The Royal Free London group

The Royal Free London group currently comprises three hospitals: Barnet Hospital, Chase Farm Hospital and the Royal Free Hospital. 

Each one is run as an independent business unit, with local leadership teams responsible for managing its own delivery, quality, risk, and operational and financial performance.

The hospitals each have a very different mix of activity and services:

Chase Farm Hospital has a focus on elective activity (as well as having an urgent care centre), helping us to ensure patients get prompt access to diagnostic services which are essential to their care. 

Barnet Hospital provides a wide range of acute medical services. 

The Royal Free Hospital attracts patients from across the UK and beyond to a range of specialist services, as well as providing acute medical services.

These hospitals are connected by a solitary group centre — like models seen internationally, such as Intermountain Healthcare in Utah, USA. Individual trusts can join the group under a range of membership options, from full membership to arrangements such as clinical partnerships or buddying.

Through leading and sharing services and resources with a group of NHS providers, we can bring together larger numbers of clinicians to share their knowledge and research about the very best ways to treat patients in line with the very best care available across the globe. 

Groups of clinical experts — known as clinical practice groups (CPGs) — structured around a speciality or patient group, have responsibility for defining clinical standards and processes, which are then implemented by each of our hospitals. 

The team ensures that diagnostic and treatment decisions are consistent and are based on the latest evidence. Pathways are embedded through our electronic patient record, ensuring they are implemented across the trust, wherever staff are based. This helps reduce unwarranted clinical variation and ensure that patients receive the best standard of care.

For example, the neonatal CPG’s work led to a dramatic reduction in the number of babies being separated from their mothers after birth. The evidence shows this has long-term detrimental effects on breastfeeding and attachment, as well as the emotional consequences for the mother's mental health. 

Working with parents, the neonatal CPG considered all the relevant guidelines and evidence and developed a standardised assessment tool for the pathway.

This supports more junior team members’ decision-making, and the availability of complete records and data allows it to be continually monitored and reviewed to ensure the tool is safe and effective. 

The CPG’s new pathway resulted in a 34% reduction in neonatal unit admissions. This means over 300 more babies per year can stay with their mothers who would have otherwise been admitted. 

In some cases, services have been able to go beyond creating hospital-based pathways and are working to promote prevention and early intervention in the community. 

We are working more closely with our non-hospital partners in the NHS and social care to help people to live longer in good health, rather than just treating people when they are sick. Our group helps us to deliver this aspiration.

There is variation in service access, delivery, and investment across north central London (NCL), which does not always reflect population need. 

It is clear that tackling health inequalities is one of NCL’s major challenges, both to bring healthy life expectancy up to at least average London levels and to address the variations in health across the system.

We want to play our part in that ambition, and we believe the Royal Free London group is part of the solution.

One example of this is our cardiovascular service, which has developed a model of integrated care, supporting patients with all levels of need from community-based diagnostics to tertiary coronary services. 

This includes community diagnostic centres, operating seven days a week, with electronic reporting which can be accessed by clinicians across the trust, regardless of their location.

The service runs multi-disciplinary teams with local primary care networks, looking at GPs’ register of heart failure patients, to triage them. Patients who are assessed as higher risk can attend a diagnostic centre for both blood tests and echocardiograms.

The heart failure CPG has developed a digital pathway which, amongst other improvements, makes it easier to screen any patient coming into hospital to see if they might be at risk of mild heart failure. It also ensures equitable access for all patients to specialist surgery, wherever they have been diagnosed. 

Since the establishment of the pathway, mortality rates for patients at the Royal Free Hospital have halved from 10.6% to 5.2%, and there has also been a reduction in mortality at Barnet Hospital from 12.7% to 9.4%.