Brent

1
Brent

• Tessa Sandall
• Assistant Director of Primary Care Commissioning

2
Brent PCT

• NHS Brent commissioned 127 million of primary
  medical care services in the year up to March
  2008.
• Achieved turnaround in April 2008, from a 25.3
  million deficit.
• Total registered population of 350,388.
• Total of 70 GP practices, with 184 GPs (168.5
  WTE).
• Expected population growth linked to the
  redevelopment of Wembley stadium and the
  surrounding areas.
• Significant proportion of population is
  transient, difficulties in registering patients
  with practices.

3
PCT Context

• Financial and governance failure in 2006-07 (25m
  deficit)
• 2007-08 Year of financial turnaround
• Complete change of executives and non-executives-
  new chair March 07, new CEO October 2007
• Double weak in Healthcare Commission ratings
  2007-08
• Financially recovered- paid back ALL deficit,
  12m surplus this year
• 2008-09 year of rebuilding
• - relationships (council, primary care, PbC,
  staff, community)
• - quality and safety of services
• - management systems
• 2009-10 step change
• - management capability and capacity
• - investment in the key determinants of health
• - partnerships with population, council and PbC

4
GP Led Health Centre
Harlesden Medical Centre
Divided into 5 wards, co-terminus with the Local
Authority.
5
Local Social Challenges

• 2007 Index of Multiple Deprivation places Brent
  within the 15 most deprived local authorities in
  the country, 53rd most deprived borough in
  England.
• 50 of the adult population do not take part in
  any form of physical exercise.
• 43 of residents are under 30.
• Regeneration of 85 acres around Wembley stadium
  increased number of tourists likely increased
  demand for unplanned care.
• Large sections of community are affluent, pockets
  of deprivation in the south of the borough.
• Close to a quarter of Brents population live in
  overcrowded conditions.
• Brent has the 4th lowest average income levels in
  London.
• Most deprived areas also have lowest income
  levels, highest unemployment, poor overcrowded
  housing and worst health outcomes.

6
Local Health Challenges

• Health inequalities present at neighbourhood
  levels, demonstrated by 9 year gap in life
  expectancy throughout Brent.
• Circulatory diseases, cancers and respiratory
  diseases are the largest cause of death.
• Most deprived neighbourhoods also have high
  mortality ratios and high rates of key health
  behaviours such as smoking, obesity, diabetes.
• One in four people in Brent smoke
• High prevalence of diabetes and tuberculosis,
  particularly in ethnic minorities, especially in
  in ethnic minorities.
• 55 of residents are from black and minority
  ethnic communities.
• Low uptake of preventative services such as
  smoking cessation and breast screening.

7
Goals

• Goal 1 To reduce premature mortality in Brent by
  20 by 2013
• Goal 2 Reduce the gap in life expectancy between
  the most deprived quintile of wards in Brent and
  the borough average by 25 by 2013
• Goal 3 Promote good health and prevent
  ill-health
•  
• Goal 4 To increase the proportion of activity
  commissioned from providers who perform at or
  above benchmarked quality and performance
  standards
• Goal 5 To meet or exceed nationallyreported
  benchmarked patient satisfaction rates for all
  services commissioned

Why? Most relevant to needs of local population,
and our local circumstances. How? Extensive
stakeholder engagement through a series of events
8
Importance of the procurement to Brent

• Improve access to primary care particular
  problem in Wembley.
• Improve of practices in Wembley meeting 24/48
  hr access target.
• Future-proof for increase in population in
  Wembley.
• Set meaningful performance indicators using APMS.
• Set the future standard for GP practices within
  Brent raise the bar.