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Member Practice Update

11 April 2018

Welcome to the member practice update

This weekly member practice update is produced by NHS Redditch and Bromsgrove, NHS South Worcestershire and NHS Wyre Forest Clinical Commissioning Groups for circulation in your practice, to provide you with essential guidance, information and useful support.

Your views and feedback are very much appreciated. If you have any comments, suggestions or contributions for inclusion in the Member Practice Bulletin, please e-mail the communications team.

In this issue:

Find out about local and national events and training here.

  • No Redditch and Bromsgrove specific news
  • No South Worcestershire specific news
  • No Wyre Forest specific news

PCE 2018/20 Update

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Thank you to the 34 practices who have returned their signed PCE contract. We know that 28 practices are in the process of arranging full signature once partners have returned from Easter leave next week.

Mild Cognitive Impairment (MCI)
Dr Anthony Kelly has drafted the following statement to clarify issues raised in relation to MCI:

MCI is an ill-defined term implying a memory problem greater than that expected by the age of the individual but not severe enough to warrant a diagnosis of dementia. The fact that the code is ill defined is a positive as it allows the clinician to use this code without further consequences in workload or implications for patient disclosure.  The patient relatives or friends may flag this up. It is important to point out that patients with this code do not necessarily deteriorate to a point where dementia becomes an obvious diagnosis.

We are asking primary care to use this code to build a register, initially as an opportunistic 'aide memoire' so that the consulting clinician when faced with the patient can ask the question has this individual's cognition deteriorated to a point where they could be categorised as suffering from dementia, and thereby aiding early intervention.

End of Life Information
We are sorry to report that there will be a delay in issuing the end of life information  detailed in the PCE Offer letter, as Dr Clare Marley is on sick leave for at least the next two weeks. We will have the information to practices by the end of April. We wish Clare a speedy recovery.

Referrals for Diagnostics
In response to feedback, this year’s PCE dashboard will identify  direct access endoscopy referrals, read codes 8HS and 8HS0, as a separate line within the Top 20. This will allow groups to track and encourage this referral route without having to rework current baselines.

MSK Policy Reminder

Members will be aware that the CCG recently re-launched the revised commissioning policy for facet joint and spinal epidural injections (full policy) following publication of National Guidance in 2017 in relation to the Management of Back Pain by both the National Institute for Health and Care Excellence (NICE) and the National Back Pain Pathway. In light of this evidence the Worcestershire Clinical Commissioning Groups together with Specialist Pain Consultants undertook a review of the current policy for use of spinal interventions. Both of these publications identified that there was insufficient published evidence to demonstrate the clinical efficacy of facet joint injections and repeat spinal epidural injections.
Worcestershire Commissioners have a responsibility to consider national guidance, particularly when an invasive intervention is not considered effective. Consequently facet joint injections and repeat spinal epidural injections are no longer commissioned and such interventions will not be offered for any new patient referred after 31 October 2017.
The mainstay of treatment, supported by published evidence, for the management of back pain is functional restoration; Worcestershire Commissioners are reviewing the current services offered with a view to enhancing availability of functional restoration for patients presenting with back pain.
Given the revised commissioning policy, patients who have had a previous facet joint or spinal epidural injection who are referred back into pain management services should not be given expectations that they will be offered a repeat injection. The Pain Management Consultants will determine the treatment options best suited for individual patients. Worcestershire Acute Hospitals NHS Trust is aware that they should not request practices to seek IFR funding from Commissioners, for repeat injections, as this is not an appropriate mechanism in this circumstance. The CCGs are currently working with the pain management service to establish options for those patients considered to be highly complex for whom existing services are limited or have been exhausted.
The Worcestershire Clinical Commissioning Policy Collaborative together with Pain Management Consultants will continue to monitor the evidence base for these interventions and revisions to this position may be made in light of published updates to local and national evidence of effectiveness and cost effectiveness and/or recommendations and guidelines from local, national and international clinical professional bodies.

Consultant Connect – Acute Surgery 

Acute Surgery has now been added to the list of WAHT specialties on the Consultant Connect system.

We know that GPs have been frustrated by low answering rates, but the Acute Surgery consultants really want GPs to call before sending patients and so we anticipate that their pick-up rate will be good.

Work is ongoing to engage with additional WAHT teams to progress to offering the system across the Top 20 Specialities, as well as continuing to support existing teams to improve call answering rates.

Thank you for your continued support in using the system.

Diabetes Prevention Week

As highlighted in last week's update, Diabetes Prevention Week is taking place 16-22 April.

To support the week, some events have been organised to help raise awareness of the Healthier You: NHS Diabetes Prevention Programme which is available to support patients who are at risk of developing Type 2 diabetes.

An Event will take place at Wildwood in Worcester on 18 April, programme trainers and people who have accessed the service will be in attendance, so if you'd like to find out more about the programme, you can pop in between 1-2.30pm. There's also an event planned at Hume Street Medical Centre on 20 April and we're looking into the possibility of an event in Redditch/Bromsgrove.

If you're practice is planning any events for the week, let us know by emailing worcs.comms@nhs.net

More information about the programme can be found at https://preventing-diabetes.co.uk/

Prescribing Top Tip

Classification of Movelat® Products - Clarification

Rubefacients such as Movelat are included in the NHSE low value medicines list and should not be routinely prescribed in primary care.

The classification of Movelat® (salicylic acid/mucopolysaccharide polysulphate) as a rubefacient rather than a topical NSAID has recently been challenged by the manufacturer. The basis of the challenge is a recent change to the Movelat® SPC with respect to the mucopolysaccharide component, which is now referred to as a ‘non - steroidal drug’.

It is the view of Worcestershire CCGs and national organisations such as Prescqipp that the product should continue to be considered a rubefacient. In their opinion the mucopolysaccharide component cannot be considered a NSAID, since:

  • The BNF does not list Movelat®
  • Mucopolysaccharide polysulphate is not listed as a NSAID
  • The BNF states - NSAIDs reduce the production of prostaglandins by inhibiting the enzyme cyclo-oxygenase. They vary in their selectivity for inhibiting different types of cyclo-oxygenase; selective inhibition of cyclo-oxygenase-2 is associated with less gastro-intestinal intolerance. This is not how mucopolysaccharide polysulphate works
  • The WHO classification of mucopolysaccharide polysulphate has not changed.

If you have any suggestions for inclusion in the 'Top Tips' then please send them to akingham@nhs.net

Primary Care Digital Transformation Regional Conferences

Digitalising primary care is the foundation of a modern, efficient and responsive NHS. The benefits of its wider use are already being shown with 14m patients now using GP online services and taking more control over their health care – saving time for themselves and practice staff.
These Primary Care Digital Transformation Events are scheduled for the 19 and 24 April 2018. View the agendas below.

19 April - Granta Centre, Great Albington, Cambridgeshire, agenda
24 April - Doubletree Hilton, Coventry, agenda

These events are open to GPs and practice staff and will consist of two parts and will be tailored to two different audiences:
  • The morning session is aimed at GPs and their GP Practice Staff and will provide useful information which can be adopted by practices, along with support in offering GP Online Services to patients. Practices will get a clear idea of the benefits they can achieve with a comprehensive implementation of online services.

  • The afternoon session is aimed at CCG Chief Information Officers, Chief Clinical Information Officers and Primary Care Commissioners and will cover the vision for general practice and the importance of taking advantage of digital opportunities in improving clinical outcomes and GP practice efficiency.

Please register for either of these events now by following the below links:

Primary Care Talks second podcast available for healthcare professionals  

The Eastern Academic Health Science Network has recently released its second podcast in the series “Primary Care Talks”  that explores innovative ways of managing primary care under pressure. This episode features Dr Hasan Chowhan interviewing Dr Miles Langdon on the NHS Primary Care Homes model.

Each episode of the podcast aims to uncover the secrets of successful primary care teams working in the NHS today. The Primary Care Talks host, Dr Hasan Chowhan, interviews fellow GPs to find out about some of the smartest approaches to improving efficiency and productivity, and driving the future of healthcare.

Training Day for Primary Care Practitioners

Osteoporosis and metabolic bone diseases
12 September 2018 - Central Birmingham

Run by the Bone Research Society, this one-day training course aims to help GPs and other primary care practitioners to better manage patients with metabolic bone diseases. Taking into account the restrictions of primary care and the 10-minute consultation, the course will focus on providing practical and actionable information. Topics will cover the diagnosis and treatment of osteoporosis and other metabolic bone diseases, including:

  • Raised calcium/hyperparathyroidism
  • Raised alkaline phosphatase/Paget's disease
  • Fracture risk assessment
  • Duration of treatment and drug holidays in osteoporosis
  • Calcium supplements - do we need them?
  • Osteogenesis imperfecta
  • Renal bone disease/osteodystrophy
  • Falls
  • Rickets

Further information and registration at: www.boneresearchsociety.org


Domestic Abuse Awareness Event

Two free domestic abuse awareness events will be delivered on behalf of the Worcestershire Forum Against Domestic Abuse.

These events are for any person that may come into contact with women, children and men who may be exposed to domestic abuse. Since 2013 some 1500 professionals have attended these events with fantastic feedback and improved practice.

The event will include inputs from The Forum, West Mercia Police, West Mercia Women's Aid, the Male Recovery Service and most importantly the powerful voices of survivors of domestic abuse. These events will give professionals a good overview and understanding of abuse, the services that are available in Worcestershire and a will provide delegates with a better understanding of the barriers to leaving an abusive relationship.

Attendance at this event  contributes to your professional revalidation and Safeguarding education hours.
The events are at The Granary Hotel, Heath Lane, Shenstone, Kidderminster, DY10 4BS between 9.30am – 2.30pm on Tuesday 26 June 2018 and Thursday 29 November 2018.
To book a place email wfadaevents@worcestershire.gov.uk

Find out more here.