Out of hospital strategy

A key priority for Brent CCG is taking forward our out-of-hospital strategy to ensure we are fit for purpose for the health service challenges over the next twenty years. 

This work aims to improve both the quality and capacity of community-based services – including primary care. We only want people to need to go to hospital when it is absolutely necessary; and we want to keep their stay in hospital as short as possible. Where we can safely provide the care people need through community based services we should. This approach is essential to delivering high quality convenient healthcare for our residents and helping to ensure the local NHS is both cost effective and sustainable. In 2014/15 out-of-hospital service developments included:

Short term assessment rehabilitation and re-ablement service (STARRS)

Brent CCG extended STARRS to include a social worker which helped establish better links with the Local Authority. The service has been recognised as an exemplar of integrated care for an ageing population who require support to remain at home if they get ill. STARRS provides services that aim to prevent hospital admissions as well as enabling early discharge and avoiding possible re-admissions. In 2014/15 the service prevented over 2,700 hospital admissions.


In October 2014, we implemented a consultant-led service in community sites across Brent to improve patient experience of care, waiting times for referral to treatment and accessibility. The service is delivering care from two community sites in Brent (Sudbury Primary Care Centre and Willesden Centre for Health & Care) rather than patients having to travel to hospital.


In March 2015, a community-based cardiology service was also launched to provide consultant-led clinics at two sites in Wembley and Willesden. Previously patients needed to travel to Northwick Park Hospital.

Brent integrated diabetes services

In October 2014, we launched Brent integrated diabetes service to improve services for patients with type 2 diabetes. The new service offers multi-disciplinary diabetes care in primary and community settings, and an extended patient education programme to help patients understand, manage and control their diabetes.

Patients on medication

Patients with arthritis and heart conditions are now being monitored in primary care rather than hospital clinics receiving support which is more co-ordinated with their wider health needs. This helps to prevent conditions reaching crisis point and needing hospital admission.

Child and adolescent mental health services (CAMHS)

In August 2014, we extended our looked-after children service and CAMHS to improve support for this specific group of vulnerable children with complex mental health needs.

Primary care dementia nurses

In May 2014, we established primary care dementia nurses for each of the localities within Brent. This increases capacity for early diagnosis and provides early intervention as well as an effective interface between primary and secondary care services for patients with dementia. In addition, the CCG and Brent Council jointly commission a Dementia Café for patients with dementia and their carers.

Weekend and evening GP appointments

In April 2014, along with our neighbouring North West London CCGs, we were collectively awarded £5 million from the Prime Minister’s Challenge Fund to help make it easier for patients to access GP services.

GP access hubs offer extended access to all patients across the 67 general practices in Brent. Click here to find out more.