Hiccups with new Brent Community Cardiology Clinics

We are sorry to say that Brent Patient Voice has discovered from personal experience that the 2 new cardiology clinics at Willesden and Wembley Centres for Health and Care which opened in March 2015 are some way from being up to scratch.

One of our number, referred in June 2015 for an urgent consultation, was offered an appointment 62 days later instead of within the 14 days specified in the contract. Another went to the Willesden Centre casually and found that for the first four months the clinic had had no IT connection, meaning that handling of appointments and transmission of test results were being done manually. The Willesden clinic continues to be open for only about 50% of the advertised contract opening times.

We immediately took up these findings with Brent CCG and the Royal Free Hospital Trust (who are providing the service). They freely admitted that there were serious problems. Since then we are pleased to say that they have been sharing information with us and explaining how they plan to put matters right over the coming weeks.

The background to this situation goes back to 2012 when the predecessor to the CCG decided to adopt a strategy to go out to competitive tender for some 13 out-patient clinics in 5 Waves. The ‘Planned Care’ Wave 1 ‘out of hospital’ policy of ‘Better Care Closer to Home’ comprised ophthalmology and cardiology services. After many delays and challenges to the process, it was not until March 2015 that Brent CCG launched these new GP referral community cardiology adult out-patient clinics provided by the NHS Royal Free Hospital group.

The contract specification is designed for a comprehensive out-patient service for routine adult cardiology cases: both for acute cases and for continuing care for heart failure. Most importantly the contract provides that “The Service will have a suitable level of clinical delivery, supervision and leadership, and will be consultant-led.” The contract specifically requires 4 of the 5 service clinics to be “consultant delivered”: community cardiology; heart failure and hypertension, heart valve disease and revascularisation.

More details from the contract (which we have obtained via a Freedom of Information request) are at Annex A which follows this story. The contract also provides that patients must be seen within 14 days from GP referral for urgent cases, and within 28 days for all other cases

Although the contract allowed a 3 month ‘ramp-up’ period from March 2015 to achieve full contract specification working unfortunately the service has not yet reached this. For over 4 months there were no IT facilities at the Willesden clinic so the administrative centre had to be moved to Wembley. Even now the Willesden Centre clinic is only working about 2½ days per week. There has been a disturbing failure to meet the contract requirements for patients being seen at first appointment. Both Brent CCG and the Royal Free admit that in most categories patients have had long delays before first appointment. We have received patient complaints about difficulty in finding the clinic within Willesden Centre for Health and Care due to lack of signs and poor training at the main reception desk.

When Peter Latham visited the Wembley Centre for Health and Care on 26 August 2015 there was no-one at the community cardiology clinic and the receptionist at a different clinic in the same suite confirmed that there had been no-one at the community cardiology clinic all day despite the contract specification and the patient leaflet stating that it should be open all day to 8.30 pm. It is now not clear how much of the opening times required by the contract the Wembley clinic is actually open.
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We are pleased that as a follow up to detailed correspondence Mr Alan Rubin, the Deputy programme lead for Wave 1 of Brent CCG offered to attend a joint meeting of the Willesden Locality PPG and the Steering Group of Brent Patient Voice on 12 August 2015. He was accompanied by Ms Navneet Willoughby the Senior Operations Manager for cardiology of the Royal Free Group and the Royal Free Consultant Cardiologist in charge of the community clinics, Dr Paramjit Jeetley.

The meeting was open and constructive. The Royal Free and Brent CCG have agreed an action plan. The IT problem at Willesden is mostly resolved. We have promised to continue to provide them with feedback, and they have promised to continue to up-date us on their attempts to remedy the defects with a full report from Brent CCG by 11 September 2015. Our request for a patient representative on the CCG community cardiology contract Review Group has been approved in principle.

The Royal Free recognise that more specialist cardiology doctors need to be recruited, in some cases on a part-time basis between the community clinics and the acute hospitals in the Trust. The situation has been aggravated by one Consultant Cardiologist in this service leaving for a post elsewhere. There have already been interviews for additional cardiologists and more are planned. Unfortunately the Royal Free tell us it that is likely to be October 2015 at the earliest before the service can be brought up to full contract specification working, assuming that the recruitment exercises are successful.

There is a parallel GP referral local NHS adult out-patient cardiology service at Central Middlesex Hospital provided by London NW Hospital Trust which has the advantage of being walk-in without prior appointment. There have been some problems over heart failure patient referrals from this service to the service at Willesden Centre for Health and Care. Following our raising this issue a meeting has been arranged between the lead Consultant Cardiologists of the Royal Free group and London NW Hospitals Trust to try to refine the referrals protocol and improve the service on patient summaries from the community cardiology service to the referring clinicians.

We would welcome news from patients about their experience with both these services.

Peter Latham and Robin Sharp.

27th August 2015

Annex A – more details from the contract

A full range of general and specialist clinics with appropriate diagnostic support will be available at both sites. In order to maximise efficiency and centralise resources, Willesden Centre for Health and Care will act as the site for stress echo-cardiography as well as being the diagnostic and administrative centre for the Service. Clinics, cardiac rehabilitation and basic diagnostics (ECG, 5 day loop and Holters, echocardiography) will be provided at Wembley.

The service will provide :

• Daily community cardiology clinics at both sites including Wednesday evening and Saturday morning clinics. These will be consultant delivered. GPSIs will be supported by an on-site consultant in a speciality clinic.
• Daily rapid access chest pain clinics run by a specialist nurse or Trust speciality doctor, and supported by a designated consultant.
• Twice weekly heart failure clinics at each site. These will be consultant-delivered with support from GPSIs/Speciality Trust Grade doctors and specialist nurses.
• Three times a week arrhythmia clinic (Twice weekly at Wembley; once weekly at Willesden). This will be consultant-delivered with specialist nurse support
• Once weekly hypertension, valvular disease and revascularisation clinic at each site. This will be consultant delivered.

There will be consultant presence in all morning, afternoon and out-of-hours sessions to ensure specialist advice is available during clinic times. Diagnostic support will be available for all clinics.

The opening times for the both the Wembley and Willesden Centres for Health and Care sites delivering the Services are:

Monday 08:30 – 16:30
Tuesday 08:30 – 16:30
Wednesday 08:30 – 20:30
Thursday 08:30 – 16:30
Friday 08:30 – 16:30
Saturday 08:30 – 12:30.

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