February 2015 Features • • • •
Proposed acquisition of West Middlesex University Hospital Award for paediatric pre-surgery relaxation app New drug driving law coming into effect in March *NEW* ‘Clinician to Clinician’ column by Prof Simon Barton
Regulators give go-ahead for hospitals to join forces
Practice Managers’ Corner Call for advisers to inform development of a new Service Directory Electronic outpatient letters to practices via NHS.net Invitation to test Standardised Referral Form Weekly Noticeboard Roundup Colorectal telephone assessment clinic launches GP signatures on Radiology requests Phlebotomy service update Looking to admit a patient? GP Training Fertility and Gynaecology Modern Management of Obesity If you have any comments or questions about this newsletter, please do get in contact. Justine Currie | GP Relationship Manager T: 020 3315 6603 E: justine.currie@chelwest.nhs.uk E: gpqueries.chelwest@nhs.net (secure)
The Competition and Markets Authority (CMA) has cleared plans for the acquisition of West Middlesex University Hospital NHS Trust by Chelsea and Westminster Hospital NHS Foundation Trust. This means one of the most significant milestones underpinning the proposals set out by the two trusts has been achieved. A pre-integration agreement - the Heads of Terms - has also been signed. The Heads of Terms sets out the expectations and responsibilities of all the organisations involved and formalises the financial
negotiations, indicates the commitment of those involved, and provides formal support from commissioners. The new, unified organisation is expected to come into being in July 2015. “This CMA ruling is great news for all of those at both trusts already working hard together to establish the potential for improving services for local people. It is good to hear an external regulator telling us we have a credible plan. This is an important step in the process towards creating a bigger trust that is better equipped to meet the challenges of 21st century healthcare.” Chelsea and Westminster Hospital’s Chief Executive Libby McManus
“It is really good news that the CMA ruling allows us to move on to the next stage of the merger of the two trusts. The focus now is on ensuring that this new organisation is wellplaced to build on the strengths of both trusts, and that each hospital continues to deliver first-class care for their communities.” West Middlesex University Hospital NHS Trust Chief Executive, Dame Jacqueline Docherty
West Middlesex University Hospital: An introduction
The assessment process examined whether the integration of the two trusts would lead to a ‘significant lessening of competition’ or a reduction in access or choice of services for local people. The CMA contacted a range of organisations and individuals as part of their analysis “We do not believe that the merger will lead to a material reduction in the quality of services for patients (including clinical factors such as outcomes, infection rates and mortality rates, and non-clinical factors such as waiting times and patient experience) and will not materially reduce the hospitals’ incentives to innovate and improve their services.” The Competition and Markets Authority The Chelsea and Westminster Trust Board will consider a full business case which will then be presented to Monitor, before the transaction is considered by the Chelsea and Westminster Trust Board and Council of Governors. The new unified trust will have around 5,000 staff and cover a potential population of nearly a million people. This acquisition will help us to improve the sustainability of services and ensure the very best healthcare is available long into the future. It will also allow the new Trust to improve the scope for research and development—ensuring that these two hospitals continue to provide high quality services for local people.
A strong and proud history West Middlesex University Hospital has a long history of pioneering, innovative healthcare spanning both World Wars and the birth of the National Health Service. The foundation stone of the West Middlesex Hospital, or as it was then called, the Brentford Union Workhouse Infirmary, was laid on 21 November 1894 and it was officially opened two years later by HRH Princess Mary Adelaide, Duchess of Teck. Over the following decades the hospital developed and expanded, becoming the West Middlesex Hospital, with a dedicated maternity department opened on 17 February 1932 by Queen Mary. The hospital retains links with its proud history, including the Marjory Warren Unit. Dr Warren came 2|Page
to the hospital as a young resident medical officer in 1926, before being promoted to deputy medical director in 1931 and after the inception of the National Health Service in 1948 she became consultant physician.
Acquisition FAQs Q: What does the West Middlesex acquisition mean for patients and GPs in NWL and Wandsworth localities? In legal terms, this is an acquisition of WMUH by CWFT. The aim is to ensure that we retain and continue best practice and procedures from both trusts in the new organisation. While technically this will be an acquisition, the two existing trusts have a lot to learn from each other and will, in essence, be brought together to form a stronger, more resilient foundation trust. Patient benefits will include: • • • •
To keep pace with the changing needs of its community, a brand new hospital building was officially opened by the former Prime Minister Gordon Brown on 17 November 2003. The current hospital features state of the art technology and purpose built facilities fit for the 21st Century and caters for patients registered to Hounslow CCG, Richmond and Twickenham CCG and Ealing CCG. Activity comparison (2013/14 stats): WMUH Outpatient attendances A&E and UCC attendances Inpatient admissions Babies delivered Theatres operations X-rays and scans Staff
246,032 130,901 45,974 4,848 10,210 193,804 2,202*
CW 590,000 112,500 76,000 6,600 77,000 3,200
*Includes ISS and Bouygues (Estates)
More patient access to research programmes Greater clinical sub-specialisation Greater organisational resilience and capacity Improved staff retention and career development: a stable workforce has strong links to higher quality of care
Most staff and patients will notice little change initially, with improvements occurring over time. The intention is that the new organisation will become more than the sum of its parts and will provide high quality, sustainable services long into the future
Q: Do Commissioners support the proposals? The Department of Health (through the NHS Trust Development Authority) and local clinical commissioning groups support the proposal. A preintegration agreement (the ‘Heads of Terms’) has been signed which sets out the expectations and responsibilities of all organisations involved. It formalises financial negotiations, indicates the commitment of those involved and provides formal support from commissioners.
Q: What are the next steps? The plan is for the new organisation to come into being on 1 July 2015. It will involve everyone from staff at grassroots level to the Secretary of State. The active involvement of staff and 3|Page
stakeholders is the most important element of the process of bringing the two organisations together. Colleagues across both trusts – both clinical and corporate – are working together to design a new structure for the unified organisation. The integration plan is focused on achieving excellent patient care and experience, in line with the values of both trusts. The Chelsea and Westminster Hospital Board will consider a full business case, which will then be presented to health service regulator Monitor. Under the FT constitution, the final commitment still needs to be ratified by the Board and CWFT Governors. The ‘Heads of Terms’ document triggers a formal consultation on the dissolution of WMUH, with a view to it becoming part of CWFT. The consultation will be held with Healthwatch groups in Hounslow and Richmond, and staff-side colleagues. Monitor will assess the information set out in the full business case to determine a 'Transaction Risk Rating'.
Q: What will the new entity be called? A branding and identity exercise is underway, taking on board the views of staff, patients and stakeholders of both trusts. The trusts and commissioners are aware that both hospitals have a long and proud history. The new trust will be sensitive to this but as yet the details have not been decided. A new public website for the unified trust is in development and a full communications campaign is planned to support public, staff and stakeholder awareness of the integration and any changes.
Q: How do I find out more? Updates on the acquisition will be provided to GPs via the CCG comms channels and via Trust GP news bulletins. We are revising and publishing a new Service Directory for all GPs ahead of the acquisition. If you have other queries or other information you would find useful about the proposed acquisition, please email westmid@chelwest.nhs.uk
Staff views on the acquisition Maternity Vivien Bell, Head of Midwifery, C&W “Bringing the two trusts together means we could potentially have one of the biggest maternity services in the country. This brings with it some challenges, but also some massive opportunities— we would have a huge population base, the potential to provide some of the most innovative, high-quality services in the country and would be a big player in terms of recruiting staff. “But becoming one of the leading maternity services in the UK is not without its challenges and risks. While we grow in size, we’ll need to ensure we maintain good communication with staff, to make sure that staff feel valued and part of a team.” Tonie Neville, Clinical Director for Women & Children and Head of Midwifery, WMUH “The Maternity Unit at West Mid has been proudly serving the needs of our local community since it was opened by Queen Mary in 1932. Since then it has been continually evolving to ensure that it provides a first-class service to meet the changing needs of women and their babies. I feel privileged to be its current custodian, and want to ensure that it has a strong future for generations to come. “I feel that joining forces with Chelsea and Westminster will bring many opportunities for both organisations. We can share knowledge and 4|Page
experience, and develop even better services at both hospitals, while maintaining our individual identities, and preserving the history of each maternity unit.”
both hospitals will be seeking to work closely together in sharing good practice and innovation as we continue to meet the growing demands on our services.
Emergency Department
“The proposed changes have the potential to generate a larger pool of staff, with a broader range of skills and experience to draw from. It could also mean we are better placed to share good practice and build on the innovative work at both trusts.
Dr Michael Beckett, Consultant in Emergency Medicine, WMUH “Both West Middlesex and Chelsea and Westminster have very active and busy ED, each serving their own distinctive and varied communities. Both serve areas of affluence, but also areas of deprivation. Both departments serve populations with a wide range of social and medical need. “The combined Trust will be responsible for providing emergency care for an area stretching from the Houses of Parliament to Feltham, with a bit in the middle which will be served by Charing Cross. While the need for two emergency departments will continue, there will be scope to coordinate training, protocols, information gathering and research. “Many of our emergency medicine trainees already rotate between West Mid and Chelsea and Westminster, and they frequently comment on the wide diversity of experience, both clinical and managerial, they get by working in both sites. We look forward to taking into the integration, among other things, our very effective ‘frequent attenders’ project and our experience gained from the close cooperation with our Urgent Care Centre and Ambulatory Emergency Care unit.
Dr Claire Emerson, Consultant in Emergency Medicine, C&W “The two separate emergency departments in a newly integrated NHS Trust will be serving a population of nearly a million people in west London. A&E colleagues in
“We are receiving substantial investment in our services in the shape of new staff, equipment and facilities, and these will be put to good use in ensuring that both departments maintain their excellent recent records in providing high quality care, while meeting national four-hour waiting times.”
Award for paediatric presurgery relaxation app
The RELAX Anaesthetics app in action Anaesthetists Peter Brooks and Corina Lee were awarded an NHS England Innovation Acorn Challenge Award for their RELAX Anaesthetics app. This powerful tablet-based solution helps to relax and distract children while they are being anaesthetised prior to surgery, making the whole experience less painful, stressful and more likely that the children's procedure will be a success. The highly acclaimed NHS Innovation award recognises and rewards innovations at an early stage that have the potential to make a big difference to patients.
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The project has been funded Enterprising Health Partnership, between CW+ and the Hospital.
through the an initiative
is an offence to drive with certain drugs above specified levels in the body, whether your driving is impaired or not.
"We are delighted to have been presented with this fantastic award. We have been testing the tablet app for a number of months and to be creating this product to help children, families and staff is really exciting. The amount of time spent during induction of anaesthesia represents a significant proportion of the workload of the theatre, even in simple cases. We are lucky to have had initial funding from CW+ and the hospital to get this off the ground. With the prize money from this award we would like to roll it out to other hospitals." Corina Lee
What medications are covered by this new law include those prescribed for: • extreme pain (morphine, diamorphine, ketamine) • anxiety or inability to sleep (diazepam, clonazepam, lorazepam, oxazepam, temazepam) • drug addiction (methadone) • attention deficit hyperactivity disorder (ADHD) (amphetamine) • multiple sclerosis (nabiximols)
To
find
out
more
about
the
app,
visit:
http://www.cwplus.org.uk/innovation/ehp/relax.htm
New drug driving law comes into effect in March
Please encourage patients: • To keep taking medicines as prescribed • To check the leaflet that comes with medicines for further information on how they may affect your driving ability • Not to drive after taking medicines until they know how the medication affect them • Not to drive if they feel drowsy, dizzy, unable to concentrate or make decisions, or if they have blurred or double vision What will happen if patients are stopped by the police? The police may use a roadside test to see if individuals have taken any of the drugs. If the test detects any relevant drugs, the type and level of the drugs in your body can be confirmed by a blood test taken at the police station. The law provides individuals with a “medical defence”. This states that you are not guilty if: • the medicine was prescribed, supplied, or sold to you to treat a medical or dental problem, and • you took the medicine according to the instructions given by the prescriber or the information provided with the medicine
On the 2nd March 2015 a new law on driving after taking certain drugs (including some medicines) comes into force. This law states that it
Further information on this new law can be found at: www.gov.uk/government/collections/drugdriving Deirdre Linnard, Head of Pharmacy 6|Page
Clinician to Clinician “Integrated Care” - Is it an aspiration, or a target or a self-evident component of any healthcare system?
Integrated Care has been a major theme of both the London Health Commission review of healthcare, compiled by Lord Darzi and the five year review of NHS England Services written by Simon Stevens, published last October. As we digest the impact of these, as well as the planned co-commissioning of specialised services, there is a great deal of work to do. From the outset, the Chelsea & Westminster has set out to work with partners equally, to develop services which increase the simplicity of access of patients to healthcare and ensure the delivery of healthcare by the appropriate clinician in the right setting. This clearly includes an increased use of community and primary care facilities as well peer support and the use of the voluntary third sector. A key component of this is the commitment to health, including preventative public health and reablement.
In 18 months of working with colleagues in Primary Care, Community Trusts and patients, I think it is used interchangeably and needs a clear definition in any document or speech where it is applied. This is my working definition:
There are a number of projects which we are specifically working with partners on to develop this, but all or any changes in care must be carefully evaluated to ensure that the outcome in continuously improving patient care and health outcomes are met, as well as achieving the financial targets for the efficiency of the NHS.
Integrated care means that the patient’s healthcare needs are provided by a team who share all relevant clinical information effectively, who work to clearly defined outcomes that are set and shared with the patient and that institutional organisational or funding barriers are avoided to deliver the most effective and evidenced based care. Efficient healthcare care should not cause harm, distress or delay to the patient.
When it comes to efficiency, there are other markers other than financial and as a patient said so eloquently at one of our user meetings, “it
I readily invite comments, especially for any improvements on my proposed definition.
I very much look forward to working with you and invite your participation in discussions (through this column) about developing integrated care but also in specific projects, where we will be looking for partners to help both design and evaluate the outcomes of our efforts.
As the Associate Medical for Integrated Healthcare, I want to work closely with colleagues in general practice, as well as those in other aspect of NHS provision including commissioners as well as patients and carers, to develop the managed pathways of care which will really improve care and drive efficiencies.
would be a much more efficient use of their time not to have to repeatedly give the same patient details and identifiers to separate clinical services who all share the same NHS rules on IT and Information Governance.” If these softer markers cannot be translated into improved efficiency of service, then we will need to review how we count the costs of care.
Professor Simon Barton, Associate Medical Director for Integration simon.barton@chelwest.nhs.uk 7|Page
Practice Managers’ Corner This section is designed to inform Practice Managers of process changes and issues that affect the day to day interface between the practice and Chelsea and Westminster Hospital. If you have a question or query that you want us to feature in this section, please do send an email with ‘Practice Managers’ Corner’ in the subject line to justine.currie@chelwest.nhs.uk.
Do you have views on what makes a great Hospital Service Directory?
advisory group and provide vital feedback on the type of information you most require as well as the most useful format for the new service directory. If you are interested or want to know more about the plans for the new service directory, please do get in contact.
Electronic outpatient letters now via NHS.net Due to on-going technical delays in sending outpatient clinic letters electronically direct into GP clinical systems (SystemOne or Emis), the Trust is now looking to send out outpatient clinic letters to practices via NHS.net email. We hope to be in a position to start sending outpatient letters to practices via NHS.net email by the end of March 2015. If you have queries about this proposal, please do get in contact.
Invitation to test the Standardised Referral Form One referral form for any referral to Chelsea and Westminster Hospital (with the exception of cancer referrals) is in development and we are still looking for practices to help us test the form to ensure it is sufficiently user friendly for GPs who use Choose and Book as well as for those practices who don’t use Choose and Book to refer patients.
With the proposed acquisition of West Middlesex University Hospital and in light of service and personnel changes we are planning to redevelop and relaunch the Organisation’s Service Directory this summer. To ensure we produce a Service Directory that is fit for GP and Practice requirements we are looking to form a small advisory group and we would like to invite a GP and Practice Manager to join this
If your practice would like to participate in this testing phase during March and April, please do get in contact.
Justine Currie | GP Relationship Manager T: 020 3315 6603 E: justine.currie@chelwest.nhs.uk E: gpqueries.chelwest@nhs.net (secure) 8|Page
Weekly Noticeboard Roundup The following is a summary of news items from the preceding weekly noticeboard news items that are disseminated via CCG bulletins:
New colorectal telephone assessment service launches Following London Cancer Alliance and Commissioners’ recommendations, Chelsea and Westminster Hospital is implementing a ‘Colorectal Telephone Assessment Service’. The straight to test patient pathway is intended to improve patient experience via quicker access to tests and results and by decreasing the number of hospital appointments for patients. We are rolling out the telephone assessment service to two week suspected cancer referrals to the Colorectal Unit from the beginning of March 2015, with the plan to roll out the telephone assessment to all patients referred to the unit later in the year. Applicable colorectal patients will be contacted by telephone within 2-3 days of referral by our Colorectal Cancer Nurse Specialist. Patients will be asked questions about their symptoms, general health and assessed for suitability for bowel prep. They will be triaged over the telephone for the most appropriate investigation and sent an appointment for the applicable test (Flexible Sigmoidoscopy, Colonoscopy, CT scan or ultrasound, MRI scan). Following our telephone assessment some patients will require an outpatient appointment prior to any tests and in such cases we will arrange this. Reminder of important items to include on colorectal referrals: recent U&Es and eGFR blood test (which is required for bowel prep and CT scans) whether the patient is fit for out-patient bowel prep please include FBC and iron studies for anaemia patients
if the patient would rather be seen in clinic before having tests please let us know in your referral letter and we will arrange this please attach your referral letter to the Choose and Book referral within 24 hours of booking the patient in. Delays in attaching the letter will result in the patient’s assessment being delayed. We have designed a patient information leaflet to give to patients referred to our colorectal service which will explain the telephone triage service. This leaflet is accessible here: http://www.chelwest.nhs.uk/gps/links/ColorectalTelephone-Assessment-Service-Mar-2015.pdf We are very grateful for your support with this initiative. Miss Sarah Mills, Consultant Colorectal and Laparoscopic Surgeon Email: sarahc.mills@chelwest.nhs.uk Tel: 020 8746 8000 Ext 58529
GP signatures are essential on Radiology Request forms GP request forms for ultrasound and x-rays must have a GP signature on them. We will accept ultrasound request form with a typed GP signature but there has to be a name please. Radiology referrals can be sent to: cawtr.radiologyreferrals@nhs.net Carien Morabito Ultrasonographer Superintendent
Patients turning up when the phlebotomy service is closed We have had a number of patients turning up at the Chelsea and Westminster Phlebotomy service for a blood test after 5pm when the service is closed. 9|Page
We hope to offer an evening pathology service later this year but until then, please remind patients that they must come to pathology (Lower Ground Floor) before 5pm and that they should contact the GP practice, and not the pathology service, for any test results. Additionally, patients who wish to have a ‘Group and Save’ test outside of a surgical patient pathway will need to pay a £50 charge as this is not covered by the NHS. Please do let them know this before sending them for a Group and Save test. Please note that paediatric blood tests are booked by the paediatric team and can be contacted on 0203 315 3019. Lorrayne Kilburn Phlebotomy Manager
GP Training Fertility and Gynaecology education session Date: Tuesday 24 March 2015, 6.30pm – 8.30pm Venue: Gleeson Lecture Theatre, Chelsea and Westminster Hospital NHS Foundation Trust This session is free to attend and the programme will cover Introduction to fertility – Mr Julian NormanTaylor Management of Endometriosis in women with infertility – Mr Dimitrios Nikolaou What patients need to know about menopause – Miss Claudine Domoney
Looking to admit a patient? If you are looking to admit an adult medical patient to Chelsea and Westminster Hospital, it is imperative to call the medical registrar on call via Trust Switchboard 0203 315 8000, option 1, bleep 0103 (24hrs a day). Please do not send your patient to the hospital without phoning ahead as this has caused problems recently when we have no beds and sick patients suddenly appear.
Fibroid management – Mr Amer Raza To reserve a space at this training session, please email justine.currie@chelwest.nhs.uk
Modern management of Obesity: Fighting an Epidemic
If you have a patient with the potential for ambulatory care (i.e. same day or next day inpatient treatment on an outpatient basis), again it is imperative to call first to discuss the patient’s suitability. The blackberry is only held 9am to 5pm (tel: 0203 315 5000 option 1), so if OOH, then please call the medical registrar (tel: 0203 315 8000, option 1, bleep 0103). Dr Hannah Skene Consultant Acute & General Medicine
Date: Tuesday 28 April 2015, 6.30pm – 9.00pm Venue: Gleeson Lecture Theatre, Chelsea and Westminster Hospital NHS Foundation Trust 10 | P a g e
Obesity is a global epidemic and modern management is continually evolving. Chelsea and Westminster is a UK centre of excellence for bariatrics, providing patients with a holistic approach to weight loss management that spans diets, psychology, endocrinology, cardiac and respiratory and surgery.
Next edition
GPs are cordially invited to attend an evening education session on the latest developments and innovations in bariatric surgery and to gain a greater understanding of the benefits of diet vs medicine vs surgery for bariatric patients.
• •
The programme will cover: • Do diets really work? Medical management of obesity – What’s new on the horizon • Psychological aspects of obesity - The real cost of obesity • The history and overview of bariatric surgery and what the future holds
In the next edition of GP News •
How the Trust is working with Community Integrated Services in Elderly care, A&E avoidance and re-enablement Find out about the early arthritis service Meet our Public Health Trainee
Did you miss the January 2015 GP News edition? If so, you can access it online here: http://issuu.com/chelwest/docs/january_2015_gp_ bulletin_final
GP Clinical Advice Line
Speakers: • Mr E Efthimiou – Clinical lead for Bariatrics and General Surgery • Ms Rhian Davies – Senior Bariatric Dietician • Dr Veronica Greener – Obesity Physician and Endocrinologist • Mrs Nuala Davison – Consultant Nurse Clinician To reserve a space for this free education session, please email justine.currie@chelwest.nhs.uk
Advance notice on upcoming GP education sessions Paediatrics - May 2015 Orthopaedics – June 2015 Dates and times of these sessions will be confirmed shortly.
Does your patient need to rearrange their NHS appointment? Patients can rearrange their outpatient appointments either by T: 0203 315 6666 E: appointment.enquiries@chelwest.nhs.uk 11 | P a g e