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Member Practice Update

  11 July 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.

Treatment of samples in hot weather  

Message sent on behalf of Worcestershire Acute Hospitals NHS Trust

Unfortunately the hot weather is causing a few problems with some samples. Specifically this relates to samples that are spun (centrifuged) before they are sent to the laboratory. In samples that are spun then left on their side in the heat we are seeing the separator gel melting and then resettling in a position that does not protect sample integrity.

Could we ask that any SPUN SAMPLES ONLY are stored upright in a fridge until they are sent to the laboratory. UNSPUN SAMPLES should not be refrigerated.

Rheumatology Services at Worcestershire Acute Hospitals NHS Trust

The CCGs have been asked to clarify that Rheumatology services at WAHT are available to patients aged 18 and over.  

Birmingham Women’s & Children’s Hospital will only accept patients who are under the age of 16.   Where a patient is being treated at Birmingham Women’s & Children’s reaches the age of 16, Commissioners expect the treating organisation to agree transitional arrangements with an adult service to ensure smooth transition by their 18th birthday.

For patients who are between 16 and 18 when they are diagnosed, please refer to University Hospitals Birmingham or Dudley Group of Hospitals as they accept patients who fall within this category.

If there are any issues with transitional arrangements, Commissioners recommend discussions with the key clinicians responsible for the patient’s current care pathway in the first instance.

Principles of the Mental Capacity Act for GPs

A Learning Briefing on the ‘Mental Capacity Act update 2018’ has been developed, highlighting the principles of the MCA and the key areas affecting GPs.

These are:

  • Individuals are presumed to have capacity.
  • All practical steps must be taken to support someone in decision-making.
  • A person is not to be treated as lacking capacity merely through making an unwise decision.
  • An action taken on behalf of a person must be in their best interests.
  • Regard must be had as to whether an act or decision is the least restrictive of a person's rights and freedoms.

The MCA prohibits blanket decision-making on behalf of people with capacity issues and introduces a functional test of capacity that is time and decision specific.

It requires everyone who cares for or treats people with capacity issues to respect their individual rights and to act in their best interests when making decisions on their behalf.

For example, if a patient suffers from early stage dementia, and needs to make a decision on whether to have the flu jab, the GP should make every effort to communicate the pros and cons of having the treatment when the patient is most alert. This is so that the patient can make a decision.

A GP becomes the decision-maker only if the patient lacks the capacity to make that decision for them and has not made an LPA granting an attorney or attorneys the power to make decisions about medical treatment. GPs must make the decision for the patient in their best interests and need to know when they can and cannot disclose confidential information.

Other key areas of the MCA affecting GPs are:

  • Independent mental capacity advocates (IMCAs).
  • The ability for adult patients to make a lasting power of attorney (LPA).
  • The establishment of a new Court of Protection.
  • Court-appointed deputies. GPs need to be aware of people appointed to these roles and when to involve them in decision-making about patients who lack capacity.

Access the full briefing here

Also, as advertised in the last week's Member Practice Update, a number of mandatory Prevent and Domestic Abuse training sessions are available to book on to, as well as Safeguarding Adults, MCA and DOLS training too. More information on these is available on the Training and Events page - 

Referrals returned to Practices due to Consultant Retiring 

The CCG is aware that there have been isolated cases recently where WAHT have returned referrals to Practices  because the Consultant who was referred to has retired, the Trust have then asked the Practice to re-refer the patient. The CCG has informed the Trust that this process is not permissible and must terminate, the Trust accept that and will work with affected Practices to resolve any issues, the CCGs expect patients to be returned to the appropriate place on the waiting list.

If there any concerns form Practices please contact simon.gartland@nhs.net

Gynaecological and Uro-gynaecological common conditions and treatment guidelines 

Following a review of opportunities identified by RightCare data, the Gynaecological and Uro-gynaecological pathways were highlighted for review.

One of the pieces of work to come out of the this review, was the development of a document with common conditions and treatment guidelines to assist GPs in the treatments of patients, to standardise pathways and help to reduce unwarranted hospital admissions.

This document is currently going through some final checks, and is expected to be officially launched towards the end of July. We hope that these guidelines will help support you and your colleagues in providing high quality care for patients accessing these pathways.


Prescribing Top Tip  

A major focus of the PCE contract over 2017/18 involved practices reviewing asthma patients and switching where applicable from Seretide® Evohaler to the preferred Worcestershire formulary options, Fostair® and Flutiform®.

The table below illustrates how successful this program of work was over the course of the financial year compared to the respective figures for 2016/17: (NB figures include generic salmeterol/fluticasone)


Items 2016/17

Items 2017/18





Reduction in Items 2016/17 v 2017/18

Reduction in Spend 2016/17 v 2017/18





























The graph below details the monthly reduction in spend during the course of 2017/18 for all three Worcestershire CCGs:

Although there are still opportunities for further savings, practices are thanked for their engagement with this work-stream which has resulted in the delivery of a considerable countywide reduction in prescribing costs in this area.

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

Worcestershire Acute Hospitals NHS Trust AGM 

Please see below an invitation to the Worcestershire Acute Hospital NHS Trust AGM.

If you would like to attend, please confirm on the email included on the invitation.

Access the invitation here.

Action on Measles – Stop the Spread

Measles cases continue to rise across England and also Europe in those who haven’t received both MMR vaccines.

While vaccine uptake levels in the UK in young children are currently very high, coverage levels dipped to a low of 80% in 2003. This means that there are significant numbers of unprotected teenagers and young adults who could catch measles both in England, particularly in environments of close mixing such as summer festivals and when they travel abroad for the summer holidays.

It is not too late to give the MMR to any young person who hasn’t had it or has incomplete vaccination history. Many young people may not know if they have been vaccinated so it is worth checking when they attend GP or Nurse appointments and offering opportunistically.