure 1: Are you registered with a GP practice in Lewisham? (All valid responses)

Total (1757) 88%

Lewisham resident (1620) 92% Non-Lewisham resident (137) 42%

Male (524) 88% Female (1140) 89% Transgender (13) 77%

16-34 (737) 84% 35-54 (692) 91% 55-64 (191) 93% 65+ (83) 94%

Disability (278) 86% No Disability (1421) 89%

White (948) 88% Mixed (123) 77% Asian (92) 91% Black (205) 92% Other (67) 93%

Christian (522) 92% Other religion (175) 89% No religion (982) 86%

Carer (245) 90% Non Carer (1434) 88% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Sample base in parenthesis

Page 61 5 Review of the on-line survey for the public consultation on the future of the New Cross Walk- in Centre and improving provision and access to primary care In interpreting the above findings it should be noted that the two Hurley Group practices (New Cross Health Centre and Hurley at the Waldron) directly promoted the consultation to their registered patients via a text message. This text message provided a direct link to the online consultation survey. This communication may have potentially inflated the overall incidence of registered patients taking part in the consultation. Figure 2 below shows all of the Lewisham GP practices that at least 1% of the registered individuals use. In total 13% of the individuals registered with a Lewisham GP practice are registered with the Amersham Vale Training Practice, with 12% registered with the Jenner Practice. A further one in ten of the registered patients are registered with the Hilly Fields Medical Centre (10%), the New Cross Health Centre (9%) and the Waldron (9%). Please note that it was the last two practices that sent out the aforementioned promotional text messages.

Figure 2: Most common GP Practices individuals within the sample are registered with (All valid responses – those registered with a Lewisham GP practice)

Amersham Vale Training Practice 13% Jenner Practice 12% Hilly Fields Medical Centre 10% New Cross Health Centre 9% Waldron/Hurley at Waldron 9% Queens Road Group Practice 6% St John's Medical Centre 4% Sydenham Green Group Practice 4% The Vale Medical Centre 4% Vesta Road Surgery 4% Waldron Health Centre (Dr Batra) 4% Grove Medical Centre 3% Honor Oak Health Centre 2% Rushey Green Group Practice 2% Belmont Hill Surgery 1% Brockley Road Medical Centre 1% Clifton Rise Family Practice 1% Deptford Medical Centre 1% Deptford Surgery (Formerly Jayram Surgery) 1% Morden Hill Surgery 1% South Lewisham Group Practice 1% Torridon Road Medical Centre 1% Triangle Group Practice 1%

0% 2% 4% 6% 8% 10% 12% 14% Sample base: 1002 Practices mentioned by less than 1% not shown

Page 62 6 GP Registration and Walk-in Centre usage

Two thirds (66%) of consultation respondents have used the New Cross Walk-in Centre within the last twelve months. This suggests that a majority of respondents to the consultation have benefited from the Walk-in Centre’s service recently.

Figure 3: Have you used the New Cross Walk-in Centre in the last 12 months? (All valid responses)

1%

33% Yes No Don't know 66%

Sample base: 1751

Usage within the last 12 months is significantly higher among those aged 16-34 (76%) and 35-54 (62%). However, this usage does not vary significantly among those registered with a GP in Lewisham (66%) and those who are not (70%). Therefore it does not appear that Walk-in Centre usage is necessarily a result of a lack of GP registration. No significant differences in usage within the last 12 months are evident by ethnicity, disability or religion.

Page 63 7 Review of the on-line survey for the public consultation on the future of the New Cross Walk- in Centre and improving provision and access to primary care

4 Views on Closure Proposal

Before individuals were presented with the questions which sought their views on the closure proposal, they were asked to indicate if they had read the consultation document or consultation leaflet before starting the survey. A majority of 91% indicated that they had read the supporting document or leaflet, but 9% had not. The latter group potentially could be responding to the proposed closure without considering the accompanying rationale. Therefore, throughout the analysis it will be highlighted if those who have not engaged with the consultation materials have significantly different views to those who have done so.

4.1 Understanding of the proposal Among the individuals who have read the consultation document or leaflet three quarters (76%) understand why the local NHS is proposing to close the Walk-in Centre. Even with this supporting material 21% do not understand why the closure is being proposed. The remaining 3% answered don’t know.

Figure 4: Having read the document do you understand why the local NHS wants to close the Walk-in Centre? (All readers - valid responses)

3%

21%

Yes No Don't know

76%

Sample base: 1335

Among all respondents i.e. those who have read the supporting documentation and those who have not, 70% understand why the local NHS is proposing to close the Walk-in Centre, while 26% do not. The remainder answered don’t know.

Page 64 8 Views on Closure Proposal

4.2 Support for the proposal The consultation responses show clear opposition to the proposal to close the New Cross Walk-in Centre with 82% of respondents unsupportive. Among the remainder, 11% of respondents support the proposal and 7% answer don’t know.

Figure 5: Do you support the proposal to close the New Cross Walk-in Centre? (All valid responses)

7% 11%

Yes No Don't know

82%

Sample base: 1752

Interestingly, opposition to the proposed closure is significantly higher among those who have read the consultation leaflet/document (82%) than among those who have not (71%). Breaking these results down further shows that opposition to the proposals is equal between those who live in Lewisham (82%) and those who live elsewhere (83%). Individuals who are not registered with a GP in Lewisham are significantly more likely to disagree with the proposed closure of the New Cross Walk-in Centre (93%) than those who do have local GP registration (81%). There is also a clear variation in opinion based on prior usage of the Walk-in Centre. Among users, 89% oppose its closure. This proportion drops to 67% among non–users, with 21% of this cohort supporting the proposed closure. Analysis by age shows that opposition to the proposed closure peaks at 86% among those aged 16-34 and 83% among those aged 35-54%. Opposition exceeds support among all age groups. Those of a mixed ethnicity (87%) also more commonly oppose the proposal. No significant variations in opinion are evident by disability.

Page 65 9 Review of the on-line survey for the public consultation on the future of the New Cross Walk- in Centre and improving provision and access to primary care

In a follow up question individuals were asked what they think is needed to increase understanding and use of GP Surgeries and the GP Extended Access Service in Lewisham. The full range of responses given to this question is summarised by the figure overleaf. Most commonly reference was made to decreasing waiting times and improving the availability of appointments in GP practices, with a third (33%) of respondents giving comments of this type. The responses suggest that Walk-in Centre use is being driven by a perceived need, i.e. an absence of alternatives within a desired time frame. Illustrative comments for this key theme are provided below. “It's not an understanding issue it's an access issue. Getting a GP appointment is extremely difficult.” “You need to actually be able to get a doctor's appointment when you need one as opposed to 3 weeks times. GPs surgeries and hospitals are already way over subscribed.” “Timely GP appointment - the waiting time is weeks!! “I recently called my GP for an urgent GP appointment for my 11 month old. No appointments were available and the receptionist only mentioned New Cross as an option - I was not made aware of the extended access service.” “Reduce the time it takes to see your GP when booking an appointment. This why I use the Waldron Centre!” “The Walk-in service is an excellent alternative. Appointments are not available for the extended hours GP service Waldron is accessible with free parking which the extended service in Lewisham does not have. Walk-in saved my life.” “Easier appointments and not having to wait two weeks just for a telephone consultation.” “The critical issue isn't better understanding of GP services it is access to them. You can't get a GP appointment in less than 3 weeks.” “Make it easier for people to get an appointment when needed urgently. It is not acceptable to have to wait days for medical concerns that arise and require immediate attention.” “I work in Lewisham. It is difficult to get an emergency appointment at the GP surgery. It's fine if you can wait a week but when you can't you need this service.” “You need to provide faster appointments so that people can see their GP when they need to not 2 months later. Not everybody can take days off work for same day appointments.” “I use the Walk-in Centre because I can't get an appointment with my GP at short notice and outside of my work hours. With the Walk-in Centre I can go after work and get antibiotics when I need.” “I use the Walk-in Centre as my GP surgery never has emergency appointments available. If the Walk-in Centre is closed, more GP appointments need to be made available across all the Lewisham surgeries.” “It is impossible currently to make an appointment in your own GP surgery (including emergency and weekends services). Also, the A&E waiting time for emergency is far too long!” “Make booking appointments easier for everyone. I have tried a couple of times recently and been told the next available time is in 2 to 3 weeks. What am I expected to do - go to A&E?!” “Tricky getting appointments at GP Surgery, and almost impossible to book ahead for non- urgent yet pressing matters. This is the first I have heard of the Extended Access service.”

Page 66 10 Views on Closure Proposal

Figure 6: What do you think we need to do to increase understanding and use of GP Surgeries and the GP Extended Access Service in Lewisham? (All valid responses)

Decrease waiting times/improve appointment system 33% Have more available staff/appointments incl. longer opening hours, more GP's 15% Keep GP surgeries open/GP surgeries are needed (incl. walk-in centres) 10%

Better communication/information (no specified source/method) 8%

Improve advertising/publicity incl. posters, billboards, adverts 8% Improve health education/awareness/understanding for patients/services and how to use them. 7% Improve the use of written information incl. letters, leaflets, newsletters 7%

Ask patients/listen to patients 5% Display information in community centres incl. surgeries, job centres, libraries 5% Improve the use of verbal communication incl. meetings, home-visits, talking to GP 4% Better organisation/management of services 3%

Improve the website 3%

Increase funding/manage funding better 3%

Remove barriers relating to registration process for GP surgeries 3%

Consider patients circumstance (incl. location/health etc) 3%

Make certain that the local community's needs are still supported 2%

Use social media 2%

Walk-in centres reduce pressure on/increase speed in GP Surgeries 2%

Email information 1%

Employ better medical staff 1%

It's fine as it is incl. happy, no problems 1%

Make information accessible to non-English speakers 1%

Lack of resources/services provided 1%

Raise restrictions/create filters for use of the walk-in centre 1%

Answered incorrectly 1%

Employ helpful receptionists <0.5%

Other 4%

Don't know 3%

0% 5% 10% 15% 20% 25% 30% 35%

Sample base: 1365

Page 67 11 Review of the on-line survey for the public consultation on the future of the New Cross Walk- in Centre and improving provision and access to primary care Implicit in many of these comments is a lack of belief that the closure of the New Cross Walk-in Centre will not be compensated for with improved primary care access elsewhere.

A further 15% of comments suggested that capacity at GP practices needs to be increased, through having more staff and a greater range of appointment options (including at evenings and weekends). “There isn't enough doctors in Acute Care and there definitely isn't enough doctors in Primary Care. It's hard enough trying to get an Appointment currently.” “There are registered patients at the New Cross Walk-in Centre who use the clinic as their primary GP in addition to emergencies. There are limited doctors in the area and thousands of students because of the university.” “It would be helpful if my own surgery was open at weekends. Have used the Waldron Centre a number of times - for me, whilst pregnant, and for children when ill at w/end.” “Make sure the doctor's surgeries are open outside office hours.” “Encourage them to open longer.” “Emergency access to GPs needs to be extended or A&E services will be abused and overextended. “Weekend appointments” “More appointments in evenings” “Employment of more staff” “More full-time GPS and more nurses. Less locums.” “Increase doctors and nurses and stop using external/ day to day staff.” “Longer opening hours and more helpful reception staff.” “To employ more GPs and nurses to enable safe practice. This will also help with improvements when trying to get appointments to see a GP and g e better choice to patients to avoid unnecessary A&E visits.” “Extended opening hours could help.”

Some of these comments also call for improvements to service signposting:

“More triage by GP staff on calling for appointments to ensure patients are aware of better alternative care options such as visiting a pharmacy and to assess how urgent appointment need is.” “Make GP surgeries usable and tell more people about what the Extended Access Service is and who can or should use it.” “I haven't heard of the GP Extended Access Service (our GP always suggests using the Walk- In Centre). It seems vulnerable to the same painful booking process and fundamental lack of appointments that our GP suffers from.” “Receptionists to tell us we can have this - not just ‘no appointments’."

Page 68 12 Views on Closure Proposal

Improved communication, information and publicity via various channels was a common suggestion throughout responses to this question, as demonstrated by Figure 6. Responses did suggest both online and offline information provision will be needed to increase understanding. “Have a clear set of information available either through telephone or online, advising on when you should visit a GP.” “I regard myself as a very well informed person with regard to local services and, until I read these proposals, I knew nothing at all about the GP Extended Access Service.” “Target communication/engagement with communities that are less likely to register with a GP and are more likely to need the Walk-in Centre - i.e. lower income, certain ethnic groups. Closing the facility without effectively communicating with them is unfair.” “Better public information.” “Improve information about these services, how to access them and how to book an appointment. provide information about how quickly appointments are available. What will happen to people moving borough unable to immediately access GP?” “You need to communicate more clearly the services available.” “More information (public information posters/leaflets/ info at GP surgeries).” “Potentially be clearer about the negatives around the use of the Walk-in (no records, lack of holistic, long-term) and also that its not an alternative to a GP.” “I've literally never heard of the Extended Access service until filling out this form.” “Provide information through the community pharmacies.” “Better engagement with non registered and registered patients to understand their needs and solutions. There has been nothing I have been aware of as a resident.” “I'd never heard of the GP extended service before now, but I did know about the Walk-in Centre, and have used twice in the past.” “Better more focused communications.” “Communication should be more effective between patients and health centres.” “I found out there is no longer a Walk-in service at my GP with a hand written note on the doors. At one point they were opening on Saturdays but again no notices were sent.” “Provide more concise information to residents, of how to use and book appointments. Make it simpler to get appointments.” “Better information - leaflets distributed by council direct mailshot from surgery.” “I do not think it is the understanding it is the fact that even if there are extended hours nobody knows if this is going to work and get an appointment when needed.” “It is not widely known about the extended access to GP services. However the Walk-in Centre is a more easily accessible service out of normal hours and is more convenient for a lot of users.” “More information on-line.” “More in Lewisham Life. More in South London press. Politicians to tell people.”

Page 69 13 Review of the on-line survey for the public consultation on the future of the New Cross Walk- in Centre and improving provision and access to primary care 4.3 Views on future service access A further question was included in the consultation in order to explore views on future access to primary care if the New Cross Walk-in Centre was closed. All were asked on a scale of 1 (not at all confident) to 10 (really confident), how confident they would feel about being able to get an appointment at a GP surgery or using the GP Extended Access Service. The full range of responses given to this question is shown by the figure below. This suggests that confidence in the alternatives are low, given that a third (33%) of respondents gave a response of 1 or 2 on the 10 point scale and a further quarter (26%) gave a response of 3 or 4 out of 10.

Figure 7: On a scale of 1 (not at all confident) to 10 (really confident), how confident do you feel about being able to get an appointment at your GP surgery or using the GP Extended Access Service, if it replaces the Walk-in Centre? (All valid responses)

1 - Not at all confident 15%

2 18%

3 16%

4 10%

5 14%

6 9%

7 5%

8 6%

9 3%

10 - Really confident 3%

Summary: Not at all (1-2) 33%

Summary: Not very (3-4) 26%

Summary: Neutral (5-6) 23%

Summary: Somewhat confident (7-8) 11%

Summary: Really confident (9-10) 7%

0% 5% 10% 15% 20% 25% 30% 35% Sample base: 1392

Page 70 14 Views on Closure Proposal

Exploring these views further shows that among those not registered with a GP in Lewisham 50% gave a response of 1 or 2 on the 10 point scale. In comparison, among those with a local GP registration 32% gave these less confident responses. This significant variation suggests that those without a GP registration may feel particularly vulnerable to the proposed changes. It is also notable that non-users of the New-Cross Walk-in Centre are significantly more likely to give responses of 7 or above on this confidence scale than current or previous users (25% vs. 13%). However, we cannot determine from the dataset whether non-use of the Walk-in Centre is due to a lack of need (i.e. no ill health), or an enhanced ability to navigate the primary care options available locally. As might be anticipated, support and opposition to the proposed closure is interrelated with views on access to the alternatives as shown by the figure below. This figure clearly shows that opponents of the closure of the New Cross Walk-in Centre are less confident about getting an appointment elsewhere.

Figure 8: Confidence in accessing alternatives based on support or opposition to the proposals (All valid responses)

Opponents of proposal Supporters of proposal 1 - Not at all confident 17% 1 - Not at all confident 2%

2 22% 2 4%

3 18% 3 8%

4 10% 4 8%

5 13% 5 13%

6 9% 6 11%

7 3% 7 12%

8 4% 8 20%

9 2% 9 11%

10 - Really confident 2% 10 - Really confident 10%

Summary: Not at all (1- Summary: Not at all (1-2) 6% 2) 39% Summary: Not very (3-4) 28% Summary: Not very (3-4) 16%

Summary: Neutral (5-6) 22% Summary: Neutral (5-6) 24% Summary: Somewhat Summary: Somewhat 32% confident (7-8) 7% confident (7-8) Summary: Really Summary: Really confident 21% confident (9-10) 4% (9-10) 0% 20% 40% 0% 10% 20% 30% 40%

Sample base: 1106 / 170

Page 71 15 Review of the on-line survey for the public consultation on the future of the New Cross Walk- in Centre and improving provision and access to primary care In terms of age, those aged 55-64 (15%) and 65+ (14%) are those who exhibit a high level of confidence (9 or 10 out of 10) that they could get an appointment at their GP surgery or using the GP Extended Access Service.

4.4 Further considerations in relation to the proposed closure The consultation also asked respondents if there is anything else they think it is important for Lewisham CCG to know before they make a decision on the New Cross Walk-in Centre. The top five themes in the responses given are shown in the figure below.

Figure 9: Is there anything else you think it is important for us to know before we make a decision? (All valid responses)

Page 72 16 Views on Closure Proposal

Figure 10 below shows all of the responses given to this question.

Figure 10: Is there anything else you think it is important for us to know before we make a decision? (All valid responses)

Closures will impact the health of the community 27%

Poor waiting times/appointment system 17% Shouldn't close services/shouldn't make cuts incl. walk-in centre 15% Closures will put more pressure on other health services 13% Consider the effect on vulnerable people incl. elderly, disabled, children, homeless 10% Services are important to the community/there are no alternatives available incl. sexual health treatment 8% Communication/information needs to be improved 6% Time/resources need to be used more efficiently incl. less admin, utilising other health facilities, not accepting all… 5% Consider impact on university students 4%

More services/surgeries are needed incl. more locations 4% Should have more available staff/appointments incl. longer opening hours, more GP's 4% There are barriers relating to registration process 4% Consider impact on working people with limited access to their GP 3% Community outreach is needed incl. campaigning, advertising, educating 2% Community's opinions should be taken into account 2%

Decisions shouldn't just be based on saving money 2% Staff are not good at their job/provide poor standard of care 2% Support for proposals 1%

Believe that the decision has already been made 1%

Answered incorrectly 1%

N/a 1%

Other 4%

No particular reason 6%

Don't know <0.5%

0% 10% 20% 30%

Sample base: 1115

Page 73 17 Review of the on-line survey for the public consultation on the future of the New Cross Walk- in Centre and improving provision and access to primary care More than a quarter (27%) gave a response that suggested the proposed closure would have an adverse impact on the community. As well as commenting on health outcomes, some of these comments also made the connection to wider NHS services, particularly the risk of more individuals using A&E services incorrectly. “This is one of the few Walk-in Centres left in London. Please do not close it. Communities need an alternative between fixed GP appointments and A&E at hospitals.”

“If the Walk-in Centre goes, a lot of people will have to travel quite far as well as being sick just to see someone for some advice. The Waldron is nothing but helpful and convenient!”

“Consider the health needs of our communities. By treating and diagnosing early we can save hundreds of thousands of pounds from the budgets of our hospitals!”

“While I understand the reasons for the Centre to be closed, I think it’s an important service for the community in moments of need. Having used the Walk-in myself in urgent need, I'm a strong advocate for it to remain.”

“Consider health risk of people being deterred from getting tested or not getting tested sooner due to fear.”

“No confidence that pharmacist will diagnose correctly. Waldron centre clearly needed - don't use the confusion card as an excuse to cut out health services - particularly as Borough is growing massively with new multi-dwellings built = extra strain on services.”

“I consider the Walk-in clinic an important aspect in the mix of health care.”

“The Walk-in Centre provides a life line to people in the area, and the proposed alternatives do not appear adequate.”

“Closing the Walk-in Centre is likely to put a lot of pressure on the A&E service.”

“I believe the current level of care is a good and reasonable service. Any changes would be to the detriment of the community.”

“This will directly impact the health of the area if it goes ahead.”

“Waldron is a very useful service for local people/families - we have used it countless times when unable to get a GP appt on the day, particularly for our daughter.”

“Access to the Walk-in Centre is important to me; it offers reassurance when other options are not available. It made a big difference to me on New Year’s Day this year.”

“I think it's important for you to remember that health problems can surprise people, and they need to know they can count of the NHS even without solid pre-planning.”

“Drop-in centres by their nature serve more than the immediate local community, they provide a crucial, sometimes life saving service. It would be a detriment to the local community to close it. Walk-in services are important for a range of Lewisham residents.”

“The Walk-in is an important service for many people in situations where they cannot get a GP appointment and provides that safety net for people in a wide area.”

“People in Lewisham need Walk-in Centres and everyone should have access to health care.”

Page 74 18 Views on Closure Proposal

Comments on poor waiting times/appointment systems which feature in the responses to other free text questions were also made here: “I have used the Walk-in on more than one occasion when unable to get a GP appointment and it has been amazing and convenient.”

“It is impossible to get an appointment with my GP (who is in Southwark). Over 2 weeks wait. If I need a doctor's note for work I need to see a doctor before this time.”

“Recently unable to see GP. 4hr wait at Walk-in but obviously needed as referred to A&E. Not sure I would have seen anyone without the Walk-in.”

“It is not possible to get urgent appointments at local GP surgeries.”

“The centre enables access to medical care for local residents when may otherwise have to wait up to 2 weeks for a GP appointment.”

“I don't mind non-Lewisham residents using the Walk-in Centre. People use the centre because GP appointments are often not available when needed.”

“Cuts in NHS funding are driving this decision, it may be the least bad one but people who are reluctant to make appointments 10 days in advance will end up clogging A and E and there will be unnecessary deaths.”

“I think it is crazy that sometimes there wait for an online booking for a GP is over 1 week and can be as much as 2 weeks.”

“Not having on the day appointments is a huge problem especially for people with complex medical conditions. So is continuity with a GP trusted to join-up patient experience and support.”

“Before you make a decision on the New Cross Walk- in Centre think of the many people that will not get a doctors appointment when urgently needed.”

“GP surgery queues are long now with the Walk-in service to imagine not having the Walk-in service, it would be my worst nightmare.”

“I depend on this service as my local GP is inadequate - I can't get a short notice appointment out of 9-6 work hours. I have to wait 3 weeks.”

“It is often very difficult to get a GP appointment making the Walk-in Centre the only option for many people.” “ If there is no Walk-in Centre does that make it more likely I will be seen by my GP at short notice?”

“Whenever I try and make an urgent appointment I am told to go to the Walk-in Centre.”

“Much harder to get appointments over past few months at our surgery.”

Page 75 19 Review of the on-line survey for the public consultation on the future of the New Cross Walk- in Centre and improving provision and access to primary care Comments that resist service cuts/closures echo the perceived negative impacts of this decision. “Don't go ahead with closing the Waldron Walk-in Centre. It's such a valuable asset for the community who may find it difficult to get time off work to go to the GP surgery - if they can get an appointment.”

“Funding needs to be available to support GP services, not to just fund more GPs. There needs to be a radical rethink to service provision that actually happens not just the usual rhetoric.”

“It is important to keep the Walk-in Centre open. Sometimes it is difficult to get and appointment with your own GP. You sometimes have to wait up to 3 weeks for an appointment.”

“Please don't close the Walk-in, it's an amazing service.”

“So many people rely on the service provided at the Waldron - I honestly beg you not to close it.”

“Closing new cross is not the answer.”

“The NHS is in trouble due to the swathe of cuts. More needs to be done to protect this vital service in Lewisham and no more cuts in services staff and facilities.”

“It's a brilliant service with great doctors - please do not close it.”

“Please don't close this service, put leaflets on how to register in multiple languages in the Walk- in.”

“Keep it open. Impossible to get GP appointments sometimes, particularly outside working hours.”

“The Waldron building was only built a few years ago. Seems a waste of money to close it and Lewisham residents will receive inferior primary care services. It is hard to get an appointment with a GP. Keep Waldron going.”

“I am registered with a doctor yet I use the walk in service regularly. I do feel the service offered is sub par at the moment but closing it down is not the solution.”

“The Walk-in Centre helps many people that otherwise wouldn't have access to medical help please don't close it.”

“The basis of the proposal to close the drop-in centre - that the demand can be better met in GP surgeries and A&E - is so narrowly focused as to make it laughable. It is a terrible idea.”

“Don't close it down because I use it and it would affect me personally.”

“Do not close or alter the Waldron it is an essential service and conveniently positioned for all borough users. Stop closing and/or repositioning our services it's getting ridiculous.”

Page 76 20 Views on Closure Proposal

It should also be noted that one in ten (10%) responses identified an equalities aspect to the decision. suggesting that some groups within the community would be disproportionately affected. “New Cross has been incredibly useful to me during two particular instances when my children were very ill indeed. It's a required safety net to a borough already struggling with the lack of available medical resources.” “Transient populations - travellers -homeless - Asylum seekers - Women in refuges.” “I've used the centre on many occasions, for myself and my young children. Particularly at the weekend when GP surgeries are closed. By closing the Walk-in Centre you will be diverting more patients to A&E, further clogging up these services.” “Waldron Walk-in has been invaluable during weekends and has avoided A&E trips for our children. My concern about closing Waldron is if not enough emergency/short notice slots are available at weekends at GP extended access.” “By shutting this centre, you will be making access to healthcare harder for many people who live and work in Lewisham.” “Think about homeless people.” “There are large groups of people (parents with young children, homeless, immigrants, precarious jobs) who will be disenfranchised by this - or have to go to A&E. This is short sighted toothpaste tube squeezing.” “The Walk-in Centre is most needed by the homeless people who are not registered with a GP practice. I don't mind if the Walk-in Centre stops treating people like me who are already registered.” “I think many young people use the Walk-in service in fact I wouldn't know where to go next in case of an emergency and my GP does not provide all the same services.” “There are marginalised people who cannot access GP surgeries, whose families and communities may suffer because they are unable to find care.” “Many vulnerable people have chaotic lives and need a centre they can Walk-in and get advice on the day.” “Your main focus should be to care for those without a recognised voice.” “I think unregistered access is important to have also.”

Page 77 21 Review of the on-line survey for the public consultation on the future of the New Cross Walk- in Centre and improving provision and access to primary care

5 Views on access to primary care

A further question on how access to primary care in Lewisham can be improved produces similar responses to those already described, with waiting times/appointments (23%), resistance to the closure (23%), more staff at GP practices (17%), enhanced appointment availability (17%) being the most common answers.

Figure 11: Do you have any suggestions about how we can improve access to primary care in Lewisham? (All valid responses)

The full range of suggestions made are shown in the figure overleaf.

Page 78 22 Views on access to primary care

Figure 12: Do you have any suggestions about how we can improve access to primary care in Lewisham? (All valid responses)

Decrease waiting times/improve appointment system 23%

Don't close services/don't make cuts incl. walk-in centre 23%

Have more available staff incl. employ more GP's 17%

Have more available appointments incl. longer opening hours 17% Be more efficient/manage GP workload better incl. not putting pressure on A&E 16% Make healthcare more accessible incl. remove barriers relating to registration process 11% Provide more services/surgeries incl. more locations 10%

Employ better medical staff/provide better care 8%

Increase funding 7%

Community outreach incl. campaigning, advertising, educating 5%

Better communication/information (no specified source/method) 4%

Consider impact on working people with limited access to their GP 4%

Improve online services incl. booking appointments, information 4% Improve telephone services incl. booking appointments, information 4% Take measures to help vulnerable people incl. elderly, disabled, children, homeless 4% It's fine as it is incl. happy, no problems 3% A different political approach to managing the NHS incl. stop privatisation 3% Employ helpful receptionists 2%

Improve available resources incl. technology 2%

Listen to doctors and patients 2%

Consider impact on university students 1%

Improve written communication incl. letters, leaflets, texts, emails 1%

Make information accessible to non-English speakers <0.5%

Consider treatment of NHS staff incl. wages, hours <0.5%

Other 4%

No particular suggestion/ Nota pplicable 6%

Don't know 1%

0% 10% 20% 30%

Sample base:1198

Page 79 23 Review of the on-line survey for the public consultation on the future of the New Cross Walk- in Centre and improving provision and access to primary care

6 Appendix: Statement of Terms

Compliance with International Standards BMG complies with the International Standard for Quality Management Systems requirements (ISO 9001:2008) and the International Standard for Market, opinion and social research service requirements (ISO 20252:2012) and The International Standard for Information Security Management (ISO 27001:2013). Interpretation and publication of results The interpretation of the results as reported in this document pertain to the research problem and are supported by the empirical findings of this research project and, where applicable, by other data. These interpretations and recommendations are based on empirical findings and are distinguishable from personal views and opinions. BMG will not publish any part of these results without the written and informed consent of the client. Ethical practice BMG promotes ethical practice in research: We conduct our work responsibly and in light of the legal and moral codes of society. We have a responsibility to maintain high scientific standards in the methods employed in the collection and dissemination of data, in the impartial assessment and dissemination of findings and in the maintenance of standards commensurate with professional integrity. We recognise we have a duty of care to all those undertaking and participating in research and strive to protect subjects from undue harm arising as a consequence of their participation in research. This requires that subjects’ participation should be as fully informed as possible and no group should be disadvantaged by routinely being excluded from consideration. All adequate steps shall be taken by both agency and client to ensure that the identity of each respondent participating in the research is protected.

Page 80 24 Page 81

With more than 25 years’ experience, BMG Research has established a strong reputation for delivering high quality research and consultancy. BMG serves both the public and the private sector, providing market and customer insight which is vital in the development of plans, the support of campaigns and the evaluation of performance. Innovation and development is very much at the heart of our business, and considerable attention is paid to the utilisation of the most up to date technologies and information systems to ensure that market and customer intelligence is widely shared.

Page 82

Equality Impact Assessment The future of the NHS Walk-in Centre and improving provision and access to primary care

AUGUST 2017 Version 5.0

Page 83

Document Control

Development Date: 04.08.2017

Document Title: The future of the NHS New Cross Walk-in Centre and improving provision and access to primary care

Document Type: Equality Impact Assessment

Owner: Lewisham Clinical Commissioning Group

Approval: Lewisham CCG Equality & Diversity Group

Circulation: Dr Marc Rowland, Chair, Lewisham CCG Dr David Abraham, Clinical Director, Urgent & Emergency Care Lead Dr Jacky McLeod, Clinical Director, Primary Care Lead

Governing Body Ratification Date: 07.11.2017

Publication Date (Website): 11.10.2017

Revised: 08.01.2018

1 | Page WIC_EIAAUGUST2017 Page 84

1. Organisation Lewisham Clinical Commissioning Group 2. Purpose of an Equality Impact Assessment (EqIA) 2.1 The objective of this initial EqIA is to identify potential positive and negative impacts that may result of the changes, with particular emphasis on fulfilling the Public Sector Equality Duties (PSED) within which NHS Lewisham CCG has a duty to; 2.1.1 Eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited under the Equality Act 2010; 2.1.2 Advance equality of opportunity between people who share a protected characteristic and those who do not; 2.1.3 Foster good relations between people who share a relevant protected characteristic and those who do not share it. 2.2 In addition, to align outcomes to community based care, which is;  Proactive and Preventative: by creating an environment which promotes health and wellbeing, making it easier for people to find the information and advice they need on the support, activities and opportunities available to maintain their own health and wellbeing and to manage their health and care more effectively;  Accessible to all: by improving access to local health and care services, including increasing children’s access to community health services and early intervention support. And for everyone to have access to urgent care when needed;  Co-ordinated: So that people receive personalised health and care services which are coordinated around them, delivered closer to home, and which integrate physical and mental health and care services, helping them to live independently for as long as possible.

2.3 The focus of this report is to assess the potential impact of the closure of the NHS Walk-in Centre, New Cross (as a result of the contract expiring) against improving access to primary care via the alternative GP Extended Access Service; on individual patients and relatives/carers who share one of more of the nine following protected characteristics (in no particular order); I. Age II. Disability III. Gender reassignment IV. Marriage and Civil Partnership V. Pregnancy and maternity VI. Race VII. Religion or belief VIII. Sex IX. Sexual Orientation

2 | Page WIC_EIAAUGUST2017 Page 85

2.4 This report should be reviewed in conjunction with the full consultation document, which is located here: http://www.lewishamccg.nhs.uk/get- involved/consultation/WiC_Consultation_FINAL_09082017.pdf 2.5 This Equality Impact Assessment has been reviewed by the CCG Equality and Diversity Group. 2.6 The report will be published and submitted to the CCG Governing Body on 7th November 2017.

3. The Service/s 3.1 NHS Walk-in Centre 3.2 The Walk-in Centre opened in March 2010. The Centre is for patients who are unable to get an urgent appointment with their GP and who have a minor injury or medical condition that is not life-threatening but needs to be seen. This is a walk- in service and is available from 8am to 8pm, 7 days a week, including public holidays. 3.3 The Centre does not offer any advice or consultations by telephone and does not have access to GP medical records for any patients, which is not uncommon for walk-in services. 3.4 In 2016/17 there were 29,528 attendances to the service, which is located in the Waldron Health Centre, New Cross. 3.5 More than half of all attendances to the service 2016/17 are not identified as Lewisham residents registered with a Lewisham GP. 3.6 In 2016/17 only 43.5% (12,726 attendances) could be identified as Lewisham residents registered with a Lewisham GP. 3.7 28.6% (8,367) of all attendances in 2016/17 could not be attributed to any Clinical Commissioning Group either GP details are unknown or the patient was not registered with a GP. 3.8 We have estimated that only 2,300 patients who attended the Walk-in Centre, where either the GP details were unknown or the patient was not registered with a GP were Lewisham residents. 3.9 The CCG adopted the Walk-in Centre contract from NHS England and the contract was further extended in 2015 for 24 months. The CCG will not be able to extend the contract again. 3.10 If the CCG were to continue to provide a walk-in facility, it would need to procure a new and different service. However, walk-in centres are not considered the best way to provide proactive, co-ordinated and accessible care for the people of Lewisham. 3.11 Lewisham CCG has the last remaining Walk-in Centre service in south London. Neighbouring Clinical Commissioning Groups in Southwark, Lambeth and Greenwich have all closed their Walk-in Centres and replaced them with GP Extended Access Hubs.

3 | Page WIC_EIAAUGUST2017 Page 86

3.12 GP Extended Access 3.13 In delivering on the Lewisham Primary Care Strategy1 – Developing GP Services, to develop innovative ways to improve access to urgent and unplanned care within primary care; the CCG set out its model care for integrated urgent and primary care. 3.14 To deliver the integrated urgent and primary care model the CCG commissioned a GP Extended Access service, which commenced on 1st April 2017. 3.15 This is in line with the General Practice Forward View2, NHS England and Our Healthier South East London Sustainability Transformation Plan, which have agreed to;  Extend access to General Practice services so that these can be accessed between 8am – 8pm, seven days per week across London;  Make broader improvements to access general practice, such as better use of technology, better patient choice; 3.16 The service allows patients to access a primary care health professional 12 hours per day from 8am – 8pm for pre-bookable and urgent primary care appointments seven days a week (including Bank Holidays) at the University Hospital Lewisham site. 3.17 Appointments are bookable up to 7 days in advance. 3.18 The service aims to;  Ensure improved and consistent access to high quality primary care services from 8am – 8pm, seven days per week.  Support patients to find the right service at the right time, through integration of access routes to urgent and core primary care services, with consistent redirection at all points from GP practices, A&E and any other urgent access points to NHS services. 3.19 Access to the service is currently by patients contacting the GP surgery where they are registered. The service is not intended to be a walk-in service, where patients arrive and queue – appointments are booked through the patients’ registered practice if the practice does not have appointments available that are convenient for the patient. 3.20 Patients can also access the service when they contact the Integrated Urgent Care (formerly NHS 111) service. In addition, it is planned nationally for patients to be able to book an appointment on-line up to two weeks in advance to see either a GP or Nurse. 3.21 From December 2017 when patients attend the Urgent Care Centre at University Hospital Lewisham, they will be redirected to the GP Extended Access after an assessment by a clinician. 3.22 The service provides 25,426 bookable appointments per year with GP face-to- face consultations, GP video consultations and nurse appointments. In 2018, this will increase to 29,914 bookable appointments.

1 Lewisham CCG – Primary Care Strategy: Developing GP Services 2016-2021 – 26/10/16 2 https://www.england.nhs.uk/wp-content/uploads/2016/04/gpfv.pdf

4 | Page WIC_EIAAUGUST2017 Page 87

3.23 Unlike, the Walk-in Centre the GP Extended Access team delivering the service are able to access, review and update medical records for patients using the service. 3.24 Not all of the appointments in the GP Extended Access service are being taken up and the service has the capacity to see patients who are currently using the Walk-in Centre – in addition to providing identical opening times. 3.25 The service is located at the University Hospital Lewisham on Lewisham High Street. Lewisham Hospital provides acute and community health services and is a key part of the fabric of Lewisham’s health economy. The high street is centrally located within the borough of Lewisham and ideally close to local amenities. The hospital is easily accessible with good public transport links and well served by several bus and cycle routes. There are pay and display parking zones on the hospital grounds including bays for drop-off, pick-up, waiting and disabled parking. There are also pay and display parking spaces on nearby streets surrounding the hospital. 3.26 In January 2017, the CCG commissioned Healthwatch3 Lewisham to seek the views of seldom heard groups in Lewisham to support the development of the Primary Care Extended Access service organised around the needs of patients and populations. 3.27 The CCG wanted to seek direct views and experiences from the following groups;  Black African and Caribbean backgrounds (who are disproportionately high users of urgent and emergency care)  People with a learning disability  People with a physical or sensory disability  Peoples with mental health issues  People living in areas of deprivation 3.28 Healthwatch spoke to 71 participants over a period of 5 weeks from the following groups and organisations, reflective of the seldom heard groups identified by the CCG;  South East London Vision (Sensory Impairment)  Africa Advocacy Foundation (Black and Minority Ethnic)  Family Health Isis (Mental Health)  Stroke Association Group (Areas of deprivation)  Lewisham Nexus Services (Learning disabilities) 3.29 There were a number of common themes from across all participants and key views for the service are summarised below;  People wanted the centre to be in an accessible and central location within the borough, with good public transport links and available car parking, at a reasonable price;  It was felt that quicker access routes to routine appointments (via the centre) would help ease patient anxiety and encourage a good relationship between the service user and provider;

3 http://www.lewishamccg.nhs.uk/about-us/how-we- work/Meeting%20papers/Primary%20Care%20Commissioning%20Committee%2015th%20August%202017.pdf

5 | Page WIC_EIAAUGUST2017 Page 88

 The importance of understanding and reading a patient’s medical history was of paramount importance to patients, in order to prevent misunderstanding when patients had complex medical conditions;  For some, the sharing of medical records was a concern, with patients stressing the importance of informing the public that this would happen if they accessed care at the centre;  A wider understanding of provision within the borough and extra facilities to support patients, would be useful for GPs practices at the centre;  Booking methods for the extended access service should be clearly communicated to the public, with booking by telephone remaining the most popular method;  Doctors with specialisms and in depth knowledge of long term conditions (e.g. HIV, learning disabilities) should be available to the extended access centre;  The infrastructure and non-clinical staff at any new centre should be trained in supporting vulnerable patients and those who may have difficulties access or navigating a new service.  Patients with long term conditions and those with physical or learning would like to be offered longer appointments to accommodate for their additional needs  Communication around the new extended access service should be available in multiple formats, that are easy to read and accessible;  Community groups and leaders should be involved in the promotion and awareness raising of the service.

3.30 The Healthwatch recommendations have been incorporated into the development of the GP Extended Access Service. 4. Population 4.1 The population density in New Cross and Lewisham Central is expected to increase by a third. In 2015, the resident population of Lewisham stood at 294,096. According to the 2014 Round of GLA population projections, the population of the borough has increased to 294,096 in 2015 and will increase further by 31,100 between 2015 and 2025, or 10.6% the next ten years. By ranking population growth between 2015 and 2025 across London boroughs, Lewisham is considered to be a ‘medium growth’ borough (ranked 11th out of 33 boroughs).

6 | Page WIC_EIAAUGUST2017 Page 89

Figure 1: Lewisham Population Growth 4.2 Lewisham has a higher population density than London as a whole (at 8,365 persons per sq km), but lower than Inner London. Over a fifth of the borough is parkland or open space. 4.3 Population growth in Lewisham is uneven and concentrated in different parts of the borough. This presents different challenges for service and estates planning. High population growth is concentrated in the north and centre of the borough where there has been greater investment in health infrastructure than in the South has benefited less. Waldron Health Centre is located in New Cross Ward. 4.4 The distribution of deprivation across Lewisham is uneven, with every ward having LSOAs (Lower Super Output Area) in at least 4 Lewisham deciles of deprivation, there is less variation in Lewisham than in many other places. Of the 166 LSOAs in the borough, 38% are in the most deprived fifth of England, 86% in the most deprived two fifths, and only 1% in the least deprived two fifths. 5. New Cross4 5.1 New Cross ward includes areas of New Cross, New Cross Gate and Deptford. In the 2011 census the population of New Cross was 15,756 and is made up of approximately 50% females and 50% males. The average age of people in New Cross is 32, while the median age is lower at 30. 51.3% of people living in New Cross were born in England. Other top answers for country of birth were 7.2% Nigeria and 3.9% Jamaica. 5.2 74.6% of people living in New Cross speak English. The other top languages spoken are 2.3% French, 1.9% Spanish, 1.8% All other Chinese, 1.7% Polish, 1.5% Portuguese, 1.4% Vietnamese, 1.0% Somali, 0.9% Italian and 0.8% Cantonese Chinese. 5.3 The religious make up of New Cross is 51.0% Christian, 24.3% No religion, 9.7% Muslim, 3.0% Buddhist, 1.4% Hindu, 0.3% Jewish, 0.2% Sikh, 0.1% Atheist. 1,421 people did not state a religion. 60 people identified as a Jedi Knight. 5.4 23.6% of people are married, 10.2% cohabit with a member of the opposite sex, 2.3% live with a partner of the same sex, 46.1% are single and have never married or been in a registered same sex partnership, 11.6% are separated or divorced. There are 848 widowed people living in New Cross. 5.5 The top occupations listed by people in New Cross are Professional 17.0%, Elementary 16.4%, Elementary administration and service 15.7%, Associate

4 https://new-cross.localstats.co.uk

7 | Page WIC_EIAAUGUST2017 Page 90

professional and technical 13.8%, Administrative and secretarial 11.5%, Caring, leisure and other service 11.0%, Sales and customer service 9.5%, Skilled trades 8.8%, Administrative 8.7%, Managers, directors and senior officials 7.9%. 6. Who uses the Walk-in Centre service 6.1 Overview: A clinical review of the presenting conditions of those patients attending the Walk-in Centre found that the majority were for wide range of acute minor medical problems, which would normally be dealt with by self-care, a pharmacist or consulting a GP or Nurse. 6.2 Of the clinically reviewed sample, the majority of patients attended for wound care (dressings etc.), limb pain, sore throats, coughs and rashes. This is in keeping with Monitor Review5 of Walk-in Centres of across the country where commonly people were treated for coughs, colds, flu like symptoms, skin conditions or infections. 6.3 Ethnicity: Users of the service who identified their ethnicity as White British or White Other (43.5% of attendances) were the largest users of the service in 2016/17. Those who identified their ethnicity as Black, Black British, African or Caribbean (37.7% of attendances) were the second highest users of the Walk-in Centre. This is in contrast to 3 years ago where those who identified their ethnicity as Black, Black British, African or Caribbean were the main users of the service. Figure 2: Walk-in Centre Activity 2016/17 by Ethnicity Ethnicity Percentage White British 26.2% Not Recorded 15.9% White other 15.3% Black or Black British African 11.2% Black or Black British Caribbean 8.7% Declined 3.4% Other Asian 3.4% Other Black background 3.1% Other ethnic groups 2.6% Chinese 2.0% Mixed White and Black Caribbean 1.9% White Irish 1.4% Mixed White and Black African 1.4% Mixed other 1.1% Asian or Asian British Indian 0.9% Asian or Asian British Bangladeshi 0.6% Asian or Asian British Pakistani 0.6% Mixed White and Asian 0.3%

6.4 Sex: In 2016/17 56.4% of all attendances to the Walk-in Centre were female and 43.5% were male and this is consistent with the Monitor Review of Walk-in Centres.

5 Monitor: Walk-In-Centre Review: Final Report and Recommendations

8 | Page WIC_EIAAUGUST2017 Page 91

6.5 Age: The Walk-in Centre is mostly used by people between the ages of 25 – 49 years followed by those between the ages of 16 – 24 years. This is reflective of the Monitor Review of Walk-in Centres, which found that younger people are the predominant users, with people between the ages of 16 – 45 years attending at higher rates than other age groups. 6.6 The majority of children under 5 years of age attending the Walk-in Centre were predominantly from the 4 GP practices located in the Waldron Centre, which took place in hours; Monday to Friday 08:00 – 18:30. 6.7 Hours: The overwhelming majority (64%) of all attendances at the Walk-in Centre took place in hours when GP practices are open, with 17% on Saturdays and 13% on Sundays and the remainder (6%) during the evenings. 6.8 The majority of Lewisham registered patients using the Centre are registered with GP practices located in the north of the borough. 6.9 In 2016/17 of those Lewisham patients using the Walk-in Centre and registered with a GP, 28.5% attendances were already registered with one of the four GP Practices; Clifton Rise Family Practice, Amersham Vale Training Practice, Dr Batra’s Practice or the New Cross GP Led service, all located in the Waldron Health Centre. 6.10 The highest users of the Walk-in Centre are patients already registered with the New Cross GP Led Service, which is co-located with the Walk-in Centre. 6.11 GP Extended Access is the alternative service for residents in Lewisham when the Walk-in Centre contract expires on 31st December 2017. For those registered with a Lewisham GP – access to the service will be as per 3.12 and 3.13. 6.12 For those patients registered with a GP in London, they will have access to the GP Extended Access Services/Hubs provided in those boroughs. These were introduced as a part of the national GP Forward View6 initiative in April 2017 across London to improve access to General Practice. 6.13 It is recognised that the GP Extended Access service is not the same service as the Walk-in Centre because it provides access to patients’ medical records and the service is bookable. Access to this service requires patients to be registered with a GP in Lewisham. 6.14 Therefore, unregistered patients will not be able to access the service unless they register with a GP practice in Lewisham. 6.15 However, there is sufficient GP practices of good quality and capacity of 25,300 (See Figure 3) located within less than one mile of the Walk-in Centre (both in Lewisham and neighbouring boroughs), which could support increased registration of an estimated additional 2,300 patients currently attending the Centre.

6 https://www.england.nhs.uk/wp-content/uploads/2016/04/gpfv.pdf

9 | Page WIC_EIAAUGUST2017 Page 92

Figure 3: GP practice capacity for new registrations located near the Waldron Distance Additional new from Raw patients that Practice Name Code Contract Waldron List practice able (miles) to register Dr. Jeyanathan and Partners G85026 PMS 0 4,477 2,000 Amersham Vale Practice G85698 PMS 0 9,013 2,000 Dr BK Batra's Practice G85717 PMS 0 6,025 3,000 Mornington Surgery G85008 PMS 0.1 4,152 3,000 Deptford Surgery G85711 PMS 0.2 4,734 1,500 Dr Mog Sarder's Practice G85736 GMS 0.2 3,007 300 New Cross Health Centre G85076 PMS 0.3 5,826 5,000 Kingfisher Medical Centre G85020 GMS 0.4 4,981 1,000 Dr R Berman's Practice G85105 PMS 0.7 5,888 1,500 St Johns Medical Centre G85038 PMS 0.7 14,485 3,000 Plumbridge Medical Centre G83641 GMS 0.8 2,426 3,000 *Total capacity within 1 mile of 25,300 the Walk-in Centre

6.16 The activity data on the Walk-in Centre use for 2016/17 indicates that there are approximately 28.6% attendances (8,367), where the GP is unknown or the patient is not registered with a GP. 6.17 Consequently, there are a number of assumptions that can be made; (i) those who have attended have chosen not to disclose this information; (ii) those attending were not asked to provide this information; (iii) they are genuinely not registered with a GP anywhere; or (iv) due to poor data quality this information was not entered onto the records. 6.18 However, even if no GP details were provided for one of the 3 reasons listed in 6.17; the expectation is that the provider of the Walk-in Centre should as a minimum have obtained the patients address. 6.19 In order to provide a reasonable estimate of the actual number of potential patients (and not attendances) that might not be registered with a GP and live in Lewisham; the first part of the patients’ postcode and multiple attendances were considered in reviewing activity data for the Walk-in Centre. 6.20 A partial postcode was used in order to ensure patient confidentiality. However, as a consequence this has meant that where partial postcodes are shared with Lewisham and at least one of the five neighbouring south east London boroughs have been included in the count. Therefore, the quantum number of unknown GP/unregistered with a GP patients will be inflated. 6.21 The review demonstrated that for those where either the GP details were unknown or the patient was not registered with a GP (as per 6.16); 70% of those patients did not have a Lewisham postcode and therefore do not live in the borough. 6.22 The remaining 30% (estimated 2,300 patients over a 12 month period) where either the GP details were unknown or the patient was not registered with a GP – either live in Lewisham and have a partial postcode that is exclusive to

10 | Page WIC_EIAAUGUST2017 Page 93

the London Borough of Lewisham e.g. SE4, SE6 and SE14; or they have a partial postcode, which is shared with Lewisham and at least one of the five neighbouring south east London boroughs (Lambeth, Southwark, Bromley, Bexley and Greenwich) and Croydon e.g. SE3, SE8, SE9, SE10, SE12, SE13, SE19 and SE26. 6.23 Therefore, 2,300 is the quantum estimated number of patients who potentially might to need to be registered with a GP. 6.24 It is also recognised that a proportion of those where the GP is unknown or the patient is not registered with a GP could be homeless. 6.25 Homelessness acceptances in Lewisham are higher than the London average at 5.9 per 1,000 people compared to 5, but have risen much less than average since 2009. 6.26 The review demonstrated that there were an estimated 188 patients in a 12 month period where either the GP details were either unknown or the patient was not registered with a GP and no postcode was provided. 6.27 The patients could either be homeless or this could be down to poor data collection or the patient declined to provide this information. However, the 188 patients could provide a maximum proxy for Homeless users of the Walk-in Centre. 6.28 The local authority (Lewisham Council) commissions 80 beds in the New Cross Ward for the homeless, which equates to a conservative estimate of 327 individuals (total client impact) per year including Rough Sleepers and Street activity; recognising that these will be some of the most vulnerable people with regard to physical health, mental health and substance misuse. 6.29 The Care Quality Commission expects GP practices to register people who are homeless, people with no fixed abode, or those legitimately unable to provide documentation living within their catchment area who wish to register with them. Homeless patients are entitled to register with a GP using a temporary address which may be a friend's address or a day centre. The practice may also use the practice address to register them. 6.30 It is recognised that Goldsmiths College is located close by and their students are directed to the Walk-in Centre; it is therefore possible to assume that a large proportion will be students. This is supported by the Monitor Review, where high numbers of students are users, who tend not to be registered in with a GP in the area in which they are attending University. 6.31 The NHS Choices advice to students is; If, like most students, you spend more weeks of the year at your college address than your family's address, you need to register with a GP near your college as soon as possible. 7. Summary 7.1 In assessing the potential impact of the closure of the NHS Walk-in Centre, New Cross (as a result of the contract expiring) against improving access to primary care via the alternative GP Extended Access service on individual patients and relatives/carers who share one of more of the nine protected characteristics – the key areas where there could be a negative impact and mitigation is required;

11 | Page WIC_EIAAUGUST2017 Page 94

(i) People who reside in the borough and are not registered with a Lewisham GP and therefore would be unable to access the alternative GP Extended Access service. (ii) People who live in another borough and are registered with a GP practice in another borough or elsewhere in the country and therefore are unable to access the alternative GP Extended Access service in Lewisham. For Lewisham CCG the priority will be our population and mitigation for those who live in the borough and are not registered with a GP.

12 | Page WIC_EIAAUGUST2017 Page 95

7.1 Equality Analysis checklists

Equality What evidence has What engagement Identify positive / How are you going to address Timeframe Group been used for this and consultation negative / no issues identified? analysis? has been used? outcomes AGE  Analysis of the  CCG Walk-in  The Walk-in  For those of the alternative GP October 2017: utilisation and Centre User Centre service is Extended Access would apply Underway activity data survey in predominantly (*providing they are registered submitted by the January and used by adults with a Lewisham GP); (i) the provider of the February 2017 between the CCG will be actively promoting service in 2016/17  CCG ages of 25-49), access to the GP Extended  Neighbourhood Commissioned with less use by Access Service from October Profiles and Healthwatch those over 65 2017 and throughout Winter; and Picture of SELDOM Heard years; (ii) the CCG has extended the Lewisham (JSNA, Report on GP  There is Primary Care Assessment Page 96 Page London Borough Extended recognition that a Service located in the UCC at the of Lewisham) Access number are University Hospital site, where  2011 Census  CCG Public parents GPs are seeing and treating (ONS) Reference Group attending with patients.  Walk-in Centre on 27th July 2017 young children  The GP Extended Access will be November 2017: Review 2014  CCG formal (Approximately providing services for children Complete. (Monitor) public and 10% of all from November 2017 in a  NHS Choices stakeholder attendances in- purpose built suite, including a consultation hours in 2016/17 play area. launched on 8th were children August to 30th under 5) and October 2017 some are not registered with a GP and therefore, the closure of the Walk-in Centre could have a negative impact.

13 | Page WIC_EIAAUGUST2017

7.2 Equality Analysis checklists

Equality What evidence has What engagement Identify positive / How are you going to address Timeframe Group been used for this and consultation negative / no issues identified? analysis? has been used? outcomes RACE  Analysis of the  CCG Walk-in  No disproportionate  The GP Extended Access Not applicable. utilisation and Centre User effect is expected. service is available to all activity data survey in  There is no patients registered with a submitted by the January and evidence to suggest Lewisham GP. provider of the February 2017 that those users of  The service has access to service in 2016/17  CCG the Walk-in Centre interpreting services as do all  Neighbourhood Commissioned would either be GP practices in Lewisham. Profiles and Healthwatch more or less  The consultation documents Complete. Picture of SELDOM Heard advantaged or have been translated into Lewisham (JSNA, Report on GP disadvantaged than Easy Read, Audio and

Page 97 Page London Borough Extended any other ethnic Vietnamese. of Lewisham) Access group. The majority  Engagement sessions are September –  2011 Census  CCG Public of all users of the planned for these groups. October 2017: (ONS) Reference Group service identified Complete.  NHS Choices 27th July 2017 themselves as  GP Patient Survey  CCG formal white or white other public and (43%), with second stakeholder highest group being consultation those who identified launched on 8th themselves as August to 30th Black or Black October 2017 other. This is a change from when the service was reviewed in 2014, where the majority of users identified themselves as Black or Black other.

14 | Page WIC_EIAAUGUST2017

7.3 Equality Analysis checklists

Equality What evidence has What engagement Identify positive / How are you going to address Specify the Named Group been used for this and consultation negative / no issues identified? Lead and analysis? has been used? outcomes Timeframe DISABILITY  Analysis of the  CCG Walk-in  No disproportionate  The GP Extended Access October 2017: utilisation and Centre User effect is expected. service is located at the Complete. activity data survey in  There is no data University Hospital Lewisham submitted by the January and available on the site, which will be compliant provider of the February 2017 numbers of service with all required regulations service in 2016/17  CCG users who identify on accessibility.  Neighbourhood Commissioned themselves as  In addition, the new purpose Profiles and Healthwatch having a disability. built suite will be Disability & Picture of SELDOM Heard Discrimination Act compliant. Lewisham (JSNA, Report on GP  The University Hospital Page 98 Page London Borough Extended Lewisham site is accessible of Lewisham) Access and has good transport links.  CCG formal public and stakeholder consultation launched on 8th August to 30th October 2017 GENDER  Analysis of the  CCG formal  No disproportionate  The GP Extended Access Not applicable. REASSIGN- utilisation and public and effect is expected. service is available to all MENT activity data stakeholder  There is no data patients registered with a submitted by the consultation available on the Lewisham GP. provider of the launched on 8th numbers of services  The service has access to the service in 2016/17 August to 30th users who identify patient’s records and October 2017 themselves as therefore, this would support being with these continuity of care for these protected users and ensuring that they characteristics. only had to tell their story once.

15 | Page WIC_EIAAUGUST2017

7.4 Equality Analysis checklists

Equality What evidence has What engagement Identify positive / How are you going to address Timeframe Group been used for this and consultation negative / no issues identified? analysis? has been used? outcomes MARRIAGE &  Analysis of the  CCG Walk-in  No disproportionate  The GP Extended Access Not applicable. CIVIL utilisation and Centre User effect is expected. service is available to all PARTNERSHIP activity data survey in  There is no data patients registered with a submitted by the January and available on the Lewisham GP. provider of the February 2017 numbers of services  The service has access to the service in  CCG users who identify patients’ records and 2016/17 Commissioned themselves as therefore, this would support  Neighbourhood Healthwatch being with these continuity of care for these Profiles and SELDOM Heard protected users and ensuring that they Picture of Report on GP characteristics. only had to tell their story

Page 99 Page Lewisham Extended once. (JSNA, London Access Borough of  CCG formal Lewisham) public and stakeholder consultation launched on 8th August to 30th October 2017 PREGNANCY  Analysis of the  CCG formal  No disproportionate  The GP Extended Access Not applicable. AND utilisation and public and effect is expected. service is available to all MATERNITY activity data stakeholder  There is no data patients registered with a submitted by the consultation available on the Lewisham GP. provider of the launched on 8th numbers of services  The service has access to the service in August to 30th users who identify patients’ records and 2016/17 October 2017 themselves as therefore, this would support being with these continuity of care for these protected users and ensuring that they characteristics. only had to tell their story once.

16 | Page WIC_EIAAUGUST2017

7.5 Equality Analysis checklists

Equality What evidence has What engagement Identify positive / How are you going to address Specify the Named Group been used for this and consultation negative / no issues identified? Lead and analysis? has been used? outcomes Timeframe RELIGION OR  Analysis of the  CCG Walk-in  No disproportionate  The GP Extended Access Not applicable. BELIEF utilisation and Centre User effect is expected. service is available to all activity data survey in  There is no data patients registered with a submitted by the January and available on the Lewisham GP. provider of the February 2017 numbers of services service in 2016/17  CCG formal users who identify  Neighbourhood public and themselves as Profiles and stakeholder being with these Page 100 Page Picture of consultation protected Lewisham (JSNA, launched on 8th characteristics. London Borough August to 30th of Lewisham) October 2017  2011 Census (ONS)  Walk-in Centre Review 2014 (Monitor) SEX  Analysis of the  CCG Walk-in  No disproportionate  The GP Extended Access Not applicable. utilisation and Centre User effect is expected service is available to all activity data survey in based on Sex or patients registered with a submitted by the January and Sexual Orientation Lewisham GP. provider of the February 2017 of the Walk-in  The service has access to the service in 2016/17  CCG formal Centre closing and patients’ records and  Neighbourhood public and patients accessing therefore, this would support Profiles and stakeholder the alternative GP continuity of care for these Picture of consultation Extended Access users and ensuring that they Lewisham (JSNA, launched on 8th Service. only had to tell their story London Borough August to 30th once.

17 | Page WIC_EIAAUGUST2017

Equality What evidence has What engagement Identify positive / How are you going to address Specify the Named Group been used for this and consultation negative / no issues identified? Lead and analysis? has been used? outcomes Timeframe of Lewisham) October 2017  2011 Census (ONS)  Walk-in Centre Review 2014 (Monitor) SEXUAL  Analysis of the  CCG Walk-in  No disproportionate  The GP Extended Access Not applicable. ORIENTATIO- utilisation and Centre User effect is expected service is available to all N activity data survey in based on Sexual patients registered with a submitted by the January and Orientation due to Lewisham GP. provider of the February 2017 the Walk-in Centre  The service has access to the service in 2016/17  CCG formal closing and patients patients’ records and

Page 101 Page  Neighbourhood public and accessing the therefore, this would support Profiles and stakeholder alternative GP continuity of care for these Picture of consultation Extended Access users and ensuring that they Lewisham (JSNA, launched on 8th Service. only had to tell their story London Borough August to 30th once. of Lewisham) October 2017  2011 Census (ONS)  Walk-in Centre Review 2014 (Monitor) CARERS  Analysis of the  CCG formal  There is no  From October 2017 to October 2017: utilisation and public and utilisation data January 2018 the CCG will Underway. activity data stakeholder available on the provide dedicated Patient submitted by the consultation numbers of services Advice & Liaison (PALS) provider of the launched on 8th users who identify Support in the Waldron Health service in 2016/17 August to 30th themselves as Centre to help people register October 2017 being with these with a local GP practice of protected their choice and provide characteristics. information on the GP

18 | Page WIC_EIAAUGUST2017

Equality What evidence has What engagement Identify positive / How are you going to address Specify the Named Group been used for this and consultation negative / no issues identified? Lead and analysis? has been used? outcomes Timeframe  As a part of the Extended Access service. formal consultation concern was raised about how carers book appointments for those in supported housing. OTHERS  Analysis of the  CCG formal  The GP Extended  The CCG commissions two November 2017: utilisation and public and Access Service is local GP practices (Honor Complete. E.G. Students/ activity data stakeholder only accessible to Oak and Rushey Green) to Homeless/ submitted by the consultation those registered deliver enhanced support the Undocumente th Page 102 Page provider of the launched on 8 with a GP in four hostels for homeless d migrants. service in 2016/17 August to 30th Lewisham, people. The CCG will review and 2017/18 October 2017 therefore Homeless these two services.  Lewisham people in New  Muliti-agency Summit on the October 2017 Borough Council Cross. Estimated of Homeless Complete. (Single Homeless 327 homeless  Commissioning Rough February 2018 Unit); people in a year. Sleeper Pilot for Deptford and  Similarly, students New Cross from nearby  The CCG will meet with the Goldsmiths College providers of services and September 2017: not registered with supports to consider improved On-going a Lewisham GP will messaging on registration. be impacted.  Getting registered with a GP support to Goldsmiths College.

19 | Page WIC_EIAAUGUST2017

Section 8: Action Plan For any negative outcomes identified in Section 2, it is important to identify the steps you will take to mitigate consequences on the nine protected characteristics. Complete the Action Plan below to identify and record how you will address these.

Equality Group Negative Outcome Mitigating Action Timeframe (Identify any resource/other implications)

ALL Users of the Walk-in Centre 1. The CCG will commission from October October 2017 – March 2018 who are not registered with 2017 to March 2018 dedicated Patient a GP practice in Lewisham Advice & Liaison (PALS) Support, located in will not be able to access the Waldron Health Centre to help people the alternative GP who live in the borough register with a local Extended Access Service GP practice of their choice and provide when the Walk-in Centre information on the GP Extended Access

Page 103 Page closes at the end of the service. year. There are on average an estimated 2,300 patients who use the Centre with a Lewisham postcode or a partial postcode, which is shared with at least one of the five neighbouring SEL Boroughs and Croydon, who are not registered with a GP.

Homeless users of the 2. The CCG commissions two local GP November 2017 Walk-in Centre service who practices (Honor Oak and Rushey Green) to are not registered with a deliver enhanced support to the four hostels GP practice will not be able for homeless people. The CCG will review to access the alternative these two services. GP Extended Access 3. Commissioners will meet with the providers October 2017 Service when the Walk-in of services and support to the Homeless Complete

20 | Page WIC_EIAAUGUST2017

Centre closes at the end of population to consider improved messaging the year. and support on GP registration. The CCG will be running a Homeless Summit jointly with Lewisham Borough Council in October as a direct result of this process, which will include representatives from the 3 homeless charities supporting New Cross, the Healthy London Partnership, Lewisham & Greenwich Trust, Pathway (Healthcare for the Homeless) and SLaM. 4. The CCG will commission a rough sleepers February 2018 pilot for Deptford and New Cross 5. The CCG will implement an engagement February 2018 and training programme for all GP practices

Page 104 Page on supporting Homeless patients in the borough using the Healthy London Partnership resource pack and on-line training tool published in August 2017. Resource pack https://www.myhealth.london.nhs.uk/healthy- london/latest/publications/homelessness- health-resource-pack Supporting GP receptionists to help people who are homeless https://www.myhealth.london.nhs.uk/healthy- london/latest/news/supporting-gp- receptionists-help-people-who-are-homeless

Undocumented Migrants 6. The CCG will incorporate training on February 2018 who are not registered with registering undocumented migrants as part a GP registered with a GP of its PLT on vulnerable groups. in Lewisham or any GP will 7. The CCG will continue to build relationships Ongoing not be able to access the and provide support to the Lewisham alternative GP Extended Migrant & Refugee Network.

21 | Page WIC_EIAAUGUST2017

Access Service

Students who are users 8. The CCG will attend Fresher’s Week at September 2017 of the service and are not Goldsmiths College to promote GP registered with a GP in Registration to students. Lewisham or any GP will 9. The CCG will develop periodic January 2018 not be able to access the communication messages in line with new alternative GP Extended student intakes throughout the year on Access Service getting registered with a GP. 10. Goldsmiths College have commissioned the Not applicable. Amersham Vale Training Practice to provide GP services to their student population.

Patients from the 3 GP 11. The CCG will work with the Amersham Vale October – November 2017 practices, which are Training Practice, Dr Batra and Clifton Rise

Page 105 Page amongst the highest Family Practice to provide additional support Lewisham users of the – particularly for those who attend with Walk-in Centre, located in children under 5 years old in hours. the Waldron Health 12. The CCG will develop communication November 2017 – Centre could attend the programme on accessing urgent primary January 2018 A&E instead when the care (in-hours and out of hours) and self- service closes. management for patients; phase 1 will be to the GP practices with patients that are the highest users. 13. In order to deliver the national requirement November 2017 of Clinical Redirection and Streaming at all Urgent Care Centres; this additional service, which consists of a GP seeing and treating patients in the Urgent Care Centre, will be fully compliant at the University Hospital Lewisham from December 2017. Lewisham CCG has been running a Primary Care Assessment Pilot, with a GP in the Urgent Care Centre at the University Hospital

22 | Page WIC_EIAAUGUST2017

Lewisham since October 2016. 14. The CCG will work with the local November 2017 pharmacists on supporting self-care for Complete patients.

Users of the Walk-in 15. Each year Lewisham CCG invests an January 2018 Centre who attended for ‘additional premium payment’ of £3.4m to wound dressings will GP practices providing core services to attend A&E instead when patients. For 2018/19, the CCG agreed in the service closes May 2017 with the Local Lewisham Medical because GP practices in Committee and the London-wide Medical Lewisham are currently Committee (which is represents GPs) to not paid to provide this include payment for wound dressings (post- additional service. operative wound care and sutra removal) as

Page 106 Page GPs were not previously paid to provide this service. The CCG launched the premium to all GP practices on 27th June 2017. All GP practices in Lewisham received their premium offer on 29th September 2017, which will take effect from 1st January 2018. Therefore, patients in Lewisham requiring wound dressings care will be able to access this service from their local GP practices.

23 | Page WIC_EIAAUGUST2017

Policy, Function or Service Development Details and Authorisation

Name of Organisation: NHS Lewisham Clinical Commissioning Committee

Name of the policy, function or service development being assessed: The future of the New Cross Walk-in Centre and improving provision and access to primary care

Is this a new/existing/revised policy, function or service development? Existing

Briefly describe its aims and objectives The Walk-in Centre opened in March 2010. The Centre is for patients who are unable to get an urgent appointment with their GP and who have a minor injury or medical condition that is not life- threatening but needs to be seen. This is a walk-in service and is available from 8am to 8pm, 7 days a week, including public

Page 107 Page holidays.

Analysis Start Date: 04.08.2017

Lead Author of Equality Analysis: Director of Commissioning & Primary Care

Date of approval: 14.09.2017 CCG Equalities & Diversity Group

Have any financial or resource implications been identified? YES

Date of Governing Body Meeting where the Equality Assessment In line with the approval received from the CCG Governing Body on 13th was ratified: July 2017 to commence Public Consultation on the future of the New Cross Walk-in Centre and improving provision and access to primary care; the Equality Impact Assessment will be published and submitted to the Governing Body on 7th November 2017.

24 | Page WIC_EIAAUGUST2017

This page is intentionally left blank