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GP Bulletin March 2012

In this issue

1. Key performance measures

2. Clinical articles and referral protocols

  • Oxford specialist Ataxia service
  • Enhanced recovery after surgery
  • Cervical cytology and HPV tests
  • Plain film X-ray services

3. Consultant appointments

4. Trust news and service developments

  • Trust Values
  • Academic Health Partnership
  • Foundation Trust update
  • Regional Trauma Centre designation
  • EPR update

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

Oxford Specialist Ataxia Clinic

This clinic welcomes the addition of an Ataxia Nurse Specialist to the team. The Clinic provides specialised support to adults and children with a suspected or confirmed cerebellar ataxia by way of a specialised management and diagnostic service that compliments existing services. The Clinic offers the expertise of Dr Zam Cader (Neurologist) and Dr Andrea Nemeth (Geneticist) and the addition of the Ataxia Nurse Specialist will ensure patients and families are supported both during and between clinic visits.

The Clinic is an Ataxia UK accredited centre. Named specialists in the following disciplines also see ataxia patients via the clinic

  • Cardiology
  • Neurophysiology
  • Neuro-ophthalmology
  • Orthopaedics

The Clinic also facilitates various research studies and the validation of new genetic tests as they emerge. The centre would like to increase the number of ataxia clinics currently being run with a particular focus on specific ataxias such as Friedreich's Ataxia.

Referrals to the clinic should be made to:

  • Dr Z Cader, Department of Neurology, John Radcliffe Hospital, Oxford, OX3 9DU
  • Dr A Nemeth, Department of Clinical Genetics, Churchill Hospital, Oxford, OX3 7LJ

or contact the Ataxia Nurse

Enhanced Recovery After Surgery (ERAS)

As part of our commitment to improve the quality of services we provide to patients and contribute to the system-wide QIPP agenda, designed to improve services for patients while at the same time securing clinical and financial sustainability, we are introducing an enhanced recovery programme for all patients undergoing elective oesophagogastric surgery from April 2012.

Enhanced recovery principles included:

  • optimising the patient's health / medical condition pre-operatively
  • assessing risk and fitness for surgery at pre-operative assessment
  • reducing starvation by using carbohydrate loading drinks up to two hours before surgery
  • minimally invasive surgery where possible
  • a clear and structured approach to post-operative management, including pain relief
  • early mobilisation and early nutrition.

The benefits of this programme are:

  • improved patient experience
  • improved patient satisfaction
  • reduced length of hospital stay
  • reduced post-operative complications
  • reduced readmissions to critical care
  • reduced readmissions after discharge.

The success of this programme depends on engagement of all professionals involved. GPs can assist by managing pre-existing co-morbidities and optimising pre-operative haemoglobin levels to ensure the patient is in the best possible condition for surgery.

Or contact:

Cervical cytology requests and HPV testing at the John Radcliffe

As you will all be aware it is now recognised that high risk Human Papilloma Viruses are responsible for cervical cancer and that the NHS Cervical Screening Programme is moving over to the use of HPV testing as part of the national cervical screening system in the UK. This will take place in two phases and is due to begin implementation in Oxfordshire by the end of March.

First year of HPV testing
The initial year (April 2012 to April 2013) will see women newly diagnosed with low grade abnormalities (borderline changes and mild dyskaryosis) on their cervical test result be tested for the presence of high risk HPV (HPV triage). If it is present they will immediately be referred to the Colposcopy clinic for further assessment. If they do not have the high risk HPV virus present then they are at negligible risk for cervical cancer and will be recalled for another routine cervical test at the relevant time period, either three or five years depending on their age. Those that do have any treatment at the Colposcopy clinic will automatically have any follow up cervical cytology sample again tested for the presence of the high risk HPV types (test of cure).

Second and subsequent years
The second year of the process (commencing late March 2013) will see all women who are on annual recall for previous abnormalities have their cervical sample tested for the presence of the high risk HPV types and sent on to Colposcopy for further assessment if it is present. If they do not carry the high risk HPV virus then they will be able to return to routine cervical testing, three or five yearly depending on their age, and therefore no longer require annual cervical testing.

As part of this new testing process all cervical sample takers are required to undergo further training on the implications of the HPV test results that will be issued in conjunction with the cytology report – the HPV status of the woman will affect how her repeat tests are managed, which will naturally cause some distress for patients. This training has been rolled out across Oxfordshire, Berkshire and Buckinghamshire during January to March this year and those sample takers that attend the training session should by now have cascade trained others in the practice. Once HPV training has been undertaken, and registered, all sample takers will then be assigned a new sample taker code for use when taking a cervical sample at any practice or clinic in any of the three counties.

Next steps
The Cytology Laboratory in Oxford had a tentative start date for HPV testing of 26 March 2012; this date [or any delayed date] will have been confirmed to all Oxfordshire practices by means of a mail shot. We know there may be teething problems, as with any new system, but are sure that if we all work together the benefits to women will be well worth it. If there are any queries please do not hesitate to contact the Cytology Laboratory:

  • Tel: 01865 220490

and we will help if we can.

Plain film X-ray services across Oxfordshire

This is a reminder of which centres offer an 'appointment only' or 'GP drop-in' service for plain film X-ray across Oxfordshire.

3. Consultant appointments

  • Dr Thisanayagam Umasunthar, BSC (Hons) MSc MRCPCH, currently locum consultant in Paediatric Allergy and Clinical Research Fellow in Paediatric Allergy, Imperial College, has been appointed as Consultant in General Paediatrics.
  • The following have been appointed as Consultants in Radiology (interventional):
    • Dr Rafiuddin Patel, MBChB (Hons) MRCS, FRCR, currently specialist registrar in radiology, at the Leeds and West Yorkshire Radiology Academy.
    • Dr Charles Ross Tapping, BSc (Hons) MRChB (Hons) FRCR, currently specialist registrar and Radiology Interventional Fellow, Oxford University Hospitals NHS Trust

4. Trust news and service developments

Trust Values

In taking forward our strategy, our focus is on communicating the vision for our organisation and the values that represent how we will achieve high quality outcomes and an excellent patient experience. They demonstrate that the wellbeing of every patient and member of staff is central to our work and that they will shape how we work with our partners.

Our values state that we aim to:

  • Provide excellent care with compassion and respect
    This means we take pride in what we do; put patients at the heart of what we do; and always go that extra mile to deliver support and respect to both our colleagues and patients.
  • Deliver, learn and continuously improve
    This means we deliver high standards based on national and international standards; strive to improve through change and innovation; and work in partnership, learning from both successes and setbacks

What will make our values distinctive is how we use them and apply them in practice. Over the coming months we will be engaging with staff about the Trust's future direction as a Foundation Trust, and the values statement will play a key part in representing how we deliver excellence. We will be working out how we translate these values into actions that respond to the needs of our patients and all our other partners including GPs.

Academic Health Partnerships

A local working party has been set up to develop proposals for an 'Oxford Academic Health Partnership'. The 'partnership' will be between NHS and University partners in Oxfordshire to develop improvements in evidence-based care, research, education and training. The aim is to strengthen collaboration across the local health economy and beyond to benefit patients and the wider local and regional communities.

Foundation Trust update

Work is continuing on the development of the Trust's Foundation Trust application. The Trust has a public recruitment target of 7,000 by September 2012 and public membership currently stands at 4,500. A formal public consultation period will take place from late June to September 2012 on the Trust's strategy and proposed governance arrangements as an FT. Staff will automatically become members, unless they choose to 'opt out', and will be represented on the Council of Governors. In preparation for the next stage of the process, programmes of work are being carried out by the Trust's clinically-led divisions, with the involvement of GPs and other commissioners, as well as with a number of partner organisations, and a revised strategic approach to the Trust's services is being developed.

Key elements of the strategy are being discussed with wider partners including GPs and the Clinical Commissioning Group

The aim is to achieve Foundation Trust status within 2013, with an application to the Department of Health planned for January 2013.

Members will elect governors to a Council of Governors who will work with the Trust Board to set the strategic direction of the Trust, generating plans to meet local needs. The Council of Governors will have a majority of publicly elected members and will also have governors elected by staff and some appointed governors from key partners such as the universities and our commissioners as well as a youth representative nominated by the Trust's young people's executive, YiPpEe. It is proposed that there will be a representative of the local commissioning group on the Council of Governors.

If you are not already one of our members, then why not join us?

We would welcome the help of practices in recruiting members e.g. distributing recruitment materials. For more information contact Susan Brown:

New designation for Trauma Centre

Proposals to consolidate major trauma services into regional networks will be implemented from April 2012. The OUH and Southampton University Hospitals' trauma services will be designated as the region's two Major Trauma Centres.

Therefore the Oxford Major Trauma Centre will be launched on 2 April to provide treatment to the most seriously injured and complex patients. Designation is expected to bring around 300 additional patients annually to the Oxford centre. Local trauma units at other hospitals in the region will provide ongoing treatment and rehabilitation.

Electronic Patient Record

Implementation has been a significant technical achievement with over 1.5m patient records migrated. Some problems as functions of the system took time to bed in, but planning is now underway for the next phase of the project which will involve roll out over the next year of the clinical functions of the system. Over 1.5m patient records were migrated, over 114,000 future appointments were migrated, more than 30,000 referrals were migrated and the merger with the NOC index has occurred successfully with over 200,000 patients merged. Respiratory Medicine will be brought on line in early May as an exemplar area We acknowledge there are still some problems but these are being sorted in through three phases of work, which are designed to ensure that we get the maximum benefit for our patients:

  • consolidation - sorting out existing problems
  • strategic review - service improvement and using the system optimally
  • roll-out of clinical functionality.