How we hold providers to account
NHS Hammersmith and Fulham CCG regularly reviews and monitors our local NHS Trusts’ performance around patient experience through monthly Clinical Quality Review Group meetings. Lay members from the CCG attend these meetings to ensure that patient voices are heard when we assess the quality of the services we commission. Lay members also chair and attend the CCG’s Patient Reference Group, so are able to relay wider patient feedback and liaise between the groups.
We use these meetings to monitor and assess patient experience by reviewing complaints, Friends and Family Test responses, comments on NHS Choices and national patient survey results. We also review any action plans that the Trusts have put in place to address areas of poor performance or poor experience. Examples of this monitoring and review process in action include the March Care Quality Review Group minutes which show a discussion between Imperial’s Director of Patient Experience, the CCG Quality Assistant Director and the Governing Body Lay Member for Patient and Public Engagement around PALS improvement projects. The minutes show the review process and also demonstrate the type of follow up activity which regularly takes place through action 4 for a subsequent meeting to take place between the Imperial Director and CCG Assistant Director to discuss areas of assurance for inclusion in the patient experience report going forward.
Another example of robust monitoring and review can be found in the May Care Quality Review Group minutes; on page 3, the patient experience report is noted as received, with the Governing Body Lay Member for public and patient engagement praising the new layout and content of the report and commenting on 2019-20 priorities. The minutes also show commissioners reviewing improvements through the PALS and complaints reports, and the clinical lead providing suggestions for how to feedback directly to patients on how their feedback has made a difference, with the Imperial Director agreeing to look into this going forward. In addition to quarterly and monthly reporting, the CCG is able to review annual reports and strategies from its providers, such as this patient and public engagement strategy from Central London Community Healthcare NHS Trust.
Our commissioners also hold regular contract monitoring meetings with our providers to ensure they are fulfilling their contractual obligations of delivering high quality health services to local people. These contract meetings can also include patient representatives such as the contract with our Out of Hours GP service. Where trends or serious risks are identified as a result of a patient concern, additional meetings are held with the provider in order to flag the issues and request remedial actions. Quarterly reports on complaints, GP Alerts and Insight Visits are regularly presented at the CCG’s Quality & Performance Committee which has a lay member and Healthwatch Central West London representative.
The feedback gathered via public engagement carried out by our providers and our engagement and commissioning staff in partnership is considered as part of the Equality and Health Inequalities Impact Assessment and Quality Impact Assessment process for considering service changes and transformation. For example, the write up of our public consultation in our decision making business case on the future of primary and urgent care included feedback gathered by our providers such as the staff at Hammersmith Urgent Treatment Centre (see pages 7-11, 93). The feedback gathered via providers meaningfully contributed to a range of mitigations and changes to the final proposals – see pages 105-127.
Providers submit monthly and quarterly reports to commissioners, which are reviewed and feedback given by commissioners on a quarterly basis. Providers then publish how they have responded to patient and CCG feedback – a recent example being the Central London Community Healthcare NHS Trust November 2019 you said we did report. The provider also advertises this information across services on a monthly basis to demonstrate to the public what actions have been taken in response to feedback. Our providers include in their complaints and PALs reports improvements based on feedback and complaints from patients. Providers’ Annual Equalities reports (EDS2) are reviewed and feedback given by commissioners.
The CCG also works closely with primary care providers to review and monitor patient experience and involvement through the following channels:
There are many examples throughout the primary care commissioning committee minutes showing how the CCG has reviewed and monitored patient involvement and experience work in primary care. Here are a couple of examples: in the June 2018 minutes, page 8 shows CCG Governing Body and Senior Management Team members discussing how the impact of GP at Scale funding on patient experience would be monitored by the CCG going forward, and shows them reviewing the Primary Care Quality Dashboard for assurance purposes. In the July 2018 minutes, pages 2-7 detail the CCG’s role in monitoring equalities, patient safety and experience in primary care and specifically for the new digital offer at Babylon GP at Hand.
The CCG has also worked on partnership projects with the GP Federation and GP practices to provide leadership training to patient and GP practice members of Patient Participation Groups. The training was codesigned with patients and primary care providers in response to patient and practice manager feedback. The CCG also supported and facilitated the roll out of an initiative called ‘Pride in Practice’ in primary care in response to community and GP practice feedback.
Sometimes the CCG will conduct insight visits if we get an indication that a service is not performing at the standard that it should be. Patient representatives are invited to carry out these visits with us and are involved in making recommendations to providers on how services can improve. Re-visits are usually undertaken around 12 months after the initial service visit to ensure recommendations have been embedded into routine practice. Insight visits can also be carried out by Healthwatch CWL. These visits are called Enter and View visits, and in 2018-19 the CCG has worked very closely with Heathwatch CWL and shared information in a timely and transparent fashion to ensure that these visits can be as meaningful as possible. In September-October 2018 Healthwatch carried out an enter and view at Hammersmith Urgent Treatment Centre to inform the CCG’s review of primary and urgent care. The report is referenced and taken into account by the CCG’s Governing Body in their subsequent Decision Making Business Case (page 8).
Our main acute provider, Imperial College Healthcare NHS Trust, has been leading some excellent award-winning community engagement projects such as 'Connecting Care for Children'. Read their quality and patient experience reports below:
Annual Patient Equality and Diversity Report
Quality Account 2017/18
Patient and Public Involvement Strategy
2017-18 Complaints Annual Report
Patient Experience Report Q2 2018-19
Patient Experience Report Q2 2019-20
Read more on their website.
View our main community provider, Central London Community Healthcare NHS Trust's, Quality Strategy and Patient and Public Engagement Strategy below:
Quality Strategy 2017-20
Patient and Public Engagement Strategy 2018-20