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Member Practice Update

14 March 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

Umbrella Pathway - Concerns and need for further follow up  

A letter from Philipa Coleman - Interim Lead Commissioner for Children and Families is now available to read in full below:

Dear Colleagues

Further to the letter dated 12 February about referrals to the Umbrella Pathway, a number of concerns and comments have been received about a lack of clarity and guidance for GPs, for which I apologise.

I can confirm that referrals will now only be accepted for assessment where an appropriate early help/graduated response has been implemented in relation to the child's needs and/or there is a completed Umbrella referral form with significant evidence indicating the likelihood of ASD. We understand that some parents currently visit their GP and ask for a referral to the Umbrella Pathway on the advice of their child's school and that GPs will not usually be in a position to fully complete the Umbrella referral form.
Instead, we would suggest that you:

Advise patients to speak with the school head teacher or SENCO. Schools are also being advised of the new referral guidelines. Schools are able to access support from the Autism/Complex Communication Needs team and educational psychology and to refer directly to some health services including community paediatrics (referrals accepted from SENCOs), speech and language therapy, CAMHS and Reach 4 Wellbeing. SENCOs can also refer to the Umbrella Pathway in line with the new guidance if the referral is supported by a professional who is involved in the Umbrella Pathway; and/or

Refer to a specific service appropriate to the child's presenting need, e.g. a paediatrician for concerns about developmental delay or disorder in more than one domain (www.hacw.nhs.uk/our-services/childrens-community-health-services/community-paediatrics/how-to-make-a-referral/) or speech and language therapy for concerns about speech, language, communication or feeding/swallowing.

Best wishes

Yours sincerely

Philippa Coleman
Interim Lead Commissioner – Children and Families

Promoting Clinical Excellence Engagement Presentation Update 

We have now met with over half the practices in Worcestershire to review the proposed PCE contract for 2018/19.  There has been a lot of really good conversations and engagement around the new contract and we would like to thank everyone that has contributed to this process.

Through this interaction practices have identified a need to include some additional information in the Repeat Prescribing and Out Patient Follow Up slides to provide more clarity.  You will find the updated slides here for your review.

IQSP Study Day Reminder 

21 March CCG Half-Day Study Event. FINAL REMINDER.

This is the date of the Promoting Clinical Excellence/IQSP half-day study event at the Pear Tree Inn at Smite in Worcester.

A light lunch will be served at 12:30 and the meeting will start promptly at 1:00pm

Attendees should be:

  • The contracted/named Clinical Lead GP for each of the 15 PCE groups (or if unable to attend a clinical representative in their place) - apologies but places are limited to contracted group leads only or a representative in their place
  • One GP representative from each practice – if the practice is not already represented by a PCE lead (see point 1)
  • Practice Management – practice and business managers are welcome to join the meeting in the afternoon from 4pm

Download the agenda here.

If you haven’t already confirmed your attendance can you please let us know by Monday 19 March.

Please email your request to: jaynehinkins@nhs.net.

Frailty Assessment Unit 

The Frailty Assessment Unit opened at the Alexandra Hospital will continue beyond 31 March 2018. As with all winter schemes an evaluation is  taking place. The Frailty Peer Review conducted in December 2017 recommended that a frailty facility was required. Work will commence involving all system partners to design the Worcestershire frailty strategy and end to end patient pathway. Whilst this work is taking place the frailty assessment unit in its current format will continue.

Please continue to refer patients meeting frailty criteria to the unit by telephoning: 01527 512102


NHS England have issued a Safety Advisory Notice to CCG’s regarding the use of the QRisk2 calculator in EMIS Web.

The official statement can be viewed via the EMIS support centre, however due to the ambiguous nature of the wording, we would like to clarify the following:

To ensure patient safety is not compromised, we strongly recommend that practices only use the EMIS Library ‘QRISK2’ template which contains the QRisk2 calculator rather than trying to mirror the requirements in a locally developed template.  The QRISK2 template is freely available to all practices and can be found in the EMIS Library > Primary Care Templates > Cardiology folders > QRISK2

If practices do decide to develop their own template, they must take appropriate steps to validate the template to ensure the scores remain accurate.

Special Allocation Scheme 

With effect from 5 February 2018 the process for requesting removal of violent/aggressive patients from a registered list has been standardised and there is now a national process known as the Special Allocation Scheme. Instead of sending a removal request form to the CCG, it now needs to be sent to PCSE (with a copy to the CCG) and they will determine whether or not a patient is eligible to be included in the Scheme.  The Worcestershire local procedure for management of such patients has been revised to reflect the change and is attached, and the form to be used is at Appendix 4. The process for dealing with patients once accepted onto the scheme remains the same.

Download SAS Procedure.

Orthoptic Secondary Screening 

Practices will be pleased to know that the Orthoptic Secondary screening that has been on hold for the past year is now back up and running. Please feel free to refer any children with a query squint to this service, as before. A copy of the referral protocol is available below as a guide.

Download HV Pre-school Pathway.

GP Resilience Programme 

Last year the CCGs were fortunate enough to receive a small amount of funding for resilience support via a bidding process last year. Three practices also submitted their own bids (via the CCG) and secured some funding.  

We have been informed NHSE has sent a letter directly to practices with a form to fill in and a cut-off date 8 May. This is the day CCGs must send the bids into NHSE and does not account for the review process that must be undertaken but CCG with LMC support. The CCG has a separate form for this process. Any practices wishing to submit a bid for resilience should contact Jo Hall or Denise Goddard to discuss the process and determine whether the bid will meet the criteria.

These bids must be submitted to the Quality and Risk Committee by 22 April 2018 at the latest. The form sent to practices by NHSE is one that has been set out nationally and has omitted funding amounts requested and timescales; we expect this will be required as part of this process so ask this be included in any bid submitted.

Backlog of Historic GP Letters 

The Trust continues to work with the CCGs and Primary Care to determine if harm or potential harm has occurred as a consequence of this error. This work is nearing conclusion and the vast majority of letters have now been reviewed. To date only one case of harm has been identified and this is being investigated as a separate serious incident to enable system wide learning to be identified and implemented.

There remains a small number of outstanding letters requiring review. In order to expedite the reviews all GP practices have been contacted and asked to return responses as soon as possible. If you have been asked to review outstanding letters and are experiencing any difficulties please can you contact the Trust on the following email address wah-tr.SYST-ClinicalApplications@nhs.net

As you know GP’s are being paid per letter they review and funding for this is only secured until the  end of March. It is therefore essential that you get any outstanding invoices from any of the three cohorts of patients returned to the Trust by the end of March. The invoices should be sent to:

Creditor Payments Department
Worcestershire Acute Hospitals
RWP Payable 6485
NHS Shared Financial Services
Phoenix House
Topcliffe Lane
West Yorkshire WF3 1WE

Tel: 0303 123 1177

The CCGs would like to thank you for your continued support in addressing this matter.

Deadline confirmed for next wave of applications for GP clinical pharmacist funding 

The deadline for wave 5 application submissions is 13 April 2018. GP practices and other providers of general practice medical services are invited to apply for funding on an ongoing basis to help recruit, train and develop more clinical pharmacists through the secure clinical pharmacist application portal (password protected). Guidance and support in submitting an application can be found on NHS England’s website.

For queries, please contact england.clinicalpharmacistenquiries@nhs.net

National Child Sexual Exploitation (CSE) Awareness Day   

National CSE Awareness Day is celebrated each year on 18th March. The event is coordinated by National Working Group Network (NWG). NWG are committed to the fight against CSE and supporting victims and their families who are subjected to child sexual exploitation. CSE Awareness Day is a day to think, spot and speak out against abuse and raise awareness of the issues surrounding child sexual exploitation.


Find out more about National Child Sexual Exploitation Awareness Day.

DATIX – Supporting Your Quality Feedback – Your Feedback is Valued.  

The new system for reporting Quality Feedback/Service Concerns, known as DATIX has been up and running now since 01 November 2017, we are interested to hear your view on the system or if you have had problems accessing the system.

If you have not tried to use the system please can you copy this link into your browser to ensure that it is working from your practice, please note that DATIX can only be accessed via your Practice Network.

Access DATIX

The system facilitates improved communication, identifies themes and trends, and informs commissioning decisions. Feedback from patients, carers and GPs are actively sought and used to continually improve services. This information is used to prompt and guide initiatives that make measurable improvements in the quality and safety of care identified by patients, carers and staff.

Please send your feedback of the DATIX system or any access issues to kimcrawford1@nhs.net.

UTI Prescribing - Quality Premium Indicator Update 

NHSE set CCG level prescribing targets from April 2017 onwards with the aim of reducing inappropriate antibiotic prescribing for urinary tract infections in primary care. This was in response to growing resistance to trimethoprim and an associated increase in the incidence of E. coli bacteraemias.

One of these targets was to achieve at least a 10% reduction in the Trimethoprim: Nitrofurantoin prescribing ratio from baseline data (June15-May16). All three CCGs are to be congratulated as they have achieved this NHSE target.

APC Antimicrobial Guidelines For Primary Care Prescribing were updated to support this necessary change in prescribing. Nitrofurantoin remains the first line option for patients with eGFR ≥ 45mls/min, with trimethoprim reserved for where there is low risk of resistance.

The graph below shows current progress and achievement of this indicator against the NHSE target for all three Worcestershire CCGs:

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

Community Transport Message 

FAO Redditch, Worcester and Wychavon practices

A letter from Stephen Blick - Project Development Worker at CT Connections is now available to read in full below:

Dear Practice Manager

By way of introduction, I am the Project Development Worker with CT (Community Transport) Connections. Information and publicity material relating to CT Connections was sent to all GP practices in these areas in September/October 2017.

The scheme promotes hospital transport to the Redditch Alexandra Hospital and Worcester Royal Hospital, for people who are unable to access public transport or where no public transport service exists. An 0300 telephone is in operation for ease of access. For many people the scheme is a lifeline. The scheme is also extended to enable people to access hospital appointments in Birmingham and the wider area.

I would like to know if you would be interested in having a ‘pop up’ display in your surgery waiting area and some additional leaflets, which would help to promote CT Connections and the wider CT Scheme? I would also welcome the opportunity to explain more about CT Connections and CT in general, so you are more aware and therefore your patients could be more aware.

If you are interested in either of these two approaches, then please let me know. I appreciate you taking the time to look at this and the schemes do have really positive benefits for some patients. Anything we/you can do to promote transport for people (especially in rural areas), is a real benefit all round.

With Kind Regards


Stephen Blick
Project Development Worker
CT Connections
Droitwich Spa and Rural Council for Voluntary Service
The Old Library Centre
65 Ombersley Street East

Living Well... with and beyond cancer 

A free conference for patients and carers

Tuesday 24 April 2018
Droitwich Methodist Church
Worcester Road,
Droitwich Spa,
Between 09:00 - 16:15

Refreshments and lunch provided.

Download promotional flyer.

Reassurance message for members of our communities   

Please see below the advice and who to contact within West Midlands Police for anyone with any concerns in relation to the letters containing threats to Muslims that were reported in the media over the weekend.

If you have any concerns relating to this matter and are outside the West Midlands Policing area, please ring 101 and ask for your local Police Prevent Team.

Contact details for your NHS England Prevent Team are below should you have any further queries.

Andy Smith, Regional Prevent Coordinator: 07730 376175
Ian Grundy, Regional Prevent Coordinator: 07730 375482
Helen Law, Business Support: 07730 381657

New clinic arrangements at John Anthony Centre from March 2018 

All clinics at John Anthony Centre for Sexual Health & Gum are now by pre-booked appointment only.

Short Notice Pre-bookable appointments Monday to Thursday available by phoning on: 0300 123 1731

  • Monday afternoon clinic call Thursday: 14:00 - 15:30 or Monday 10:00 - 11:30
  • Tuesday morning clinic phone Monday: 17:00 - 18:30
  • Wednesday morning clinic phone Tuesday: 13:00 - 15:00
  • Thursday afternoon clinic phone Thursday: 09:00 - 11:00

Limited number of advance Pre-bookable clinics:

  • Monday:  09:00 - 11:30
  • Tuesday:  13:30 - 15:30
  • Thursday: 09:00 - 11:00 (Contraception implant fitting)

Phone 0300 123 1731 for availability. If you are unable to keep your appointment, please send a text stating your name or patient number to 07879636294 or phone 0300 123 1731.

Information on other services and clinics can be found on our website: www.knowyourstuff.nhs.uk