Newham Partnership Programme

UCLPartners and Newham Clinical Commissioning Group (CCG) are working in partnership, bringing together health, academic, education and improvement experts to drive health improvement for people in Newham.

This programme aims to accelerate understanding of how to improve the health of people in Newham and put ideas into practice to make a real, long-term difference. The programme began in 2013 and it supports a network of people who are interested in using inquiry and improvement approaches to improve health. This network includes those working across GP practices, health clusters, Newham Council, acute and mental health trusts, academics and other experts in the community.

Since its launch the programme has had multiple successes in Newham including:

  • Developing the capacity of a federated group of small to medium sized GP practices
  • Implementing a gold standard peer mentoring programme – More than Mentors
  • Exploring the scope and feasibility of a peer-supported diabetes self-management programme for young people which led to the development of a strong local network aimed at re-designing young people’s diabetes services.

Read more about the successes of the programme

The programme is now split into five defined workstreams:

  1. GP development
  2. Low birth weight babies
  3. Pre-diabetes
  4. Cardiovascular disease
  5. Dynamic populations

GP development

This workstream was initiated in 2014 and aims to embed improvement science methods into the general practice community, encouraging a systematic and evidence-based approach to improving patient care.

It will do this by:

  • Building capacity and capability in the use of improvement science amongst the workforce
  • Testing new approaches to large scale improvement using quality improvement techniques
  • Engaging the general practice community in pragmatic service evaluation.

This workstream is led by Professor Martin Marshall, Newham GP, Professor of Healthcare Improvement at UCL and lead for Improvement Science London.

Progress to date

Achievements so far include:

  • The appointment of two new research masters students
  • The creation of a learning network for people involved in postgraduate studies
  • Identification of training opportunities in systematic improvement for Newham health professionals, with training being delivered in partnership with East London Foundation Trust and the Quality Improvement (QI) team at UCLPartners.
  • The creation of a GP Quality Improvement (QI) collaborative – This was created by QI Fellows Dr Subir Sen and Dr Mike Jones, two local GPs. This collaborative involved ten general practices and four service users and aimed to improve care for people with complex health and care needs. As a result of this work, a quality improvement academy has been developed in Newham.
  • The appointment of a researcher in residence to develop a new programme of participatory research that will explore and contribute to the development of new networked cluster and federated models of general practice.

Low birth weight babies

Newham has one of the highest proportions of babies born with low birth weight in England, however the nature of the problem remains unclear. This workstream aims to gain an in depth understanding of the problem specific to Newham by co-designing and piloting a prediction and prevention programme, which will lead to evidence-based practice. It also aims to develop the research skills of local staff to create sustainability in the future.

The leads for this workstream are Angela Harden, Professor of Community and Family Health at University of East London and Professor Judith Stephenson.

Progress to date

An analysis of antenatal and birth records at Newham University Hospital has led to a better understanding of the causes of low birth weight in Newham.

The next step will be to co-design and test actions to prevent low birth weight and provide better support to families.

Pre-diabetes

Newham has a higher than average prevalence of diabetes. Prevalence of type 2 diabetes in young people is increasing in the borough and there are a large number of women with gestational diabetes. This workstream aims to provide clarity on the definition, identification and management of pre-diabetes, which is a major concern for the population of Newham.

Specifically, this workstream aims to:

  • Map the local population between the ages of 25 and 79 years, who are currently diabetes-free based on existing data collected by primary care; to help identify those at risk of developing diabetes.
  • Conduct a systematic review of literature to determine the most-appropriate and cost-effective intervention for those at high-risk of developing diabetes
  • Testing pilot interventions locally using existing local resource with the aim of creating pathways for use in primary care locally

It is anticipated that this work, based largely in primary care, will develop research skills locally, help evidence-based commissioning and provide the basis for a future research programme exploring a borough wide intervention.

This workstream is led by Dr Shanti Vijayaraghavan, Consultant Physician at Barts Health NHS Trust and Dr Jim Lawrie, Newham CCG and Newham GP.

Progress to date

Since starting in November 2014, the workstream has:

  • Produced maps of the borough to identify areas at high risk for pre-diabetes
  • Completed review of literature on diabetes to allow better understanding of screening and management processes
  • Identified GP practices who will work with relevant stakeholders to trial different models of pre-diabetes management
  • Undertaken a systematic review of cost effectiveness of screening strategies and interventions to manage pre-diabetes.
  • Charted the ‘unmet need’ for pre-diabetes screening and interventions in Newham
  • Started a mapping exercise to define current services aimed at managing pre-diabetes in Newham, including cost and benefit data (where available)
  • Identified the particularly high risk population of women with a history of gestational diabetes (they have a 70% chance of developing diabetes in 10 years) and started working with a local GP practice to design a tailored gestational diabetes prevention programme

As a result of the findings from this workstream, Newham has been selected as a first wave pilot of the National Diabetes Prevention Programme.

Cardiovascular disease

Early mortality rates from cardiovascular disease (CVD) and emergency admission rates for coronary heart disease and stroke in Newham are significantly higher than the national rate.

This workstream aims to prevent and improve the treatment of cardiovascular disease by examining how electronic health records can be used to:

  • Define clinical and referral pathways in primary care,
  • Enhance the diagnosis and management of CVD
  • Enhance the NHS Health Check programme
  • Reduce cardiovascular risk in Newham’s ethnically diverse population by empowering patients to take control of their cardiovascular risk reduction strategy.

This workstream is led by Professor Adam Timmis, Professor of Clinical Cardiology at Barts Health NHS Trust and Dr Bhuphinder Kohli, Newham GP.

Progress to date

Since starting in January 2015, this workstream has:

  • Started the development of a personalised CVD risk report, working with patients to seek feedback on design and early use and piloting the repost in three GP practices in Newham.
  • Created an electronic symptom specific CVD diagnosis template which is being piloted in three GP practices in Newham before being rolled out
  • Commenced development of an electronic diagnosis specific template for hospital referral with the aim of integrating the template across Newham hospitals.

The personalised CVD risk report was presented at the NHS Annual Health Check conference in 2016.

Dynamic populations

Newham borough has one of the most dynamic populations in England, with a 20-40 percent annual turnover in GP patient lists. This workstream aims to analyse available data to better understand Newham’s dynamic population and how it impacts both on patient health and wellbeing and on key deliverables for primary care in Newham.

Progress to date

An analysis of the mobility of the population in Newham was conducted in order to help accurately predict the demand for services in the borough. The next phase of the project will be to co-design interventions that address the challenges associated with this dynamic population.

This workstream is led by Dr Ashwin Shah, Newham CCG and Gail Findlay, Director of Health Improvement at the Institute of Health and Human Development at the University of East London.

Links

A herculean task for the Olympics borough (British Medical Journal)

London Borough of Newham

Queen Mary University of London