chelsea and westminster hospital nhs foundation trust gp news - february 2016
DESCRIPTION
Monthly GP newsletter encompassing news from Chelsea and Westminster Hospital and West Middlesex University Hospital sites. GP queries can be directed to [email protected]TRANSCRIPT
February 2016 In this edition Trustwide News Junior Doctor strike arrangements –
Wednesday 10 February
GP Clinical advice
100,000 Genome project
Have you heard about ClinicQ?
Upcoming events North West London Perinatal Mental
Health Conference – Friday 18 March
Third Trans Health conference – April
2016
Sexually Transmitted Infection
Foundation Course – 12/13 May 2016
Menopause Study Day – 19 October
2016
Chelsea and Westminster site specific: Difficulties contacting the appointment
office and making referrals in January Pain assessment awareness month Perfect week for theatre use The Acute Diagnostic Oncology Service
continues to meet its target Improving Gynaecological 2WW referrals
West Middlesex University Hospital site specific: Putting West Mid Ambulatory
Emergency Care (AEC ) on the map
Trustwide News Junior Doctor strike arrangements – Wednesday 10 February The next proposed strike action is scheduled from 8am Wednesday 10 February to 8am Thursday 11 February and affects non-emergency care only. During the proposed strike:
Emergency care will be prioritised and we expect to safely run all urgent and emergency care services including A&E, UCC and maternity, as well as cancer appointments
To enable safe emergency care, the following arrangements have been made for planned appointments scheduled for 10 February:
a) Patients who have been prioritised based on consultants’ clinical decision-making have already been notified by letter or telephone that their appointment will proceed even in the event of strike action and that they should attend their appointment as detailed in their hospital letter
b) Patients not in the priority cohort have been notified by letter to confirm that their appointment will only proceed if the strike is called off. If the strike does go ahead, these patients will not be seen and should not come to hospital. If the strike goes ahead, we will be contacting these patients to reschedule their appointment.
Walk-in radiology services will be available during the strikes but there may be a short additional delay in reporting on scans.
Cover arrangements Please note that Rhian Burgess, Communications Manager, will be picking up any GP queries and issues during my absence over the next five weeks. To contact Rhian, please email [email protected] or via telephone: 0203 315 6603 I will be back at the Trust on Monday 14 March 2016.
Justine Currie, GP Relationship Manager
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Patients who have any questions about their appointment during strike action can contact: CW PALS on 020 3315 6727 or WMUH Appointment Office on 020 8560 2121. We will be increasing staffing in the appointments offices during strike action to ensure people can get through as quickly as possible. We apologise for any inconvenience caused but our focus during industrial action is ensuring that we continue to provide safe emergency care to patients. Thank you in advance for your assistance and support during the upcoming strike action. If you have any additional queries about the upcoming strikes, please call 020 3315 6603 or email [email protected]. GP Clinical Advice To recap, clinical advice is available to GPs pre-referral or post discharge via: 1. Chelwest Webform
nww.gpadvice.chelwest.nhs.uk Clinical options available include Medicine, Surgery, Paediatrics, Radiology and Women’s Health 2. WMUH Choose and Ask form
www.westmidcolorectal.org.uk/ask/submit.php Clinical options include A&E, Anaesthetics, Audiological Medicine, Breast Surgery, Cardiology, Chemical pathology, Colorectal Surgery, Dermatology, Elderly Medicine, Emergency Surgery, Endocrinology, ENT, Gastroenterology, General Medicine, General Surgery, Haematology, Histopathology, Medical Microbiology and Virology and Neurology 3. Telephone Hotline: 020 3315 5000
Clinical options include 1- Medical, 2-Surgery, 3-Paediatrics, 4-Women’s Health, 5-Older Peoples Services, 6-Acute Diagnostic Oncology Service
100,000 Genomes Project
On 22 December 2015 NHS England announced that Imperial College Healthcare NHS Trust has been designated a Genomic Medical Centre (GMC) in partnership with Royal Brompton & Harefield NHS Foundation Trust, Royal Marsden NHS Foundation Trust and Chelsea and Westminster Hospital NHS Foundation Trust. These four trusts make up Imperial College Health Partners NHS GMC which will contribute to the successful delivery of the 100,000 Genome Project, a national initiative which aims to sequence the genomes of 100,000 participants, for the first time, to enable new scientific discovery and medical insights, and bring benefit to patients. The trusts will work together to ask patients with cancer and inherited rare diseases if they would like to participate, gather their samples and relevant medical information to build up a bank of anonymised data in order to better understand the role that genes play in disease and what treatments will work best for each individual patient. The project has the potential to transform the future of healthcare by improving our knowledge of the influence of genetics on disease, how other people can be helped with similar diseases in the future, and how different types of tests can be developed to detect changes beyond the genome. In addition to these long-term benefits, some participating patients might benefit in the short-term as a conclusive diagnosis may be reached for a rare and inherited disease more quickly, or a treatment for cancer may be targeted at the particular genetic change that is present in the cancer. For more information: www.genomicsengland.co.uk/the-100000-genomes-project
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Have you heard about ClinicQ? CliniQ is a holistic sexual health and well-being service for all trans people, partners and friends. We are a trans-led team, who offer a safe, confidential space for those who may not feel comfortable accessing standard health and well-being services. In recognition for our unique approach to services, we recently received the Nursing Times award for ‘Enhancing Patient Dignity’.
We are open every Wednesday, from 5–7pm at 56 Dean Street in Soho.
Our services include:
Free, confidential sexual health screening (including HIV & Hep C)
Liver function tests (important for monitoring the impact of hormone therapy)
Hepatitis B testing and vaccination
Cervical smear testing (for anyone over 25 with a cervix)
PEP—Post-Exposure Prophylaxis (Emergency HIV Medication)
Hormone injections (with ID and proof of prescription)
Gender identity counseling
Drug & alcohol counseling/support
Housing Advice (1st Wednesday of the month – Stonewall Housing Drop-in Service)
Sexual assault & hate crime support and on-going case work (Via Galop)
Health Adviser support & non-statutory social work
Social support & community drop-ins
Acupuncture
Yoga (1st, 2nd, 3rd Wednesday of each month)
Intersections – A group for queer & trans Muslims, held at cliniQ
We are a walk-in service and all trans people, partners, and gender questioning people are eligible for support. We also accept referrals for counselling, mentoring and casework from primary care, gender identity services, and social services. For more information please see: www.cliniq.org.uk or email [email protected].
Upcoming events North West London Perinatal Mental Health Conference - Friday 18 March 2016 The Plenary Lecture on Friday 18 March 2016, 9.30am – 4.30pm at St Paul’s Centre, Queen Caroline Street, W6 9PJ will be given by Dr Margaret Oates OBE, Consultant Perinatal Psychiatrist and Clinical Director for East Midlands Strategic Clinical Networks, NHS England, speaking on: Lessons for maternal mental health – UK confidential enquiries into maternal deaths The programme for the day includes: • Keynote speeches from Clare Dolman
(Vice Chair, Bipolar UK) and Dr Lucinda
Green (Consultant Perinatal Psychiatrist,
Guy’s and St Thomas’)
• Interactive breakout sessions on
Tokophobia & Birth Anxiety, Medications
in Pregnancy & Lactation, Screening &
Communication in Pregnancy
• Collaborative working practice
For more information and to register your attendance, please click the image:
Third Trans Health conference – 26 April CliniQ, the UK’s only trans-led sexual health and wellbeing service is hosting a 3rd national conference, Trans Health Matters. This is the first event in the UK to specifically address issues of sexual health, HIV and trans populations. It will include a range of speakers, and will be host to the UK
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launch of WHO’s Trans Implementation Tool, as well as addressing current issues, including updates from Public Health England concerning trans HIV surveillance, PEP and PrEP. The event will be held at the Coin Street Neighbourhood Centre on 26 April. For more info see www.cliniQ.org.uk. Sexually Transmitted Infection Foundation Course – 12 & 13 May 2016 The next St Stephen’s Aids Trust /Chelsea and Westminster Hospital Sexually Transmitted Infection Foundation course will be held on 12 & 13 May at St Paul’s
Centre, Hammersmith. For details please email [email protected] or see our website www.ssat.or.uk Menopause Study Day – 19 October 2016 Claire Ballone, Clinical Nurse Specialist, is hosting a menopause study day in partnership with the British Menopause Society on the 19 October 2016 at Chelsea and Westminster Hospital. If you would like a copy of the programme and to sign up for this study day, please email [email protected] or call 020 3315 3168.
Chelsea and Westminster Hospital Difficulties contacting the appointments office Practices have flagged concerns with referral fax and email downtime over the past fortnight. We apologise for any inconvenience caused and we have now rectified the technical issues with our email and fax to email set up. E-referrals (previously Choose & Book) is our preferred referral mechanism and this has been unaffected by our technical issues. If you are concerned that any referrals have not been received, please resend them to us either by faxing 020 3315 8484 or emailing [email protected] To minimise waits for patients getting through to our appointment booking line, we have had to reduce the number of potential people waiting in the queue to 4 for each call handler available to ensure those queueing only wait a maximum of 7 minutes. Mondays and Tuesdays are typically our highest call volumes days (the team receive over 18,500 calls a month) with less calls coming through on Thursdays and Fridays. Our average wait in January 2016 was 3 minutes and 46 seconds.
If patients are having difficulty getting through, please advise them to call 020 3315 6666 towards the end of the week if possible or to email us on [email protected]. Patients will receive a response to their email within 4–48 hours. A longer-term plan to deliver significant improvements in scheduling and notifying patients of appointments is already underway as part of our Clinical Admin Redesign complete with a Patient Portal solution which will give patients direct access to managing their own appointments online. These developments are 6–18 months away from full implementation and we appreciate your continued patience and understanding while we continue to improve our appointment booking service for patients and practices. Nicola Richards – Head of Patient Access Pain Assessment Awareness Month In January, the Pain Management Service (PMS) celebrated Pain Assessment Awareness Month.
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The aim was to highlight and disseminate the Trust assessment tools for managing both adult and paediatric pain across the Chelsea and Westminster site. The focus included ensuring that all clinical areas are using the same pain assessment tools to ensure effective and timely pain management to achieve the best patient outcomes. The PMS carried out ward teaching. Currently at Chelsea and Westminster Hospital we use the following Adult Pain Assessment tools—numerical rating scale (NRS), verbal rating scale (VRS) and Abbey. For Paediatric pain management clinical areas we use the following pain assessment tools—FLACC, Wong and Baker FACES and the numerical rating scale (NRS). For further information about our pain assessments, please contact [email protected] or bleep 0148 Mon–Fri, 8am–6pm. Perfect Week for theatre use This month we are launching a new adult theatre timetable at the Chelsea and Westminster Hospital site aimed at increasing efficiency and minimising surgery delays for patients. In tandem with the launch of this new theatre timetable, we are implementing a Perfect Week model. The Perfect Week: Theatres initiative follows the success of the Perfect Week model used across the NHS but this time focuses on the patient’s journey to the operating theatre for surgery, from adding the patient to the waiting list, scheduling the admission and pre-operative assessment through to admission on the day, the operating theatre and recovery. There are on average over 400 operations carried out at Chelsea and Westminster Hospital every week, between 160 to 180 as day cases, 140 elective inpatient operations, on average 70 paediatric cases and 40 to 50 patients require emergency or trauma procedures. During the Perfect Week, staff at all levels and of all professions are encouraged to
look at what the job they do and how it might be changed to improve the patient’s journey. Lead Nurse for Theatres Jo McCormack said: “We are aiming to take a detailed look at the patient experience of surgery, making sure we use all our operating theatres to best effect and ensuring we always follow best practice in everything we do. As part of this open approach to theatre use, staff from across the Trust have been encouraged to take part.” The Acute Diagnostic Oncology Clinic (ADOC) continues to meet its targets Our acute oncology team see patients within 24 hours of GP referral. We assess, and arrange investigations on the same day, wherever possible, minimising the number of patient visits, avoiding A&E attendance and unnecessary inpatient stays. The team inform the GP within 24 hours of the clinic visit with a summary of investigations, results and plan of action. If cancer is diagnosed your patient will be discussed at the next MDT and treatment or care started as soon as possible. If cancer is excluded the team will discharge your patient back to the GP, or where urgent, refer your patient to another team directly.
Referral criteria ADOC is a clinic for patients with urgent suspected cancer.
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Your patient needs to meet the following criteria:
If in doubt please call to discuss with our team to identify the best referral pathway. Contact details Call the GP advice line on 020 3315 5000 select Option 6 for ADOC or email [email protected] If you would like a member of the ADOC clinic team to come and talk to you and your colleagues please contact Project Manager [email protected]
Improving Gynaecological 2WW referrals We have seen an increasing number of inappropriate Gynaecological 2WW referrals and we recognise that it’s in everybody’s interests to increase 2WW referral appropriateness and to minimise any unnecessary patients’ distress. We are keen to work with our local GPs to ensure that 2WW priority slots are used appropriately, that the criteria for referring patients as suspected cancer are better understood and that all the necessary details are included in all Gynaecological 2WW referrals. To this end, we have created a 2WW referral feedback template that we will be launching this month which will be sent back to the referring practice, accompanied by the original referral, as and when required.
This feedback template is designed to be a teaching and learning aid for the GP and practice concerned to help inform future clinical decision making around 2WW referrals. If you have any questions about this proposed feedback process, you can contact Susan Odgen and Emma Mathurien, Specialist Cancer Nurses on [email protected] Please see below for a copy of the feedback NUCA referral template that we are implementing.
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West Middlesex University Hospital Putting West Mid Ambulatory Emergency Care (AEC) on the map
With an AEC Network Excellence Award win in the bag, a glowing report from local patient group Healthwatch Hounslow, and Dr Elora Mukherjee at the helm leading her team in developing innovative and collaborative approaches to improve the service further, it’s clear to see that West Middlesex University Hospital’s AEC unit is going from strength to strength. AEC services have come on a long way since its inception in October 2014 and some of the new services which have launched as a result of the AEC include:
Weekly Consultant-led Rheumatology sessions based in AEC
Weekly Consultant-led Radiology sessions based in AEC
Intranet based antibiotic therapy referral form
Thrombosis clinics
Procedural pathways including: lumbar puncture, ascitic drains, chest drains and pleural aspirations
Newer services such as those listed above, along with enhanced specialist input ensure the service is of the same standard as inpatients, which is one of the AEC’s key aims: to avoid an unnecessary admission to the hospital without compromising patient care.
One consultant who provides regular input for AEC patients is Consultant Rheumato-logist Dr Gagandeep Thakar: “It has been a pleasure to provide Rheumatology specialist input in the AEC. Patients have given positive feedback of their experiences on the unit and commented on the prompt and efficient treatment they have received.” Dr Mukherjee is now trying to find colleagues who share her vision and can help her deliver new and innovative approaches within the service: “The AEC team is keen to work collaboratively with all departments within the Trust to improve patient outcomes. Our goal is to create a better patient experience and expedite patient care so avoiding unnecessary patient admissions, or where admission is required, to reduce the length of stay.” The AEC team has already started outreach efforts with its internal partners, including departments they regularly interact with such as A&E. They have conducted update sessions for medical registrars and A&E staff, and have been in contact with the Urgent Care Centre (UCC) to ensure processes run smoothly and optimise patient care as much as possible. Clinical Lead for A&E Dr Jasmin Cheema, comments on the relationship which has developed between A&E and AEC over recent months: “Essentially, processes have matured and there is much more of a seamless relationship between AEC and A&E. The service is working better from our perspective, and any issues that have arisen are highlighted and resolved in a timely and appropriate manner, ensuring excellent patient care. “Dr Mukherjee has been absolutely excellent in driving the AEC forward and has included A&E wherever needed. Our juniors feel much more included and listened to, particularly as she has done sessions with them. It is now easier to contact the AEC doctor and have a patient seen. We get a great response to our referrals.”
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Strong external links with Hounslow and Richmond Community Health (HRCH) have also been established with the recent enhancement of an outpatient antibiotics therapy (OPAT) service. This enables patients who need IV antibiotics but are otherwise well enough to go home, to receive their treatment on a daily basis at home. This is particularly suitable for those patients who are unable to travel to the hospital each day or those requiring antibiotic therapy over a prolonged period of time. On top of this, clinical governance has also been improved thanks to the recent introduction of an ICE referral pathway. The service has been facilitated with input from the IV Line Practitioner, Oliver Lynch: “Before the role of IV Line Practitioner was developed, patients were given antibiotics via a cannula or a PICC line for long term treatment. This sometimes meant delays in placing the appropriate line and it involved repeated cannulation for some patient groups. I have developed a nurse-led PICC line service which allows placement of PICC lines from Monday to Friday. We have developed the OPAT service to introduce midlines which allow patients to have up to 4/52 weeks of IV antibiotics and to take regular blood tests, thus preventing further delays in placing the right line, and attempted venepuncture with regular cannula use and providing a much more pleasant experience for the patient.” Since its launch in October 2014, the AEC has regularly received positive feedback from patients via NHS Choices. Some recent examples include: “I have recently been to the AEC unit where I found the staff were terrific, in particular two members of staff, as well as the lovely staff that do your observations when you go in. They were extremely kind and understanding and did their very best on all my treatment to make it painless, comfortable and private.” “Today I had the pleasure to visit the AEC Unit and the kind and caring attention that I received was beyond and above anything you could wish or hope for. My wife, who was with me as I am a Parkinson's sufferer, was equally impressed. We felt comfortable and cared for—thank you for restoring my
faith in this hospital. Now since my excellent care and kindness today I feel more confident and able to once again rely on West Mid as our centre of excellence.” Clinical Lead Dr Mukherjee explains what this kind of feedback means to the staff: “It’s incredibly satisfying to have the AEC recognised in this way and this really is testimony to the outstanding efforts of the entire AEC team over the last few years. However, as Clinical Lead it’s important to me that while we celebrate our success, we don’t just rest on our laurels but continue to seek new ways to improve. To do this we need to keep engaging with all of our colleagues, partners and users who have touch points with our service, and actively involve them as we enhance existing services and develop new ones. This is absolutely critical for the AEC’s continued success.” New for 2016—an AEC roadshow! In January, the AEC roadshow visited all the localities in Hounslow to raise awareness and reach out to community GPs who frequently engage with the service. The team had already visited Hounslow CCG’s Council of Members in October 2015 and as a result of positive feedback, arranged to meet with GPs in all five localities within the borough. Geralyn Wynne, Deputy Managing Director of Hounslow CCG has worked closely with the AEC team from the start: “The Ambulatory Emergency Care service feedback from GPs and patients has been extremely positive. It is a good service which provides a same day comprehensive assessment and treatment of the patient, which avoids them being admitted to hospital if appropriate”. This year will also see the launch of several new and exciting services:
A temporal arteritis pathway An ambulatory atrial fibrillation pathway Development of a PleurX drain service Plans for developing more inhouse
ultrasound scanning Keep an eye out for more AEC updates over the coming months.