We’re a collaboration of the eight Clinical Commissioning Groups in North West London, working together to improve healthcare services for our two million residents.
Our vision for North West London is that everyone living, working and visiting here has the opportunity to be well and live well.
We are working with patients and the public to design, develop and implement major transformation programmes. This involves improvements to services provided by our GPs and in the community, as well as to our hospitals so that patients receive the right care, in the right place, when they need it.
As a clinically led programme, we are led by three Medical Directors:
Dr Mark Spencer
Dr Mark Spencer is the clinical expert and lead for the programme. Mark has been GP and trainer in Acton since 1989 in a medium sized practice where he is now senior partner and maintains an interest in respiratory disease amongst others. He became involved in commissioning with an interest in Evidence Based Medicine via fundholding and was then in the leadership teams of PCG and then Ealing PCT where he was lead Clinical Director and PEC Chair before moving to give clinical input in NHS North West London.
Dr Susan LaBrooy
Dr Susan La Brooy was Medical Director at The Hillingdon Hospitals Foundation Trust for six years. She is also Consultant Physician in Acute Medicine and Care of the Elderly with more than 25 years of experience including four years spent as a Senior Lecturer and Head of Department at the University of Singapore. She has undertaken a range of leadership and change management roles including modernising older people’s services in the health community, clinically leading the merger of Mount Vernon and Hillingdon Hospitals, and most recently as clinical quality lead achieving Foundation Trust Status for the Hillingdon Hospitals Foundation Trust. Susan also led a team responsible for improving A&E targets for the Modernisation Agency, and contributed to the London and National Implementation for Older People. As Associate Dean at the London Deanery from 2004-2011 she ensured the successful implementation of the controversial Modernising Medical Careers and managed the Trust Liaison Dean Service supporting education and training in Trusts across London.
Dr Tim Spicer
Dr Tim Spicer is a General Practitioner and Partner at the Richford Gate Medical Centre in Hammersmith and is also Chair of Hammersmith and Fulham Clinical Commissioning Group. Tim entered medicine as a mature student following a successful career in the Arts. He has more than eight years of experience in commissioning and has contributed to a wide range of projects including the North West London Integrated Care Pilot and is currently Co-Chair of Continuity of Care integrating Health and Social Care for the residents of Hammersmith and Fulham.
The case for change
Shaping a healthier future is a clinically-led programme designed to improve the quality of care for the residents of North West London. It was set up to address a range of challenges facing the local health economy (and the NHS more broadly) and to meet changing patient needs, which are placing ever greater demands on the local NHS. People are living longer, the population as a whole is getting older, and there are more patients with chronic conditions such as heart disease, diabetes and dementia. More needs to be done to improve care and prevent ill health, and improvements need to be made to ensure better, consistent access to high quality care. Patient needs are not being best met, with our hospitals unable to provide the 24/7 consultant-delivered care required under London quality standards. There are too many hospitals with low quality buildings.
The Case for Change, published in January 2012, provides specific details of the challenges which the programme was set up to address. Clinical leadership is central to the programme, including four Medical Directors (from both acute and primary care) leading through the core Programme Executive, a senior Clinical Board representing Medical Directors and CCG Chairs from across North West London, and pan-North West London clinical working groups focusing on specific services and models of care.
The Shaping a healthier future changes
In North West London our clinicians have developed one of the most ambitious visions for health and care transformation in the country. Our aspiration, driven by clinicians, is for an outcome-based, integrated health and social care service centred on the needs of the citizen.
In 2012 we went out to public consultation with our proposals to deliver better care to the people of North West London. Our full consultation document can be viewed online.
The decision to implement the changes was taken by the Joint Committee of Primary Care Trusts (JCPCT) at a public meeting in February 2013.
The Decision Making Business Case (DMBC), which includes the CCG out-of-hospital strategies, sets out the rationale behind these proposals and the vision for the future.
This vision for the future of healthcare in North West London is being taken forward by eight CCGs which are made up of GPs from North West London’s eight boroughs.
Following the JCPCT decision the programme was subject to two different external reviews:
- Judicial review – the High Court rejected the case brought by Ealing Council to seek to halt the Shaping a healthier future programme of planned improvements to patient care across North West London
- Independent Reconfiguration Panel (IRP) review – following referral by Ealing Overview & Scrutiny Committee, the Secretary of State commissioned an IRP review of the programme.
On the advice of the IRP the Secretary of State supported the Shaping a healthier future recommendations in full, but also determined that changes to A&E services at Hammersmith Hospital and Central Middlesex Hospital should take place “as soon as practicable”. Local clinicians strongly supported the decision of the Secretary of State, and North West London has proceeded with implementation of this decision.
The collaboration board is made up of all eight CCGs in North West London. The vision of the collaboration board is to improve patient care across the health economy as a whole. Our commitment is to do so by respecting the individual sovereignty of our member CCGs, promoting meaningful stakeholder engagement and facilitating evidence-based decision making in the best interests of our respective local health populations. The collaboration board meets to consider general strategic business. It steers the direction of joint strategic proposals on matters of mutual interest that will be taken to CCGs’ governing bodies for a decision. It also provides a transparent mechanism through which CCGs will collectively hold one another to account in relation to CCGs’ joint agreements and strategies.
Implementation Programme Board
The Implementation Programme Board is made up of representatives from the eight CCGs, the Trusts in North West London, the SaHF programme, the Health Education England - North West London (HEENWL), NHS England and the Patient and Public Representative Group. It acts in an advisory role to CCG Governing Bodies and also provides programme updates through the North West London CCG Collaboration Board. The Implementation Programme Board has responsibilities to:
- Bring together local commissioners and local providers to jointly manage implementation
- Plan, manage progress, resolve issues and manage risks and interdependencies
- Receive and discuss progress reports from workstream leads
- Track system-wide delivery of QIPP (quality, innovation, productivity, prevention) and cost improvement programme and enabling projects as they pertain to the delivery of Shaping a healthier future by, for example, delivery of admissions avoidance and reductions in length of stay
- Receive and discuss key programme deliverables such as common modelling assumptions and outline and full business cases for capital expenditure
- Ensure the different parts of the programme maintain sufficient focus on issues relating to clinical risk, workforce, travel & access, equalities and carers and that appropriate patient engagement continues
- Ensure appropriate links are made with other strategic programmes and organisations outside North West London
The Clinical Board is made up of medical staff and has been set up to provide clinical advice for the reconfiguration programme, ensuring that the approach to implementation across primary and secondary care is clinically sound and that clinical safety and quality are protected during the implementation period. It has responsibilities to:
- Monitor and manage clinical risk to patients and the clinical delivery of services across North West London during reconfiguration implementation, agreeing collective action to address any issues
- Lead clinical implementation planning, in particular advising on safe sequencing of change and readiness for change
- Provide expert clinical advice on other programme deliverables if needed, including local workstream deliverables
To seek advice where necessary from:
- The Governing Body
- The Clinical Networks - expert advisory groups of clinicians in key areas of transformation.
• To commission the Clinical Networks / Clinical Implementation Groups to provide advice on any specialty-specific implementation issues
CCG Governing Bodies
As set out in the Health and Social Care Act 2012, each CCG must have a governing body. This body must have an audit committee and a remuneration committee. The CCG governing body is responsible for making the final decisions within the CCG and is accountable to NHS England and to our member practices, as well as to the public. Every GP practice has a vote to elect its representatives onto the governing body.