January 2015 Features Detecting Hip problems in babies and young children Welcome to the Chief Nurses’ Cabinet Paving the way to Personalised Medicine
Detecting hip problems in babies and young children
Practice Managers’ Corner Outpatient clinic letters going electronic A&E Discharge Summaries update Invitation to test Standardised Referral Form Weekly Noticeboard Roundup Early Pregnancy Assessment Unit extended opening times Orthopaedic referrals redirected to local MSk services Consultant advice available via web and phone What to do if your patient wishes to access private care Did you know patients can rearrange their appointment via email? Ultrasound waiting times update Patients’ Support Service GP Survey – give us your views GP Training NWL Surgical Network session – 9 February Online Paediatric Testis Management Module Upcoming GP education sessions 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)
Screening for Developmental Dysplasia of the Hip (DDH) is part of the Newborn and Infant Physical Examination however some cases of DDH are only picked up by GPs at the 6-8 week infant checks or even later. What to look out for? A family history (any close relation with hip problem that started when they were a baby or young child) Breech presentation (at delivery or in the last trimester irrespective of gestational age at delivery or mode of delivery Babies with these risk factors should be referred for routine ultrasound regardless of any clinical findings. Clinical findings include positive Ortalani or Barlow’s examination, clicky hips, reduced hip abduction or unequal leg lengths. With
respect to asymmetrical thigh skin creases, these should be established with the pelvis and hips in a neutral position; unequal leg lengths or reduced hip abduction may also be apparent. Further guidance is available here: newbornphysical.screening.nhs.uk/standards
Parent information leaflet on baby hip health is available from the STEPS charity: www.steps-charity.org.uk/Downloads This should be given to any parents of infants referred for screening. Risks to patients if DDH goes undetected as infant? The earlier DDH is identified treatment can usually occur without surgical intervention being required.
Divisional Nurses: - Nathan Askew (Women's, Neonates, Children's and Young People, HIV/GUM and Dermatology Services) - Claire Painter (Planned Care Surgery and Clinical Support) - Sarah Wheatland (Emergency and Integrated Care) One of the cabinet’s aims is to increase visibility of senior nurses within the Trust. In response to feedback from staff, patients and governors, from February, Barry, Lucy and Vanessa will be wearing very visible red uniforms. The senior nurses (matrons, lead nurses and chief nurses’ cabinet) will also be visiting assigned ward and clinical areas every Friday for ‘Back to Floor’ visits.
How to refer? Infants under 6 months of age should be referred for an ultrasound scan and if there are any concerns from this scan they will be seen in Orthopaedic clinic for management. Infants over 6 months of age should be referred into the Orthopaedic team at Chelsea and Westminster Hospital. These infants will be assessed to determine if a hip x-ray is indicated. If so all investigations and results will be undertaken and given in the one appointment slot. Paediatric Orthopaedic Physiotherapy Practitioners: Tel: 0203 315 1604 Fax: 0203 315 1607
Welcome to the Chief Nurses’ Cabinet The Chief Nurses Cabinet is the leadership body for meets patient care and nursing issues at the Trust. Members include: Interim Director of Nursing: Vanessa Sloane Deputy Chief Nurse: Lucy Connolly Assistant Chief Nurse: Barry Quinn Head of Midwifery: Vivien Bell
Vanessa, Barry and Lucy in the new red uniforms “As a cabinet, we believe in providing strong, professional nursing leadership to inspire , motivate and empower the nursing team ensuring high quality, evidence based care is given to all patients. We are committed to service improvement, staff experience and development and most importantly providing excellent patient experience.” You can contact the Chief Nurses Cabinet via E: pa.directorofnursing@chelwest.nhs.uk Q: What are your specific areas of nursing responsibility within the Cabinet? Vanessa Sloane – Interim Director of Nursing: I am leading the Matrons and Lead Nurses group and I am aligned to the Planned Care Division to provide additional leadership and support. 2|Page
Lucy Connolly – Deputy Chief Nurse: I will be providing leadership and support to the Women’s and Children, HIV and Sexual Health & GUM, and Dermatology division. I chair and support the Ward Sister Charge Nurse meetings and I am the main contact in the Cabinet for the nursing and healthcare assistant workforce. Barry Quinn – Assistant Chief Nurse: I will provide a professional lead role for specialist nurses and midwifes. I will also take on the lead role for nursing education and multi-professional research Q: What’s your career highlight to date? Vanessa Sloane – Interim Director of Nursing: “Having undertaken a variety of nursing roles, I spent 18 months working as a service manager within paediatrics at the time of 18 week pathway introduction – an interesting experience which has given me great respect for our service managers and the jobs they do. I am very excited by the new opportunities in my role as Interim Director of Nursing. I feel very passionate about leadership within nursing, and how we do the best for our staff and patients.” Lucy Connolly – Deputy Chief Nurse: “Caring for older people is my nursing passion and I have a Masters Degree in Gerontology at Keele University. I have held a wide variety of roles including clinical governance coordinator, clinical risk management lead and even ventured into directorate management heading up the elderly division which I loved with a passion and then latterly an emergency department and acute medicine division which was a ‘different’ yet enhancing experience! More recently I have held the post of Head of Nursing Workforce - providing professional advice to HR on nursing related matters. I have loved the whole of my career in the NHS so far and am thrilled to be part of the Chief Nurse Cabinet at Chelsea and Westminster Hospital.” Barry Quinn – Assistant Chief Nurse: “I have worked in healthcare for 30 years in hospital, hospice and community settings in the UK and Ireland and my specialist areas are Cancer and
Palliative Care and I am the Trust lead for end of life care at Chelsea and Westminster Hospital. I am a board member and chair of a number of national and international organisations focusing on advancing leadership and improving clinical practice. Alongside my clinical and leadership roles I am a Visiting Lecturer at the University of Surrey and the Royal Marsden Hospital, and a CLAHRC Fellow.” Vivien Bell – Head of Midwifery: “I have trained as both a nurse and a midwife with the majority of my career in maternity services. I started my midwifery career in the East Midlands where my own children were born. I trained as a supervisor of midwives in Leeds and I believe that midwives have a privileged position in a unique life event.” Nathan Askew – Divisional Nurse: “My particular areas of interest are in high dependency care, advancing nursing practice and patient experience. I also have a keen passion for nursing education as well as the development and support of the role of the health care assistant. It is exciting to be working within so many outstanding services and with people who are so passionate about the great work which they undertake.” Claire Painter – Divisional Nurse: “Having initially trained at Barts in the 1980’s, my professional career has remained in London. I still feel the same sense of privilege of being a nurse that I felt when I first entered nursing and I am delighted that the next chapter of my professional life will be in an organisation with such strong values and a fantastic clinical reputation.” Sarah Wheatland – Divisional Nurse: “I started my career as a paediatric staff nurse at The Hillingdon Hospital NHS Trust in 1995 before moving to St Mary’s Hospital, Paddington, which is now part of Imperial College Healthcare NHS Trust, in 2002. “I have worked my way from ward sister on the bone marrow transplant/infectious diseases ward to Lead Nurse for Paediatrics and I completed a master’s degree in Leading, Managing and Partnership Working.” 3|Page
Paving the way to Personalised Medicine
The trusts will work together to ask patients with cancer and inherited rare diseases if they would like to participate, gather their samples and relevant medical information to build up a bank of anonymised data in order to better understand the role that genes play in disease and what treatments will work best for each individual patient. The project has the potential to transform the future of healthcare by improving our knowledge of the influence of genetics on disease, how other people can be helped with similar diseases in the future, and how different types of tests can be developed to detect changes beyond the genome.
Chelsea and Westminster partners with Genomic Medical Centre to join fight against cancer and rare diseases. In late December, NHS England announced that Imperial College Healthcare NHS Trust has been designated a Genomic Medical Centre (GMC) in partnership with Royal Brompton & Harefield NHS Foundation Trust, Royal Marsden NHS Foundation Trust and Chelsea and Westminster Hospital NHS Foundation Trust. These four trusts make up Imperial College Health Partners NHS GMC which will contribute to the successful delivery of the 100,000 Genome Project, a national initiative which aims to sequence the genomes of 100,000 participants, for the first time, to enable new scientific discovery and medical insights, and bring benefit to patients. Professor Derek Bell, Director of Research and Development, Chelsea and Westminster Hospital, said: “I am delighted that Chelsea and Westminster is part of this exciting project. This work and research has the potential to change our understanding of cancer and rare diseases, and help to shape future treatments.”
In addition to these long-term benefits, some participating patients might benefit in the shortterm as a conclusive diagnosis may be reached for a rare and inherited disease more quickly, or a treatment for cancer may be targeted at the particular genetic change that is present in the cancer. Professor Jonathan Weber, director of Imperial College Academic Health Science Centre (AHSC), said: “The 100,000 Genome project has the potential to transform the future of personalised medicine. The creation of Imperial College Health Partners NHS Genomic Centre will allow researchers and clinicians at the Trust and College to be at the forefront of medical innovation by sequencing genomes on an unprecedented scale. This could help us bring better treatments to patients with cancers and rare diseases. We aim to translate our findings in as fast a timeframe as possible so that people could benefit from new therapies, personalisation of drugs and more accurate diagnostic testing.” Imperial College Health Partners NHS GMC is supported by Imperial College Health Partners Academic Health Science Network and is one of 11 centres of this kind in the world, all in the UK.
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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
Outpatient letters going electronic Last year we trailed sending outpatient letters electronically two practices. Whilst these practices liked the timeliness and convenience of the electronic outpatient clinic letters, they disliked the duplication of receiving both paper and electronic. The Trust has now approved the purchase of the software that will allow us to deactivate paper copies of outpatient clinic letters when a practice begins to receive them electronically. Once this is in place, we will be contacting practices to confirm their electronic go-live date for electronic outpatient clinic letters.
A&E Discharge Summaries duplicates have been switched off On the 22 January 2015, we switched off duplicate paper copies of A&E discharge summaries for practices who already receive a copy of their patient’s A&E discharge summaries electronically into their GP System (be that SystemOne or Emis Web). We hope eliminating these duplicates will prove to be a process efficiency for our local practices and ourselves. If your practice doesn’t currently receive A&E discharge summaries electronically you will continue to receive copies via post. However we would like to invite you to consider switching over to electronic A&E discharge summaries, as it helps ensures that practices receive patient’s discharge summaries including notification of medication
changes etc. within 24 hours of a patient’s discharge, if not sooner, compared to 2-3 days via post. If this is of interest or you would like to discuss this further please contact Justine Currie, GP Relationship Manager
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 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. If your practice would like to participate in this testing phase between February and March, please contact justine.currie@chelwest.nhs.uk
Weekly Noticeboard Roundup The following is a summary of news items from the preceding weekly noticeboard news items that are disseminated via CCG bulletins:
Early Pregnancy Assessment Unit extended opening times The EPAU at Chelsea and Westminster Hospital is now open on Monday and Thursday evenings and alternative Saturdays. Monday: 9-1pm, 2-4pm, *NEW* 5-7pm Tuesday: 9-5pm (closed 1-2pm) Wednesday: 9-5pm (closed 1-2pm) Thursday: 9-1pm, 2-4pm, *NEW* 5-7pm Friday: 9-5pm (closed 1-2pm) Saturday: *NEW* 8.30am – 1.30pm (alternative Saturdays from 17 January 2015)
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Please note patients for EPAU are seen by appointment only. Any queries, please contact EPAU on 020 3315 5073. Maureen Morgan – Women’s Services Coordinator, Chelsea and Westminster Hospital.
Orthopaedic referrals redirected to local Musculoskeletal Services From Monday 19 January 2015, as part of local QIPP plans, our commissioners have asked us to vet all Orthopaedic referrals sent to Chelsea and Westminster Hospital and redirect any suitable patients to local Musculoskeletal (MSk) services where it is clinically appropriate to do so. Typical waiting times for MSk services range from 2-6 weeks where as Orthopaed referral waiting times to be seen in secondary care can be up to 12 weeks so we hope this changes will improve patient experience and access. Referrals will be vetted by the ESP team at Chelsea and Westminster Hospital and the following exclusion criteria has been agreed as not being suitable for redirection to MSk: Patients under 18 years of age Patients already seen by MSk for that condition/joint Patient agreement to proceed to surgery Other clinically urgent referrals The redirection pathways have been agreed with the MSk teams in Hammersmith and Fulham, Central London, West London and Wandsworth CCGs. Patients and GPs will receive notification that the referral has been redirected to an MSk service and we are finalising a patient information leaflet that we will be distributing to patients to help explain these changes
Between 8am-6pm Monday to Friday, you can now dial 0203 315 5000, select from 6 options and be transferred to the selected consultant mobile (with the exception of Gynaecology where the Lead Nurse will answer the phone and then liaise with the relevant consultant as required). Option 1 – Medical Option 2 – Surgical Option 3 – Paediatrics Option 4 – Women’s Services Option 5 – Older People Services *NEW* Option 6 – Voicemail (to request a call back in four hours) Please note that this number is a dedicated number specifically designed for GPs. Please do not give this number out to patients or advertise this number publically. Add the GP Advice Line - 0203 315 5000 - to your contact database today and download a flyer for your consulting room here: www.chelwest.nhs.uk/gps/links/gpsap.pdf
How to access consultant advice via the web: We are delighted to report that we have received two hundred GP queries via our new GP advice webform to date. Have you tried this service yet?
Consultant Advice by web and phone
To access this service and get a consultant response within 24 hours (Monday to Friday) go to: https://nww.gpadvice.chelwest.nhs.uk
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Please note the website is only accessible from an N3 enabled computer
Does your patient wish to be seen privately? Did you know Chelsea and Westminster Hospital has dedicated private patient facilities for Fertility, Maternity, General Surgery, Medicine, Dermatology and Paediatrics? To make a private referral: T: 0203 315 8484 E: private.enquiry@chelwest.nhs.uk
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
Ultrasound Waiting Times Update We have received queries about our current ultrasound waiting times. To confirm routine ultrasounds are completed within six weeks with the exception of MSk ultrasounds requiring an injection (which are classed as therapeutic and are not covered by the 6 week diagnostic standard). Current waiting times for therapeutic MSk ultrasounds are approximately 12 weeks. We are currently seeing 175 MSk ultrasound patients a week (140 of those typically requiring injections) however demand for MSk ultrasounds has grown significantly over the last few years and we are currently exploring options to increase our capacity but this is a national problem so it’s not an easy fix. Alan Kaye – Diagnostics Service Manager
Patients’ Support Service Do your Patients require assistance when coming to outpatient appointments? The Friends Patient Support Project has developed a volunteer-led escorting service for patients coming to Chelsea and Westminster Hospital on
their own who have additional support needs. This service encompasses being greeted on arrival at the main entrance or transport lounge, escorted to their appointment and ensuring any patient needs whilst on site are met. The types of patients that could benefit from this service include the elderly people with additional support needs people who are anxious to attend the appointments on their own and need emotional support. This service is known as ‘By Your Side’. The By Your Side service is different from the Hospital portering service in that it is a “one to one” service, tailored on the needs of the patient who request the service. For example, a recent patient requested the service as she comes to hospital with her guide dog and needed someone sitting with the dog, while she is having the X-ray. Here’s what patients had to say about the ‘By Your Side’ service:
‘Having someone looking after my husband (with Alzheimer) while I was having my text done, gave me such peace of mind’ ‘Knowing that when I arrive at the Hospital someone will wait for me and stay with me, takes away all the stress’ To request the ‘By Your Side’ service for a patient, please complete the referral form at least one week ahead of their appointment: http://www.chelwest.nhs.uk/yourvisit/request-additional-support
GP Survey – Give us your views Do you have feedback or suggestions for how we can improve your experience of working with Chelsea and Westminster Hospital? Here’s your chance to let us know what we do well and what we can improve www.surveymonkey.com/s/GPSurveyOct2014
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Your feedback to this 10 question survey is invaluable and will allow us to ensure we focus our energies on the areas and business process improvements that will most benefit you and your patients.
This programme will take less that 10 minutes and 99% of GPs have found this to be a useful programme.
GP Training
https://www.surveymonkey.com/s/Chelsea UDT
North West London Paediatric Surgical Network Study Evening
Upcoming GP Education Sessions
The online module is accessible:
Orthopaedic ‘Sports Injury’ Session – March 2015 Bariatrics Session – April 2015 Paediatrics Session - May 2015
Tuesday 10 February 2015, 5.30-8pm Venue: Gleeson Lecture Theatre, Lower Ground Floor, Chelsea and Westminster Hospital Challenges in Paediatric Testes Management 5.30-6.00pm: Tour of Chelsea Children’s Hospital Surgical Facilities followed by refreshments 6.00-6.30pm: Paediatric Orchidopexy: When, where and by whom? - Will Sherwood 6.30-7.00pm: Paediatric Acute Scrotum: A Network Guideline – Nisha Rahman and Simone Eccles 7.00-7.30pm: Medico-legal aspects of Acute Scrotal Exploration – Peter McDonald 7.30-8.00pm Discussion RSVP: m.farrugia@nhs.net
Dates and times of these sessions will be confirmed shortly.
Next Edition In the next edition of GP News will be doing a deep dive into Chelsea and Westminster Hospital’s proposed integration with West Middlesex University Hospital. This will cover: -
The rationale for the proposed integration Integration Timeline Proposed benefits for patients and GPs Key facts about West Middlesex University Hospital Clinical perspectives on the integration
Marie-Klaire Farrugia, Consultant Paediatric Urologist
Online Paediatric Testes Management Module now available to GPs The Chelsea Children’s Hospital has developed an educational programme on the management of children with undescended testis The management of undescended testis is changing due to better understanding of the pathophysiology. This educational programme aims to show us the current practice and to provide you with an educational summary of current evidence and recommended practice.
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