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Working together across North West London

In the NHS in North West London, we are making sure that patients and the public are at the heart of everything we do.

In order to ensure that our residents have rapid access to the health and care services they need, we need to have clear leadership, a strong clinical and patient voice and to operate as efficiently as possible.

The NHS and its partners have a long history of working together in NW London and the eight Clinical Commissioning Groups (CCGs) are now planning to progress this further with a single leadership structure and a Joint Committee, as there are some decisions which are better taken together, once.

Vision for working together

The NHS, local councils and other stakeholders are working in partnership to develop and improve healthcare in NW London through our joint health and care partnership. A joint strategy was published in October 2016 and we continue to work with local people and organisations as we implement those improvements.

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As part of this move towards greater partnership working, in September 2017 the eight governing bodies of the CCGs in NW London agreed to move to having a single Accountable Officer, instead of two Accountable Officers, across the eight CCGs and a Joint Committee for certain NW London wide decisions.

We need to ensure that in making changes, we make the right decisions, at the right level and in the right place.

We recognise the importance of local engagement and decision making and each CCG will continue as a sovereign statutory body, making decisions and commissioning services which are specific to their local area, such as primary care.

However, whilst there are local needs which must always be understood and addressed, the NHS in NW London wants to reduce variation in patient care and experience no matter where you live in the region. There are some issues and challenges which cross borough and CCG boundaries and which are more effectively planned and commissioned across multiple boroughs. A good example is acute care, where we are commissioning from hospitals which serve many boroughs.

  • Taking a joint approach to decisions like this will provide the CCGs with a stronger voice and will help reduce the postcode lottery in care for patients. For example, we have a much greater negotiating power when we work as one and we can seek greater improvements for patients, such as reducing the time between a referral and treatment by speaking to our providers with a single voice.
  • It also allows us to provide greater scrutiny and influence on any decision that affects our area. For example, we will have more influence on improving patient safety and the quality of services local people get from our hospitals and other providers if we join together.
  • Taking a decision in public once rather than the same decision in public eight times will also improve the efficiency of the organisation and enable decisions to be made more quickly which in turn allows service improvements to be implemented earlier for patients.

Our intention is to build on best practice, commission services jointly where it is appropriate to do so, whilst ensuring that all we do continues to be rooted in local needs with patient involvement throughout.

CCG Constitutions

A change to CCG constitutions is required to enable this more collaborative approach. Joint decision-making requires clear and transparent governance and accountability. This is best achieved by harmonising the eight CCG constitutions. This does not change the CCGs’ local focus or remove their local accountability – that remains essential. What it does do is to ensure we are clear, consistent and legally compliant when we work together. We are currently seeking the views of the London Local Medical Committee and their members on the proposed constitution before progressing to the next stage.

Public involvement

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The NW London Lay Partner Forum and local CCG lay partner groups are made up of patient representatives who work in partnership with the CCGs to bring the patient voice to strategy, planning and implementation across NW London.

The current membership of the Joint Committee includes five of these representatives - two from Healthwatch and three CCG Lay Members.

The Joint Committee will be held in public which means our residents are able to attend. We are currently working with our patient representatives to make sure that meetings are fully accessible and can be viewed online for those not attending in person.

We will also ensure that papers at the Joint Committee have a plain English summary with an audit trail that clearly shows how we involved our patients and considered the equalities of our residents.

Timings and next steps

The new Accountable Officer, Mark Easton, took up his post on 1 June 2018 and as part of the move to more collaborative working, he is currently reviewing the management structure of the organisation.

The Joint Committee is currently operating in shadow form and is working through a number of key matters to ensure there is clarity on the membership, role and decision making topics.

Once the Terms of Reference and constitution have been agreed, the Joint Committee will begin in full.

View the Shadow Joint Committee papers here