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Member Practice Update

13 June 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 


Clinical Commissioning Policy Update / Treatments of Limited Clinical Benefit 

Prior Approval Phase 9 – 8th June 2018

Practices are requested to note the latest release of new commissioning policy detailed in the table below. The “go live” date for adoption of the policy and implementation of prior approval is 9th July 2018. Please note the actions required by primary care.


Policy Status

Key Points

Primary Care Actions

Symptomatic Knee Pain

(MSK Policy)

Revision to existing policy

Development of new pathway for management

Acute provider required to seek prior approval for treatment

Symptomatic Knee Pain Pathway is essentially a “Non-osteoarthritis” Pathway; Patients with OA to be managed via OA pathway

Two GP knee referral forms: Symptomatic Knee Pain (non-OA, non-trauma) or Consideration of Hip/Knee Replacement surgery (OA); the latter already in use


  • X-rays (anteroposterior weight bearing, lateral) to establish red flags or osteoarthritis (OA)
  • Knee MRI no longer available for primary or intermediate care providers


  • Urgent referral to trauma clinic (or A&E) for trauma and red flags
  • Early referral for “True mechanical symptoms” as defined to intermediate provider
  • Routine referral for patients who fail non-operative interventions over 6 months and without evidence of OA
  • Community Based Physiotherapy Service being established in R&B CCG to accommodate this pathway

Arthroscopic intervention limited to patients who benefit (without OA)

Load new referral template onto EMIS

Ensure all doctors utilise the referral template and can access the full commissioning policy

Link to policy

Other Commissioning Policy News and Issues

(1) Management of historic Patients who have received Facet Joint or Spinal Epidural Injections

It is acknowledged that there is a small cohort of highly complex patients who have previously received a facet joint or spinal epidural injection and are proving very difficult to manage in primary care.  It is suggested that patients who fit into this “highly complex” category are referred back into pain management services for consideration of alternative treatment options.

(2) Referral Templates

Where referral templates are provided by the CCGs these MUST be loaded onto EMIS and used as the main referral source rather than sending providers individual patient letters

Important Update from Pregnancy Advisory Service  

The pregnancy advisory service is moving forward electronically and will now only be accepting referrals via their email:


Download the updated referral form.

A dedicated team of nurses and doctors are available via this email account, please contact them with any queries or enquiries that will be addressed in a timely manner.

GCA Fast Track Service  

Since the introduction of the new Worcestershire GCA pathway WAHT has seen an unanticipated rise in the number of suspected GCA referrals. This has led to a strain on AEC and has highlighted their limited experience of managing this difficult condition. As a result WAHT have decided to pilot a GCA fast track service within rheumatology.
The service commenced 1 June 2018. There are 2 dedicated GCA clinics per week offering a total of 5 new patient slots. Patients will be seen and undergo temporal artery scanning in a one-stop clinic and will be seen within 2 working days of referral. The clinic slots will be exclusively for referrals from primary care during the pilot period. Referrals will only be accepted by fax of the referral form available here. Patients must meet the clinical criteria for suspected GCA and atypical cases will need to be discussed. Patients with visual symptoms should be referred directly to Ophthalmology as per the current pathway.

It's anticipated that 5 slots per week should be easily sufficient for this rare condition. If all clinic slots are full GPs will be advised to refer patients to AEC as per the current pathway.
Auditing of the quality of referrals and patient outcomes will take place during the 2 month pilot period.

STP Stakeholder Briefing  

The latest STP Stakeholder Briefing is now available to read.

Access it here.

CCG Key Messages for June 2018  

The CCG Key Messages for June 2018 are now available to read.

Access them here.

Paper Switch Off at Gloucestershire Hospitals NHS Foundation Trust – 4 June 2018  

Whilst 1 October 2018 is the absolute deadline for NHS e-Refferals, locally a project group including representation from Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire CCG, NHS Digital, and the Local Medical Committee agreed to a paper switch-off date for GP referrals to Consultant led services across all specialties of 4 June 2018. This date has been further ratified following a ‘soft launch’ period which showed that e-RS utilisation rates were sufficiently high enough to proceed with the earlier switch off date. 

If you have any queries please contact the Gloucestershire Hospitals NHS Foundation Trust e-Referrals Paper Switch off email address:


Link change for raising Adult Safeguarding Concerns  

Worcestershire County Council has changed the link for reporting a safeguarding concern electronically for ADULTS ONLY.

The new link is: ylyc.worcestershire.gov.uk/raising-an-adult-safeguarding-concern/

Prescribing Top Tip  

Stoma Deodorants

Stoma deodorants form part of the 18/19 PCE contract and are listed as Worcestershire “Do not prescribe” items; prescribing is therefore NOT supported in Worcestershire. If a stoma bag is correctly fitted, no odour should be apparent except when it is emptied or changed and the expectation is that standard, purchased, household air fresheners should be used if and when needed. If odour is present at times other than changing or emptying then the patient should be referred to a stoma nurse specialist.

This letter can be found on the ‘prescribing resources for clinicians’ section of the APC website and can be sent to patients currently receiving stoma deodorants on repeat prescription.

An EMIS search identifying such patients forms part of the PCE searches and can be found at
Worcestershire PCT search & reports - Medicines management countywide – Worcs items which should not be prescribed – Stoma deodorants.

12 month’s prescribing data to the end of March 2018 for all three Worcestershire CCGs is shown in the table below:


Total Cost of Stoma Deodorants April17 – Mar18

Redditch & Bromsgrove


South Worcestershire


Wyre Forest




It is recognised that specialist stoma nurses may occasionally recommend deodorant products that have a dual function for specific clinical problems, e.g. deodorant lubricant drops for ‘pancaking’ (where stool sits at the top of the bag). In this situation it would be appropriate to document this as a clinical exception, use the read code 8b3o8 and record that this is on the recommendation of a stoma nurse specialist in the patient’s notes.

The Community Stoma Nurse Specialists contact details are:

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

Emphasis on Workforce  

As part of the GPFV workforce plan apprenticeships for admin staff has been highlighted as a key recruitment and training vehicle. More information on how an apprentice might benefit your practice can be found here on the Herefordshire and Worcestershire Training Hub.

Physician Associates is another area which has the potential to become a very valuable part of our workforce in the future.

Find out more.

Hereford and Worcester AAA Screening  

Hereford and Worcester Abdominal Aortic Aneurysm Screening Programme now has a facebook page.

Access it here.

CSE Bulletin  

The latest Child Sexual Abuse and Exploitation Bulletin is now available to read.

Access it here