Cardiology Clinic Update at 15th April: patient rep no longer wanted

Brent Patient Voice has been closely monitoring the introduction of the new NHS Brent Community Cardiology Service commissioned by Brent Clinical Commissioning Group and provided by the Royal Free London NHS Foundation Trust at Willesden and Wembley Centres for Health and Care.

This is an up-date on our 3 earlier reports.

In September 2015 Brent CCG invited BPV Steering Group member Peter Latham to be a patient representative on the joint CCG/Royal Free Hospital monthly contract review group for this service. Our main continuing concern for patient safety was on the 14 day contract maximum waiting time for urgent cases from referral to first offered appointment. There has still been no explanation for our member’s 62 day wait for an urgent appointment. It was not until January 2016 that the Royal Free provided the full patient figures required by the contract for compliance with the 14 day urgent case maximum waiting time to first appointment.

We have continued to make regular un-announced spot checks at both the Willesden and Wembley clinics to see what services are being provided.. The Chief Operating Officer of Brent CCG Sarah Mansuralli has written to us thanking us for the intelligence we have provided about the Royal Free non-compliance with its contract. With this information Brent CCG has pursued an NHS ‘contract query’ procedure attempting to hold the Royal Free to the terms of its contract.

There are now clinics at both centres each weekday. Saturday working required by the contract was only started in March 2016. More specialist cardiologists have been appointed. There is an acknowledged gap in the contact specification with no provision for diastolic heart failure cases. In November 2016 the CCG promised to issue a contract variation to cover this but have not yet confirmed that this has been done.

At the last joint contract review group meeting on 2 March 2016 we saw the Royal Free cardiology service much improved figures for patient activity for January 2016 including their seeing 98% of urgent cases within 14 days as against the specific contract requirement for 100%. At this meeting Brent CCG announced that they were discontinuing patient representation on the joint contract review group. On BPV writing to protest at this as we have not yet seen full contract compliance, the CCG claimed that the Royal Free are now substantially contact compliant.

There are still 4 issues on which we have not yet seen confirmation of the required clinical standard for this community cardiology service:

1. We have not yet seen any monthly statistics from the Royal Free to confirm that all patients referred to this service assessed as urgent have been seen within 14 days of referral as required by the contract. We have not seen any figures since the January 2016 figures despite our 31 March Freedom of Information Act request to the Royal Free for the February 2016 figures.

2. We have not yet seen confirmation of the full evening and Saturday clinics required by the contract.

3. At a visit to the Willesden clinic on Saturday 2 April 2016 it appeared that the junior Royal Free Cardiologist on duty carrying out stress echocardiograms was working without the required on-site supervision by a Consultant Cardiologist. We have written to the Royal Free senior management with full details to this incident but to date have not received a reply.

4. Brent CCG appear not yet to have put in place their promised contract variation to cover diastolic heart failure cases.

We note that Brent patients can be referred to an alternative NHS out-patient cardiology service at Central Middlesex Hospital at Park Royal provided by London NW Hospital Trust who run Northwick Park Hospital which provides a walk-in service without appointment for patients referred to the service by their doctor.

Peter Latham.

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