JUNE 2015 In this edition of GP News: Your chance to win £100 John Lewis Voucher: Pre-Integration GP Survey Specialist pain clinics available to patients Gold framework accreditation for EoLC New pharmacy service for outpatients New A&E department takes shape Bariatric and pregnancy study Responding to the CQC inspection – Peer review points to the way forward E-referrals update Telephone clinic poster GP advice easy reference guide updated
YOUR CHANCE TO WIN £100 JOHN LEWIS VOUCHER: ANNUAL GP SURVEY
If you have any comments, questions or requests for articles in this newsletter, we’d love to hear from you. Justine Currie | GP Relationship Manager T: 020 3315 6603 E: justine.currie@chelwest.nhs.uk E: gpqueries.chelwest@nhs.net (secure)
We are entering an exciting period with the proposed acquisition of West Middlesex University Hospital (WMUH) by Chelsea and Westminster Hospital NHS Foundation Trust (C&W) on 1 September 2015. While many of the services will remain exactly as they are, this is also a great opportunity for our organisations to learn about what we each do best from the perspectives of GPs and patients. To this end we invite you to take part in a survey by Friday 24 July 2015. We are distributing paper copies of the survey to practices but help us to save significant costs by completing this survey at: http://bit.ly/GPsurvey2015 (case sensitive)
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All responses received by the date above will be entered into a prize draw to win a £100 John Lewis voucher—electronic responses will receive two entries, and postal responses one entry into the prize draw. If you have any questions about this survey or require additional paper copies, please contact Justine Currie.
referred to pain management therapy that might exacerbate their symptoms. How to refer: A normal pain referral with the inclusion of ‘Survivor of torture’ wording in it will automatically ensure that these patients are triaged into this clinic. GPs are not required to include details of their torture or to press the patient for any details of their torture. Exclusion criteria: FGM and domestic violence Benefits: Reduction in DNA, good compliance with ongoing medical treatment, cut down/ rationalisation of medications, amended patient notes to reflect preferences, joint psychology/pain medicine report for GPs.
Miss Zoë Penn Medical Director Chelsea and Westminster
Dr Roger Chinn Medical Director West Middlesex University
SPECIALIST PAIN CLINICS AVAILABLE TO PATIENTS
What is torture?
“... 'torture' means any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from him or a third person information or a confession, punishing him for an act he or a third person has committed or is suspected of having committed, or intimidating or coercing him or a third person, or for any reason based on discrimination of any kind, when such pain or suffering is inflicted by or at the instigation of or with the consent or acquiescence of a public official or other person acting in an official capacity. It does not include pain or suffering arising only from, inherent in or incidental to lawful sanctions.”
Arabic-speaking womens’ only group:
The Specialist Pain team being awarded a Survivors of Torture Pain Clinic initiative quality award by Governor Susan Maxwell in May 2015.
Three specialist pain clinics have been developed at Chelsea and Westminster in response to patients’ specialist requirements: 1. 2. 3.
Survivors of torture Arabic-spoken women’s only group Fibromyalgia clinic
Survivors of torture This award winning monthly clinic (soon to run twice a month due to demand) was set up in November 2014 and is designed specifically as a one-stop shop clinic. Patients have a 90 minute appointment and receive a full medication review by a Clinical Nurse Specialist, a consultation by a consultant pain specialist, Dr Bianca Kouler, and a brief psychological assessment with Clinical Psychologist, Dr Susan Childs. The survivors of torture clinic is specially designed to prevent vicarious retraumatisation by ensuring these patients are not
This group has been designed in response to a need to develop a language-free pain education and pain management module for Arabic women who have very poor literacy skills. The course runs four times a year and each course is four weeks long and is suitable for Arabic women who have mild to moderate pain related mood disorder. Over the course they are guided through graded exercises, diagrammatic breathing and relaxation strategies to control secondary pain symptoms. Additionally the course aims to educate these women on the benefits of reducing extensive rest periods, and increasing activity. This course has proven to be very successful and has a 100% retention rate of women to attend the first session.
Fibryomyalgia clinic A dedicated one-stop shop fibryomyalgia clinic run by Dr Bianca Kouler and Dr Susan Childs has been developed to meet the needs of individuals experiencing widespread pain or multiple places of pain over joints. Research is now highlighting that pain killing injections are not effective and this clinic provides a joint psychological and physiological assessment and diagnosis in the same clinic. The clinic has excellent patient attendance and compliance and treatment plans crucially match individual patients’ motivation levels. If you have any questions about these specialist pain clinics you can contact: Dr Susan Childs - Clinical Psychologist via email: Susan.Childs@chelwest.nhs.uk
NEW PHARMACY SERVICE FOR OUTPATIENTS
Boots UK is also now managing the hospital’s pharmacy at 56 Dean Street.
END OF LIFE CARE GOLD STANDARD FRAMEWORK ACCREDITATION
Chief Pharmacist Deirdre Linnard cuts the ribbon with Boots Store Director Asif Aziz A new outpatient pharmacy service provided by Boots UK opened its doors at Chelsea and Westminster Hospital this month. Around 125,000 outpatient prescription items are dispensed at the Trust each year to patients attending the outpatient clinics. The items range from eye drops and pain killers, right through to medicines used to treat cancer. The new Boots pharmacy will offer patients a more flexible service and extended hours of service, whilst maintaining the high standards of patient care. Having a dedicated pharmacy just for outpatient prescriptions has significantly reduced patients’ waiting time for their prescriptions with average waiting times dropping from 40 minutes to under 15 minutes. Deidre Linnard, Chief Pharmacist said: “Over the years the number of outpatient attendances at the hospital has significantly increased. Based right in the middle of the hospital on the Ground Floor, the new pharmacy service provided by Boots will help improve the patient experience by reducing waiting times, providing more choice about where patients can get their medicines and improving accessibility seven days a week. “The new partnership between the hospital and Boots will build on the skills and experience of both organisations to provide benefits to patients, visitors and staff whilst enabling the hospital’s pharmacy staff to develop the pharmacy service for its inpatients.” Peter Bainbridge, Director of Pharmacy, Boots UK added: “We are delighted to be working in partnership with Chelsea and Westminster Hospital to help offer their patients the best possible pharmacy service. We are continuously seeking opportunities to provide better healthcare solutions and this partnership not only ensures we are located where customers want and need us most, but also allows us to work together to support patient care in the local community and make a real difference to people’s health and wellbeing.”
Julie Armstrong Wilson (GSF), Professor Keri Thomas (GSF), Dr Barry Quinn (End of Life Care Lead), Gary Artiss (CNS Palliative Care) On Thursday 26 June the Trust hosted an End of Life Care Gold Standard Framework (GSF) conference for acute hospital implementation partners in the South East. The conference was led by Professor Keri Thomas and Julie Armstrong Wilson (GSF Team). Chelsea and Westminster Hospital is one of the first London teaching hospitals to implement the End of Life GSF. This framework builds on the Trust’s existing End of Life Care Strategy and focuses on engaging non-specialist teams, clinical and non-clinical in end of life care. Phase 1 of this 2-3 year programme has involved rolling out the framework to six of the Trust’s wards; specifically AAU, ITU, Lord Wigram (Surgical), Ron Johnson (HIV/Oncology), Nell Gwynne (Stroke), Edgar Horne (Care of the Elderly). The framework, like the Trust strategy, promotes early identification, patient and family choice, better symptom management, working with GP colleagues and linking with community partners such as CLCH where appropriate. Phase 2 of this work will include rolling out this programme to our soon-to-be colleagues at West Middlesex University Hospital (post September 2015 acquisition). As part of this work and the PLACE Educational Project focussing on bands 1-5, the Trust has developed an App teaching tool to support staff reflections and understanding of the wider end of life care pathway from acute care to nursing home and hospice end of life care. This app will be launching in July 2015, is free and may be of benefit to community staff including medical students, Practice based nurses, District nurses, support staff and clerical colleagues. Dr Barry Quinn, Assistant Chief Nurse, Senior Lecturer King’s College
LESLEY WATTS APPOINTED CHIEF EXECUTIVE
RESPONDING TO THE CQC INSPECTION – PEER REVIEW POINTS TO THE WAY FORWARD Work continues to progress in addressing the issues raised by last autumn’s inspection by inspectors from the Care Quality Commission (CQC). In April, we carried out a full internal peer review of services which was assessed and reported on as a CQC inspection would.
Lesley Watts has been appointed Chief Executive of Chelsea and Westminster Hospital NHS Foundation Trust. She will begin at the Trust on 15 September 2015. A nurse and midwife by training, Lesley has executive managerial experience at the highest level, having been a Chair of an NHS Trust, a Foundation Trust Governor and Director of Nursing and Operations at a major hospital. She is currently Accountable Officer (Chief Executive) for East & North Hertfordshire Clinical Commissioning Group, which has been nominated for Health Education England Governing Body of the Year and nationally recognised for its patient participation and engagement work. Chairman Sir Thomas Hughes-Hallett said: “I am delighted that Lesley will be joining our team. Her leadership and obvious energy, empathy and enthusiasm will help us to continue to build an organisation with local, regional and world-class ambition. “She has been pivotal to delivering successful mergers and acquisitions within the NHS and has a proven track record in delivering financial turnaround. She oversaw the merger of the Bedfordshire and Hertfordshire Health Authorities into a Strategic Health Authority, established and delivered an £84m turnaround project, and led a programme to pursue clinical improvement in the redesign of local health services.” Lesley will become Chief Executive of an enlarged organisation created in the event of the Trust coming together with West Middlesex University Hospital, which is proposed to come into being on 1 September 2015.
Chief Nurse Vanessa Sloane said: “We were extremely pleased to be rated as Good overall by our peers. On the whole we found that many improvements had been made to rectify matters highlighted by the CQC inspectors and many of our services would be rated as Good if the inspectors were to return. We had seen real improvements in the scores for Medicine, Surgery, Children and young People and End of Life Care, however, there is still room for yet more improvement. “Our peer reviewers felt extremely welcomed by our teams, who were very open and honest with them. Our patients in the most gave good feedback stating that they felt informed, well cared for and involved in their care. “Thank you all for your ongoing hard work, our action plan continues, but for the most part these actions are part of our daily work and we must make sure to see them as such, and not as something extraordinary.” How we rated, area by area Medicine (including stroke and older people) Surgery Theatres Acute and Urgent Care End of Life Care Outpatients Children and Young People HIV and Sexual Health
GOOD GOOD GOOD Requires improvement GOOD Requires improvement GOOD OUTSTANDING
Actions coming out of the Review: Identifying staff and patients Issue: ID for both staff and patients were inconsistent. Action: Reviews and agree standard policy and procedures for ID checks across the organisation and implement spot checks on patients and across the Trust to ensure these have been implemented and embedded. Medication Issue: Drug safety and administration inconsistent. Action: All drugs cupboards/trolleys to be checked to ensure they are in good working order and, if need be, be replaced or fixed. Implement best practice for drug administration and
safety with immediate effect, with spot checks by senior nursing team and pharmacy team to ensure compliance. Documentation Issue: Documentation standards were inconsistent in patient notes. Action: A full review of the way documents – particularly patients’ notes – are handled to be carried out as a matter of urgency. Staffing levels Issue: Some staff concern over levels of staff on wards. Action: Safe staffing levels to be put on display in all wards and managers to review any worries or concerns by staff into staffing levels in certain areas.
Phase 1 plan – new fractures, majors and imaging
Staff awareness Issue: Staff unaware of a number of key reports, policies and procedures. Action: Focus on ‘back to floor’ communications by managers to discuss key reports and issues with staff. Ensure that nursing forums/work groups cascade information to all members of teams.
Once this phase is up and running work will begin immediately on the next phases of the project providing a new resuscitation room and paediatric A&E. The work will continue over the winter and will be completed by the summer of 2016.
NEW A&E DEPARTMENT TAKES SHAPE
Lorna Gibson, General Manager for Emergency and Integrated Medical Care said: “Once we are fully open we will have more space, more staff and more state-ofthe-art equipment to treat patients in an emergency. All this will be done in a spacious modern environment providing for more than 110,000 a year.
The project is a major plank in the Trust’s role as an active partner in developing the Shaping a Heathier Future programme in North West London.
New A&E treatment rooms
A crucial part of Chelsea and Westminster’s newly expanded accident and emergency service will be coming on stream in August. The first phase of a £12million redevelopment of the Emergency Department will create a larger majors treatment area, x-ray unit with CT scanner, fracture clinic and emergency observation unit.
“This is the biggest capital scheme the hospital has seen since it was built over 20 years ago and cements the hospital’s position as a major hospital in west London providing high quality emergency services to a growing population.” We are planning to invite GPs to come and see the new Phase 1 space prior to opening it to the public. If you would like a guided tour, please get in touch.
BARIATRIC PREGNANCY STUDY
TELEPHONE CLINIC POSTER
Miss Mina Savvidou, Professor Johnson and Dr Tanya Maric are looking to recruit patients who are pregnant and have had previous bariatric surgery for a study looking at the growth vs gestational age of babies and the prevalence of preterm delivery in this cohort of women. Specifically this study is examining the growth of these babies as they are at higher risk of being small for gestational age and whether these women do have reduced Gestational Diabetes Mellitus (GDM) and preeclampsia rates. The women participating in the study will receive serial growth scans (four extra scans) and will be asked for additional blood/urine and stool samples (timed with the routine bloods wherever possible). These additional samples will enable the team to study the metabolic environment the baby is developing in. If you are referring any patients for antenatal care who have had bariatric surgery in the past, please help us identify potential candidates for this study by stating the type of bariatric surgery in the referral. We are keen to invite women to take part in this study as early as possible in the pregnancy. Dr Tayna Maric - Clinical Research Fellow and Registrar in Obstetrics & Gynaecology. Tanya.Maric@chelwest.nhs.uk
E-REFERRALS UPDATE Please note that if the e-referrals system is not available, you can still refer patients to us via email: chelwest.gpreferrals@nhs.net Please note: The Heart Failure Exercise Clinic has a gap in availability due to a staff vacancy. We have a new nurse joining the Trust in September who will be running these clinics. Gabriel Hammond - Outpatients Performance Manager
Every practice should have received the new telephone clinic posters to display in patient waiting rooms. If you would like any more posters – they can be downloaded here:
http://www.chelwest.nhs.uk/uploads/telephoneclinics-jun-2015.pdf
GP ADVICE EASY REFERENCE GUIDE This guide has been updated to reflect new additions to the service. Guide is available online at the following url or turn to the next page: http://www.chelwest.nhs.uk/uploads/Easy-Reference-GuideGP-Advice-Services.pdf
MISS THE LAST EDITION OF GP NEWS? You can find last month’s edition of GP news here: http://bit.ly/MayCWnews
REFERENCE GUIDE: Clinical advice from Consultants available to GPs via phone and web
GP Advice Telephone Hotline How to access?
Dial 0203 315 5000 and select from the following options: 1. 2. 3. 4. 5.
Medical Surgery Paediatrics Women’s Health Older Adults Service (over 65s) *NEW* 6. Acute Diagnostic Oncology Clinic *NEW* You will either be able to speak directly to a consultant and get an answer there and then or you will be able to leave a message for a call back. Availability?
Monday to Friday, between 8am and 6pm
When to use the service?
When you need to contact a Consultant urgently or you are looking to refer a patient to: the acute assessment or ambulatory care service (Medicine Option 1) the Older Adults Clinic Acute Diagnostic Oncology Clinic (patients who can’t wait two weeks for a NUCA)
Exclusions?
Referring patients for a routine outpatient appointment. These should be made via Choose and Book or faxed to the appointment office on 0203 315 8814 Non-clinical queries i.e. chasing missing discharge or outpatient letters Calls from patients (please don’t share this number with patients)
GP Advice Web Form http://nww.gpadvice.chelwest.nhs.uk Please note the nww. rather than www. You can select from the following options: Medicine Paediatrics Radiology Surgery – Colorectal *NEW* Surgery – General Surgery – Orthopaedics Surgery – Plastics Surgery – Urology Women’s Health Within 48 hours, you will receive a response to the NHS.net email address you detailed in the web form. Monday to Friday, between 8am and 6pm When you are seeking advice from a consultant on a less urgent matter and can wait up to 24 hours for a response Examples: Whether a patient needs to be referred or to discuss a primary care management plan for this patient Advice on non-urgent medication changes Referring patients for an outpatient appointment or to get a patient admitted We will be developing a series of FAQs to answer commonly asked questions so please do take a look at FAQs (which will be located in the blue bar underneath the query form) before submitting a query.
Please note: Chelsea and Westminster Hospital GP advice services are designed to provide GPs with information to inform the clinical care and management of their patients. Clinical decision-making and clinical responsibility for patients remains the responsibility of GPs until the point a patient is referred to Chelsea and Westminster Hospital. If you have any questions, comments or experience any issues with either of these services, please contact justine.currie@chelwest.nhs.uk or T: 0203 315 6603
June 2015