Choosing wisely for Kingston Wisely- booket.pdf · Choosing wisely for Kingston Proposed changes to...

20
Choosing wisely for Kingston Proposed changes to local healthcare Have your say

Transcript of Choosing wisely for Kingston Wisely- booket.pdf · Choosing wisely for Kingston Proposed changes to...

Page 1: Choosing wisely for Kingston Wisely- booket.pdf · Choosing wisely for Kingston Proposed changes to local healthcare Have your say. 2 ... Prescriptions for gluten free food 9 8. Prescriptions

Proposed changes to local healthcare in Richmond

Choosing wisely for Kingston Proposed changes to local healthcare

Have your say

Page 2: Choosing wisely for Kingston Wisely- booket.pdf · Choosing wisely for Kingston Proposed changes to local healthcare Have your say. 2 ... Prescriptions for gluten free food 9 8. Prescriptions

2

NHS Kingston Clinical Commissioning Group

Page 3: Choosing wisely for Kingston Wisely- booket.pdf · Choosing wisely for Kingston Proposed changes to local healthcare Have your say. 2 ... Prescriptions for gluten free food 9 8. Prescriptions

Proposed changes to local healthcare in Richmond

3

Proposed changes to local healthcare in Kingston

Contents

1. Introduction 4

2. What is Kingston CCG? 4

3. Context 5

4. Challenges for the local NHS 6

5. What are the proposed changes? 7

6. Prescriptions for self-care medications 8

7. Prescriptions for gluten free food 9

8. Prescriptions for baby milks and specialist infant formula 10

9. Prescriptions for vitamin D supplements 11

10. IVF and specialised fertility services 12

11. Supporting patients to become “surgery ready” 13

12. Clinical exceptions: Individual Funding Request (IFR) 14

13. How will we engage with local people? 14

Have your say

If you are interested in getting involved and keeping in touch with health matters in Kingston, sign up to our mailing list at www.kingstonccg.nhs.uk

To find out more, contact the Patient and Public Engagement Lead, Hannah Keates: [email protected] or call 020 8339 8000.

Get Involved

Your feedback helps us to ensure we are commissioning the right services for Kingston residents. You can do this through:

• Joining your surgery’s Patient Participation Group – speak to your practice manager

• Meeting us at local community events – view our online events calendar

• Attending a CCG meeting – you’ll find dates for these on our website

Page 4: Choosing wisely for Kingston Wisely- booket.pdf · Choosing wisely for Kingston Proposed changes to local healthcare Have your say. 2 ... Prescriptions for gluten free food 9 8. Prescriptions

NHS Richmond Clinical Commissioning Group

4

1 Introduction

Kingston Clinical Commissioning Group is seeking your views on our proposals to make some changes to local healthcare.

2 What is Kingston CCG?

NHS Kingston Clinical Commissioning Group (KCCG) is a membership organisation made up of all twenty-two GP practices in the borough. We are responsible for buying healthcare for the 204,510 people registered with our practices.

This includes NHS services like emergency care, hospital care, primary care, community and mental health services and prescribing medicines.

GreaterLondon

Borough of Kingston

NHS Kingston Clinical Commissioning Group

Page 5: Choosing wisely for Kingston Wisely- booket.pdf · Choosing wisely for Kingston Proposed changes to local healthcare Have your say. 2 ... Prescriptions for gluten free food 9 8. Prescriptions

Proposed changes to local healthcare in Richmond

5

KCCG commissions a range of services for our population and it is KCCG’s responsibility to work with all stakeholders and ensure that the people of Kingston get the best possible healthcare within the available budget.

To ensure that KCCG remains within its allocated budget and that everyone in Kingston has equal access to necessary care; and that only treatment which offers value to our population, we are considering some changes to local healthcare. The CCGs decisions are always based on the Ethical and Commissioning Principles outlined below

• Health Outcomes - The aim of commissioning is to achieve the greatest possible improvement in health outcome for our population, within the resources that we have available

• Clinical Effectiveness - We will ensure that the care we commission is based on sound evidence of effectiveness

• Cost Effectiveness - We will take into account cost-effectiveness analyses of healthcare interventions (where available) to assess which yield the greatest benefits relative to the cost of providing them

• Equity - We consider each individual within our population to be of equal value. We will commission and provide health care services based solely on clinical need, within the resources available to us.

• Access - KCCG will ensure that the care we commission is delivered as close to where patients live as possible.

3 Context

• Patient Choice - KCCG respect the right of individuals to determine the course of their own lives, including the right to be fully involved in decisions concerning their health care.

• Affordability - KCCG may not be able to afford all interventions supported by evidence of clinical and cost-effectiveness within their available budgets.

• Needs of the Community - Public health is an important concern of KCCG, and KCCG will seek to make decisions which promote the health of the entire community.

• Quality - KCCG will aim to commission high quality services as evidenced against national and international best practice

• Policy Drivers - The Department of Health issues guidance and directions to NHS organisations which may give priority to some categories of patient, or require treatment to be made available within a given period.

• Exceptional Need - There will be no blanket bans on treatment since there may be cases in which a patient has special circumstances which present an exceptional need for treatment.

• Disinvestment - As well as commissioning new services on the basis of the criteria above, KCCG will keep existing services under review to ensure that they continue to deliver clinical-and cost-effective services at affordable cost.

Proposed changes to local healthcare in Kingston

5

Page 6: Choosing wisely for Kingston Wisely- booket.pdf · Choosing wisely for Kingston Proposed changes to local healthcare Have your say. 2 ... Prescriptions for gluten free food 9 8. Prescriptions

NHS Richmond Clinical Commissioning Group

6

4 Challenges for the local NHS

The NHS is faced with a number of challenges - nationally and locally. As a result, our clinicians need to ensure we commission services that will meet the greatest health needs in our communities. People are thankfully living longer lives but are often living the latter part of their lives with a number of illnesses and conditions.

It is important, therefore, that the CCG budget is spent where care is needed most and invested in developing services that meet the priorities Kingston residents have previously identified. Primary care and adult and child mental health services are examples of priority areas where we are investing.

Unfortunately there is not enough funding to do everything we would want to for our communities. This means that the CCG is having to consider changes to its commissioning arrangements in a number of areas as part of the Choosing Wisely programme.

These include the prescribing of:

• Self-care medications for acute illnesses that will get better over time

• Some baby milks where alternatives can be purchased over the counter

• Gluten free products

• Vitamin D supplements

The CCG will also be considering changes to:

• IVF treatment eligibility

• How it supports patients to become surgery ready

NHS Kingston Clinical Commissioning Group

Page 7: Choosing wisely for Kingston Wisely- booket.pdf · Choosing wisely for Kingston Proposed changes to local healthcare Have your say. 2 ... Prescriptions for gluten free food 9 8. Prescriptions

Proposed changes to local healthcare in Richmond

7

5 What are the proposed changes?

Prescriptions for Vitamin D

Prescriptions for gluten-free foods

Prescriptions for baby milk

Prescriptions for self-care

medications

IVF and specialised fertility services

Supporting patients to be surgery ready

We want to hear your views on the proposals set out in this document. As GPs and other health professionals we work together to determine the best use of our £255 million annual budget to keep people in the borough of Kingston healthy and well. No decisions have or will be taken until we’ve considered your views on the three areas set out below:

• IVF and specialised fertility services

• Supporting patients to be surgery ready

• Prescriptions for:

- Self-care medications

- Gluten-free foods

- Baby milk

- Vitamin D

Proposed changes to local healthcare in Kingston

Page 8: Choosing wisely for Kingston Wisely- booket.pdf · Choosing wisely for Kingston Proposed changes to local healthcare Have your say. 2 ... Prescriptions for gluten free food 9 8. Prescriptions

NHS Richmond Clinical Commissioning Group

8

6 Prescriptions for self-care medications

Background

Most minor illnesses will get better within a short period of time. Many people buy medicines from pharmacists and shops to help with their and their family’s symptoms. These treatments have no significant effect on the duration of the illness. The majority of people can and do treat themselves without needing to see a GP.

We are proposing that, in line with the majority of people, when someone attends their practice for such self-limiting illnesses, the GP will not prescribe but will ask the patient to buy from their pharmacist or from other sources any medicines they choose to help with their symptoms. This will include for example common painkillers, cough medicines and lozenges for cold and flu symptoms.

All patients will continue to be treated with appropriate medication where there is evidence of effectiveness and where their condition requires it.

This change will be assisted by a self-care programme in development by Kingston Clinical Commissioning Group and Royal Borough of Kingston that will support people in treating themselves without having to visit a GP, often with support of a pharmacist.

What are we proposing?

We are proposing to review the use of prescriptions for minor ailments that would otherwise get better with time.

Until now, the NHS has often funded these medications despite the fact they are widely available over the counter, frequently at a lower cost.

The local NHS is proposing to stop prescribing common painkillers, cough medicines and lozenges for mild respiratory infections like cold and flu and antihistamines to treat mild hay fever. The treatment of other minor illnesses may be reviewed with the aim of promoting self-care whilst making sure that those people with potentially serious conditions will continue to be able to access GP treatments.

This service currently costs the local NHS up to £100,000 per annum.

NHS Kingston Clinical Commissioning Group

Page 9: Choosing wisely for Kingston Wisely- booket.pdf · Choosing wisely for Kingston Proposed changes to local healthcare Have your say. 2 ... Prescriptions for gluten free food 9 8. Prescriptions

Proposed changes to local healthcare in Richmond

9

7 Prescriptions for gluten-free food

Background

For over 30 years the NHS has provided a range of staple gluten-free foods on prescription to patients suffering from coeliac disease. This is because historically alternatives were difficult to find, and often expensive, compared to their gluten containing equivalents. Fortunately this is no longer the case and most supermarkets now stock a wide range of gluten-free products.

What are we proposing?

Kingston CCG is proposing that we stop prescribing gluten-free foods because:

• While coeliac disease is a very serious condition, a gluten-free diet doesn’t require medical supervision, and this decision will not impact on the standard of care we provide to coeliac patients.

• We currently don’t prescribe foods for people with other special dietary requirements such as nut allergies.

• All major supermarkets and many other retailers, commonly stock gluten-free foods as well as other special diet alternatives, at a far lower cost to the public than if it was provided by the NHS.

• The range of gluten-free foods available in supermarkets is much wider than those prescribed by the NHS.

• It is possible to eat a healthy balanced gluten-free diet without the need for specialist dietary foods as other low cost naturally gluten-free foods such as rice and potatoes are widely available.

• Improved food labelling now means people are able to see whether ordinary food products are free from gluten and can be safely eaten.

Who might be affected by this proposal?

The majority of people who currently receive gluten-free foods on prescription in Kingston..

Who would be exempt from the proposal?

We are asking local people to tell us if there are any exemptions we should consider.

This service currently costs the local NHS £46,000 per annum.

Proposed changes to local healthcare in Kingston

Page 10: Choosing wisely for Kingston Wisely- booket.pdf · Choosing wisely for Kingston Proposed changes to local healthcare Have your say. 2 ... Prescriptions for gluten free food 9 8. Prescriptions

NHS Richmond Clinical Commissioning Group

10

8 Prescriptions for baby milks and specialist infant formula

Historically it was difficult to buy infant formula used for lactose intolerance as there was a limited range available on the high street There is now online and in-store availability of cow’s milk and lactose-free alternatives for infant formula at most major pharmacies and supermarkets. These are now at a similar cost to standard infant formula.

Background

Breastfeeding should be strongly encouraged as providing the safest, most nutritionally adequate form of feeding for most infants. A change from breast milk to formula milk should not be initiated if the mother is happy to continue breastfeeding. Consideration should be given to supplement breast milk with formula milk should this be necessary.

Where breast feeding is not in place, parents should purchase appropriate infant formula milks. For those qualifying for ‘Healthy Start’ support, vouchers may be spent on infant formula milk that is based on cow’s milk and says on the packaging that it can be used from birth. This therefore includes lactose-free milks which are derived from cow’s milk. For more information about Healthy Start go to www.healthystart.nhs.uk

What are we proposing?

In order to maintain a consistent approach amongst all GP practices within Kingston it is proposed that GPs no longer provide soya-based infant formula milk, thickened infant

formulas or formulas for lactose intolerance on prescription as these are now widely available to buy from community pharmacies and supermarkets at a similar cost to standard infant formula.

Who might be affected by this proposal?

Parents whose babies and infants are currently prescribed soya, thickened or lactose-free formula milk for example those with:

• Gastro-oesophageal reflux disease (GORD)

Who would be exempt from the proposal?

We are proposing that infant formula and baby milks will be provided by the NHS only where there is a medical need and they are not widely available. For example babies and infants with the following conditions:

• Failure to thrive

• Pre-term Infants

• Specific medical conditions for example renal or liver disease and phenylketonuria

The CCG wants to understand what you think about these exemptions, and any other exemptions we should consider.

This service currently costs the local NHS up to £150,000 per annum.

NHS Kingston Clinical Commissioning Group

Page 11: Choosing wisely for Kingston Wisely- booket.pdf · Choosing wisely for Kingston Proposed changes to local healthcare Have your say. 2 ... Prescriptions for gluten free food 9 8. Prescriptions

Proposed changes to local healthcare in Richmond

11

9 Prescriptions for vitamin D supplements

Background

Vitamin D helps to regulate the amount of calcium and phosphate in the body. These nutrients are needed to keep bones, teeth and muscles healthy. A lack of vitamin D can lead to bone deformities such as rickets in children, and bone pain and tenderness as a result of a condition called osteomalacia in adults. In February 2012, Chief Medical Officers for the United Kingdom published a letter to health professionals to increase awareness of the risk of vitamin D deficiency amongst certain groups. The letter set out a recommendation for vitamin D supplementation in these risk groups and advised that vitamin D was available for purchase or could be prescribed for those who are not eligible for the Healthy Start scheme. Since publication, some practices have promoted self-care whilst others have prescribed for their patients, creating inequality in their approach. Promoting self-care in all areas will help address this.

What are we proposing? Kingston CCG is proposing that we stop providing vitamin D maintenance dose supplements through the NHS in certain circumstances because:

• Vitamin D supplements are now widely available at reasonable cost in all major supermarkets, pharmacies and other retailers.

• Being low in vitamin D at any given time does not necessarily constitute a chronic deficiency. It is normal for levels to fluctuate according to your exposure to sunlight and diet variations.

• The Scientific Advisory Committee on Nutrition (SACN) has recently published recommendations advising that everyone over one year should take 10 micrograms of vitamin D supplementation.

• Foods such as fish and eggs are high in vitamin D and can easily be found in local supermarkets.

• With Healthy Start vouchers, you can apply to get free vitamins if you qualify (https://www.healthystart.nhs.uk/healthy-start-vouchers/do-i-qualify/)

Who might be affected by this proposal? People who do not fit the exemption criteria outlined below, who are currently receiving ongoing prescriptions for vitamin D maintenance therapy.

Who would be exempt from the proposal? Kingston CCG will continue to fund vitamin D treatment courses where individuals are found to be deficient. In addition, maintenance therapy may be continued in those individuals who have had two or more treatment courses in the past and are known to be at specific risk of further vitamin D deficiency (such as multiple pregnancies). We are also asking local people to tell us if there are other exceptions we should consider.

This service currently costs the local NHS £5,000 per annum.

Proposed changes to local healthcare in Kingston

Page 12: Choosing wisely for Kingston Wisely- booket.pdf · Choosing wisely for Kingston Proposed changes to local healthcare Have your say. 2 ... Prescriptions for gluten free food 9 8. Prescriptions

NHS Richmond Clinical Commissioning Group

12

10 IVF and specialised fertility services

Background

The success rate of IVF depends on the age of the woman undergoing the treatment as well as the cause of the infertility (if it’s known). Younger women are more likely to have healthier eggs, which increases the chances of success.

What are we proposing?

In 2014 the CCG revised its IVF policy to:

• Increase the age for women up to their 43rd birthday to meet the National Institute for Health and Care Excellence (NICE) recommendation

• Make fertility investigations available to same-sex couples, provided they are able to demonstrate sub-fertility

• Routinely fund the following treatments:

o Cryopreservation and storage pre-cancer treatment

o Intra-uterine insemination

o Donor insemination

o Ovulation Induction

o Surgical Sperm retrieval

We are now considering whether we should significantly increase the thresholds for IVF and specialised fertility services which could mean

• IVF and specialised fertility treatment is available only for people with infertility as a result of cancer treatment or to prevent transmission of chronic viral infections; or

• IVF and specialised fertility treatment is no longer commissioned.

Who might be affected by this proposal?

Each year around 100 people in the Kingston CCG area undergo NHS funded IVF treatment.

Who would be exempt from the proposal?

Couples with exceptional clinical circumstances may still be eligible for funding under the individual funding request process.

No change is proposed for couples whose courses of treatment are already underway, that is where a referral has already been made.

We are asking local people to tell us if there are any other exemptions we should consider.

NHS Kingston Clinical Commissioning Group

Page 13: Choosing wisely for Kingston Wisely- booket.pdf · Choosing wisely for Kingston Proposed changes to local healthcare Have your say. 2 ... Prescriptions for gluten free food 9 8. Prescriptions

Proposed changes to local healthcare in Richmond

13

11 Supporting patients to become “surgery ready”

Background

Kingston CCG is considering introducing a policy of increasing patient readiness before planned operations, in particular addressing smoking and excess weight. Using the moment when a patient is being referred for planned hospital treatment to direct a patient towards services aimed to make them more fit before their operation and take an active role in their care is a key opportunity to improve the health of local people.

What are we proposing?

A proposal could be that the referring GP may refer overweight patients for an opinion, but patients with a BMI over 40 (or with a BMI between 30 and 40 with metabolic syndrome) are supported to lose weight and will not receive surgery, unless there are exceptional circumstances, until

• They reduce their weight by at least 10% over 9 months

• Or to a BMI of less than 30

The new policy could apply to routine referrals to ALL surgical specialities (excluding cardiology, cardiothoracic, neurosurgery and fracture related procedures) that may require a general or spinal/epidural anaesthetic.

We are also proposing a policy on the management of smokers requiring a planned operation.

A proposal could be that smokers requiring a surgical referral to all surgical specialities should be referred to an appropriate smoking cessation service in order that they are aware of the risks associated with smoking and surgery and have the opportunity, and are supported, to quit smoking in advance of their surgery.

Patients would not be required to quit smoking to have surgery, but must be in a position to make an informed choice about the risks.

It is not proposed to ban any patients receiving treatment on the basis of their smoking or weight. It is likely that there would be a firm requirement that patients have made genuine supported steps or achieved a particular goal over a period of time to address smoking or excess weight before referral and/or approval to operate is given. There is also the option for the proposal to be set as “guidance only”.

Who would be exempt from the proposal?

We are asking local people to tell us if there are any exemptions we should consider.

Proposed changes to local healthcare in Kingston

Page 14: Choosing wisely for Kingston Wisely- booket.pdf · Choosing wisely for Kingston Proposed changes to local healthcare Have your say. 2 ... Prescriptions for gluten free food 9 8. Prescriptions

NHS Richmond Clinical Commissioning Group

14

12 Clinical exceptions: Individual Funding Request (IFR)

The Individual Funding Request (IFR) process would be still available for patients whose clinician believes there are exceptional circumstances and then makes an application under the IFR process.

If there is deemed to be a clinical exception to a treatment or procedure then an IFR can be made. Requests may include conditions for which the CCG does not fund or does not have an agreed policy.

Where eligibility is unclear, the final decision is made through an application to the IFR team. The application needs to be made on behalf of the patient by a clinician (often your GP or a hospital consultant), and the key point to remember is the need to demonstrate that there is a clinical exception for the treatment or procedure or why the patient should receive treatment which is outside of the CCG’s current funding arrangements.

13 How will we engage with local people?

We know that the proposals in this document will be important to a number of people in Kingston. That is why we are seeking your views at an early stage in the process.

We will encourage local people to give us their views by reaching out to specific groups including:

• Targeted groups who may be most affected and seldom heard groups, for example through children’s centres for specific initiatives.

• Patient participation groups in GP practices.

• Community and voluntary groups and organisations working with vulnerable and seldom heard groups.

• Healthwatch Kingston

Further information and the questionnaire will be available on our website:

www.kingstonccg.nhs.uk

NHS Kingston Clinical Commissioning Group

Page 15: Choosing wisely for Kingston Wisely- booket.pdf · Choosing wisely for Kingston Proposed changes to local healthcare Have your say. 2 ... Prescriptions for gluten free food 9 8. Prescriptions

Proposed changes to local healthcare in Richmond

15

Choosing wisely for KingstonProposed changes to local healthcare

Have your say Public Drop in SessionsWednesday 29 March, 5.30pm – 8pm Tolworth Recreation Centre, Fullers Way North, KT6 7LQ

Thursday 6 April, 11am – 2pm Richard Mayo Centre, Eden St, Kingston upon Thames, KT1 1HZ

Wednesday 12 April, 2pm – 5pm Surbiton Health Centre, Ewell Rd, Surbiton, KT6 6EZ

We will also be attending community events and meetings over the next few weeks to hear your views.

For more information see our website : www.kingstonccg.nhs.uk

Proposed changes to local healthcare in Kingston

Page 16: Choosing wisely for Kingston Wisely- booket.pdf · Choosing wisely for Kingston Proposed changes to local healthcare Have your say. 2 ... Prescriptions for gluten free food 9 8. Prescriptions

NHS Richmond Clinical Commissioning Group

16

Choosing Wisely Questionnaire:

Please let us have your views – either by completing the survey below and returning it in an envelope marked Choosing Wisely to the address below or via our online survey, available via our website: www.kingstonccg.nhs.uk:

NHS Kingston CCG, FREEPOST RTEA-KBHY-CHCS, Royal Borough of Kingston upon Thames, Guildhall 2, High Street, Kingston upon Thames, Surrey KT1 1EU

1. Having read the engagement document, how much do you agree with the statement “I understand why the local NHS is looking at the prioritisation of health services, procedures and funding”

Strongly agree Agree Disagree Strongly disagree

2. How much do you agree with the statement “I understand why the local NHS is proposing to stop prescribing some items which are now readily available or cheaper to buy directly?”

Strongly agree Agree Disagree Strongly disagree

3. How much do you agree that the local NHS should stop prescribing over the counter medicines for minor illnesses other than for the exempt groups listed in this document?

Strongly agree Agree Disagree Strongly disagree

4. How much do you agree that the local NHS should stop prescribing gluten-free products?

Strongly agree Agree Disagree Strongly disagree

5. How much do you agree that the local NHS should stop providing all prescribed soya, thickened or lactose free baby milks and infant formula other than for the exempt groups listed in this document?

Strongly agree Agree Disagree Strongly disagree

6. How much do you agree that the local NHS should stop providing Vitamin D other than for the exempt groups listed in this document?

Strongly agree Agree Disagree Strongly disagree

7. How much do you agree that the local NHS should only make IVF available in exceptional circumstances?

Strongly agree Agree Disagree Strongly disagree

8. How much do you agree that the local NHS should help increase patient readiness or fitness for planned operations by supporting patients to stop smoking and/or reduce their weight?

Strongly agree Agree Disagree Strongly disagree

What will happen with your views?We will consider all the views raised with us at a Governing Body meeting held in public and publish a report of the findings on the CCG website – www.kingstonccg.nhs.uk

NHS Kingston Clinical Commissioning Group

16

Page 17: Choosing wisely for Kingston Wisely- booket.pdf · Choosing wisely for Kingston Proposed changes to local healthcare Have your say. 2 ... Prescriptions for gluten free food 9 8. Prescriptions

Proposed changes to local healthcare in Richmond

17

Are there any specific concerns you would have about any of these proposals?

Are there any specific actions you can suggest which would address your concerns?

Should there be any additional exemptions from any of the proposals? Please state any groups to be exempt, the proposal they should be exempt from and your reasons.

Are there any other treatments, procedures or medicines you think we should be considering when making decisions about prioritisation of health services, procedures and funding?

Is there anything else you would like to tell us about these proposals?

Proposed changes to local healthcare in Kingston

17

Page 18: Choosing wisely for Kingston Wisely- booket.pdf · Choosing wisely for Kingston Proposed changes to local healthcare Have your say. 2 ... Prescriptions for gluten free food 9 8. Prescriptions

18

NHS Kingston Clinical Commissioning Group

About you Are you responding as:

a local resident

a representative of an organisation (please specify)

a clinician, commissioner or other healthcare professional (please specify)

We would like to let you know about the outcome of this engagement, so will be posting an engagement report in the Governing Body section of the Kingston CCG website on May 20th.

We would be grateful if you could complete the following information about yourself. Please be assured that this information will not be linked to your answers and health professionals will not receive any information that identifies you personally. These questions are optional and if you would prefer not to answer, then please leave them blank or tick the “prefer not to answer” option.

Please write in the name of your GP practice:

Which of the following age groups do you fall into?

16–24 25–34 35–44 45–54 55–64 65–74 75+ Prefer not to say

Are you...

Male Female Prefer not to say

Please indicate your ethnic origin, are you:

White – British or Irish

White – other white background

Black or Black British

Asian or Asian British

Mixed

Chinese

Prefer not to answer

Any other (please write in below)

18

Page 19: Choosing wisely for Kingston Wisely- booket.pdf · Choosing wisely for Kingston Proposed changes to local healthcare Have your say. 2 ... Prescriptions for gluten free food 9 8. Prescriptions

19

Notes

Proposed changes to local healthcare in Kingston

19

Page 20: Choosing wisely for Kingston Wisely- booket.pdf · Choosing wisely for Kingston Proposed changes to local healthcare Have your say. 2 ... Prescriptions for gluten free food 9 8. Prescriptions

20

Kingston Clinical Commissioning Group Level 3, Guildhall 1, High Street, Kingston KT1 1EU

Tel: 020 8339 8000

Email: [email protected]

If you need this document in another format or language,

please contact us at [email protected]

or call on 020 8339 80

NHS Kingston Clinical Commissioning Group