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Oxford University Hospitals NHS Foundation Trust

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GP Bulletin November 2011

In this issue

1. Key performance measures

2. Clinical articles and referral protocols

  • Children's Clinical Decision Unit
  • New consent form for surplus tissue donation
  • Existing OCDEM diabetic patients
  • Neuropathic Pain and Opioids

3. Consultant appointments

4. Trust news and service developments

  • New Divisional Director
  • Integration update
  • Electronic Patient Record
  • Gynaecological Services at the Horton
  • Aural Care Service

1. Key performance measures

The goal of seeing, treating, discharging or admitting 95 percent of patients within four hours effectively remains as a performance indicator.

Healthcare associated infections

2. Clinical articles and referral protocols

Children's Clinical Decision Unit

A Children's Clinical Decision Unit (CDU) opened on Bellhouse-Drayson Ward in the Children's Hospital in October. The unit is open every day from 10.00am until midnight for medical and related conditions. It will provide assessment, treatment and/or observation of children, under 16 years old, who need to be in hospital for less than 8 hours. Children are assessed in the Emergency Department in the usual way, referrals booked through the ward Registrar (bleep 1392) – all referrals must be made by 9.00pm. Children admitted to CDU will then either be admitted to an inpatient bed or discharged home. Patient consent for surplus tissue donation.

New consent form for surplus tissue donation

The Trust carries out research which aims to inform and improve patient care, in partnership with the University of Oxford. It has become clear that the existing consent form for asking patients to donate surplus tissue is no longer fit for purpose. A new, more generic consent for research has been created that will ask the patient to sign an opt-in agreement to donate any surplus tissue for possible future research. An opt-in for all surplus tissue samples to be considered for research will provide much more material for researchers to consider than the current system. The filtering process for how appropriate the samples are will happen much further down the line. Any disease-specific research will still have to go through the normal channels of ethics approval and specific consent forms for each clinical trial. The patient information leaflet on consent for surplus tissue donation can be found at http://tinyurl.com/cjo92vv

Existing OCDEM diabetic patients

Please could you advise your Diabetic patients that the Diabetic Specialist Nurse Team at the
Oxford Centre for Diabetes, Metabolism & Endocrinology (OCDEM) are happy to take calls from existing patients. The team works: Monday to Friday (not available weekends and bank holidays). Please call 01865 857357. There is an answerphone which is monitored regularly, so leave a message and the team will get back to you as quickly as possible.

Neuropathic pain and opioids - the Pain Relief Unit

Patient criteria
The MDT service is available for patients who are currently attending, or are known to the Pain Services.
New patients who are unknown to the Pain Services should be referred with their consent via their general practitioner, and be assessed by at least one core member before discussion at the MDT meeting.
Previous patients (discharged from the Oxford Pain Services) may be referred for discussion at MDT for advice to determine if re-admission is appropriate.

All current patients should have a primary consultant from the Pain Service. However, the primary consultant is not necessarily the referring clinician. The patient can be referred to the MDT on behalf on the named consultant by another clinician.

Meetings
GPs can refer to Guidelines developed by the PCT and Pain Relief Consultants on the management of neuropathic pain and opioids on the PCT website http://tinyurl.com/cvk3shh (look under the heading central nervous system): this can only be used on an NHS connection.

GPs are welcome to question us about their patients via the email advice line oxonpainadvice@nhs.uk and you can also visit and discuss joint patients in our regular PROBLEM (patients requiring opioids beyond levels expected for management) meetings held as part of our MDT meeting on Monday afternoons. The meetings take place in the Seminar Room, Pain Relief Unit, Churchill Hospital. There are currently two meetings in a month, held on a Monday starting at 1.30pm. The average time for discussion varies, but is on average 20 minutes per case. Each MDT meeting is two hours long.

3. Consultant appointments

  • Dr Garry Tan has been appointed as a Consultant in Clinical Diabetes and Diabetes Research.
  • Dr Alistair Moore and Dr Najib Rahman have been appointed as Consultants in Respiratory Medicine (Lung Cancer).
  • Dr Niall McLeod and Mr Pradeep Anand have been appointed as Consultants in Oral and Maxillofacial surgery.

4. Trust news and service developments

New Divisional Director for Critical Care, Theatres, Diagnostics and Pharmacy

We are pleased to advise you that Professor Fergus Gleeson has been appointed the new Divisional Director for Critical Care, Theatres, Diagnostics and Pharmacy. Professor Gleeson is a consultant radiologist and also the theme leader for Imaging Research with the Biomedical Research Centre.

Dr John Stevens (Paediatric Anaesthetist) has also recently been appointed as the Clinical Director for Theatres, Critical Care and Anaesthetics. John took up the post from Monday 12 December.

Integration completed on 1 November

The new Oxford University Hospitals NHS Trust was created on 1 November 2011, and the first Board meeting was held on 3 November 2011. The new integrated Trust runs the county's four teaching hospitals - the Nuffield Orthopaedic Centre, Horton General, John Radcliffe and Churchill hospitals. The different hospital sites will retain their current names and identities.

The joint working agreement with the University of Oxford also formally came into effect at the point of the merger, which is a strategic alliance supporting a health sciences partnership that will integrate patient care, teaching and medical research to deliver the best in clinical treatment. The NOC is now a seventh division of the Trust – the Clinical Division of Musculoskeletal and Rehabilitation Services.

The external websites of each Trust are being combined into a single website www.ouh.nhs.uk. This will involve the transfer of all web pages and documents into the new site which may take some time. In the meantime both sites will remain active: www.noc.nhs.uk and www.oxfordradcliffe.nhs.uk.

The Electronic Patient Record

This is the biggest transformation programme that the Trust has ever seen, and it promises to provide a modern and comprehensive set of tools to support the Trust in achieving its strategic objective to be a provider of high quality and efficient patient care and treatment.

Phase 1 went live at the Trust over the weekend of Saturday 3 December, replacing the Patient Administration System, and going live in the Emergency Department and Maternity. There will now be a planned stabilisation period after which we will begin the phased roll out across the Trust of the additional clinical functionality.

The NOC CRS upgrade happened on weekend of Saturday 5 November, which moved them onto the latest version of software, so that they are using the same system as the rest of the OUH.

Gynaecological services at the Horton

The Oxford University Hospitals NHS Trust is expanding Gynaecology services at the Horton General Hospital to provide more day surgery and diagnostic services during the week and, in partnership with GPs, to provide clinics for women with menstrual problems or problems during the early stages of pregnancy.

The Horton was providing day surgery services for gynaecology patients in a generic day surgery unit and some inpatient beds on a 12 bedded gynaecology ward. But these inpatient beds were often taken up by non-gynaecology patients - about 60 percent of ward capacity was frequently taken up by patients outlying from other specialties. This change provides a dedicated Gynaecology Day Surgery and Diagnostic Service from Monday to Friday and ensures that the Gynaecology Unit is being used by Gynaecology patients.

The expanded day surgery and diagnostic service will be primarily for patients from Banbury and north Oxfordshire, Milton Keynes and Buckinghamshire. Six inpatient beds, within a same-sex area, will also be established on the surgical ward for Gynaecology patients who need an overnight stay following surgery or who are admitted as emergency cases.

The new Women's Day Surgery and Diagnostic Unit opened on 28 November 2011. The opening times for the unit are 7.30am - 8.00pm. An Urgent Gynae Clinic will also be operational from that date. This clinic will be held in the 'old' ward area, namely the treatment room and side rooms, and will be staffed by a senior nurse and a care support worker. There will be an appointment system so GPs will be offered an appointment for their patient when they contact the ward. The number of scans that are available remains the same and the location of the scanner also remains the same, however the improvement/development of the scanning facility for early pregnancy loss is something that we want to focus on in the next financial year.

Patients who need to be seen outside of the day surgery and clinic opening hours will be seen in the Emergency Department and admitted to the surgical ward in a female environment/bay should they require admission. There is no reduction of Gynae medical staff and should surgery be required out of hours, the same arrangements continue as now. On-call Gynae medical staff continues as now so a GP will still contact the on call registrar as they currently do.
We are moving clinics up to the Horton, namely Urodynamics, Menstrual and Reproductive Medicine, although these will occur in the New Year and come ‘on board’ in a measured manner. We are also considering a nurse-led Menopause clinic.

Aural Care Service

Since November the aural care services have been temporarily reduced. The Trust is recruiting to two vacant posts within the aural care team but this may take some time. In the meantime the Trust will reduce the number of clinics it runs for this service - and clinics at the Horton will be suspended until April 2012. Please could GPs be aware that referrals for simple wax clearance will need to be managed within primary care during this period. For patients from the North of the county, there is an alternative aural care service provided at Northampton General four mornings per week, if residents north of Banbury would find this easier to attend.

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