GP Bulletin September 2012


In this issue

1. Key performance measures

2. Clinical articles and referral protocols

  • PCAS reminder
  • Colorectal 2 week waits
  • Abnormalities in immune protein
  • Clinical Genetics
  • Specialist Diabetes Service

3. Consultant appointments

4. Trust news and service developments

  • Changes in Rehabilitation Medicine
  • Children's Critical Care
  • Barnes Unit
  • New nurse-led clinic for thoracic surgery follow-up
  • Trauma expansion complete
  • EPR update
  • Medical revalidation
  • Engagement with primary care
  • FT consultation

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

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2. Clinical articles and referral protocols

Paediatric Consultant Advisory Service (PCAS): reminder

PCAS is an advisory service for general practitioners and all primary healthcare professionals. Paediatric consultants will be available for two hours (Monday to Friday) to give advice on non-urgent queries. They will also respond to requests for advice sent by email. Email responses will be within 24 hours to sender's mailbox.

The service started on 1 September 2011. This service will not replace the standard referral route for the urgent assessment of sick children.

How to use the service: Telephone: 12 noon to 2pm (Monday to Friday). For the John Radcliffe Hospital call us on 01865 741166 Bleep 4734. For the Horton General Hospital call us on 01295 275500 Bleep 850.

Colorectal 2 week wait referrals

It appears that the National Awareness and Early Diagnosis Initiative (NAEDI) has resulted in some confusion for patients and blurring of the referral guidelines. This has resulted in a significant number of bowel cancer screening patients having the screening process interrupted (sometimes at the very last minute) and being re-referred via 2 week wait instead. This has serious consequences for the waiting list times at the OUH and can mean delays in receipt of colonoscopy for the patient.

When a patient within the screening age group 60-69 presents, please consider the following:

  • Have they received a test kit from the screening service?
  • Has it been completed and returned?

If yes:

  • What was the outcome? If they have received a letter (copied to GP) advising that the test was clear and that they will receive a further kit in two year’s time/been discharged as over the age limit: please deal with their current symptoms as appropriate.
  • If they have not yet completed the process (e.g. they may have had a letter advising them that their first test was unclear and they need to complete another) then please advise the patient to continue with the screening process. They will receive 1-3 test kits to ensure that they are adequately screened. You will receive a letter advising of the outcome.

If no:

  • Treat as appropriate in accordance with symptoms.
  • If not appropriate for further investigation, the screening centre can advise when screening is due (01295 229834).

The team of Specialist Screening Practitioners (SSPs) would be happy to visit your practice and provide information and staff training as required.

Please call 01295 229834 to arrange a convenient appointment.

Abnormalities in immune protein

Presence of abnormalities in immune protein (paraprotein) production is not uncommon in > 50 year olds. This is estimated to be present in up to five percent of over 50 year olds in the community and in up to 10 percent in over 80 year olds.

A small proportion (one percent per annum) will progress to a related cancer called myeloma. As a large proportion of these people will be followed up in the community with blood tests, it is vital that we develop a robust algorithm to guide this process. Currently, this is performed by serial blood paraprotein analysis.

It is hoped this will be a handy tool for clinicians and nurses in the community.

Clinical Genetics

This is a friendly reminder to GPs that, when you are referring a patient with a family history of cancer, could you please complete the family history questionnaire, which can be found on our Clinical Genetics referrals page.

Please note that you do not need to complete a family history questionnaire for any other referrals.

Diabetes

Dr Garry Tan is a consultant diabetologist who has recently joined Oxford University Hospitals from the University of Nottingham and Derby Hospitals NHS Foundation Trust. He trained in Manchester, London and Oxford before moving to Nottingham and Derby as a Consultant Endocrinologist and Associate Professor. While working in Nottingham and Derby he developed integrated care services across primary and secondary care barriers using innovative commissioning models. In Oxford, he will help to develop the NHS diabetes service and is working as part of the Long Term Conditions programme. He would be very keen to meet GPs and practice staff in order to understand what local clinicians need from the local specialist diabetes service.

If you would be happy for him to visit you, please contact him: garry.tan@nhs.net

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3. Consultant appointments

Consultants in Obstetrics and Gynaecology:

  • Miss Lee Nai Lim, BSc, MBBS, Diploma of Family Planning and Reproductive Health, D Phil, MRCOG.
  • Miss Brenda Kelly, BSc (Hons), MBChB, PhD, DFFP, MRCOG.

Consultant in Neuroanaesthesia and Neurocritical Care:

  • Dr Simon Raby, BSc (Hons), MBChB, MRCP, FRCA.

Consultant in Oncoplastic Breast Surgery:

  • Dr Pankaj Roy, MBBS, FRCS, MD.

Consultant in Gynaecological Oncology:

  • Mr Krishnayan Haldar, MBBS, MD, MRCOG, RCOG.

Consultant in Ophthalmology Specialising in Ocular Plastics:

  • Mr Jonathan Norris, MBChB, MRCOphth, FRCOphth.

Consultants in Anaesthetics with Special Interest in Vascular and three posts for Consultants in Anaesthetics with Special Interest in Trauma:

  • Dr Jonathan Mason, MBChB, MRCP, FRCA, EDRA (Post 1 - Vascular).
  • Dr Vikram Halikar, MBBS, DA, DNB, FRCA, DFRA (Post 2 - Vascular).
  • Dr Amy Swenson, BSc (Hons), MBBS, MRCP, FRCA (Post 1 - Trauma).
  • Dr Adam Fendius, BSc (Hons), MBBS, FRCA, CCT (Post 2 - Trauma).
  • Dr Matthew Stevens, BSc (Hons), FRCA, (Post 3 - Trauma).

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4. Trust news and service developments

Changes in Rehabilitation Medicine at the NOC

Dr John Outhwaite, Consultant in Rehabilitation Medicine, retired at the end of July. The options for GP referrals include referrals to other Rehabilitation Consultants with an interest in pain management, including Dr David Henderson Slater and Professor Derick Wade, both based at the Oxford Centre for Enablement, or to the Pain Service, based at the Churchill Hospital.

Children's Critical Care Service

In June the Paediatric Intensive Care Unit (PICU) and Paediatric High Dependency Unit (PHDU) merged to create an integrated Children's Critical Care Service.

Please also note that the PHDU has relocated to the old Coronary Care Unit (CCU) based on Level 1 of the John Radcliffe Hospital. The contact numbers remain the same: (2)21267 or (2)21304.

This exciting development marks the culmination of a vision developed over a number of years. It heralds a new era with increasingly integrated working and brings benefit to patients through greater flexibility of staffing and capacity. This means there is potential to increase the number of children receiving critical care in an appropriate environment.

For further information, please contact Sharon Buchanan, Deputy Matron for Children’s Critical Care: sharon.buchanan@ouh.nhs.uk.

Change of contact details for the Barnes Unit

Please note that the contact numbers for the Barnes Unit (self-harm and psychiatric liaison) have changed to:

New nurse-led clinic for thoracic surgery follow-up

A group of patients undergoing thoracic surgical procedures were identified as fit for discharge home apart from continuing to require intercostal drainage. The Advanced Nurse Practitioner for thoracic surgery has introduced a nurse-led clinic to provide follow-up for these patients until the drains are removed, facilitating early discharge.

Trauma expansion complete

The phased expansion of the Trauma Centre is now complete. SCAS staff and OUH staff have agreed a triage protocol so that ambulance crews can assess patients at the scene of an accident and decide whether or not their case is a major trauma.

EPR update

After the successful go-live the Trust has spent the past few months stabilising and improving the system. There have been some issues with the new 18 week wait software as we were the first users of the system. These issues have now been mostly resolved and staff are being re-trained in both inpatient and outpatient workflows. The Trust has been through a major programme to check patient waits are being managed and we are confident that this is the case.

In the Emergency Department improvements to the system have been made and the system is managing the waiting times and producing ED summaries which are being sent directly to practices.

In Maternity a major re-work has commenced, and this will be implemented early in the new year. In the meantime some improvements have been implemented and staff are fully engaged in the improvement programme.

Alongside improvement to EPR, the transcription programme is being implemented for outpatient letters, and over the next few months more specialties will be sending clinic letters directly to practice systems, which will reduce the need to scan in practices and ensure a speedier turnaround for patients.

We are undertaking a quarter one commissioning data review with the PCT/CCG team to confirm the accuracy of commissioning data and to identify any residual problems.

We acknowledge there have been problems in such a major change programme, but we have had an active programme to manage this and we believe we are making significant progress.

We would like to thank everyone in primary care for their co-operation with this and we will continue to improve the patient experience with the new system.

Medical revalidation

The Trust has a statutory obligation to implement revalidation in December 2012, which will be led by Professor Baker as the Responsible Officer (RO) for the OUH with Dr Tony Berendt as the revalidation Lead. There are 797 doctors in the Trust and in 2013-14 20 percent of the doctors will revalidate with the remaining 80 percent in the following two years. Every doctor with a licence to practice must revalidate.

Engagement with the GP and wider primary care community

As part of our Foundation Trust application, we have been reviewing how we engage with our partners in the health and social care system. Our interactions with GPs and the wider primary care community are extremely important to us, particularly given the current changes within the NHS. We participate in and have helped to develop a number of mechanisms both to strengthen communications and to bring together GPs with consultants and managers from the Trust. These include for example:

  • the joint work programme on delayed transfers of care
  • the various QIPP programme boards
  • the joint liaison meetings between the North Locality and the Divisional and Clinical Directors from the Trust to discuss issues relating to the Horton
  • the joint issue-specific task forces such as the Transfer of Information Task Force
  • regular contact with the Local Medical Committee.

We want to explore what else we can do to ensure that the effectiveness of our collaborative efforts is maximised for the benefit of our patients. We would, therefore, welcome your ideas and suggestions. Please could you kindly forward these to alison.barnes@ouh.nhs.uk in the Media Office.

Foundation Trust consultation - we need your views!

You may be aware that the OUH is in the process of applying to become a Foundation Trust and would greatly appreciate your views on the application document:

There is also an online questionnaire that can be completed if you would like to give us your views in this way. We are sharing this consultation document widely with patients, staff, key stakeholders and partners inviting comments on elements of the proposals. If you would prefer a paper copy we can send it in the post and you are very welcome to send us a written response either by email or by post.

Freepost address:

  • FREEPOST OUH FOUNDATION TRUST OFFICE

The consultation ends on 12 October 2012.

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Freedom of Information
NHS Choices