Harrow community outpatient services (review and next steps)

The service currently sees around 600 patients a year and is run by a GP with specialist expertise (GPwSI) in headaches.

The service was set up to reduce outpatient appointments and waiting times to neurology for adults with headaches.

The service helps patients with migraines, headaches and pain medication management.

Referral route

Patients currently enter this outpatient service through a referral from their GP, following an initial GP appointment. (Note - not all GPs in Harrow refer into the service, as it is one of two referral pathways available, some GPs will refer patients directly to hospital.)

The referral is then triaged by the GPwSI in the community headache clinic and one of three outcomes occurs: The referral is:

• accepted by the community service and the patient is seen, treated and discharged.
• reviewed and fast tracked on to a hospital service to be seen by neurologist.
• seen and sent on to a hospital service following the first assessment, re-joining the hospital waiting list.

Service data

Out of the 600 patient referrals sent to the service in 21/22:

• 47 patients (7.9%) were directly referred to hospital by the community service.
• 548 patient referrals (91.6%) were accepted to be seen in the community service.
• After first assessment in the community service 11 further patients were referred to be seen in hospital.
• Less than 5 (0.5%) referrals were rejected, rejections are for the wrong service or incorrect referral.
• 80% of patients are seen once in the clinic and get the help they need. Just 20% have more than one appointment.
   

Waiting times

• The waiting time for the current community neurology (Headache clinic) is
  10 weeks.
• The current waiting time to be seen for routine headache appointment in hospital is around 26 weeks.
   

Future scenario to further explore and engage service users

We want to hear from service users and residents on how this service should be provided in future. 

Our initial thoughts are that we would like to continue to provide a community headache clinic in Harrow, for the following reasons:

• The waiting times and clinical support for patients from this type of service are good, with few onward referrals to hospital and faster treatment.
• For the majority of patients this means they only have one appointment in the community and get the help and support they need.
• Expertise in the community clinic can be used to avoid hospital referrals, and treat patients with medications which cannot always be started by their GP.

We would like to hear the public’s views on this scenario going forward.

What do you think?

• Share your thoughts by emailing: nhsnwl.healthiernwl@nhs.net 
• Fill in our feedback form

• An online discussion is being held on 6 June, 12 -1pm – please register here

• Feedback closes on 20 June 2023

The service currently sees around 600 patients a year.

The service has eight sessions a month, four run by two GPs with a specialist expertise in gastroenterology and four by a consultant gastroenterologist for four sessions.

The service was set up to increase the number of patients (who can safely) be seen and treated within the community.

Symptoms/conditions the current service helps with:

Some liver and gastro problems, (without urgent specialist need) for example:

• Abdominal pain
• Food intolerance, Coeliac disease
• Rectal bleeding
• Reflux
• Irritable bowel syndrome (IBS), constipation and diarrhoea

Referral route

Patients currently enter this outpatient service through a referral from their GP, following an initial GP appointment. (Note - not all GPs in Harrow refer into the service, as it is one of two referral pathways available, some GPs will refer patients directly to hospital.)

The referral is then triaged by the community gastroenterology team and one of three outcomes occurs: The referral is:

• reviewed and returned to the GP with advice. 
• accepted by the community service and the patient is booked into be seen.
• reviewed and referred to hospital to be seen by gastroenterologist in hospital.

Service data

Out of the 600 patient referrals sent to the service in 21/22:

• All 600 patient referrals were accepted to be seen in the community service.
• 474 patients (79%) were offered a first appointment in the community clinic.
• 120 patients (20%) were referred directly to secondary care (hospital).
   
  • Of the patients referred on again to wait to be seen in hospital - specialist consultants reviewed these cases and advised that 36 patients (30%) could have been seen directly by their GP with advice and guidance, without the need to see the patient in hospital. This generates an assumption that more patients seen by the community service could be been seen faster by their own GP with advice and guidance from a hospital specialist.
     
• The low number of patient referrals triaged and returned to the GP with advice or rejection (1%) suggests limited triage of referrals when received by the community service.

Waiting times

• On average patients are being seen within 10 weeks of for the community outpatient service.
• The average waiting time for a first appointment in hospital is 16 weeks.
• Evidence suggests that around 200 patients (30%) of these patients waiting for 10 weeks or more to be seen either in the community clinic or hospital could get help/treatment within a week or two using advice and guidance to their GP.

Future scenario to further explore and engage service users

We want to hear from service users and residents on how this service should be provided in future. 

Our initial thoughts going forward are that we would like to explore using existing GP practice and hospital services/staff to see these patients, these are our reasons:

• The waiting times and clinical support for patients from hospital gastroenterology services are good.
   
• Small numbers of patients would be added to the current hospital waiting list around 400 a year.
   
• More patients could be seen by their GP within a week or two, with the use of **advice and guidance, meaning more patients will receive faster treatment and have fewer onward referrals.
   
• The current service also exacerbates inequalities for patients in the Northwick Park Hospital catchment area, as not all GPs refer into the community service.
   
• A single referral route for GPs that ensures patients are triaged by a consultant for advice and guidance or directly books them in for a hospital appointment, will provide a better experience for patients, in terms of less appointments to get the help they need.

** The advice and guidance service links GPs with specialist hospital clinicians (across NW London) who can provide them with advice and guidance on next steps for treatment and medication, to help support the patient with-in the practice. Meaning the patient does not need to wait to be seen in hospital. This service is continuingly being improved and was not in place when the community outpatient services were set-up.

We would like to hear the public’s views on this scenario going forward.

• What do you think?
• Share your thoughts by emailing: nhsnwl.healthiernwl@nhs.net
• Fill in our feedback form

• An online discussion is being held on 6 June, 12 -1pm – please register here

   

  Feedback closes on 20 June 2023

The community service receives 2400 referrals for children a year.

The service is run by GPs with a specialist expertise (GPwSI) in pediatrics, supported by a consultant.

The service was set up to provide support and treatment for children with low level and routine conditions, without families needing to go to hospital for an outpatient appointment.

Symptoms/conditions the current service helps with for children include:

• Breathing problems including asthma
• Rashes, eczema
• Abdominal pain, reflux, diarrhoea, constipation, food intolerance
• Headaches
• Flat feet and gait problems
• Babies feeding problems and support for parents
   

Referral route

Children currently enter this outpatient service through a referral from their GP, following an initial GP appointment. (Note - not all GPs in Harrow refer into the service, as it is one of two referral pathways available, some GPs will refer patients directly to hospital.)

The referral is then triaged by the children’s community outpatient service and one of three outcomes occurs: The referral is:

• sent on to hospital if the child’s need is more than the service can support.
• referred back to the GP if support is not required or advice can be given.
• accepted by the community service and the child is seen.

Clinical audit/review

An independent clinician has reviewed a random sample of patients seen at their first appointment through the current outpatient service.

98 patient cases were looked at (10%) for children’s first community outpatient appointments in 2021/22.

• The data for these 98 children shows that 59 of the 98 children (60%) could have been treated by their GP, with advice and guidance, without needing to refer the child to any other service. Saving the child an additional onward referral and second appointment.
   
• The remaining 39 children could have been referred directly onto a specialist children’s/hospital service and not seen in the community outpatient clinic.
   
• Further analysis of all the 2400 children referred to the children’s outpatient service showed that 576 children (24%) were referred onto a hospital service after a first appointment with the community.
   

This means that these children had two appointments before seeing to a specialist. Waiting up to 18 weeks for each appointment, before getting treatment.

Waiting times

• The community service currently sees 52% of children within 18 weeks.
• The hospital sees 86% of within 18 weeks.

Future scenario to further explore and engage service users

We want to hear from service users and residents on how this service should be provided in future. 

Our initial thoughts going forward are that we would like to explore using existing GP practice and hospital services/staff to see these patients, these are our reasons:

• Most children (60%) can be seen faster by their GP with **advice and guidance from a specialist. This means children will get help within one to two weeks at their own GP practice, rather than waiting up to and over 18 weeks in the community service.
   
• For children who need hospital help, it would be faster to refer them directly to the hospital and wait for one appointment rather than two.
   
• There would also be one pathway for referrals for all Harrow GPs, ensuring equity across the borough and one simple referral route for all GPs.
   

** The advice and guidance service links GPs with specialist hospital clinicians (across NW London) who can provide them with advice and guidance on next steps for treatment and medication, to help support the patient with-in the practice. Meaning the patient does not need to wait to be seen in hospital. This service is continuingly being improved and was not in place when the community outpatient services were set-up

We would like to hear the public’s views on this scenario going forward.

• What do you think?
• Share your thoughts by emailing:nhsnwl.healthiernwl@nhs.net
• Fill in our feedback form

• An online discussion is being held on 6 June, 12 -1pm – please register here

   

  Feedback closes on 20 June 2023

The service currently sees around 2900 patients a year.

It is a consultant led community ENT service for adults over 18 years old.

The service was set up to treat more patients in the community and reduce referrals to hospital.
 

Symptoms/conditions the current service helps with:

• Obstructions
• Dizziness
• Nose problems including obstruction
• Tonsillitis, sore throat, hoarseness
• Neck swelling
• Other non-urgent ear, nose and throat conditions

Referral route

Patients currently enter this outpatient service through a referral from their GP, following an initial GP appointment. (Note - not all GPs in Harrow refer into the service, as it is one of two referral pathways available, some GPs will refer patients directly to hospital.)

The referral is then triaged by the community ENT team and one of three outcomes occurs: The referral is:

• reviewed and returned to the GP with advice and guidance.
• accepted by the community service and the patient is booked into be seen.
• reviewed and referred to hospital to be seen by ENT specialist in hospital.

Service data

Out of the 2900 patient referrals sent to the service in 21/22:

• 2871 of the patient referrals (99%) to the service were accepted.
• 2610 patients (90%) were offered a first appointment and seen.
• 260 patients (9%) were referred directly to secondary care (hospital).

Waiting times

• Most patients (92%) are seen within 10 weeks in the community outpatient service.
   
• The average waiting time for a first appointment at hospital is 27 weeks, with >2000 patients currently waiting more than 41-52 weeks.

Future scenario to further explore and engage service users

We want to hear from service users and residents on how this service should be provided in future. 

There is a need to provide community support for ear, nose and throat patients as waiting times in secondary care are significant. This is not just a problem in Harrow, but across NW London.

At this point in time, we would like to further explore developing a new ear, nose and throat services across NW London. This would be with a view to engage and develop a service that works for residents and builds on learning from the current community services.

Developing a sector wide service would provide equity in access for all residents and allow us to utilise specialist support from all our hospitals in building and designing something new.

We would like to hear the public’s views on this scenario going forward.

• What do you think?
• Share your thoughts by emailing: nhsnwl.healthiernwl@nhs.net
• Fill in our feedback form

• An online discussion is being held on 6 June, 12 -1pm – please register here

   

  Feedback closes on 20 June 2023

Feedback on these services, to-date, has been gathered through the following channels over four weeks in February 2023. In total 199 responses were submitted to our survey.