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Annual Report 2017-2018. North East and North Cumbria AAA
Screening Programme
Prepared by Tracy Gilchrist Screening Manager Gateshead Health NHS Foundation Trust
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NENC AAASP Contact Details:
0191 445 2554
The North East and North Cumbria AAA Screening Programme Queen Elizabeth Hospital Sheriff Hill Gateshead Tyne & Wear NE9 6SX
https://www.facebook.com/qegateshead?ref=ts&fref=ts
http://www.qegateshead.nhs.uk/aaa
https://twitter.com/QEGateshead
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The North East and North Cumbria AAA Screening Programme 2017/18 Annual Report
Contents
NENC AAASP Contact Details 2
Overview of Performance: Clinical Director’s Statement 3
Overview of Operational Performance: Screening Manager 5
The Screening Programme 5
Screening Venues 6
Why do We Offer Screening? 7
Screening Outcomes 8
Referral to a Vascular Unit 8
Incidental Findings 9
Screening Nurse Practitioner 9
Programme Performance 10
Pathway Standards 10
Waiting Time Standards 11
Service Specification Reports 12
Quality Assurance: Consultant Radiologist/ QA Lead’s Statement 13
Clinical Governance 14
Multidisciplinary Meetings 14
Programme Board Meetings 14
Operational Board Meetings 14
Senior Management Meetings 15
Meeting Attendance 15
Service User Feedback and Incidents 15
Education and Training 16
Research and Audit 17
Right Results 17
Attended not Screened 17
Customer Satisfaction Feedback
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Referral Outcomes 23
Reducing Inequalities 23
Promotion and Events 25
Future Developments 30
Resources 30
References 31
Appendix
1. Screening venues, frequency and times 32
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Overview of Performance: Clinical Director’s Statement
Once again it is my pleasure to be writing an introduction to the 2017/2018 annual report for the
North-East and North Cumbria abdominal aortic aneurysm screening programme. It has been
another great year, and I would like to highlight some of our particular successes.
We have successfully taken over the running of screening and surveillance clinics in North Cumbria
and developed effective coordination with the vascular unit in Carlisle in relation to onward
referrals. Well done team for sorting out the difficult logistics to provide a great service across such a
wide area.
We remain the largest aneurysm screening programme in the NHS at present and despite the
difficulties associated with covering such a large geographical area we are one of only 8 of 41
screening programmes in the NHS who have successfully reached all the national QA targets. That is
a huge credit to the whole team at QE Gateshead and has been highlighted at a national level. Again
well done all.
An enormous amount of work has also been done by the team to try to improve attendance and we
have seen a very significant improvement in attendance rates for aneurysm screening such that
more than 80% of men invited attend across the programme – putting us in a position of having one
of the best attendance rates in the NHS. Fantastic!
We also had some very successful coverage on the Look North BBC programme during the year and
this led to a significant increase in awareness about the importance of aneurysm screening amongst
the public and resulted in a large increase in self referrals for screening. We will continue to make
every effort to improve public awareness as this is essential if we are to keep attendance rates high.
As well as these headline successes the team continues to deliver a very good efficient service across
the region and our nurse practitioners have continued to try and improve our coordination with the
vascular units and GPs and to work with the men with aneurysms to try and improve their
cardiovascular risk factors. Our technicians have also continued to turn excellent job at scanning
with some of the lowest scan failure rates in the country and our health improvement practitioners
have spearheaded our efforts to highlight the program to GP and the general public.
It is been a great year, but we are not complacent. We know there are areas we can still improve in
and we are working on those. We will have our national QA visit and assessment later this current
year and we will take on board any comments or suggestions from them. However I am confident
that we will be seen on national inspection to be an excellent unit and a credit to the region and to
screening services at the Queen Elizabeth Hospital, Gateshead.
Gerry Stansby
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Overview of Operational Performance: Screening Manager
Welcome to the first Annual Report for the North East and North Cumbria (NENC) AAA Screening
Programme. The report concentrates on the data for the 2017-18 screening cohort and aims to
highlight the continued achievements of the NENC Programme during the screening year.
The North East of England AAA Screening Programme (NE AAASP) commenced screening in January
2011. The programme boundaries were extended to include North Cumbria in April 2017. We are
the largest local screening programme covering a population of 3.1 million over a large demographic
area bordering Scotland in the North and Yorkshire and Lancashire in the South.
We have completed our seventh full year of screening and we continue to strive to deliver real
improvements for our target population. We have performed in excess of 95,000 screening tests
over the last seven years and have increased the provision of screening venues from 27 to 39.
Our service is aligned with the values of the NHS Constitution. We are committed to putting patients
at the heart of everything we do and our goal is to ensure a safe, consistent and efficient screening
service. We continue to focus on improving service quality and maximising delivery by listening to
service user comments and bench marking our performance against the NAAASP and Public Health
England Quality Standards and key performance indicators. We have consistently met all national
performance targets and commissioning requirements. In addition we undertake multiple local
audits to improve the quality and clinical safety of the local programme to ensure the right result is
given to the right gentleman at the right time.
NENC AAASP is delivered by a highly motivated and enthusiastic team consisting of screening
technicians, nurse practitioners, programme lead, CST, Coordinator, health improvement
practitioner and admin staff who ensure the delivery of care is consistently of a high quality. A
special thank you must be made in recognition to all of those who continue to work so hard to
ensure we deliver a safe, effective programme which ensures National Standards are maintained in
the provision of AAA screening in the North East and North Cumbria. The continued success of the
local programme is undoubtedly thanks to their dedication and hard work.
Finally I would like to congratulate the team at Gateshead Trust for another successful year, their
dedication, hard work and high standards of professionalism are consistently recognised and
reflected not only in friends and family feedback and by their peers at Gateshead Trust but also
nationally as once again the programme was named as one of the 8 programmes to achieve all of
the standards.
Tracy Gilchrist
Screening Manager
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The Screening Programme
If you are a man aged over 65 you are more likely to have an abdominal aortic aneurysm (AAA). That
is why the NHS AAA Screening Programme invites men for screening during the year (1 April to 31
March) that they turn 65. Men are sent an appointment at a screening site local to their area of
residence by the administration centre based at the Queen Elizabeth Hospital, Gateshead. Men over
65 who have not previously been screened or diagnosed with an aneurysm can request a scan by
contacting the North East and North Cumbria (NENC) Abdominal Aortic Aneurysm Screening
Programme (AAASP) admin team directly on 0191 445 2554.
The North East of England AAASP commenced screening in January 2011. In April 2017 the
programme boundaries were extended to include North Cumbria and the programme title changed
to the North East and North Cumbria (NENC) AAASP. We are the largest local screening programme
covering a population of 3.1million distributed over a large demographic area. The programme
offers screening to all eligible men (registered with a GP) residing within the following CCG
boundaries:
NHS North Cumbria NHS Darlington NHS Durham Dales, Easington and Sedgefield NHS Hambleton, Richmondshire and Whitby NHS Hartlepool and Stockton-on-Tees NHS Newcastle Gateshead
NHS North Durham NHS North Tyneside NHS Northumberland NHS South Tees NHS South Tyneside NHS Sunderland
Our aim is to maximise attendance at screening and our venues and sites have been chosen to
ensure the travel time to the screening site does not exceed 45 minutes if at all possible.
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Screening Venues
The NENC AAASP offers community based screening at 39 venues throughout the North East and
North Cumbria (including 5 offender Health venues).
North of Tyne Berwick Infirmary
Blyth Community Hospital
Cresta Unit (Newcastle General Hospital)
Hexham General Hospital
Molineux Primary Care Centre Morpeth NHS Centre Shiremoor Resource Centre Ponteland Road Health Centre Regent Centre Gosforth Spring Terrace Health Centre The Bondgate Surgery Alnwick County Durham & Darlington Bishop Auckland General Hospital
Darlington Walk in Centre
Peterlee Health Centre
Queens Road Surgery
Sacriston Medical Centre
Sedgefield Community Hospital Stanley Primary Care Centre
South of Tyne Blaydon Primary Care Centre
Cleadon Park Primary Care Centre
Gateshead Health Centre
Grindon Primary Care Centre
Houghton Primary Care Centre Washington Primary Care Centre Teesside Lawson Street Health Centre
North Ormesby Village Resolution Centre
One Life Primary Care Centre Hartlepool
Redcar Primary Care Centre North Yorkshire Friarage Community Hospital Richmond Community Hospital Whitby Community Hospital South of Tyne
North Cumbria Hill Top Heights (Carlisle) Penrith Hospital Workington Community Hospital Offender Health HMP Durham HMP Frankland HMP Holme House HMP Kirklevington HMP Northumberland
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Why Do We Offer Screening?
Aorta with an AAA taken from NAAASP Invitation Leaflet
The aorta is the main blood vessel that supplies blood to your body. It runs from your heart down through your chest and abdomen. In some people, as they get older, the wall of the aorta in the abdomen can become weak. It can then start to expand and form an abdominal aortic aneurysm (AAA). Men are six times more likely to have an aneurysm than women and it is estimated that around 1 in 70 men aged between 65 and 74 in England have an AAA.
The chance of having an aneurysm increases with age and the risk of having an abdominal aortic
aneurysm can also increase if:
You smoke
You have high blood pressure
Your brother, sister or parent has, or has had, an abdominal aortic aneurysm
If you have an aneurysm you will not usually notice any symptoms. This means you cannot tell if you
have one, will not feel any pain and will probably not notice anything different.
An aorta which is only slightly larger than normal is not dangerous, however, it is still important to
monitor whether the aneurysm is getting bigger.
A large AAA over 5.5cm in diameter is rare but can be very serious due to a high risk of rupture. As
the wall of the aorta stretches it becomes weaker and can burst, causing internal bleeding. Around
80 out of 100 people die when an aneurysm bursts. The programme targets men aged 65 and over
because 95% of ruptured aortic aneurysms occur in this group.
The screening test for AAA is a simple, pain-free ultrasound scan of the abdomen that usually takes
less than 10 minutes. The technician will ask you to lie down and lift up or unbutton your shirt. You
will not need to undress. The technician will put a cool jelly on your abdomen and then move a small
scanner over the skin. The scan will show a picture of the aorta on a screen that the technician will
measure. You will be told your result straight away and your GP will be informed by letter.
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Screening Outcomes; in relation to aortic size.
Measurement Likelihood Category Outcome
<3cm 985 in 1,000 men Normal – no AAA Discharge- no further tests needed
3.0-4.4cm 14 in 1,000 men
Small aneurysm Annual appointments
4.5-5.4cm Medium aneurysm Quarterly appointments
≥5.5cm 1 in 1,000 men Large aneurysm Referral to vascular unit for further tests and consideration of surgery
Referral to a Vascular Unit
Consistent practice is required to promote high standards of care within AAA screening. The NHS
AAA Screening Standard Operating Procedures “Essential Elements in Providing an Abdominal Aortic
Aneurysm (AAA) Screening and Surveillance Programme- March 2017, version 5.0”(2) states the
principles for AAA Screening include the rapid referral to a Vascular Unit for those meeting the
criteria for considering treatment.
Vascular Units have been assessed by the National Programme and the Vascular Society of Great
Britain and Ireland to be able to provide appropriate surgical treatment for open and endovascular
repair of abdominal aortic aneurysms.
If an aorta measures ≥5.5cm a referral to an agreed vascular unit for surgical review will be made
within 1 working day of the scan. All referrals should be seen in the vascular outpatients department
within two weeks of the referral being made. If the AAA has a diameter on ultrasound of over 7cm,
an urgent referral will be made with every attempt to see the patient at the next available
outpatient clinic.
If surgery or stenting is indicated, the operation should be completed within eight weeks of the date
of referral from the screening programme to minimise the risk of AAA rupture.
Current NENC AAASP performance against these standards can be found within the Programme
Performance section of the report.
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Incidental Findings
The screening test objective is to identify abdominal aortas only. If any incidental findings are found
the programme has developed a local protocol with the Commissioning team in line with National
Guidance to ensure that the gentleman are promptly referred for further tests/treatment as
appropriate:
Enlarged iliac aneurysm
Gentlemen with enlarged iliac measurements ≥ 2.5cm will be reviewed on an individual basis
by the Clinical Director and Consultant Radiologist Lead. Where appropriate gentlemen will
be referred for a vascular consultation at the nominated vascular unit
Potentially Serious pathology
Gentlemen with a potentially serious pathology will be referred to their local GP for urgent
referral to the local hospital for further imaging
General pathology
Gentlemen with routine pathology will be referred to their local GP for non-urgent referral
to their local hospital for routine imaging
Screening Nurse Practitioner (SNP)
Men with an AAA require close monitoring, support and secondary prevention to reduce their
overall cardiovascular risk and improve outcomes. The aim of the nurse specialist consultation is to
provide an assessment and advice regarding the health and lifestyle of men with screen detected
AAAs at specific points in the screening process. The NHS Abdominal Aortic Aneurysm Screening
Programme Nurse Specialist Best Practice Guidelines, February 2016, Version 1.0 (3) states:
All screen positive men should be offered a face to face appointment with the nurse specialist within
12 weeks of their initial scan. If the gentleman is unable or unwilling to attend a face to face
consultation they should be offered a telephone consultation with the nurse specialist, this should be
offered within 12 weeks of their initial scan
Due to the geographical locations and limited operating hours of clinic venues NENC AAASP is unable
to offer all men a face to face SNP appointment within twelve weeks. NENC AAASP has agreed with
NAAASP to offer all gentlemen a telephone nurse assessment (ideally within two weeks of this
appointment) and a face to face appointment at the subsequent surveillance appointment. NENC
AAASP identified 145 ‘new’ aneurysms during 2017-18. The SNP completed the following:
Booked SNP Telephone
Assessment
Completed Telephone
Assessments
DNA telephone
assessment
Declined SNP
assessment
Identified by another
programme
Number of SNP appointments completed
within 12/52
143 141 2 1 1 97.2%
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During the telephone assessment the SNP takes a detailed medical history, records all current
medications and reviews the observations obtained at the clinic; weight, height, BMI, blood pressure
and pulse. This enables us to give relevant and timely health promotional advice regarding healthy
eating and increased exercise to reduce BMI, smoking cessation and reducing alcohol intake. The
screening programme recommends that all men with an AAA should commence antiplatelet and
statin therapy unless there are contradictions.
The SNP can also offer support with any emotional concerns men may have regarding, for example,
working, driving, contacting DVLA, travel and travel insurance and discuss familial risks associated
with AAA. The SNP provides a detailed report for the GP highlighting all advice given and alerting the
GP to any risk factors identified and the screening programme recommendation regarding
antiplatelet and statin therapy.
A member of the nursing team attends as many subsequent surveillance appointments as possible.
At each surveillance appointment the gentleman will have a repeat ultrasound scan of his abdominal
aorta. This face to face contact involves the review of aneurysm growth, blood pressure, and
compliance with medications, progress with reducing BMI, smoking cessation, and increasing
physical activity if required. There is also an opportunity to offer reassurance and counselling,
particularly if the AAA has been increasing in size and a referral to the vascular team is imminent. A
SNP reviews the information collected for every man under surveillance after each attendance and
writes to the man’s GP, documenting the advice given and highlighting any risk factors or concerns
identified.
Programme Performance
Pathway Standards
Performance against the Pathway Standards is provided by NAAASP on a quarterly basis. The
standards assess the screening process, the acceptable threshold is the lowest level of performance
which programmes are expected to attain to ensure patient safety and programme effectiveness.
The standards allow for continuous improvement enabling providers and commissioners to identify
where improvements are needed across the pathway. NENC AAASP provides this information to our
commissioners via multiple meetings including Programme Board, Operational Board and
Contractual meetings. There are four Key Performance Indicators:
AA1: Completeness of Offer
AA2: Coverage of Screen
AA3: Coverage of Annual Surveillance Screen
AA4: Coverage of Quarterly Surveillance Screen
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NENC AASP KPI performance (as reported by NAAASP) for 2017-18 is below:
KPI Tested/ offered
Total % National Average
Purple <90% not achieved; Amber 90% to <99% acceptable; Green ≥99% achievable
AAA1: Completeness of Offer
18291 18294 100.0% 99.6%
Purple <75% not achieved ; Amber 75% to <85 acceptable; Green ≥85% achievable
AAA2: Coverage of Screen
15152 18294 82.8% 80.8%
Purple <85% not achieved; Amber 85% to <95% acceptable; Green ≥95% achievable
AAA3: Coverage of Annual Surveillance Screen
629 698 90.1% 91.1%
AAA4: Coverage of Quarterly Surveillance Screen
428 474 90.3% 91.9%
Attendance rates have progressively improved across the region over the last 7 years. The 2017-18
data confirms we are performing slightly higher than the National average with 82.8% of our eligible
population tested during the screening year. This is a 9.2% increase from our first screening year
where we tested 73.6% of the eligible population.
We can contribute this achievement to several factors:
Revised communications strategy involving social media, local press coverage, Trust website
and working closely with CCGs, GP practices, pharmacies, local support groups and our
stakeholders
Health Improvement Practitioner presence at stakeholder events throughout the region to
promote the service and increase awareness
Waiting Time Standards
It is the screening provider’s responsibility to track individual referrals with the receiving Trust and
ensure they are monitoring any delays in the patient being seen for assessment or subsequent
treatment. Pathway Standards 11 and 12 allow NENC AAASP to effectively monitor any delays in the
patient being seen for assessment or subsequent treatment and act accordingly. Unless there is an
acceptable reason for delay, this will be investigated by NENC AAASP as a screening safety incident
in accordance with National Screening Programmes guidance on managing safety incidents in
screening programmes. All delays are reported to the local screening programme board and the
regional Quality Assurance team.
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Information taken from NAAASP Quality Standards Report July 2018 *includes cohort & surveillance data NENC
Performance *National
Performance Acceptable Achievable
AAA-PS-11 % subjects with AAA
≥5.5cm seen by a vascular specialist within two weeks
94.4% 94.6% ≥90% >95%
AAA-PS-12 % subjects with AAA ≥5.5cm
deemed fit for intervention and not declining, operated on by a vascular surgeon within 8 weeks
67.6% 52.5% ≥60% >80%
Service Specification Performance
The Screening Management and Reporting Tool (SMaRT) database enables the local programme to
obtain ‘real time’ performance data. Service specification reports include men who attended
screening after the NAAASP Key Performance Indicator (KPIs) data submission deadline therefore
there is variation from the KPI data reported by NAAASP. The NENC AASP service specification
performance (as reported to our commissioners) for 2017-18 is shown below: Information taken from SMaRT Database Report June 2018
Initial screens service specification report 17-18 Count %
Total eligible subjects 18515
Subjects with insufficient details to make offer 84 0.5%
Subjects offered screening who are tested 15224 82.2%
Measurement <3.0cm and discharged 15067 99.0%
Measurement of 3.0-4.4cm 127 0.8%
Measurement of 4.5-5.4cm 18 0.1%
Measurement of ≥5.5cm referred to vascular surgeon 9 0.1%
Information taken from SMaRT Database Report June 2018
Surveillance screens service specification report 17-18 Count %
Total surveillance subjects 832
Subjects offered screening who are tested 788 94.7%
Measurement <3cm and discharged 3 0.4%
Measurement of 3.0-4.4cm 597 75.8%
Measurement of 4.5-5.4cm 148 18.8%
Measurement of ≥5.5cm referred to vascular surgeon 29 3.7%
Measurement of <3cm overridden into surveillance 8 1.0%
Information taken from SMaRT Database Report June 2018
Self-Referral screens service specification report 17-18 Count %
Total self-referral subjects 466
Subjects offered screening who are tested 435 93.3%
Measurement of 3.0-4.4cm 430 98.9%
Measurement of 4.5-5.4cm 4 0.9%
Measurement of ≥5.5cm referred to vascular surgeon 1 0.2%
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Quality Assurance: Consultant Radiologist/ QA Lead’s Statement
Our screeners remain busy in clinics throughout the region performing aortic measurements on men
in their 65th year and also surveillance imaging of men with small aneurysms. As in previous years
the number of new aneurysms detected far exceeds the number of men referred for surgery or
those lost to follow up.
Much of our quality assurance work is directed at ensuring the consistent high quality and reliability
of these examinations. In the 2017-18 screening year we performed 2250 quality assurance reviews
on;
All men with aortas above 3cm requiring surveillance or referred to surgical units as required
by national standards.
Random samples of each screeners examinations on a rolling basis
All possible incidental findings
Any examination where the screener requests another opinion
Training new screening technicians
It is reassuring the vast majority of examinations were performed to a high standard and again our
rate of incomplete examinations (where the aorta could not be measured) is well below that
national average.
This is only part of our role however and we assess quality in other ways and are very grateful to
everyone who took the time to complete one of our satisfaction surveys or feedback their
experiences of our service to us. We take all of your comments seriously and changes resulting from
these have included opening new screening venues to reduce travelling time and improve the
opportunities for men to attend screening venues near to where they live or work.
The first round of the National Programme Quality Assurance reviews are almost complete. Several
members of our team have been involved in visiting other programmes as advisors and assessors
and this has been an invaluable opportunity to observe how screening is delivered elsewhere and to
benchmark our work against that of other programmes. We hope that this preparation will serve us
well for our own upcoming review in November 2018.
Our local recruitment to the UK Aneurysm Growth Study has now ceased but recruitment will
continue from the research centre at Leicester University. Thanks to all of our men for their support
and to our screening technicians for all of their hard work in making this project so successful. This is
now producing some useful outcomes and in the past year publications regarding the genetic basis
for aneurysms and also on the management of risk factors for cardiovascular disease in men with
aneurysms have been presented and published. As this is a long term study assessing aneurysm
growth rates it will however be several years before all of the main results are available.
In the meantime we have undertaken other smaller scale studies and in the last year have presented
work assessing the links between social deprivation and travel distances and attendance for
aneurysm screening.
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For further information regarding any aspect our quality assurance or research please get in touch
Dr Colin Nice
Clinical Governance
The Department of Health (1998) defines clinical governance as a framework through which NHS
organisations are made accountable for the quality of service they provide (7). The aim is that
services will be continuously improved through the creation of an environment in which excellence
in clinical care will flourish. There are seven areas of activity which are used to make sure we deliver
the highest quality health care to our service users:
Clinical audit
Clinical effectiveness
Clinical information
Education and training
Risk management
Service user, carer and public involvement
Staffing and staff management
NENC AAASP is committed to embedding Clinical Governance throughout all of its processes.
‘SafeCare’ is QE Gateshead’s internal branding created to communicate the trust’s overarching
patient safety ethos. Integral to this is the vision that no patient should suffer unnecessary harm,
pain or suffering as a result of an error or planned medical intervention.
The leadership, management and governance of the NENC AAASP are integral to assuring the
delivery of high-quality person-centred care. We achieve this by the following:
Programme Board Meetings
The senior management team now meets twice a year with the Programme Board, which represents
the Commissioning members to discuss programme performance, current risks, patient feedback
and incidents using National performance criteria as a bench marking tool.
Operational Board Meetings
The AAA screening team now meets twice a year with the Screening and Immunisation Lead and QA
team to discuss programme operational performance, current risks, patient feedback and incidents
using National performance criteria as a bench marking tool.
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Senior Management Team Meetings
Senior Management MDTs bring together staff with the necessary knowledge, skills and experience
to ensure high quality diagnosis, treatment and care. The MDT meeting is about considering the
patient as a whole not just about treating the AAA taking into account of the patient’s views,
preferences and circumstances wherever possible when considering their advice on the care that is
most appropriate for the patient’s condition.
Multi-Disciplinary Team Meetings
All members of the local programme attend a multi-disciplinary team meeting. The meetings offer
an ideal opportunity to embed the SafeCare culture of the programme and of Gateshead Health NHS
Foundation Trust into our daily practice. They offer an exceptional opportunity for all of the team to
meet to discuss current performance, improvement initiatives, staffing, risk management,
disseminate information and share good practice.
Meeting attendance is illustrated below:
Programme Board
Operational Board
Senior Management
NENC MDT NENC Staff
Clinical Director 2/2 1/1 4/6 6/8 N/A
Consultant Radiologist 2/2 0/1 4/6 5/8 N/A
Screening Manager 1/2 1/1 2/6 4/8 4/8
Programme Lead/CST 2/2 0/1 3/6 5/8 5/8
CST (commenced Nov 17) N/A 1/1 2/3 2/2 2/2
Nurse Practitioners 1/2 1/1 6/6 8/8 8/8
Admin Coordinator 2/2 1/1 6/6 8/8 8/8
Health Improvement Practitioner 2/2 1/1 3/6 8/8 8/8
Nominated Screening Technician(s) 2/2 1/1 N/A 8/8 8/8
NB attendance rates affected by annual leave, maternity leave and sick leave
Service User Feedback and Incidents
NENC AAASP is committed to learning from complaints and incidents to improve clinical safety and
improve the quality of the screening service. All complaints and adverse incidents are reported using
the electronic data base DATIX system and are promptly investigated by the senior management
team. All incidents and complaints are reported to the Regional QA team and our Commissioners.
Each incident is awarded a severity grade by establishing the likelihood of recurrence and the
consequence of the incident.
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Datix severity scoring matrix
Screening incidents 2017-18:
4 low harm incidents resulting in improvements to failsafe procedures and staff health and
safety procedures
14 no harm incidents resulting in improvements to administrative, booking and reporting
procedures
All DATIX incidents and lessons learned are discussed at the local MDT meetings, project board
meetings and are also shared within the Trust via the Trust Risk Management strategy. Notification
is also made to our Commissioners, the regional Quality Assurance team, NAAASP, Public Health
England and other appropriate stakeholders in the event of a Serious Incident.
We will continue to build on the foundation of an open culture of learning and information
dissemination to continue to make improvements and enhance the quality of our service by careful
monitoring of performance and customer feedback.
Education and Training
All technicians and Nurse Practitioners employed by the NENC have completed the required NAAASP
screeners training or are currently in the process of completing the Diploma for Health Screeners
Qualification. Training and assessments are undertaken in house, with written assignments being
double marked by external examiners from the awarding body and an external Clinical Skills Trainer
(CST) assesses the screening technician final practical assessment.
The training commitment for screening staff remains continuous and mandatory training, online and
face to face, and in house development courses are regularly attended by screening all staff. Group
and individual skills training, takes place at regular intervals throughout the year.
17
In addition to their initial training and qualification, technicians and nursing staff are assessed at
least every four months at clinic by the CST in relation to carrying out the examination, ergonomics,
equipment safety and knowledge. This helps to ensure an extremely high standard of practice is
maintained. Eight random images are also examined for quality every month for each individual by
the consultant radiologist or ultrasound lead.
All the team undertake regular Continued Professional Development, which we expect will become a
national requirement for screening technicians at some point in the future. We reflect on any events
that we may attend, and regularly feedback by presenting to colleagues at our monthly Staff and
MDT meetings. We regard this as a shared learning activity where we can all learn good practice and
discuss findings with other members of the team.
We strive to maintain a caring, efficient, high quality and friendly service, where our no blame
culture allows us all to learn from others.
Audit and Research
Right Results Audit
A “Right Results” policy is in place to ensure that there are standard operating procedures at all
stages of the screening pathway. A daily audit is completed to ensure the right subject and GP are
given the correct results in a timely fashion. These standard operating procedures are regularly
reviewed and are embedded in the overall risk management process for the screening programme.
Attended not Screened Audit
This is a continuous audit which commenced in 2013, and focuses on men who attend for their
appointment, but do not have a screening test. The aim of the audit is to identify why the man is not
screened and to facilitate screening using a variety of mediums in order to improve the patient
journey and increase screening uptake.
If screening does not occur, screening staff complete a form which is then returned to the screening
office. The Screening Nurse Practitioner examines the information provided and attempts to
facilitate a further appointment whenever possible.
During the 2017-18 screening year 43 men attended but were not screened at their first
appointment for a variety of reasons shown below:
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Number of attended not screened at 1st appointment cases April 2017-March 2018
The primary reason for non-screening remains centred on those men who are unable to consent for
screening, and maybe divided into two categories:
Men who lack the capacity to consent, and require a best interest decision be made on their
behalf
Men who are unable to understand information provided due to language barriers, and
require interpreter assistance to ensure information delivery and understanding
Collectively these issues relating to consent account for 41% of all ANS cases for the 2017-2018
screening year. 14 of the 18 men progressed to a scan at 2nd appointment; a best interest decision
‘not to progress to scan’ was made by the GP in 4 cases.
22 men did not progress to a scan at a 2nd appointment (driving concerns, consent / best interest
decisions by GP, existing vascular patients/ EVAR/ Open repair).
There were no identified trends to indicate screening sites, screening technician, environmental
factors, and days of the week or times of appointments contributed to ANS figures.
Customer Satisfaction Feedback
NENC AASP believes that the patient is the most important member of the health care team and is
central to ensuring safe and high quality care. AAA screening encourages people who use services to
influence how the service is run through providing suggestions via verbal and written feedback
(comments cards), patient feedback and Friends and Family questionnaires.
Patient satisfaction questionnaires are completed for 1 week, every month. All screening clinic
venues are included on a rolling programme. Men were asked to rate the NENC AAA Screening
service on the following categories:
Appointment details
18
10
4
6
1
1
1
2
0 2 4 6 8 10 12 14 16 18 20
Consent
Driving Concerns
Existing vascular unit patient
interpreter required
Open abdo wound
Previous EVAR
Previous Open repair
Refused Scan
19
Screening clinic facilities
Your clinic appointment
Staff performance
Men were also invited to provide comments and suggestions to improve service provision at the end
of each category on the questionnaire.
During 2017/18, 1148 patient satisfaction questionnaires were completed.
Results showed high levels of patient satisfaction with 91% men rating their appointment as
excellent.
Of the completed questionnaires;
1043 men rated their appointment as excellent
35 men rated their appointment as good
2 men rated their appointment as satisfactory
68 men did not answer this question
Similarly, high levels of patient satisfaction were recorded for information given about the screening
test and information about the results. In both cases, 92% of men rated the information as
excellent.
91%
3% 0%
6%
Appointment rating
Excellent Good Satisfactory Blank
20
Of the completed questionnaires;
1053 men rated their appointment as excellent
39 men rated their appointment as good
2 men rated their appointment as satisfactory
54 men did not answer this question
Of the completed questionnaires;
1051 men rated their appointment as excellent
36 men rated their appointment as good
1 men rated their appointment as satisfactory
60 men did not answer this question
92%
3% 0%
5%
Information given about the screening test
Excellent Good Satisfactory Blank
92%
3% 0%
5%
Information given about the results of the screening test
Excellent Good Satisfactory Blank
21
In relation to screening clinic facilities, 1101 (96%) men reported that the clinic was easy to find. 26
men (2%) said the clinic was not easy to find and a further 21 men (2%) did not answer the question.
Although a number of clinics were claimed to be difficult to find, 9 out of the 26 responses (35%)
related to the clinic at Cresta, suggesting patients may need additional locality information.
Wherever possible appointments are made as close as possible to the location of the GP practice
where an individual is registered. This was reflected in the findings relating to travelling time, with
87% of respondents claiming it took them less than 30 mins to get to their appointment.
96%
2% 2%
Was the clinic easy to find?
Yes No Blank
87%
10%
2% 1%
Travel time to clinic
Less than 30mins 30-45 mins Over 45 mins Blank
22
Of the completed questionnaires
999 men travelled less than 30 mins
115 travelled between 30 – 45 mins
26 men travelled over 45 mins to attend their appointment
8 men did not answer the question
Those that travelled more than 45 mins to attend their appointment, attended a range of venues,
suggesting no one particular clinic venue was problematic in getting to. Venues where men travelled
more than 45 mins to attend included:
Berwick Bishop Auckland Carlisle Cleadon Park Cresta
Hexham Redcar Richmond Sedgefield Stanley
In relation to the clinic appointment, current screening letters advise that men should be seen within
30 minutes of their given appointment time. When asked if they had to wait beyond their
appointment, the majority of men stated that they were seen on or before their appointment time.
397 men were seen before their appointment time
589 were seen on their appointment time
87 men had a wait of up to 10 mins
15 men waited between 11-20 mins
4 Men waited over 20 mins
56 men failed to answer the question
35%
51%
8%
1% 0%
5%
Appointment waiting time
before appointment time on time wait up to 10 mins
wait between 11-20 mins wait over 20 mins blank
23
The majority of men (1089) stated that they were treated with dignity and respect, with only 1
individual answering no to this question. 58 men failed to answer the question.
Clinic appointment times are largely dictated by the venue opening times and availability (usually
Monday- Friday 09:00-17:00); however the days and hours of service operation need to be flexible
to account for the needs and wants of the target population. The patient satisfaction questionnaire
asked men whether they would have preferred an evening appointment or a Saturday appointment.
Of the completed questionnaires;
66 men said that they would prefer an evening appointment
1013 said they would not prefer an evening appointment
69 men did not answer the question
58 men said that they would prefer a Saturday appointment
1015 said they would not prefer an Saturday appointment
75 men did not answer the question
The preference for evening and weekend clinics remains low and has not increased since previous
years. This will continue to be monitored and the possibility of additional clinics will be investigated
if the need arises.
Referral Outcomes
This is an audit to ensure the NENC AAASP and the current approved vascular units are achieving the
acceptable Pathway Standards and Waiting Time Standards set by NAAASP. Outcome records from
the Northgate SMaRT system and local data capture is used to ascertain our current performance
level. All data is validated with NAAASP to ensure accuracy.
This audit process has resulted in significant improvements in waiting times for patients. The
monitoring process also reinforced the need for a NENC AAASP update at the Vascular Advisory
Group Meetings to provide further clarification and additional guidance on the monitoring of the
current standards.
Reducing Inequalities
Screening for AAA has important ethical differences from clinical practice, because we are targeting
apparently healthy people we need to ensure we are offering enough information to allow
individuals to make informed choices about their health. There are risks associated with screening
and it is important that people heave realistic expectations of what the programme can deliver.
NENC AAASP ensures all men invited for screening are fully informed about the benefits and risks
associated with testing for AAA by enclosing the information leaflet provided by NAAASP with their
invitation letter.
24
We can provide information leaflets in alternative formats including easy read, audio and other
languages on request and we are able obtain assistance from interpreting services and the learning
disability team if individuals need additional support. We discuss the benefits and risks of the
screening test at appointments and offer men the opportunity to ask questions before we perform
the scan.
Our vision is to achieve high quality, personal treatment for all men invited for screening. Every
member of the NENC AAASP team plays an important role in promoting equality throughout the
screening pathway from identifying and inviting eligible men for screening to ensuring men are
offered the right treatment at the right time, and feel they are treated with dignity and respect.
The AAA programme is designed to reduce risk at a population level and is therefore most effective
when coverage is high and screening uptake is independent of health inequalities within the
population. We completed a Health Equity audit (HEA) in 2017 (7) which helped us explore and
understand the reasons for differences in uptake throughout the region allowing us to improve our
service provision. The HEA reviewed data to identify inequalities in relation to provision, access,
locality, screening uptake and population enabling us to:
Identify local need
Understand the risk factors for low screening uptake
Address health inequalities
Allocate resources effectively to reduce variation in service and uptake
Focus interventions according to need
Develop strategies and plans according to need
Identify and work with partners from across all sectors
Implement interventions to tackle inequalities and provide a more equitable service
We have developed an action plan to prioritise and implement recommendations that were made in
the HEA. NENC AAASP aims to ensure equity of access for all our men by providing screening at
various local venues across the region including community hospitals, primary care centres and
prisons. We understand men may not be able to attend their appointment on the date or time
allocated and alternative appointments/ venues can be arranged by contacting the screening office.
Men are automatically offered a second appointment if they do not attend their first appointment. If
men do not wish to be screened they can cancel the appointment and we can offer screening at a
later date if required.
NENC AAASP works in partnership with the Cumbria and North East (CANE) Screening and
Immunisations team to improve screening uptake for AAA screening and reduce inequalities
throughout the North East and North Cumbria. An inequalities plan was developed in April 2015; it is
linked to the aims and objectives of the 2015-18 Screening and Immunisations Strategic Plan which
was formulated following the PHE/NHSE Health Inequalities Key Stakeholder Event in February 2015.
The plan is reviewed at each Programme Board Meeting. The Screening Manager, Programme Lead,
Health Improvement Practitioner and a member of the CANE team meet regularly throughout the
year to discuss progress.
25
Service Promotion and Events
Our focus throughout 2017 -18 screening year has remained to continue improving awareness of the
programme, reduce inequalities/barriers to attending and to work with GP practices to support
them to increase uptake.
Below are some of the year’s highlights:
Commissioning for quality and innovation (CQUIN)
CQUINs are extra quality improvement goals that are agreed with commissioners. The CQUIN
enables us to look at the quality of service delivered and ensures continuous quality improvement,
whilst delivering better outcomes for patients. The NENC AAASP has a two year CQUIN, which aims
to improve outcomes and reduce inequalities through patient participation. NHS England
Commissioners receive progress reports at the end of each quarter.
In year 1, we developed an action plan to enable us to collect feedback from four different target
groups:
People who engage, this group were given a service improvement questionnaire to
complete at clinic
People who engage then go on to DNA, were telephoned by nurse practitioners
People who don’t engage, were sent questionnaires
General public were asked to complete a short awareness questionnaire at public awareness
events and focus groups.
Feedback was collected and reviewed, and from the feedback three different initiatives were
developed and presented to commissioners to agree one as a work scheme to progress for year 2 of
the CQUIN.
The work scheme that was agreed was to ‘increase uptake and reduce inequalities through GP
engagement’. This is a continuation of work that has already been completed within practices and
will be progressed throughout the coming year, targeting the lowest compliant localities first.
GP Engagement
Throughout the year we worked with GP practices to raise awareness of the programme. We
achieved this by attending Practice Manager, GP and Practice Nurse Meetings, and also attended
Time in Time Out (TITO) events.
Brief intervention training was delivered to practice staff; they received resources for campaigns and
were supported to facilitate awareness campaigns within practices. They were given display
materials and an electronic toolkit of resources to assist them to increase uptake. We are now
receiving more referrals from GP practices engagement.
26
Health Improvement Practitioner and Programme Lead/ CST at DFP TV event
Pharmacy Engagement
Pharmacies in low compliant areas were contacted and some agreed to add flyers
to prescription packets to help promote the programme.
They were also given display materials for venues and offered AAA brief
intervention training for staff. We have since had an increase in referrals from
pharmacy engagement.
Community Engagement
A range of community AAA awareness interventions have been completed across localities. These have been in many different settings including community centres, shopping centres, libraries, hospitals, GP practices and bus stations. Five days of promotion was completed in the Metro Centre at Gateshead which was organised by a marketing company, DFP TV. The package included a promotional video that was played throughout the 5 day event on a large screen within the centre
AAA staff attended to chat with members of the public, answering any questions people had and
handing out information about the programme. 1,484 Service improvement questionnaires were
completed to assess local knowledge of the programme and the results are below:
Only 27% who completed the questionnaires that they were aware of the AAA screening
programme, 66% of people asked for more information. They were given AAA literature, and were
able to have a discussion with one of the health promotion team on the day.
Locally developed promotional poster
27
54% of people completing the questionnaires said that work commitments were the greatest barrier
to attending screening appointments, 48% stated clinic times, 24% location, 33% family or carer
duties.
31%
67%
2%
Q1. Aware of the AAA programme
Yes
No
Missing 66%
29%
5%
Q2. Request for AAA Information
Yes
No
Missing
0
200
400
600
800
1000
1200
Workcommitments
Time ofappointment
Location Family or carerresponsibilities
Barriers to attending screening
YES
NO
Missing
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Communications
We worked closely with the Trust Communications Team to develop a NENC AAA communications
strategy, which helps us to inform men 65 and over, living in North East of England and North
Cumbria about the AAA screening programme. It went live in November 2016 and includes:
Review of the Trust website content to ensure the information on it is up to date
Commissioning new engaging and informative posters and artwork which can be used
both at poster sites and digitally (including social media and screen savers)
Developing a new animated video to illustrate what an AAA test is
Developing a suite and timeline of regular social media updates. Targeting posts for
geography and age
A campaign launch to promote the new animated video, with posters and graphics to
supplement
Increasing staff awareness by including articles in QE Weekly
Health Matters article to promote with GPs
Developing a suite of case study examples
Media work to develop key messages with local journalists
We will primarily be targeting males aged 65 and living in North East England, and North Cumbria,
who are registered with a GP. The general audiences include:
Residents
Primary Care providers
NHS staff in North East England, and North Cumbria
Media in North East England, and North Cumbria
Key stakeholders
In addition, we will also be targeting some more specific patient groups:
Populations identified as those not attending
Harder to reach groups/ travellers/ LBGT groups
Males 66+ and living in North East England, Cumbria who haven’t had a s screen
Key messages for implementing this strategy (through the action plan) are as follows:
Abdominal Aortic Aneurysms are a serious issue – with life threatening consequences
Taking up a screening offer is an important and vital step in looking after your health
Individuals need to have the right information to make a decision on the relative benefits
and risks of screening
The screen is quick, easy and not intrusive
Abdominal Aortic Aneurysm screening could save your life
NHS, Local authority, third sector, the community and other stakeholders are working
together to deliver screening and improve uptake
29
Working with other organisations
We continue to work with other organisation to support one another with campaigns throughout
the year. These include Cancer Research UK, Health professional Engagement facilitators that
support GP practices to reduce barriers to screening and help to increase uptake. We continue to
attend Cancer Research & Macmillan roadshows, to help increase public awareness and reduce
barriers to attending screening, and engage with other wellbeing networks who are working within
harder to reach communities, to build capacity and promote AAA screening to a broad range of
audiences.
The NENC AAASP team also attended several events over the screening year to promote the service
and increase awareness within the stakeholder groups.
SMaRT User Group Meetings
The user group meeting is attended by nominated regional representatives for the local screening
programmes. The aim of the meeting is to review the current performance of the national database
provided by Northgate Solutions and improve service provision. The meeting also reviews the
potential impact of requests for change from local programmes at a national level. The SMaRT user
group representative for Cheshire and Merseyside, Cumbria and Lancashire, Greater Manchester
and the North East is currently the NENC AAASP Admin Coordinator.
Vascular Advisory Group (VAG) Meetings
The Screening Manager or Programme Lead/ CST and the Clinical Director (VAG chair) attend the
quarterly regional vascular network meetings to provide feedback regarding current performance
against the waiting time standards.
Health Improvement Practitioner at Cancer Research UK event
Health Improvement Practitioner at Macmillan roadshow
30
NHS AAA Screening Programme Networking and Information Day
The NAAASP networking day is an excellent opportunity for programme managers, CSTs and nurse
practitioners to share best practice and service improvement initiatives to improve local service
delivery. The meeting includes a presentation by national clinical lead on current performance and
how the national programme might be optimised in the future.
Practice Nurse/ Practice Manager and CCG Meetings
The NENC AASP Health Improvement Practitioners team regularly attend CCG, practice nurse and GP
practice manager meetings throughout the region to increase awareness and provide coverage data
in order to improve service delivery.
Future Developments
The NENC AAASP continues to work closely with GP practices, local support groups and our
stakeholders to improve attendance in areas where screening uptake is poor.
Information about our screening service is available in local pharmacies, GP practices, on the QE
website, twitter feed and on the QE Gateshead Facebook page.
Resources
AAA Screening Leaflets; information in other languages:
https://www.gov.uk/government/publications/abdominal-aortic-aneurysm- screening-invitation-
leaflet
AAA Screening Patient Decision Aid: http://sdm.rightcare.nhs.uk/pda/aaa- screening/
PHE Local Health: http://www.localhealth.org.uk/#sid=98;v=map10;sly=ccg_2013_DR;l=en;z=30
7642,737901,423026,346881
31
References
1. The 2017-18 NHS England Service Specification No 23 (Abdominal Aortic Aneurysm
https://www.england.nhs.uk/commissioning/wp- content/uploads/sites/12/2016/04/serv-spec-23-
abdominal-aortic- aneurysm.pdf
2. Essential Elements in Providing an Abdominal Aortic Aneurysm (AAA) Screening and
Surveillance Programme- March 2017, version 5.0 available at:
https://www.gov.uk/government/publications/aaa-screening-standard-operating-procedures
3. NHS AAA Screening Programme Pathway Standards (2016) available at:
https://www.gov.uk/government/publications/aaa-screening-quality-standards-and-service-
objectives
4. NHS Guidance on Waiting Time Standards (June 2018) available at:
https://www.gov.uk/government/publications/aaa-screening-waiting-times-standards/aaa-
screening-monitoring-waiting-times-to-surgery
5. UK NSC/National Screening Programmes guidance on managing safety incidents in screening
programmes available at:
https://www.gov.uk/government/publications/managing-safety-incidents-in-nhs-screening-
programmes
6. NHS England’s Serious Incident Framework available at:
https://www.england.nhs.uk/wp-content/uploads/2015/04/serious-incidnt-framwrk-upd.pdf
7. The North East of England and North Cumbria Abdominal Aortic Aneurysm Screening
Programme Health Equity Audit available at:
https://www.qegateshead.nhs.uk/node/631
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Screening Venues Frequency and Times
Area Site Day Frequency Clinic Times
North Cumbria
Hill Top Heights (London Road) MONDAY FORTNIGHTLY 10:05-16:30
Penrith Hospital MONDAY MONTHLY 10:00-16:45
Workington Community Hospital FRIDAY FORTNIGHTLY 10:45-16;05
Durham & Darlington
Bishop Auckland General Hospital THURSDAY FORTNIGHTLY 09:35-17:00
Darlington Walk in Centre WEDNESDAY MONTHLY 09:15-16:20
Peterlee Health Centre TUESDAY MONTHLY 09:15-14:40
Queens Road Surgery MONDAY EVERY 2
MONTHS 09:15-16:20
Sacriston Health Centre MONDAY MONTHLY 09:15-14:40
Sedgefield Community Hospital TUESDAY EVERY 2
MONTHS 09:15-16:20
Stanley Primary Care Centre MONDAY WEEKLY 09:00-14:40
North of Tyne
Alnwick Bondgate Surgery FRIDAY EVERY 3 MONTHS 09:45-17:00
Berwick Infirmary THURSDAY EVERY 3 MONTHS 10:15-17:00
Blyth Community Hospital and Health Centre MONDAY WEEKLY 09:15-14:40
Cresta Unit at Newcastle General Hospital FRIDAY
EVERY 2
WEEKS 09:00-14:40
Hexham General Hospital FRIDAY EVERY 2 MONTHS 09:40-16:30
Molineux Primary Care Centre THURSDAY WEEKLY 09:15-14:40
Morpeth Health Centre FRIDAY MONTHLY 09:15-14:40
Regent Centre FRIDAY MONTHLY 09:15-14:40
Shiremoor Resource Centre FRIDAY WEEKLY 09:15-14:40
Spring Terrace Health Centre THURSDAY WEEKLY 09:15-14:40
North
Yorkshire
Friarage Community Hospital TUESDAY MONTHLY 09:40-17:00
Richmond Community Hospital THURSDAY MONTHLY 09:20-16:45
Whitby Community Hospital MONDAY EVERY 3 MONTHS 10:15-17:00
South of Tyne
Blaydon Primary Care Centre MONDAY WEEKLY 09:15-14:40
Cleadon Park Primary Care Centre WEDNESDAY WEEKLY 09:00-14:40
Gateshead Health Centre WEDNESDAY FORTNIGHTLY 09:15-14:40
Grindon Primary Care Centre FRIDAY FORTNIGHTLY 09:00-14:40
Houghton le Spring Primary Care Centre TUESDAY MONTHLY 09:00-14:40
Washington Primary Care Centre TUESDAY MONTHLY 09:00-14:40
Teesside
Lawson Street Health Centre WEDNESDAY FORTNIGHTLY 09:35-17:00
North Ormesby Resolution Health Centre TUESDAY FORTNIGHTLY 09:35-17:00
One Life Primary Care Centre Hartlepool TUESDAY MONTHLY 09:35-17:00
Redcar Primary Care Centre WEDNESDAY MONTHLY 09:35-17:00
HMP Health
Services
HMP Durham
AS REQUIRED
QUARTERLY a n d additional if requested
As per offender health clinic availability
HMP Frankland
HMP Holme House
HMP Kirklevington
HMP Northumberland
Appendix 1
33