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Member Practice Update

16 January 2019

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 specific Redditch and Bromsgrove news
  • No specific South Worcestershire news

CCG Key Messages - January 2019

The CCG Key Messages for January 2019 are now available to read.

Access them here.

General Practice Forward View Update

Update on Transformation Funding 18/19

As we are now in the final quarter of the 2018/19 financial year this is a reminder to all practices who have yet to apply for any outstanding transformation funding that we will be accepting bids until 31 January 2019. This is to allow time for the remaining bids to be considered and for the End of Year Assessment Report process to be completed, with the outstanding 10p being released during March.

For any practices that are not able to submit bids by 31 January, any outstanding funds will be carried forward to 2019/20.

The CCGs are awaiting further clarification from NHSE on the process and funding for future Transformation Funds for 19/20 in line with NHSE Planning Guidance and the NHS Long Term Plan. As per previous years, the GPFV Implementation Group will review and approve any new guidance before it is issued to practices.

The End of Year Assessment reports will be sent directly to practices during early February for completion and return.

Clarity TeamNet – communication tool presented at Primary Care Event (20 November)

If you weren’t at the event you can find more information here www.digitalhealthforum.co.uk/clarity-teamnet/.

Clarity TeamNet is an information management system used every day by Practices, Federations, CCGs, CSUs, Trusts, Local Authorities, NHS England and many others. It was built from the ground up for sharing, exchanging and collaborating in Primary Care

Following positive feedback from practices, The CCGs have agreed to fund for three years across Worcestershire. Roll out plan is currently being agreed with Clarity, intended go live date April 2019. Clarity will be in touch with practices to discuss individual needs, if you would like to be one of the first practices to adopt the system please contact ben.furlow@nhs.net (Project Lead).

Resilience in General Practice Event

The free half day Resilience in General Practice Event will take place on 13 February at The Crown and Sandys.

The event is open to GPs and practice staff looking at strategies and tools to help organisations and their staff to adapt and stay motivated.

You caqn book your place by emailing SOWOCCG.worcestershireprimarycare@nhs.net

Find out more here.

Promoting Clinical Excellence Update

PCE 18\19

With only two months remaining of the 18\19 PCE contract and final payment due in March, it’s really important that practices and their NT\PCE groups are fully aware of any current gaps in delivery. The CCG will be contacting practices and groups throughout this period and this will be done in a way which is intended to help you.

PCE 19\20

Although the current contract spans two years i.e until 31 March 2020, we are able to vary with agreement the content for the 2019\20 contract.  The first draft of the proposed changes will be shared with the LMC on 17 January which will trigger a 7 week engagement period. The LMC will collate feedback from practices which will be shared with the CCG by 1 March with a final decision on content being made by the Primary Care Commissioning Committees in Common on 13 March.

The driver and continued focus of the proposed changes, which we believe to be minimal and proportionate, is a reduction in unwarranted variation and this will extend in 19\20 to how practices and groups undertake key processes. Methodology and funding stay the same. Our aims in proposing these changes are to:

  • Maintain simplicity
  • Provider greater clarity for practices
  • Ensure consistency of approach
  • Support delivery of Financial Recovery in 19\20

We’ll keep you updated via the MPU and please feel free to contact the Primary Care Commissioning Team if you want to discuss further via SOWOCCG.worcestershireprimarycare@nhs.net 

Next week’s briefing will include an update on Local Enhanced Services.

Clinical Commissioning Policy Update/Treatments of Limited Clinical Benefit

Prior Approval phase 11 - 16 January 2019

Please read through the below update, which contains revised commissioning policies and actions required by Primary Care.

Access the update here.

Digital General Practice Update

Non-Palliative Care Special Notes

GP Surgeries should also be encouraged to use Pyrusium for Special Notes. A large number of surgeries still fax Special Notes to Out of Hours (they receive approx 50 a month). The faxes have to be manually added to Adastra (clinical system that OOH use) which not only takes considerable time but has patient safety implications:

  • Fax may get lost
  • Fax is unreadable
  • Fax is read by inappropriate person
  • Note may be added to the wrong patient
  • Note not updated as quickly or often as they should be

And remember, faxes will be banned across the NHS from March 2020 in a bid to improve patient safety so may as well start get familiar with the process!

Access to Adastra

You may be interested to know when using Black Pear’s Pyrusium to create/amend Non-Palliative Special notes it negates the need for Practices to use Adastra and then follow this up with a separate email to the Ambulance Control Centre.

When you create/amend Non-Palliative Special notes using Pyrusium not only are they instantly available in EMIS but also they automatically appears natively in the OOH/111 Adastra system workflow when a patient calls. It also creates live notification to WMAS of new EPaCCs/Special Notes records and any subsequent changes (see diagram at the bottom of the web link below). There will also soon be direct integration that enables direct flagging and alerts in Cleric (clinical system the WMAS crew use).


Community Outpatient Services 

Sent on behalf of Worcestershire Health and Care NHS Trust

An inaccurate e-mail was shared last week with a number of acute staff and GPs regarding the future provision of the Trusts community hospital services. 

Worcestershire Health and Care NHS Trust does not plan to ‘close’ or ‘decommission’ community hospital based outpatient services as was stated in the email.  The Trust is committed to providing a comprehensive range of services across its sites and welcomes the continuity of outpatient services from our hospitals. 

The Trust has been keen for some time to holddiscussions with partners about how we can ensure these services are delivered in the most effective way. There is a mixed picture of historical contractual arrangements for these clinics that we would like to resolve to provide more stability for these services moving forward. 

Every Autumn the commissioners issue their commissioning intentions for the following financial year. The purpose of this process is to signal to providers the key issues that they would like providers to consider for the following year’s contract. Providers are also encouraged to respond with the areas that they would like to discuss during the contract negotiations. This year as part of our response the Trust confirmed that they wanted to review the way outpatient services were managed to ensure that moving forward the most appropriate provider leads the operational oversight of each specialty clinic. So for example some of the surgical pathways are split between acute and WHCT leadership and they would like to discuss consolidating these. Their aspiration is for these clinics to continue to operate as they are now in community hospitals but for us to discuss and review the lead organisation to oversee the management of each pathway, particularly the surgical pathways.

Equally they would like to discuss clinics for people with Long Term Conditions (LTC) that currently occur in Worcestershire Acute Hospitals NHS Trust (WAHT) premises as they would like to discuss the option of more of them being provided on community hospital sites to allow a stronger interface between the acute specialists for LTC and the neighbourhood teams.

The Trust has signalled their intention to work closely with WAHT, Worcestershire CCGs and our Alliance Boards to review the management of community hospital based activity/clinics as outlined above. This discussion is now even more timely in light of the NHS national plan which was published last week and outlined the need for us to review the way outpatient services are delivered and consider an increased level of digital consultations to enable an increase in productivity and efficiency to meet rising demand and provide more flexible options for patients.

A working group has been set up within the Trust but we would not make any changes until all organisations have agreed an approach that works for everyone.

This proposal is about who manages and leads each speciality pathway not  the actual clinical provision. The Trust wants these clinics to continue in community hospitals as they are now with the staff who currently support them.

Launch of Wyre Forest and Redditch and Bromsgrove’s MSK Single Point of Access / Advanced Physiotherapy Practitioner Service

A big thank you to all practices for your support during launch of the new community based MSK pathway. Technical glitches’ experienced by a small number of practices have been resolved and solutions communicated to relevant parties. Should you have any queries or issues regarding the processes for your respective MSK service please do not hesitate to get in touch with the named contacts below:

Wyre Forest Service Contact - Anthony Howells at ahowells@ascenti.co.uk
Redditch and Bromsgrove Contact - Debra Silipo at debra.silipo@nhs.net

Key points to note:

  1. From Monday 21 January 2019, direct access requests for MRIs and Ultrasound will no longer feature on ICE for general practitioners. In line with the new MSK pathway the Advanced Physiotherapy Practitioners will assess patients and request imaging in line with the MSK Guidelines recently published
  2. The Oxford Hip and Knee scoring sheet should be attached to the referral only for those patients with pain and osteoarthritis likely to proceed to hip and knee replacement
  3. The new MSK referral form must be used for all physiotherapy and advanced physiotherapy practitioner (APP) services.
  4. Please refer to the MSK commissioning policy “Musculoskeletal Surgery and Therapeutic Interventions” for guidance regarding red and amber flags which should be referred directly to secondary care.

Faecal Immunochemical Tests for Faecal Occult Blood (FIT FOB)

In line with NICE guidelines, Worcestershire Biochemistry Laboratory are now offering Faecal Immunochemical Tests for Faecal Occult Blood (FIT FOB) testing. This commenced on 1 of January 2019.

Read a full update here, including information about patient packs that will be distributed to practices later this month.

Can practices also ensure that the correct version of 2ww Colorectal Referral Form, which includes FIT test, is uploaded on to your practice systems. A copy of the referral form is attached for ease. Please delete all previous versions.

Wrist splints for Carpal Tunnel Syndrome

Further to the implementation of the Carpal Tunnel Syndrome (CTS) Management Pathway earlier this year, arrangements have been put in place to enable NHS provision of wrist splints for patients with a diagnosis of mild/moderate CTS in accordance with this pathway.

The process for ordering a wrist splint is detailed in the attached letter sent directly to practices. Practices are required to load the wrist splint order form onto EMIS. The practice will not be invoiced for the supply of requested Wrist Splints.

The costs of the wrist splints will be met by the CCGs through the existing contract with Dacey’s Orthotics hosted by Worcestershire Health and Care NHS Trust.

E-referral for IAPT/Healthy Minds service

Around 50,000 people in Worcestershire experience more common mental health illnesses such as depression, low mood or anxiety. The Worcestershire Healthy Minds service can support them through group courses, 1:1 counselling and online resources. We can also signpost to community support if appropriate.

From 12 December 2018, GPs have been able to use the e-referral service to make appointments for patients requiring IAPT Services/Healthy Minds Services.  

GPs can now complete the referral with the patient, allowing the patient to leave the practice with the date and time of their appointment, and you can handover care for the patient to Worcestershire Health & Care NHS Trust, which runs the Healthy Minds service. Patients will be booked into a telephone assessment appointment and are not required to attend a clinic for this assessment. 

As per other services currently available on e-Referral, patients can book their appointment whilst with you, or alternatively they can be given the central booking line number and phone to book at their convenience.  

We believe this is a positive addition to e-Referral bookable services, and that you and your patients will benefit from this access. It’s a much better system that will allow patients to access services much quicker. Attached is more information on the e-referral process.

Prescribing Top Tip

Prescribing of Mesalazine EC 400mg & 800mg Tablets 

Asacol® modified-release (MR) tablets and Octasa® MR tablets are both identically licensed for the treatment of mild to moderate acute exacerbations of ulcerative colitis (UC) and maintenance of remission of UC and Crohn’s ileo-colitis.(1,2,3,4)

 Following a review of the literature, changes have been made to the recommendations on inter-changeability of oral mesalazine preparations. The BNF now states that there is no evidence to suggest that any one oral preparation of mesalazine is more effective than another.(5)

Asacol ®MR and Octasa® MR are similar in terms of formulation, optimal pH for drug release and site of drug release.(6)

Currently Octasa® MR costs significantly less than Asacol® MR in primary care. NHS list prices are given in the table below (as per Mims, January 2019):

Drug Presentation

NHS List Price

Unit Price

Asacol® MR 400mg

£27.45(84) £54.90(168)


Asacol® MR 800mg

£54.90 (84)


Octasa® MR 400mg



Octasa® MR 800mg

£40.38 (90)  £80.75(180)


Based on 12 months prescribing to the end of Oct 18, a switch from Asacol /mesalazine MR 400mg to Octasa® MR 400mg, and  Asacol®/mesalazine MR 800mg to Octasa® MR 800mg will generate the following savings throughout the three Worcestershire CCGs:


Spend of Asacol® & Mesalazine 400mg & 800mg 12m to Oct 18

Spend if 100% prescribed as Octasa®

Saving if 100% switch to Octasa®

Saving if 80% switch to Octasa®

Redditch & Bromsgrove





South Worcestershire





Wyre Forest





All Worcs CCGs





A protocol for this switch can be found in the Prescribing Resources for Clinicians section of the APC website at: Asacol to Octasa Switch Protocol

A suite of suggested switch letters can also be found on the same website page:

  • Asacol to Octasa Switch Letter
  • Asacol to Octasa – Appointment Request letter
  • Mesalazine to Octasa - Amend letter


  1. Asacol® 400mg MR tablets SmPC. Accessed 21/9/2018. Available online at www.medicines.org.uk/emc/product/2217/smpc
  2. Asacol® 800mg MR tablets SmPC. Accessed 21/09/2018. Available online at www.medicines.org.uk/emc/product/6167/smpc
  3. Octasa® 400mg MR tablets SmPC. Accessed 21/09/2018. Available online at www.medicines.org.uk/emc/product/2827/smpc
  4. Octasa ®800mg MR tablets SmPC. Accessed 21/09/2018. Available online at www.medicines.org.uk/emc/history/24302
  5. Prescqipp Bulletin 79 mesalazine MR prescribing. Accessed 21/09/2018. Available online at www.prescqipp.info/our-resources/bulletins/bulletin-79-branded-mesalazine-prescribing/
  6. UKMI/SPS bulletin – Mesalazine bioequivalence. Accessed 22/11/2018. Available online at: UKMI/SPS bulletin mesalazine

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

Dedicated NHS veterans’ Mental Health Services

The NHS provides dedicated mental health services for those who have served in the British Armed Forces – the Veterans’ Mental Health Transition, Intervention and Liaison Service (TILS) and the Veterans’ Mental Health Complex Treatment Service (CTS), both available across England.

Both services are provided by specialists in mental health who have an expert understanding of the Armed Forces. TILS is a dedicated out-patient service for serving personnel approaching discharge from the Armed Forces and veterans who are experiencing mental health difficulties. The CTS is an enhanced out patient service for ex-forces who have military related complex mental health difficulties that have not improved with previous treatment.

Access to both of these services is through the TILS. Individuals can contact the service direct or ask to be referred via a GP or military charity.

More information is available in this leaflet.

Safeguarding Update 

Children's Social Care and Safeguarding structure chart

An updated Children's Social Care and Safeguarding structure chart has been developed.

Access it here.

Safeguarding Contacts

An up-to-date Safeguarding Team contacts list is now available.

Access it here.

Safeguarding/Prevent Training

Further dates have been added for anyone needing to complete level 3 Safeguarding Adults, Safeguarding Children or Prevent training over the next few months.

Places are filling up for Prevent training, but there are plenty of spaces available for the session on 21 February at Kidderminster Health Centre.

Access all the dates, alongside a document detailing your safeguarding training requirements here.

St Richard's Information Session - Understanding Pain and it's Management

St Richard’s will be launching their first Living Well information session, Understanding Pain and its Management - An introduction, on Tuesday, 29 January from 3.30 - 4.30pm at the hospice in Wildwood Drive, Worcester.

This free session is open to people with a serious progressive illness and their carers. No referral is needed and you do not need to be already under the care of St Richard's to attend. This is a short group session aiming to help people understand what pain is and what options are available to help them live and cope with it.

St Richard’s asks that individuals coming to the group are independent or can be independent with the support of a family member or friend. This is a group session and will not include one-to-one medical advice or have clinical support available.

Individuals can pre-book online https://bit.ly/2M7SBMQ or call the pre-booking message line 01905 760900.

Improving Cancer Services  

An event will take place on 31 January at Prospect View Medical Centre, Malvern from 1-3.30pm.

The event is aimed at people who have either themselves or who know somebody who has been affected by cancer to come along and hear what the plans are to improve services in Herefordshire and Worcestershire.

Find out more here.

Pathology GP User Meeting 

The next Pathology GP user meeting will take place on Tuesday 22 January at 9:30am in the Pathology Seminar Room at Worcester Royal Hospital.

Please direct any questions to wah-tr.dutyBMS@nhs.net

Wyre Forest News  

Health and Wellbeing Update - January 2019

Wyre Forest District Council has issued their latest Health and Wellbeing Update.

Access it here.