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Member Practice Update

6 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 South Worcestershire specific news   
  • No Wyre Forest specific news 

MRI Protocol for Prostate Patients  

In recent weeks Worcester Acute Hospitals Trust has been working on the development of a straight to MRI process for prostate patients. From Tuesday 8th May Worcester Acute started running a test process for 12 weeks to assess the impact and outcomes of a straight to MRI testing service for prostate patients. 

This is a clinically driven internal pathway change within the trust that involves bringing forward the MRI appointment to enable the MRI results to be discussed at the patients’ first outpatient appointment. The MRI will be requested by the Consultant.

In this way Worcester Acute hope to reduce the wait currently experienced for this test and thus reduce the time to diagnosis and treatment for a greater proportion of prostate patients.

In light of this change we would now ask GP colleagues to inform patients that:

  1. they are on a two week referral pathway  and why.
  2. they will receive an outpatient appointment date within 2 weeks
  3. once the Consultant Urologist has reviewed the referral they may be called for an MRI scan prior to their outpatient appointment.

See the new process below:

Prostate Referral

Worcester Acute are capturing data and reviewing as they progress and subject to any adverse outcomes they anticipate that this will become the norm for this process after the testing is complete. 


NHS e-Referrals - Paper Switch Off at Gloucestershire Hospitals NHS Foundation Trust  

As you will be aware, the Standard NHS Contract for 2018/19 requires the full use of the NHS e-Referral Service (NHS e-RS) for all consultant led first outpatient appointments. From 1 October 2018, providers will no longer be paid for activity which results from referrals made other than through the NHS e-RS. NHS England and NHS Digital are driving this programme with Trusts and CCGs across the Country, and it’s being referred to as 'Paper Switch Off'.

Whilst 1 October 2018 is the absolute deadline, 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. 

Referrals not sent by e-RS after this date will be returned to the referring practice and will need to be submitted via e-RS. If you have any queries please contact our dedicated NHS e-Referrals Paper Switch off email address.

Spinal Cord Stimulator service  

NHS Dudley CCG has recently confirmed that Dudley Group of Hospitals has served notice on the Spinal Cord Stimulator service (provided as part of the pain management service). The service will no longer be available from 31st May 2018 as their lead clinician, Professor Jon Raphael, is leaving the Trust. 

For existing Dudley Group Spinal Cord Stimulator patients:

NHS Dudley CCG and Dudley Group of Hospitals NHS Trust have agreed the attached information, which has already been sent to any patient who has received a Spinal Cord Stimulator from this service. This letter advises them of the closure and the recommended alternative providers for this treatment going forward. In addition, the Dudley Health Economy has sent a separate letter to their GP to inform them of this change in service at the same time. The letter includes an attachment detailing the closest providers of SCS, however, the choice of provider will depend on the device that the patient has fitted. 

Download the GP letter, Patient Letter & Centres for SCS List.

For NEW SCS Patients:

As referrals for SCS are made by Consultants in Pain Management, Worcestershire CCGs will share the list of providers with our local Pain Management Service at Worcestershire Acute Hospitals NHS Trust to ensure they are aware of the change in service provision.

Carbapenemase Producing Enterobacteriaceae (CPE) Quick Guide  

Due to an increasing incidence in the number of CPE cases and contacts being identified, a number of these are now registered with Worcestershire GPs and/or living/residing in Worcestershire care homes. To promote appropriate management and enhance knowledge the attached ‘CPE Guide‘ has been developed in line with the PHE Non-Acute CPE Toolkit. The attached CPE Guide will support care homes in their management of residents when identified with a Carbapenemase Producing Enterobacteriaceae (CPE) or if a contact following a recent healthcare admission that requires screening. This guide will be issued to the home by the Infection Prevention Nurses alongside an information  leaflet.

To assist with the awareness of patients who are a CPE carrier, we strongly advise that you add the code 65QJ to any patient identified as a carrier.  This code should be added as an ‘active significant problem’ to enable it to be picked up easily in associated patient correspondence.  To add further visibility of this problem / code, an EMIS alert protocol has been created.

Download the Reference Guide, EMIS protocol and instructions for adding this to your EMIS system.

A further development is planned for a warning alert to be activated by OptimiseRx if antibiotics are prescribed for patients with the CPE carrier code included in their clinical record. We will notify you once this becomes available.

Prescribing Policy  

An updated Worcestershire Prescribing Policy has been approved by the CCG and has been added to the website: Prescribing Policy

The policy outlines the expectations for NHS prescribing, detailing standards that all prescribers are expected to adhere to. It also seeks to provide clarification for prescribing situations not covered by the NHS or where NHS responsibility for prescribing is not clear.

Areas covered include:

  • Prescribing against national and local guidance
  • Prescribing following a private consultation
  • Patients travelling abroad
  • Travel vaccines
  • Occupational health vaccines
  • Prescribing licensed medicines for an unlicensed use (off label)
  • Prescribing unlicensed medicines/ substances not in the Advisory Committee on Borderline Substances (ACBS)

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


Improving Access - Resources  

Promote Extended Access in your practice, as part of the 'Extended Access Core Criteria'  ensure services are advertised to patients, including notification on practice website, poster display and social media.

Download an poster here or access the full suite of resources here.

Please continue to promote the 'GP Extended Access Survey' to your patients, the link is: www.surveymonkey.co.uk/r/WorcsAccess

STP Stakeholder Briefing  

The latest STP Stakeholder Briefing is now available to read.

Access it here.

R&B: COPD Telehealth 

Redditch and Bromsgrove CCG has the highest numbers of patients registered with COPD and comparatively the highest number of COPD emergency admissions.

The focus of this pilot project is to implement Telehealth to provide mobile technology solutions for COPD patients predominantly in Kingfisher Team.

Patients  will be provided with remote monitoring devices to support them in in monitoring their clinical signs, taking a more active role their care and self-management of their condition.

This approach will offer numerous benefits including timely effective and efficient management of their symptoms by appropriate clinicians, reducing unnecessary face-to-face appointments for both GP and community based staff, access to medication rescue packs for patients with COPD who are able to instigate treatment appropriately and safely, pulmonary rehabilitation and support groups.

If you have a patient who may benefit from this project or require further information please contact Helen Abdulah.