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Member Practice Update

7 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

E-Referral Usage  

As you will be aware from previous communications, the Standard Contract for 2018/19 requires the full use of the NHS e-Referral Service (eRS) within Acute Trusts for 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-Referral Service.

University Hospitals Coventry and Warwickshire NHS Trust (UHCW) has agreed with NHS England to deliver paper switch-off for GP referrals to Consultant led services across all specialties by 31 May 2018. UHCW will be piloting their paper referral rejection process in Orthopaedics (including Paediatrics)  and Urology (excluding Paediatrics) from Monday 19 March 2018, ahead of delivering a phased switch-off across all other specialties throughout April - May 2018.

To be clear; from 19 March 2018 all referrals to all Trauma & Orthopaedics and Urology service delivered by UHCW MUST be sent via eRS (formerly Choose and Book).
Referrals not sent by eRS will be returned to the referring practice and will need to be done again via eRS.


Sites/ services affected

Priorities included

Switch Off Date

Trauma & Orthopaedics (Including Paediatrics)

UHCW and Rugby St Cross

Urgent, Routine and 2WW

19 March 2018


Urgent, Routine and 2WW

19 March 2018

Paediatric Orthopaedics only

George Eliot

Urgent and Routine

19 March 2018

Prior to the 19 March 2018, if there are any exclusions within the above specialty areas this detail will be provided.

Work is currently underway with local CCGs and UHCW’s specialty teams to prepare them for the move to a total e-Referrals service. Over the coming weeks UHCW will be providing practices with more detail about the process for returned referrals. Please ensure all your staff are aware of this change.

A wealth of information and guidance can be found on the NHS Digital website.

E-Referral Update from UHB (Queen Elizabeth Hospital Birmingham)

The Host Commissioner, Birmingham Cross City CCG, has sent an update from their local e-RS workstream which will have an impact on the referral mechanisms for UHB:

“UHB has agreed with NHS England to deliver paper switch-off for GP referrals across all specialties by 31 May 2018. UHB will be piloting their paper referral rejection process in Endocrinology and Diabetic Medicine from Monday 26 February, ahead of delivering a phased switch-off across all other specialties throughout April - May 2018. To be clear; from 26th February all referrals to Endocrinology and Diabetic Medicine at UHB MUST be sent via eRS (formerly Choose and Book).

Referrals not sent by eRS will be returned to the referring practice and will need to be done again via eRS. Patients will not be given an appointment until the referral is made by eRS. Urgent referrals can still be sent using current methods whilst the electronic pathway is developed.
Over the coming weeks UHB will be providing practices with more detail about this pilot and the process for returned referrals.  Please ensure all your staff are aware of this change.”
Please note that Worcestershire CCG’s do not have any influence on UHB’s paper switch off programme plan and this is not linked to Worcester Acute Trust’s plan, which we will keep you updated on in due course.

Frailty Assessment Unit Alexandra Hospital  

With regards to previous articles in relation to the Frailty Assessment Unit (FAU) at the Alexandra Hospital, we would like to remind all GPs to ensure the patients meet inclusion criteria before contacting the FAU.

The frailty assessment unit criteria is based on national recognised Bournemouth frailty criteria. For those who have not previously seen the criteria it is shown below

Frailty Assessment Unit Inclusion Criteria:

This is in accordance with the Bournemouth criteria:

Group 1:
Patients over 90 years of age

Group 2: Patients aged 75 and over, with 2 or more of the following geriatric giants:-

  • IMMOBILITY - (movement disorders, Parkinson’s Disease, new or worsening)
  • INCONTINENCE - (new or worsening)
  • INSTABILITY - (including falls and frailty)
  • INTELLECTUAL IMPAIRMENT - (dementia and delirium, excluding learning disabilities)
  • IATROGENESIS - (polypharmacy - on 5 or more medications)

Group 3: Patients aged 65 or over, from a Nursing Home, Residential Home or Community Hospital

Frailty Assessment Unit Exclusion Criteria

The following patient exclusion applies. These patients would not be appropriate for the frailty pathway. The pathway for these patients remains the same as prior to the implementation of the Frailty Assessment Unit on 16 October 2017.

Patients (fitting into any of the above groups) with single organ pathology best managed by a specialist e.g. (not limited to):

  • CURB 3 pneumonia
  • Primary Cardiac Issues
  • Upper GI bleeds
  • Acute Surgical Diagnosis
  • Trauma with a Suspected fracture
  • Acute Chest pain/suspected MI
  • Unstable Blood glucose <3 or > 28 including DKA
  • Acute abdominal pain with collapse
  • Suspected or new CVA/TIA

  • Head injury/trauma, unconscious, GCS <9
  • Collapsed patient requiring resuscitation

The following patient pathways also remain unchanged i.e. the patient should be conveyed/ referred to the nearest acute hospital:

  • Fractured neck of femur
  • Suspected sepsis.

When a patient meets the frailty criteria please telephone 01527 512102 to arrange an attendance.

21 March CCG Half-Day Study Event  

Just a reminder for your diary. This is the date of the PCE/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 13:00

Attendees should be:

  1. 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
  2. One GP representative from each practice – if the practice is not already represented by a PCE lead (see point 1)
  3. Practice Management – practice and business managers are welcome to join the meeting in the afternoon from 4pm – we are in the final stages of confirming details with our external secondary care speakers, so we will forward an agenda once this has been completed.

Please send confirmation of your attendance to Jayne Hinkins by 14 March 2018.

Wyre Forest Governing Body Election update  

Following an election process managed by the LMC, the following candidates are now confirmed as Wyre Forest Governing Body GP members from 1st June 2018:

  • Dr Tristan Brodie
  • Dr Louise Bramble

We would like to thank to all member practices for their participation in the election process.

Countywide Primary Care Improvement Community – launching 18 April 2018   

Following the success of the Time for Care programme across the county, NHS England’s Sustainable Improvement Team have offered to work with the CCGs to launch a Countywide Primary Care Improvement Community in order for us to have the opportunity to work across the county to design how we would like to work together in the future.

As a reminder, the Time for Care Programme covered three elements, with different approaches being taken across the county;

  • Productive General Practice (Quick Start) 3 practices in Redditch and Bromsgrove, 8 practices in Wyre Forest and 9 practices in South Worcestershire, completed the programme.
  • 2 days Quality Improvement Training – Wyre Forest and South Worcestershire participated in two intensive days training in the summer of 2017
  • Learning in Actions – 6 sessions focussing on a quality improvement project over 6 months – Redditch and Bromsgrove chose this approach

The purpose of this improvement community will be to bring together all of the work we have done across the county over the past year including; PM training, PM mentorship, Time for Care, and to start designing the Annual PM update. This will be your opportunity to agree how we continue to meet to learn together, recharge batteries, share stories and connect with others.

The launch session will be an informal afternoon. Attendees will benefit from the day in a number of ways:

  • Share energy and good ideas - what is working well locally, what can we learn from successes and failures? A chance to take some ideas back to your practices for using your 18-19 Transformation Funding!
  • Meet new/reconnect with colleagues making a difference every day to the lives of patients and colleagues
  • Refresh knowledge of how to use tried and tested improvement tools and techniques and hear about emerging approaches
  • Find out more about the newly launched national Primary Care Improvement Community and how it can support you in your work
  • Agree how this community will continue to inform the work on Practice Manager development across the county  including the new Annual PM update.

This event is aimed at Practice Managers and Practice Staff.

The event will be held on the afternoon of Wednesday 18 April, venue to be confirmed, with a 12:00 start. To book your place, please e-mail the Primary Care Team sowoccg.worcestershireprimarycare@nhs.net (including any dietary requirements).

Winter Visiting Service – Paramedic Requests  

There are still severe pressures on local acute services and paramedics have been asked to tap into the GP Winter Visiting Service where it is clinically appropriate for a patient to be visited by their own practice, rather than conveyed to hospital.

The CCG wanted to make practices aware of this, and request their co-operation in responding to these patients in a timely manner in line with the Winter Visiting Scheme.

Treatments of Limited Clinical Benefit 

Prior Approval Update Phase 7 – 27February 2018

Following on from our last update on the 17th January 2018, please download the EMIS referral form via the updated “Commissioning of Circumcision” policy.

Download here.

Key Safeguarding Contacts  

Please download the latest 'Key Safeguarding Contacts' for the CCGs, WHCT, WHAT and WCC Children’s Services and WCC Adults Services.

Think Sepsis  

70% of sepsis cases develop within Primary Care. It is estimated that there is potential to reduce deaths by up to 10,000 per annum by the optimisation of care.

“THINK SEPSIS” is a Heath Education England programme aimed at improving the diagnosis and management of those with sepsis.

Prompt recognition of sepsis and rapid intervention will help reduce the number of deaths occurring annually. learning materials can be accessed via this link, support the early identification and management of sepsis in primary care.

In order to access any e-LfH programme, you will need an e-LfH account. It is easy to register using your NHS email account or via an existing ESR account.

Do you have patients with dysphagia in your care?   

Changes to the descriptions of modified textures are coming in to affect to meet the IDDSI (International Dysphagia Diet Standardisation Initiative) global terminology and standards from April.

The changes are evidence-based with the aim to improve patient safety and allow consistency between services and better comparisons in research.

Changes to fluids descriptors: from April 2018
Changes to food descriptors: by April 2019

Speech and Language Therapists across the Worcestershire Health economy are working to improve our continuity of care and reduce risks to do with the changes by:

  • Organising training and education for staff in our work settings and facilitating the change to IDDSI.
  • Liaising with suppliers (e.g. of thickeners and prepared meals) to effective and efficient implementation of IDDSI.
  • Introducing a ‘Dysphagia Passport’ that travels with the patient, and gives current recommendations for food/fluid textures and other useful information about their swallowing (e.g. ‘feeding at risk’ status and care planning considerations). 

Thickness Chart

Lacri-Lube Availability issues – Consider Switch to VitA-POS  

We understand there are stock availability issues with Lacri-Lube®.

Practices are reminded that VitA-POS® eye ointment is the preferred night time ocular lubricant for mild dry eye conditions as highlighted on the county guidance: Dry Eye - Worcestershire Health Economy Guidelines Dec 16

VitA-POS® contains 300 applications per tube, is preservative free and sterile for six months after opening. Due to its extended shelf life VitA-POS® is more cost effective than Lacri-Lube® (which is sterile for only one month after opening).


Pack Size











Clinicians will need to advise patients not to discard the VitA-POS® 28 days after opening.

Switch Protocol and Patient Letters

A suggested switch protocol for practices to follow which includes example patient letters can be found in the “prescribing resources for clinicians” section of the APC website: VitA POS Switch Protocol for practices.

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

‘Primary Care Talks’ – new podcast series   

The Eastern Academic Health Science Network is soon launching a series of podcasts that delve into innovative ways of managing the intensifying needs of primary care.

Each episode aims to uncover the secrets of successful primary care teams working in the NHS today. Primary Care Talks’ host, Dr Hasan Chowhan, interviews fellow GPs to find out about some of the smartest approaches to driving efficiency and productivity, and how to tackle leaps forward in science such as integrating genomics into primary care.

Primary Care Talks is aimed at frontline primary care professionals, with the aim of sharing best practice and encouraging necessary change. The first three episodes will cover: genomics, multi-lingual healthcare and the primary care home model.

For a preview, listen to the first podcast with Dr Neil Modha on ‘Breaking the language barrier’, via SoundCloud.

Does your GP practice support or take part in public health research?

Clinical Practice Research Datalink
(CPRD) allows GP practices to gather feedback and contribute to medical research to improve patient care. CPRD is a not-for-profit government research service providing anonymised healthcare records for public health research. Find out more about how this works in blogs by David Mullett of the Royal College of General Practitioners and by GP Dr Tommy Hunter.

Benefits include:

  • Regular prescribing and patient safety reports to help GPs review patient care
  • Patient representation in research evidence informs national clinical guidance and best practice;
  • Practices can opt into contributing data to CPRD by completing questionnaires and taking part in clinical studies. These are not compulsory, but do give an income to practices taking part. 
  • Case reviews from QI reports, questionnaires and research can be used as evidence for annual appraisal and five-yearly professional revalidation;
  • Joining is an easy, one-off process following which anonymised data automatically flows to CPRD.

All data is anonymised and adheres to robust information governance and security regulation frameworks.

The data held by CPRD is varied and representative of the UK population in regards to age, gender and ethnicity. As more practices sign up, the amount of data held will grow.

Data extracted from GP practices can be used to prove the safety of drugs/vaccines and is especially vital in circumstances where there would be increased risk to test a new drug on a person, for example if they were pregnant.

Joining CPRD is endorsed by Royal College of GPs (RCGP) and NHS England as part of the Five Year Forward View and Next Steps.  If you are part of a GP practice, please consider getting involved or, if you work with GPs or practice staff, encourage them to take part via the registration page.

Dementia Community Roadshow visiting Evesham Market Place on 20 March 2018

Alzheimer’s Society’s Dementia Community Roadshow is to visit Evesham’s Market Place on 20 March, WR11 4EF, from 10am to 4pm.

It aims to increase local awareness and understanding of the condition which affects an estimated 4,300 people across South Worcestershire.

Dementia is set to be the 21st century’s biggest killer and affect 1 million by 2021. The Roadshow will demonstrate a community uniting against dementia and there will be opportunities to film and interview members of the public, Alzheimer’s Society staff and members of Evesham Dementia Action Alliance.

For more information contact: james.dixon@alzheimers.org.uk.

FREE: Neurophysiology Training Day - 27 march 2018 

GP’s and Consultants: CPD and Refresher
Junior Doctors: Introduction to Neurophysiology

Morning: Talks
  • Indication for investigations
  • Procedure
  • Interpreting results

Afternoon: Practical demonstrations
  • NCS
  • EMG
  • EEG

In the friends room at the CHEC WRH. Please RSVP to lydia.Collins@nhs.net

Ride for Rory 2018 Sunday 22 April 

Don the lycra, oil up those pedals and join us on a sponsored 18 or 57 mile family cycle ride in and around Redditch, Worcester and Wyre Forest areas. Both routes start and finish at the Alexandra Hospital, Redditch – the longer route is more challenging for more experienced cyclists.
In aid of the £1.6million Worcestershire Prostate Cancer Surgical Robot  Appeal (Rory the Robot).


  • £10 per Adult and £5 per Child - payable on registration.
  • Over 12s only. Under 16s must be accompanied by an adult.

For more information and to register:

Call: 01905 768954
Email: nicky.langford@nhs.net
Website: www.rorytherobot.com

How to Import EMIS Template Files 

To access EMIS files, please follow the below instructions:

Template Manager / Resource Publisher

  • Save the EWDT form to a computer (somewhere that you will find them again easily)
  • Go to Document templates section of the above module
  • In your folder structure select and ‘enter into’ a folder where you want to import them (e.g. referrals / 2 week wait etc)
  • On the EMIS Ribbon click on ‘Import’
  • Locate the file, double click it / select it and it will import
  • You can now view / edit / test as needed