1. Tower Hamlets Networks
Simon Brownleader
Ashraf Ullah

3.  Population 262,000
 Diverse mix – large Bengali community
 Major health inequalities
 Primary care under-resourced
 Variability in service quality - LTC
Background

4.  Increased investment
 Creation of 8 networks
 Geographically aligned
 4-5 practices per network
 Funding for management infrastructure
2008/9

5. 5
36 Practices in 8 networks
6
5
*
1
2
3
4
5
6
8
9
10
7
11
12
15
13
16
14
17
18
19
24
21
22
20
23
25
26
27
28
29
30
31
32
33
34
35
36
Pop: 28,956
Pop: 23,868
Pop: 38,529
Pop: 33,948
Pop: 25,549

6.  Blithehale Health Centre
 Albion Health Centre
 The Spitalfields Practice
 Health E1 Homeless Medical Centre
 XXP Surgery
East End Health Network

9. 36 Tower Hamlets practices
8 geographical networks
Network staff £1.2m
Care packages £3.5m
LES £3m
Total £8m

10. Improved our IT
Network admin staff
Educational budget
Changed LES to Network care Packages (NIS)
EEHN LTD
Monthly MDT meetings with specialists
Organisational change

11.  Similar to LES but stricter targets
 Payment is made to the network
 70% in advance
 30% on network achievement
Funding

15.  CVD (Health check, hypertension & 2nd prevention)
 Diabetes
 COPD
 Immunisation
Care packages

16. Did we make a difference?

17. MMR Immunisation 2006-10

18. Diabetes Hba1c by practice network
NW1 NW2 NW3 NW4 NW5 NW6 NW7 NW8 Borough
Apr-11 7.63 7.97 7.91 7.56 7.44 7.70 7.80 7.65 7.71
May-11 7.67 7.95 7.93 7.56 7.45 7.68 7.78 7.63 7.71
Jun-11 7.67 7.96 7.92 7.56 7.45 7.66 7.77 7.62 7.70
Jul-11 7.70 7.94 7.95 7.63 7.50 7.71 7.78 7.66 7.73
Aug-11 7.74 7.92 7.97 7.62 7.54 7.74 7.80 7.63 7.75
Sep-11 7.72 7.91 8.00 7.59 7.52 7.74 7.78 7.60 7.75
Oct-11 7.71 7.89 8.00 7.56 7.50 7.72 7.75 7.60 7.73
Nov-11 7.69 7.85 7.97 7.52 7.51 7.76 7.75 7.59 7.72
7.10
7.20
7.30
7.40
7.50
7.60
7.70
7.80
7.90
8.00
8.10
Averagebynetwork
Network Average HbA1c
GP Network average forHbA1c forpatients on register(excludingdiagnosed within last 6 months)

19. 0
50
100
150
200
250
300
2009 2010 2011
COPD admissions/100,000 population* in
east London, 2009-11
Tower Hamlets
Newham
City and Hackney

21.  Shared values
 Trust
 Size
 Organisation
 Data
 Peer comparison/support
 Incentives
 Education
 Autonomy
Why does it work?

22.  Improving quality of care plans
 Frail complex and co-morbidities
 Innovation & integration into the community
 Networks +
 Delivery of other community services (CHS)
 Risks around funding – uncertainty/complexity
Future Focus