The Health and Wellbeing Board of Brent Council met on Monday 22 January 2024 to discuss access to primary care services, the progress of Integrated Neighbourhood Teams, and preparations for upcoming inspections of SEND and Adult Social Care services. Key decisions included noting the progress on improving primary care access and approving the next steps for the development of Integrated Neighbourhood Teams.

Access to Primary Care Services

The Board received an update on the progress made in improving access to primary care services in Brent, following the 'No One Left Behind' report published in March 2021. Versha Varsani, Head of Primary Care for Brent, highlighted that while GP-led appointments have reached their highest levels in five years, with 2.7 million appointments offered since October 2022, demand continues to outstrip supply. Enhanced Access Hubs provide an additional 148,700 appointments annually, and a pilot scheme for Same Day Access is currently running until March 2024.

Significant progress has been made in increasing the number of staff in Advanced and Specialist Roles (ARRS), with a 134% increase in Whole Time Equivalent (WTE) staff since April 2022. This has translated into improved capacity and more appropriate use of GPs. All 51 GP practices in Brent are accredited as Safe Surgeries, ensuring that barriers such as lack of ID, proof of address, or immigration status do not prevent patient registration.

The Board was informed about the expansion of community pharmacy services, including the initiation of oral contraception services and the relaunch of blood pressure checks. The new Pharmacy First scheme, launching in January 2024, will introduce seven new clinical pathways.

Digital inclusion remains a focus, with efforts to educate residents on using the NHS App, which offers functionalities such as online consultations, messaging, access to patient records, appointment booking, and prescription ordering. A long-term vision is to develop a single point of contact, both by telephone and online, for a virtual Access Hub to triage patient requests and direct them to the most appropriate service.

The Board noted that while 55% of appointments offered are face-to-face, this is believed to reflect patient preference and is in line with national benchmarks. Concerns were raised about the accessibility of the NHS App for all users, and it was agreed that action would be taken to investigate whether British Sign Language needs are catered for. The report also highlighted that NWL NHS is working with a specialist GP to focus on developing women's health clinics across the borough.

Dr Melanie Smith, Director of Public Health for Brent Council, highlighted the achievement of 100% of GP practices being accredited as Safe Surgeries and suggested a mystery shopping exercise to assess its practical implementation. Simon Crawford, Deputy CEO of London North West University Healthcare NHS Trust (LNWUHT), agreed to undertake further analysis on whether this has led to a reduction in A&E attendances.

Integrated Neighbourhood Teams (INTs)

Josefa Baylon, Head of Integration for Brent at NWL NHS, provided an update on the development of Integrated Neighbourhood Teams (INTs). The approach focuses on three key enabling workstreams: workforce and organisational development, estates, and ICT, data, and digitalisation. The Board was asked to approve the next steps and comment on how to ensure meaningful community input and effective impact measurement.

Significant progress has been made in co-production and engagement, with workshops held in Willesden, Wembley, and Stonebridge, Harlesden & Kensal Green, and Roundwood neighbourhoods, involving over 200 residents and staff. A draft local estates strategy has been developed, and several new premises for GP practices are progressing, including Wembley Park Medical Centre and Kilburn Park Medical Centre. Community Diagnostic Centres in Willesden and Wembley are also operational or nearing completion.

The Board discussed the importance of addressing health inequalities, with a life expectancy map showing a correlation between deprivation and reduced life expectancy. Tom Shakespeare, Director of Integrated Care Partnership, acknowledged that while the INT programme itself does not come with significant additional resource, the ICP is making a case for increased investment in other areas.

Concerns were raised about ensuring equity within hyperlocal areas and reaching hard-to-reach communities. Officers highlighted the use of co-production and a bottom-up approach, with engagement with diverse communities and faith groups. The Board also noted that no Integrated Care Hubs have opened yet, with officers still in the scoping and design phase. The long-term vision includes developing campus-style hubs where health, primary care, social care, and voluntary sector services are located together.

The Board requested that future updates include information on PCN alignment with Brent localities, health improvement targets for each locality, practical examples of work undertaken, and links with existing hub models.

Learning from Inspections

SEND and Alternative Provision Local Area Inspection

Nigel Chapman, Corporate Director of Children and Young People at Brent Council, introduced a report on the preparedness for the joint inspection of SEND services by Ofsted and the Care Quality Commission (CQC). The inspection will use a new framework, and Brent's local area partnership is considered to be in a reasonable position, with strengths identified in the strong relationship with parents and carers. Shirley Parks, Director of Safeguarding, Performance and Strategy, confirmed that work is underway to address areas of development, such as CAMHS waiting lists. Jonathan Turner, Borough Lead Director for Brent at NWL NHS, noted that the Integrated Care Board (ICB) is aware of the potential for multiple inspections due to its wider footprint. The Board resolved to note the report and welcome the Designated Clinical Officer for SEND post for Brent.

CQC Inspection of Adults Social Care Services

Rachel Crossley, Corporate Director of Care, Health and Wellbeing at Brent Council, presented information on the preparations for the CQC inspection of Adult Social Care (ASC) services. The new inspection process focuses on a Single Assessment Framework, assessing four main areas: how ASC works with people and providers, leadership, safety (particularly safeguarding), and feedback from partners. Claudia Brown, Director of Adult Social Care, added that the inspection would look at outcomes for service users and that ASC has not been inspected for over ten years. The department is being supported by colleagues from the children and young people's department, who are more accustomed to regular inspections. The Board noted that ASC works with external providers and discussed how accountability is sought in cases of failure. Simon Crawford confirmed that LNWUHT has been engaged in the process and highlighted the strong working relationship between ASC and discharge teams. The Board resolved to note the report and recognise the significance of a whole-system approach to the upcoming CQC ASC inspection.

Any Other Urgent Business

Follow up on Winter Pressures – Risk Management of System Pressures

Simon Crawford provided an update on winter pressures at LNWUHT, highlighting the impact of Junior Doctor strikes and the high number of ambulance conveyances to Northwick Park Hospital. He detailed measures taken to manage capacity, including the opening of temporary beds and the mobilisation of transfer and discharge support teams. Dr Haidar updated on the support provided by primary care, including the opening of PCN hubs on Sundays during the Christmas period. Patrick Laffey, Deputy Director of Operations at Central London Community Healthcare (CLCH), outlined how community services supported the acute trust through rapid response and community rehabilitation beds. The Board thanked colleagues for their updates and offered appreciation for the work of staff over the winter period.

Measles Update

Dr Melanie Smith provided an update on measles, noting that national MMR immunisation rates are at a ten-year low, with London at risk of a significant outbreak. Locally, MMR immunisation rates are increasing but remain below the 95% level required for herd immunity. The local response includes amplifying national messages about the seriousness of measles and the safety and effectiveness of vaccination. Brent is also locally promoting a free porcine-free vaccine alternative. The Public Health team is lobbying the NHS to introduce MMR immunisation alongside Covid and Flu vaccinations. The Board noted the need for a national vaccination campaign and agreed that Councillor Nerva and Dr Melanie Smith would write a joint letter to request this at a national level.

The meeting was declared closed at 8:00 pm.