Poor air quality and rising temperatures due to climate change are already having a significant impact on health now and in future decades. The NHS produces millions of tonnes of waste and contributes to a significant proportion of England’s total carbon emissions. The impact of these are starting to be seen on the health of our population. For this Forum, the London Clinical Senate joined with Public Health England to hear the latest information and evidence on the sustainability challenges we face and to collaborate on addressing these.

This event was held on Thursday 5 March 08:45-16:00 at 15 Hatfields and the programme is available here.

The presentations delivered at the event were as follows:

A summary report with key messages from this Forum will be available soon.

There is variation in the extent that quality improvement (QI) is used in primary care in London and huge potential to apply and embed QI to drive change. The emergence of Primary Care Networks (PCNs) brings opportunities, as well as risks, when considering a structured approach to QI. This Forum explored the practical principles and critical features to enable STPs and PCNs to most effectively implement QI in their locality.

This event was held on Thursday 3 October 2019 08:30-12:30 at the King’s Fund and the programme is available here.

The presentations delivered at the event were as follows:

A summary report with key messages from this Forum will be available soon.

At this Forum, system leaders, clinicians and patients heard and discussed what health and care outcomes and best value means from a clinician, finance director, patient, carer, public and integrated care perspective. Attendees had the opportunity to debate ideas on what delivering best value means and how a value based approach could be adopted systematically.

This event was held on Thursday 30 May 2019 09:00-12:30 at the King’s Fund and the programme is available here.

The presentations delivered at the event were as follows:

The Forum also featured a marketplace, with information stalls from:

  • Healthcare Financial Management Association
  • London Mental Health Clinical Network
  • London Dementia Clinical Network
  • Healthy London Partnership
  • NHS RightCare
  • Getting It Right First Time

A summary report with key messages from this Forum is available here.

At this Forum, system leaders, clinicians and patients heard about the current challenges in the system from service users, carers, health and social care staff, London Ambulance Service and the police. Attendees discussed and debated ideas and potential solutions for how the whole system can improve the experience of those of all ages in mental health crisis.

This event was held on Thursday 7 February 2019 09:00-13:00 at the King’s Fund and the programme is available here.

The presentations delivered at the event were as follows:

A summary report with key messages from this Forum will be available soon.


The rapid increase in demand for services, constrained funding and a number of other challenges have greatly impacted the supply and retention of the health and social care workforce both nationally and within London.

This Forum event looked at the implications and difficulties that workforce challenges have caused across the whole health and social care system and identified new opportunities to help resolve London’s workforce challenges.

This event was held on Thursday 11 October 2018 09:00-13:00 at the King’s Fund and the programme is available here.

The aims of the event were to:

  • Attendees to have a better and broader understanding of the health and social care workforce challenges in London
  • Sharing of ideas and good practice
  • STPs to take away ideas and to develop plans to respond to their challenges
  • Each attendee to pledge to do 1 thing to tackle the workforce challenges

The presentations delivered at the event were as follows:

Table discussions were held to share ideas and thoughts on approaches to tackling the workforce challenges being faced.

The Forum concluded with a panel discussion where the panellist provided their key reflections and thoughts. The panellists were:

  • Gabrielle Jacob (Programme Manager – Human Resources for Health Programme, World Health Organisation)
  • Dr Josephine Sauvage (Chair Islington CCG, Clinical Lead North London Partners, Clinical Lead for Workforce development NLP)
  • Wendy Brewer (Director of Workforce and Organisation Development, West London NHS Trust)
  • Lizzie Smith (Local Director, Health Education England North London and Regional Lead for Mental Health)
  • Richard Ballerand (London Clinical Senate Patient and Public Voice Group Member)
  • Chris Caldwell (Programme Director for CapitalNurse, Director of Nursing & Systems Workforce Transformation Tavistock & Portman NHS Foundation Trust)
  • Schellion Horn (Director of Operations and Transformation at Healthy London Partnership)

A summary report with key messages from this Forum is available here.


The move towards integrated care systems is acknowledged and understood by most senior leaders in our trusts, clinical commissioning groups and local authorities but is often less well understood by staff working directly with patients, carers and citizens.
This meeting of the London Clinical Senate Forum focussed on exploring what this new landscape, including shared responsibilities for population health, means in practice and the implications this has for leadership skills and behaviours at all levels of the system, but especially for staff below board or governing body level and those working at the front line.
This event was held on Thursday 17 May 2018 09:00-13:00 at the King’s Fund and the programme is available here.
The Forum aimed to identify and develop the opportunities and benefits for staff, carers and patients of working in an integrated way. Getting the most from such opportunities will require effective leadership at all levels in the system as we recognised there are barriers to overcome; for example, organisational barriers, budgets, relationships, culture, behaviours, attitudes or simply a lack of experience, knowledge or understanding about how to make these changes work. We identified the obstacles likely to impede change most and ways in which we can address them. We drew on learning from changes that have been introduced at different levels of the system to inform this.

The aims of the event were to:

  • Create a shared understanding of what the change from organisational leadership to integrated system leadership, including the responsibility for population health, will mean in practice and the competencies it requires.
  • Identify the both the enablers and barriers to developing system leadership skills at different levels and across teams.
  • Agree the steps required to support leadership development and facilitate the delivery of integrated care systems that will benefits patients, carers and our fellow Londoners

The presentations delivered at the event were as follows:

The Forum concluded with a panel discussion where the panellist provided their key reflections and thoughts from what they had heard during the morning. The panellists were:

  • Samira Ben Omar, Head of Systems Change, Integrated Care System, North West London Collaboration of Clinical Commissioning Groups
  • Nicola Kingston, London Clinical Senate Patient and Public Voice Group Member
  • Julie Lowe, Programme Director, South East London STP
  • Dr Anatole Menon-Johansson, Clinical Lead for Sexual Health, Guy’s and St Thomas’ NHS Foundation Trust
  • Beverley Tarka, Head of Adults and Health, London Borough of Haringey
  • Dr Jane Wilson, Medical Director & Consultant Obstetrician and Gynaecologist, Kingston Hospital, NHS Foundation Trust

A summary report with key messages from this Forum will be available shortly.

Transforming general practice is critical to transforming the wider health and care system. It is relevant to everyone. “Transforming Primary Care in London: A Strategic Commissioning Framework”, published in November 2014, set out an ambition to deliver more accessible, coordinated and proactive primary care for all patients. Since then, we have seen significant changes both in the way that primary care is delivered across London, and health and social care’s political and regulatory landscape.

It is widely recognised that collaborating at scale is a vital enabler for general practice to deliver the ambitions it outlined. Collaborating at scale supports greater resilience and sustainability of the general practice workforce, as well as investment in development and innovation in areas such as estates and digital technology.

Integration and collaboration across general practices and primary care is already taking place in London. The majority of general practices belong to an at scale organisation, such as a federation or a super-practice. However the nature and extent of collaboration beyond provision of extended access varies considerably. Developing a more explicit commitment to general practice at scale is an essential driver to transforming care in London, ensuring a consistent vision and pace of change to support new models of integrated care. Work is currently taking place across London to set out what “good” general practice at scale looks like i.e. how care is delivered, how it functions and how it participates in the wider system. This will help determine what is needed to achieve it.

This meeting of the Clinical Senate Forum supported this work. Chaired by Dr Vin Diwakar, Medical Director, NHS England London Region and Clinical Senate Forum co-Chair, it enabled participants to contribute to co-creating a vision for general practice in London and determining the next steps we need to take, in particular, how we can use, align and develop our people, processes, systems and resources to deliver.  The programme is available here and aimed to:

  1. Develop a shared view  about how general practice needs to transform to create a sustainable, integrated health and care system and effectively participate in new models of care across London;
  2. Agree what needs to happen to achieve this vision and the early priorities.

In the opening session, several speakers discussed developing general practice at scale, from different perspectives, sharing views and learning about why change is important, examples of how this could be achieved and critical factors and considerations in doing so.

What is important about General Practice? Patients’ views
Trevor Begg, Patient Representative

Why we need to change? A regional perspective (click here)
Dr Jonty Heaversedge, Medical Director for Primary Care and Digital Transformation, NHS England (London Region) and  Dr Michelle Drage, Chief Executive, Londonwide LMCs

An introduction to Primary Care Home – an integrated, multi-professional approach (click here)
Dr Nav Chana, Chair of the National Association of Primary Care

Next steps for general practice in London: learning from international  organisations (click here)
Dr Rebecca Rosen, GP and Senior Fellow, The Nuffield Trust

Organisational development is essential to support system change – lessons from London’s Primary Care Quality Academies (click here)
Professor Rebecca Malby, School of Health and Social Care, London South Bank University and Nick Downham, Independent Improvement Expert, Primary Care Quality Academy, London South Bank University

New models of care: Insights from the national vanguards
Samantha Jones

The second part of the meeting provided space for participants to consider the vision and journey so far for general practice at scale within London’s five Sustainability and Transformation Partnerships and to consider the next steps and what would assist this. In a final session, key themes from discussions were shared.

A summary report with key messages from this Forum is available here.








Outpatients have probably been a feature of hospitals for as long as they have existed, but the current structures seem to have started in the seventeenth century, with the Royal College of Physicians starting their clinic in 1696 (BMJ 1:6118;974-977). Little has changed since! Transforming outpatient access and care is a key area for London’s Sustainability and Transformation Partnerships (STPs). All have identified the need for alternative and innovative ways of responding to these issues: How do we build Patients and GP access to specialist advice when they need it? How do we empower patients with shared decision-making and support self-care with access to information and advice when they need it? How do we develop patient centred pathways that seamlessly span primary and secondary care? For many, patients and professionals alike, the traditional outpatient clinic and pathway is an outdated approach. Reasons are varied and multiple:

  • we need to improve patient experience;
  • we must strive to improve efficiency and value – for GP, patient and hospital;
  • patients’ needs are changing with more people are living with long-term conditions increasingly managed through self-care and by a wider team in primary care;
  • there are issues of workforce capacity, availability of staff and skills, and different types of “specialist” not always recognised;
  • referrals and waiting times are rising and DNA rates are high, but the variation between and within practices, hospitals, and populations suggests improvement is possible.

Developments in out of hospital care, particularly primary care transformation, use of technology and digitally enabled solutions, empowering people, and optimising skills and experience of different workforce groups all present significant opportunities to improve. However, one size will not fit all. This meeting of the Clinical Senate Forum explored these issues and: 1. Considered what is important to patients and clinicians in accessing specialist advice 2. Shared and learned from different models designed to improve access to timely advice within the context of an effective, person centred pathway, building consensus on what good looks like 3. Identified the most critical factors that need to be addressed to enable implementation of proven models at greater scale across London and considered how this could be achieved The programme for the meeting is available here. Dr Vin Diwakar, Medical Director, NHS England (London Region) and Clinical Senate Forum Co-Chair set the scene for the Forum’s discussions with a presentation reflecting on the history of outpatient care, the current context for the NHS and opportunities to improve people’s experience and outcomes by transforming the way care is delivered. We then heard different perspectives on what is important in accessing specialist advice and how pathways could be improved, including traditional approaches to outpatient care. Howard Bluston shared a patient’s perspective; Dr Mark Spencer provided a GP’s perspective and shared experience as a carer; Dr Mike Gill gave his views as a secondary care doctor now working in a “one stop practice” for people with complex needs); Dr Elizabeth Mumford shared experience of caring for people in outpatient services as a junior doctor and Rosalie Barratt, an Advanced Practitioner Physiotherapist, shared an allied health professional’s perspective, highlighting that several clinical groups provide specialist advice and care. A key aim of this Forum was to stimulate discussion and learning about what works, key factors for success, challenges and barriers and the conditions that need to be in place to overcome them. The majority of the meeting involved participants exploring different approaches, learning and impact with colleagues involved in developing and delivering them. Examples of  shared from London and elsewhere, including companies involved in the DigitalHealth.London Accelerator (see information below): The East London Community Kidney Service [click here] Flare to Care (pathway for inflammatory bowel disease) [click here] City & Hackney Referrals Management [click here] OurPath – a digital behavioural change programme [click here] City and Hackney primary care mental health service [click here] DrDoctor – using technology to improve outpatient pathways Ealing Community Musculoskeletal Service [click here] Diabetes Appointments Online: the Newham Experience [click here] Moving towards sustainable eye care services Eye Health Network for London: Achieving Better Outcomes Evaluation of a minor eye conditions scheme delivered by community optometrists Improving Cancer Pathways: implementation of the Recovery Package and Stratified Follow-up [click here] Recovery Package & Stratified Follow-up Precis Following these discussions, Dr Nicola Burbidge, Chair of Hounslow CCG, gave an overview of the approach and underpinning principles for outpatient pathway transformation in North West London  [click here], illustrating one STP’s approach.  In the final session, participants came together in London’s five STP geographies: to share and discuss what they had learnt; to consider what changes and innovations could have greatest impact in ensuring improved, patient centred pathways; and to give advice about the pan-London enablers and support that would assist most in achieving change.

A SUMMARY REPORT with views and recommendations from this Forum is available here. This includes key messages from the meeting plus information on all of the examples of change and innovation shared with contact details of people involved to help with follow-up conversations. It also provides links to some further information and resources. Please also the read this blog written by two of the Clinical Senate’s junior doctor fellows to share their reflections on the Forum and the issues discussed.

The Clinical Senate Forum in January 2017 focused on out of hospital care and shared experiences and learning from a range of different initiatives being implemented across London, exploring factors that enable successful and sustainable change. We noted then that enhancing and expanding care out of hospital is a core, and critical, part of London’s five sustainability and transformation partnerships’ plans (STPs) and so we continued this theme in May 2017 and focused on improving health in care homes, which is a key part of the overall approach that STPs are taking to meet older people’s needs and one that requires an integrated, whole system response. Meeting the needs of a growing and ageing population is one of the key challenges for our health and care systems. Whilst overall London has a younger population than other parts of the country, the number of Londoners aged over 80 is rising and is predicted to increase by 40% over the next 15 years. As the greatest users of health and care services we need to consider how to best meet the needs of older people, particularly the frail elderly, supporting them to have the best possible quality of life and care. The recently published Next Steps for the NHS Five Year Forward View, describes the task clearly; “As people live longer lives the NHS needs to adapt to their needs, helping frail and older people stay healthy and independent, avoiding hospital stays where possible. To improve prevention and care for patients, as well as to place the NHS on a more sustainable footing, the NHS Five Year Forward View called for better integration of GP, community health, mental health and hospital services, as well as more joined up working with home care and care homes”. Many people living in care homes have complex needs, for example limited mobility, falls risks, dementia, incontinence, cardiovascular and cardiorespiratory disease, often with multiple prescribed medications. There is significant evidence that a more proactive approach and more responsive support can improve health and quality of life, breaking the cycle of emergency admission, delayed discharge, reducing independence and subsequent re-admission that many frail older people experience. Next Steps for the NHS Five Year Forward View highlights early results from parts of the country that have started doing this – the “care home vanguard” areas, which include the Sutton Homes of Care Vanguard in South West London, are seeing slower growth in emergency hospitalisations and less time spent in hospital compared to the rest of the country, with the difference particularly noticeable for people over 75, and meaningful savings from reducing unnecessary prescribing costs. Approximately 29,000 people live in nursing or residential homes in London, though there is significant variation in provision across our boroughs. It is well recognised that many challenges exist within the care home market,  and we need to acknowledge that challenges also exist in provision of domiciliary care. The framework for enhanced health in care homes, developed by NHS England’s New Care Models team with the six care home vanguards, describes the care and quality, financial and organisational barriers that in many parts of the country are holding back the care for people living in care homes or who are at risk of losing their independence. London is no exception. The framework provides an approach to tackling these issues with a suite of evidence-based interventions, which are designed to be delivered within and around a care home in a coordinated manner to improve the quality of life, healthcare and planning for residents. Enhancing health in care homes through more integrated working should be everybody’s business. Through this meeting we:

  1. Considered the needs of ageing and frail elderly Londoners living in care homes and the opportunities to improve their health and well-being as a key part of wider health and care transformation plans;
  2. Improved participant’s understanding of London’s care home market and the issues faced by providers of care and commissioners; and
  3. Shared examples of innovation and good practice to improve health and well-being, quality of care and care planning and the impact they are having and consider how these initiatives could be progressed at greater scale across London.

This programme for the meeting is available here. Professor Oliver Shanley OBE, Regional Chief Nurse, NHS England and NHS Improvement (London Region) opened the meeting, outlining the aims of this Forum and its relevance in supporting improvement across London (click here for slides).Suzanne Peppitt then very powerfully talked about making care homes a new beginning: a relative’s perspective. Aileen Buckton, Executive Director for Community Services, Community Services Directorate, London Borough of Lewisham & London ADASS Branch Chair, then gave an overview of London’s care home market (click here) and William Roberts, National Lead for Enhanced Care in Care Homes, New Care Models Programme, NHS England shared learning from the care home vanguards (click here). With the scene firmly set and the opportunities to enhance health in care homes and the benefits clear, nine examples of innovation and good practice were shared and discussed to explore and disseminate approaches, impact and learning. Information on each is included below. Sutton Homes of Care Vanguard, one of six care home vanguards within NHS England’s New Care Models programme, shared the vanguard’s overall programme of work with a focus on three key elements: Quality and Assurance; Workforce Education and Training and the Hospital Transfer Pathway (aka “the red bag”). The Health Innovation Network (HIN) shared an overview of the HIN’s work in residential and nursing homes and learning about developing a care home network and adoption and spread (illustrated through adoption and spread of “the red bag”). Health 1000: The Wellness Practice shared learning from supporting care homes in considered whether enhanced primary care in nursing homes in Havering is effective. Focused, coordinated care for people living with long term conditions. IUC Pilots: Fast Access to a GP via the *lines for health care professionals. Colleagues shared learning from pilots introduced last winter to respond to pressures across the urgent and emergency care system, which included testing an improved response to calls from care homes with Fast access to a GP. The Argyle Surgery in Ealing, North West London, shared outcomes and learning from a proactive multidisciplinary team approach to intensive management of nursing home patients four years on. The Argyle Care Home Service and  infographic. The London Dementia Network shared models of service delivery which have proved effective in supporting care home staff in meeting the needs of people with dementia and behavioural and psychological symptoms; and care pathway overview. St Christopher’s Hospice shared the approach and learning through reaching out to implement an end-of-life care programme in care homes (see the summary report). Mouth Care Matters – improving the oral health and general health of older adults. This is a programme developed by Health Education England to educate staff about the importance of identifying and meeting people’s mouth care needs, an area often neglected in care homes. Mouth Care Matters. The vital role our senses play in ensuring good physical and mental health are often overlooked. Colleagues from NHS England and the NIHR NWL CLAHRC discussed why good sensory health is important to quality of life and independence for older adults and shared models of delivery. Eye health needs for older adults; What Works – hearing loss and healthy ageing; Commissioning services for people with hearing loss.

A SUMMARY REPORT with reflections and recommendations from this Forum can be accessed here. It also includes key messages from each speaker; further information about the examples of good practice shared and discussed with contact details of colleagues leading their development and delivery; key points from STP group discussions and links to some further resources to support enhancing health in care homes.

This Clinical Senate Forum  focused on how as a collective we develop high quality, value based out of hospital care, particularly exploring the factors that enable successful and sustainable change.

Expanding and strengthening out of hospital care is one of the most important enablers for the delivery of high quality, sustainable health and care services over the coming years. The NHS Five Year Forward View highlights the benefits a coordinated multidisciplinary approach can have on patient outcomes and system resilience, and efficiency. Outputs from local and regional good practice, have demonstrated how the implementation of new or enhanced out of hospital services and care models could transform health and care systems but also pose challenges that need to be overcome to have the intended population impacts.

Comprehensive out of hospital is a broad topic encompassing a wide range of services and issues, so we focusd on initiatives aimed at admission avoidance and facilitating discharge. The programme included:

  1. Sharing the vision for out of hospital care over the next 2-5 years in  London’s five Sustainability and Transformation Plans and priorities for development
  2. Considering different examples of out of hospital care that have been implemented, the impact they have had or are having
  3. What patients and clinicians identify as the most important issues to take into account as we place increasing emphasis on delivering care out of hospital
  4. Discussing how we make sure that the breadth of skills and experience available in our multi-professional workforce are recognised and utilised
  5. Identifying common features of successful change, key barriers and what we need to do to overcome them, particularly from a whole system perspective

The programme for the meeting is available here and the SUMMARY REPORT from the meeting can be accessed here. This includes information about the initiatives shared and discussed on the day with contact details of colleagues leading their delivery and links to supporting information (also provided below) and it sets out what participants identified as the most important issues, opportunities and enablers for improving out of hospital care, drawing out key themes.

Dr. Vin Diwakar (Medical Director, NHS England London Region) gave a presentation to set the scene for the Forum’s discussions.

Please see below a list of out of hospital care initiatives shared at the meeting:

  • Health 1000 : The Wellness Practice
    Further information can be found in the overview and Q&A.
  • Camden & Islington Psychosis & Long Term Conditions Integrated Practice Unit – Click here.
  • Children and young people’s health partnership – Click here.
  • ESCAPE-pain – Click here.
  • East London primary care mental health service – Click here.
  • Islington Children’s Hospital @ Home service
    • Overview – click here
    • Evaluation – click here
  • Falls Specialist Response Care – Click here.
  • Islington Practice based mental health team – Click here.
  • Community Independence Service – Click here.
  • The Living Well Network
  • Innovation in medicines optimisation

    • Lewisham Integrated Medicines Optimisation Service (LIMOS)  – click here
    • Guy’s and St Thomas’ NHS Foundation Trust Pharmacy Model for frail older people – click here
  • Bromley-by-Bow, DIY Health
  • Improving care home access to urgent care – Click here.

In preparation for the Forum we identified serval other examples of good practice and related work being undertaken across London. Links to this work are provided below:

  • A&E Avoidance Schemes across London – Click here.
  • Delayed Transfer of Care and the discharge process – Click here.