Hammersmith & Fulham

Hammersmith and Fulham is a small, but densely populated borough with 179,000 residents living in 6.3 sq. miles.

  • More than 90% of contacts with the health service take place in the community, involving general practice, pharmacy and community services.
  • Imperial College Healthcare NHS Trust and Chelsea & Westminster NHS Foundation Trust are the main providers of acute and specialist care.
  • Central London Community Healthcare (CLCH) provides community nursing and therapies and West London Mental Health Trust provides mental health services.

Hammersmith and Fulham CCG 2015/16 annual report.

The chair of Hammersmith & Fulham CCG:

Dr Tim Spicer

Population demographics

  • 179,000*
  • The age profile of the borough is common to other inner city areas in that it has a very large young working age population and relatively fewer children and older people.
  • Compared to London overall, the borough has the 5th lowest proportion of children, 4th highest proportion of young working age residents and ninth lowest proportion of people over retirement age.
  • One in four of the borough’s population was born abroad. The population in the borough is socio-economically and culturally diverse.
  • One third (32%) of the population are from black, Asian and minority ethnic (BAME) groups.

*based on 2013 ONS figures

Health challenges

  • The principle cause of premature (<75) and avoidable death in Hammersmith and Fulham is cancer, followed by cardiovascular disease (which includes heart disease and stroke).
  • Mental health is the most common reason for long term sickness absence, and several of the wards in the deprived parts of the borough fall into the 20% highest in London for incapacity benefit/ESA claimant rates for mental health reasons.

Service improvements

Integrated care

  • The Community Independence Service brings together health and social care staff to help people stay in their own homes and to support them in getting home from hospital quicker if they do need to be admitted. There were 776 referrals to the service up to January 2015.
  • A Care Homes Pilot and Integrated Care Programme brings health and social care professions together with care home staff to look at reasons for ambulance call outs and admissions to hospital from care homes. The teams have looked in particular at preventing falls and managing medication. Data from the third quarter of 2014/15 shows that three care homes had seen a reduction in the number of residents needing admission as a result of the scheme.
  • The Older People’s Rapid Access Service provides comprehensive geriatric assessment within short time frames. This enables patients to access investigations and specialist opinion and remain cared for at home.

Community and GP services

  • The two urgent care centres at Hammersmith Hospital and Charing Cross Hospital had moved to 24/7 operation by June 2014.
  • A community gynaecology service has been set up, and a community ophthalmology service will start during 2015/16. Both mean more people can be treated nearer to their home.
  • GP practices are being supported in providing end of life care through the recruitment of an end of life care coordinator and community matron. Staff are coordinating patient care through End of Life meetings enabling patients to live as comfortably as possible. 308 patients have been added in the last 12 months and 669 registered in total.
  • 30 GP Practices have come together to deliver 18 new community services to a common standard for all patients in the borough with some starting in February 2015. Services include 24-hour blood pressure monitoring in the patients home, anticoagulation services for those on blood thinning medication and complex wound management.
  • Primary Care Plus has been set up to offer enhanced services for patients with mental health needs, including more GP support.
  • Weekend opening has started across Hammersmith and  Fulham with five practices open each weekend (9am-4pm Saturday and Sunday) seeing patients from any practice in the borough.
  • We are investing in other ways of increasing access to GPs for patients. Currently 25 practices offer telephone consultations, 19 practices offer online appointment booking and all 30 offer longer appointments to those that need them.
  • Hammersmith and Fulham CCG is investing in the primary care buildings needed to deliver more services for residents in, or close to, their own homes including:
  • A new health and wellbeing centre at White City has opened.
  • Plans for health and wellbeing centres at Charing Cross Local Hospital and Parsons Green in the south of the borough.

Mental health and wellbeing

  • A psychiatric liaison service is now in place providing mental health support to people already being treated for physical health conditions. It provides patients with a single point of access and support when they go home.
  • Integrating Mental Health to ensure people receive the most appropriate care, closer to home. So far we have invested in four Primary Care Mental Health Workers that support GP Practices to manage more complex mental health patients in the community.
  • North West London was the second area nationally to have its action plan approved for the ground-breaking Mental Health Crisis Care Concordat, ensuring better, joined up, care for people experiencing mental health crisis.

Our future plans

Whilst we have made significant improvements, there is still more we want to do to improve care in Hammersmith and Fulham.

Integrated care

  • Continue to invest in an expanded, single tri-borough Community Independence Service (CIS) to provide rapid response and in-reach to hospitals, enabling patients no longer needing acute care to go home. Increase investment in neuro-rehabilitation community support and bed based intermediate care in the community to support recovery and return to independence.
  • Develop ways to support people to self-manage including peer support programmes, with a particular focus on those with chronic lung disease, Cancer, Diabetes or Dementia.
  • Extend Personal Health Budgets to adults with long-term conditions to give people more choice and control over how they are supported.
  • Work with the public health team to develop supportive and resilient neighbourhoods and communities across tri-borough.
  • Provide additional support from pharmacists and physiotherapists for people in care homes across health and social care to enable better focus on outcomes, maximise value and reduce need for hospital admissions and London Ambulance Service call outs.

Mental health and wellbeing

  • Urgent care in North West London has undergone extensive redesign for which we have achieved national recognition. In 2015/16 we will embed the urgent care work through a single point of access and merge existing teams. We will continue our work with other agencies including Metropolitan Police.
  • Ensure there is a Child and Adolescent Mental Health Service (CAMHS) professional available 24 hours to respond to a crisis.
  • We will have an extended and co-produced maternal mental health service (perinatal).
  • Ensure people with learning disabilities have equal access to mental health services.
  • Develop a mental health and wellbeing strategy across North West London. This will involve partnership working across health and social care and other partners.

Community and GP services

  • Continue to invest in organisational development for the newly formed GP Federation, equipping them with the skills and capacity to work together to deliver services at scale.
  • Integrated Home Care services: the CCG and the local council are working together to specify a new home care service model and pathway, with a focus on regaining independence following a stay in hospital.

We also plan to:

  • Invest in a new community ophthalmology service to improve convenience and experience for patients.
  • Invest in a new community musculoskeletal service to reduce wait times and improve patient experience.
  • Increase provision of community cardiology services in line with best practice.
  • Invest in education and self-management support for diabetes patients, making best us of technology and providing integrated mental health support.
  • Improved buildings: Hammersmith and Fulham is investing in the primary care estate needed to deliver more services in an out-of-hospital setting. Four practices will receive a share of £70,000 to improve their buildings.  In addition, building on the success of the Parkview hub, where we have co-located four GP practices alongside a range of social care and specialist health services in a brand new, state-of-the-art building, we are actively pursuing the development of a second out-of-hospital hub in the south of the borough to provide an additional range of services closer to home.

Charing Cross Hospital

  • North West London will make a significant investment of approximately £150m to develop Charing Cross into a local hospital, with A&E department, to better serve the needs of the local population.
  • A proportion of that investment will develop a primary care hub on the site.
  • The local hospitals will play a critical role within the wider urgent and emergency care network to admit patients, provide local services, and work with the specialist emergency centres as part of the network.
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